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October 09, 2006

Bredesen's BS

Forgot to mention this yesterday, but it's rather appalling to see Tennessee governor Phil bredesen hanging out in the New York Times counseling Democrats to "concentrate on a single issue: health care."

When last we saw Bredesen, he was kicking nearly 200,000 folks off TennCare, the state's health care program. He has, since then, sought to make amends with a stingier program providing care to the high-risk and working uninsured, but his accomplishments on the issue are a deterioration of health care in Tennessee, not an improvement. He's shown little creativity, no interest in an innovative, universal state solution or comprehensive national solution, and no compunction about tossing poor and sick Tennesseans off the program if the bottom line beckons.

In other words, he's got some nerve.

October 9, 2006 | Permalink


Berve? That's a bit harsh.

Posted by: Matt Weiner | Oct 9, 2006 1:32:04 PM

Bredesen did all this in the face of an electorate and legislature that was completely unwilling to provide the necessary revenue to avoid significant cutbacks in the existing plan. And to think that Tennessee's voters would be receptive to an "innovative, universal state solution" is completely unrealistic and seems to suggest almost complete ignorance of the state's political dynamics for the last twenty or so years.

It makes little sense to me to lay this at Bredesen's feet. If you expect a governor to have the ability to completely rewrite the preexisting preferences of his electorate and opposition, feel free to direct your readers' dollars to Professor X PAC.

Posted by: aeroman | Oct 9, 2006 2:46:31 PM

What is berve?

Posted by: Litz | Oct 9, 2006 2:46:45 PM

The more important issue here than whether or not Bredesen is a bad guy is that THE DEMS HAVE TO TALK ABOUT NATIONAL SECURITY! The idea of another "let's talk about domestic issues and cede security to the Republicans" election makes me gag. It would be the perfect way to rescue the Republicans from their current quagmire.

Posted by: Rebecca Allen, PhD, ARNP | Oct 9, 2006 2:50:30 PM

As a former Tennessean, I'd have to agree with aeroman, but to put it in more plain terms:

Tennesseans absolutely *refuse* to pass an income tax (the people this would most benefit are too ignorant to know they'd benefit). When last the governor (a Republican) and the legislature tried, it led to bricks being thrown through windows as the statehouse and constant threats directed at the congress. Without that income and with a balanced budget amendment in the state constitution, there's very little that Bredesen could do.

Posted by: Hcc | Oct 9, 2006 2:52:23 PM

he was kicking nearly 200,000 folks off TennCare

Be fair, the Republicans in Tenn. are filling the voter rolls with people. Admittedly made up people but they're filling them.

Posted by: olvlzl | Oct 9, 2006 2:52:44 PM

Also to be fair, Bredesen did propose alternatives (not appealing alternatives, necessarily) to kicking people off, including cutting back on specific types of services. Advocates for TennCare recipients took him to court, and won the battle, but lost the war -- ultimately, there has to be a funding mechanism for promised care. I don't think you can say Bredesen wanted to kick people off TennCare.

Posted by: Barbara | Oct 9, 2006 3:02:54 PM

Have to agree with aeroman. The state's budget has to balance, and so does Medicaid's. And let's not cry over the loss of TennCare, a program that literally had NO medical management. It was, for all intents and purposes, not an HMO but a private fee-for-service design -- i.e. the worst of all worlds. Bredesen didn't create TennCare. He was just the one smart enough to figure out it was unsustainable. Good for him, having the courage and sense of responsibility to solve the problem, instead of kicking the can down the road. He could easily have done nothing, and have the next governor kick even more people off the program. You know, the way George W. Bush is treating Iraq (leaving it to "future presidents" to resolve).

Since there is strong pressure in the electorate AGAINST more taxes, moreso here in Tennessee than elsewhere, Bredesen's plan is about the most any blue-stater could hope for in this environment. It's good that he's going to cover, and manage, the sickest, since they are the ones driving the cost crisis, and that the working uninsured will get coverage.

That said, yeah, Rebecca's right, too. Bredesen's trying to get us to relive the Kerry campaign of 2004. My guess is he's mouthing what he's been fed by the DLC in hopes of getting on the short list for the VP nomination in 2008. Bredesen's actually been mentioned, albeit as a longshot, for a presidential run.

Posted by: Rick | Oct 9, 2006 3:07:26 PM

Berve = balls + nerve?

Posted by: ckennedy | Oct 9, 2006 3:13:01 PM

Unlike the United State, Tennessee doesn't have a unitary executive. Thus, Bredesen can do little without approval from the legislature. The legislature wasn't willing to provide new funds, and given the state is contrained constitutionally to pass a balanced budges, cuts has to be made. period.

It's always easy to say "well, he should have done this alternative" or "hey, he should have raised revenue" without actually knowing whether Bredesen actually had the ability to do those things.

Posted by: Josh | Oct 9, 2006 3:16:33 PM

This criticism of Bredesen is a bit unfair for reasons stated above by Barbara, Hcc and aeroman. He's done a decent job of keeping a bad situation from turning disasterous. Just imagine for a moment what we'd have seen had Van Hilleary been elected four years ago.

And, I've just got to say that as a former TennCare recipient, the program not only saved my life (no one else would insure me for my epilepsy meds), but it was far better than what most states provide.

Kudos are in order: I see Atrios has made Bredesen "Wanker of the day."

Posted by: eris | Oct 9, 2006 3:18:38 PM

Buck you all. Bicks.

Posted by: Buford P. Stinkleberry | Oct 9, 2006 3:23:13 PM

As one who has first-hand knowledge of the effects of these cuts across many hundreds of recipients (I was a Hearing Officer who heard the due-process appeals of many of those disenrolled), I can only say that your analysis/critique is at best incomplete. For every single heart-wrenching example of a hard-working family with a dire need for care who was forced from the program, there were 25 (conservative estimate) who were - in the absence of an acute catastrophic event - going to be better off without TennCare and the effects of poly-pharmacy.

You would be amazed at how many people are bi-polar in this state (such that they could receive the expensive second generation antipsychotics - recently approved for the "manic" side of this "disorder"), suffering from acute GERD (acid-reflux), seasonal allergies, in need of some anti-depressant, and don't forget - of course - the xanax (or other benzo) and some form of an opiate. You have no idea how many "pain clinics" there are that are so very concerned about their patients well-being (and there ability to pay for their treatment). Oh and Vioxx - for a while there - was one of the most prescribed TennCare drugs. We all know that everyone is much worse without that. . . What? You can't buy it anymore? Oh that's right. . .it was marginally more effective than Aleve and it killed thousands of folks. . .

Blame the payors (states/insurance companies/hmos/etc.) all you want - they certainly share some of the blame.

But until you ask yourself, "What exactly are we asking them to pay for?" you are not going to understand the underlying nature of this problem.

Number of preventable deaths due to lack of insurance (IOM, 2004): 18,000.

Number of preventable iatrogenic deaths (those due to/caused by medicine) at hospitals (IOM, 1999): 48,000-99,000 (VERY CONSERVATIVE and OLD ESTIMATE).

Number of preventable deaths caused by prescription drugs/polypharmacy: approx. 100,000 (VARIOUS SOURCES)

Although there may be some overlap in the above, the fact that should not be overlooked is that medicine certainly kills a lot more people each year than that which can directly attributed to "lack of medicine." I know these are to some degeree apples and oranges. . .but ask yourself: "Are they?"

At a minimum, this should be a starting point for analysis. We spend more than enough money in this country on healthcare, but until the medical profession itself gets it head outta its own ass and hand outta everyone else's pocket - it doesn't matter what type of system you have to pay for it all - IT WILL STILL BE BROKEN.

Posted by: sandoz | Oct 9, 2006 3:23:22 PM

I'm going to agree with the above posters & offer a reluctant defense of Bredesen, too-- granted, since he's a rather conservative technocratic Dem who made millions in for-profit healthcare, his credibility is minimal on this topic, but he really didn't have any other options. To have reformed and properly funded TennCare would have required a fairly broad political agreement that just wasn't happening, and this was the only issue with which his GOP opponents could hobble him anyway.

And I've been telling people practically since 11/3/04 to give up on Bredesen as a presidential candidate; the man has precisely zero charisma and only enjoys a high approval rating because he does make the trains run mostly on time without upsetting the bible-thumpers too much.

Posted by: latts | Oct 9, 2006 3:32:37 PM

There's not much I can add that my fellow Tennesseans haven't already ponied up. There's no doubt that Philbert's burned the village to save the village, but that village was full of disease and it needed burning.

Taxation in Tennessee makes no sense. It needs to be restructured top to bottom, but as long as the airwaves are dominated by wingnut generals who tell their troops to get down to the Capital and intimidate it's just not going to happen.

I don't think Phil's hands were tied quite as tightly as some here, and I've yet to hear a truly creative solution from the man. While Ezra's account may be incomplete he may deserve Atrios' "WOTD" for asking others to do his work for him.

Posted by: PeskyFly | Oct 9, 2006 3:50:22 PM

Put me in with the Bredesen defenders. I have a friend who's a public health care consultant, and he said TennCare is an object lesson in what not to do if you're setting up a Medicare replacement. I always figured he was the only person with the knowledge to make it work. That he couldn't says little about his abilities (or compassion) and a lot about the program.

And yes, our tax structure is a scandal. Here in Nashville, we pay close to 10% sales tax on everything, including food.

Posted by: hamletta | Oct 9, 2006 3:51:43 PM

I agree with hamletta that Bredesen's not what you'd call innovative... he picks a few broad goals (pro football for Nashville when mayor, TDOT's image issues) & pursues them, and just manages other issues fairly competently. An income tax isn't happening here, although we do have the Hall tax on interest & dividends (I think?), and the combined sales tax is 9.25% in the major cities, with some foods being a percentage point lower. In Murfreesboro, thirty miles out, they pay the maximum 9.75% and have a stupid name.

Oh, and I also agree that TennCare is a terribly designed program, supposedly meant to be a great public/private blend that exemplified the best of The Market™, but of course that was a crock.

Posted by: latts | Oct 9, 2006 4:00:47 PM

Let's be fair. Our Tennessee state insurance coverage was covering almost 25% of the population and making it possible for employers to cut back the health benefits that they supplied their own employees. This was a problem that had to be fixed, which Gov. Bredesen did with a minimum of fuss. The bottom line is that he deserves credit for saving TennCare from being discarded in its entirety.

Posted by: ddresser | Oct 9, 2006 4:29:49 PM

I have been in TN for 7 years - previously from CO and IL. When I arrived, the state was in deep financial trouble. The majority of Tennesseans are 110% against a state income tax -REALLY against it; gun-carrying against it.

I followed most of Bredesen's steps to get TN out of the red and back on track. He did everything from across-the-board pay cuts (Bredesen gives his salary to the state - he is a millionaire) to shutting down the state parks for awhile to a total revamping of TennCare.

He held TV conferences with each major step, explaining where we were and what and why he was doing the next thing.

As with any public benefit there were large and plentiful abuses in TennCare. The average person on the program was receiving 30 (THIRTY) prescriptions. There were who-knows-how-many people on TennCare that didn't belong and then there were the truly needy.

I think Bredesen tried to save TennCare "as is" but financial restraints brought it down ( the courts certainly didn't help ). The fact that it is still functioning at a reduced level is a plus for the governor.

We still have no state income tax but we do have a balanced budget, a growing "rainy day" fund and teachers and other state employees are getting pay raises. Tennessee is not a rich state and Bredesen is not perfect but he is one of the best elected officials I have ever seen. You can keep the charisma.

And Ezra, I would be interested in what you based your post on.

Posted by: maryo | Oct 9, 2006 4:30:10 PM

Chiming in to agree--Tennessee is possibly the most anti-tax state in the country. And not anti-tax as in "will vote against peopel who raise taxes"--anti-tax as in, "will start riots opposing taxes that will never apply to them."

Posted by: SamChevre | Oct 9, 2006 4:56:42 PM

Bredesen is creative enough when it comes to cutting deals and recruiting high-profile talent to Tennessee. During his tenure as mayor of Nashville, he managed to convince Dell to locate here (their biggest stateside facility outside of Austin), and he wrangled deals with the NFL and the NHL to bring the Titans (formerly the Oilers) and the Predators (an expansion team) to town. Fair enough.

Problem was, he financed both deals off the backs of local taxpayers and skipped along to higher office. The city has inherited two locally-funded enterprises which are in financial straits, and for which no one has found a creative solution. (Now the city hustlers are busily trying to spend $500 million in tax increment funding and bond issues and whatnot to build a megaplex of a convention center.)

And politically, TennCare is one of the least of his sins. None of the posters defending Bredesen mention his program of workman's comp reform, which really made some of his staunchest promoters in the 2002 campaign -- namely the unions and the trial lawyers -- understandably upset.

Let's not forget, either, that Bredesen carried no water for Kerry in 2004. Rather, he mocked and ridiculed Democratic activists for backing Kerry, stating flatly in the Chattanooga TFP, as one example, that Kerry had no chance. Instead, Bredesen focused his "yeoman" efforts in two high-profile state Senate races, and both of his candidates lost. Tennessee, then, lost Democratic control of the Senate for the first time in a generation. Heckuva job, Phil.

I suspect that few people defending Bredesen here also realize what happened to the state DP after he took office. The entire senior staff was, erm, "encouraged to pursue other opportunities." These loyal Democrats helped him win election, and that was their reward. Sad, really.

Need I mention the fact that he's promised to sign the anti-gay marriage amendment if voters approve it this fall? Nah, I didn't think so.

I have a used mop which has sharper political instincts. It's fortunate for him that the TN Highway Patrol cronyism scandal didn't stick as hard to him, either, as it did to his political brain, deputy governor Dave Cooley.

Most fortunate for Bredesen, in all, is that because he has held the line on taxation, he enjoys huge support among Republicans -- he's polled as high as 20 points more favorable among the GOP than among self-ID Dems.

Bredesen has been a wanker for a long, long time before today.

Posted by: Andy Axel | Oct 9, 2006 6:27:10 PM

And the moral to this story? Only a "wanker" (in your eyes) can be elected statewide in Tennessee or as President. Heeheehee.

Posted by: Ned Williams | Oct 9, 2006 6:33:55 PM

Ned conveniently forgets that Al Gore Jr. was elected statewide twice -- four times, if you count both VP bids. Heeheehee.

Posted by: Andy Axel | Oct 9, 2006 6:38:47 PM

Andy, I think most of us are at least partly aware of Bredesen's sins, but still think he's the best we're likely to see in a state as culturally conservative as this one, at least anytime soon. Even adequate governance is usually a progressive victory in the South; it's almost like people are proud of their bottom-fifth status on quality-of-life issues.

Posted by: latts | Oct 9, 2006 7:34:57 PM

Bredeson is in no way the problem in Tennessee.

As posters have pointed out, the diseases there are hate radio stations owned by G. Gordon Liddy admirers, their gun-toting confederates, and profound ignorance.

Bredeson is a very, very bright guy. His opponent, the total Repug dud Van Hillery, ran on being a good ole boy, with ads featuring NASCAR and banjo music. Bredeson is Thomas Jefferson himself by comparison.

Posted by: deben | Oct 9, 2006 7:56:48 PM

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