Health-care debate wearing on Democrats' unity, popularity

By Dan Balz
Washington Post Staff Writer
Saturday, December 19, 2009

Amidst the spectacle that has become the health care debate, Democrats have taken comfort in the belief that they will be rewarded politically if in the end they pass something -- almost anything. That proposition is being sorely tested in these final days of maneuvering.

For all the talk of the damage President Obama has sustained during this long and difficult year, congressional Democrats have suffered at least as much -- and will have to face the voters far sooner than the president.

Senate Majority Leader Hary Reid announced Saturday he had the 60 votes to pass the bill. The House still must be persuaded to go along but Obama and the Democrats are one step closer to achieving the goal that has eluded so many presidents and Congresses. That in itself is a significant achievement.

The long fight has been costly, however. The health care debate has split the Democratic coalition. Unity has given way to bitter infighting. This has been a moment for individuals to make war on one another.

What good will that existed among Democrats at the start of Obama's presidency has been fractured and will be difficult to put together again. The events of the past week underscore that reality.

Joe Lieberman who bolted the party in 2006 to salvage his Senate seat and then accepted the Democrats' generosity to maintain his committee chairmanship despite having backed John McCain in last year's presidential race, held the party hostage in negotiations, enraging many liberals.

Howard Dean, who has grievances about the way he was discarded by the Obama team after running the Democratic National Committee for four years, has led a vocal guerrilla war against the bill from outside the Congress, enraging the party leadership.

Democratic centrists have extracted costly promises to stay aboard but still fear for their political futures. Bloggers and progressive activists have counterattacked against them vowing retribution. Labor is unenthusiastic to hostile.

Progressives in Congress have swallowed hard over the compromises that have been needed to round up enough votes to beat back a Republican filibuster.

Hard-headed politicians would say there was no way to avoid this kind of squabbling, given the stakes and complexity of health care reform and the rules of the Congress. There are no immaculate legislative struggles on a piece of social legislation of this consequence.

Leading Democrats also believe that, in the end, voters care less about process than about outcomes. If, in the face of united Republican opposition, the Democrats produce historic changes in the availability of health care to millions more citizens and protect against some of the arbitrary practices of the insurance industry, that will override the messy path to success.

But there is something broader for Democrats to worry about as they try to finish their work this year and prepare for 2010 and the midterm elections. What began as an undercurrent of dissatisfaction has grown throughout the year. Disappointment with the president is dwarfed by discontent with the Congress.

No Congress is ever loved, but the assessments of this Congress are striking in their negativity. In the most recent NBC News-Wall Street Journal poll only seven percent rated the performance of Congress above average, and 34 percent called it one of the worst.

Two benchmarks put that number into perspective. In October 1994, shortly before Republicans ousted Democrats from power in the House and Senate, 16 percent called that Congress one of the worst. In October 2006, just before Democrats recaptured control, 25 percent called that Congress one of the worst. In the past five months, the percentage who rate this Congress that low has jumped 11 percentage points.

Thirty-five percent gave the Democratic Party a positive rating, still higher than the 28 percent who rated the Republican Party that way. But since February, Democrats have seen their overall image go from net positive to net negative. Republicans, while still living in negative territory, have improved slightly.

A third finding underscores the problem for Democrats: 38 percent said their member of Congress deserves to be reelected, while 49 percent said it is time to give a new person a chance. That is identical to the percentage who said give a new person a chance a month before the 1994 GOP landslide and slightly above the number a month before the 2006 Democratic takeover.

Why won't that anti-Washington sentiment fall equally on Republicans and Democrats? Because it rarely does. Republicans are hardly secure or popular, but Democrats are in control. If the public is ready for change again next November, the Democrats will feel the brunt of that anger.

Many factors contribute to the dissatisfaction with Washington. People are angry about bailouts for bankers. The unemployment rate is at 10 percent. They see the deficit rising and worry about the long-term consequences. Conservatives and liberals question whether their leaders have the right priorities.

Health care has exhausted the Democrats and tested their capacity to govern. Democrats hope that passage of a health care bill will prove to be a political restorative. But the longer the debate has gone on, the less people like what they think they may be getting. Congress may be on the cusp of a historic achievement, but right now the public believes the status quo is preferable to change.

Democrats have a dual problem. They must find the votes to pass a bill to avoid the charge that, even with their big majorities, they are incapable of governing. They also must persuade voters that the policy changes they want to enact include far more plusses than minuses.

That is a big challenge, not only for Obama and Democratic leaders. They are governing in difficult times and and see themselves close to the finish line on health care. But they are nonetheless bracing for a difficult election year in 2010.

Congressional staffers turn lobbyists:

Health care lobby drafts army of insiders to help fight overhaul

Former staffers of lawmakers from Harry Reid to Mitch McConnell push clients' agenda

Tribune Newspapers

December 20, 2009

WASHINGTONDavid Nexon had a big problem. An early version of national health care legislation contained a $40 billion tax aimed squarely at members of the medical device trade association he represents.

Nexon, a former adviser to the late Massachusetts Sen. Ted Kennedy, went to work. He marshaled 14 people like himself -- lobbyists who were once congressional aides, many of them from staffs of congressional leaders or committees that had a hand in crafting the health care overhaul.

When Senate Democrats unveiled their bill in mid-November, Nexon's handiwork was evident. The tax on device-makers was still large -- $20 billion -- but only half what it might have been without the efforts of Nexon and his fellow lobbyists.

Nexon's team is an illustration of how deeply the health care industry has embedded itself on Capitol Hill, using former aides of lawmakers and ex-lawmakers themselves.

An analysis of public documents by Northwestern University's Medill News Service in partnership with the Tribune Newspapers Washington Bureau and the Center for Responsive Politics found a revolving door between Capitol Hill staffers and lobbying jobs for companies with a stake in health care legislation.

At least 166 former aides from the nine congressional leadership offices and five committees involved in shaping health overhaul legislation -- along with at least 13 former lawmakers -- registered to represent at least 338 health care clients since the beginning of last year, according to the analysis.

Their health care clients spent $635 million on lobbying over the past two years, the study shows.

The total of insider lobbyists jumps to 278 when non-health-care firms that reported lobbying on health issues are added in, the analysis found.

Part of the lobbying pressure on current members of Congress and staffers comes from the powerful lure of post-congressional job possibilities.

"There's always a worry they may be thinking about their future employment opportunities when dealing with these issues, particularly with health care, because the stakes are so high and the breadth of the issues -- pharmacies, hospitals, doctors," said Emory University political scientist Alan Abramowitz.

Lobbyists' earnings can dwarf congressional salaries, which currently top out at $174,000 annually for lawmakers and $156,000 for aides, though committee staff members can earn slightly more.

In the health care showdown, insider lobbying influence has magnified the clout of corporate interests and helped steer the debate away from a public insurance option, despite many polls indicating majority support from Americans, according to Rutgers University political scientist Ross Baker.

"It imposes a kind of conservative bias on the discussion," said Baker, himself a former Senate staffer.

The lineup of insiders working for clients with health care interests includes at least 14 former aides to House Majority Leader Steny Hoyer and at least 13 former aides to Montana Democratic Sen. Max Baucus, the chairman of the Finance Committee and a key overseer of the health care overhaul.

Nexon, who is now senior executive vice president of the Advanced Medical Technology Association, is among at least a half-dozen former Kennedy aides lobbying on health care.

Nexon acknowledged the value of congressional connections, "but in the end, it's not who I know, it's what I know."

It makes sense to hire former staffers for the health care showdown because they tend to be "more generalists, dealing with a broad range of issues," something that is in demand for legislation that sprawls across at least a half-dozen federal agencies and encompasses issues ranging from tax policy to hospital reimbursement rates, according to Nexon.

But specific issues also get specialized help. Earlier this year, the Christian Science Church hired a former Kennedy staffer, Carolyn Osolinik, and three of her colleagues at the Mayer Brown law firm, all veterans of Capitol Hill. The firm has been paid at least $110,000 so far to push a provision requiring insurers to consider covering Christian Science prayer treatments.

Phil Davis, a senior official of the church, said the church wanted access to decision makers. "The noise level goes sky high. It's hard to get in to talk to people," he said.

The largest insider lobbying cadre belongs to the Pharmaceutical Research and Manufacturers of America, or PhRMA, which employs at least 26 former congressional members and staffers, according to Medill/CRP research.

Two other drug interests, biotech firm Amgen Inc. and the Biotechnology Industry Organization trade group, with at least 24 and 16 insiders respectively, ranked second and fourth among reported hiring over the past two years of lawmakers' former staffers and members of committees considered in the analysis.

"The numbers shouldn't surprise anyone," said Ken Johnson, a PhRMA senior vice president. "Former staffers have a unique understanding of how the legislative process works. And when you are trying to advocate on behalf of smart public policies, you want smart people on your team."

But Bob Edgar, president of Common Cause, a nonpartisan, nonprofit watchdog group, had a harsher assessment, blaming "a toxic cocktail of insiders and money" for short-circuiting a government-run plan that would have competed with private insurers.

"We'll get a bill. And the president will sign it. But it'll be less than the country deserves," said Edgar, a former six-term member of the House.

Health care lobbyists increase their effectiveness by strategically targeting their campaign contributions or the donations of the interests they represent, Edgar said.

Health industry contributions to congressional candidates have more than doubled so far this decade, rising to $127 million in the 2008 election cycle from $56 million in the 2000 election, with disproportionate sums going to the party in power and to members of committees that oversee health care, according to the Center for Responsive Politics.

But lobbyist and former Kennedy staffer Andrew Rosenberg said political conditions, not big money or the predispositions of lobbyists sidelined a public option.

"You could see this coming from a long way off. The Democratic Party is now the big tent party. They have to get to 60 votes. That is the reality," Rosenberg said. "It was going to have to be something that appeals to moderates" opposed to expanding government-run health insurance.

 

Tribune Newspapers' Tom Hamburger and Joe Markman contributed to this report.

Sen. Ben Nelson, right, agreed after hours of negotiation Friday to back the Senate Democrats’ legislation, making him the pivotal 60th vote.

"Senate Democrats said on Saturday that they had clinched an agreement on a far-reaching overhaul of the nation’s health care system, and that they were on track to approve the legislation by Christmas over fierce Republican opposition."

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Copenhagen climate conference: The grim meaning of 'meaningful'

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Gutless, yes. But the planet's future is no priority of ours

Obama emerges from climate talks with slender pact and bruised stature

US president urges decisive action on climate change, but shows no sign that Washington will take such steps itself

Barack Obama emerged from the chaotic final hours of the Copenhagen summit last night having salvaged an agreement for action on global warming – and his own reputation as a politician who can bridge the most challenging of political divides.

After 15 hours of negotiations, an exhausted looking Obama said he managed to secure a deal on climate change incorporating America's three main goals of emissions cuts, financial aid for the poorest countries, and a measure of accountability for emissions pledges from developing countries.

But he acknowledged the skimpy 2.5 page draft produced at the end of his effort was not the comprehensive agreement he had come to Copenhagen for.

"I think it is important that instead of setting up a bunch of goals that just end up not being met, that we get moving," he said. "We just keep moving forward."

Obama's hectic day of negotiations began immediately on his arrival in Copenhagen, when he encountered what he described as a "fundamental deadlock" between rich and developing countries.

Much of that was a product of the deep resentment at America for its emissions reductions target: a 17% reduction over 2005 levels by 2020. That offer too was conditional on Congress passing climate change legislation. In the final days of the summit, a more vexing issue emerged over America's demands that China and other rapidly emerging countries offer an accounting of their actions to curb the growth of greenhouse gas emissions.

Obama emerged last night claiming to have wrung an important concession from China and India to offer a fuller accounting of its emissions reductions.

"The truth is that we can actually monitor a lot of what takes place through satellite imagery and so forth," he said.

The reassurances are crucial for American domestic political consumption, where there is concern about losing economic ground to China and India in the transition to a clean energy economy. It did not seem at first that the president would be capable of breaking down the divide. Obama's eight-minute speech to the summit was viewed as a huge disappointment.

Although he called for bold and decisive action, Obama – who had been skittish at going to Copenhagen in the first place – offered no sign that Washington was willing to take such steps itself.

There were no further commitments on reducing emissions, or on finance for poor countries, beyond Hillary Clinton's announcement that the US would support a $100bn global fund to help developing nations adapt to climate change. He did not press the Senate to move ahead on climate change legislation, which environmental organisations have been urging for months. Obama did say America would follow through on his administration's clean energy agenda, and would live up to its pledges.

But in the absence of any evidence of that commitment the words rang hollow and there was a palpable sense of disappointment in the audience. He warned African and island countries that the alternative – of no agreement – was worse.

Obama's lacklustre speech proved a frustration to a summit that had been looking to him to use his stature on the world stage, and his following among African leaders, to reach an ambitious deal.

But by the end of the day, after Obama spent hours closeted with Chinese, Indian, South African and Brazilian officials, he managed to pull the situation back from the brink.

In his press conference, Obama held up the results of his deal-making as a sign that the era of American isolation under George Bush was over, and that he had returned the country to a position of leadership.

The day of diplomacy also allowed him to reassert the political skills which have not been seen to best advantage in the US during the struggles over health care and Afghanistan. "The time has come for us to get off the sidelines and shape the future that we seek. That is why I came to Copenhagen today," he said. "I believe that what we achieved in Copenhagen is not going to be the end, but rather the beginning."

UN hails climate deal as 'essential beginning'

As delegates agree to "recognise" the US-brokered deal, Ban Ki-moon, the UN secretary general, welcomes the progress in the face of strong opposition from developing nations.

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World leaders hailed an “historic” deal on climate change after two weeks of difficult negotiations in Copenhagen.  

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China holds the world to ransom

Michael McCarthy:

Beijing accused of standing in the way of climate change treaty at Copenhagen as US throws down the gauntlet by backing $100bn fund to help poorest countries

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Arianna Huffington says of the Huffington Post: "Our site is not built around the freebie. Our site is built around very hard-working editors and reporters who do all the curating and aggregating and original content. Then bloggers can write when they want, if they want."

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The Conservative-Christian Big Thinker

By DAVID D. KIRKPATRICK

Robert P. George, a Princeton University professor of jurisprudence and a Roman Catholic, is this country’s most influential conservative Christian thinker.

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“If there really is a vast right-wing conspiracy,” the conservative Catholic journal Crisis concluded a few years ago, “its leaders probably meet in George’s kitchen.”

Peter Alliss: 'I always thought it could all go wrong for Tiger'

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David Ashdown

 "He's a handsome black man married to a beautiful white girl, and there are some strange people in America, who take exception to that."

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Democratic congressman from North Carolina angers supporters by voting against health-care bill

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"People want change, and when someone puts their foot in the door to kill the whole thing, that's what has them riled up," said Michael Lawson, an African American leader of the state Democratic Party and one of Kissell's constituents. "It's almost like 'Mr. Smith Goes to Washington,' but Mr. Smith turned out to be somebody that wasn't Mr. Smith."

Barack Obama says world is 'running out of time'

President has given warning that the Copenhagen climate conference is running out of time amid fears that the meeting could yet end in failure.

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Liberal Revolt on Health Care Stings White House

By SHERYL GAY STOLBERG

Liberals like Senator Bernard Sanders are signaling that they have compromised enough to win over moderates.

• A Race to Win Nelson's Vote

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Nation of Islam investigated:

U.S. recalled 2007 intelligence probe on group because report violated rules about spying on Americans

By Sebastian Rotella

Tribune Newspapers

December 17, 2009

WASHINGTON

-- The Department of Homeland Security issued but then recalled a 2007 intelligence analysis about the Nation of Islam after deciding that the document broke rules on intelligence activity in the U.S., officials said Wednesday.

Internal DHS documents reveal that intelligence chiefs found that analysts "unintentionally and inadvertently" violated rules governing the collection, retention and distribution of information concerning "U.S. persons and organizations." The apparent error took place during the Bush administration, an agency spokesman said Wednesday, adding that steps have been taken to ensure it does not happen again.

"DHS has implemented a strong and rigorous system of safeguards and oversight to ensure similar products are neither created nor distributed," said Matthew Chandler, a spokesman for the agency. "DHS is fully committed to securing the nation from terrorist attacks and other threats, and we take very seriously our responsibility to protect the civil rights and liberties of the American people while fulfilling this mission."

The 2007 analysis was titled "Nation of Islam: Uncertain Leadership Succession Poses Risk," according to DHS documents released Wednesday as the result of Freedom of Information Act lawsuits by the American Civil Liberties Union and the Electronic Frontier Foundation, a privacy group.

At the time, Nation of Islam leader Minister Louis Farrakhan had ceded control to an executive board and gone into seclusion to recover from complications of prostate cancer treatment.

He remains active, though his exact role in the Chicago-based group is unclear. Nation of Islam officials did not return calls for comment.

After the analysis came out, a subsequent review found the analysis had violated internal intelligence guidelines that protect civil liberties and govern the collection and retention of information on the Nation of Islam and other "U.S. persons," a supervisory official wrote.

"The intelligence note on the Nation of Islam should not have been written," the official wrote. "The organization -- despite its highly volatile and extreme rhetoric -- has neither advocated violence nor engaged in violence." The official stressed that the violation had not been intentional and that during more than two years, this was the first among thousands of intelligence analyses about which questions had been raised.

A Columbia University researcher who focuses on the Nation of Islam said the revelation recalled FBI probes in the 1960s and 1970s.

The U.S. government has long been interested in leaders of the religious movement that melds black nationalism with the Islamic faith, said Zaheer Ali. "As a historian, it's not surprising that the federal agencies under a new name -- in this case 'Homeland Security' -- would be so interested."

While no investigation has produced evidence suggesting the Nation of Islam poses a threat, such concerns linger, he said.

"In the minds of many, Islam poses a threat. Black people pose a threat. And the combination of black people and Islam pose a threat in the imagination of people," Ali said. "I don't think our intelligence community is immune to these kinds of perceptions."

The analysis under scrutiny was prepared in October 2007 by the Office of Intelligence and Analysis of the Department of Homeland Security, according to agency officials.

That office acts in cases involving domestic security as a conduit for the flow of intelligence between federal agencies -- principally the FBI -- and state and local law enforcement authorities.

DHS intelligence personnel in that office routinely write analyses based on information gathered by other agencies, but do not engage in intelligence collection in the field, officials said.

The intelligence and analysis note was distributed by e-mail to 482 recipients, including federal intelligence officials, congressional staff and "at least one state government entity and one educational institution," a DHS report said, without naming them.

Immediately after the note about the Nation of Islam was sent, the office's intelligence oversight officer and its associate general counsel "expressed concerns" about its "content and dissemination," documents said.

DHS intelligence officials contacted the recipients and asked them to delete the note, the documents say.

 

Tribune reporter Manya A. Brachear contributed to this report from Chicago.

The Senate’s Game Changer

Nati Harnik/Associated Press

An opponent of health care legislation demonstrates outside Senator Ben Nelson’s office in Omaha, Neb., on Tuesday.

The Nebraska Cornhuskers may have just missed out on college football’s Bowl Championship Series, but with the Great Health Care Debate of 2009 late in the fourth quarter, the whole game seems to be riding on one of the Huskers’ biggest fans: Senator Ben Nelson.

Mr. Nelson, who is arguably the most conservative of the Senate’s Democrats, has been uncertain about the health care legislation all year long, reminding reporters and colleagues alike that he will not make up his mind until he has gotten a close look at the bill.

And given that the bill keeps changing — yet another version of it is expected to be revealed by the Senate majority leader, Harry Reid of Nevada, within the next 48 hours — it has not been particularly easy for Mr. Nelson to come to a decision one way or another.

But with other Senate Democrats saying that their major concerns appear to have been addressed, Mr. Nelson seems to be the last big holdout. Mr. Reid is getting ready to throw him the ball, and if Mr. Nelson catches it, the question is: which way will he run?

Mr. Nelson has said that perhaps his biggest concern is the issue of insurance coverage for abortions. He proposed an amendment seeking to tighten restrictions in the Senate bill, and it was defeated. But Senate leaders are trying hard to find a compromise.

He has already made a mark on the bill. After Mr. Nelson, a former state insurance commissioner and insurance company executive, said he would not support a provision ending the industry’s limited exemption from antitrust laws, Mr. Reid stripped it out.

“Until I see more details, I am not going to know whether I could support the bill,” Mr. Nelson said in a conference call on Wednesday.

Mr. Nelson disputed rumors that he was being pressured or that Congressional leaders or the White House were trying to buy his vote with financial aid for his home state. “They are false, period,” he said. “Nebraskans who have known me for decades, know my vote cannot be bought and I cannot be threatened.” He added: “I am looking at this health care reform on its own merits, on what’s best for Nebraskans.”

He laid out a list of concerns, including the provisions related to abortion, questions about efforts to slow Medicare spending, and worries over proposed new taxes, fees and other mandates in the bill. Mr. Nelson said he wants to be sure the bill will help contain long-term health care spending. He said he was opposed to a new long-term care insurance program included in the bill, and that he was skeptical about proposed cuts in payments to nursing homes and for home health care providers.

Mr. Nelson said he had met with President Obama for the third time in eight days and had expressed his concerns about the legislation while also hearing out Mr. Obama. “He made a strong case for passing health care reform, but it remains to be seen if it was compelling,” he said.

But even as he said he had major concerns about the legislation, Mr. Nelson also described the current state of the health care system as unacceptable. He said that without legislation, some residents of his state would face bankruptcy as a result of medical bills, while others would die as a result of lacking health insurance.

“Not trying to help Nebraskans would be the worst thing I could do,” he said.

Even if Mr. Nelson ultimately supports the legislation, it remains to be seen if he will agree to do so in time to meet Mr. Reid’s goal of passing the bill by Christmas.

Mr. Nelson has previously expressed reluctance to support a partisan health care bill. And so far no Republican has expressed support.

Senator Olympia J. Snowe, Republican of Maine, had a strong hand in writing the legislation in the Senate Finance Committee and has said she very much wants to vote for a heath care overhaul. But she has also made clear that she thinks Democrats are rushing it.

Mr. Nelson said that even as all eyes turn to him, he’s not feeling any heat. “I am not feeling any pressure from the party,” he said. “I know what they would like me to do.”

 

 

Success on health reform holds risks for Democrats

By Matthew Dowd
Thursday, December 17, 2009

President Obama needs an exit strategy. I am not referring to Afghanistan or Iraq (though there are quite a few similarities between the situation Obama is in on health-care reform and the political difficulties President George W. Bush faced on Iraq). Congressional Democrats and Obama are headed toward a "catastrophic success" politically if they pass health-care reform in its current legislative form. And catastrophic success was a term then-President Bush used on Iraq when he acknowledged the great initial victory but didn't take into account the long-term calamity and costs.

I am not seeking to argue the substance of health care and the merits or demerits of the bills, and will leave that to experts in policy and its effects. I am talking about the politics of the legislation and the effect it is likely to have on Obama and Democrats in Congress.

Unlike many other pundits and political experts in both parties, I think that passage of a bill by the Democrats at this point will be politically damaging to both the president and congressional Democrats. Conversely, defeat of the legislation is much more likely to hurt Republicans in Congress.

The latest Post-ABC News poll shows the president's overall approval rating at a new low of 50 percent -- about the rating President Bush had going into the November 2004 election, when Democrats said Bush was ripe for defeat.

There are many reasons for this drop in support for Obama. The stagnant economy is the biggest factor, but close behind is the fact that the administration is pushing health-reform efforts that have polarized the electorate, and that independent and swing voters have moved against in large measure.

As Wednesday's Post-ABC poll shows, a majority of Americans believe that if this bill passes, their health-care costs will rise, the federal deficit will increase, the costs of the overall health-care system will climb, and their own care would be better if the system stays as is. Democrats (including former president Bill Clinton) claim that they need this bill to pass for political reasons. But let's examine that. At present, a majority of Americans are against the effort, the legislation lacks bipartisan support, the costs of the reforms are upfront, and the benefits won't kick in until after the 2012 elections. When has that ever been a formula for political success?

If this legislation passes, Democrats will be held accountable for any failures or problems in the system. So if Americans' insurance premiums rise, they will blame the Democrats. If patients have to wait in line at emergency rooms, it will be seen as the Democrats' fault. If health-care costs don't drop, the Democrats will face the wrath of the electorate.

Many Democrats, including people in the administration, blame poor marketing for their difficulties in passing health reform. They say they haven't gotten the message out. But advocates of reform have spent millions on advertising and lobbying this year. And Obama, who many say is the best orator ever to occupy the White House, has pushed for this legislation constantly over the past six months. In that time, support for Obama's handling of health-care reform has dropped by more than a net of 30 points.

Yet before Republicans cheer that they may defeat this effort, they should beware what they wish for. A vast majority of Americans still believes that we need fundamental health-care reform. If the legislation fails, Democrats can blame Republicans by saying reform was in sight and the GOP blocked it without offering a real alternative to decrease costs and increase access.

The dominant issues today are the economy and jobs, and the public doesn't see either party making these a real priority. Further, polls show trust in government handling of domestic issues remains at historic lows. What most voters hear from Washington these days is squabbling over health reform involving a government role they don't trust and don't want.

My advice? Leaders in Washington ought to concentrate on what matters to Americans, not on what they think should matter to voters. Come up with a health-care bill that draws real bipartisan support. And before pushing a bigger role for government, begin to restore trust in the government's ability to do even small things. Democrats pushing so hard for success on health care could find themselves in a situation resembling President Bush's situation on Iraq. They could topple the statue and win the day, but lose politically over the coming months and years.

The writer, a political analyst for ABC News, was the chief strategist for George W. Bush's 2004 presidential campaign.

Senator Charles E. Schumer

Word Prompts Apology From Schumer

Senator Charles E. Schumer apologized on Wednesday for using a crude term to refer to a flight attendant who had asked him to turn his cellphone off on a US Airways plane before takeoff.

Mr. Schumer and his fellow Democratic senator from New York, Kirsten E. Gillibrand, were seated next to each other on the New York-to-Washington flight on Sunday, and both were talking on their cellphones, according to Politico.com, which first reported the incident. After an announcement that cellphones must be turned off, both senators initially kept talking on their phones.

Ms. Gillibrand ended her call, but Mr. Schumer kept talking.

The flight attendant then approached Mr. Schumer and told him the entire plane was waiting for him to shut off his phone. Mr. Schumer ended the call, but then argued that he was entitled to keep his phone on until the cabin door closed.

When the flight attendant, whom Politico did not identify, walked away Mr. Schumer turned to Ms. Gillibrand and described the attendant as a “bitch.”

A Republican aide on the plane overheard Mr. Schumer’s comment and described the incident to Politico. The aide was not identified.

After it was reported on the Politico Web site on Tuesday, Mr. Schumer issued an apology and called the flight attendant to say he was sorry.

“The senator made an off-the-cuff comment under his breath that he shouldn’t have made, and he regrets it,” said Brian Fallon, a Schumer spokesman.

The Federal Aviation Administration says it is a violation of aviation regulations to disobey the instructions of a flight crew.

Through her office, Ms. Gillibrand said Mr. Schumer was “polite” and “turned off his phone when asked.”

But according to the aide who overheard Mr. Schumer, the phone rang again moments after the attendant had told Mr. Schumer to shut it off. “It’s Harry Reid calling, I guess health care will have to wait until we land,” Mr. Schumer said.

 Republicans, religion and the triumph of unreason

How do they train themselves to be so impervious to reality?

Sarah Palin really has claimed ? with a straight face ? that Barack Obama wants to kill her baby

Something strange has happened in America in the nine months since Barack Obama was elected. It has best been summarised by the comedian Bill Maher: "The Democrats have moved to the right, and the Republicans have moved to a mental hospital."

The election of Obama – a black man with an anti-conservative message – as a successor to George W. Bush has scrambled the core American right's view of their country. In their gut, they saw the US as a white-skinned, right-wing nation forever shaped like Sarah Palin.

When this image was repudiated by a majority of Americans in a massive landslide, it simply didn't compute. How could this have happened? How could the cry of "Drill, baby, drill" have been beaten by a supposedly big government black guy? So a streak that has always been there in the American right's world-view – to deny reality, and argue against a demonic phantasm of their own creation – has swollen. Now it is all they can see.

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Since Obama's rise, the US right has been skipping frantically from one fantasy to another, like a person in the throes of a mental breakdown. It started when they claimed he was a secret Muslim, and – at the same time – that he was a member of a black nationalist church that hated white people. Then, once these arguments were rejected and Obama won, they began to argue that he was born in Kenya and secretly smuggled into the United States as a baby, and the Hawaiian authorities conspired to fake his US birth certificate. So he is ineligible to rule and the office of President should pass to... the Republican runner-up, John McCain.

These aren't fringe phenomena: a Research 200 poll found that a majority of Republicans and Southerners say Obama wasn't born in the US, or aren't sure. A steady steam of Republican congressmen have been jabbering that Obama has "questions to answer". No amount of hard evidence – here's his birth certificate, here's a picture of his mother heavily pregnant in Hawaii, here's the announcement of his birth in the local Hawaiian paper – can pierce this conviction.

This trend has reached its apotheosis this summer with the Republican Party now claiming en masse that Obama wants to set up "death panels" to euthanise the old and disabled. Yes: Sarah Palin really has claimed – with a straight face – that Barack Obama wants to kill her baby.

You have to admire the audacity of the right. Here's what's actually happening. The US is the only major industrialised country that does not provide regular healthcare to all its citizens. Instead, they are required to provide for themselves – and 50 million people can't afford the insurance. As a result, 18,000 US citizens die every year needlessly, because they can't access the care they require. That's equivalent to six 9/11s, every year, year on year. Yet the Republicans have accused the Democrats who are trying to stop all this death by extending healthcare of being "killers" – and they have successfully managed to put them on the defensive.

The Republicans want to defend the existing system, not least because they are given massive sums of money by the private medical firms who benefit from the deadly status quo. But they can't do so honestly: some 70 per cent of Americans say it is "immoral" to retain a medical system that doesn't cover all citizens. So they have to invent lies to make any life-saving extension of healthcare sound depraved.

A few months ago, a recent board member for several private health corporations called Betsy McCaughey reportedly noticed a clause in the proposed healthcare legislation that would pay for old people to see a doctor and write a living will. They could stipulate when (if at all) they would like care to be withdrawn. It's totally voluntary. Many people want it: I know I wouldn't want to be kept alive for a few extra months if I was only going to be in agony and unable to speak. But McCaughey started the rumour that this was a form of euthanasia, where old people would be forced to agree to death. This was then stretched to include the disabled, like Palin's youngest child, who she claimed would have to "justify" his existence. It was flatly untrue – but the right had their talking-point, Palin declared the non-existent proposals "downright evil", and they were off.

It's been amazingly successful. Now, every conversation about healthcare has to begin with a Democrat explaining at great length that, no, they are not in favour of killing the elderly – while Republicans get away with defending a status quo that kills 18,000 people a year. The hypocrisy was startling: when Sarah Palin was Governor of Alaska, she encouraged citizens there to take out living wills. Almost all the Republicans leading the charge against "death panels" have voted for living wills in the past. But the lie has done its work: a confetti of distractions has been thrown up, and support is leaking away from the plan that would save lives.

These increasingly frenzied claims have become so detached from reality that they often seem like black comedy. The right-wing magazine US Investors' Daily claimed that if Stephen Hawking had been British, he would have been allowed to die at birth by its "socialist" healthcare system. Hawking responded with a polite cough that he is British, and "I wouldn't be here without the NHS".

This tendency to simply deny inconvenient facts and invent a fantasy world isn't new; it's only becoming more heightened. It ran through the Bush years like a dash of bourbon in water. When it became clear that Saddam Hussein had no weapons of mass destruction, the US right simply claimed they had been shipped to Syria. When the scientific evidence for man-made global warming became unanswerable, they claimed – as one Republican congressman put it – that it was "the greatest hoax in human history", and that all the world's climatologists were "liars". The American media then presents itself as an umpire between "the rival sides", as if they both had evidence behind them.

It's a shame, because there are some areas in which a conservative philosophy – reminding us of the limits of grand human schemes, and advising caution – could be a useful corrective. But that's not what these so-called "conservatives" are providing: instead, they are pumping up a hysterical fantasy that serves as a thin skin covering some raw economic interests and base prejudices.

For many of the people at the top of the party, this is merely cynical manipulation. One of Bush's former advisers, David Kuo, has said the President and Karl Rove would mock evangelicals as "nuts" as soon as they left the Oval Office. But the ordinary Republican base believe this stuff. They are being tricked into opposing their own interests through false fears and invented demons. Last week, one of the Republicans sent to disrupt a healthcare town hall started a fight and was injured – and then complained he had no health insurance. I didn't laugh; I wanted to weep.

How do they train themselves to be so impervious to reality? It begins, I suspect, with religion. They are taught from a young age that it is good to have "faith" – which is, by definition, a belief without any evidence to back it up. You don't have "faith" that Australia exists, or that fire burns: you have evidence. You only need "faith" to believe the untrue or unprovable. Indeed, they are taught that faith is the highest aspiration and most noble cause. Is it any surprise this then percolates into their political views? Faith-based thinking spreads and contaminates the rational.

Up to now, Obama has not responded well to this onslaught of unreason. He has had a two-pronged strategy: conciliate the elite economic interests, and joke about the fanatical fringe they are stirring up. He has (shamefully) assured the pharmaceutical companies that an expanded healthcare system will not use the power of government as a purchaser to bargain down drug prices, while wryly saying in public that he "doesn't want to kill Grandma". Rather than challenging these hard interests and bizarre fantasies aggressively, he has tried to flatter and soothe them.

This kind of mania can't be co-opted: it can only be overruled. Sometimes in politics you will have enemies, and they must be democratically defeated. The political system cannot be gummed up by a need to reach out to the maddest people or the greediest constituencies. There is no way to expand healthcare without angering Big Pharma and the Republicaloons. So be it. As Arianna Huffington put it, "It is as though, at the height of the civil rights movement, you thought you had to bring together Martin Luther King and George Wallace and make them agree. It's not how change happens."

However strange it seems, the Republican Party really is spinning off into a bizarre cult who believe Barack Obama is a baby-killer plotting to build death panels for the grannies of America. Their new slogan could be – shrill, baby, shrill.