I hope you'll follow over with it.

Okay, so that’s not actually my weekend question, though that song is stuck in my head. Here’s the real one: Can you imagine any realistic scenario under which union density in this country stops declining and starts substantially improving? How would it go?

1) Your organizers should’ve gotten Atul Gawande instead of me. He’s better at this sort of thing.

2) The politics of health-care reform are almost 100 percent about insurers. The success of health-care reform is almost 100 percent about doctors.

3) Attitudes toward doctors range from terrified to awed. Insurers are afraid of them because if doctors begin saying insurers are denying necessary treatments, the backlash, as insurers found in the 1990s, can be tremendous. Same goes for governments. Patients are in awe of them, because they are sick and scared and desperate for the help of anyone who seems to know how to make them better.

4) For that reason, cost control theories that rely on the patient to become more sensitive to costs or the insurers to become more aggressive on costs will fail. The only thing that will work is giving doctors the information and incentives that allow them to practice medicine in a way that controls costs.

5) In the future, either doctors will make less money than they are expecting to make now or there will be fewer of them than we project there will be now (perhaps because there will be more nurse practitioners and MinuteClinics). Politicians don’t like to say this clearly, but it’s true. It has to be true. If it isn’t true, America becomes functionally insolvent and ends up a “Mad Max”-esque dystopia . . . where doctors either make less money than they are expecting to make now or there are fewer of them than we project there to be now.

6) This means one or more of the following things will happen: 1) Doctors will be paid on outcomes, with the curve constructed such that most doctors are making less but the best doctors are making more; 2) doctors will not be the only ones doing doctorlike things; 3) some disruptive innovation, such as IBM’s Watson, will have made various classes of doctors less necessary; 4) we’ll have moved to an all-payer or single-payer system where we’ve cut doctor payments dramatically; 5) more people are flying their jet packs to India for surgeries; 6) we’ll have dramatically cut health-care subsidies such that fewer people are able to afford health care; 7) something I haven’t thought of.

7) We will try No. 1 first, because it’s better to cut “unnecessary procedures” than doctor pay. We will try No. 7 eventually. I don’t think No. 5 is very likely.

8) For what it’s worth, I am sorry about all this. I’m a journalist. Things used to be better for us, too.

9) It won’t be all bad. Patient outcomes will be better than they are now. Mistakes will be rarer. We’ll have a much clearer idea of what works and what doesn’t. Some form of serious medical-malpractice reform will become law. There will be less paperwork.

10) All this is to say, the endgame for the health-care system is that it spends a lot less than we currently project and works a lot better than it currently does. That’ll be tough for the people caught up in the “spends less.” It’ll be great for the people who are part of the “works better.”

Lew fires back over at the White House blog, noting that “these Treasury bonds are backed by the full faith and credit of the U.S. government in the same way that all other U.S. Treasury bonds are, making them anything but ‘worthless IOUs’ as Krauthammer suggests. The government has just as much obligation to pay back the bonds in the Social Security trust fund as we do to any other bondholders.

I’m actually pretty sympathetic to arguments against trust fund accounting, because I a) think the trust funds confuse people, and b) think that they cramp our options for funding Social Security. At the end of the day, there is one federal government. It raises a certain amount of money, engages in a certain amount of spending, and a dollar it uses for one purpose is a dollar that it cannot use for another purpose. When I talk about Social Security and Medicare, I often get e-mails from liberals saying these programs are self-financed and they don’t have any relationship to the deficit. That’s true in the sense that they are not increasing deficits now, but it’s untrue in the sense that they are projected to vastly increase deficits later. When their revenues stop meeting their expenses, in other words, they will begin increasing the deficit. They are not separate in any serious way.

That said, it’s important to take Lew’s point about Treasury securities seriously. Treasury securities are considered among the single safest investments on Earth. It’s not overstating matters to argue that much of the modern financial system rests upon the confidence investors have in them. When you hear that investors are making a “flight to safety,” it means they’re buying Treasury securities. The same Treasury securities that the Social Security system purchases. If the government defaults on those bonds, the economy will fly into a tailspin.

Krauthammer knows this well. “You can’t not pass it,” he said of an increase in the debt ceiling. “It is catastrophic.” What would be catastrophic in that scenario is the Treasury failing to pay back holders of its securities. We won’t do that. We can’t do that. And that’s true for the bonds that Social Security holds as well as the bonds that investors hold. They are not worth less when the government buys them than when private investors buy them. And, incidentally, Treasury yields are very low right now, suggesting that investors think the government overwhelmingly likely to make good on its IOUs.

Now, that judgment is really saying that the market is confident that we’ll eventually make the decisions needed to bring total government revenue a lot closer to total government spending. That might require changes to Social Security, though it doesn’t strictly need to require changes to Social Security (Social Security could be funded through revenue from the income tax, for instance). Either way, the Treasury bonds that Social Security is holding aren’t worthless, or, if they are worthless, we’re in much worse shape than most people realize.

Add to that picture a House Republican majority determined to pursue contradictory fiscal policy in 2011 and it’s easy to imagine America’s shaky recovery derailing altogether. And if the recovery derails, then it’s very difficult to see Barack Obama getting reelected in 2012. Incumbents who run successful political campaigns run on “things are pretty good” or “things are clearly and quickly getting better.” They don’t run on “but weak growth in China isn’t my fault.”

There are obviously two buckets of problems here. One bucket Obama — and the U.S. government in general — can’t fix. The other bucket is full of stuff we can fix, or at least influence — contradictory policy in 2011, high oil prices that could be eased by opening up the Strategic Petroleum Reserve (though that needs to be done carefully) and central bank policy during a difficult period in the global recovery. The interplay between the stuff we can’t control and the stuff we can will decide what happens in 2012. It is far and away the most consequential political story right now, even though it’s not being covered as such.

Liebesman managed to appropriate a host of familiar scenes and situations from Hollywood’s war-and-invasion oeuvres, but forgot to steal a story or characters worth watching. There are a few clever action gags disbursed throughout, but mostly it’s a mish-mash of meaningless military-movie cliches and copycat conflicts any infrequent moviegoer has seen a half-dozen times before. Despite its title, Battle doesn’t even bother to deliver an authentic Los Angeles; most of the city scenes were shot in Louisiana on account of the state’s generous film subsidies. (Apparently Liebesman is also willing to take money borrowed from taxpayers.)

People focus too much on polls about what “the people” think about “the issues.” What a lot of analysis misses is that (a) many voters aren’t paying attention at all and (b) most voters have stronger opinions about famous politicians than they do about issues.

So consider that among self-identified Republicans, getting more education makes you less informed about global warming. But that’s not because Republicans with BAs are ignorant compared to Republicans without them. On the contrary. Republicans with BAs are better informed about what the Republican view is and therefore worse informed about the underlying issue because the Republican position is mistaken.

One common mistake that flows from this is to overrate the relevance of polls showing that the public supports various component pieces of the legislation you favor. You saw this a lot during health-care reform, where the specifics of the law were popular but the law itself was not and liberals took that to mean they had a mere simple communications problem. What those polls really told you was that in a world where the two parties both agreed to support something like the Affordable Care Act, the Affordable Care Act would be extremely popular. But in a world where there was a bitter and endless fight over the Affordable Care Act, the Affordable Care Act wasn’t going to be very popular. Polls that try to gauge support for laws by testing policy preferences are testing a world we don’t actually live in.

The right answer is that comparative-effectiveness review is a fancy term for studies that test multiple drugs or treatments against one another to see which one works best — studies, in other words, that compare them for effectiveness. That way, when doctors go to prescribe something for you, they’re prescribing the thing that’ll do the most to help you at the lowest cost. My hunch is that most patients think comparative-effectiveness review is already how medicine works, and would be dismayed to learn how little good evidence there is behind what their doctor is telling them.

Mike Huckabee’s answer is that comparative-effectiveness review is the seed from which “the poisonous tree of death panels will grow,” which is, if not a sensical image, at least a vivid one. CER will become our version of Britain’s National Institute for Health and Clinical Excellence, which in Huckabee’s telling, “decides who lives and who dies based on age and cost of treatment.”

You’ll notice that nowhere in Huckabee’s description of comparative-effectiveness review is the “comparing for effectiveness” part mentioned. Instead, Huckabee is engaged in an effort to take evidence-based evaluation of different treatments off the table. And Huckabee isn’t alone in this effort. In January of 2009, Mitch McConnell, Jon Kyl, and Pat Roberts cosponsored legislation banning Medicare from using comparative-effectiveness review data to make coverage decisions. If I’m remembering this correctly, the GOP managed to get language along these lines into the stimulus.

So at the moment, the Republican Party’s position is that Medicare and Medicaid cannot use studies measuring the effectiveness of different medical treatments when deciding what to cover or not cover. Another way to say that is they’ve decided against saving money by making better decisions about what to buy. Their remaining options are to save money by paying doctors and hospitals less than things currently cost, or to save money by giving seniors and Medicaid recipients less than they currently need. With smart rationing off the table, dumb rationing is all we have left.

It's not about reducing the deficit. If it was, then the tax deal wouldn't have passed in December, entitlements would've been in the mix from the beginning, tax expenditures and defense spending would be on the table, etc. Nor is it about cutting spending. If it was, then the cuts wouldn't be limited to 12 percent of the budget. Rather, it's about cutting non-defense discretionary spending.

But most Americans don't know that. Boehner frequently says that "the American people want us to cut spending," but he never says that "the American people want us to cut non-defense discretionary spending." And that's because they don't: poll after poll has found Americans resistant to the sort of cuts you find in the non-defense discretionary bucket, which focus on education, worker retraining, nutrition programs, heating-oil subsidies, etc. They'd much prefer tax increases on the rich, or cuts to defense.

But Republicans wouldn't prefer tax increases on the rich, or cuts to defense spending. And they know that if entitlements get opened up, tax increases will immediately be on the table -- one of the easiest and most popular ways to cut Social Security's shortfall is to lift the cap on payroll taxes. But for Republicans at this moment in time, that's unthinkable. The beauty of focusing on non-defense discretionary spending is that it's spending they don't really like and that's totally disconnected from any sort of tax. And that gets to what this debate is really about: not cutting spending or reducing the deficit, but cutting spending Republicans don't like while avoiding any and all tax increases -- even if that means the country has higher deficits and the middle- and working-class bear more of the burden. The difficulty for Republicans is they've not wanted to clearly explain that philosophy to the American people, and so now they're in the odd position of arguing against Democratic efforts to do more for the deficit and do more to cut spending but not really being able to say why they oppose those efforts.

Top Stories

Congress will likely pass another three-week funding extension, reports Carl Hulse: "With little hope of a budget deal being reached before the end of next week, House Republicans are preparing another short-term spending measure to give the House and Senate a chance to come to agreement over a broader plan to keep the government operating through Sept. 30. Lawmakers and top aides on Thursday said stopgap legislation to be considered next week would most likely cover three weeks and include an additional $6 billion in cuts, possibly drawn from spending reductions offered by Democrats and the White House in earlier budget talks. The current two-week law expires next Friday and carries $4 billion in cuts. Movement toward another short-term solution came after the Senate on Wednesday rejected competing Republican and Democratic budget measures."

House Speaker John Boehner doesn't want to debate entitlements just yet, reports Simmi Aujla: "House Speaker John Boehner accused Democrats on Thursday of trying to 'muddle' the budget debate with their calls for reforms to entitlement programs. Boehner told reporters that Democrats who want to include a debate about Social Security, Medicare and Medicaid and tax increases are getting way ahead of themselves. 'The American people want us to cut spending. Because they know that cutting spending will in fact create a better environment for job creation,' he said. 'To try to muddle the current issue with entitlement programs, tax increases -- that’s what the next budget process is for. We’ll have plenty of opportunity to talk about that,' he said."

Wisconsin's anti-union bill passed the legislature, reports Karen Tumulty: "Wisconsin Gov. Scott Walker won his drive to strip the state's government workers of nearly all of their collective-bargaining rights Thursday, after a three-week standoff that brought tens of thousands of protesters to the Capitol. The new legislation represents a major setback for organized labor, but the political battle over public employees and their rights to bargain is likely to continue - not only in Madison. The state Assembly passed Walker's proposal a day after Republican senators outmaneuvered the 14 Democratic senators who had fled Wisconsin to deny a quorum needed for passing a budget measure. By stripping the bill of its spending language, they were able to pass it with only Republicans present."

Guitar heroics interlude: Television plays "Marquee Moon" live.

Got tips, additions, or comments? E-mail me.

Still to come: The House voted to cut a foreclosure prevention program; the CBO says repealing the individual mandate would increase the ranks of the uninsured, but cut the deficit; Obama is pushing for a government reorganization plan; Obama will address higher gas prices today; and the world's fastest popcorn popper.

The House voted to cut a foreclosure prevention program, reports Felicia Sonmez: "The House on Thursday voted to end the Federal Housing Administration Refinance Program, one of two federal foreclosure-assistance programs on the chopping block this week. The measure, H.R. 830, passed on a 256-to-171 vote, with 18 Democrats breaking ranks to join Republicans in backing it. One Republican, Rep. Joe Heck (Nev.), joined Democrats in opposing the proposal; Heck represents Nevada's third district, which was the district hardest-hit by foreclosure in 2010...The program has used only $50 million of the more than $8 billion that has been set aside for it, leading to criticism from Republicans that it ought to be terminated and the money used to pay down the federal deficit. The Senate is unlikely to take up the bill, however, and the White House earlier this week issued a veto threat."

Banks are saying that principal write-down will "slow the recovery," report Nick Timiraos and Dan Fitzpatrick: "Bankers are ratcheting up their rhetoric as they fight a mortgage-servicing settlement proposal, predicting lasting damage to the U.S. economy in an effort to force regulators to soften terms of any penalties. On Thursday, Wells Fargo & Co. Chief Executive John Stumpf said extensive loan principal reduction would increase the U.S. deficit if taxpayers are forced to pay for write-downs of loans held by government-controlled Fannie Mae and Freddie Mac. 'It's important to the country so that whatever happens does not slow down the recovery,' Mr. Stumpf said. Bank of America executives issued similar warnings on Tuesday, calling principal reductions 'no panacea' and questioning the fairness of the approach."

The Federal Housing Administration's head is leaving: http://wapo.st/fAq3wF

A study suggests the SEC needs a bigger budget, reports David Hilzenrath: "The Securities and Exchange Commission needs more money to meet its expanding responsibilities, but it hasn't made the most of the funds it already has, according to a study of the agency ordered by Congress last year. The consultant's report, a draft of which was obtained by The Washington Post, mentioned other issues that may be undermining the effectiveness of the agency responsible for policing Wall Street. Those include low morale, few staff members with experience working in financial markets, and a slowdown in reviews of money managers and brokerage firms. The study, performed by Boston Consulting Group, is due to be submitted to Congress by March 14."

February's deficit was the biggest in American history: http://on.wsj.com/hI50Lp

Obama is allowing Republicans to dumb down the deficit debate, writes Paul Krugman: "As the national debate over fiscal policy descends ever deeper into penny-pinching, future-killing absurdity, one voice is curiously muted -- that of President Obama. The president and his aides know that the G.O.P. approach to the budget is wrongheaded and destructive. But they’ve stopped making the case for an alternative approach; instead, they’ve positioned themselves as know-nothings lite, accepting the notion that spending must be slashed immediately -- just not as much as Republicans want. Mr. Obama’s political advisers clearly believe that this strategy of protective camouflage offers the president his best chance at re-election -- and they may be right. But that doesn’t change the fact that the White House is aiding and abetting the dumbing down of our deficit debate."

Businesses want smart investment from state governments, not lower taxes, writes Delaware Gov. Jack Markell: http://wapo.st/ehuDvW

John Boehner and Mitch McConnell are playing an effective game of "bad cop, worse cop", writes Keith Hennessey: "Rather than good cop, bad cop, Republican Leaders are playing bad cop, worse cop with their Members. Speaker Boehner and Leader McConnell are together the bad cop. On both substance and tone they have positioned themselves with the aggressive spending cutters in their party. At the same time, they can privately tell the Democratic negotiators, 'You think we’re bad? You should see our freshman. They’re nuts. We’re not sure we can deliver them for anything short of the House-passed bill.' While Boehner and McConnell are the bad cop, the freshman / Tea Party / conservative rank-and-file Republicans are the worse cop...The Republican Leaders’ weakness at delivering votes for a weak bill becomes negotiating strength."

Time lapse interlude: Grapes shriveling into raisins, sped up from 3 months to 30 seconds.

Health Care

The CBO found that repealing the individual mandate would increase the ranks of the uninsured, but cut the deficit, reports Derek Thompson: "The CBO finds that repealing the mandate would increase the number of people without health insurance by 16 million people in 2021. From the CBO: 'About 4 million fewer people would have employment-based coverage; about 6 million fewer people would obtain coverage in the individual market; and about 6 million fewer people would have coverage under Medicaid or CHIP.' CBO also estimates that striking the mandate would increase premiums for policies in the individual market by '15 percent to 20 percent.'...The upshot is that repealing the health insurance mandate would trim our deficit at the cost of more uninsured people and higher health care premiums."

The insured don't currently pay for the uninsured's health care, write John Cogan, Glenn Hubbard, and Daniel Kessler: http://on.wsj.com/dOPIj1

Two House Democrats want to undo Medicare's Independent Payment Advisory Board, reports Julian Pecquet: "Two House Democrats have signed onto a Republican bill to repeal a health reform provision that the Obama administration has touted as a central tool to keep health costs under control. Rep. Shelley Berkley (D-Nev.) became a co-sponsor of legislation to repeal the Medicare payment board on Wednesday, one week after Rep. Michael Capuano (D-Mass.). A spokesman for the congresswoman said she remains committed to the law's cost-cutting goals but wants Congress to be in charge...The Independent Payment Advisory Board fast-tracks cuts to Medicare payments when spending reaches a pre-determined target. The Congressional Budget Office estimated that it would save $28 billion through 2019."

Domestic Policy

Obama wants a government reorganization plan within 90 days, reports Ed O'Keefe: "President Obama is giving aides 90 days to find ways to overhaul federal trade and export agencies, according to senior administration officials familiar with his plans. The president is expected to sign a memorandum Friday formally launching a reorganization plan he announced during his State of the Union address that is set to focus first on revamping 12 trade and export agencies and may later shift to other government operations. The process will be led by Office of Management and Budget Deputy Director Jeffrey D. Zients and Obama's former staff secretary, Lisa Brown. Other top officials from across the government are expected to join the discussions, according to the aides, who were not authorized to speak on the record."

The just-passed Wisconsin bill allows the firing of striking workers: http://bit.ly/frE6KP

Republican budget plans include big cuts for Head Start, reports Jennifer Steinhauer: "The difficulty Senate Republicans faced voting this week for a bill full of spending cuts is best illustrated on the home page for the Alaska Head Start program’s Web site. On the bottom of the page is a picture of Senator Lisa Murkowski, Republican of Alaska, receiving an award for her long support for Head Start, the preschool program for poor children. At the top of the page is a note imploring Alaskans to call Ms. Murkowski’s office and beg her not to vote for a Republican bill that would cut the program’s budget by $2 billion, or nearly a quarter of President Obama’s 2011 budget request of $8.2 billion. The current level is $7.2 billion. On Wednesday afternoon, Ms. Murkowski did so anyway... Research on the program has shown that children who complete it do better socially and academically than children not enrolled in the program."

New York and other states should do away with "last in, first out" teacher layoffs, writes Michelle Rhee: "With looming budget cuts, New York's governor and legislature must act quickly to save our best teachers. It is abundantly clear from the research that the most important school factor in determining a child's success is the quality of the teacher at the front of the classroom. That's why it's absolutely imperative that state leaders completely eliminate the 'last in, first out' policy, which mandates that the last teachers hired must be the first fired, regardless of how good they are. This policy makes absolutely no sense. Why sacrifice our children's future when we can enact laws that save great teachers while ridding the system of those we know are less effective?"

Street vendor interlude: A vendor in Shanghai gives new meaning to "instant popcorn."

Energy

Obama will use a press conference to address higher gas prices today, reports Laura Meckler: "President Barack Obama will address rising energy prices at a news conference on Friday, but he is not expected to call for releasing oil from the Strategic Petroleum Reserve. Unrest in the Middle East and North Africa has driven up gasoline and heating oil prices in the United States. Republicans in Congress have raised the volume on their criticism of Mr. Obama's energy policies, and some Democrats have called for Mr. Obama to release oil from the strategic reserves in an attempt to moderate prices by increasing supply. White House officials would not say what steps Mr. Obama would put forward, if any, during his press conference. But an administration official said Thursday evening not to expect an announcement on drawing oil from the strategic reserve."

High gas prices are improving GOP environmental legislation's chances in the Senate: http://politi.co/fFQoH7

A House bill to strip the EPA of its climate-regulating power is moving forward, reports John Broder: "House subcommittee voted on Thursday to strip the Environmental Protection Agency of its power to regulate greenhouse gases, chipping away at a central pillar of the Obama administration’s evolving climate and energy strategy. The sharply partisan vote was preordained by the Republican takeover of the House. Republicans and their industry allies accuse the administration of levying taxes on traditional energy sources through costly environmental regulations, threatening the economic recovery and driving jobs overseas...A parallel bill has been introduced in the Senate, although passage remains uncertain. President Obama has vowed to veto such legislation."

GOP Rep. Joe Barton argues that cutting oil subsidies will lead Exxon Mobil to go out of business: http://bit.ly/hfPdc9

Some House Democrats have introduced a bill to tap the Strategic Petroleum Reserve, reports Andrew Restuccia: "A group of House Democrats introduced legislation Thursday to tap the country’s oil reserves in response to rising prices. 'This is the time to deploy a responsible amount of reserves before it is too late,' Rep. Edward Markey (D-Mass.), the author of the new bill, told reporters. Markey's bill represents the latest effort by Democrats to release oil from the Strategic Petroleum Reserve (SPR), a 727-million-barrel emergency stockpile of oil. But the proposal faces opposition from Republicans and at least one senior House Democrat. The legislation would require that over the next six months at least 30 million barrels of oil be released from the SPR. President Obama ultimately has the authority to release oil from the SPR."

Closing credits: Wonkbook is compiled and produced with help from Dylan Matthews and Michelle Williams.

Having posed the question, I may as well answer it: If I’m honest with myself about which blogs I check daily, my list would include Ross Douthat at the New York Times, Reihan Salam at the Agenda, Josh Barro at the Agenda/Public Sector Inc./various other places that Josh Barro blogs, Avik Roy at Forbes, Megan McArdle at the Atlantic, Will Wilkinson at the various Will Wilkinson outlets (which are usually aggregated here), Keith Hennessey at his eponymous blog, Greg Mankiw at his also-eponymous blog and Tyler Cowen and Alex Tabarrok at Marginal Revolution. I frequently disagree with David Brooks, and I read his new blog, but as of yet he hasn’t said anything I disagree with in his new blog, so I’m not sure he qualifies yet. There are a lot of other bloggers whom I like and disagree with, but they’re often on large group blogs that I don’t want to wade through, and so I don’t read them as often as I’d like.

Who’s on your list?