Tilting at windmills.

The essentials

As health care reform gets down to the wire this fall, I hope readers will remember these main ways to reduce costs while improving care:

* Give the government the power to negotiate prices with the drug companies. This could save Medicare a ton of money--the Veterans Administration cut its drug bill in half when given the right to negotiate. The House bill makes this reform, but the Los Angeles Times reported that the White House has made a deal with the drug companies' chief lobbyist, Billy Tauzin, not to support the reform. According to the New York Times, the White House at first confirmed the deal, but then denied it--sort of. The potential savings of having the government bargain for drug prices are so great that Obama should leave no doubt. He should repudiate the deal. Better to betray Billy Tauzin than to betray the American people.

* Abolish or radically reduce drug advertising. Remember, it was outlawed until relatively recently--and for good reason. Not only does it often obscure dangerous side effects, it encourages people to bug doctors to prescribe drugs either that they don't need or that are the most expensive of the possible therapies. Representative Jerrold Nadler has offered a bill to take away the tax exemption that is now given to drug advertising. And the FDA is proposing regulations that would require drug ads to disclose side effects in an obvious way instead of rapidly reciting them sotto voce over sunny pictures of people happily enjoying the benefits of the drug.

* Encourage doctors to work in Mayo-and Cleveland-type clinics that have doctors working together, and that pay salaries instead of fees for service. Massachusetts, the only state with experience offering near-universal health care, is now being urged by a high-level commission to abolish fee for service, which encourages physicians to recommend services that pay the highest fee, rather than those that are the most needed by the patient.

* Don't allow physicians to administer expensive tests in their own offices when that encourages them to order more tests than they ordinarily would. To understand why, consider this anecdote reported by the Washington Post's Shankar Vedantam: "In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months they were ordering scans at a rate that had climbed more than 700 percent. The increase came in the months after the urologists bought their own CT scanner."

A saboteur in pundit's clothing

Even though the Washington Post reports that Max Baucus "has emerged as a leading recipient of Senate campaign contributions from the hospitals, insurers and other medical interest groups hoping to shape the [health care] legislation to their advantage," MSNBC's Lawrence O'Donnell ardently defends him. My own fear is that the "business-friendly" Baucus will compromise away any chance at meaningful health care reform.

To the best of my knowledge, MSNBC has never disclosed that O'Donnell, who often appears on the network, was as a Senate staffer in 1993 and 1994 one of the more notorious saboteurs of Hillary Clinton's health reform efforts.

It's the redeployments, stupid

Soldier suicide has become such a problem that we now have an Army Suicide Prevention Task Force. The Washington Post recently published an editorial deploring the problem, and proclaiming, "Deterrents should be encouraged." The editorial concluded by saying, "What factors contributed to such an increase remain to be seen." The editorial writer should have pondered his previous sentence a little bit longer. It says, "In the Army alone, the number of suicides has doubled since 2004." To me, the implication is clear: 2004 was when soldiers in Iraq began to realize that they were going to have to return. Since then the suicide rate has steadily increased, as they have to go back again and again, experiencing the stress caused by prolonged exposure to danger.

Yet all the Army can offer them is the hope, recently voiced by Secretary of Defense Robert Gates, that "we can begin moving toward a year at home, 15 months' to 18 months' dwell time." According to the Washington Post's Walter Pincus, "The goal, Gates said, is one to two years at a time at home, 'as quickly as possible.'" Gates added, "I mean, the truth of the matter is there's about a third of the Army that's never deployed at all. But that's just the way it is, frankly, given the different specialized capabilities of the different units." I don't accept that it has to be that way. We can get out of Iraq now. Greg Jaffe, one of the best reporters of the war at the Post, recently wrote that "the Iraqis don't really need or want American forces around anymore."

Avoiding collateral damage 

The plan was for the CIA to train small teams that could hunt, kill, or otherwise thwart al-Qaeda operatives. It was canceled in dune by Leon Panetta, who was upset that he and the Congress hadn't been told about it. I'm sorry. I thought it was a very good idea. It's better to be precise in our targets, killing only al-Qaeda, and not the innocent people who all too often suffer the "collateral damage" of drone and other air attacks--not to mention that precise targeting could eliminate the need to send a large army after al-Qaeda. And if it is bad not to tell Panetta and Congress, it was even worse for the CIA bureaucrats to have done so little in six years to implement such a needed program. One of the agency's greatest problems, next only to its longtime foot dragging on language learning, has been its extreme reluctance to take on risky missions.

In his spy novels, the Post columnist David Ignatius is brutally frank about the CIA's failings. For example, his most recent novel, The Increment, describes an Iranian nuclear scientist who is willing to spill the beans, but the CIA doesn't have the ability to extricate him. It doesn't have the personnel capable of that kind of mission. Instead, they have to rely on a British team to get the scientist out.

Roberts's Rules

I'm beginning to really dislike Chief Justice John Roberts. He seemed charming and sometimes brilliant during his confirmation hearings. But his decisions have revealed a troubling lack of humanity. Consider his recent opinion rejecting a right to DNA tests that could prove the innocence of prison inmates. We now have enough experience with DNA testing to know that it has proved 241 convicts were not guilty of the crimes for which they were imprisoned.

Unfortunately, three states do not require DNA testing at all, and others limit its use. That's why we needed action by the Supreme Court making the requirement mandatory throughout the country.

In the case before the court, the plaintiff, William G. Osborne, even offered to have the test done at his own expense. But Roberts said no, concluding that it was up to the state to change its own laws, putting states' rights ahead of human rights and displaying a cold, cold heart.

Limbaugh's lunatics and those with less excuse

The health care fight has brought out the brainless, not only in the general public but in the media as well. Limbaugh's lunatics have been shouting down members of Congress who have been attempting to discuss health care in town meetings in their districts. We can forgive some of them--innocents who have been misled by lies from the insurance industry, Limbaugh, and other Republicans.

But the media should know better. Newspapers and networks have been citing as authoritative a study by the Lewin Group that said the health care program's public option would cause zoo million out of 160 million to be forced from private insurance into the public plan. None of these reports mentioned that the Lewin Group is funded by an insurance company, United Health Group--that is, until the Congressional Budget Office said the Lewin Group study was wrong. And then at last Jennifer Haberkorn and S. A. Miller of the Washington Times reported that the Lewin Group was "owned by an insurance company."

Smart but wrong, part 1

The Washington Post's Howard Kurtz is a smart fellow, but he writes a column complaining that Obama's duly press conference about health care wasn't news, and questioning whether the networks should have run it.

Obama was answering reporters' questions that represented questions on the minds of the public about an important issue, trying to explain his health care program to the American people. Some of Franklin Roosevelt's greatest fireside chats were not designed to make news, but to explain. Were the networks wrong to run them? I don't think so.

Smart but wrong, part 2

Chris Matthews and Chuck Todd are also smart--super-smart--about politics, but maybe not so swift about substance. After the conference, Matthews complained that Obama hadn't done a good job of explaining. But I think Matthews just didn't do a good job of listening. He implied that he wouldn't be able to get the medical tests he needed, when all Obama had said was that we shouldn't pay for having the same tests repeated by different doctors. Todd later said Obama had "promised" not to raise your taxes if you made less than a million dollars. I can't find any record of such a promise by Obama at any time.

How will it play in Vail?

Did you notice how quickly Nancy Pelosi retreated from a proposal to finance health care reform by raising couples' taxes on incomes over $500,000, and instead embraced $1 million as the income at which the tax would kick in? Could that have anything to do with the fact that she represents disproportionately rich San Francisco? Whatever Pelosi's motivation may be, Democratic members from other wealthy districts have also repudiated the $500,000 threshold for couples as well as the $350,000 one for individuals. They include Gerry Connolly, from the richest district in the United States, which happens to be in the lobbyist and government contractor haven of northern Virginia, and Colorado's Jared Polis, who represents Boulder, Vail, and what the Wall Street Journal's Jonathan Weisman describes as "the tonier suburbs of Denver."

To what extent have the Democrats become the new party of the rich? The answer, I think, will prove to be key to the success of both real health care reform and deficit reduction. Neither is going to happen without our more affluent citizens paying more taxes than they do now.

Politicians from wealthy districts are not the only obstacles. The bigtime journalists who work for major newspapers and networks now have, as I've been pointing out a lot recently, attained incomes that alone or combined with their spouses' exceed the $250,000 threshold Obama established as the point where any of his tax increases would begin. Few of the reports we've been getting from the large newspapers and networks support tax increases that would affect them. For example, Jackie Calmes of the New York Times recently wrote an article headlined, "Obama's pledge to tax only the rich can't pay for everything, analysts say," in which she implicitly accepts the argument that a top tax rate of 45 percent would not be acceptable.

But our greatest prosperity has come in periods when the top tax rates have been 70 percent or more. In 1948, we had a combination of low unemployment, low inflation, and low military budgets with a top tax rate of 82 percent. Unemployment that year actually fell beneath 4 percent, as indeed it has four other times since World War II. In each case the tax rate was 70 percent or higher. The last time unemployment fell as low as 4 percent was under Bill Clinton, when tax rates were considerably higher than they are now, and the deficit was plummeting instead of soaring.

Only bilingual applicants need apply

Good news for all of you who can't stand bureaucratese. A Senate committee has passed a bill that requires federal agencies, in the words of the Washington Post's Joe Davidson, "to write their job announcements in plain language rather than the dense government jargon so common in this town." The Obama administration's Office of Personnel Management has already been trying to clarify job announcements. This reform is badly needed. Qualified potential applicants have been prevented from learning about suitable job openings because the nature of the job has been so obscured by government gobbledegook, either because the civil servants who write the announcements have been brainwashed by reading too many memorandums, or because the civil servant wants to hide the job from outsiders so it can be given to a pal.

But I didn't guess the part about the kidney-smuggling rabbis

Several years ago, I tried to guess what headlines would appear in newspapers fifty or a hundred years from now. I may have been overly optimistic that newspapers would exist then. But anyway, here's one of the headlines I came up with: "Corruption alleged in New Jersey." Of course, I can't resist seizing the moment to recognize my prescience. But more seriously, how could a culture of corruption become so thoroughly entrenched in New Jersey? The same is also true of several other states: Louisiana, Illinois, West Virginia. I hope someone will write a book exploring how states that seem so different could be so similar in the dedication of public officials to lining their pockets illicitly.

Sick of credit swaps? You'll love these natural gas futures!

Many people have been outraged to discover Citigroup's plans to give a bonus of $100 million to one man: Andrew J. Hall. To those who are indignant that Citigroup is using part of the $45 billion bailout we gave it to pay such a large bonus, Citigroup replies that Hall has netted the company about $2 billion in the last five years.

I am disturbed less by the amount of the bonus than by how Hall made the $2 billion. He was "trading" in the energy market. He may well have played a role in last year's horrific run-up in gas prices, and in the continuing and unsettling price swings in the energy markets. Even more disturbing--much more disturbing--is that the bank was trading in energy futures, speculating on whether the price would go up or down. Isn't that the very kind of risky practice that led to last year's financial meltdown? Is that kind of trading ever a proper role for a bank?

It's the other guy

When Nationwide Insurance asked a sample of 1,503 drivers, "Have you ever talked on your cell phone while driving?" 81.3 percent answered yes. When the researchers asked, "Do you consider yourself to be a safe driver?" 98 percent answered yes.

Yet when they were given a list of distracting activities, and asked, "Which of the following do you feel is the MOST dangerous distraction for people while driving?" by far the greater number--48 percent, as against 18 percent for the next most distracting--chose "Using technology like a cell phone or e-mail or electronic device."

In other words, using a cell phone while driving is a terrible idea--unless I'm doing it.

OMG!!!! need pickup @ hospital r u free?

Another recent New York Times story tells of a similar study done by Virginia Tech of the danger of texting while driving heavy vehicles or trucks. The Tech study found the risk of accidents increased twenty-three times when the driver was texting. Fox News displayed its dedication to accuracy by reporting on its news ticker that the increase was 23 percent.

The Clinton tapes

After devoting two years to playing a crucial role in establishing the identity of the Washington Monthly, Taylor Branch left in August of 1972 to go to Austin, Texas. There he joined a young couple from Arkansas, Bill and Hillary Clinton, on one of the more quixotic endeavors of the era--trying to persuade conservative Texans to vote for the very liberal George McGovern.

Although that effort met its predictable fate in November, the three had become friends in the meantime. Then they went their separate ways; the Clintons returned to Arkansas, where their political efforts would meet with greater success, and Branch came back to Washington, where he became the Washington editor of Harper's.

They got together again in December 1992, twenty years later, after Branch had published Parting the Waters, the first volume of his landmark biography of Martin Luther King dr., and Bill Clinton had been elected president of the United States. The old friendship quickly resumed, now reinforced by mutual self-interest--Branch's in gaining access to a president, and Clinton's in the credibility he could gain from Taylor's reputation as a journalist and historian. By January 1993, Taylor was helping to write Clinton's first inaugural address. Soon, Bill was seeking Taylor's advice on how to preserve the history of his administration. They came up with the idea of taping informal interviews Taylor would conduct with the president. And they stuck to the plan, averaging more than eight sessions a year throughout the Clinton presidency.

The result is Branch's new book, The Clinton Tapes: Wrestling History With the President. It is totally fascinating, taking you not only inside the White House, but inside Bill Clinton's mind at one critical moment after another. Taylor proves a sympathetic friend, on the whole admiring of Clinton and his presidency. But he sees Clinton's tragic flaw: self-pity.

Of the Lewinsky affair, Clinton says, "I think I just cracked." Taylor explains: "He felt sorry for himself. When this thing started with Lewinsky in 1995, he had gone through a lot of people dying, his mother, Vince Foster, Rabin--plus the mean-spirited investigations of him and Hillary and everybody else. Oh, and they ran over him with the 'Contract with America,' and took the Congress. He just cracked. He said he could've done worse. He could've blown something up."

Only Bill Clinton could conclude that we should be grateful that he didn't do something worse. Still, if any president is ever entitled to self-pity, Clinton is that man. The Whitewater scandal, unforgivably hyped by the New York Times, turned out to be a total nonstarter. Even the obsessive Ken Starr could not find a single indictable offense involving Whitewater of which Clinton was guilty.

Branch concludes, "The great sadness for me is that [Clinton] had come so close to proving all the scandals baseless. Now Lewinsky alone vindicated the cynicism." He reproaches Clinton, "You let them off just when their accounting was finally due."

Clinton's effort to seduce Branch with flattery and kindness and Taylor's effort to resist provide an intriguing subplot. One has to suspect flattery as a motive for at least several of the many times that Clinton solicited Taylor's counsel, but there were definitely more than a few times when his interest in the advice was, like his kindness, sincere. (I can remember seeking Taylor's opinion when he was only twenty-two years old.) In one case, Taylor's advice may have affected history. On the issue of whether to send troops to Haiti to reinstate Aristide, Clinton's advisers were sharply divided, with both Hillary and Colin Powell strongly against. Taylor may well have provided the tipping point with his passionate advocacy of Aristide's cause.

Charles Peters is the founding editor of the Washington Monthly.