Healthcare update - Lynch expressing concerns, too

The Boston Herald is reporting that Stephen Lynch (MA-9) will probably vote no on Obamacare and opposes the sleight of hand "deem-and-pass" maneuver Nancy Pelosi is considering. While Massachusetts’s all-Democrat delegation to the House is ranked the most liberal delegation in the house, a number of Massachusetts Congressman are in play on Obamacare. The Herald reports that in addition to Lynch, Michael Capuano (MA-8) and John Tierney (MA-6) are undecided. Ed Markey (MA-7) is likely to vote for the bill.

My guess is once the time to vote rolls around, the Bay State delegation will toe the party line as usual, vote for the bill, and then claim credit as among the deciding voters.

Race profile: 8th Suffolk District -- Walz v. Marston

The 8th Suffolk District encompasses parts of Boston and Cambridge. Incumbent Democrat Marty Walz has the following map on her website: 

Walz - Walz has solid, traditional credentials.  She earned her BA magna cum laude from Colgate, has a Masters from the Kennedy School and her JD from NYU.  Walz has practiced law for a couple of notable firms, including well regarded employment law specialists Littler Mendelson. Her website says Walz "had a particular focus on preventing illegal discrimination and harassment in the workplace."  Walz also practiced in-house for publisher Harcourt General, Inc.

Walz is seeking election to her fourth term on Beacon Hill. Walz's website touts her success obtaining funds for local projects and blocking a proposal to reroute Storrow Drive onto the Esplanade.  Walz says she supports "gradually increase[ing] the personal exemption and decreas[ing] the income tax rate as the state collects more revenue."  She offers no suggestion of how the state will "collect[] more revenue," but rather assumes that is will do so.

Walz's website also says she:

• Supports a longer school day and school year.
• Supports incentives for construction of "affordable housing" units.
• Supports a state constitutional amendment "giving every resident a constitutionally protected right to adequate health care."
• Supports gay marriage, ascribing current debate to a "1913 law, born of racial discrimination."
• Supports "reproductive freedom;" Walz is on the Board of NARAL Pro-Choice Massachusetts.  Walz also promotes her support for stem cell research, including legislation promoting Massachusetts as a center for stem cell research
• Is the lead sponsor of 1) An Act Relative to the Reinstatement of the Clean Environment Fund to increase the number of bottles on which a deposit is required at purchase, with proceeds to "support[] recycling, climate protection, parks, urban forestry, water quality and conservation, and air quality;" and 2) "An Act Relative to Electronic Waste and Recycling" imposing a fee on sales of electronic products to promote recycling of those produces.
• Supported raising the minimum wage to $8.00.

Brad Marston - Republican challenger Brad Marston is a Georgetown grad with a finance background.  Marston began his career at First Boston and rose to Senior VP of New York-based Gruntal and Company.  While Marston gave up finance in 1994 and has since become an actor, his website emphasizes his “over 25 years of business and management experience.”

Marston’s website sets out an agenda to parallel Scott Brown, a growing, if obvious, trend among GOP candidates in the Bay State.  The first statement on his home page hits at popular discontent over taxes and jobs and he promises to provide government “liv[ing] within its means,” small business growth and entrepreneurship.  His later reference to “taking care of people truly in need” harkens back to GWB’s Compassionate Conservatism circa 2000.

Marston is running like many potential 2012 candidates on being the outsider.  He vows to end “closed door meetings and back room deals” and promises the openness and transparency that Obama touted during the campaign but has abjured as President.  In the Bay State context, Marston takes the theme a step further, referring repeatedly to the need for “balance” on Beacon Hill and asking for support from “Republicans, Democrats and Undeclared voters alike.”  Marston implicitly links one-party governance with corruption on Beacon Hill, noting that three consecutive House Speakers (all Democrats) have been subjected to Federal indictments. 

Marston’s site lists several specific proposals:

• Job creation through tax simplification and reduction, and support for small business growth; consolidation or elimination of redundant and wasteful state economic agencies.
• Cut sales tax even more than the 2009 increase, rolling back to 3%.
• Significant spending cuts; Marston says
• The Earmark Transparency Act requiring creation of a searchable web listing of all earmarks (Marston slams earmarks as “the antithesis of open, transparent government”).
• $2 billion in budget savings, including four specific proposals: 1) Repealing the “Pacheco Law” that increases government expenses in favor of public unions; 2) expanding the Group Insurance Commission already covering some state and municipal employees, retirees, etc.; 3) expanding the state’s managed care program to include Medicaid patients; and 4) reforming the public employee pension system.
• Eliminating 6400 of the 7500 new public sector jobs created since 2004. 
• Limiting spending increases to parallel inflation and population growth.
• Directing all capital-gains revenue to restoring the Stabilization fund.

Upshot - Marston has been waging an aggressive campaign since putting his hat in the ring.  His Facebook profile has 3,900 friends and provides a constant flow of information on Marston's canvassing, speaking and fund-raising.  Marston has been quite visible at GOP events in and around Boston, seeking to create face and name recognition in the party core.  However, his website’s “groups” page counts only 19 members among 7 groups and the members page shows only 98 members.

And any race in Suffolk is going to be a tough contest for a Republican, particularly a relative unknown.  Every Rep from Suffolk is a Democrat.  That said, at this point Marston seems to be leading the race on ideas.  Walz hasn't made any statements that address the core issues that are driving voters -- jobs, the economy, the deficit.  Marston's proposals may not be enough to get elected in a strong left district, but they are at least ideas.

It’s early for a state race, but Marston needs to make a name for himself and needs the funds to do it, and as of the end of 2009, Walz was leading the fundraising race with $83K to Marston's $4K.  A lot has happened since then, and a lot will happen before the election, but Marston needs to make up some ground, fast.

Brown stays the course

Scott Brown has delivered the Republican response to President Obama’s weekly Radio address and he has done so quite well.

Obama’s speech tacked to safe center ground, promoting his education reform bill.  Citing reports that the state of education in the US is in relative decline compared to other nations, Obama contended that whereas American emphasis on education in the last century “lifted living standards and set us apart as the world’s engine of innovation.”  today “American 15 year olds no longer even near the top in math and science” and the US has fallen behind in both high school graduation rates and “the proportion of college graduates we produce[].”  It is not clear what “proportion” he was referring to.

Obama propped Arne Duncan as an “outstanding Education secretary” and touted the Race to the Top program that recently made Massachusetts a finalist for additional education funding and brought Governor Patrick some needed positive attention.  Obama announced he will propose an overhaul of No Child Left Behind and that the forthcoming reform bill will “provide educators the flexibility to reach” new, high standards.  Obama vaguely promised to reward progress, encourage reforms in failing schools, and promote constant improvement.  Obama also asserted contrary to evidence that parental involvement is the strongest factor in a child’s academic success, that teachers are “the most important factor in a child’s success,” a sop to populous and powerful teachers’ unions.

Obama then sought to bring his education reform proposal back to promoting those issues he holds more dearly -- “improving the economy, reforming the healthcare system, encouraging innovation in energy and other growth industries of the 21st century.”  Obama’s effort to link the inherent good of better education to the dubious good of his own popularly reviled health care reform proposal comes off flat and deceptive.

Brown’s statements were far more persuasive and far less forced.  Brown emphasized the same themes he pressed during his campaign, saying his election “told politicians in Washington to get its priorities right.”  Brown pressed over and over the disparity between the administration’s push for healthcare reform and the population’s despair for jobs, saying the people want “their president and Congress to focus on creating jobs.” Brown dismissed the Democrats’ headlong drive to pass a healthcare bill -- any healthcare bill -- as “bitter, destructive and endless;” Obama and the Democratic leadership “made takeover of healthcare their first priority;” Obama has failed to improve unemployment that was at 7.2% last January and now is almost 10%; Obama promised in the State of the Union to focus on jobs and the economy, yet promptly returned to the “same 2,700-page, multi-trillion dollar healthcare legislation.”  Brown dismissed health care reform as a distraction and a “disastrous detour.”

Brown also tapped into public frustration at Washington elitism.  Brown commented that Washington is behaving “at its very worst” by ignoring polls showing strong popular opposition to health care reform and Democrats’ demand that they are “going to get their way whether the American people like it or not,”  adding that the administration is “defying the public will” on healthcare.

Brown directly attacked Obama’s failure to live up to his own promises.  While Obama “pledged transparency,” Obamacare is “tainted by secrecy, concealed cost, and . . . backroom deals.”  Despite a promise of bipartisanship, the administration has “resorted to bending the rules” and will “seize control of healthcare in America on a strict party-line vote.” 

Brown hit directly at Nancy Pelosi and “others” as “handing down their marching orders, telling [Democratic congressmen] to vote for this bill no matter what.”  Brown continued that in the contest between the leadership’s dictate and the population’s demand, “I’d suggest going with the will of the people.” 

Brown’s final statements were the strongest by either man:

“[F]rom the very beginning of this debate, the American people have called it correctly. In every part of the country, Republicans and Democrats have agreed on serious, straightforward, commonsense healthcare reform. They expect us in Washington to do the same – working together, acting fairly and by the rules, and staying focused on the need to make the American economy as strong as it can be.  That is the business that brought me here on an unexpected journey to Washington. And, it’s the responsibility of everyone sent here to serve our country.”

Apparently Deval is a really bad governor

Democratic polling firm Public Policy Polling is reporting Deval Patrick's approval ratings are dead last among Governors, coming in at a lowly 22%.  The Massachusetts Republican Party released a statement from Massachusetts Republican Party Chair Jennifer Nassour, saying "It's confirmed: Deval Patrick is the worst governor in America” and that Patrick has been “more concerned with getting his political supporters state jobs and growing the size of government than helping create private sector jobs."  PPP has been notably reliable in recent years -- the Wall Street Journal found PPPs polling among the best in the 2008 election cycle and hit the Brown-Coakley contest exactly.

On January 12, PPP opined  Patrick’s then 2-point lead over Charlie Baker didn't t look “particularly sustainable.”  That poll put Patrick at 29%, Charlie Baker at 27% and Cahill at 21%.  PPP noted even then that undecided voters (who broke strongly for Scott Brown a week later on January 19) were 7% for Patrick and a massive 72% against.  The keys in the Patrick-Baker contest seem to be 1) whether Cahill stays in the race (if he drops, Baker is way ahead) and 2) whether Patrick can succeed where Coakley failed so miserably and hold the independents needed to win.

Neal to vote no?

Richard Neal (MA-2) has been cited as one of the approximately 12 House Democrats who may defect in the event of an up-or-down vote on the Senate's version of Obamacare. Neal was in the five vote majority in November when the House passed a health care bill including Bart Stupack's (D-MI) amendment prohibiting federal dollars from funding abortions. The Senate Bill that Pelosi and Obama are hoping to pass through the House lacks the Stupack Amendment's strong language, and Neal is apparently among those threatening to scuttle the bill. Neal's voting record on abortion and reproductive ethics issues is little scattered. He has a 30% rating from National Abortion and Reproductive Rights Action League (NARAL) and a 0% from National Right to Life (NRLC).

Gubernatorial race poll shows Baker gaining

A recent note from Charlie Baker's team notes new poll data indicates growing support for Baker. The Boston Herald has reported that the latest Rasmussen Reports poll has Patrick leading Baker 35-32, with Cahill taking 19 percent and a huge 14 percent undecided. Equally noteworthy, Patrick leads lagging Baker rival 34-19, with Cahill jumping to 30 percent. The implication is that Cahill's numbers in a Patrick-Baker race are being siphoned from the Baker side, not the Patrick side. Should Cahill find himself running a distant third as the election approaches and throw his support to Baker, Patrick could find himself trailing badly.

Healthcare battleground?

Governor Patrick has taken a strange turn in the gubernatorial race, attacking Charlie Baker on health care costs. Patrick's website touts that he "call[ed] out" Baker for "opposing limits on rising health care costs." Patrick blamed rising health care premiums for "choking job creation in our state" and therefore asserted that Baker (and Tim Cahill) are no on the side of small business. The web posting dinged Baker for being CEO of Harvard Pilgrim at a time of rising premiums (which Patrick sites as having grown 131% in the last ten year, and for opposing Patrick's plan to give the Commissioner of Insurance the power to cap premiums.

Baker's team responded in an email saying Baker remains "proud of his record as the head of Harvard Pilgrim Health Care" and noting HPHC "has been the number one health plan in the country for member satisfaction five years in a row." Baker reiterated his past support for "transparency in health care pricing." Baker dismissed Patrick's attack as "last-minute, election year proposals and frantic attempts to avoid his record of increased spending, tax hikes and mismanagement during our fiscal crisis."

Patrick's late populism is transparent and disingenuous. Anyone who believes that health insurance premiums can be capped without health care coverage being reduced is deluding themselves. This is simple logic. I refer to the cost of identifying a condition and treating it, including all professional fees, device expenses, etc. as "real health care prices." If real health care prices are increasing, premiums must increase as well. If premiums are not allowed to rise, insurers will find that they are or are threatened with paying health providers more than they are receiving from patients. That will leave two options: 1) decrease coverage (meaning that while your premiums are lower, you're out of pocket in the case you need care is higher) or 2) cease operating. If you consider proposals at various levels to require health insurers to provide specific coverage minimums, option 1 may not be an option, leaving only option 2.

In short - capping premiums is a non-starter from a purely economic standpoint. It is hollow, a Potemkin village trying to fool voters into thinking they will save money, when in fact that will never happen.

The central questions are why real health care prices are rising and what we can do to stop it. Why prices are rising is the more interesting question. As pointed out in an article several months ago (that will be posted when found), increased health care costs do not come out of the blue. Health care is vastly different than it was a decade ago, let alone forty or fifty years ago. Gene therapies that were science fiction now actually happen, saving and improving lives. Procedures that were once exotic are now routine -- transplants, in vitro fertilization, etc. New and transformative medical devices, including methods of re-growing organs from a donor's own reverse-engineered stem cells, are in the works. But all of these things cost money. Sure, a few stitches probably shouldn't cost much more today than it did ten years ago (adjusted for inflation), but if the new coverage menu includes, for instance, a pace maker, and that pace maker wasn't on the menu twenty years ago, then you have to expect to pay a little extra for the comfort you're getting that you'll get the pace maker if you need it. Add up all the new things that you might get if you need it, and that could be thousands of incremental cost increases. The relevant analysis of health care costs is how the costs of procedures that have existed for an extended period have changed, and to an extent how much better a new procedure is than the procedure it replaced, and how much the cost has changed.

In light of these observations, the question how to stop health care cost increases appears inappropriate. The better question -- and the one many market-oriented commentators have been asking -- is how to unpackage health care insurance. Insurance providers are currently required to provide certain coverage to everyone they cover, even if the purchaser could not ever possibly use that benefit. If insurance premiums have risen due in large part due to covering additional procedures, the best way to reduce premiums is to reduce the procedures covered. One obvious reform would be to allow consumers to purchase and insurance providers to sell a la carte coverage, picking and choosing those coverages the consumer wants to pay for (perhaps with a minimum coverage for catastrophic injuries and conditions). This maximizes consumer choice, while simultaneously reducing consumer expense by taking away those incremental increases for coverages the consumer doesn't want.

Baker's statements on this issue ought to be very simple -- Patrick attacks Baker for leading an insurance provider while health care prices rose. So what? For five years running Baker's customers, as a whole, have been the most satisfied in the country. They think they're getting what they pay for. End of conversation.

Fundraising update

The Charlie Baker and Richard Tisei campaigns asserted today asserted that they out fund-raised both the Patrick-Murray and Cahill-Loscocco teams. Baker-Tisei reportedly raised over $560K in February and $950K in the first two months of 2010. Patrick has deposited a bit over $260K through February and Murray deposited $58K in January.

Cash on hand reports are:
Baker - $1,620K (end of January)
Tisei - $402K (end of January)

Patrick - $754K (end of February) (end of February, 2006 -- $716K)
Murray - $238K (end of January) (end of January, 2006 -- $224K)

The Republican ticket is out fund-raising the Democratic incumbent and the Democratic ticket's fund-raising is down marginally from the 2006 campaign (in a significantly poorer economy). It seems clear that there is a strong push for the Republicans, and Scott Brown probably deserves the credit for getting donors in the habit of giving to GOP candidates.