Monday, April 30, 2007

Blog Summit Reaction: Where the Rubber Meets the Road

There seemed to be two big themes that cut through the various panels at the second annual WisPolitics Blog Summit on Saturday:
  1. The democratizing effect of the blogosphere.
  2. How this democratization interacts with the traditional media in an attempt to garner influence.
The democratizing effect of the blogosphere is somewhat self-explanatory -- anyone with a basic ability to navigate the web and access to the Internet can start a blog. But some good critical discussion did take place on this topic in the third panel with Eugene Kane, Dasha Kelly, and Jennifer Morales regarding who's opted to participate in the democratization and, subsequently, the impact of that on the blogosphere.

But the focus of the other panels seemed to lean most heavily on the second theme, while largely taking the first as a given. Aside from a few comments here and there -- like one by John Kraus about the need for blogs to take their message deeper into the community via activism and organizing -- the majority of the discussion seemed to agree that working through the traditional media defined the blogosphere's influence and, as a result, its success.

A number of instances of blog stories "breaking through" into the traditional media were tossed about by panelists and commenters alike to serve as examples of how blogging is making -- or, at least, can make -- a difference.

But it wasn't noted that most, if not all, of these breakthrough stories are essentially muckraking in nature. A blogger records something a politician says, other bloggers pick up on it, eventually it hits the traditional media, and then the politician is forced to issue a comment on the matter.

I don't want to take away from this purpose of blogging. More accountability is certainly important (although it could be argued that the fact everything politicians say can be recorded and used against them simply reduces candor and increases the use of strictly rehearsed canned comments).

But there is a whole other side to blogging that doesn't really have any way of participating in this -- that is, the policy discussion side. This is the side of blogging that isn't seeking to report any new stories, but rather critically discuss issues of importance more in the manner that an op-ed columnist would.

The awesome power of the Internet not only allows voices to be recorded and easily reproduced, it also allows access to a variety of information that bloggers can pull together and share with readers through links that can enhance discussion and awareness of a topic. What's more, the comments allowed on most blogs create a space for immediate engagement with readers and it also provides an opportunity for the reader to use the awesome power of the Internet to call the blogger on half-baked analyses or outright disingenuousness.

There's really no way this side of blogging can be fully replicated in traditional media formats like print, television, or radio. So the idea that bloggers gain their influence and, as a result, their success through breaking stories that eventually get picked up in the traditional media leaves the policy side of blogging entirely behind.

And, to the extent that bloggers are trying to be influential, the belief that bloggers best (or only) shot at success comes through muckraking makes issue-oriented blogging largely irrelevant.

I admit to being a bit biased on this question since I see this blog as more of an issue-oriented blog than one that does any sort of actual reporting in the journalistic sense. To me, the main problem with politics is its commercialization, which has come largely through the way the media packages it into easily consumable soundbites along with coverage that focuses on stories aimed at eliciting the same type of emotional reaction that people get from watching "Desperate Housewives" or "24" (i.e., scandals, violence, etc.).

There seem to be fewer and fewer places people can go to get hard-hitting critical news pieces, and it was always my hope that the blogosphere -- or at least a portion of it -- could serve as one of those places.

And, to an extent, I think that parts of the blogosphere do provide this type of place, but the discussion at the blog summit seemed to be aimed at the other parts of the blogosphere that are seeking to interact or compete, depending on your perspective, with the traditional media, which, I fear, is simply going to result in the commercialization of the blogosphere in much the same way that our political culture in general has been commercialized.

Muckraking, while undoubtedly important, is tailor-made for the type of emotionally-based political coverage that's become the favored style of the business-minded media. Scandalous and horrifying sells, the critical examination of a policy issue simply doesn't.

So where does this leave issue-oriented blogging?

It seems to me success for issue-oriented blogging just isn't going to come through direct interaction with the traditional media in the same way as muckraker-blogging. And I understand the argument that issue-oriented blogging can be important in the sense that opinion leaders may be reading it, and they just might spread the message through their traditional media megaphones.

But this, to me, leaves things too much to chance, while also unjustifiably legitimizing the place of those opinion leaders as the gatekeepers for how issues should be perceived by the public. What's more, it's essentially tossing in the towel on the democratizing potential of the blogosphere, and succumbing to the belief that the hierarchy of the traditional media is and should be the name of the game.

Rather, the best bet for issue-oriented blogging influence and, as a result, success is for it to become a piece of a larger puzzle. It gets back to Kraus' point about the need for blogging to turn to grassroots activism to create a human element where the virtual discussion can be played out.

In this sense, the issue-oriented blog would be a facet that works in conjunction with meet-ups, forums, leafleting, etc., where the rubber, so to speak, would actually meet the road. While it may work for some national blogs to remain predominantly online and still have an effect on public opinion due to their extensive readership, the issue-oriented state and local blogs -- for the most part -- simply can't in order to gain wide influence and success.

This presents severe limits for someone like me who doesn't have the time or mindset for the activism that could take my issue-oriented blogging to the next level. But I suppose it's somewhat comforting to think that I could if I would.

UPDATE: Go here to see my follow-up on who I think the issue-oriented blogging should be influencing.

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Friday, April 27, 2007

The American Public Thinks What?

The Pew Center released perhaps the most detailed survey on the 2008 presidential race to date, and it had one particular section that really caught my eye.

Pew asked respondents to place all of the candidates on an ideological scale from 1-6, with 1 being the most conservative and 6 being the most liberal. It also asked them to place themselves on the scale to get an idea for where registered voters of each party stand in relation to their candidates.

Here's the resulting chart:

(Click image for a larger view.)

The first thing that jumped out at me is how far respondents -- particularly Republican respondents -- placed the Clintons to the left. The fact is they're both centrist Democrats. There's just no way they're the furthest to the left out of that bunch.

But that, of course, is reality, and reality isn't necessarily where electoral politics is always played out. Republicans have long demonized the Clintons, and that can create a perception that they're ideologically extreme when that, in fact, just isn't the case. More evidence of this comes from the fact that nearly 2/3 of all Republican respondents gave Hillary the top liberal rating of 6.

It also struck me how incorrectly the respondents have placed John Edwards. Even Republican respondents pitted him as the most conservative Democrat in the bunch, which probably sounds ridiculous to most people who know anything about Edward's platform these days.

But it seems likely most people are still thinking of the 2004 Edwards, who was a relative moderate in his policy ideas, even though he was still quite populist in his message. I also imagine the fact that Edwards played the nice guy in 2004 has an effect on how ideological people perceive him to be -- again, a case of perception trumping reality.

I'd say Obama's placement is the most accurate of the three. Although if I was rating it and the mid-line Dem was a 4, then I'd place Obama at a 4, Clinton slightly to the right -- probably a 3.8 or 3.9 -- and Edwards slightly to the left, probably a 4.2 or 4.3.

Turning to the right, there is a clear difference between where most Republicans place themselves and where the top three GOP candidates are placed.

Of course, the right is probably more dependent on what issues you're talking about than the left. While the Dem candidates have a similar ideological position in terms of social, economic, and foreign policy issues, there is much greater divergence on the right.

Particularly in the case of Giuliani, social issues would likely place him where he's currently at on the scale, perhaps even a bit to the left, but he'd be a lot further to the right on economic and foreign policy issues.

And it would really depend on which McCain and Romney you were talking about in order to accurately place them. If it's the 2000 presidential candidate or the Massachusetts governor, respectively, they'd probably be about where they're currently at; but if you're talking about the 2008 candidates in both instances, they'd both be further to the right than they currently lie (no pun intended) on the scale.

It's similar to Edwards in the sense that most voters clearly aren't aware of McCain's and Romney's current position on issues -- or they don't believe them -- but the transformation of McCain and Romney has been undoubtedly more profound than that of Edwards. While Edwards has shifted the tone of his populism, McCain and Romney have completely altered their position on many issues to make themselves more palatable to the hard right.

The poll also found a large divergence in the way that Republicans and Democrats view the ideology of the Dem candidates, but striking similarity in the way both groups view the ideology of the GOP candidates. Here's that chart:

What's particularly notable is that independents tend to be much closer to Democrats in their view of Dem candidates. This demonstrates that Republicans tend to have a particularly skewed perception of the ideology held by Dem politicians.

Call it the Fox News effect.

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Thursday, April 26, 2007

A Presidential Ticket for the Indies

The partisan in me is hesitant to praise a third-party ticket in an election year that's looking to be a strong one for Democrats, but I think the organization called Unity 08 that's formed to put together an independent ticket in the 2008 presidential election deserves some attention.

Importantly, however, the group is not actually attempting to create a third party. As it writes on its website: "We are not looking to build a new and permanent party. That might happen, but our objective is to fix the old parties. A Unity Ticket in office for one term or even taking part in just one election can bring new ideas, new integrity and new leaders to the fore."

When I first heard about Unity 08, it just seemed to me to be a centrist group that simply worked for a middle ground on all issues. And while that's true to a certain extent, after looking into it a little more, it's clear that there's more a play than just compromise. In fact, the main crux of the organization is to eschew the power and influence special interests have over both political parties today.

According to the website: "Unity08 strongly believes the corrupting influence of special interest money is a major cause of today’s fundamentally broken political system. Lobbyist money plus pandering to the intense ideological bases by both parties yields the blame-game partisan bickering that has destroyed voter confidence. No other issue will get solved until this one does."

In this sense, it's a very populist-oriented group. In fact, any registered voter can be a nominating delegate. All it takes is signing up over the Internet and you get a vote on who gets on the Unity ticket in 2008. The only requirement is that the presidential and vice presidential nominees are from different parties or not affiliated with any party.

And looking through the list of organization leaders, it's clear this group isn't made up of a bunch of slouches who happen to have web skills. The Advisory Council has two former governors, some top academics, a handful of business leaders, and Sam Waterston (Assistant DA Jack McCoy on "Law & Order").

The group's take on the issues is also refreshing:

Unity08 divides issues facing the country into two categories: Crucial Issues — on which America’s future safety and welfare depend; and Important Issues — which, while vital to some, will not, in our judgment, determine the fate or future of the United States.

In our opinion, Crucial Issues include: Global terrorism, our national debt, our dependence on foreign oil, the emergence of India and China as strategic competitors and/or allies, nuclear proliferation, global climate change, the corruption of Washington’s lobbying system, the education of our young, the health care of all, and the disappearance of the American Dream for so many of our people.

By contrast, we consider gun control, abortion and gay marriage important issues, worthy of debate and discussion in a free society, but not issues that should dominate or even crowd our national agenda.

In our opinion — since the disintegration of the Soviet Union — our political system seems to have focused more attention on the “important issues” than the “crucial issues.” One result: The political parties have been built to address the interests of their “base” but have failed to address the realities that impact most Americans.

This is a bold statement in the sense that it puts the base of each party in the same boat with the special interests -- both, in the view of Unity 08, have hijacked our country's two major parties and, in effect, our country's political process.

Most simply put, the founding belief of Unity 08 is that the majority of the country is not polarized -- it's the political parties that are polarized, along with the minority of the population that closely ascribes itself with one of those parties (that is, the folks often writing and reading political blogs), and the special interests have gladly funded the polarization to accomplish their own narrow and self-serving goals.

This is a trenchant message, and one that gets at the age-old question: Do most Americans generally eschew politics because they don't care, or because they feel the political parties they're forced to choose between at election time don't care about them?

The success of the Unity ticket could help answer that question.

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Wednesday, April 25, 2007

Confronting the "Dems are Weak" Meme

The Washington Post has an article today on Rudy Giuliani doing his best impression of Karl Rove by claiming the country would be in more danger from terrorists with a Democratic president.

The polls show that most Americans think otherwise. But clearly this isn't a strategy for most Americans. Instead, it's aimed at primary voting GOPers. The goal is to rally the base by giving them a reason to be proud about being Republicans again.

The trick for Giuliani will be transferring this message into the general election if he wins in the primary season. Much of Giuliani's popularity after September 11 came through his purported leadership in uniting the country against a clear enemy. This new message, however, is markedly different in that it uses September 11 to separate the country into the tough and the weak rather than unifying it with a wholly positive message.

What will also prove difficult for Giuliani, should he make it to the general, is continuing to leap frog Iraq when attempting to take people back to the days after September 11. In the Post article cited above, Giuliani continuously uses the frame that Democrats would put the country on the defensive in the war on terrorism. But, at the same time, he's careful not to explicitly equate Republicans with a strong offense even though it's obviously implicit in his argument.

After all, in the eyes of most Americans these days, it was an overzealous offense that drove us into a pre-emptive war in Iraq, which is exactly the topic Giuliani is trying to avoid.

I can just picture a Democratic candidate easily throwing this in Giuliani's face in a debate. But, of course, the effectiveness of this turnaround is very much dependant upon what Democratic candidate we're talking about.

To be fully effective, it really needs to be a Dem who opposed the Iraq War from the get-go. That clearly hurts Hillary Clinton, but it also limits John Edwards even though he has apologized for his vote and can claim he's learned from his mistake. The most effective at making this argument would be Barack Obama and Bill Richardson, although Al Gore and Wes Clark could also use it if they were to enter the race.

Of course, this isn't to say the Dems should choose their candidate with a GOP opponent in mind. In fact, the opposite is true.

The Dems need to nominate a candidate who can best express and embody the fundamental Democratic position on national security -- that the emphasis needs to be on terrorism, and invading Iraq distracted the country from that goal and in the process fueled more terrorism; and, furthermore, the problems of Iraq are not military-based, but policy-based, resulting primarily from a combination of the Bush administration's horrendous planning and its general squandering of the international goodwill that existed in the aftermath of September 11.

If the Democrats don't nominate someone who can express and embody that position, and subsequently use it as a base for articultating what we should do now, they may just waste that refreshing position they now enjoy in the polls.


Side-Note: I want to emphasize that I don't think Clinton or Edwards can't win in the general because of their Iraq War vote; I just think it limits their effectiveness in delivering the fundamental Democratic position on national security.

UPDATE: Obama responds to Giuliani:
Rudy Giuliani today has taken the politics of fear to a new low and I believe Americans are ready to reject those kind of politics. America’s mayor should know that when it comes to 9/11 and fighting terrorists, America is united. We know we can win this war based on shared purpose, not the same divisive politics that question your patriotism if you dare to question failed policies that have made us less secure.
An excellent response. It highlights the divisiveness of the comment and notes that it's policy failures that have hurt America, not a lack of military strength or patriotism, while simultaneously touching on Obama's core campaign theme of creating a new type of politics based upon shared hope.

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Tuesday, April 24, 2007

The Reality of Health Mandates in Wisconsin

It seems some clarification is necessary when it comes to health coverage mandates in Wisconsin.

When opponents -- usually conservatives -- talk about these mandates, they make them seem like universal mandates that affect every insurance policy in the state. Here's a recent post by Owen that lambastes liberals for sacrificing "other people’s dollars to make themselves feel better about fighting the latest crisis":
Currently in Wisconsin, I count at two dozen mandated coverages. They are everything from HIV infection coverage to lead screening coverage to optometric coverage to breast reconstruction coverage. The problem with mandating coverages is that it forces health insurance plans to cover all sorts of stuff that may not apply to the people in the plan.
Let's take a look at those four coverages Owen mentions: HIV infection coverage, lead screening coverage, optometric coverage, and breast reconstruction coverage.

The way Owen lays them out, it makes it seem like every insurance policy in the state is forced to cover all of these procedures. But when you look at the actual state statutes -- which Owen even cites -- you find that they all come with significant "ifs" attached.

HIV drug coverage is mandated only if the plan includes other prescription drug coverage. Lead screening coverage is mandated only if the participants are under 6 years old. Optometric coverage is mandated only if the plan covers the same vision procedures by another health care provider. Breast reconstruction coverage is mandated only if mastectomy procedures are also covered and the reconstruction coverage only applies to breast tissue that's incidentally affected by the mastectomy procedure.

All of the state mandates have similar restrictions, whether it involves limiting the coverage to specific types of plans, specific age groups, or only in the event that the same procedures are already covered elsewhere in the plan. A more reader-friendly rundown of coverage mandates in Wisconsin can be found here.

And contrary to the line that these mandates significantly increase health costs, the ones that are the most universal are aimed at preventative care -- such as screenings, immunizations, mammograms, etc. -- that most experts agree keeps costs down by catching ailments early in their development.

The mandates that pertain to treatment, as opposed to detection, are intended to ensure that patients are provided complete coverage when any coverage is included; for instance, it's mandated that if policies cover diabetes treatment, they also cover the cost of equipment that's necessary for treatment such as insulin pumps. But policies still have the option to not cover diabetes treatment at all, just like policies can avoid the optometry mandate by not covering vision treatments or the chiropractic mandate by not covering back treatments.

You can certainly still take issue with the mandates, but at the very least they should be discussed and portrayed accurately, and doing so puts a big question mark on the charge that they are a significant driver of health care costs in the state.


Side-Note: Owen definitely isn't the only person to comment on mandates in this way; I just picked his post because it happened to catch my eye this morning.

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Friday, April 20, 2007

Wisconsin Medicaid Ranked 5th Best in Nation

This ranking is according to a new study by the advocacy group Public Citizen, which looked at four factors in its analysis: eligibility, scope of services, quality of care, and provider reimbursement.

Breaking down the scores, Wisconsin ranked 9th on eligibility, 14th on scope of services, 16th on quality of care, and 9th on reimbursements. The overall ranking of 5th came because, as the report put it, "Wisconsin's Medicaid program is unusually consistent across the board."

To put the rankings in perspective, the study found that even the top ranking states aren't doing all that well with their Medicaid programs. The top possible score was 1000, and the top ranking state, Massachusetts, came in with a score of about 646. Wisconsin scored 607. At the bottom was Mississippi at 318, Idaho at 325, and Texas at 336.

It seems the key to the rankings are reimbursements. The top state for reimbursements is Alaska, but, not coincidentally, Alaska also ranks toward the bottom on eligibility and scope of services because it limits participation and the services it reimburses. The same is true for almost all of the top 15 states for reimbursements; of those fifteen, only Wisconsin and Nebraska also rank in the top 15 for both eligibility and scope of services.

Even the top overall state, Massachusetts, ranks high on the first three measures but comparatively low on reimbursements at 23rd. Wisconsin and Nebraska stand out for being able to put together a remarkably consistent Medicaid program. Nebraska is in the top 15 in all categories, and Wisconsin only misses on the quality of care measure where it ranks 16th.

These high rankings for Wisconsin are directly correlated with the fact that our state places a high priority on funding for health care. Along with K-12 education, health care is consistently at the top of state expenditures each year.

Nevertheless, even in states like Wisconsin and Nebraska, as long as Medicaid patients remain separate from other payers in the system, they will be treated differently.

For instance, while Wisconsin reimbursements are high compared to other states, they're still low compared to those in private insurance plans. This not only increases costs for those in private plans -- insomuch that Medicaid reimbursements come in under the actual cost of the care -- but it also makes care, particularly non-immediate care, more restrictive for Medicaid patients because providers are more reluctant to accept patients that bring lower payments.

As an example, a 2005 study found that Medicaid patients were able to easily and quickly secure emergency care follow-up appointments 34 percent of the time, while those in private plans were able to do so 64 percent of the time.

It's time to start considering universal coverage plans that work to phase out Medicaid by lumping those patients in with the rest of the payer population. The state will still need to subsidize those who can't afford coverage on their own, but at least that coverage will come on a level playing field with other patients while simultaneously offering more payment consistency for providers.

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Thursday, April 19, 2007

GOP Health Care Reform: Same Old, Same Old

Not that I was expecting much, but the health care reform plan announced by Assembly Republicans yesterday is pretty weak.

Here are the points, one-by-one:

Make HSAs state tax deductible

Unlike some on the left, I don't have a problem with the idea of HSAs, but I do have a problem with their application in our existing fragmented health care system. There are a littany of reasons, but here are the high points:
  • The majority (70 percent) require preventative care to be applied to the deductible, which provides incentives for people to skimp on routine care that can catch many ailments when they're minor and relatively inexpensive to treat.
  • One-third of people with employer-sponsored HSAs do not receive any contribution from their employer, meaning they're forced to foot the $2000-$10,000 annual deductible completely on their own (the other two-thirds get an average employer contribution of $1185, which could be reasonable if the deductible is closer to the lower end of the HDHP spectrum).
  • HSAs, as they currently exist, tend to attract healthy and wealthy participants, which increases the risk -- and subsequently the cost -- associated with traditional plans that are needed by many of the less healthy and less wealthy.
All of this isn't to say HSAs aren't viable in any format. If they come as part of a comprehensive plan that eliminates system fragmentation and ensures consumer/patient safeguards like covered preventative care, a reasonable amount of annual start-up funding for the HSA, a reasonably low annual deductible and out-of-pocket maximum, and ensures successful community rating, then HSAs can have some beneficial effects of weeding out unnecessary care that adds to the overall cost of the system. The GOP plan, however, offers none of this.

Make health insurance premiums state tax deductible.
This is a good idea, and it's already part of Governor Doyle's '07-'09 budget. But to put the proposal in perspective, for those without insurance or those who are currently under-insured, making the premiums tax deductible won't do much to make adequate coverage affordable. [Updated -- see below.] According to the numbers put forward by the Doyle administration, the tax deduction would mean a family that spends $3600 per year in premiums would save $236. That's helpful, but it's not a solution.

Encourage workplace wellness
Employer-sponsored wellness programs have shown good potential, but -- in and of themselves -- they still amount to nothing more than tinkering around the edges of what makes our health care system so expensive. Similar to HSAs, these programs would be a great addition to a comprehensive health care proposal, but their effect is going to be muted in our existing fragmented health system where the uninsured, under-insured, and our inefficient payer structure are still the primary problems.

Improving Transparency of Health Care Costs
Nobody is going to disagree with more transparency, but its effectiveness is very much in question. Studies have shown patients don't take the time to "shop around" for care, in part because they can't -- especially for the non-elective procedures that actually cost a lot of money -- but also because of the geographic disbursement of most health care providers (a trend that's growing as systems continue to consolidate). And for more intricate procedures that tend to be the expensive ones, another problem is that costs are unpredictable since the way the human body reacts to treatment is often unpredictable. New treatments may become necessary that weren't initially anticipated.

Also, other studies show most patients tend to rely on the recommendation of their primary care doctor rather than scoping out prices prior to receiving treatments. Adding to the problem is that studies have shown that quality care ratings often don't correlate with quality care; so while it may be easy to compare price, it's not easy to compare the bang you're getting for your buck.

In the end, while the GOP plan isn't surprising, part of me was still holding out hope for a bold free marketer plan like the one I discuss here by CATO economist Arnold Kling. Kling's plan is to essentially transform health insurance as we know it by only covering catostrophic care and opening up the rest to individual consumerism.

I don't agree with Kling's plan, as I detail in the post cited above, but at least it's something bold rather than the same old, same old tinkering that's become a mainstay of the GOP's proposals for dealing with our nation's top domestic issue.

UPDATE: Initially this post said that employer-sponsored insurance premiums are already state tax deductible. That's not always the case; evidently many large employers allow employee premiums to be paid through a pre-tax payroll deduction, but this isn't a universal practice in the state.

This certainly adds some weight to that part of the proposal, which, again, is already in Doyle's '07-'09 budget. But while saving $236 on a $3600 annual premium bill is nice, it doesn't come close to addressing our fundamental health care problems.

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Tuesday, April 17, 2007

Dissent in the WMC Ranks?

The Cap Times had an interesting article yesterday on the growing politicization of the corporate lobby group, Wisconsin Manufacturers and Commerce (WMC).

I've discussed before how many business leaders don't cite taxes as their biggest concern, or even close to their biggest concern, although it's clearly the biggest message coming out of the group that claims to represent their interests.

In a WMC survey last spring, for instance, taxes landed 7th on the list of business concerns behind health care costs, competition, labor shortage, energy, regulation, and economic slowdown. Similarly, a recent survey of biotech companies in Wisconsin listed skilled and educated workers, access to university research, health care costs, and access to investment capital as the top concerns; taxes didn't make the list.

And, in February, Northwestern Mutual Life CEO Edward Zore surprised an audience of business leaders in Milwaukee when he told them: "Taxes for us are not bad."

In yesterday's Cap Times article, a similar sentiment was struck by one of WMC's own board members. According to Randy Smith, president of City Brewing Company in La Crosse, "Sure, taxes are important but they don't make or break us."

Also at issue was the way WMC has a knack for trashing the state's business climate -- which it ties entirely to taxes via rankings by the right-wing Tax Foundation -- while ignoring many of the positive aspects that make doing business and living in Wisconsin viable options. To be sure, when a variety of economic factors are considered, Wisconsin actually ranks as one of the top states for business performance, vitality, and development capacity.

WMC's leadership claims it's not supposed to be a cheerleader for the state, but there's a lot of reasonable middle ground between cheerleading for the state and trashing it. And considering the group's extremely deep pockets, what makes WMC's tunnel vision rhetoric so destructive is that it distracts the state from tackling public policy issues that could significantly help Wisconsin businesses.

With some of those issues -- such as health care reform and investment in university research -- just around the corner in Wisconsin politics, the question becomes: How much more of the WMC trash are members going to be willing to take?

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What Sunk Imus: Racism or Sexism?

I didn't follow the Don Imus flap very closely because the incident -- and the commentary that surrounded it -- seemed to be the same old, same old to me: A shock jock turned the shock level up a little too high and got burned for it.

But one piece that I do want to take the time to point out regarding Imus is this column by a good friend of mine from grad school, Jason Stahl.

The opening to the piece poses an interesting question: If Imus never used the phrase "nappy-headed," would he have been fired?

The column goes on to explain that the answer to that question is likely "no," leading into Jason's second point -- and my favorite part -- which serves as an explanation for why black rappers are able to get away with using similar language toward women.

As Jason explains:
Namely, there is an element of American culture that now encourages men to bond across racial lines in their objectification of women. Thus, elite white record company owners, black rappers and the Don Imuses of the world can come together to "put women in their place." This message then filters down through the culture, sending the message that sexism is not only fine, but valued by those in power.
If you neutralize the racial element of Imus' comment, he probably would've gotten away with it. And since black rappers are able to neutralize the racial element of their comments by being, well, black, they're able to simultaneously get away with their sexism.

Jason's entire column is well-worth the read, and so are the other pieces he's written as a weekly columnist for the Minnesota Daily, which you can find here.


Side-Note: Jason's article about the Imus flap reminds me of the Super Bowl halftime show a few years back. Everyone was so obsessed with the fact that Janet Jackson's boob was partially-exposed, no one seemed to care that Justin Timberlake ripped off her clothing to expose it. Is the boob itself really the most offensive aspect of that scenario?

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Monday, April 16, 2007

What We Should've Seen Five Years Ago

Just wanted to mention an absolutely tremendous program that started airing on PBS last night called "America at a Crossroads."

It's an 11-part series that covers, as described on the website, "the war on terrorism; the conflicts in Iraq and Afghanistan; the experience of American troops serving abroad; the struggle for balance within the Muslim world; and global perspectives on America’s role overseas."

I watched the first episode last night called "Jihad: The Men and Ideas Behind Al Qaeda." It was terrific. It traced the growth of fundamentalist Islam from the 1940s, explaining how the organization known as Al Qaeda was formed from a splinter faction of the Muslim Brotherhood in the 1980s (although the roots of the splinter go back into the 1970s).

There are two major themes that run through the development of the splinter group: 1) The application of violence, and 2) The emphasis on recruitment.

On the first theme
, the application of violence refers to ideological shifts rather than simply tactical changes. As the splinter faction became more entrenched in the use of violence to spread its message of fundamentalist Islam, it widened its definition of "the enemy" at key points.

In the late 1970s, the violence was aimed primarily at those Middle Eastern leaders who professed secularism, particularly in Egypt where Ayman al-Zawahiri -- Osama bin Laden's lieutenant today -- lived. But into the 1980s, shifts took place to widen the scope of violence to include Western powers, especially the US, that supported secularism in the Middle East and, probably even more important, virtually anyone who the splinter faction deemed to be an infidel -- even if that person professed a faith in Islam.

While the vast majority of Muslims in the Middle East, and even a majority of those who subscribe to fundamentalism, do not approve of the use of violence, the inclusion of Muslims in the definition of "enemy" was viewed by most Islamic scholars as a particularly inappropriate interpretation of the Koran, and it demonstrated just how far the splinter group had strayed from the rest of Islam between the mid-1970s and the mid-1980s.

On the second theme of recruitment, fundamentalist Islam as a whole gained significantly from the Six Days War in 1967 when secularist leaders in Egypt and Jordan fell to the Israeli forces. That war convinced many young Muslims that secularism was being punished by Allah and that fundamentalism was the way to go.

But it wasn't until the 1980s when the Soviets invaded Afghanistan that the splinter faction gained its first influx of recruits, including Osama bin Laden. From that point the organization grew and in the late 1980s formalized itself under the banner of Al Qaeda.

Throughout the 1990s, bin Laden believed that provoking the United States into a "cowboy reaction" was the best tactic for confronting the West. He witnessed firsthand the success the Soviet excursion into Afghanistan had in galvanizing the splinter movement, and he wanted to replicate that development with the US.

The first American reaction came in 1998 when Clinton ordered bombing in the Sudan in response to attacks on two American embassies in east Africa, which only helped fuel Al Qaeda's development.

The next reaction was more severe. When the US invaded Afghanistan in the wake of September 11, bin Laden expected the attack to galvanize Al Qaeda, but it actually had the opposite effect. Aside from letting bin Laden and other Al Qaeda leaders go in the hills of Tora Bora in December of 2001 by not putting US forces on the ground, the war in Afghanistan was a resounding success for the US.

Aiding the success was widespread sympathy in the Muslim world for the horrific attacks of September 11 and general mistrust of the Taliban in Afghanistan.

But, as the "America at a Crossroads" documentary made clear, all of that goodwill and momentum after Afghanistan was more than wiped away in 2003 when the US invaded Iraq and became -- in the eyes of many Muslims -- an occupying force in the region.

One Muslim commentator referred to the Iraq War as a "revival" for Al Qaeda, which was nearly flattened after Afghanistan. The Iraq War has brought about the development of homegrown terrorist cells throughout the region as anger and economic displacement led many to take up the banner of Al Qaeda even though the organization itself is less centralized than before due to disruptions in communication lines. At present, Al Qaeda serves more as an informal label or stamp for terrorism than an explicit chain of command.

It appears that only a few clips from part one are out on the series website, but hopefully they'll be adding more once the entire program has aired.

Parts two and three are set to air tonight on PBS -- at 8:00pm and 9:00pm, respectively. Each deal with the view of the Iraq War from the perspective of US soldiers.

The second part is called "Warriors" and it provides an in-depth profile of six American soldiers on the front lines of the Iraq War in Baghdad during 2005. The third part is called "Operation Homecoming: Writing the Wartime Experience" and it looks at the wars in Iraq and Afghanistan through the writings of the American soldiers who participated in the conflicts.

Here's the rest of the series lineup:

Tuesday, April 17
"Gangs of Iraq" at 8:00pm
"The Case for War: In Defense of Freedom" at 9:00pm

Wednesday, April 18
"Europe's 9/11" at 8:00pm
"The Muslim Americans" at 9:00pm

Thursday, April 19
"Faith Without Fear" at 8:00pm
"Struggle for the Soul of Islam: Inside Indonesia" at 9:00pm

Friday, April 20
"Security Versus Liberty: The Other War" at 8:00pm
"The Brotherhood" at 9:00pm

Check them out if you have the time.

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Thursday, April 12, 2007

"We are healthy only to the extent that our ideas are humane."

The loss of a celebrity figure who I admire usually strikes me with more reflection than sadness; however, I can't help but feel sad about the loss of Kurt Vonnegut.

I read Slaughterhouse-Five one summer in college and I was hooked. Never really being the type to be taken by novels, I was amazed at how much Vonnegut I could read and still not get sick of it.

The fall semester after that summer break I poured through Breakfast of Champions, Cat's Cradle, Bagombo Snuff Box, Galapagos, Hocus Pocus, and Slaughterhouse-Five for a second time, not to mention any non-fiction article by Vonnegut that I could get my hands on.

Even though I studied history in college, I would say no writer had more impact on my thoughts than Vonnegut.

Vonnegut's unending interest in the potential for humanity to create, destroy, and do everything in between demonstrated for me that believing in humankind is a matter of faith as much as believing in anything.

And he was damn funny.


Listen: For those who never had the pleasure of reading Breakfast of Champions, the title of the post is the tombstone epitaph for one of the book's central characters, Kilgore Trout, who served as Vonnegut's alter ego in a number of novels.


Is the Heat on Biskupic Really Shocking?

The hubbub over the appeals ruling on the Georgia Thompson conviction is a good reminder of how fast things can change in politics.

It's remarkable how quickly the fortunes of those directly involved in the case changed, particularly Thompson's, but also very much Biskupic's. While most still consider Biskupic to be a straight-shooting career prosecutor, that doesn't exclude legitimate questions about his decision to investigate and prosecute this case.

It's also remarkable how quickly tunes can change regarding when to aggressively investigate matters of possible political corruption.

Here's Jeff Wagner in January 2006 when the Thompson indictment came down: "[The difficulty of proving the case] suggests to me that there is a lot of fire to go with all the smoke. It also suggests that this may very well only be the tip of the iceberg."

And here's the title of Wagner's post from yesterday: "Time For The Biskupic Attack Dogs to Chill."

That's quite a transformation from "a lot of fire to go with all the smoke" to just "chill."

Rick Esenberg, who is probably the most adept local conservative blogger when it comes to framing issues, strikes a similar note as Wagner and makes the following reasonable comment about why Biskupic looked into the Thompson case:
What we had here was people within the procurement process saying that a civil servant said that "her bosses" wanted the contract to go to a firm whose principals were campaign donors and that they thought she steered the process in that firm's direction. It doesn't shock me that the US Attorney was interested in that.
If you want to boil the case down into those simple terms, Esenberg has a point. There is absolutely no reason for the US Attorney not to take an interest in a case like that (actually prosecuting it and asking for prison time at sentencing, of course, are different questions).

But can't the same be said about those who are looking into the matter now that Biskupic's case was absolutely shredded by the appellate court?

Those who are entrusted with the authority to look into possible cases of federal prosecutorial misconduct -- that is, the Senate Judiciary Committee -- are doing just that: They're looking into it.

And why shouldn't they? The Thompson case was clearly used for political reasons, even if it turns out it wasn't explicitly undertaken for political reasons. Plus:
  • Strong evidence shows that politics played a role in which US attorneys were fired by the Bush administration and which ones were deemed "loyal Bushies" and allowed to stay.
  • Biskupic's office was identified by White House officials as a place of concern for its supposed hesitancy to prosecute alleged voter fraud in Milwaukee -- a label that evidence suggests may have put him on a short list of US attorneys to be fired.
  • New evidence shows that those concerns about Biskupic's office were taken to the White House by the state GOP in Wisconsin -- the same group that clearly used Biskupic's case against Thompson for political reasons.
Taking all that into account, is it really all that shocking that the Senate Judiciary Committee is interested in looking into this case?

The stance that Biskupic's office is taking is that no one from the Bush administration explicitly told him to prosecute Georgia Thompson.

But that's not the purpose of the Senate Judiciary Committee inquiry. According to the letter signed by members of the committee: "We are concerned whether or not politics may have played a role in a case brought by Steven Biskupic, the U.S. attorney based in Milwaukee, against Georgia Thompson."

That's a different standard for the oversight inquiry than the defense that's currently being put up by Biskupic's office.

And if this oversight inquiry results in a case against Biskupic that's beyond thin, then it should be dropped.

I bet Georgia Thompson wishes Biskupic would've felt that way about his case against her.

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Wednesday, April 11, 2007

Stem Cell Debate Frozen in Time...For Now

Just like last year, it doesn't appear the Senate will have enough votes to override another Bush veto on extending federal funding for embryonic stem cell research.

Just like last year, social conservatives are hyping adult stem cell research as if there needs to be a choice made between it and embryonic stem cell research.

And before folks get too excited about the recent research that took place in Brazil in which adult stem cells were used to eliminate, at least in the short term, the need for insulin shots in Type I diabetes patients, they may want to check out this snippet on the study:

The transplants were conducted at the University of Sao Paulo. Lead researcher Dr. Julio Voltarelli doubts the treatment will become widespread "because it is too cumbersome, expensive and potentially toxic."

Other treatments under development, such as embryonic stem cell transplants, may prove to be simpler and less toxic, Voltarelli said.

The bottom line, which this snippet makes clear, is that adult stem cell research is great, but so is embryonic stem cell research. That's what the vast majority of the scientific community believes, and that's what the majority of this country believes.

But the reality is that for the next two years, the social conservatives in the GOP will be able to block the expansion of embryonic stem cell research in the US in spite of those majorities.

Spending time on the substantive issue of stem cell research just seems pointless. I did it last year, as did others. But it makes little to no difference because it's not the public that needs to change -- it's those in power.

And here's a rundown of where the major known contenders for the White House in 2008 stand on the issue of embryonic stem cell research.

All of the Dem candidates support it wholeheartedly. On the GOP side, both Giuliani and McCain support the use of federal funding for research on new embryonic stem cell lines, which is the bill Bush vetoed last year and will again this year. McCain voted for the bill last year.

That leaves Mitt Romney as the only major known presidential candidate who opposes the use of federal funding for embryonic stem cell research using new lines. But, as appears to be the case with many social issues, Romney was for it before he was against it. According to the Pew Forum on Religion and Public Life: "Prior to 2005, Romney broadly supported research on embryonic stem cells. He traces the change in his stance to an epiphany during meetings with stem cell researchers."

No wonder social conservatives don't have a clue about who to support in 2008.

But even if the GOP is able to find another candidate who feels like Bush about embryonic stem cell research, that shouldn't exactly alleviate concerns. After all, that may help get a candidate through the primaries, but it's going to require a lot of explaining heading into the general.

And if the gubernatorial race in the battleground state of Wisconsin last November is any indication, the explanation is going to take more than simply hiding behind support for the generic phrase "stem cell research" or trying to divert attention to the issue of funding rather than the research itself.


Tuesday, April 10, 2007

Transparency Only Part of the Story for Navitus

News is out that Dean Health Plan of Madison has purchased Navitus Health Solutions, a pharmacy benefits manager also based in Madison.

Navitus is the company that manages the drug benefits for the state government and many local units in Wisconsin. Since moving to Navitus in 2004, estimates are that the state has saved $160 million in pharmacy benefit costs.

The Journal Sentinel article this morning on the deal points to transparency as the driving factor behind the savings. According to the article:

Critics have contended that PBM [pharmacy benefit manager] customers can never know how much a drug costs. Three of the largest PBMs - Medco Health Solutions Inc., Express Scripts Inc. and Caremark Rx Inc. - have faced allegations that they inflated drug prices.

Navitus' business model, in contrast, is based on fully disclosing what the drugs actually cost after discounts, rebates and other price breaks.

"You can see exactly what your savings are," said David Stella, deputy secretary of the Department of Employee Trust Funds, which administers the health plans for state employees. "It's not a black box like some models."

Dean Health Plan contends that this sets Navitus apart from its competitors.

"This is the only truly transparent model in the country," said Bob Palmer, chief executive of Dean Health Insurance, the parent of Dean Health Plan.

This needs a bit of clarification. The transparency in this case isn't going all the way to the consumer -- "the customer" referred to above is the employer. This isn't a case, as it may seem at first glance, of knowledgeable consumers being unleashed on the market and drastically lowering health costs as individuals.

As a state employee, Navitus is my pharmacy benefits manager, and I don't have a clue what my prescriptions actually cost aside from the co-pay level. My employer does, and it ensures that, aside from a reasonable cut for Navitus, all of the savings from negotiation with the drug companies are transferred into lower drug costs for me and my employer.

But transparency alone doesn't tell the whole story of what has allowed Navitus to save the state $160 million in three years. This snippet from a Cap Times article that appeared last June paints a more complete picture (emphases mine):
The second major [state health plan] change was the consolidation of prescription drug benefits under one pharmacy benefits manager, Navitus Health Solutions, a Wisconsin company that was created to meet the state's needs.

The Group Insurance Board demanded complete transparency in all financial transactions with drug manufacturers and that all rebates and savings from discounts be passed through to the plan, which also has greater purchasing power due to consolidation.

Navitus created a committee of pharmacists and physicians from across the state who developed a list of preferred drugs and chose the best in each class.

The board changed the drug benefit under the program from a two-level co-pay structure to a three-level co-pay structure. The first level, mostly generics, cost $5 per prescription, the second level $15 per prescription, and the third level $35 per prescription.

There are three important points in this:
  1. The role of purchasing power in the reduction of costs.
  2. The use of a centralized board to oversee the creation and implementation of the drug benefit program along with a committee of health professionals to guide the plan choices.
  3. The use of a more varied tiering structure for participant co-pays based upon cost and classification.
These are all key points that should be transferred into aspects of any health care reform plan entertained by the state as a whole.

In particular, some fear the use of a centralized board would lead to placing undue influence over the program make-up into the hands of too few (see here, pages 21-22). But, as the state's experience with Navitus demonstrates, that's just not likely to happen, particularly when there's strict public oversight involved.

And the use of tiering is important because it puts some onus on consumers to make cost effective decisions, but it also doesn't force them to navigate the complicated waters of health care costs entirely on their own.

A major consultant for the state when it revamped its health plan a few years ago -- which included the move to Navitus -- was David Riemer, the primary architect for the Wisconsin Health Plan, which is one of three health care reform proposals being considered by Dems and some Republicans in the state legislature.

Under Riemer's direction, the state used a centralized board and a tiering structure on the traditional health care plan side, in addition to the pharmacy benefits side, resulting in millions of dollars in savings for the state to go along with $160 million saved in drug costs. Republican state Senator Alberta Darling called the revamping "a shining example" and referred to the new health plan and pharmacy benefits set-up as "the best in the country."

Let's hope that such a pragmatic attitude, as opposed to an ideological one, carries forward into the health care reform debate for the state as a whole.


Friday, April 06, 2007

Biskupic Owes the Public He Represents in Court an Explanation

I don't have much to add on the overruling of the Georgia Thompson conviction that hasn't already been said here and here, among other places.

The case didn't start off aimed at Thompson. But when Steve Biskupic realized he wasn't going to get anywhere else, he decided to save face by throwing the hammer down as hard as he could on Thompson. He even asked the court for a longer sentence in federal prison. A year and a half wasn't long enough for him; he wanted a full two years.

And maybe not showing up at an appeals hearing on arguably your biggest case of the year is commonplace for US attorneys, but it sure sounds pretty pathetic to me.

There were already questions being raised about Biskupic's place in the US attorneys controversy, and I'm sure this incident will intensify those questions. Time will tell if there's anything to the answers.

I'm sure someone will come out with a defense of Biskupic, claiming that he was only doing his job and if there was nothing to the case the conviction wouldn't have happened in the first place.

But there's almost always a chance for conviction in political cases that are as publicly hyped as the Thompson one. Add to that the reputation federal trials have for being unpredictable -- which is why most defendants take a plea before trial, something Thompson, tellingly, didn't do before her trial or her sentencing -- and the initial conviction looks a lot less impressive.

As Marquette law professor Michael O'Hear put it: "The fact is, the sentences are so tough in the federal system, the best way to get any sort of a break on the sentence is to plead guilty and cooperate. Very few defendants are willing to roll the dice. Even some with very excellent defenses are just not willing to take a chance, because trials are kind of random."

Once a sober audience had a chance to look at the case, though, it took them only a few hours -- when deliberations on cases like this usually take a few weeks -- to toss the conviction and call the prosecution's case "beyond thin." Listening to the audio of the appeals court testimony, it's clear that, as much as anything, the judges were in utter disbelief about why charges were even filed in the first place.

And let's not forget this case, which was practically laughed out of the appeals court, was the state's case. Biskupic was representing the people with this "beyond thin" case.

I think Biskupic owes the public that he represents in court an explanation beyond this useless three sentence statement. What the public deserves to know, among other things, is why Biskupic chose to use public resources on a case that it took an appeals court a virtually unprecedented amount of quickness to dismiss.

If Biskupic wants to wait until the full appeals decision is out, that's fine. But an explanation is owed.

UPDATE: Jessica McBride speculates that Biskupic's flimsy case was just the result of "an aggressive prosecutor":
I am willing to bet that Biskupic looked at the case and thought something was rotten there. He thought, put the screws to the lower level player in the tough case with imperfect evidence to see if she will flip on those really responsible. That's how aggressive prosecutors work.
Considering it landed a woman in federal prison for four months, I hope Biskupic has a better explanation than that it was just a fishing expedition that happened to come up empty.

And trying to land a bigger fish doesn't even start to explain why Biskupic called for two years at sentencing. What was he hoping to get out of that? Did he honestly think she'd sit in her cell for awhile and then decide to finally roll over on someone?

I think he knew full well by sentencing that she wasn't rolling anywhere because there was no one for her to roll over on. That fact was obviously abundantly clear to the three appeals court judges. Which brings us back to the question, what exactly was Biskupic doing with this case?

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Thursday, April 05, 2007

The Dem Presidential Field: I Like What I See

I'm not completely sold on any one Dem candidate for president, but Barack Obama continues to impress.

The $25 million Obama raised in the first quarter of this year isn't nearly as impressive as the fact that it came from 100,000 different people -- that's twice Hillary Clinton's number and nearly three times John Edward's number. Notably, the top GOP taker, Mitt Romney, refused to disclose the number of individual donors contributing to his $20 million haul, a sign that it's not an impressive figure.

On the whole, I'm really quite happy with the Dem field at this point -- it's certainly a far more impressive list than what currently exists on the right. I think the top three Dem candidates all have unique strong points:
  • Obama is a movement candidate. He not only has the ability to change the party that controls the White House, he has the ability to change the way the country thinks about politics. And, importantly, he can do it for people who never thought they would give a damn about politics. The guy's a rock star.
  • Edwards is a populist candidate. His message strikes directly at the heart of the conservative conception of class as a cultural entity, which -- even more than foreign policy -- has been the trademark of the conservative ascendancy dating back to Goldwater. Edwards reminds people that class is about economics, while simultaneously reinserting that fact as the centerpiece of the Democratic Party.
  • Clinton is as attuned to detail as it gets. But not in a boring, minutiae-driven kind of way. She has the ability to both master the details and present them in a way that flat-out impresses audiences, even those you'd think she would turn off. As an ironworker put it at a recent union rally: "She knows all our passwords."
I'll probably end up backing Obama or Edwards because they have the ability to be the type of president that Reagan was for the GOP -- one who can change attitudes in addition to the party that sits in the Oval Office. Obama can change attitudes toward politics, Edwards can change attitudes toward the Democratic Party. I just don't see Clinton having that type of influence, although I respect -- more than a lot of lefties, it seems -- what she brings to the table.

And I know there are a lot of people out there who lament how early the presidential race is starting, and I see their point. But, at the same time, 2008 could be much more than just a presidential election.

This is the first time in over 50 years when neither a sitting president nor a sitting vice president is running. Toss into the mix distress over Iraq and US foreign policy in general, along with growing unrest over economic inequality at home, and the times look downright ripe for a change that spans beyond the typical one that Americans are asked to consider every four years.

And that's the type of decision that deserves an early start.


Wednesday, April 04, 2007

Election Hindsight: Handling the Negativity

The Clifford camp ran a hard race. I have little doubt those who participated in the campaign did their best to win and that should be commended.

Hindsight, as they say, is 20/20. If Clifford pulled out the victory, a post like this wouldn't exist. It's easy to say things should've been done differently after the results are tallied.

But that doesn't mean we shouldn't critically examine how things went to better prepare for future races. And that next State Supreme Court race is just around the corner with Justice Louis Butler's seat up next year, although the lessons of the Clifford campaign are certainly transferable into other elections.

When a margin of victory is as large as it was in the Clifford-Ziegler race, there are probably a number of factors involved in the outcome. But I have to agree, at least in part, with Nate when he writes:
Clifford and her Democratic posse gambled on a strategy of giving voters as little information as possible about her, while simultaneously attacking Ziegler like a pit bull. I think its fair to say that such a strategy back fired.
I wouldn't say the Clifford camp was trying to hide its candidate, at least not consciously, but the emphasis on attacking Ziegler is unquestionable, and those attacks did serve to drown out any positive message that Clifford had to offer. But, even worse, the attacks didn't fit into any logical framework that voters could easily understand.

It seems the left forgot the lessons of the gubernatorial election last fall: At least in statewide races, negativity works best when it complements a campaign theme, not when it defines it.

Just check out the ads that were run by the Clifford side in the race. Aside from a spot or two on the newspaper endorsements Clifford received, everything else is about Annette Ziegler. And after those hits on Ziegler, there wasn't a clear and logical bridge leading voters back to Clifford.

To be sure, while Ziegler was clearly just as negative with her ads, that negativity fit into a simple, effective, and consistent frame: Clifford = activist attorney, Ziegler = experienced judge. In other words, Clifford's alleged weaknesses fed directly into Ziegler's alleged strengths.

It's just like in the gubernatorial race when Doyle's "Green is extreme" line dovetailed perfectly with his campaign's message on stem cell research. When Green hit Doyle on ethics, conversely, he had little to follow it up except lame assurances that he was a good guy.

Clifford, likewise, followed her ethics charges against Ziegler with the fact that she had extensive legal experience along with the backing of a number of newspaper editorial boards around the state; but those points are only peripheral to the issue of ethics. That just isn't going to play as well as the activist attorney vs. experienced judge frame.

I don't have anything specific to offer that could've helped the Clifford campaign create a more seamless link between its negative message and its positive message, and it would be pointless to speculate on that level of detail. But the clear lesson for future races is that negativity cannot be a standalone enterprise.

And while simply balancing the amount of negative with the same amount of positive may be better than leaning heavily on the negative, the best results come when the negatives of the opponent lead voters directly into the positives of the candidate.

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Tuesday, April 03, 2007

Health Care Battle Coming Soon to Wisconsin

Typically stories that cover state issues in national publications provide an overview of the topic without any new information.

But this article by Milwaukee-based writer Roger Bybee on health care reform in Wisconsin that appeared on the American Prospect website last week does delve into some new points that I haven't seen mentioned in the state or local media.

The thrust of the article centers on the Wisconsin Health Care Reform Campaign, formed last month as an umbrella group for 31 organizations (and counting) pushing for health care reform in the state. The participating organizations range from labor unions to the AARP to Planned Parenthood to the Wisconsin Council of Churches.

There has been some talk that none of the three health care reform proposals out there today -- the Wisconsin Health Plan, the Wisconsin Health Care Partnership Plan, and the Wisconsin Health Security Plan -- would be the actual proposal that moves forward to the state legislature, and Bybee's article confirms that.

And that's where the Wisconsin Health Care Reform Campaign comes into the picture. Not only has the group served as an umbrella organization for the Wisconsin groups and citizens who want to help push comprehensive health care reform, it also has been the sponsor of a number of public forums on health care reform around the state that are aimed specifically at coming up with a "unity" plan that can be brought to the legislature.

Bybee notes in the American Prospect article that the unity plan could come as early as next month.

With Dems in control of the state Senate and the governor's office -- Bybee cites "insiders" who say Doyle will likely sign whatever comprehensive proposal gets to his desk -- that leaves the GOP-controlled state Assembly as the biggest formal obstacle in passing a reform bill.

But just as looming is the special interest opposition that is sure to greet any proposal. Heading up the anti-reform charge would be insurance and underwriters groups under the umbrella organization I discussed last week called the Coalition for Sensible Health Care Solutions.

While it's my belief that any viable reform measure can't wipe out the insurance industry in Wisconsin, the fact is insurance companies thrive on our current fragmented market that -- with the help of the underwriting industry -- allows for the adverse selection that can transform profits into big profits, and, at the same time, leave thousands uninsured and thousands more under-insured.

The insurance industry will fight hard to maintain this status quo by proposing measures that tinker around the edges while leaving the fundamental problem of fragmentation -- which also just so happens to be its money-maker -- in place, and it will do so under the guise of "putting the consumer in charge" and inaccurately referring to reform plans as "government run health care" or "socialist medicine" despite knowing that consumers as individuals stand little to no chance in the health care market (with the exception of minor and routine procedures; that is, the ones that are largely elective, non-severe, and, as a result, don't cost much). Pooling is the ticket to consumer power while community rating -- the opposite of adverse selection -- is the key to consumer equity, but that's not how it will be framed by those who benefit from the status quo.

The other big guns on the opposition side will be the Wisconsin Hospital Association (WHA), the pharmaceutical lobby, and the corporate special interest group Wisconsin Manufacturers and Commerce (WMC).

The anti-reform impetus of the WHA results from fear that any payer-side consolidation would even out the consolidation on the provider side that currently gives health systems increasing leverage over consumers. The opposition of Big Pharma is similar, stemming from an increase in consumer bargaining power that would come with ending our existing fragmented health system.

As for WMC, although its member groups have made it clear that reducing health care costs is a top priority, the organization's incessant focus on taxes -- which falls way down on the list of member concerns -- suggests any funding mechanism that relies on the shared responsibility of employers in addition to employees won't be looked upon kindly by the biggest spending special interest group in the state.

But as long as the unity plan can demonstrate the savings and cost stability it would provide the majority of employers in the state -- including public entities that pay health care costs out of tax dollars -- the WMC will have a more difficult time explaining how its opposition to the plan is in the best interest of many businesses it claims to represent.

Other right-wing groups like Americans for Prosperity, the Coalition for America's Families, and the Wisconsin Policy Research Institute -- along with talk radio in the Milwaukee metro area -- will also throw their support behind the anti-reform side to create a political frenzy that very likely could be bigger than the fight over the failed TP amendment last year.

All-in-all, it should be an interesting summer and fall in Wisconsin state politics.


Monday, April 02, 2007

The Trials and Tribulations of a Brewers Fan

This what I wrote on opening day a year ago:
While last year the goal was mediocrity, this year the expectations are a bit higher. Some are saying playoffs, but I’m just hoping they're still in legitimate playoff contention in August and September. I say 85-90 victories for the year sounds about right.
75 victories later, the Brewers season was over.

I'll keep my predictions to myself this time around. But this is the first year I'm trying my hand at fantasy baseball -- I've been in fantasy football for the past four years -- and my Week 1 starting line-up makes it pretty clear who I at least hope will do well:

C - Johnny Estrada
1B - Prince Fielder
2B - Brandon Phillips (I just missed Weeks in the draft)
3B - Alex Gordon (I had Koskie but dropped him)
SS - Bill Hall (CBS Sportsline still has him at short)
RF - Michael Cuddyer
LF - Hideki Matsui
CF - Gary Matthews (got steroids?)
SP - Chris Capuano
SP - Dave Bush
SP - Tom Glavine
SP - Derek Lowe
SP - Daisuke Matsuzaka
RP - Mariano Rivera
RP - Armando Benitez

I also have Suppan and Turnbow on my bench to start.

As my roommate in college put it, there's nothing more prevalent at the start of a season than the cool confidence of an uninformed fan.


And Then There Were Three

The tentative partnership agreement between Froedtert and Columbia St. Mary's seems to be a move for survival as much as anything. It really tells you something when the two systems combined still don't match the size of Aurora.

If the proposed partnership goes through, that'll leave three health systems in the Milwaukee area for adult patients: Froedtert/Columbia St. Mary's, Aurora, and Wheaton Franciscan.

It's no coincidence that the announcement comes as the large physician group Advanced Healthcare gets set to consider Aurora's purchase offer later this month. Advanced Healthcare docs currently have privileges at Froedtert and the Columbia St. Mary's hospitals; it's pretty clear the overriding purpose of merging the two, and making the announcement now, is to convince the physician group to stay put.

If Aurora is successful in purchasing Advanced Healthcare, it's virtually guaranteed to build a hospital in the northern metro area, taking a huge chunk of business from the Columbia St. Mary's Ozaukee campus -- the system's crown jewel, and the same hospital that's being hurriedly expanded, along with the Columbia St. Mary's Milwaukee campus, in spite of claims that the partnership with Froedtert is going to bring consolidation.

There certainly are more questions regarding the partnership than there are answers right now. The joint press release from Froedtert and Columbia St. Mary's claims the two "would become financially integrated, governed and managed as a single local entity." Yet, at the same time, the release uses the phrase "partnership" to describe the deal, which makes it seem less complete than a true merger.

After all, Froedtert already has a well-known partnership with the Medical College of Wisconsin and the two are still very much separate entities. How is this new proposed partnership with Columbia St. Mary's going to be different?

It's clear the two will share a bank account and, at least to a certain extent, employees, which is already two big steps further than Froedtert's existing partnership with the Medical College. But how much further are Froedtert and Columbia St. Mary's going to take it? Are the two going to come up with a common name? A common corporate center? A common CEO? A common board of directors?

Also, how will the religious affiliations of each system co-exist? For instance, Columbia St. Mary's -- which is part of Ascension Health, the largest Catholic health system in the country -- houses its fertility services in a separate organizational entity on its campuses to (superficially) keep in line with the teachings of the Catholic Church. Will Froedtert, with its less obvious ties to the Lutheran church, be expected to do the same at its hospitals?

These are all key questions for answering the questions raised by skeptics about whether the partnership will result in efficient consolidation or inefficient duplication.

It's difficult to see how reducing the number of providers in the Milwaukee area even more will put payers in a better position to negotiate cheaper prices. But answering the questions above will help determine whether the new Froedtert/Columbia St. Mary's entity will actually work to create the efficiencies that would make cheaper prices possible.

If it turns out this partnership is merely about bookkeeping and putting together a more impressive fiscal portfolio to compete with Aurora for groups like Advanced Healthcare, as opposed to reducing duplication of services and administration, then it's pretty clear there's no way for the results to be in the best interest of health care consumers in the Milwaukee area.