Obsidian Wings

Medicare Part D: Damage

by hilzoy

I remember the day my attitude towards William Weld shifted from a mild dislike to active antipathy. It was back in the mid 80s, when Weld was Governor of Massachusetts. He had recently proposed a drastic change in Massachusetts' housing policy, which, many people feared, would lead to a lot of people winding up homeless. (I think it was a drastic curtailment of section 8 funds, but I could be wrong. I was spending a lot of time with housing policy wonks back then -- a bunch of very smart, very well-informed people, mostly centrists, to whom good evidence-based policy mattered a lot more than ideological correctness -- and they were all terrified about what the change would do.) One day Weld was asked about the possibility that his program would leave a lot of families homeless, and he said, in this absolutely cavalier way, that if it turned out that a lot of people were thrown out onto the street, he'd just change the program back the next year. (The 'cavalier way' is crucial here: I could imagine someone expressing doubts about the program, and explaining why he'd chosen to support it in a way that did justice to the problems it might cause. That would not have disturbed me in the same way. What bothered me was that Weld's response was not thoughtful; it was flippant.)

As though just changing the program back again would be enough. As though that would make things all better again.

I thought: consider a family who were, as they say, working hard and playing by the rules, who were just barely making ends meet with help from Section 8 (or whatever it was), and who, as a result of this change, lost their home. Consider the effects on their children, who have to try, somehow, to get their homework done in a van or a homeless shelter. Consider the fights that might erupt between the parents as a result of the stress and misery of trying to figure out how to keep their family together on the streets. Marriages break up over less, and it's hard to imagine that the stress alone wouldn't take a serious toll on everyone around, including the kids. Consider the humiliation, for the parents, of having to take their kids to shelters and food banks, and the cost to the kids whenever one of their classmates asked: so, where do you live? (This is supposing they stayed in school. If not, consider the cost to them of dropping out or missing large chunks of school time.) Consider the impacts on their health of life on the streets. Think of all the damage that living on the street would do to a family.

Now imagine William Weld saying: Oops! my bad!, and changing the program back. This family might reapply for assistance, and in a few years might get it. But an enormous amount of damage would have been done to them in the meantime. Life on the streets is not good for anyone, especially for children. You don't have to be some sort of miracle of empathy to recognize this. And the contrast between the thought of that damage and Weld's completely cavalier attitude to it just enraged me.

I feel the same way about Medicare Part D. Because a lot of the damage that will be done to people as a result of Medicare Part D is like the damage done to a family by becoming homeless in this respect: you can't just wave a magic wand and make things better again once you realize your mistake. The damage is permanent, and it cannot be undone. And that makes the thoughtless, cavalier way in which this policy was written and adopted completely outrageous.

More Fun From Medicare Part D

by hilzoy

Tomorrow's NYT has an article about the problems poor people with mental illnesses are having with the new Medicare prescription drug plan. It's not pretty:

"On the seventh day of the new Medicare drug benefit, Stephen Starnes began hearing voices again, ominous voices, and he started to beg for the medications he had been taking for 10 years. But his pharmacy could not get approval from his Medicare drug plan, so Mr. Starnes was admitted to a hospital here for treatment of paranoid schizophrenia.

Mr. Starnes, 49, lives in Dayspring Village, a former motel that is licensed by the State of Florida as an assisted living center for people with mental illness. When he gets his medications, he is stable.

"Without them," he said, "I get aggravated at myself, I have terrible pain in my gut, I feel as if I am freezing one moment and burning up the next moment. I go haywire, and I want to hurt myself."

Mix-ups in the first weeks of the Medicare drug benefit have vexed many beneficiaries and pharmacists. Dr. Steven S. Sharfstein, president of the American Psychiatric Association, said the transition from Medicaid to Medicare had had a particularly severe impact on low-income patients with serious, persistent mental illnesses. "Relapse, rehospitalization and disruption of essential treatment are some of the consequences," Dr. Sharfstein said. (...)

At Dayspring Village, in the northeast corner of Florida near Jacksonville, the 80 residents depend heavily on medications. They line up for their medicines three times a day. Members of the staff, standing at a counter, dispense the pills through a window that looks like the ticket booth at a movie theater. Most of the residents are on Medicare, because they have disabilities, and Medicaid, because they have low incomes. Before Jan. 1, the state's Medicaid program covered their drugs at no charge. Since then, the residents have been covered by a private insurance company under contract to Medicare.

For the first time, residents of Dayspring Village found this month that they were being charged co-payments for their drugs, typically $3 for each prescription. The residents take an average of eight or nine drugs, so the co-payments can take a large share of their cash allowance, which is $54 a month. Even after the insurer agreed to relax "prior authorization" requirements for a month, it was charging high co-payments for some drugs - $52 apiece for Abilify, an anti-psychotic medicine, and Depakote, a mood stabilizer used in treating bipolar disorder.

The patients take antipsychotic drugs for schizophrenia; more drugs to treat side effects of those drugs, like tremors and insomnia; and still other drugs to treat chronic conditions like diabetes and high blood pressure.

"If I didn't have any of those medications, I would probably be institutionalized for the rest of my life," said Deborah Ann Katz, a 36-year-old Medicare beneficiary at Dayspring. "I'd be hallucinating, hearing voices.""

Great: we have people who get a $54 monthly cash allowance being charged a $52 copay for one prescription. But wait: it gets better! Consider the experience of looking through all those different prescription drug plans, each with their different copays and deductibles and formularies, deciding which to choose. Perfectly sane people with backgrounds in the health professions have said they find it almost impossibly confusing. Try to imagine how it strikes someone with a serious mental illness:

"Sponsors of the 2003 Medicare law wanted to drive down costs by creating a competitive market for drug insurance. They focused on older Americans, not the disabled. They assumed that beneficiaries would sort through various drug plans to find the one that best met their needs. But that assumption appears unrealistic for people at Dayspring Village.

Heidi L. Fretheim, a case manager for Dayspring residents, said: "If I take them shopping at Wal-Mart, the experience is overwhelming for them. They get nervous. They think the clerks are plotting against them, or out to hurt them."

Residents of Dayspring Village see worms in their food. Some neglect personal hygiene because they hear voices in the shower. When nurses draw blood, some patients want the laboratory to return it so the blood can be put back in their veins.

Under the 2003 Medicare law, low-income people entitled to both Medicare and Medicaid are exempted from all co-payments if they live in a nursing home. But the exemption does not apply to people in assisted living centers like Dayspring Village. (...)

"We are all aware that the next couple of months will be difficult for these clients, and that the possibility of a transition to a nursing home is their only option if prescriptions are not covered in assisted living facilities," Ms. Medina said in a memorandum to local social service agencies.

Luis E. Collazo, administrator of Palm Breeze, an assisted living center for the mentally ill in Hialeah, Fla., said many of his residents were forgoing their medications on account of the new co-payments. "Because of their mental illness," Mr. Collazo said, "they don't have the insight to realize the consequences of not taking their medications. Without their medicines, they will definitely go into the hospital.""

And who do you suppose will pay for their hospitalization, or for their stay in a more expensive nursing home? We, the taxpayers, of course. Not that that will begin to make up for the damage done to those mentally ill patients by going completely psychotic. That damage will not be made whole.

Paul Krugman reminds us (sorry, TimesSelect) how we got into this mess:

"Consider the career trajectories of the two men who played the most important role in putting together the Medicare legislation.

Thomas Scully was a hospital industry lobbyist before President Bush appointed him to run Medicare. In that job, Mr. Scully famously threatened to fire his chief actuary if he told Congress the truth about cost projections for the Medicare drug program.

Mr. Scully had good reasons not to let anything stand in the way of the drug bill. He had received a special ethics waiver from his superiors allowing him to negotiate for future jobs with lobbying and investment firms - firms that had a strong financial stake in the form of the bill - while still in public office. He left public service, if that's what it was, almost as soon as the bill was passed, and is once again a lobbyist, now for drug companies.

Meanwhile, Representative Billy Tauzin, the bill's point man on Capitol Hill, quickly left Congress once the bill was passed to become president of Pharmaceutical Research and Manufacturers of America, the powerful drug industry lobby.

Surely both men's decisions while in office were influenced by the desire to please their potential future employers. And that undue influence explains why the drug legislation is such a mess."

But besides Scully and Tauzin, the Congressional Republican leadership, who drove this bill, and President Bush, who signed it, surely deserve a lot of the blame for how it has turned out. If the patients at Dayspring Village who used to imagine that the clerks at WalMart were out to get them start having paranoid fantasies involving members of Congress who are willing to sacrifice the sanity, and perhaps the lives, of Medicare's most vulnerable recipients just to gratify their contributors and to be able to gain a short-term advantage in the 2004 elections, they will not be wrong. Just because you're a paranoid schizophrenic doesn't mean they aren't out to get you.

At some point traveling for business stopped being fun

An overlong deposition and an unexpected Friday night spent alone in San Francisco.  It's OK.  It's what attorneys do sometimes. 

This is an open thread.  There's more after the break, if you've got time to kill.

Know Hue?

In response to Macallan's illuminating post on the passing of Hugh Thompson (the whistleblower who helped expose Lt. James Calley and the My Lai massacre), I wrote in comments that the war crimes we committed at My Lai were atrocious, but they paled before the atrocities of the North Vietnamese, citing as an example the slaughter of 5,500 civilians by the North Vietnamese at Hue during the Tet offensive. The American people have heard plenty of our war crimes but little of the war crimes committed against the Americans and the inhabitants of South Vietnam by the North Vietnamese communists and their southern fellow travelers. A commenter disputed my claim on the number of civilian casualties so, using the free Internet sources I could muster, I investigated.

Maryland Court Strikes Down Laws Against Gay Marriage

by hilzoy

From my hometown paper:

"A Baltimore Circuit Court judge today struck down Maryland's 33-year-old law against same-sex marriage, ruling in favor of 19 gay men and women who contended the prohibition violated the state's equal rights amendments.

Anticipating that her decision eventually would be appealed to Maryland's highest court, the Court of Appeals, Judge M. Brooke Murdock stayed action on her ruling pending that appeal.

"After much study and serious reflection, this court holds that Maryland's statutory prohibition against same-sex marriage cannot withstand this constitutional challenge," Murdock wrote in her decision."

The decision is here. It turns on this provision of the Maryland Constitution:

"Art. 46. Equality of rights under the law shall not be abridged or denied because of sex."

(Parenthetically: this is the first time I've actually read the Maryland Constitution. Besides the equal rights amendment, it contains this: "the doctrine of non-resistance against arbitrary power and oppression is absurd, slavish and destructive of the good and happiness of mankind." I love the Revolutionary generation.)

As far as I can tell, the main question on which the decision depends is this: is a prohibition on same-sex marriage best understood as (a) a prohibition on marrying persons of one's own gender, which applies equally to men and women, or (b) a prohibition (for men) on marrying men, even though women can marry them, and a prohibition (for women) on marrying women, even though men can marry them? In practice, its effect will always be to prevent a given man or woman from marrying someone else, just because he or she is of the wrong sex, but is it best understood as one prohibition that applies to everyone, or as two prohibitions that are illegitimate, because based on sex?

The opinion argues, I thought rather persuasively, that the first interpretation of prohibitions on marrying someone of a different race had been considered and rejected in Loving v. Virginia. That is: one could understand miscegenation laws as not being discriminatory: after all, everyone gets to marry someone of the same race as themselves, and no one gets to marry someone of a different race. So what's the problem? The Supreme Court said that this was wrong: that miscegenation laws are, in fact, discriminatory, and cannot stand. The court in this case argued that if Loving is right, then it's equally implausible to regard a ban on same-sex marriage as non-discriminatory (since everyone gets to marry people of the opposite sex, and no one gets to marry people of the same sex.) Rather, it held, when the law tells Edward or Sebastian: you cannot marry your lovers, even though hilzoy could, and the reason you can't and she can is just that she is female and your lovers are male, it is discriminating against them on the basis of their gender.

It's quite interesting. I have no idea whether there is some body of case law interpreting Loving that shows this opinion to be hogwash, or whatever, but it seemed convincing to me.

And I'm glad my state is, one way or the other, getting on board. (Preemptive note: I would not be glad to see it getting on board via a court decision if I did not believe that the case was, as best I can tell in my non-lawyerly way, correctly decided. For what it's worth, I read the Maryland Constitution first, to keep myself honest, and thought I couldn't see a justification for striking the laws down. I was therefore prepared to think this was a bad ruling, but was persuaded by the court's reasoning about Loving and similar cases.)

OMG...They're Coming For Us Where We Live Now!

Long-time readers may recall my painful confession from many moons ago that I am terrified of whales. I don't know why, it's totally irrational...they live in the ocean, I live inland. Or at least it used to be that way:

A lost and likely sick whale swam up the River Thames past Parliament and Big Ben in central London on Friday, attracting huge crowds and a police boat escort before nearly beaching itself on the shallow riverbank.

The Northern bottlenose whale appeared to be about 20 feet long, witnesses said. The whale, which usually is found in the cold waters of the North Atlantic, was about 40 miles from the mouth of the Thames on the North Sea.

Tom Howard-Vyne said he saw the marine mammal swim under Westminster Bridge near Big Ben.

"I saw it blow. It was a spout of water which sparkled in the air," he said. "It was an amazing sight."

TV stations followed the marine mammal with live coverage as it wandered into shallow water near the muddy banks of the tidal waterway. The whale appeared to get stuck several times, and officials wearing yellow jackets could be seen running up and down the shoreline at low tide trying to push it back into deeper water.

I'm not falling for that whole "Oh poor me, I'm not well" ruse it's got going on either. They're coming inland to get us people!

I'm moving to Kansas.

One in Hope and Doctrine, One in Charity

By Edward_

In visting my family at Christmas in Ohio, a hotbed of Evangelical Christian American ideology if ever there was one, I noticed a remarkable shift in the attitudes there this year. On previous trips, I had been simply bullied back to New York. The Religious Right was on the rise, and nothing was going to stop it. Now, however, it appears that having scaled that mountain of political power and surveyed their new domain from the top, the Religous Right are catching a glimpse of themselves they can't quite stomach.

Perhaps they caught a clear reflection of themselves in the placid lake below, or perhaps it is indeed just really lonely up there, I don't know. But I do know that the bombastic arrogance and in-your-face confrontation I had experienced in Ohio over the previous 4 years or so has given way to something much less assertive...something bordering on a mix of self-disgust and desire for approval. It's expressing itself in such a way as to suggest that having gained all that power, the Religous Right now wants to be loved as well, or forgiven, it's hard to tell. One clue that it's a desire to be forgiven comes in The New York Times Op-Ed by Charles Marsh today:

In the past several years, American evangelicals, and I am one of them, have amassed greater political power than at any time in our history. But at what cost to our witness and the integrity of our message?

Recently, I took a few days to reread the war sermons delivered by influential evangelical ministers during the lead up to the Iraq war. That period, from the fall of 2002 through the spring of 2003, is not one I will remember fondly. Many of the most respected voices in American evangelical circles blessed the president's war plans, even when doing so required them to recast Christian doctrine.

Marsh offers some damning criticism of Evangelical leaders who enthusiastically supported the war and illustrates how they trampled Evangelical doctrine in order to do so:

The war sermons rallied the evangelical congregations behind the invasion of Iraq. An astonishing 87 percent of all white evangelical Christians in the United States supported the president's decision in April 2003. Recent polls indicate that 68 percent of white evangelicals continue to support the war. But what surprised me, looking at these sermons nearly three years later, was how little attention they paid to actual Christian moral doctrine. Some tried to square the American invasion with Christian "just war" theory, but such efforts could never quite reckon with the criterion that force must only be used as a last resort. As a result, many ministers dismissed the theory as no longer relevant. [...] The single common theme among the war sermons appeared to be this: our president is a real brother in Christ, and because he has discerned that God's will is for our nation to be at war against Iraq, we shall gloriously comply.

Marsh concludes with an even more damning assessment, implying that in the end this was simply a way of buying access to the White House:

What will it take for evangelicals in the United States to recognize our mistaken loyalty? We have increasingly isolated ourselves from the shared faith of the global Church, and there is no denying that our Faustian bargain for access and power has undermined the credibility of our moral and evangelistic witness in the world.

Perhaps that's what I noticed in Ohio...a growing sense of shame. Evangelical Christianity turns on forgiveness, instant born-again type forgiveness, in fact. But with the war dragging on, that kind of forgiveness isn't coming fast enough to appease their conscience perhaps. If I'm honest, I have to admit, I don't mind seeing them squirm a bit. They were anything but generous on their ascent. But that's not very Christian of me, I know. Let's hope they can reconcile their conscience with their political ambitions before the next war.

Medicare: Compare And Contrast

by hilzoy

I've seen a few comments on various blogs saying that the problems with the rollout of Bush's prescription drug program are inevitable, either because that's just what happens when government gets involved in something, or because rolling out a big new program is inevitably complicated. And Mark Schmitt argues that undermining public confidence in government was actually part of the Republicans' plan:

"Every problem they are encountering was built in from the start in the structure that forces elderly and disabled people, their adult children or helpers, to make immensely complicated financial and medical choices, for a benefit that amounts to nothing more than a modest discount on wildly inflated prices. This is what they voted for, and they know it. (...)

My thesis was that Republicans knew there would be a backlash against the Medicare bill, but they understood that it would take the form of a backlash against government in general, and that would be to their advantage. Seniors struggling over a dining table covered with complicated forms, small-print prescriptions, and no-win choices weren't going to be muttering, "Goddamn Dennis Hastert, I"m never voting for his party again." They would be muttering, "Damn government, can"t do anything right.""

Whether or not some or all Republican members of Congress actually made any such calculation (and if they did, they sold out the health and possibly the lives of senior citizens for political gain, and should be driven from office forthwith), people are, predictably, saying that the sorts of problems we're seeing are inevitable. That being so, it's important to ask whether this is, in fact, true. And lo! via Kevin Drum, TNR has a great article that tries to answer this question by comparing the rollout of Bush's Medicare prescription drug program to the rollout of Medicare itself. Excerpts:

"But consider what happened when the Johnson administration rolled out Medicare for the first time in July 1966. Back then, the obstacles were even more daunting than they are today. Rather than simply adding a benefit for a relatively narrow class of services (prescription drugs), introducing Medicare meant establishing an entirely new insurance program in just eleven months. There were concerns about hospital capacity: What if seniors held off on medical treatment until the benefit kicked in and then flooded facilities? There were also racial complications: LBJ had insisted that Medicare refuse payments to hospitals that didn't abide by federal civil rights guidelines. Since many Southern hospitals remained segregated, senior citizens there might have had no place to go.

So what happened on the day that this complex program was implemented? Thousands of senior citizens simply went to the hospital and got the health care they needed. "There were no crises that I remember," says Yale University political scientist Theodore Marmor, who worked in the office overseeing Medicare implementation and went on to write The Politics of Medicare, the program's definitive history. Newspaper accounts from the '60s back him up. Under the headline "medicare takes over easily," a Post writer described the program's first day as "a smooth transition, undramatic as a bed change." Three weeks later, the Times affirmed that "medicare's start has been smooth."

What did Johnson do right that Bush did wrong? Start with the people he put in charge. Today, the man directly responsible for Medicare is Mark McClellan, a physician and former Stanford economist. Though hardly a Michael Brown, McClellan has no prior experience when it comes to implementing social insurance programs. (His predecessor, Tom Scully, left CMS to become a lobbyist almost immediately after the Medicare bill passed.) The man Johnson tapped to run Medicare was Robert Ball, a longtime civil servant who had worked his way up through the Social Security Administration starting in 1939. He and other veterans helped design the program--urging, among other things, that the law take effect in summer, when hospitals would be least crowded.

Another difference between the two administrations is their willingness to take initiative. Last year, experts repeatedly warned the Bush administration that it had inadequate contingency plans in place, culminating in a December Government Accountability Office report that predicted with eerie accuracy exactly what has happened at pharmacies around the country these past two weeks. LBJ's team was far more cautious. Although confident that hospitals could handle any potential surges, it still drew up plans for transferring patients to overflow facilities, even lining up helicopters in Texas to provide speedy transport.

Granted, senior citizens probably need more hand-holding in 2006 than they did in 1966, because the new law channels its drug coverage through private insurance companies from which beneficiaries must choose. But that, too, is a distinction: While Bush talks of "choice" as his plan's greatest virtue, seniors seem bewildered by having to pick from as many as 52 different prescription plans, each one with different premiums, cost-sharing requirements, and lists of drugs covered. By contrast, Johnson administration officials had argued against inundating seniors with such options. "I would not have dreamed of going about this in a way that meant individuals had to choose from among all these possibilities," Ball says today. "I would have expected chaos.""

And bear in mind that the 'choices' the Bush program gives senior citizens are a bunch of different plans with different copays, different deductibles, and different formularies. For people taking various prescription drugs, just finding a plan that covers all the drugs they take may be a serious challenge. And, as I said in my last post, the plans can add or drop medications from the list of those they cover each month, while seniors are locked into their plans for a whole year. So even if seniors manage to navigate all these choices and find one that covers all their medications and works well for them, there's no guarantee at all that that plan won't drop the medications they take the next month, leaving them high and dry.

Personally, I value being able to choose, with my doctor, which medications to take, and knowing that they will be covered*, over being able to choose among a large number of insurance plans that could decide to change the features I have counted on one month into my year-log commitment. But then, we all know I'm weird.

* One might ask: if a government-run medicare prescription drug plan covered all drugs, how would it manage to control costs? There are a lot of ways to do that other than just not covering drugs. Too many, in fact, to list here. (Requiring newly diagnosed people to try cheaper drugs that work as well as newer, more expensive ones for most people first, for instance. And, of course, letting the government negotiate lower prices. And many, many more.)

Medicare Part D And Me

by hilzoy

As I'm sure you all know by now, the introduction of Bush's Medicare prescription drug benefit has been an unmitigated disaster. As of last Saturday, a dozen states had declared public health emergencies because of it, and over twenty have stepped in to make sure seniors get the drugs they need. The new benefit is unbelievably confusing. One of the main reasons for choosing one of the plans it offers over others is that that plan covers all the medications you're actually taking; yet while the insurers who offer those plans can change which medications they cover every month, seniors are locked into those plans for a whole year. And, my favorite detail of all, the government is forbidden to either compete against private companies by offering its own plan, or to bargain for lower prices on drugs.

The rollout of the plan has had its own share of problems. "Dual eligibles" -- those who are eligible for both Medicare and Medicaid -- have thus far had their prescriptions covered under Medicaid. Now, all of them have been enrolled in one or another plan, and will supposedly be exempt from many of its costs. The trouble is that neither the information about their new plans nor the fact that they are eligible for low co-pays seems to have found its way onto the system's computers.

I Like It. Heh Heh Heh.

by hilzoy

Via Kevin Drum: Carville and Begala have a new, radical plan for campaign finance and lobbying reform. Nothing wishy-washy about this one:

"Here's how our plan would work:

First, we raise congressional pay big time. Pay 'em what we pay the president: $400,000. That's a huge increase from the $162,000 congressmen and senators currently make. Paul, especially, has been a critic of congressional pay increases. But he is willing to more than double politicians' pay in order to get some of the corrupt campaign money out of the system. You see, the pay raise comes with a catch. In return, we get a simple piece of legislation that says members of Congress cannot take anything of value from anyone other than a family member. No lunches, no taxi rides. No charter flights. No golf games. No ski trips. No nothing.

And when it is campaign time, incumbents would be under a complete ban on raising money. You read that right. No president or member of Congress could accept a single red cent from individuals, corporations, or special interests. Period.

Challengers, on the other hand, would be allowed to raise money in any amount from any individual American citizen or political action committee. No limits, just as the free-market conservatives have always wanted. But here is the catch: Within 24 hours of receiving a contribution, the challenger would have to report it electronically to the Federal Election Commission, which would post it for the public to see. That way, if you want to accept a million dollars from, say, Paris Hilton, go for it. But be prepared for voters and reporters to ask what you promised her in exchange.

The day after you disclose Paris's million bucks, the U.S. Treasury would credit the incumbent's campaign account with a comparable sum—say 80 percent of the contribution to the challenger to take into account the cost of all the canapés and Chardonnay the challenger had to buy to raise his funds as well as the incumbent's advantage. So if Paris gave the challenger a mill, the Treasury would wire $800,000 to the incumbent. It couldn't be much simpler. You might even call it the flat tax of campaign laws.

The penalties for violation would be swift. If an incumbent accepts so much as a postage stamp, he loses his seat. If a challenger doesn't report contributions, he loses his shot. If you cheat, you are out on your ass.

What if the incumbent wants to spend her own money? After all, the Supreme Court has made it clear that the Constitution does not allow restrictions on how much money a candidate—challenger or incumbent—can spend. No problem. Uncle Sam would write the challenger a check for an equivalent amount. Unlike today, no one would have the upper hand simply because they were loaded.

What if a sitting congressman wants to run for senator, or a senator wants to run for president? Would he be allowed to raise funds? Sure. He'd just have to do what Bob Dole eventually did—resign his Senate seat and hit the campaign trail like a regular citizen. If you want to run for higher office, you have to get off your current pedestal first.

The idea is to fundamentally change the role and responsibilities of incumbency. Under our plan, incumbents have to live by Thomas Jefferson's maxim: “When a man assumes a public trust, he should consider himself as public property.” (We know, we know, the language is archaically sexist, but we are not going to edit Mr. Jefferson.) Once you assume an elected office, you achieve a new status. You are no longer a campaigner. You are a public servant. As such you should not be in the fundraising business. You should be in the exclusive business of making policy."

I have no doubt that there are problems with this somewhere. (What to do about independent expenditures and contributions from parties leap to mind.) But, fundamentally, I think it's exactly right. No gifts, campaign contributions, trips, etc. for public servants. No financial advantage for incumbents (unless you count e.g. the franking privilege.) No more making leadership positions, chairmanships of committees, etc. contingent on fundraising success. And best of all, no more incentive to do appalling things like let members of industry actually draft legislation in exchange for contributions. All this and no apparent conflict with Buckley v. Valeo, either. How cool is that?

And, as Begala and Carville point out, we'd more than recoup the costs of this if there were no more incentives for members of Congress to give presents from the taxpayers to their contributors:

"We haven't seen the final data for 2004, but in all the federal races in 2000—congressional, senatorial, and presidential—candidates spent a total of $1.6 billion. Half of that, which is what taxpayers would have had to shell out under our plan, would be a lot of money: $800 million. But that is nothing compared to what the current system costs us. Those special interests who pour money into politicians' campaigns get something in return. Actually, they get a lot in return. Special tax breaks, special loopholes, special funding of pork-barrel projects, maybe even a no-bid contract or two. The energy bill passed in 2005 handed $2 billion in subsidies to the ethanol industry—you know, the fine folks at Archer Daniels Midland. It gave the makers of the controversial fuel additive MTBE another $2 billion. And another $8.1 billion in tax breaks for oil, coal, and electric utilities. In all, that one bill cost you $80.8 billion.

All of a sudden $800 million—one percent of the cost of one bill—doesn't seem like very much money, does it?"

I like it. I can't wait to see their proposal for redistricting reform.