Crunch Time for Health Care

By Dan Froomkin
2:30 PM ET, 06/ 8/2009

The future of health care will likely come into into much clearer focus in the next few weeks, which explains why President Obama is suddenly getting more involved. I wrote a week ago about how health care will be Obama's big test. Well, we're getting close to exam period.

Despite surprisingly broad agreement about the need to hold down costs and expand insurance coverage, there are still several key issues that remain far from settled.

Last week, Obama clarified his position on several of those key issues. He signaled his strong support for a "public option" that would compete with private insurance plans and urged senators to cap income-tax deductions for the rich. At same time, he indicated he might support some sort of insurance mandate for all Americans, and might be willing to tax employer-sponsored health insurance.

Now, in the next few days, he's expected to talk in greater detail about where he thinks the money to pay for expanded coverage would come from. Kim Chipman and Ryan Donmoyer write for Bloomberg:

Within the next 10 days, Obama will give details of plans that White House aides say would pay for the bulk of a new health-care system. This includes his recent call for an extra $200 billion to $300 billion in savings for the Medicare and Medicaid programs for the elderly and the poor, the officials said.

Sheryl Gay Stolberg writes in the New York Times:

After months of insisting he would leave the details to Congress, President Obama has concluded that he must exert greater control over the health care debate and is preparing an intense push for legislation that will include speeches, town-hall-style meetings and much deeper engagement with lawmakers, senior White House officials say.

But as Mr. Obama wades into the details of the legislative debate — a process that began last week when he released a letter staking out certain specific policy positions for the first time — he will face increasingly difficult choices and risks.

For instance, Stolberg writes:

If he embraces a tax on employee benefits, an idea he attacked when he was running for president, he may infuriate labor and the middle class. If he insists on a big-government plan in the image of Medicare, he could lose any hope of Republican support and ignite an insurance industry backlash. If he does not come up with credible ways to pay for his plan, which by some estimates could cost more than $1 trillion over 10 years, moderate Democrats could balk.

Obama is reprising an idea he first floated in his February budget proposal, but which even some congressional Democrats termed a nonstarter.

Obama senior adviser David Axelrod told CNN's John King yesterday that at a meeting with Senate Democrats last week, Obama

made a very strong case for the proposal that he put on the table, which is to cap deductions for high income Americans. And he urged them to go back and look at that. He said, I'm not -- you know, everybody ought to put their ideas on the table. I'm not foreclosing anything, but I really think my idea is the best.

The so-called "public option" is shaping up as the single biggest item of contention. Paul Krugman writes in his New York Times opinion column:

The big health care push is officially on....

But the devil is in the details. Health reform will fail unless we get serious cost control — and we won't get that kind of control unless we fundamentally change the way the insurance industry, in particular, behaves....

Without an effective public option, the Obama health care reform will be simply a national version of the health care reform in Massachusetts: a system that is a lot better than nothing but has done little to address the fundamental problem of a fragmented system, and as a result has done little to control rising health care costs.

Right now the health insurers are promising to deliver major cost savings. But history shows that such promises can't be trusted. As President Obama said in his letter, we need a serious, real public option to keep the insurance companies honest.

Robert Reich blogs for TPM Cafe:

This is it, folks. The concrete is being mixed and about to be poured. And after it's poured and hardens, universal health care will be with us for years to come in whatever form it now takes.

And as Reich sees it:

Big Pharma and Big Insurance are gaining ground in their campaign to kill the public option in the emerging health care bill....

They don't want a public option that would compete with private insurers and use its bargaining power to negotiate better rates with drug companies....

One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to the states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they've been doing for years. A third is bind the public plan to the same rules private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers.

And then there's the option being championed by moderate Republican Sen. Olympia Snowe, which would automatically "trigger" a public option if certain goals haven't been met. Reich is skeptical of that one, as well.

The Washington Post editorial board writes that Obama

ought to reconsider his aversion to changing the unfair and counterproductive arrangement by which employer-provided health insurance is not treated as income for tax purposes. Following a White House meeting, Mr. Baucus reported that the president was open to limiting the value of this tax-free benefit, and we hope that is what the president meant when he referred in the letter to "appropriate proposals to generate additional revenues."

E.J. Dionne Jr. writes in his Washington Post opinion column that

the toughest behind-the-scenes battles will be about how much the insurance companies, the drug companies and the providers are willing to give up to get a government bailout of the health system....

The hardest part of the health-care fight, says Ralph Neas, the CEO of the National Coalition on Health Care, may not be providing assistance for the uninsured... but getting all the players to agree to serious cost controls.

Obama pitched his plans -- in general terms -- in his weekly address on Saturday.

Matt Bai writes in the New York Times Magazine that the stakes are enormous. Unlike Obama's past legislative victories, designing a new health care system

is a legislative goal that has eluded every Democratic president since Harry Truman and that Obama repeatedly vowed to accomplish during last year's campaign; he has said that it is not only a moral imperative but also a crucial part of his plan to remake the American economy, an ever-expanding share of which is swallowed up by doctors' bills and hospital stays. Making good on his promise will require not just public expenditure on a disorienting scale but also the kind of activism and creativity, the birthing of new rules and institutions, at which Washington hasn't succeeded for generations....

Obama's success in passing an expensive and sprawling new health care program will depend, in some part, on whether he can persuade Democrats in Congress that he is not going to wilt under pressure from industry lobbyists or allow a bill to be undone by tensions in his own party. They also have to be persuaded that the cost savings Obama is projecting from a new health care system really are going to materialize in the near future — and that members aren't going to have to face furious voters a few years out, when deficits are reaching unsustainable levels and showing no signs of remission."

Bai's story, written before Obama began asserting himself last week, sings the praises of his hands-off-Congress approach. He writes:

If the president were to shed his reticence and set out his terms for a bill, Republicans would focus on their differences with Obama and would most likely end up abandoning the process, either because they wouldn't believe a compromise was possible or because they would want to seize on any excuse to derail his agenda.

And almost on cue, as Erika Werner writes for the Associated Press:

Republican Sen. Chuck Grassley says that President Barack Obama "got nerve" to go sightseeing in Paris while telling lawmakers it's time to deliver on a health care overhaul.

Grassley, the top Republican on the Finance Committee, is key to any bipartisan health care deal. Using Twitter — the Internet-based social connection service allows users to send mass text messages called "tweets" — the Iowa Republican issued two angry "tweets" Sunday morning as the president wrapped up an overseas tour....

Grassley's first tweet: "Pres Obama you got nerve while u sightseeing in Paris to tell us 'time to deliver' on health care. We still on skedul/even workinWKEND."

And Laura Litvan writes for Bloomberg:

A group of Senate Republicans sent a letter to President Barack Obama declaring their opposition to including a government-run plan in a health-care overhaul, saying it would be a 'federal government takeover' of the health system.

Back to the Grind

By Dan Froomkin
2:26 PM ET, 06/ 8/2009

Have all those inspiring words -- most recently in Cairo and Normandy -- set the bar too high for the Obama presidency?

Jonathan Weisman and Laura Meckler write in the Wall Street Journal: "President Barack Obama returned home from abroad Sunday to find that his own oratory laying out an ever-more-ambitious agenda, both in foreign and domestic policy, is ratcheting up demands for concrete achievements."

Mike Allen writes for Politico: "Obama is moving into a new season of his presidency where it's clear that his celebrity is going to be durable, and now he wants to start leveraging it to add clear accomplishments on a long list of issues that have flummoxed his predecessors."

New York Times opinion columnist Roger Cohen describes Obama's central formula as calling upon people to view "differences honestly, air them, recognize our common humanity, overcome mistrust, build coalitions through seeing our shared interests, and rise above hurt by valuing the future's promise over the past's scourge. What saves this message from the tawdry is Obama's own embodiment of these values in his unlikely life story, his tremendous intellectual courage, and his gift for empathy. The Cairo speech was a brave idea executed with sensitivity." But now, he writes: "All the rhetorical groundwork the president has now laid — on Iran, Israel-Palestine, the Muslim world — will come to nothing if high principle is not matched by street-smart cunning and maneuver. Obama's got to get off the podium and down into the bazaar if he's going to come home with the goods."

Alan Cowell writes in the New York Times about Obama's soaring D-Day speech in Normandy: "Whatever has happened before, Mr. Obama seemed to say repeatedly, can be overcome. 'You remind us that in the end, human destiny is not determined by forces beyond our control,' he told veterans of the D-Day landings in Normandy on Saturday. 'Our history has always been the sum total of the choices made and the actions taken by each individual man and woman. It has always been up to us.'"

Here is Obama on the Middle East, from his remarks in France on Saturday in a joint appearance with the French president: "Both sides are going to have obligations. I've discussed the importance of a cessation of settlement construction, but I also want to reemphasize, because that's gotten more attention than what I've also said, which is the Palestinians have to renounce violence, end incitement, improve their governance capacity so that Israelis can be confident that the Palestinians can follow through on any commitments they make across the table."

Here's Obama on North Korea, in the same appearance: "North Korea's actions over the last several months have been extraordinarily provocative and they have made no bones about the fact that they are testing nuclear weapons, testing missiles that potentially would have intercontinental capacity.... My preference is always to use a diplomatic approach. But diplomacy has to involve the other side engaging in a serious way in trying to solve problems. And we have not seen that kind of reaction from North Korea. So we will continue to consult with our allies. We'll continue to consult with all the parties who previously have been involved in the six-party talks. But we are going to take a very hard look at how we move forward on these issues, and I don't think that there should be an assumption that we will simply continue down a path in which North Korea is constantly destabilizing the region and we just react in the same ways by, after they've done these things for a while, then we reward them."

Edwin Chen and Julianna Goldman write for Bloomberg: "As Obama concludes his fourth trip abroad as president, he has added to his portfolio, playing First Tourist... From Ottawa to Paris, his often unexpected appearances win the attention of the local citizenry while serving up a sharp contrast to the style of his predecessor, who rarely took in the sights and sounds of the countries he visited.... Obama, a self-described 'student of history,' was particularly enthusiastic about visiting the pyramids, aides said."

AFP reports: "A US 'taster' tested the food being dished up to President Barack Obama at a dinner in a French restaurant, a waiter said Sunday. 'They have someone who tastes the dishes,' said waiter Gabriel de Carvalho from the 'La Fontaine de Mars' restaurant where Obama and his family turned up for dinner on Saturday night."

Quick Takes

By Dan Froomkin
2:22 PM ET, 06/ 8/2009

Jackie Calmes writes in the New York Times about "the underlying tensions that have gripped Mr. Obama's economic advisers as they have struggled with the gravest financial crisis since the Depression, according to several dozen interviews with administration officials and others familiar with the internal debates. By all accounts, much of the tension derives from the president's choice of the brilliant but sometimes supercilious Mr. Summers to be the director of the National Economic Council, making him the policy impresario of the team....[E]ven as top administration officials acknowledge the occasional strains among economic advisers, they say the president is thrilled with the job Mr. Summers is doing in his current post."

Brett Blackledge writes for the Associated Press: "Eager to show action on the ailing economy, President Barack Obama promised Monday to speed federal money into hundreds of public works projects this summer, vowing that 600,000 jobs will be created or saved." Here is a White House summary.

Jake Tapper, Karen Travers and Stephan Z. Smith report on Tapper's interview with Lakhdar Boumediene, a 43-year-old Algerian now free in France after 7½ years in Guantanamo: "Asked if he thought he was tortured, Boumediene was unequivocal. 'I don't think. I'm sure,' he said. Boumediene described being pulled up from under his arms while sitting in a chair with his legs shackled, stretching him. He said that he was forced to run with the camp's guards and if he could not keep up, he was dragged, bloody and bruised. He described what he called the 'games' the guards would play after he began a hunger strike, putting his food IV up his nose and poking the hypodermic needle in the wrong part of his arm. 'You think that's not torture? What's this? What can you call this? Torture or what?' he said, indicating the scars he bears from tight shackles. 'I'm an animal? I'm not a human?'"

William Glaberson writes in the New York Times: "The Obama administration is considering a change in the law for the military commissions at the prison at Guantánamo Bay, Cuba, that would clear the way for detainees facing the death penalty to plead guilty without a full trial. The provision could permit military prosecutors to avoid airing the details of brutal interrogation techniques. It could also allow the five detainees who have been charged with the Sept. 11 attacks to achieve their stated goal of pleading guilty to gain what they have called martyrdom."

New York Times public editor Clark Hoyt critiques a May 21 Times story that former vice president Dick Cheney used to attack Obama's plan to close the prison at Guantanamo. The story, which credulously related information from a Pentagon report about recidivism among Guantanamo detainees, "was seriously flawed and greatly overplayed. It demonstrated again the dangers when editors run with exclusive leaked material in politically charged circumstances and fail to push back skeptically. The lapse is especially unfortunate at The Times, given its history in covering the run-up to the Iraq war. The article seemed to adopt the Pentagon's contention that freed prisoners had 'returned' to terrorism, ignoring independent reporting by The Times and others [i.e. McClatchy Newspapers] that some of them may not have been involved in terrorism before but were radicalized at Guantánamo. It failed to distinguish between former prisoners suspected of new acts of terrorism — more than half the cases — and those supposedly confirmed to have rejoined jihad against the West. Had only confirmed cases been considered, one in seven would have changed to one in 20."

AFP reports: "Obama is 'deeply concerned' over the sentencing of two US journalists by North Korea and his government is using 'all possible channels' to obtain their release, The White House said early Monday."

The White House is trying out a new way to give out tickets to Obama's town hall meetings. Obama has one scheduled for Thursday in Green Bay, and tickets can be requested on the White House Web site. WBAY-TV reports that those without Internet access can call (202) 757-9821.

Salon debunks 12 "[c]razy right-wing myths about Obama."

Michael Wolff writes for Vanity Fair that Obama's media team "doesn't want to talk about the meticulous calibration of everything to do with retailing its image and message because it is all so meticulously calibrated." Press Secretary Robert Gibbs, Wolff writes, "clearly doesn't take the press very seriously. Gibbs is perfectly affable and even, in his way, courtly. And yet he seems to be not quite listening. Nothing touches him."

How Cheney Bent DOJ to His Will

By Dan Froomkin
11:25 AM ET, 06/ 8/2009

Three newly-disclosed Justice Department e-mails thoroughly vindicate the most cynical suspicions about how former vice president Dick Cheney bent ostensibly independent Justice Department lawyers to his will and forced them to manufacture legal cover for his torture policies.

The e-mails, which date back to a 2005 re-evaluation of interrogation policies, were written by then-deputy attorney general James Comey. They reveal Cheney's extraordinary influence over then-attorney general Alberto Gonzales and key lieutenants -- including top officials in the department's Office of Legal Counsel (OLC).

Comey describes how he and some of his colleagues had "grave reservations" about the legal analyses being concocted for Cheney. And he accurately predicts that Cheney and other White House officials would later point the finger at the Justice Department during the investigations that would inevitably ensue once the administration's actions were made public.

Indeed, in one e-mail, Comey describes an exchange with Ted Ullyot, then Gonzales's chief of staff: "I told him that the people who were applying pressure now would not be there when the s--- hit the fan. Rather, they would simply say they had only asked for an opinion."

Gonzales and Ullyot both came to Justice from the White House counsel's office. And Comey writes that "everyone seemed to be thinking as if they still work at the White House and not the United States Department of Justice."

Noting that he had already announced his resignation at the time, Comey expresses sadness that some top officials who were "too weak to stand up for the principles" that undergird DOJ.

This is exactly what many of us have been alleging for a long time.

In one e-mail, Comey describes a dramatic meeting with Gonzales, in which he warned that approval of the interrogation techniques would likely lead to criminal prosecution.

"In stark terms I explained to him what this would look like some day and what it would mean for the president and the government," Comey writes. "I sketched out the 'summation' that could be made to demonstrate that some of this stuff was simply awful. I told him it would all come out some day and be presented in the ways I was presenting it."

The e-mails date back to DOJ's second round of finding legal rationalizations for torture. By 2005, the department had renounced the original August 1, 2002, "torture memo" from the OLC, the CIA's office of inspector general had questioned the legality and effectiveness of the techniques being used at the CIA's secret prisons, and the CIA had abandoned waterboarding -- but not many other extreme measures.

Cheney's quest to restore the necessary legal cover resulted in three new memos, which were among those declassified and released in April by the Obama administration.

The first memo concluded that brutal interrogation techniques including waterboarding did not individually violate the federal criminal prohibition against torture.

The second memo concluded that even the combined use of those techniques didn't violate that particular statute. Those two memos were issued on May 10, 2005.

The third memo, dated May 25, managed to conclude that the techniques didn't even violate the United Nations Convention Against Torture's prohibition of "cruel, inhuman or degrading treatment."

The previously undisclosed e-mails from Comey were Web-published on Saturday by the New York Times. But Scott Shane and David Johnston chose to focus on a minor point -- that Comey and other lawyers, even while expressing their grave concerns about the interrogation methods in question, had approved the first memo.

"When Justice Department lawyers engaged in a sharp internal debate in 2005 over brutal interrogation techniques, even some who believed that using tough tactics was a serious mistake agreed on a basic point: the methods themselves were legal," Shane and Johnston wrote.

Yes, Comey approved the first memo. And that certainly tarnishes his reputation. Comey, almost alone among senior Justice Department officials, had somehow managed to emerge with his reputation intact -- so much so that Politico even reported in May that "some White House officials" (and I'm assuming they meant this White House, not the last one) were suggesting he was Supreme Court material.

But Comey was ever the pragmatist. The most famous Comey story, as related by Comey himself in 2007, involved a dramatic rebellion in March 2004 -- complete with a mad dash to the hospital bedside of then-attorney general John Ashcroft -- in which Comey, backed up by Ashcroft, refused to reauthorize a secret NSA warrantless surveillance program as it was then constituted. But most legal scholars believe the whole program, not just the still-mysterious part Comey objected to, was operating in clear violation of the Foreign Intelligence Surveillance Act.

Blogger Marcy Wheeler argues that Comey's acquiescence to the argument that the interrogation tactics individually didn't violate one particular law does not mean he necessarily considered them legal. He may have felt -- and apparently did feel -- that they violated other laws, including the Convention Against Torture. He certainly felt that their use in combination -- which is how the CIA used them -- was clearly illegal.

Wheeler also argues -- with some justification, it seems to me -- that the e-mails were probably leaked to the Times in a "pre-emptive strike" on an upcoming report from the DOJ's Office of Professional Responsibility. That report is said to harshly criticize former OLC lawyers John Yoo, Jay Bybee and Steven Bradbury for their role in approving torture.

The message their defenders clearly wanted to send -- and which the Times conveyed -- was that even those DOJ officials who had thus far "escaped criticism because they raised questions about interrogation and the law" agreed with at least some of the rationales put forth by Yoo et. al.

But the actual e-mails, in which Comey documents his various conversations on the matter, don't really support that message. Rather, they paint a portrait of a hopeless rear-guard action by Comey and others against Cheney and his willing lackeys.

As Glenn Greenwald blogs for Salon: "[T]he real story here is obvious -- these DOJ memos authorizing torture were anything but the by-product of independent, good faith legal analysis....

"These DOJ memos, like the CIA reports [in the run-up to war in Iraq], were all engineered by the White House to give cover to what they wanted to do; they were not the precipitating events that led to and justified those decisions."

In his April 27 e-mail, Comey describes telling Gonzales directly about his "grave reservations" about the second memo. Gonzales's response? "The AG explained that he was under great pressure from the Vice President to complete both memos, and that the President had even raised it last week, apparently at the VP's request and the AG had promised they would be ready early this week."

Comey also notes that OLC lawyer Patrick Philbin had previously reported that then-acting OLC director Steve Bradbury "was getting constant similar pressure from [White House counsel] Harriet Miers and [Cheney counsel] David Addington to produce the opinions." Comey adds: "Parenthetically, I have previously expressed my worry that having Steve as 'Acting' -- and wanting the job -- would make his susceptible to just this kind of pressure."

By the end of the April 27 e-mail it appears that Gonzales has agreed to give Comey a chance to alter the second memo. But in the April 28 e-mail, Comey recounts a conversation with Ullyot, Gonzales's chief of staff, in which it becomes clear that Comey has been outflanked by Cheney and that the memo will go out as written.

Comey concludes: "People may think it strange to hear me say I miss John Ashcroft, but as intimidated as he could be by the WH, when it came to crunch-time, he stood up, even from an intensive care hospital bed. That backbone is gone."

And by his May 31 e-mail, his wistful regrets have turned into barely contained fury.

The previous day, the department had issued the third memo, essentially giving a go-ahead (and perhaps even more importantly, retroactive approval) to torture. There was to be a high-level meeting on the subject at the White House later than day. And in a morning meeting with Gonzales, Comey's entreaties evidently fell on deaf ears.

"The AG began by saying that [then-national security adviser Condoleezza] Rice was not interested in discussing details and that her attitude was that if DOJ said it was legal and CIA said it was effective, then that ended it, without a need for detailed policy discussion," Comey writes. "Pat and I urged the AG in the strongest possible terms to drive a full policy discussion of all techniques."

Comey then writes about delivering to Gonzales that imagined "summation" in the case against the administration for torture. And, he adds: "I mentioned that there was a video of an early session, which would come out eventually."

Comey writes that later that day, upon returning from the White House, Gonzales "said the meeting had gone very well, and that there had been a full factual and policy discussion. He said the issues were fully presented and and he had drawn my 'worst-case scenario' for them. At the end, all the Principles approved the full list."

Comey's prediction that "simply awful" things would be eventually made public was proven correct. But the video he mentioned was one of many that the CIA conveniently destroyed less than six months later. And of course his vision of a criminal prosecution remains unfulfilled. Oh, to hear that summation -- either from Comey, or from a federal prosecutor.

Cartoon Watch

By Dan Froomkin
10:09 AM ET, 06/ 8/2009

Ann Telnaes on the Cheney brand, Adam Zyglis, John Sherffius and Michael Ramirez on Obama's Middle East message, John Trever on Obama's challenge, Jeff Danziger, Stuart Carlson and Joel Pett on the terrorists's Obama dilemma, Kevin Siers on the Sotomayor defense, Pat Bagley on Obama's health-care allies, and RJ Matson and Dave Granlund on the White House garden.

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