Jack Newfield of The Nation remembers Kennedy as the senate's fighting liberal, the "best and most effective senator of the past hundred years."
James Ridgeway of Mother Jones laments:
We are left with weak, squabbling, visionless Democratic puppets and a President whose domestic reform policies are adrift-sliding towards the horizon with each passing day.
The loss is a blow to healthcare reform. Alex Koppelman of Salon notes that with Kennedy's passing, the Democrats have lost one of their most effective bipartisan deal-makers. Democrats will also be down a vote in the senate for the foreseeable future because Massachusetts state law doesn't allow for the appointment of an immediate replacement.
Naturally, with congress on vacation, wackos are rushing in to fill the media vacuum. Eric Boehlert asks in AlterNet why Republicans the only ones allowed to get angry about healthcare reform, or anything else. He notes that in 2003, the media decided that Howard Dean was too angry for prime time. During the Republican National Convention in 2008, SWAT teams were sent to raid the homes of suspected anarchist protesters. And yet, conservative demonstrators in Arizona are allowed to tote rifles just outside the security perimeter of a presidential event.
RNC Chair Michael Steele raised eyebrows by championing single-payer healthcare in an op/ed in the Washington Post framing the GOP as defenders of Medicare.
Odd that Steele has so much love for Medicare, but none for the nation's other leading source of government-run healthcare, the Veterans Administration (VA). This week, Steele accused America's other leading public insurance provider of encouraging veterans to commit suicide, based on a booklet published by the VA which explains living wills, advanced directives and other key concepts in end-of-life care, Rachel Slajda reports for TPM DC.
Progressives have been doing a great job debunking the death panel and death book myths, like this creative photo essay from TPM. But we're scarcely addressing the misconception that underlies them: The idea government-administered health insurance is inherently more prone to rationing than private health insurance.
Newt Gingrich and other prominent opponents of reform claim that a public option will restrict choices and deny care. What they don't say is that for-profit insurance is rationing. When your insurance company covers an old drug for your condition, but not a new one with fewer side effects, that's rationing. The company is restricting your treatment choices to improve its bottom line. When an employer or an insurer decides not to cover mental health care, that's rationing. The entire business model is predicated on charging people more and giving them less care so there's more money left over for the stockholders.
No health insurance can cover every treatment, no matter who runs it. But public insurance has two major advantages: 1) Public insurance tends to be cheaper to administer; 2) The tough choices about what to cover are ultimately in the hands of the voters, not health insurance bureaucrats with an eye on the bottom line.
The whole town hall concept is turning out to be a strategic blunder for the White House. The format makes legislators and the media sitting ducks for extremists and astroturfers who want to paint themselves as typical citizens. As Sandy Heierbacher of the National Coalition for Dialogue and Deliberation writes in YES Magazine:
[T]he town hall design sets the stage for activist groups and special interest groups to try to ‘game' the system and sideline other concerned citizens in the process. As Martin Carcasson, director of Colorado State University's Center for Public Deliberation, recently pointed out, "the loudest voices are the ones that get heard, and typically the majority voices in the middle don't even show up because it becomes a shouting match."
How much more clear can the Republicans be? They are not interested in bipartisanship. Sen. Chuck Grassley (R-Iowa), supposedly the Senate's leading reasonable Republican on healthcare, couldn't even be bothered to rebuke a town hall participant who hinted about assassinating the president, as Raw Story reports.
If the Democrats want healthcare reform, they are going to have to go it alone. Let's hope they pass a bill that would make Sen. Kennedy proud.
]]>On Saturday, Obama told a town hall meeting in Colorado: "Whether we have it or we don't have it, [the public option] is not the entirety of health care reform. This is just one sliver of it, one aspect of it."
"I don't understand why the left of the left has decided that this is their Waterloo," an unnamed senior White House official gripes in this morning's Washington Post.
The White House is sorely mistaken if it thinks that the public option belongs in the "nice but not necessary" category. Josh Holland of AlterNet explains why the public option is the pillar of healthcare reform. Without it, there's little hope of containing costs or reigning in the power of insurance companies:
It may be just one "aspect" of health reform, but without it, the legislation promises to be a massive rip-off; a taxpayer give-away of hundreds of billions of dollars to an unreformed ‘disease care' industry.
The industry would get millions of new customers thanks to generous government subsidies and a law requiring that (almost) everyone carry insurance. And that windfall would come without the structural changes needed to bend the medical "cost curve" in years to come - without any provisions that might endanger the industry's bottom line.
In Salon, Robert Reich agrees. Competition between private insurance companies and the public option is the only hope to controlling costs. A public plan could bargain with providers to reduce costs and pass the savings on to taxpayers. The private insurance industry would have to slash its prices to compete.
Without a public option, "reform" would likely involve subsidies to private insurance companies, temporarily dulling the pain as premiums rise unchecked. That's the worst of both worlds.
Progressives shouldn't be surprised at the White House's noncommittal stance, though. Obama campaigned on a public option, but he has always framed it a darned good idea, not as a non-negotiable demand.
Why is it so difficult to get a healthcare bill through the Senate with the supposedly filibuster-proof majority? The simple answer is that the Dems need 100% of their delegation to cooperate in order to break a filibuster. So, the Democrats have 60 seats in the Senate but no way to advance their agenda without capitulating to the conservative Blue Dogs. The Republicans can be counted on to filibuster whatever the Democrats come up with. Which means that conservative Democrats like Sen. Max Baucus (D-Mont.) hold the balance of power.
As Ari Melber of The Nation explains, Baucus and his Republican counterpart Sen. Chuck Grassley (R-Iowa) also rule over the powerful and conservative Senate Finance Committee, which has been tasked with writing the Senate version of the healthcare bill.
Also in The Nation, Tom Geoghegan argues that it's time to break the stranglehold by abolishing the procedural filibuster. Unlimited debate in the Senate is enshrined in the constitution. In an old school filibuster, senators simply refuse to shut up until the session ends and the bill dies without a vote. In 1975, a group of liberals wrote a rule of Senate procedure that effectively allows senators to "filibuster" simply by saying they want to. In the old days, a filibuster was a grueling public ordeal. Senators slept on cots and spelled each other off. Today, "filibustering" means signing a form. It's private, easy and cost-free. The Republicans can, and will, filibuster all major Democratic legislation without having to stand in public and risk being branded as obstructionists.
As a result, 60 is the new 50 in the Senate. Since it's just a rule, the procedural filibuster could be abolished by a simple majority vote. Friends of the filibuster defend it as a bulwark against tyranny. Abolishing the procedural filibuster would discourage frivolous obstructionism, but keep the old school filibuster for cases when legislators actually care enough to lose sleep over it.
Ever wonder why the strongest public option, single-payer, was never on the table? Maybe because even the strongest proponents of the public plan are taking money from the insurance and biomedical industries. Mother Jones Rachel Morris wants to know why UNITEDHealth consultant Tom Daschle was on Meet the Press Sunday. A former Democratic senator, Daschle is a senior adviser to Obama on healthcare reform and a leading advocate of a public plan. However, he recently resumed a private consulting arrangement with UNITEDHealth, America's largest health insurer. Even public plan champion Howard Dean is a strategic adviser on healthcare policy to the lobby firm of McKenna, Long, and Aldridge. Dean won't disclose his clients, but McKenna represents a number of clients in the biomedical and health science industries.
The prospects of a public option are dimming, but not necessarily because of any rapid about-face by the White House. The Senate bill is in the hands of the Blue Dogs, who say they won't have legislation until November. Obama won't put the screws to the Blue Dogs, but there's still plenty of time to for citizens to make their voices heard.
]]>This week’s edition of the Weekly Pulse is shorter than usual. Our team is getting ready for the fourth annual Netroots Nation blogger conference in Pittsburgh, PA. Esther Kaplan, editor of the Nation Investigative Fund, and I are conducting an investigative reporting workshop on Saturday from 1:30-4:15 p.m. Join us and help expose the corporate roots of the Teabagger/Town hall mob movement.
Here’s the latest news on the healthcare front: Republicans and their allies are pressuring Democratic healthcare reformers at townhall meetings around the country. Addie Stan has a blockbuster piece in AlterNet that exposes the network of corporate funders and lobbyists behind the mobs.
The Progressive’s Ruth Conniff explains the mobs’ marching orders, as spelled out in a memo by Bob MacGuffie, a volunteer for the Tea Party Patriots, an anti-reform group with ties to former Republican Rep. Dick Armey’s pressure group Freedom Works. MacGuffie instructs town hall protesters to shout at lawmakers and attempt to throw them off their game as they try to make the case for health care reform. So much for reasoned discussion.
As I reported in In These Times, the teabaggers are trying to scapegoat organized labor as the instigators of confrontations at town hall meetings. On August 6, a scuffle broke out in front of a town hall meeting in St. Louis. The below video clip shows the last 10 seconds of a scuffle in which a man in an SEIU t-shirt lies prostrate on the ground. A 38-year-old conservative activist claims to have been severely beaten, but the video shows him apparently uninjured, darting around to different cops and trying to convince them that he was attacked. The man’s lawyer claims that he saw his client get punched in the face and kicked in the head by SEIU members.
A spokesman for the St. Louis County police told me that the police hadn’t reviewed the video because nobody had submitted it to them, despite a call to the public to turn over evidence for the investigation. The fact that the videographer hasn’t turned over the video kind of makes you wonder if the teabaggers really take the “evidence” as seriously as they claim.
How’s this for irony? According to Talking Points Memo, the activist was asking for money to pay his hospital bills because he’s uninsured.
Finally, Jodi Jacobson of RH Reality Check reports that Kansas Now is calling upon AG Eric Holder to restore the Federal Marshall security detail of prominent late-term abortion provider Dr. Leroy Carhart, a friend and colleague of the late Dr. George Tiller. Carhart was placed under protection after Tiller was shot. But the feds didn’t even wait for the trial of Tiller’s alleged assassin to wrap before pulling Carhart’s detail. Now he’s on his own, just as the alleged killer’s links to a broader coalition of violent anti-choicers are coming to light.
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Dave Weigel of the Washington Independent points to July 31 memo from House Minority Leader John Boehner (R-Ohio) entitled "A Very Hot Summer," in which he announces that the GOP has launched an "entrepreneurial insurgency" against healthcare reform.
And now the National Republican Congressional Committee (NRCC) is openly celebrating the angry mobs of anti-reform protesters that are disrupting town hall meetings and shouting down pro-reform Democrats, as Eric Kleefeld of TPM DC notes. “Roaring Chants Interrupt Healthcare PR Campaign As Dems Lose Their Cool and Town Halls Turn Into ‘Town Hells’,” gloats one NRCC email message to reporters. This campaign’s official logo depicts a donkey being roasted alive.
If the reformers used the NRCC’s playbook, reporters would be deluged with retaliatory tweets claiming that teabaggers are killing babies and raping old women, but facts are stubborn things. As of press time, the Pulse is not aware of any ritual sacrifices by teabaggers at townhall meetings.
Steve Benen of the Washington Monthly warns that the GOP’s strategy to egg on the wingnuts could have unintended consequences:
It’s probably the one angle the corporate interests and their lobbyists haven’t considered: the unintended consequences of rallying confused right-wing activists to shout down policymakers who’ll improve their health care coverage. Once you wind up the fanatics and point them in the direction of a town-hall meeting, you never really know what they’re going to say, do, wear, or hold. In at least one case at the Doggett event, there really was a sign with Nazi “SS” lettering.
Top Obama adviser David Axelrod denounced groups like Conservatives for Patients Rights for stoking the protesters. Axelrod pledged to aggressively combat misinformation about the Obama administration’s reform plan, as Rachel Slajda of TPM reports. Is it a coincidence that Axelrod was abruptly issued a Secret Service detail this week without explanation?
In the American Prospect, Paul Waldman describes how Republican members of Congress are promulgating the urban legend that the healthcare bill includes mandatory euthanasia:
In some tellings, government bureaucrats will visit the elderly to force them to choose their manner of death. In another, their doctors will be required to “tell them how to end their life sooner” (this one is being popularized by Betsy McCaughey, as despicable a merchant of lies as has ever slithered through our public debate). One GOP member of Congress after another has simply dispensed with all the complexity and said that the Democratic health plan will cause seniors to be “put to death by their government” or some variation thereof.
The rumor grew out of a provision to reimburse doctors for end-of-life care, including discussions of living wills, as Waldman explains.
Speaking of misinformation, Rep. Kent Sorenson (R-Iowa) is tweeting nonsense about a shadowy healthcare commissioner who decide’s everything for you, as Jason Hancock of the Iowa Independent reports. “Page 42 healthcare bill ‘Health Choices Commissioner’ will decide health benefits for you. You will have NO choice,” Sorenson breathlessly informed his followers. In fact, according to an analysis by the Pullitzer Prize-winning website PoliFact, the healthcare commissioner would regulate insurance companies to make sure they don’t exclude people for preexisting conditions.
At the rate misinformation is mutating, perhaps Republicans will have convinced themselves that the bill will create Health Care Commissar who will involuntarily euthanize you and make your grandmother have an abortion by tomorrow morning.
Congress will return from summer break on September 4. Expect heated rhetoric and increasingly frenzied political theater in the weeks ahead.
]]>The House bill would create an insurance exchange where the self-employed and small employers could order off a "menu" featuring a public plan and various private options. The hope is that insurance companies would offer better rates in order to put their plan on the national menu. Private options would also compete against the public plan.
Healthcare reform could look very different by the time the Senate gets through with it, but that's not slowing down the prognosticators. In the Prospect, Dana Goldstein considers what the new bill might mean for reproductive healthcare. One of the most important questions is whether the public option will cover abortions. Under the new bill, an independent medical commission would decide what's covered, so abortion wouldn't become a political football. Goldstein calls this a victory for reproductive rights.
Brian Beutler of Talking Points Memo reports that the progressive Healthcare for America Now supports the House healthcare reform bill.
Feministing's Miriam Zoila Pérez has an update on the newly-appointed surgeon general, Regina Benjamin. Benjamin, an African American from Alabama, has as strong background in clinical medicine and rural healthcare. Like so many of Obama's nominees, Dr. Benjamin has an engaging personal story. She's the past president of the American Medical Association, and the recipient of a McArthur Genius Grant for her work on rural healthcare.
But after Hurricane Katrina, Benjamin bartered with patients who couldn't pay cash, exchanging checkups for oysters and homemade goodies. A former colleague told the New York Times that she routinely prescribed birth control, but that the clinic didn't have abortion facilities. As Steve Benen notes in the Washington Monthly, Benjamin's track record of working with the poor and the uninsured sets her apart from early favorite Dr. Sanjay Gupta, a neurosurgeon and chief medical correspondent for CNN. The job of the Surgeon General is largely symbolic. Obama may be hoping that Benjamin's record of altruism will lend credibility to the administration's call to doctors to temper their self-interests in the name of the public good.
Phillip Longman argues in the Washington Monthly that open source code could make the difference between a triumph and a boondoggle in the race to digitize America's health records. Longman contrasts two hospitals, one which used open-source code and another that chose a closed, copyrighted program. The former could be modified and improved by tech-savvy doctors and nurses who actually used the software, so it got steadily better. The latter, an expensive solution devised by a private contractor, started bad and stayed that way. Unfortunately, according to Longman, the Obama administration is leaning towards the closed option.
And finally, Terry Allen of In These Times reports on the massive homeopathy FAIL that robbed untold numbers of people of their sense of smell. A zinc-containing preparation called Zicam was marketed as a homeopathic cold remedy. The FDA doesn't require homeopathic remedies to be tested for safety and efficacy. Homeopathic tinctures are generally so heavily diluted as to no traces of the ostensible active ingredient. However, Zicam contained enough zinc to damage the olfactory nerves.
]]>The president was probably reacting to a spate criticism of Democrats perceived to be dragging their feet on healthcare reform. Democracy for America released a spot calling Sen. Mary Landrieu (D-LA) a "sellout" for taking $1.6 million in campaign contributions from the healthcare industry and failing to endorse a public plan. The naming and shaming is unlikely to stop, regardless of the president's preferences. If progressives were to stop haranguing vulnerable Democrats, they'd loose their main point of leverage on healthcare reform.
Laura Flanders argues that progressives can't afford to sit back and let the healthcare industry do all the lobbying. She estimates that industry groups are spending $1.4 million a day to influence the healthcare debate:
Why are [public plan fans] pushing so hard? Well, consider what they're up against. Pulling against anything remotely public, is the biggest lobbying blitz Washington's ever seen. The Washington Post reports that private insurers, drug companies and their representatives spent more than $126 million on lobbying in the first quarter of this year.
And they've hired more than 350 former government staff members and retired members of Congress to do all that lobbying work.
Realistically, whose interests would actually prevail if progressives worked to pass whatever bill lobbyists hashed out in the Senate? Probably not ours. AfroNetizen links to a handy diagram showing how many former Congressional staffers from key senate committees are lobbying their old bosses on behalf of the healthcare industry.
Steve Benen of the Washington Monthly wonders why the Democrats are so fixated on a creating a bipartisan healthcare bill in the first place:
What are the chances, my friend asked, that Republicans would accept the importance of "bipartisanship" in shaping the policy? What are the odds that GOP leaders would make a series of concessions to Democrats, and tolerate Republican centrists who were toying with the idea of siding with the minority party?
It reminded me of a conversation I had the other day with a friend of mine about an alternate universe. Imagine, my friend said, there was a Republican president, working with large, obstructionist-proof Republican majorities in the House and Senate. The Republican president's approval rating was about 60%, and he'd just won a popular electoral mandate on a key issue, which Republicans have prioritized literally for generations.
The answer, of course, is that Democrats lack party discipline. If the Republicans were in charge, they'd hash out a plan within their own caucus and apply pressure to bring the dissenters into line. Democratic activists who criticize Landrieu and other wishy washy Dems are just trying to impose some discipline from the bottom up.
In other health reform news, Paul Waldman argues in the Prospect that a public health insurance system is superior because, at the end of the day, private insurance companies want to take our money and deny us care. It's nothing personal, that's just their business model. Private companies have a huge profit incentive to cover as little as possible or to place bureaucratic obstacles in the way of patients to discourage them from taking advantage of the benefits they're nominally entitled to.
Conservatives threaten that a public option will put a government bureaucrat between patients and doctors. That's a lie. In any kind of insurance scheme, some "bureaucrat" has to make a decision about what the plan will cover. In the public insurance system, bureaucrats answer to politicians, who in turn answer to the people that use the system. In a private system the bureaucrats answer to shareholders that demand ever-increasing profits. Arithmetic dictates two basic ways to make more money in the insurance business: Raising premiums or cutting services. Insurance companies could theoretically save money by becoming more efficient but for some reason they still spend much more on administration than Medicare does to provide the same coverage.
Kevin Drum of Mother Jones tackles the insurance industry mythology that people in other countries hate their "government run" health insurance: "France's system, however, is surprisingly American in its basic underpinnings. And while no system comes out tops in every single metric, French healthcare [...] is better than ours on almost all of them and does it for close to half the cost."
Finally, Obama and his chief of staff Rahm Emanuel have been playing good cop/bad cop all week. While Obama has been swearing up and down that he supports a full public plan, Emanuel has been saying that the White House would be willing to cut a deal to create a public plan that only kicks in if there isn't "enough" competition in the private insurance market. It's tough to tell which of them is serious. Is Obama just placating progressives while letting Rahm reassure the insurance companies of the White House's true agenda? Or is it Rahm who's trying to placate the insurance industry? It will be interesting to see how this game plays out.
]]>"The public plan, I think, is an important tool to discipline insurance companies," Obama said during yesterday's White House news conference. "I think there is going to be some healthy debate about the shape that this takes." He outlined three options: Get insurance through your employer, buy insurance on your own, or buy insurance from a marketplace where public and private insurance providers compete for business.
In the Washington Monthly, Steve Benen notes the central irony of the standard insurance industry criticism of Obama's plan:
A public option, critics tell us, would provide a horrible, bureaucratic service for customers, including rationing and long waiting times. But here's the follow-up: if that's true, no one would choose the public option and insurance companies would be just fine for the indefinite future.
Except, of course, insurance companies and their policymaking allies know better. Which is why they're panicking.
As Senate Democrats continued to cast about for an elusive bipartisan compromise on healthcare reform, their colleagues in the House are pushing ahead on their own. House Democrats are holding hearings this week on draft legislation and is written without Republican input. The house bill would require all Americans to have health insurance and put new restrictions on employers as well. The Uptake is covering the hearings live.
By allowing the proliferation of multiple healthcare bills, the Obama administration is deliberately avoiding the mistakes that the Clintons made in 1994, according to Mark Schmitt in the American Prospect. Instead of submitting its own 1300-page bill to Congress, the Obama administration is letting the legislative branch hash out the details while the executive branch hovers above the fray:
The Obama White House has a huge advantage that the Clinton administration didn't: The plan is basically written, and it has a constituency. Everything Clinton spent a year on is done. All the work to build consensus around fundamental features - a regulated insurance market, an individual mandate, and a public plan to provide a competitive benchmark - made up the outlines of every Democratic presidential candidates' proposals. They have been further developed at the think tanks and various "strange bedfellow" coalitions that have been at work in Washington for at least four years. There are some questions about details and cost containment, but all the major alternatives have fallen by the wayside. It's an extraordinary accomplishment, and a real testament to the infrastructure that's been constructed for progressive policy as well as politics.
The big picture approach gives the administration room to shore up key allegiances with powerful interest groups. Last week, many feared the public option was DOA when congressional budget analysts announced that the proposal would cost more than expected. Mike Madden explains in Salon that things were looking grim until Obama struck a deal with Big Pharma to save $80 billion on drugs for seniors:
So the deepest significance of the deal between the government and PhRMA, the drug lobby, may well have been what it meant politically. Yes, the announcement means Medicare patients will no longer have to deal with an odd "doughnut hole" in their drug coverage; before Monday, the government pays for seniors' prescriptions if their annual cost is under $2,700 or more than $6,100, but not if the price is in between. But more important, the news gave the administration a public relations victory - the president just saved the government, and seniors, $80 billion - to kick off a week where Obama plans to play offense, not defense, on healthcare.
Mike Lillis of the Colorado Independent explains why filling the donut hole isn't a big sacrifice for the industry: Drug companies have already profited handsomely from the prescription drug program. Furthermore, Lillis notes, the companies may still come out ahead if seniors begin to buy donut hole drugs that they previously couldn't afford. Even at half price, Big Pharma still does okay.
Finally, Eleanor Bader of RH Reality Check brings us the story of how the Women's Medical Fund helps women who can't afford abortions. The Pennsylvania fund was established in 1985 after state Medicaid cut off abortion funding. The Fund is one of over 100 abortion access funds nationwide providing options for poor women that anti-choicers sought to take away by manipulating healthcare coverage for political ends.
Healthcare reform, priority one on Obama's domestic agenda, is finally getting its moment in the spotlight. Competing healthcare bills are taking shape and a vigorous public debate is underway. Keep checking The Pulse for play-by-play coverage of the most important policy battle in a generation.
]]>In very simple terms, this is a fight between groups with a vested interest in expensive healthcare and everyone else. This week, the American Medical Association warned Obama that a public plan could restrict patient choice. But for millions of Americans, getting a choice between healthcare and no healthcare would represent a 100% increase in their healthcare options. Obama's public plan would also give people the choice of keeping their private health insurance. The public plan is an additional option, not a diminution of options.
The AMA is a powerful interest group, but it doesn't speak for all physicians. Several prominent groups representing doctors and medical students, including the American Association of Family Physicians, co-signed a declaration supporting Obama's push for a public plan this week.
Expect the health insurance lobby to fight the public option tooth and nail, says economist Dean Baker in AlterNet. It's smart business from their perspective. Platitudes about the free market aside, no real capitalist welcomes competition. As Baker points out, a public plan represents competition to health insurance companies. For every dollar Medicare pays to providers, it spends two cents on administration. Whereas private insurers spend about fifteen cents on the dollar in administrative costs. Baker estimates that if a public plan were available, insurance profits would drop by 20-30%, all things being equal.
Former president Bill Clinton invited about 20 progressive bloggers to his Harlem office on Monday for a seminar-style discussion about the work of the Clinton Foundation. Several staff from Media Consortium member organizations were in attendance, including yours truly. Healthcare was a major topic of conversation. Emily Douglas of RH Reality Check, who also attended the meeting, writes:
The former President observed that the country, emerging from a "post-9/11 emotional straitjacket" has become "more communitarian" - and that President Obama has fewer budget issues, and less Republican opposition, to content with when attempting reform. But, most importantly, "everything is worse now" - health care spending has doubled, more are uninsured, and disposable income, adjusted for inflation, is down.
Clinton said that he's optimistic about the prospects for healthcare reform this year, but he encouraged Obama to drive a hard bargain with congressional Republicans. All things considered, the former president said, it would be better to pass healthcare with 60 votes for the sake of the Obama administration's long-term relations with congress. The alternative would be to pass healthcare through budget reconciliation, which would require only 51 votes, but which would incur a lot of ill-will among Republicans. However, Clinton cautioned against writing a weak bill to avoid reconciliation. In Clinton's opinion, if we don't contain healthcare costs by moving to outcomes-based medicine and making our healthcare delivery systems more efficient, the system will be unsustainably expensive.
James Ridgeway of Mother Jones has also been mulling the challenge of writing a bill that's acceptable to enough Republicans to avoid a budget reconciliation fight. Ridgeway fears that sweeping structural reform will take a back seat to political expediency. He fears that by trying to please everyone, Obama could end up pleasing no one:
One disturbing possibility is that health care could become a replay of the credit card legislation. The pattern goes something like this: First, we get a propaganda blitz heralding sweeping changes. But although the final legislation corrects some of the most egregious abuses, it doesn't change the system's underlying flaws. So, for example, insurance companies may be required to cover people with preexisting conditions-a need Obama illustrated vividly in his AMA speech with moving references to his mother's battle with cancer. We might see what the president called "more efficient purchasing of prescription drugs," which presumably means faster approval of generics and giving the government greater power to haggle with Big Pharma over drug costs. We will likely see incentives for health care providers to offer more cost-effective-and, hopefully, better-treatment. These things are not meaningless, and they will provide a modicum of relief to some struggling Americans. But they do virtually nothing to strike at the deeper problems of the for-profit health care system. And they offer only a fraction of the savings that a single-payer system would provide.
If the healthcare debate sounds vague and abstract, that's because it is. There are several competing bills coalescing, but at this point, there's no overall vision for reform. Everything is up for grabs. Never afraid to think big, Sen. Bernie Sanders (I-VT) is circulating a petition for single-payer healthcare, with an assist from Chelsea Green.
Surely the weirdest healthcare story of the week comes from Tracy Clark-Flory of Salon: An anti-choice blogger who claimed to be carrying a non-viable pregnancy to term out of pro-life principle was exposed as a hoaxster when an alert reader identified her "dead baby" as a doll. It's not clear why the 26-year-old social worker perpetrated the hoax. Jessica Valenti of Feministing injects a note of compassion for the perpetrator, "Though as angry as this makes me, I'm with Sadie at Jezebel on this: ‘It's tempting of course to use this as a chance to take an easy bash at anti-choice, and revel in anything that makes them look foolish, but frankly, I'm just sad for this woman.' As am I."
]]>Tiller's murder was terrorism by any reasonable definition of the term. It was a politically-motivated act of conspicuous brutality, designed to suppress abortions through fear. The feds will probably stop short of investigating Tiller's murder as a terrorist attack. That designation would unleash vast federal powers to investigate large swathes of the radical anti-choice movement and hold accountable anyone who gives them the slightest aid and comfort. The feds are simply not prepared for the political fallout that would ensue if, say, Operation Rescue were officially designated as a terrorist organization.
But Tiller's assassination seems to be working as an intimidation tactic. On Tuesday, Dr. Tiller's family announced that his clinic, one of only three facilities of its kind in the country, will close its doors forever. Tracy Clark-Flory writes in Salon that the terrorist got exactly what he wanted:
A lesson in the effectiveness of terrorism: Dr. George Tiller's Kansas clinic is closing permanently, according to his family's lawyers. In a statement Tuesday, the family said: "We are proud of the service and courage shown by our husband and father and know that women's healthcare needs have been met because of his dedication and service." They will continue to honor his memory "through private charitable activities" - in other words, the type of activism that is less likely to get a person killed.
Of course, the intimidation won't stop at a single act. As James Ridgeway notes in Mother Jones, the alleged assassin is inciting further violence from his jail cell:
The fact that the family made clear that it would not be involved "in any other similar clinic" suggests that they are traumatized and fearful-in a word, terrorized. And no wonder, since Roeder, as I detailed yesterday, has issued warnings from his jail cell of further attacks on abortion providers-an act which, coming from just about any other comparable source, would certainly be deemed terrorism, and treated accordingly.
Making explict the link between Tiller's murder and larger political goals, the Associated Press headline calls the closing a "tainted victory" for the larger anti-choice movement.
Professional anti-choicer Ross Douthat sparked controversy in an op/ed for the New York Times, insinuating that Dr. Tiller might still be alive if pro-choicers didn't make such a big deal about protecting late-term abortions. Hilzoy of the Washington Monthly tackles some Douthat's errors, starting with his misleading implication that third trimester abortions are unregulated. Without that premise, Douthat's argument falls apart, since he's arguing in effect that pro-choicers have created a free-for-all in which anyone can get a late term abortion for any reason.
Amanda Marcotte of RH Reality Check does a great job exposing the misogyny behind the anti-choice myth of frivolous late-term abortions. If you think that women are flighty, irrational, fundamentally unserious beings, you expect them to opt out of pregnancy on a whim after months of gestation. The imagined problem of casual late-term abortions reveals what anti-choicers really think of women, that they are lesser beings who need to be controlled by the state. Dr. Tiller's motto was the exact opposite: Trust women.
]]>Political Scientist Scott Lemieux writes for TAPPED that, in light of her distinguished resume and inspiring biography, Sotomayor's confirmation is all but assured:
[...] Obama cited three criteria in choosing Sotomayor: 1) her intellectual capacity (as demonstrated in her sterling academic record, her success as an assistant district attorney, and her distinguished service as a federal judge); 2) her approach to judging based on her opinions, which represent a high level of craftsmanship and attention to detail; and 3) her compelling personal story, rising from poverty in the Bronx to Princeton to being an editor at the Yale Law Journal. This combination of factors will, I think, make her confirmation inevitable.
In the Nation, John Nichols says that the Sotomayor pick "reflects America". Within hours of the announcement of Souter's resignation, conventional wisdom had pegged Sotomayor as the odds-on favorite for the nomination. There were a few bumps along the way, though. Brian Beutler of TPM reports on the anatomy of a preemptive whispering capaign starring anonymous law clerks quoted in the New Republic questioning Sotomayor's intelligence and temperament.
While Sotomayor has a reputation for being a liberal jurist, her record contains few hints about her views on abortion. Attorney and feminist writer Jill Filipovic reviews Sotomayor's record on abortion for RH Reality Check. Sotomayor has only ruled on one major abortion-related case in her time as a judge, Center for Reproductive Law and Policy v. Bush, and as Filipovic says, Sotomayor's conclusion "isn't going to warm the hearts of reproductive rights activists."
But, as Filipovic explains, abortion wasn't the issue at stake in this case. Rather, the question was whether the Bush administration's Global Gag Rule was violating the constitutional rights of American NGOs. The gag rule threatened to revoke their federal funding for working with foreign NGOs that discussed abortion. For various technical reasons, Sotomayor concluded that the rule was constitutional after all. Filipovic continues:
If anything, CRLP v. Bush highlights precisely why Sotomayor should, in a sane world, be an easy confirmation: She sticks to the rule of law, respects precedent and writes thoughtful and reasoned opinions. She was nominated to the federal district court by George H.W. Bush. Her decisions are left-leaning insofar as she generally seeks to protect Constitutional rights by supporting religious freedom and free speech, and she often sides with the plaintiffs in discrimination cases - hardly "activist" material.
Emily Douglas, also of RH Reality Check, notes that the conservatives aren't buying the "common ground" abortion rhetoric the White House has been pushing. Even if the White House has the votes to confirm Sotomayor, and everyone knows it, a Supreme Court nomination battle is a golden fundraising opportunity for the right wing, so expect a lot of sound and fury from that quarter. It makes them feel relevant.
In other reproductive health news, Dana Goldstein discusses a recent literature review by the Guttmacher Institute arguing that coitus interruptus is an under-studied and possibly underappreciated form of birth control. The paper got a lot of discussion because the conventional wisdom is that withdrawal is ineffective. The study cites a figure that couples who use withdrawal perfectly have a 4% yearly chance of getting pregnant vs. 2% for couples who use condoms perfectly. However, the study doesn't compare what percentage of couples who try to use withdrawal actually achieve perfect use compared to couples attempting to use condoms or other methods. Sex educators' main concern, apart from the fact that withdrawal doesn't protect against STDs, is that an unusually large number of people attempting it fail to achieve the desired results. If you only count the efficacy for successes, you get a distorted picture. In a follow-up post, Goldstein asks whether doctors might be biased against non-hormonal birth control.
It's not just big businesses like GM that shoulder the burden of expensive private health insurance. In a special issue of the Washington Monthly, Jonathan Gruber argues that a universal healthcare program could increase American competitiveness by giving people the security they need to start their own businesses without having to worry about whether they can afford health insurance for themselves or their workers.
]]>Last week, The New York Times proclaimed that Obama scored a "political coup" just by getting the industry groups and SEIU to the table. Maybe so, but writers featured in last week's Pulse remained skeptical that the industry would make good on its unenforceable cost-cutting promises. Skepticism was the healthy response.
Three days after the promise, industry groups started accusing Obama of overstating their commitment. Health Czar Nancy Ann DeParle confirmed that the president garbled the stats slightly when he said that the groups had pledged to cut the rate of growth in healthcare costs by 1.5 percentage points per year. However, the outcry over the slip-up is revealing. The groups are now scrambling to reassure their members that they never promised to reduce costs by any specific amount in any given year. Of course they didn't. In order to keep that promise, they'd have to act right away-which they clearly have no intention of doing.
So, it comes as little surprise when Steve Benen of the Washington Monthly reports that Blue Cross/Blue Shield is crafting a PR campaign to trash the whole idea of a public plan, a key element of Obama's healthcare reform agenda. One of the industry groups that signed off on the aforementioned $2 trillion pledge was America's Health Insurance Plans (AHIP). Several members of AHIP's board of directors work for Blue Cross or Blue Shield.
In The American Prospect, Paul Waldman notes that the same coalition of Republicans and big business that opposed President Clinton's healthcare reforms 15 years ago are gearing up for a rematch. These folks, who might as well be called Americans for the status quo are trying to own the word "reform" under the tutelage of GOP message master Frank Luntz, according to Waldman.
Some people oppose healthcare reform because they fear a tax increase. That's not a foregone conclusion, but healthcare is so expensive that reform could be a bargain even if we had to raise taxes to pay for it. In AlterNet, Dean Baker asks why his fellow economists are so complacent about the status quo where healthcare is twice as expensive and not quite as beneficial as it is in other developed countries. Baker argues that the extra costs are tantamount to a huge tax on the entire economy:
The excess health care spending comes to more than $1.2 trillion a year or the equivalent of more than $16,000 for a family of four. Paying too much for health care has the same economic impact as a health care tax. In effect, we have a health care waste tax that is about 10 percent larger than the projected federal revenue from the personal and corporate income tax combined. In short, this is real money.
This is a tax that Americans pay without realizing it. Money that could be going towards pay raises is going to support ever-increasing insurance premiums, for those who are lucky enough to have health coverage through their jobs. It's a tax that employers have to take into account when they decide whether to build a plant in the United States, or across the border in Canada where the government takes care of health insurance.
And last but not least, while you can't get blood from a stone, you can get plasma from an overextended American consumer. Credit Solutions of America, a credit counselling service advised clients to sell their blood plasma to make ends meet, Moe Tkacik reports in Talking Points Memo. That's especially ironic when you consider that medical bills cause over half of personal bankruptcies, according to a 2005 survey by Elizabeth Warren, a Harvard professor who went on to become Obama's chief financial industry bailout overseer.
]]>This week, the White House teamed up with healthcare industry giants for a two-day PR blitz on health reform. A coalition of industry leaders sent a letter to president Obama over the weekend, pledging to help contain healthcare costs. The signatories include PhRMA (drug makers), Advamed (device manufacturers), the AMA (doctors), the AHA (hospitals), AHIP (health insurance), and SEIU’s Health Care project. The corporate signatories are the very same interest groups that have fought U.S. healthcare reform for generations. AHIP, America’s Health Insurance Plans, helped torpedo the Clinton plan in the 1990s with the infamous “Harry and Louise” TV spots.
Progressive healthcare writers are divided as to whether Obama’s rapprochement is a good sign. One school of thought is that the interest groups have finally seen the writing on the wall. Arguably, the industry realizes that some kind of healthcare reform is inevitable and they hope to get the best possible deal by cooperating. Another perspective, not necessarily incompatible with the first, is that this kind of “cooperation” will ultimately co-opt Obama’s reform program.
Mike Madden summarizes the main thrust of the industry charm offensive in Salon:
Some of the organizations that have fought hardest against changing the system in the past are — for now, at least — saying they’ll work for it this time around. To demonstrate how serious they are, they joined Obama Monday to say they’ll work voluntarily to cut the growth rate of healthcare costs by 1.5 percent each year for the next decade. Unchecked, costs would increase by more than 6 percent a year, so the administration says the country — private employers and the government combined — would save $2 trillion from the effort. An average family of four could save $2,500 a year within five years.
The letter itself offers few details as to how the industries will actually go about saving money. More to the point, there’s nothing forcing these groups to follow through on anything they’ve pledged to do.
Still, if you parse the platitudes, the industry is diverging slightly from Republican anti-reform rhetoric. The GOP has been crusading against comparative effectiveness research (CER) ever since the stimulus bill set aside a billion dollars to fund it. CER is just research to discover which treatments give the best outcomes for the money, but the GOP would have us believe that it’s a stalking horse for rationing. Whereas, the industry coalition’s letter talks about cutting costs by “aligning quality and efficiency incentives” and “adherence to evidence-based best practices” – basically, big words for “studying the evidence” and “trimming the fat” – the core of the CER agenda.
Steve Benen of the Washington Monthly thinks the new conciliatory posture is encouraging evidence that the Republican opposition to reform is in such disarray that the industry is prepared to make nice with the Obama administration:
…I’m encouraged anyway, in part because it suggests the right’s opposition is completely falling apart, as the reform push picks up needed momentum, and in part because it brings these heavy-hitters into the tent, where they’re far less likely to start launching vicious attacks.
Andy Stern, president of the Service Employees International Union (SEIU), also secured a seat at the table. As Ezra Klein suggests in the American Prospect, the fact that Stern is in the room is a testament to his skill as a coalition builder. SEIU represents millions of Americans, including many healthcare workers. Stern told Klein that the group had set itself a June 1 deadline to put forward concrete proposals that can be assigned dollar figures. The Finance Committee’s first bill drops in June, so the committee will have to work fast if they want to see their suggestions incorporated.
Josh Holland of AlterNet says we should beware of the healthcare execs’ blandishments. Holland notes that they promise to reduce the growth in costs to “only” 4.7% a year:
There’s no news here — “voluntary” codes of conduct, self-regulation and industry-driven initiatives for the private sector to address complex policy issues have long been a standard tactic for heading off real regulation, real accountability measures, systemic reforms.
In Mother Jones, James Ridgeway agrees that the initiative is a mere publicity stunt, seeing as there’s nothing but the threat of public embarrassment to hold the group to any of its pledges.
“Public embarrassment”? From Big Pharma and the health insurance companies–-two of the most shameless industries in the history of corporate capitalism? In any case, even if the $2 trillion reduction is achieved, it clearly won’t come out of industry profits.
Even if we do get healthcare reform this year, what would the end product look like? In the Nation, Trudy Lieberman, director of the health and medicine reporting program at CUNY, takes a hard look at the messages the president has sent so far. She foresees a package that’s congenial to Obama’s corporate allies:
It’s becoming clearer that reform will include some or all of these options: requiring everyone to carry health insurance (an individual mandate à la Massachusetts); subsidizing a portion of the 85 percent of the uninsured who can’t afford to buy a policy; taxing some of the health benefits workers now get from employers to pay for insurance for the uninsured; letting people keep the coverage they have even though it’s likely to cover less as time goes on; shoving more people onto Medicaid; and trying to get insurers to insure sick people. There may or may not be a public insurance option–maybe like Medicare, or maybe not–that would compete with private insurers and theoretically reduce the cost of insurance.
All this conciliation is not cost-free. In the following video, economist Richard Wolff tells The Real News that Obama risks a grassroots backlash if he caters to corporate interests on healthcare. People want better healthcare, not just a choice of bad options. If the result of “reform” is an inferior public plan alongside the private system, employers will have an incentive to push their workers onto the public plan, and we’ll all be worse off.
The president may not support a true national healthcare plan, but don’t count the friends of single payer out yet. Doctors and other advocates for single-payer healthcare crashed a Senate Finance Committee meeting this week to protest their exclusion from a series of roundtable discussions on healthcare policy, as Laura Flanders reports on GRITtv. “Every lobbyist in America is at the table, when are the American people going to be heard?” shouted one activist. A handful of activists were arrested when they refused to come to order.
]]>So far, swine flu hasn’t developed into the deadly global pandemic that many feared. Was it all media hype, as Cervantes argues for AlterNet? Or did all that quarantining and hand-washing actually help? While we’ll never know what might have been, perhaps we should consider the relatively mild swine flu as a cheap lesson–a dry run, if you will.
The swine flu scare underscores the need for strong public health infrastructure, writes Amitabh Pal in the Progressive:
When the flu began taking its toll, Mexico didn’t have a single facility to test for the virus, and so samples had to be sent to the United States and Canada. Mexican health officials were slow to pick up on the initial outbreak of the disease, and, by the government’s own admission, still have not been able to reach out to the public in an effective manner.
Pal argues that Mexico’s healthcare system is in disarray in part because of international pressure from to decrease the government’s role in healthcare in accordance with the prevailing free-market ideology.
Laura Carlsen of New America Media also worries about the health fallout from globalization, arguing that NAFTA helped swine flue. According to Carlsen, globalization created a perfect storm for the development and spread of an epidemic flu in Mexico–a rapid shift to factory farming, the breakdown of public health infrastructure, and accelerated flow of people and goods across the border.
Americans shouldn’t be smug about our own state of readiness. In the American Prospect, Harold Pollack takes “moderate” senators to to task for pinching pennies on public health:
Throughout, our key opponents were moderate senators who had no problem supporting the usual giveaways to powerful constituencies, yet who balked at spending small amounts on useful but unsexy measures to prevent sexually transmitted infections, promote family planning, help people quit smoking, finance substance-abuse treatment, and, yes, prepare to fight pandemic flu. In a $2.4 trillion health-care economy dominated by personal medical services, it once again proved nearly impossible to channel public investments into population-level activities that are often much more cost-effective.
Just because this particular epidemic didn’t spread, that doesn’t mean that a deadly influenza virus couldn’t emerge in the future. In fact it’s a virtual certainty that such outbreaks will continue to happen, as they have at unpredictable intervals throughout human history.
Vermont senator Bernie Sanders (I) argues that the new Democratic super-majority in the Senate, created by Arlen Specter’s party switch, is a golden opportunity to achieve national healthcare. “Clearly the United States needs to join the rest of the industrialized world with a real national healthcare program that guarantees comprehensive healthcare to every man, woman and child–and we save money as we do that,” Sanders told Ed Schultz. Watch the clip, via Chelsea Green:
Finally, Stephanie Mencimer of Mother Jones raises questions about the safety of NuvaRing, a novel contraceptive technology from Schering Plough that promises the benefits of hormonal birth control without the hassle of taking a pill. However, more than 100 lawsuits blame Nuva for serious side effects, including deadly blood clots:
Making birth control easier is, of course, a good thing. But for years there have been serious safety questions about the “third generation” hormones used in NuvaRing and several other contraceptives on the market—questions that NuvaRing’s labeling sidesteps by saying that it is “unknown” how the device compares to other hormonal birth control.
It’s been an eventful week in healthcare. We failed to beef up public health earlier this year because some legislators lacked a sense of urgency, but prevention seems a lot more pressing in light of our brush with swine flu. Before Specter’s defection, it seemed like healthcare might never pass the Senate, but now there’s at least a hope of breaking a filibuster if the Democrats can hammer out their internal differences. We’ve got a long way to go on public health and healthcare reform, but we passed some important milestones this week.
]]>As Dana Goldstein reports in TAPPED:
Sebelius' confirmation has been delayed as her home state Republican legislature has forced her to deal with a series of abortion-related bills. Her latest pro-choice veto inspired a Republican backer of her nomination, Sen. Sam Brownback, to hint that he may change his mind and vote "no" on her appointment.
Of course, it was all an act, though some conservative activists suspect that swine flu was just a ruse to guilt-trip Republicans into confirming Sebelius. Seriously.
Wendy Wright, of the conservative group Concerned Women for America, told the Washington Independent that "If there's even a hint that [Department of Homeland Security] is manipulating the health situation to push a political appointee through, well, it almost defies imagination that they'd be willing to that."
Some costs of the Republican war on science became evident this week as the U.S. declared an state of emergency over swine flu. John Nichols of the Nation recalls that the Republicans cut $420 million for pandemic preparedness from the stimulus bill on the grounds that public health spending had nothing to do with economic recovery:
Senate Republicans led by Maine Senator Susan Collins attacked the public-health spending and successfully eliminated it from the Senate version of the stimulus. Collins complained at the time to CNN that: "There's funding to help improve our preparedness for a pandemic flu. There is funding to help improve cyber security. What does that have to do with an economic stimulus package?"
Collins read the stimulus legislation, and the threat, wrong. So, too, did Senate Democratic leaders, who compromised with her wrongheaded demands in order to secure support for a watered-down stimulus plan.
If you've been watching the stock market lately, or talked to a travel agent, you know exactly what pandemic preparedness has to do with the economy. Airline and manufacturing stocks were especially hard-hit by flu fears this week, not to mention pork bellies.
Sen. Arlen Specter of Pennsylvania announced yesterday that he was becoming a Democrat. As Jonathan Stein and Nick Bauman explain in Mother Jones, the far-right caused Specter's defection. The longtime Pennsylvania senator broke with the Republicans not on principle, but because preliminary polling data showed that he couldn't win a primary challenge by far-right Republican, Pat Toomey.
In theory, the Democrats now have a filibuster-proof 60-seat majority, but not until the winner of the Minnesota senate race, Al Franken, is seated. As Brian Beutler notes at TPMDC, there are enough divisions in the Democratic caucus to reduce a super-majority to mere majority on many important votes. Specter has a reputation as a moderate Republican and few expect the party switch to radically affect his votes. However, Senate Majority Leader Harry Reid now has leverage over Specter, because Reid now controls Specter's committee assignments.
Finally, in TAPPED, Ezra Klein argues that the Democrats are wise to continue asserting their right to pass healthcare through budget reconciliation-and therefore with a simple majority-if no healthcare bill is passed before the October 15. Let's call it the Don't Drop Dead Date. Hopefully, the prospect of reconciliation will spur Republicans to cooperate on healthcare reform, because the alternative is being left out all together.
]]>As Steve Benen of the Washington Monthly notes, timetables matter, politically. Furthermore, as Ezra Klein explains at TAPPED, a pact between Baucus and Kennedy is a big step forward: these two key committee chairs now have a plan to avoid the turf wars that stymied reform in 1994. This time, the two Senators have pledged to work together to write similar bills, instead having their respective committees produce very different legislation, like they did last time.
Experts agree that successful healthcare reform must work on two fronts: Paying for care while simultaneously keeping the cost of care in check. Elsewhere on TAPPED, Klein discusses why American healthcare costs so much compared to other countries. He points to a study by the famous McKinsey consulting company showing that the extra cost is not because we're sicker, nor because we consume more healthcare:
The answer, in the end, is that we're getting a bad deal. You know how when you go shopping you look for sales? America sort of does the opposite of that. We pay more for each unit of care, more for health system operations, and more for health system administration. McKinsey found that "input costs-including doctors' and nurses' salaries, drugs, devices, and other medical supplies, and the profits of private participants in the system-explain the largest portion of high additional spending, accounting for $281 billion of spending above US [Estimated Spending According to Wealth]. Inefficiencies and complexity in the system's operational processes and structure account for the second largest spend above ESAW of $147 billion. Finally, administration, regulation, and intermediation of the system cost another $98 billion in additional spending."
Marcia Greenberger of the National Women's Law Center outlines what's at stake for women in the healthcare reform debate at RH Reality Check. She writes:
In our broken health care system, nearly one in five women is uninsured. Even for those who have health insurance, women are more likely than men to have health coverage that has too many gaps, including large co-pays, life-time limits, and exclusions or limitations in needed services like mental health care or prescription drugs. Since women, on average, have lower incomes than men, they are at particular risk of financial barriers to care; one in four women says that she is unable to pay her medical bills, and women are more likely than men to delay or go without needed health care because of cost.
Speaking of raw deals, Martha Rosenberg describes how big pharma distorts science to get approval for yet more drugs of questionable safety and efficacy in AlterNet. Rosenberg notes that the Justice Department is cracking down on AstraZeneca and Forest Laboratories for hiding key scientific evidence that called the safety of their products into question.
What pharmaceutical companies aren't dumping onto the market, they're dumping into the water supply, according Lauren Kirchner of Air America Radio: 271 million pounds of drugs, from antibiotics to tranquilizers, have been legally dumped into the U.S. water supply over the past 20 years.
The Vatican keeps nixing Barack Obama's picks for ambassador to Vatican City for being pro-choice, according to the American Forum. Carolyn Kennedy was a front-runner until she was disqualified for being personally pro-choice. I would note that there's something of a Catch-22 here. Minor ambassadorships are, after all, rewards for big time political backers. The only reason anyone is in line for this job is because they helped the pro-choice Barack Obama get elected. This could take a while.
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