Conn Carroll's blog

The Wall Street Journal reports:

Desperate to prevent medical costs from engulfing the federal budget, the [Medicare]'s central planners decided last week to deny payment for a new version of one of life's most unpleasant routine procedures, the colonoscopy. This is a preview of how health care will be rationed when Democrats get their way.

At issue are "virtual colonoscopies," or CT scans of the abdomen. Colon cancer is the second leading cause of U.S. cancer death but one of the most preventable. Found early, the cure rate is 93%, but only 8% at later stages. Virtual colonoscopies are likely to boost screenings because they are quicker, more comfortable and significantly cheaper than the standard "optical" procedure, which involves anesthesia and threading an endoscope through the lower intestine.

Virtual colonoscopies are endorsed by the American Cancer Society and covered by a growing number of private insurers including Cigna and UnitedHealthcare. The problem for Medicare is that if cancerous lesions are found using a scan, then patients must follow up with a traditional colonoscopy anyway. Costs would be lower if everyone simply took the invasive route, where doctors can remove polyps on the spot. As Medicare noted in its ruling, "If there is a relatively high referral rate [for traditional colonoscopy], the utility of an intermediate test such as CT colonography is limited." In other words, duplication would be too pricey.

This is precisely the sort of complexity that the Democrats would prefer to ignore as they try to restructure health care. Led by budget chief Peter Orszag, the White House believes that comparative effectiveness research, which examines clinical evidence to determine what "works best," will let them cut wasteful or ineffective treatments and thus contain health spending.

If you read this blog you already know that Sen. Arlen Specter has announced he will be finally switching parties to become a Democrat. Good riddance. Specter voted for every ounce of terrible new spending under Bush and he has been an equally worthless speed bump to Obama's spend-a-thon.

The contrast between the geriatric Washington big government/big business/big labor Specter and Pat Toomey couldn't be greater. This is great news for the GOP's 2010 chances.

The White House, the DNC, and Americans United for Change are all apparently about to double down on their "Republicans equal Limbaugh" strategy. My thoughts on this are summed up by a comment on Ann Althouse's blog highlight by Instapundit: "Does anyone really think Team Obama's focus on Limbaugh reflects their success so far in office."

This should be the only talking point when conservative surrogates are brought on TV to talk about this compleltely fake controversy: The only reason the Obama White House is attacking Rush Limbaugh is because Obama already has been a complete failure in office. Since his election in November the market has lost 25% of its value and every single one of his policy announcements has only been followed by hundreds of thousands of more lost jobs.

Obama, the Democrats, and the left desperately want to change the subject from Obama's performance. That is why they are investing time, resources, and hundreds of thousands of dollars in demonizing Rush. How does any of this help the American people?

Speaker Hastert's long term spokesman John Feehery has a piece in the Politico suggesting "an after action review should be done by congressional Republicans to see what they could have done better" during the stimulus debate. Feehery prefaces:

I don’t think the GOP should cheer too long or too hard about the end results. After all, really bad policy is about to be signed into law by the president. The government will expand dramatically because of this stimulus package. And at some point, the government will have to raise taxes to pay for this spending spree.

I agree with all of this so far. It is always valuable to look back and take an objective look as possible at what worked and didn't work after any legislative battle. So I was eager to see what Feehery's punch line would be:

Some sort of stimulus was going to pass this Congress. It was only a matter of time. But had the Republicans maximized their leverage, coordinated their message better and unfitted their party, they might have forced even more changes to the ultimate package, changes that might have spared the country the pain of stupid spending and the inevitable tax increases that come along with it.

Feehery is dead wrong here. The Democrats control the House, Senate, and White House. They wanted revenge for the Iraq war and they had a decades worth of spending plans that they were dying to see enacted into law. As soon as it was clear that Obama was going to let Obey take the lead writing the bill, it was written in stone that this stimulus bill was going to be a leftist, wet-dream, deficit spending clusterf**k. There was no way Pelosi and co were going to let House GOPers change the essential nature of the bill.

Pretending that there were some minor changes to the bill that House GOPers could have unified and made a stand on, that would have made the bill better, is just pure fantasy. Obama communicated this fact to the GOP when he met with both caucuses. Does Feehery remember Obama's "I won" rhetoric? Obama said there would be no changes to his temporary, class war tax cuts which any true conservative would never sign on to.

The GOP brand is in the toilet now. After eight years of runaway domestic spending under Bush, the GOP has no credibility in sounding the fiscal responsibility alarm. The way to fix this is not more capitulation to massive increases in federal spending.

The GOP needs to learn the lesson of the Medicare Part D expansion. Feehery's bosses thought they could enact the largest expansion of Medicare in the program's history, but make it better by including some free-market elements around the edges like Medicare Advantage and competitive bidding for medical equipment. Well, you know what happened? The competitive bidding was scrapped by Congress before it could ever take effect and Medicare Advantage was gutted this past summer too.

The lesson: Big government is never market friendly. When you expand the size of government, the socialists will always prevail in the end.

The solution here is to take the long view. The GOP should be taking principled policy stands that offer maximum contrast with the Democrats. This stimulus bill is just the beginning of the left's overreach. After this bill Obama will tackle: housing, omnibus appropriations, alternative energy, and health care. All of these will be insanely expensive. And don't think this is the last stimulus bill either. The economy is going to suck for at least another year, and the left can use this as an excuse to pass another stimulus free for all at anytime.

At some point the American public will grow tired of an economy that only stagnates and falls while the deficit spending explosion in Washington continues with no end in sight. I still think 2010 is too early for the GOP to capitalize on the imminent failure of theBush/Obama bailout parade, but if the GOP marks a clear break with Bush's profligate spending, and the Democrats continue to demonstrate that their economic plan is just Bushonomics on steroids, then we have a real shot of making Obama a one-term president.

Minority Leader John Boehner (R-OH) did a fine job this Sunday on Meet the Press. His "wasteful Washington spending" that does "nothing to help create jobs" message was widely picked up in the papers today. I only have one bone to pick: he didn't make the point that none of the new spending in Obama's trillion dollar spending plan is temporary.

By National Economic Council director Lawrence Summers' own criteria, only a stimulus bill that is "timely, targeted, and temporary'' can have any hope of succeeding and there is nothing temporary about the spending in Obama's plan.

When the left was still in the wilderness, Peter Daou outlined a messaging "triangle" writing:

Forming a triangle of blogs, media, and the political establishment is an essential step ... Simply put, without the participation of the media and the political establishment, the netroots alone cannot generate the critical mass necessary to alter or create conventional wisdom.

Right now both the blogs and the media are hitting the "Nothing Temporary About This Stimulus Spending" message. David Brooks is on board. George Will is on board. Heck even The Washington Post is on message.

Now we need the GOP leadership to get on the same page.

Blogging on Obama's stimulus strategy, Jon writes:

Republicans are in a difficult situation here.

• If they oppose the bill and it fails, they will be blamed (fairly or not) for any economic problems.

• If they support the bill and it passes, they will share the blame for the enormous costs it will entail.

• If they oppose the bill and it passes, the lack of policy leverage would leave the bill much worse than if they had forced potentially valuable compromises (e.g., sunset provisions and exit strategies).

I agree that Republican's face a "difficult situation here" but we should not pretend for a second that there any "potentially valuable compromises (e.g., sunset provisions and exit strategies)" on stimulus spending. As TARP shows us, once money is authorized, it will be spent and probably on items that never would have been approved of in the first place (like the nationalization of the US auto industry).

Furthermore, any "sunset provisions" or "exit strategies" can also be easily ignored or revisited down the road. Take Medicare. When conservatives caved in to George Bush and Tom DeLay on the prescription drug benefit, some votes were secured by promises that regulations would be passed that would introduce competitive bidding into Medicare's current price fixing system for buying medical supplies.

So what happened when the regulations were about to become law? The medical suppliers went crying to Democrats and big government Republicans asking them to kill the competitive bidding rule. The result? No competitive bidding in Medicare procurement and we're still stuck with the massive new prescription drug benefit.

The same fate will befall any type of fiscal responsibility measures inserted into Obama's trillion dollar stimulus. When the time comes for the measure to actually reduce spending, the left will change the law to allow the taxpayer spigot to keep flowing.

The politics and policy on the stimulus are the exact same: Republicans who hope to be future leaders in the party must say no to any stimulus that includes hundreds of billions in dollars in new spending.

Politico has a story up now titled "Nepotism Nation: Dems embrace dynasty politics." It details just how familiar the names being put forward to fill the Senate seats being  vacated by the Obama brain drain are. Go ahead and read the article for all the gory details, but MSNBC's Chuck Todd made the point first and more succinctly:

Could the four Democrats seeking Senate seats in the four Obama-presidential related vacancies all be relatives of famous politicos in their home states: John Salazar in Colorado, brother of Ken? Beau Biden in Delaware (in 2010, once he gets back from Iraq), son of Joe? Lisa Madigan in Illinois, daughter of Assembly Speaker Michael? And Caroline Kennedy in New York, well, you know who she is, right?

Why does this matter? Well the GOP is going to need every bullet we can get are hands on if we hope to make up ground in the Senate in 2010. Reinforcing an already existing 'Dynasty Dems' meme in the media will be a great theme to build on. Obama's operating coalition is ripe for an attack along these lines. In his first post-election analysis Michael Barone observed:

The top and bottom coalition. Obama led among those with incomes under $50,000 (big) and those above $200,000 (narrowly). Among the 56 percent with incomes in the middle, it was pretty much even. Similarly, Obama won 63 percent among those with no high school education and 58 percent among those with postgraduate degrees but led only very narrowly among those in between. That's reflected in the finding that McCain did better with noncollege whites (58 percent-40 percent) than college whites (51 percent-47 percent). At the moment, this top-and-bottom coalition outnumbers the broad middle. But if the political balance tips, it could be the other way around.

The first politician that I've observed assemble a top-and-bottom coalition was Mayor John Lindsay of New York. He started off as a Republican, a very liberal one, and won the mayoralty in 1965 and 1969 with coalitions of affluent Manhattan whites on the one hand and blacks and Latinos on the other. In both elections, he won with a plurality of the vote and was behind in the four outer boroughs taken together. Lindsay championed soft policies (in the sense of the word in my book Hard America, Soft America) on crime and welfare that produced disaster in New York and in other cities where such policies were followed. Those policies answered the demands of both sides of his top-and-bottom coalition: The top wanted generous policies toward the poor that made them feel good about themselves, the bottom wanted short-term money transfers and leniency toward criminals in their midst. The top paid a small price for the results of these policies; the bottom paid a very large one.

A similar outcome is entirely possible under Obama. Obama's rich supporters on the coasts want to pass global warming legislation that will make them feel better about themselves as they jet back and forth over the rest of the country struggling to survive under huge new energy taxes. The fact that many of the Senators passing this legislation are part of wealthy Dem Dynasties can only help our candidates.

In typical scream-first-think-later style, Media Matters has gone all out with at least two very lengthy posts claiming to debunk the 'falsehood' that General Motors recently paid more than $70 per hour in labor costs. No matter how Media Matters may try and twist the truth, that $70 figure is an accurate representation of the burdens GM faced under their union contract. More imporantly, under their new union contract, GM will continue to face higher labor costs than their non-uninon competitors.

The disagreement in figures boils down to this: in their 1996 SEC filing, GM claimed they faced labor costs of $73.26 per active hour worked. The total was made of two main components: cash compensation ($39.68) and benefit/government required programs ($33.58).

The UAW disputed those numbers at the time and wrote:

In 2006 a typical UAW-represented assembler at GM earned $27.81 per hour of straight-time labor. A typical UAW-represented skilled-trades worker at GM earned $32.32 per hour of straight-time labor. ... In addition to regular hourly pay, the labor cost figures cited by the companies include other expenses associated with having a person on payroll. This includes overtime, shift premiums and the costs of negotiated benefits such as holidays, vacations, health care, pensions and education and training. It also includes statutory costs, which employers are required to pay by law, such as federal contributions for Social Security and Medicare, and state payments to workers’ compensation and unemployment insurance funds. The highest figures sometimes cited also include the benefit costs of retirees who are no longer on the payroll.

So basically the UAW/Media Matters argument is that the $70 per hour figure is misleading because that is not what the average UAW member takes home in cash. But GM's labor costs, thanks to bloated union contracts and other government taxes and mandates, include a whole lot more than just wages.

As the UAW details, some of those costs include "overtime" "shift premiums" "vacations" "health care" "federal contributions for Social Security and Medicare" and "state payments to workers' compensation and unemployment insurance funds." Just because an auto worker doesn't take these benefits home in every pay check, doesn't mean their free. All of these benefits cost money and that money does not come from magical fairies. These labor costs come out of GM's bottom line.

So yes, the UAW did recently sign a labor contract with GM that will lower GM's average labor costs to $62 per hour by 2010. But that would still be $9 higher than the $53 Toyato currently pays, and Toyota claims total labor costs at its older U.S. plants are around $48.

So the fact still remains that Barack Obama and the Democratic Congress are about to nationalize three auto companies that, unless significant changes are made to current labor agreements, will face a significant comparative disadvantage on labor costs. Those are the facts.

Another take on the Fairness Doctrine. Conservatives do need to do a better job watching comes out of the regulatory bodies. -Patrick

Patrick makes some fair points in his 'Crying Wolf on the Fairness Doctrine' post, but I think he is more than a bit sanguine about the regulatory environment our talk radio allies might soon be facing. Let me boil Patrcik's argument down to four main points:

1. Obama is too smart to provoke a fight on the Fairness Doctrine
2. the internet is more politcally powerful than radio
3. there is a finite bandwith for conservative messaging
4. conservatives need to be talking about issues that matter to Americans, like the economy, and not phantom issues like the Fairness Doctrine

Here's my response:

1. Yes, Obama is too smart to bring back the 'Fairness Doctrine'. You are absolutely not going to see any movement in Congress to pass legislation forcing the FCC to revive the same rule it abandoned in 1987. But as the Center for American Progress points out, Congress does not need to pass any new legislation: "The public obligations inherent in the Fairness Doctrine are still in existence and operative, at least on paper." Instead you will see a regulatory push at the FCC to intimidate conservative radio stations by shortening their licensing requirements from every eight, to every three years, and forcing them to meet stepped up "public interest" requirements. This new standard would be just as vague and ripe for abuse as the old Fairness Doctrine ever was.
2. Yes, the internet is clearly better at raising money and coordinating election activity. But talk radio is still a force, especially in legislative battles. Patrick mentions the key role talk radio played in the immigration debate. Does the internet even have a similar legislative victory? Yes, the Glenn Greenwald's and firedoglake's of the world generated thousands of phonecalls to Capitol Hill on FISA, but who won that fight? And how did their chosen candidate end up voting? There is no doubt the GOP needs to grow online, but now is not the time to be casting reliable allies like talk radio to the wolves.
3. There is no finite bandwith for anyone's messaging, left or right. This reminds me of the mistake I made arguing that the netroots made a strategic mistake by going after Joe Lieberman in 2006. It seemed like a waste of their resources. It wasn't. Their fight agianst Lieberman became a rallying cry for larger issues, set the tone for 2006, and brought in new activists and money. As long as a fight fits into a larger narrative, it only expands and amplifies our messaging reach.
4. Like Patrick, I also believed conservatives looked clueless this fall bringing up some guy from the '60s nobody had ever heard of while the economy crashed. But a re-regulation of radio broadcasting along the lines that CAP envisions is a real threat to freedom of speech. And the way Obama will porbably go about it, bypassing Congress and using a bureacratic out of touch regulatory body, is exactly the route the Obama administration is probably going to take on cap and trade as well.  As Patrick points out  CAP "president John Podesta is leading the Obama transition" and he "is dead serious."

I do believe that some of the more heated "the sky is falling" rhetoric on the return of the Fairness Doctrine is over heated. But that does not mean we should be complacent and let the FCC eat talk radio at its leisure. We must be vigilant for any signs that the Obama adminsitration is follwing CAP's policy recommendations on the issue, and hit back hard when they do.

Perhaps I spent too many years reading Chuck Todd's analysis at The Hotline, but I try to explain pretty much everything that goes on in Washington through sports. The Sarah Palin saga is no different.

First let me say that I love Gov. Palin, believe she is a top shelf political talent, and that she did adequate last night. But she could have been better. And the McCain campaign is entirely to blame for her underperformance.

Palin is like a highly talented first round baseball draft pick. She is going to be great someday, but when McCain picked her in August, she was simply not ready to face major league pitching the very next day. This is not to say she would not be ready to be VP on January 20th. Just that she needed some practice.

And the McCain campaign should have been getting her that needed practice from day one. The major leagues have a farm system for a reason. To develop talent. From day one Palin should have been on Hannity, Hewitt, Rush, and Laura. Is this group going to challenge her in the same way Charlie Gibson will? No. But they would give Palin the opportunity to answer detailed policy questions in a friendly environment, to hone her skills at explaining her world view, and to grow comfortable in the media spotlight.

But the McCain camp did not choose this route. Instead the sequestered Sarah with top McCain advisers who crammed her with McCain-answers instead of letting her discover Palin-answers on her own. Major league teams don't build pitching staffs by calling up their best talent and then leaving them on the bench. They send them to organizations where they are given an opportunity to develop their natural talents, so that when they do play in the bigs, they will be that much better.

McCain still can pursue this strategy. Palin did fine last night, but she could have done better. She should be out talking to every friendly media outlet the McCain camp can find. This would both rally the troops and give Palin some needed practice.

Remember, its not like Obama didn't get the same treatment. The media absolutely adore him, and protected him fiercely early on. He is now a much better politician for it. Unfortunately conservatives do not have a deep bench of Gwen Ifill's in the MSM that are writing books about how awesome Sarah Palin is. Quite the opposite. The MSM hates her with a red hot passion.

So let's get Palin on Rush and Laura and Beck as quickly as possible. Her future, and ours, will be better for it.