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Saturday, February 20, 2010

The Next Round on Health Care

Politics is a never-ending war by peaceful means, to paraphrase Clausewitz, and thus, like war and sporting events, induces violent emotional swings in its participants. A single battle, goal, or touchdown can plunge participants and viewers from the heights of joy to the depths of despair, and in each of these spheres the most effective players are the ones who can keep their heads when all around are losing theirs and focus upon long-term trends rather than short-term fluctuations. (One of the more important points in my post last week, I think, was how difficult it has become for major players in today's economy to do anything but give in to short-term emotional binges, even when they know they are doomed to end badly.) Three weeks ago the Massachusetts senatorial election dealt a devastating blow to Democratic morale and convinced Republicans that they are on the way to a return to power. In the last few days, however, there are signs that the White House may have regrouped, drawn appropriate conclusions, and prepared a dramatic move forward of its own.

The White House has indicated that the President will present a new health care bill of its own before the projected bipartisan summit with Republican leaders--a summit which they may well decide to boycott. But they have coupled that announcement with leaks that the new bill may proceed through the reconciliation process, that is, that it may circumvent the filibuster rule in the Senate and pass by a simple majority. That, it seems to me, will surely be necessary now to get any bill at all. But 8 Democratic Senators have now gone further, and suggested that this bill include the public option--the opportunity for citizens to buy into medicare--that the House passed but the Senate never even voted on, because it could not command 60 votes. Returning to my war metaphor, this amounts to escalation--and with the Republicans obviously determined, as Jim DeMint put it almost a year ago, to "break" the President by defeating any health care plan, that is entirely appropriate. More to the point, it means that the health care reform bill might actually accomplish something, and that it might squarely put the issue of public vs. private interests back on the table. And there is no question that where health care is concerned, public and private interests are in conflict.

As most readers probably know already, health care costs are increasing again, dramatically. This, given our system, is inevitable. With millions more people out of work--most of them relatively young and healthy--millions fewer are receiving employer-based health care. That means the insurance companies are taking in less, and to keep their balance sheets healthy, they have to charge continuing customers more. That in turn will encourage more healthy people to do without health insurance, making it more expensive for those who keep it. This is the "death spiral" that Paul Krugman wrote about on Friday. In a European country, as Krugman has pointed out, health care for all has the kind of first claim on the national budget that social security and medicare have here, and an economic downturn would not make it more expensive, except insofar as it makes more people sick.

If the Democrats and the Administration really want to take a more populist tack, they might point out that the "health care crisis" is not a crisis at all for either the insurance companies or the drug companies. Because they can fix their prices and, in the case of the drug companies, do so well off of medicare, they are not suffering significantly, if at all, from the economic crisis (although they have laid off personnel.) Here are some findings from a recent government of the situation in the insurance industry: "Profits for the 10 largest insurance companies rose 250 percent from 2000 to 2009, 10 times faster than inflation. . . .The top five for profit insurers -- WellPoint, UnitedHealth Group Inc., Cigna Corp., Aetna Inc. ad Humana Inc. took combined profits of $12.2 billion, up 56 percent from 2008, the report found. The chief executives of the top five insurers received $24 million on average in 2008, the report said." (For a full story on the report, go here.

The drug companies are rebounding handsomely as well. In the last ten years they have managed both to increase sales and to substantially increase the percentage of their revenue distributed as profits--and several have shown an extroardinary rebound during 2009. Merck in 2009 had sales of $27.4 billion and profits of $12.9 billion--a significant decrease in sales from $40 billion in 2000, but an increase in profits from only $8 billion in that year. Pfizer, which spends much more money on marketing than Merck, has increased its sales by about 60% since 2000, to $50 billion, and more than doubled its profits, to $8 billion. Bristol Myers sales are about the same now as in 2000, at $18 billion, but profits have more than doubled, to $10.6 billion. (All the recent figures are from earnings reports that I found summarized on the web.) The chief executives of both the insurance companies and the drug companies are of course drawing salaries and bonuses in the tens of millions. These are all expenses which the citizenry of Canada, Britain, France and Germany do not have to pay, and that's a big reason why they pay so much less for health care than we do. And as the President has repeated again and again, we can't afford this any longer.

Now this brief look at the health care situation, like the somewhat longer look I took last week at the big banks, suggests two things. First of all, both our financial system and our health care system are severely dysfunctional for the average American and society as a whole. Secondly, both dispose of enormous resources and owe their profits, indeed, to continuous, massive, highly effective lobbying in Washington. (Susan Bayh, wife of Evan Bayh, the "centrist" Democrat who just decided to retire from the Senate and salt away the $13 million in his campaign chest, is on the board of Wellpoint Insurance, by the way.) They are not going to surrender their privileges and their enormous share of national income without a fight. And in the hyperpartisan political atmosphere of crisis in which we live today, at least one party--in the case of health care, the Republicans--was very likely to wind up in their corner. The Democrats, up until now, have been trying to pass a major reform without upsetting the insurance and drug industries too much. It didn't work.

Barack Obama belongs to Generation X, a Nomad generation. Previous Nomad generations have only come into the White House after the end of a great national crisis--Washington and Adams from 1789 to 1800, Grant and his Gilded Age successors beginning in 1869, and Truman and Eisenhower from 1946 to 1960. With the major exception of John Adams, these men successfully pursued the kind of bipartisan, consensus government that Obama as sought himself. They could do so because the great, violent political struggles of their era were over, and had hammered out a new consensus--particularly in the cases of Eisenhower and Truman. We are at least a decade and probably more from reaching that point. Meanwhile we need a leader who understands that getting us pointed in the right direction, by any means necessary, is more important than bipartisan consensus--and that he must indeed choose between the two.


Anonymous said...

Dr. Kaiser:
Meanwhile we need a leader who understands that getting us pointed in the right direction, by any means necessary, is more important than bipartisan consensus--and that he must indeed choose between the two.

Please do remember that by any means necessary works for anyone who's in power.

After the upcoming November, 2010, elections and 2012 elections, the same by any means necessary
will be available to the winner.

The more democrats try to rahm their agenda, which voters had told them, repeatedly, they don't agree with the less of them will be elected. It will be crystal clear to voters what was promised to them and what was done.

Any discrepancy between words and deeds will have the same result as it did for someone who said:"Read my lips, no new taxes."

All i can say to you is: Bring it on!

Anonymous said...

"The more democrats try to rahm their agenda, which voters had told them, repeatedly, they don't agree with the less of them will be elected. It will be crystal clear to voters what was promised to them and what was done."

Given how elections are structured here, it's a real stretch to claim that voters "tell" anyone anything. For instance, pretty much the only thing that the 2008 contest articulated was a general sense of revulsion at Republican failings. The **real** reason why so many people are disappointed with Obama is that so much of what he's done has worked mainly (not entirely) to the benefit of the very oligarchy that's made such a botch of the economy.

In strict terms, disappointment is unwarranted. To anyone who was paying attention, Obama made it pretty clear that he wasn't offering anything more than typical Dem triangulation and hedging. He should have come out swinging right away, during his inaugural address. He should have launched his administration with a "malefactors of great wealth" speech, and hammered the finance "industry" AND the Republican Party without mercy. I suspect that he's already let opportunity slip. But I hope that Dr. Kaiser is correct, and Obama is (finally!) beginning to see the world as it is.
-- sglover

Anonymous said...


I quite disagree with you. Voters of the Commonwealth of Massachusetts have clearly TOLD the current administration what they thought
about its policies by electing Senator Scott Brown.

Furthermore, great many voters who brought the current administration to power are finaly seeing it for what it is and will rectify that in november, 2010.

Anonymous said...

Sen. Harry Reid on filibuster:


Unknown said...

It is beyond belief to me that some people are so fearful of government-run healthcare but fail to see the con job being perpetrated by the health insurance cabals and big pharma. I don't know what "Anonymous" means by his statement that the voters disagree with the public option...if they do, they're misinformed. The profit motive does not belong in health care. Neither does expensive (and somewhat counterproductive) advertising.

I can tell you this for certain: I will never vote for another Republican in my lifetime.

hetyd4580 said...

Very interesting blog, Dr. Kaiser. I hope you are open to your readers being exposed to an alternative perspective re. Obama's generational identity.

Only very few actual experts anywhere have said that Obama is part of Generation X. By contrast, a long list of prominent experts have said that Obama is part of Generation Jones. Google Generation Jones, and you’ll see it’s gotten a ton of media attention; in fact, the Associated Press' annual Trend Report chose the Rise of Generation Jones as the #1 trend of 2009. Many top commentators from many top publications and networks (Washington Post, Time magazine, NBC, Newsweek, ABC, etc.) specifically refer to Obama as part of Generation Jones. Here is a 5 minute YouTube video with over 20 influential pundits talking about Obama as a GenJoneser: http://www.youtube.com/watch?v=1Ta_Du5K0jk

It is important to distinguish between the post-WWII demographic boom in births vs. the cultural generations born during that era. Generations are a function of the common formative experiences of its members, not the fertility rates of its parents. Many experts now believe it breaks down more or less this way:

DEMOGRAPHIC boom in babies: 1946-1964
Baby Boom GENERATION: 1942-1953
Generation Jones: 1954-1965
Generation X: 1966-1978

Here is an op-ed in USA TODAY about Obama as the first GenJones President:

Here's a page with a good overview of recent media interest in GenJones, with many media references to Obama as a GenJoneser:

wesvolk said...

hetyd4580 - If (that's "if") one were to recognize "Generation Jones" as an actual generational division, then yes, Obama would fall in that designation, which was first put forth at the 4th Turning website about 10-12 years ago, to represent the 1957-1965 cohort, so that it straddled the years before and after the Boomer/Gen X line established by Strauss and Howe of 1960/1961.

Generation Jones represents a subset, not an actual generation. It is a nice utilization of the observation that those born at the end of one generation and those born at the start of another share many common traits.

A good example is the observation that GHW Bush and Jimmy Carter, as well as Chief Justice Rehnquist - all 1924 cohorts, shared many traits with the Silent Generation, even as they were born in the last year of what Srauss and Howe labeled as a GI Generation birth year.

Generations can not be a mere 11-12 years long as you've attempted to suggest in your chart. Generations by their very nature follow birth patterns and should be a minimum of 17-18 years long, and really shouldn't exceed 24-25 years, in order to represent the turnings of our historical periods.

I prefer the Strauss & Howe generational assumptions, and readily accept the concept of subsets within. I'm a mid-'50s Boomer myself, and freely admit my subset of Boomer is different from the Bill Clinton, Hillary Clinton, GW Bush subset born 8-10 years earlier, as was Dr. Kaiser.

So, let's look at Obama as a first year Gen Xer (13er) having that 1961 birth. For me, Obama is a great indicator of how well Strauss and Howe did drawing that 1960/1961 line. I'd have been proud to consider Obama a Boomer, but contrast him with the Clintons, John Kerry, John Edwards, and you'll see how he is certainly of a different time and place.

Silent Generation, 1925-1942;
Baby Boomers, 1943-1960;
Generation X (13ers), 1961-1981 (?);
Millennials, 1982 (?) - 2003 (?)
Homelanders (New Artist Gen.), 2004 (?) - Present


hetyd4580 said...

Dr. Kaiser, I'm glad you are open to an honest discussion about these issues. So we are agreed then about the clear difference between those Obama's age vs. those who are Clinton/Gore/George W's age. So the remaining issue is whether we look at GenJones as a distinct generation or as a kind of subgeneration, which at core is a question of what defines a generation.

The clear consensus among generation experts is that generations are now getting shorter (partly because of the acceleration of culture), which is why so many of these experts now argue that generations are approximately 10-15 years long. Your claim that "Generations by their very nature follow birth patterns and should be a minimum of 17-18 years long" reflects a Strauss and Howe viewpoint which has been largely rejected by experts in this field. While S&H certainly contributed valuable insight, they made a fatal flaw by not factoring in the shortening of generation length over time. This is one of the key reasons why S&H have become less popular over the years, and has never reached anything other than a fringe/minority following.

This is why mainstream experts overwhelmingly see Obama as part of Generation Jones, and almost none (other than S&H enthusiasts) see him as an Xer. Even Neil Howe acknowledged that Obama is part of GenJones in a Washington Post op-ed last year.

Common sense should play a role here as well...does Obama really strike you as anything remotely like the stereotypic multi-pierced/tattooed slacker cynical Xer? Do Xers really write books with titles focused on "Hope"? Arguably, cynicism is the central personality trait of Xers. Does Obama really seem cynical to you? Even Obama himself has referred to himself as part of Generation Jones, and said that he is not a Boomer nor Xer.

With all respect to S&H fans, it's time to quit beating the dead horse of Obama as an Xer. It's not true no matter how enthusiastically it's said.

Seth C. Burgess said...

Another great conversation. I had never heard of this "Generation Jones" idea previously.

Anonymous said...

Health Care Reform
41% Favor Obama’s Health Care Plan, 56% Oppose
Tuesday, February 23, 2010

Voters still strongly oppose the health care reform plan proposed by President Obama and congressional Democrats and think Congress should focus instead on smaller bills that address problems individually rather than a comprehensive plan.

A new Rasmussen Reports national telephone survey finds that 41% of voters favor the proposed health care plan, while 56% oppose it. Those figures include 45% who strongly oppose the plan and just 23% who strongly favor it.


Elaine Brown from Indiana said...

Dr. Kaiser is RIGHT, and so is Carol. President Obama is dealing with a crisis that includes anywhere from 50,000 to 200,000 people dying every year in this country directly from lack of health care! Imagine if a town here in Indiana like Bedford disappeared off the map. Or what if a city the size of Ft. Wayne disappeared??? There would be a HUGE outcry! Look at what happened in Haiti (they lost over 200,000 people--and all the world is sending aid!) AND...there are 50 MILLION AMERICANS with NO health insurance!!! Can we just go on with the STATUS QUO in this country??? Remember, our President was elected because the PEOPLE Of this country VOTED him in, and because so many spoke, the Republicans weren't able to FIX the election like they did in 2000 and 2004! I read somewhere that if EVERY single registered Democrat voted, that there would NEVER be another Republican president! I think that might be true. And also remember that the President STILL has a majority of Americans supporting him! He has taken experts from EVERY side looking at our Economic crisis (which was caused by BUSH) and our health care crisis. The "party of NO" tries to block EVERY single thing that the President does. No matter WHO it would have been, even our former Senator Bayh--he would have been portrayed as a "communist", etc. because rich Repubs want to keep draining this country like they did under Bush, keeping the status quo and letting entities like insurance reap more and more and huger profits, let exec's make millions while workers make $7.00 an hour, break all the unions, send all the jobs overseas and more! In a few years, insurance costs will be over 20% of our GNP! This is unacceptable. I voted for CHANGE! And I hope and pray this will come. Screw the crap about taxes! That's what
they always holler. But change must come, or this country WON'T make it! I don't know why I waste my words though--the Republicans will NEVER change!!! They are putting this country on hold while they hold out like spoiled rich brats!!!

Anonymous said...

Ms. Brown:

where did you come up with those numbers? Care to divulge the source of it? Or you just make up the numbers as you go along?

As for assertion that a republican would never win, just look at the election of Senator Scott Brown. Enough said.

There will be much more of that in november, 2010 and beyond.

You can also take a look at the following video:


wesvolk said...

hetyd4580 - I answered your question, not Dr. Kaiser, but yes, thank you for your ideas and discussion on this.

Nevertheless, a generation IS tied to the concept of giving birth. So unless there's a whole hidden crop of 11 & 12 year olds having kids, then no, generations aren't getting shorter. It's still roughly an 18-20 year process, with approximately 80-year patterned cycles taking place - over the course of four distinctly identified generational archtypes.

I have no problem with a group of people who have commonly-shared experiences bonding and identifying themselves as a generational group. And I've already granted that early-born in a generation have differences from late-born in a generation.

But Generation Jones is not a generation. It's highly conceited of people to self-identify themselves as a generation of just 10, 11, 12 years in length, because that's who you associate yourselves with. Douglas Coupland, who coined the phrase Generation X would no longer be of that generation in your identification, yet he clearly identified the characteristics that separated Gen X from the Baby Boomers.

Strauss and Howe and the fourthturning.com website are still the predominant forces of determination for generational theory, and have hardly been mere contributors to the field, whose work is now rejected. The loss of William Strauss is still deeply felt, but those of us who earned our generational spurs following the publication of their book Generations in 1991, know where the true purveyors of truth about our generational history, future, and perceptions lie.


Anonymous said...

Dr. Kaiser:

here are some new polling numbers about Millenials.

The "Millennial Generation" of young voters played a big role in the resurgence of the Democratic Party in the 2006 and 2008 elections, but their attachment to the Democratic Party weakened markedly over the course of 2009. The Democratic advantage over the Republicans in party affiliation among young voters, including those who "lean" to a party, reached a whopping 62% to 30% margin in 2008. But by the end of 2009 this 32-point margin had shrunk to just 14 points: 54% Democrat, 40% Republican.


hetyd4580 said...

wesvolk, when you write "So unless there's a whole hidden crop of 11 & 12 year olds having kids, then no, generations aren't getting shorter", you are confusing familial generations (grandparents/children/grandchildren) with cultural generations (Boomers/Jonesers/Xers). They are completely different concepts, and while the issue you raise about the age of reproduction is completely relevant to familial generations, it has absolutely nothing to do with cultural generations.

A main reason that S&H have never been able to rise above a minority view among generation experts is an inflexibility/rigidness that doesn't allow for changing times. Most experts clearly believe that generations are getting shorter. S&H fans need to adapt to this changed reality. One can believe in S&H and also believe in GenJones, it just takes some willingness to adapt to new realities.

wesvolk said...

hetyd4650- I am a traditionalist (at least when it comes to a mere 20-year-old theory or understanding of how our cyclical history works in this country). I am obviously strongly devoted to the work of Strauss & Howe in this field, and any contemporary work is rooted in their pathfinding volumes of the 1990s.

Strauss & Howe were describing cultual generations, not familial generations, yet one has to respect the concept of the familial generation to be the root of a generation itself. Generations are based on the concept of succeeding groups of individuals' childhoods.

No generation's childhood experiences, which are the basis of your identification of a cohort group, is complete in just 10 or 11 or 12 years. Pontell's Generation Jones is simply recognizing a cohort group that intersects a truer dividing line between the Boomers and the Xers.

I did some research in differentiating the generations. Thank you for prompting me to do so. Other than specific sites that are expressly related to Generation Jones, Google or Wikipedia searches for "generations" or "cultural generations" return to Bill Strauss and Neil Howe, their theories, and their relevence today to understanding this topic. Generation Jones does not figure into these equations.

Here's a piece from Psychology Wiki on "cultural generations":

Psychology of Generations Cultural generations are cohorts of people who were born in a certain date range and share a general cultural experience of the world. Birth cohorts classified as "generations" have tended to cover periods of around 15 or 20 years (more or less the length of a childhood), with different sources establishing different ranges for them.

Some authors have noted (e.g. Neil Howe and William Strauss: The Next 20 Years: How Customer and Workforce Attitudes Will Evolve, Harvard Business Review, July-August 2007) that certain generations in history share certain common traits. For example, individualist or collectivist attitudes, or more idealistic or practical (materialistic) view of the world. In this sense we could say that in the US, GI generation was an idealist/collectivist generation, Silent generation was/is practical/collectivist, Baby boomer generation was idealist/individualist, and Generation X is practical/individualist (managerial type), whereas the latest generation Y (millennial) will again be idealist/collectivist, just as the old GI generation.

Howe and Strauss have called those 4 types prophet, nomad, hero and artist, and have claimed that they interchange cyclically in the US history, noting only one exception of a missing generation during the Civil War Crisis, when the Hero generation was lost, and after the "Gilded" (1822-1942, nomad type) generation the US gave immediately birth to an artist generation, called the "Progressive" (1843-1859).

According to them, Prophet generations are born after a great war or other crisis, during a time of rejuvenated community life and consensus around a new societal order. Nomad generations are born during a cultural renewal, a time of social ideals and spiritual agendas, when youth-fired attacks break out against the established institutional order. Hero generations are born after a spiritual awakening, during a time of individual pragmatism, self reliance, laissez-faire and national (or sectional or ethnic) chauvinism. Artist generations are born during a great war or other crisis, a time when wordly perils boil off the complexity of life, and public consensus, aggressive innstitutions and personal sacrifice prevail.


hetyd4580 said...

wesvolk, I am very familiar with S&H's work; I read Generations in 1991, and each of their books since. You are completely exaggerating their level of importance and influence.

The definition of Boomers which is still overwhelmingly the most used ends in 1964, with the most popular definition of Xers clearly starting in the mid-1960s. I think it's ridiculous to base a generation on the irrelevant variable of birth rates, and I completely disagree with that birth rate-based 1946-1964 Boomer definition, but I am able to be honest and admit that this is obviously still the most used definition.

S&H's suggested start year of 1961 for GenX is very much a minority opinion, which has never caught on in a big way. The GenJones concept is much newer, but has caught on significantly already.

Your devotion to S&H has obscured your objectivity on these issues. Any serious research on this topic reveals unequivocally that S&H's theories are not widely accepted. Most generation experts continue to reject their formulations. Most articles and books about generations certainly do not use, or even refer to, their theories.

And as far as your earlier post about Doug Coupland: yes, that's true that he is a part of GenJones, not GenX. He has himself acknowledged that he is a GenJoneser, and has also said that he was writing in his book "Generation X" about a fringe of GenJones which became the mainstream sensibility of GenX.

Anonymous said...

Dr Kaiser:

you might find this interesting:

Area author Amy Bass: W.E.B Du Bois story reflects larger issues of American history

You can see the story at: