The Atlantic Politics Channel

The Quest For 60

2009-11-22T00:40:39Z

A curated list of the 30 top #HCR Twitterers as the Senate debates health care reform legislation.

A Milestone In the Health Care Journey

2009-11-21T16:29:56Z

When I reached Jonathan Gruber on Thursday, he was working his way, page by laborious page, through the mammoth health care bill Senate Majority Leader Harry Reid had unveiled just a few hours earlier. Gruber is a leading health economist at the Massachusetts Institute of Technology who is consulted by politicians in both parties. He was one of almost two dozen top economists who sent President Obama a letter earlier this month insisting that reform won't succeed unless it "bends the curve" in the long-term growth of health care costs. And, on that front, Gruber likes what he sees in the Reid proposal. Actually he likes it a lot.

"I'm sort of a known skeptic on this stuff," Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing." Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. "The bottom line," Nichols says, "is the legislation is sending a signal that business as usual [in the medical system] is going to end."

Both the Senate bill's priority on controlling long-term health care costs, and its strategy for doing so, represents a validation for Senate Finance Committee chairman Max Baucus (D-MT). When Baucus released his health reform proposal last September, after finally terminating months of fruitless negotiations with committee Republicans, Democratic liberals excoriated his plan as a dead end. And on several important fronts--such as subsidies for the uninsured, the role of a public competitor to private insurance companies, and the contribution required from employers who don't insure their workers--Reid moved his product away from Baucus toward approaches preferred by liberals.

But the Reid bill's fiscal strategy, and its vision of how to "bend the curve," almost completely follows Baucus' path from September. Baucus' bill was the first to establish the principle that Congress could expand coverage while reducing the federal deficit; now that's the standard not only for the Senate but also the House reform legislation. And, perhaps even more importantly, the Reid bill maintains virtually all of Baucus ideas' for shifting the medical payment system away from today's fee-for-service model toward an approach that more closely links compensation for providers to results for patients. In the Reid bill, there is some backtracking from Baucus' most aggressive reform proposals, but not much.

Almost everything Baucus proposed to control long-term costs have survived into the final bill. And, with only a few exceptions, that's just about all the systemic reforms analysts from the center to the left have identified as the most promising strategies for changing the economic incentives in the medical system. (The public competitor to private insurance companies championed by the Left would affect who writes the checks in the medical system, but not what the checks are written to pay for.) Most of the other big ideas for controlling costs (such as medical malpractice reform) tend to draw support primarily among Republicans. And since virtually, if not literally, none of them plan to support the final health care bill under any circumstances, the package isn't likely to reflect much of their thinking.

In their November 17 letter to Obama, the group of economists led by Dr. Alan Garber of Stanford University, identified four pillars of fiscally-responsible health care reform. They maintained that the bill needed to include a tax on high-end "Cadillac" insurance plans; to pursue "aggressive" tests of payment reforms that will "provide incentives for physicians and hospitals to focus on quality" and provide "care that is better coordinated"; and establish an independent Medicare commission that can continuously develop and implement "new efforts to improve quality and contain costs." Finally, they said the Congressional Budget Office "must project the bill to be at least deficit neutral over the 10-year budget window and deficit reducing thereafter."

As OMB Director Peter Orszag noted in an interview, the Reid bill met all those tests. The CBO projected that the bill would reduce the federal deficit by $130 billion over its first decade and by as much as $650 billion in its second. (Conservatives, of course, consider those projections unrealistic, but CBO is the only umpire in the game, and Republicans have been happy to trumpet its analyses critical of the Democratic plans.) "Let's use the metric of that letter," said Orszag, who helped shape the health reform debate for years from his earlier posts at CBO and the Brookings Institution. "Deficit neutral; got that. Deficit-reducing second decade, got that. Excise tax: That was retained. Third is the Medicare commission: has that. Fourth is delivery system reforms, bundling payments, hospital acquired infections, readmission rates. It has that. If you go down the checklist of what they said was necessary for a fiscally responsible bill that will move us towards the health care system of the future, this passes the bar."

McClellan, the former Bush official and current director of the Engleberg Center for Health Care Reform at the Brookings Institution, was one of the economists who signed the November letter. McClellan has some very practical ideas for improving the Reid bill (more on those below), but generally he echoes Orszag's assessment of it. "It has got all four of those elements in it," McClellan said in an interview. "They kept a lot of the key elements of the Finance bill that I like. It would be good if more could be done, but this is the right direction to go."

Reid gave ground on one Baucus proposal that the economists identified as a priority-taxing high-end insurance plans. Like many health reformers, the economists who wrote Obama argue that such a tax "will help curtail the growth of private health insurance premiums by creating incentives to limit the costs of plans to a tax-free amount." Amid intense opposition from unions, Reid raised the thresholds at which family plans would face that excise tax from $21,000 to $23,000. But given all the pressure from labor, the more striking thing may have been that Reid didn't increase the thresholds even more; the CBO calculated the proposal, which the House excluded from its bill, would still raise $35 billion annually by 2019. "They held pretty strong," said one administration health care expert. "It's not like unions haven't been making the case that it shouldn't have been a much higher number."

On delivery reform, Reid stayed even closer to the Baucus blueprint. The Finance bill laid out a series of measures to change the way providers are paid for delivering care to Medicare recipients; the hope was that once Medicare instituted these reforms, private insurers would also adopt many of them. "The goal here is that the things we do in Medicare will translate over into the private sector, and there is quite a bit of historical precedence for that," said one Democratic aide involved in drafting the package.

The Baucus delivery reform ideas revolved around two central aims. One was to reward Medicare providers who deliver care more efficiently and penalize those that don't. The Reid bill upholds the major proposals Baucus offered to advance that goal. For instance, hospitals under current law must report on their performance in treating patients for common conditions like heart problems and pneumonia; under the bill, their Medicare payments, for the first time, would be affected by their ranking on those reports. Hospitals would also be penalized if they readmit too many patients after surgery or allow too many to acquire infections while in the hospital itself. Another provision would begin the process of applying such "value-based purchasing" toward other providers like hospice providers and inpatient rehabilitation facilities.

With physicians, the Reid plan takes a step back from the Finance Committee bill but still a long step beyond current law. The Finance Bill proposed automatic reimbursement reductions for doctors who order up the most care for Medicare recipients with similar medical and demographic characteristics. That was meant to respond to the research showing big disparities in spending on medical services for similarly-situated patients in different communities. But, Democratic sources say, that proposal ran into charges that it would promote rationing-and even function as "a death panel by proxy"-by compelling doctors to arbitrarily reduce care. So the final bill takes a less direct route toward a similar end. It requires Medicare to begin studying the utilization patterns of doctors participating in the program. And then it establishes a "values based payment modifier" that would, in a budget-neutral manner, increase reimbursements for physicians found to deliver high-quality care at lower cost, and reduce them for physicians at the other end of that spectrum. "It will, we believe, have the same net effect [as the original proposal]," said the Democratic aide. "It should change behavior around that threshold."

The other set of Baucus proposals were intended to promote more coordination among providers. These have survived almost verbatim into the final bill. The bill encourages groups of providers to establish doctor-led "accountable care organizations" to more comprehensively manage patients' care by allowing them to share in any savings for Medicare they produce. It also establishes a voluntary national pilot of "bundled" payments that would encourage hospitals, doctors and other providers to work more closely together. Another pilot program would test coordinated home-based care for chronically ill seniors.

Finally, the Reid bill maintains the two powerful institutions the Finance legislation proposed to promote these reforms and develop new ones. The one that's attracted the most attention is an independent "Medicare Advisory Board." Under the Senate bill, that board would be required to offer cost-saving proposals when Medicare spending rises too fast; Congress could not reject its proposals without substituting equivalent savings. Since the board would be prohibited from offering changes that raise taxes or "ration care," and since the legislation initially exempts hospitals from its recommendations, it could choose to promote the sort of payment reforms the bill establishes. (More prosaically it might also clear away some of the expensive coverage mandates that Congress imposes on Medicare under pressure from different elements of the medical industry). Given the limitations imposed on the commission, an equally important means to expand these reforms might be a second institution the legislation creates: a Center for Medicare and Medicaid Innovation in the Health and Human Services Department. Though this center has received much less attention than the Medicare Commission, it could have a comparable effect. It would receive $1 billion annually to test payment reforms; in a little known provision, the bill authorizes the HHS Secretary to implement nationwide, without any congressional action, any reform that department actuaries certify will reduce long-term spending. While the House bill omitted the Medicare Commission (a top priority for Obama) it included the innovation center.

No one can say for certain that these initiatives will improve efficiency enough to slow the growth in health care spending. Some are only pilots; others would affect only a small portion of providers' revenue from Medicare. CBO typically evaluates them skeptically: it generally scores little or no savings from most of them. Former CBO director Robert Reischauer, who signed the November 17 letter, says that's not surprising. "CBO is there to score savings for which we have a high degree of confidence that they will materialize," says Reischauer, now president of the Urban Institute. "There are many promising approaches [in these reform ideas] but you...can't deposit them in the bank." In the long run, Reischauer says, it's likely "that maybe half of them, or a third of them, will prove to be successful. But that would be very important."

While generally supportive of Reid's approach, McClellan, the former Medicare administrator under Bush, offered several specific ideas for strengthening it. He says the Senate should improve the capacity of HHS to more quickly evaluate whether the payment reforms are working, and also to provide data and technical assistance to new physician groups like the accountable care organizations that will be attempting to better coordinate care. "Ideally you'd both be able to tell the organizations involved and Congress what is working or not, and give the organizations the feedback and data they need to know whether they are doing a good job," he says. McClellan also believes that the plan needs sharper sticks-tougher penalties on providers who don't provide efficient and effective care. "There are a lot of carrots and not so many sticks," he maintains. Of course, tougher penalties might provoke more opposition from provider groups like hospitals and physicians now tenuously supporting the legislation.
[[McClellan stands at the forefront of centrist Republican thinking on health. Even the more ideologically conservative health care thinkers to his right generally don't oppose long-term reform ideas like bundling payments (John McCain promoted that during his presidential campaign). But they tend to view them as insufficient or tangential to the real problem. Their view highlights a fundamental difference between the parties' on health care. To save costs, Democrats mostly want to change the incentives for providers. Republicans mostly want to change the incentives for patients by shifting toward a model where insurance covers only catastrophic expenses and people pay for more routine care from tax-favored health savings accounts. In essence, the Republican view is that the best way to hold down long-term costs is to directly expose patients to more of them. Few Democrats accept that logic though and it has little influence on either chamber's legislation.

Another Republican cost-containment priority missing from the bill is meaningful medical malpractice reform. (The bill only encourages states to think about it.) Nichols, of the centrist New America Foundation, would like to see that included as well. Its omission is one reason he says he gives the plan a "b" rather than an "a"; the other is he'd like to see mechanisms to more quickly diffuse into the private insurance system reforms that show promise in Medicare. Democratic sources say a group of centrist Democrats led by Virginia Senator Mark Warner is trying to devise a package designed to do just that, perhaps by expanding the role of the independent Medicare advisory commission.

The attempt in all these ideas to nudge the medical system away from fee-for-service medicine toward an approach that ties compensation more closely to results captures how much the health care debate has shifted toward cost-control. So far, the rise in health care spending has proven almost invulnerable to every previous attempt to tame it, like the managed care revolution in the 1990s. Even if Obama signs into law a final bill embodying all these reform proposals, many skeptics wonder if they can bend, much less break, the seemingly inexorable increase in health care spending. Reischauer understands that skepticism, but isn't able to entirely suppress a kernel of optimism that this latest reform agenda may prove more effective than its predecessors. "One never knows whether we're turning the corner or if this is just playing the same old game for another inning," he says. "But I sense there's something different out there. I think the medical profession and its leaders have read the handwriting on the wall and are trying to evolve." If so, the ideas the Senate will begin voting on tonight could mark a milestone in that journey.

Question Of The Weekend: How Important Is The Vote?

2009-11-21T13:30:10Z

How important is Saturday's Senate vote on health care reform, given that a "yes" would simply mean that debate starts nine days later, and that "no" would mean health care fails its first test and Reid is probably forced to change parts of his bill?

The Resetting of Afghan-U.S. Diplomacy

2009-11-20T20:12:16Z

No one felt very good about Thursday's inauguration of Afghan President Hamid Karzai's second term. The White House, recognizing the necessity of a close ally in Kabul but the need for our complicated relationship with Karzai to change, is hitting reset. The Washington Post's Rajiv Chandrasekaran explains our "softer approach" to be led by Secretary of State Hillary Clinton:

[T]op diplomats and generals are abandoning for now their get-tough tactics with Karzai and attempting to forge a far warmer relationship. They recognize that their initial strategy may have done more harm than good, fueling stress and anger in a beleaguered, conspiracy-minded leader whom the U.S. government needs as a partner.

The new approach, which one official described as a "reset" of the relationship, will entail more engagement with members of Karzai's cabinet and provincial governors, officials said, because they have concluded that the Afghan president lacks the political clout in his highly decentralized nation to purge corrupt local warlords and power brokers. The CIA has sent a longtime field officer close to Karzai to be the new station chief in Kabul. And State Department envoy Richard C. Holbrooke, whose aggressive style has infuriated the Afghan leader at times, is devoting more attention to shaping policy in Washington and marshaling international support for reconstruction and development programs.

President Obama's war strategy has typically treated Karzai as more like part of the problem than part of the solution. Replacing hard-charging Special Envoy Richard Holbrooke with higher-ranking Clinton, who is showing more deference to Karzai, as Karzai's point contact positions him as less a subordinate nuisance and more a strategic partner. This shift, as well as the increased attention U.S. officials are giving to the Afghan government at all levels, implies some serious changes. It sets up the U.S. as not just a counter-terrorism, counterinsurgency force, but a long-term partner in building Afghan government and civil society. It suggests out mission in Afghanistan will be as much or more focused on Afghan governance and political stability as on finding and killing the Taliban.

The military looks to be on board as well. Secretary of Defense Robert Gates yesterday said, "improvements in governance in Afghanistan will be evolutionary. We are not going to go from a situation where we have a fair amount of dissatisfaction now to believing that these problems have been solved in two weeks or a month, or on the basis of a single speech." Gates appears to be signaling his attention to and participation in a long-haul approach that makes governance a top priority. "[C]orruption and a lack of good government -- governance --are real impediments to the success of both the Afghan government and our own efforts." It's one thing for Holbrooke or Clinton to care about governance, but Gates focusing on governance suggests that the military and nation-building missions in Afghanistan will go very much hand-in-hand.

As President Obama nears his decision on increasing troop levels in Afghanistan, the implication here isn't as much about numbers as duration. Everyone agrees that building civil society in a place that has none will take years, and if the military is a part of that, it would imply a long-term military presence. In a Q&A on Tuesday with USA Today, Senator John Kerry, chairman of the Senate Foreign Relations committee, anticipated "four to five years" before an exit.

What Giuliani 2012 Would Look Like

2009-11-20T20:11:10Z

The New York Daily News suggested Thursday that, according to one source, former New York Mayor Rudy Giuliani might use a run for Senate--if he wins--as a launching pad for taking another stab at the White House in 2012.

Giuliani's 2008 presidential campaign went down in flames, more or less, but he remains a nationally recognized figure with a respectable support base. So, in light of this speculation, why not engage in some more, and ask what a Giuliani presidential campaign in 2012 would look like?
If Giuliani entered a Republican primary field, it would, unavoidably, introduce a very significant element into the campaign: he would be the only Republican presidential candidate not running hard to the right.

As conservatives have mobilized this year against President Obama's economic agenda--and against Obama himself--there is a tremendous amount of fiscal-conservative energy within the right's ranks, with a strong movement to purge centrists from the GOP. And 2012 contenders know it: the conservative grassroots provide a source of energy that candidates want (and will want) to tap.

Nor do they want that conservative energy to turn against them: they've seen how conservatives have mobilized, nationally, to attack Gov. Charlie Crist (R) in Florida, and no one wants to become the Charlie Crist of the national political scene. Tea Partiers and Freedom Works activists will look to mobilize across the country in 2010 races, and that could prove a test run for conservative grassroots influence in 2012.

Hence, most candidates fear and respect the thus-untamed Tea Party hydra.

Giuliani, on the other hand, has already faced attacks from the right. He stood onstage with Mitt Romney, Mike Huckabee, and Fred Thompson at a GOP primary debate and explained that he's pro-choice. It's a hump he's already gotten over: conservatives know where Giuliani stands, and many of them know they don't like him. But the critical moment, for him, has passed.

In that regard, he would provide Republicans with what could be their only centrist alternative in 2012.

There's one notable exception, however: Newt Gingrich, who has pressed for pragmatic, centrist candidates to be embraced by the GOP.

Giuliani was a solid contender in 2008--at first. Before the Iowa caucuses and the New Hampshire primary drew closer, Giuliani carried roughly the same national weight as his two chief rivals of the early primary: John McCain and Mitt Romney.

What did him in, plain and simple, was his Florida strategy. Not running in Iowa or New Hampshire--while setting up shop in Florida, and putting all his eggs in that basket--essentially cost him his shot at the White House.

"My instincts originally were, if you lose, you gotta go down fighting. You can't allow yourself to lose a primary. I think I should've fought Iowa harder. That was the beginning of becoming irrelevant," Giuliani told New York Magazine in October of this year.

Running a second time around, that strategy would likely go out the window. While Giuliani said he should have run harder in Iowa, New Hampshire might prove a better fit, given that he's more recognizable in the Northeast.

But Giuliani knows how to run a national campaign. He's pro-business, and his talking points include slashing the New York City budget and incentivizing businesses to hire more workers through tax cuts.

It probably won't be Giuliani's season. Most of the energy on the right involves conservatism--and ideological conservatism at that. Giuliani's main selling point is his competence as a manager. That's not at a premium right now among conservatives--but you never know whether or not it will be in 2012, especially if the rest of President Obama's first term goes badly.

But with most of the candidates vying for the conservative mantel in 2012--vying harder than they did in 2008, when the maverick John McCain presented an opportunity for the GOP to gather moderate independent votes in the general election--Giuliani would be the odd man out.

It's impossible to say how likely that is, but it would, at least, be interesting to see.

Cleaning the Inbox on Fridays

2009-11-20T19:26:22Z

Pretty interesting polling numbers for Sen. Blanche Lincoln and John McCain. Throw in the trouble brewing in SC for Lindsay Graham, and that poll after poll, and Tim Geinther's pounding on The Hill, shows people think government is helping Wall Street and big corporations and not them, and you have wonder when the Democratic unity damn breaks wide open and everyone runs for cover.

The Four Holdouts -- Lieberman, Lincoln, Mary Landreiu and Ben Nelson. The most compelling Saturday night drama since ... the Golden Girls. Actually, Ben Nelson is out. He's actually in. He'll vote to allow debate to proceed. And since it's been revealed that Landreiu wants Harry Reid to raise money for her next month, let's presume she's a "yes" vote. And Lieberman ... is Lieberman.

A victory for Ron Wyden: a version of his "Free Choice" amendment will appear in the Senate health care bill. Under the legislation now, Americans "with employer-provided coverage, whose income is below 400 percent of the federal poverty level and whose premiums are between 8 and 9.8 percent of their total income will be exempt from having to purchase health coverage but will not be able to access the exchange to qualify for government assistance to purchase insurance. " Wyden's amendment means that these folks can use their employer health subsidies -- currently tax free -- to buy an insurance plan in the exchange.

This: well -- it's been a month of sausage making, and as we learned in July, when the sausage is in the oven, Obama can't escape the taint of partisanship that Americans seem to be rebelling against.

SarahPAC Sells "Going Rogue"

2009-11-20T19:22:38Z

In case your local Barnes & Noble is out of Sarah Palin's "Going Rogue: An American Story"...or in case you don't want to wait in line for a signature, don't worry: there's another way. Palin's political group, SarahPAC, is selling signed copies for donations of $100 or more. It just sent out an email notifying supporters that the offer ends Wednesday, Nov. 25 at noon Eastern.

This allows Palin to make extra money off the book for her political efforts, accruing some financial capital for SarahPAC along with any political capital she gets from her signing tour and media blitz.

For Your Entertainment: Zolitics

2009-11-20T19:21:06Z

From the political consultants who brought you Rick Santorum and Tom Ridge, a behind-the-scenes moc-u-mentary of American politics: Zolitics presents Moving Numbers. I like to call it Rick Brabender gone wild. Love the Frank Luntz in-jokes.

Moving Numbers Episode 2: "Whatever It Takes" from Zolitics on Vimeo.

Obama Dips To 49

2009-11-20T19:08:43Z

President Obama's job approval rating has dipped to 49 percent in the most recent numbers from Gallup--the lowest number Gallup has given him since his inauguration. It makes him the fourth fastest president, since Gallup started keeping track of Truman, to fall below 50 percent--behind Ford (3 months), Clinton (4 months), and Reagan (also 10 months, but sooner).

It's not his lowest approval number--Zogby put him at 42 percent in August, and Harris reported him at 45 percent in October--but Gallup has usually given him the friendliest numbers of any polling agency, which is what makes this number significant.

Specter Thinks They'll Get To 60

2009-11-20T18:43:45Z

Sen. Arlen Specter (D-PA), who knows a thing or two about being a swing vote in the Senate on major pieces of legislation, says he thinks Democratic leaders will get the 60 votes needed to advance health care reform in its first vote on Saturday. "Getting 60 votes is never easy, but I believe we'll get the 60 votes. Frequently, senators will vote for cloture to start the debate, reserve judgment depending upon how the amendments go," Specter told MSNBC. But Specter has been considered a key swing vote--with margins equally narrow to those on health care--on both the stimulus and the Employee Free Choice Act, so he speaks from a position of some authority here.

Labor Vs. Chamber: Swine Flu Sick Days

2009-11-20T17:55:47Z

It's the next round in the ongoing battle between organized labor and the U.S. Chamber of Commerce: paid sick leave in light of the swine flu epidemic.

Labor has long supported mandatory paid sick leave. Now, in light of the H1N1 flu epidemic, labor and labor-friendly Democrats are trying to pass legislation through Congress that would mandate paid sick leave for American workers--they could earn up to 7 days under a bill proposed by Rep. Rosa DeLauro (D-CA), the Senate analogue of which was introduced by Sen. Chris Dodd (D-CT). DeLauro's bill would only apply to businesses that employ 15 or more workers.
Supporters of the legislation are presenting it as an emergency response to swine flu, as more Americans are getting sick this year but don't get paid for their time off. They make a health argument for the policy, too: if a food-service-industry worker, for instance, gets swine flu but can't afford to miss work, it puts more people at risk of infection.

That said, it's an effort to pass a general sick-leave policy: it's not that people who get swine flu would get extra sick days--it's that everyone would get sick days, which labor has wanted for a long time.

As part of this push, the Service Employees International Union has launched an online petition against the Chamber. "Despite widespread support for this measure, the U.S. Chamber is trying to kill it," SEIU says.

The Chamber says it does not oppose the legislation and that DeLauro has proposed and that the it doesn't have a policy on mandatory paid sick leave. It also accuses SEIU of using inaccurate data on how many Americans have paid sick leave: SEIU says 30 percent; the Chamber says 83 percent.

Like Yankees vs. Red Sox, Yin vs. Yang, and Spy vs. Spy, the labor/Chamber feud is a contrast in structural opposites that may actually never end, progressing through the ages until both are locked in deadly combat as the last escape vessel leaves the imploding Earth...nor would our political world be complete without it.

Sick leave is not a new battleground, but the H1N1 epidemic has brought it back into the fore.

How Clinton Came To Be Secretary Of State

2009-11-20T16:31:47Z

Jonathan Van Meter profiles Hillary Clinton in the latest issue of Vogue, and he's got some nice tidbits about how Clinton came to be Secretary of State. With all the post-primary bitterness between the two camps, and all the speculation that she might be named VP, Clinton was apparently quite surprised to be offered the job at State:

"I was stunned after the election when President Obama asked me to consider this," she says. "I really was very unconvinced. I did not think it was the right thing to do. I didn't want to do it. I just really had a lot of doubts, and I kept suggesting other people: Well, how about this person! How about that person! This one would be really good! But then a friend of mine called me and basically said, 'How would you have felt if you'd been elected and you'd called him and asked him to do this?' And that really made a big impression on me. How do you say no? And so...I said yes. And here I am." She laughs and picks up her fork and stabs a kiwi out of her fruit salad and pops it in her mouth.

And it was President Obama himself who did most of the legwork in convincing her: some of her aides were certain, up until the last minute, that she would say "no," but Obama swayed her back each time:

Each time Clinton wavered, Obama would talk her through it again. "At the end of the day," says one of her aides, "it was the president who sold her on it. He didn't delegate it." Says another staffer, "They started talking about it substantively, looking around the globe, and they were basically in the same place. The things they disagreed about in the campaign? We didn't believe he was actually going to have coffee with Ahmadinejad. It was something he shouldn't have said in the campaign, and we pounced on it. The tiny differences in their foreign-policy ideas during the primaries evaporated during the general election."...

What finally changed her mind? "Obama wouldn't take no for an answer, and he was just very smart with her," says one of her aides. "He talked about it from the right place in the right way, helping her imagine what it would be like. And she said, OK, well, let's think about it some more. Eventually he was successful at convincing her. He would not let her off the hook. Knowing her and having worked with her--that button got pushed, that we-need-you-to-serve-your-country button."

And now, here she is. One can't help but think that things have worked out, politically: despite the initial rumblings about her portfolio not being big enough--and that the appointment of special envoys Richard Holbrooke and George Mitchell to Afghanistan/Pakistan and the Middle East had usurped some of her eminence and authority--Clinton is now in a position of doing real, important, and sometimes glamorous work, and the talk of disaffected PUMAs has pretty much gone away. Which might not be the case if she'd said "no."

How Popular Is Palin?

2009-11-20T15:17:57Z

The conventional wisdom on Sarah Palin is that she's a divisive figure, and, from what polls tell us, that's true: according to Pollster.com's average, 38 percent of Americans hold a favorable view of her, while 49.2 percent view her unfavorably. So she's in minus territory--11.2 percent more Americans view her negatively than positively--which is bad for any politician running for office (if indeed she is).

That's worse than other top-tier 2012 contenders, too, whose favorable/unfavorable splits, according to the same average, are 36.9 / 27.3 for Mitt Romney and 44.6 / 23/9 for Mike Huckabee.

But among Republicans, she does quite well, outperforming her two chief rivals.
According to a new Fox poll--the first major poll on Palin since her book release and media blitz--a full 70 percent of Republicans view her favorably, while 21 percent view her unfavorably. Huckabee, meanwhile, collects 63 percent favorable vs. 28 percent unfavorable; Romney gets 60 percent favorable vs. 20 percent unfavorable.

The Fox poll also gives her a better overall favorability picture: among all 900 registered voters in the sample, 47 percent viewed her favorably vs. 42 percent unfavorably.

So it's possible the book, the signing tour, and the media blitz have helped her. (Or it's possible Fox's poll was just particularly friendly to her).

ABC's polling, conducted before the book release, showed her at 76 percent favorable among Republicans. CBS, meanwhile, gave her a 52 percent favorable rating among GOPers, with 16 percent unfavorable and 32 percent undecided--a much larger quotient than in the other polls, which sometimes indicates that the surveyors didn't press respondents as hard.

To compare this to the president: at the height of his post-election popularity, President Obama topped out at 79 percent among all Americans. Right now, according to Quinnipiac, 87 percent of Democrats view him favorably.

So while Palin may be a divisive figure to the whole of the American public, that's not the case among Republicans. Perhaps this will come to bear in 2012.

Question Of The Day: Will It Pass

2009-11-20T11:30:11Z

The Senate will vote on Majority Leader Harry Reid's health care package on Saturday. Will it pass? If it doesn't, how big of a setback will it be to Democratic health reform?

The Rundown, 11/20

2009-11-20T11:00:28Z

It's Friday! The day that Congress goes home for a nice, long weekend of reconnoitering with constituents and...except there's a health care bill to consider. The Senate will stay in DC today--and tomorrow--for a Saturday vote on Senate Majority Leader Harry Reid's health care bill.

In the meantime, Democratic leaders will be busy trying to secure votes from the moderate members of their caucus. Sen. Mary Landrieu (D-LA) has said she will announce today whether or not she'll vote to close debate and bring the bill to an up-or-down vote.
The Senate Finance committee will consider two nominations--Mary John Miller as an assistant Treasury secretary and Charles Collyns as a deputy undersecretary at Treasury--while the House Financial Services Committee will mark up the Financial Stability Improvement Act, plus a bill debit card holders should be cheering for: a bill to restrict credit card overdraft fees.

In Foreign policy news, diplomats from the U.S., Britain, China, France, and Russia will meet in Brussels today to develop a new package of sanctions on the dreaded Iran.

The Sarah Palin book-signing extravaganza tour continues today with stops in Cincinnati and Columbus, Ohio. She drew over 750 to an event in Noblesville, Indiana yesterday--we'll see if she can keep up that pace in the swing state of Ohio.

And it's National Adoption Day tomorrow. Health and Human Services Secretary Kathleen Sebelius will host a ceremony today in Washington, DC to commemorate it.