Not long ago, I stopped watching the network Sunday shows. After all, who needs to spend an hour or two of valuable weekend time listening to elected officials and party hacks regurgitating the same tired talking points you’ve been hearing all week? But there’s no denying that Meet the Press, This Week, Face the Nation, and to a lesser extent Fox News Sunday are enormously influential. They confer status on the people who appear, they define the limits of official debate, and they help set the agenda for the rest of the media. So while they are often tiresome to sit through, they can’t be completely ignored. That’s why I couldn’t stay silent after seeing this celebratory tweet from Betsy Fischer, the longtime executive producer of Meet the Press:
If you watch the Sunday shows, the only thing you’ll be surprised about is that McCain hadn’t passed Dole (or anyone else) already. In fact, I wrote a column three whole years ago asking why the hell anyone still cares what John McCain thinks, and the question has become even more relevant in the time since. He’s a member of the minority party in the Senate who is not part of the leadership and has virtually no influence over his fellow senators. In 29 years in Congress, he has managed to produce exactly one significant piece of legislation (the McCain-Feingold campaign finance reform law), which got gutted by the Supreme Court. His knowledge of and ideas about policy are notoriously shallow and self-indulgent, running more toward phony moralism about tiny earmarks than the search for actual solutions to thorny problems. In his supposed area of expertise, national security, he can be relied on to offer the most simple-minded and uninformed opinions possible (Of course we should use military force! Which country were we talking about again?). So the public needs to hear his sage words in about the same measure as they need to hear those of other presidential losers. Why isn’t Michael Dukakis getting on Meet the Press? I’ll bet he’d be a more interesting guest than McCain.
Yet all the Sunday shows call McCain, again, and again, and again. Why? There are a few reasons, but what they all come down to is that people in the DC media just love, love, love them some John McCain (God help me, I wrote a whole book about it). He spent a couple of decades massaging their egos and convincing them that he was their best buddy, an investment that paid off splendidly. They love his alleged mavericky maverickness (don’t get me started on what a crock the whole “maverick” thing is). On the Sunday shows, McCain is what passes for “unpredictable.” So they’ll keep inviting him on. I wouldn’t be surprised if one day Betsy Fischer tweets, “Congratulations to John McCain on his 100th appearance on Meet the Press!”
By: Paul Waldman, The American Prospect, March 18. 2012
The controversy over contraception has faded a bit. Congressional Republicans are rethinking efforts to overturn a requirement that would make birth control coverage a mandatory part of health insurance. Rush Limbaugh has stopped talking about the issue, at least for the moment.
But the issue hasn’t gone away entirely. The administration is still working on ways to accommodate the wishes of some large religious institutions opposed, for reasons of faith, to sponsoring employee benefits that cover contraception. (On Friday, it unveiled a few options and announced it was seeking public comment on them.) Conservatives, meanwhile, continue to press their case.
With that in mind, let’s talk about a conservative argument that isn’t simply about religion or the morality of birth control. It’s the suggestion that birth control coverage simply doesn’t belong in health insurance, because it’s not an expense that all of us should be subsidizing.
Among those making that argument recently was syndicated columnist Mona Charen. After arguing that contraception costs “less than the cost of a weekly trip to Starbucks” and that a variety of programs, public and private, make free contraception available to the poor, Charen draws a distinction between birth control and other types of drugs:
Contraceptives are not a matter of life and death. But even if they were, such as cancer drugs are, is that an argument for forcing insurance companies to provide them free? Why not force free distribution of all medicines? The mandate makes no economic, social or moral sense.
Actually, it makes economic, social and moral sense.
Let’s put aside the question of whether contraception coverage should be “free,” because that’s not really the issue anymore. Republican Senators Roy Blunt and Marco Rubio, along with the Conference of Catholic Bishops, have said they oppose any requirement that forces employers to cover contraception, regardless of whether such coverage requires out-of-pocket expenses.
And, one more time, let’s dispense with this notion that every woman can get birth control for less than the weekly cost of Starbucks. As noted here previously, the cheap drugs at Target, Walmart, and the other big chains are great if you take the standard combination hormonal pills, which combine estrogen and progestin. But some people cannot or should not take those pills. They’re not good for postpartum women who are breast-feeding, for example, and they cause side effects for many others. They may not be as effective, for some women, as methods like intrauterine devices, depo-provera, or surgical sterilization.
How many women fall into those categories? It’s a minority of the population, to be sure. But that’s always the story with health care and health insurance. At any one time, most people don’t require expensive medical care. Only a small number of people do. It’s precisely for the sake of that group – the ones who face high expenses, and could face financial or medical turmoil without assistance – that insurance exists.
Keep in mind that, at some point or another, pretty much everybody falls into that category. Maybe you’re not a woman who needs expensive birth control. You might still be a woman, or a man, who ends up with heart disease. Or allergies. Or a chronic gastro-intestinal problem. Or cancer. Insurance is there to take care of you, so why shouldn’t insurance be there to take care of a woman who needs more expensive forms of contraception?
No, birth control isn’t treatment for an acute condition. It’s routine, preventative care. But that hardly undermines the case for coverage. Think about eye exams for a moment. Or blood pressure checks. Both of these are widely available, for very low cost. In fact, if you do the math, over the course of a year either one would cost less than a year’s supply of even generic hormonal contraception. But insurance typically covers those costs and, under the Affordable Care Act, insurance must cover those costs – because this sort of care keeps people from getting serious medical conditions and, quite possibly, saves money in the long run.
The very same things are true of birth control. Pregnancy is a wonderful thing, but it’s also a serious medical condition that requires serious medical attention. (Those of you unfamiliar with what pregnancy entails might want to consult this page from the American Academy of Family Physicians – or ask a woman who has been pregnant.) Don’t forget, too, that some women take contraception to control their menstrual cycles or for reasons that aren’t really related to avoiding pregnancy.
Some critics insist there’s a difference between screening for hypertension or vision problems, on the one hand, and controlling the timing of pregnancy, on the other. Non-procreative sex, they say, is a purely voluntary act, for which others should not have to pay. “No one is touching your birth control, ladies,” conservative writer Amanda Carpenter tweeted on Friday. “We just don’t want to be forced to pay for it.” But, according to statistics from the Guttmacher Institute, 99 percent of women use birth control at times during their reproductive years. Based on that, I think it’s safe to assume that non-procreative sex is an activity in which virtually everybody engages, at some point or another, and for which a large majority will need birth control.
And so we’re back to the question that’s always been at the very heart of our health insurance debate: Do we think responsibility for medical expenses should lie primarily with individuals, even if that means some won’t be able to afford it? Or is it a burden we wish to spread more broadly, across society, so that everybody can get the care they need, at a price they can afford?
You know where I stand on that question.
P.S. When the administration announced its options for accommodating religious institutions on Friday, it also released a rule about health plans for college students – and, in so doing, revealed that, for legal reasons, it does not have the authority to regulate all the plans. Sarah Kliff has the story. It doesn’t sound like a huge deal, but, as she notes, it’s yet another reminder of how complex insurance regulation is in the U.S.
By: Jonathan Cohn, The New Republic, March 16, 2012
It’s said that you can judge a man by the quality of his enemies. If the same principle applies to legislation, the Affordable Care Act — which was signed into law two years ago, but for the most part has yet to take effect — sits in a place of high honor.
Now, the act — known to its foes as Obamacare, and to the cognoscenti as ObamaRomneycare — isn’t easy to love, since it’s very much a compromise, dictated by the perceived political need to change existing coverage and challenge entrenched interests as little as possible. But the perfect is the enemy of the good; for all its imperfections, this reform would do an enormous amount of good. And one indicator of just how good it is comes from the apparent inability of its opponents to make an honest case against it.
To understand the lies, you first have to understand the truth. How would ObamaRomneycare change American health care?
For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, “non-group” insurance market.
The fact is that individual health insurance, as currently constituted, just doesn’t work. If insurers are left free to deny coverage at will — as they are in, say, California — they offer cheap policies to the young and healthy (and try to yank coverage if you get sick) but refuse to cover anyone likely to need expensive care. Yet simply requiring that insurers cover people with pre-existing conditions, as in New York, doesn’t work either: premiums are sky-high because only the sick buy insurance.
The solution — originally proposed, believe it or not, by analysts at the ultra-right-wing Heritage Foundation — is a three-legged stool of regulation and subsidies. As in New York, insurers are required to cover everyone; in return, everyone is required to buy insurance, so that healthy as well as sick people are in the risk pool. Finally, subsidies make those mandated insurance purchases affordable for lower-income families.
Can such a system work? It’s already working! Massachusetts enacted a very similar reform six years ago — yes, while Mitt Romney was governor. Jonathan Gruber of the Massachusetts Institute of Technology, who played a key role in developing both the local and the national reforms (and has published an illustrated guide to reform) has surveyed the results — and finds that Romneycare is working pretty much as advertised. The number of people without insurance has dropped sharply, the quality of care hasn’t suffered, and the program’s cost has been very close to initial projections.
Oh, and the budgetary cost per newly insured resident of Massachusetts was actually lower than the projected cost per American insured by the Affordable Care Act.
Given this evidence, what’s a virulent opponent of reform to do? The answer is, make stuff up.
We all know how the act’s proposal that Medicare evaluate medical procedures for effectiveness became, in the fevered imagination of the right, an evil plan to create death panels. And rest assured, this lie will be back in force once the general election campaign is in full swing.
For now, however, most of the disinformation involves claims about costs. Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.
Because the truth does not, sad to say, always prevail, there is a real chance that these lies will succeed in killing health reform before it really gets started. And that would be an immense tragedy for America, because this health reform is coming just in time.
As I said, the reform is mainly aimed at Americans who fall through the cracks in our current system — an important goal in its own right. But what makes reform truly urgent is the fact that the cracks are rapidly getting wider, because fewer and fewer jobs come with health benefits; employment-based coverage actually declined even during the “Bush boom” of 2003 to 2007, and has plunged since.
What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can’t afford essential care. So this reform had better survive — because if it doesn’t, many Americans who need health care won’t.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 18, 2012
We’re 15 days out from the expiration of our eighth stopgap — yes, our eighth stopgap — to extend funding for transportation infrastructure. The last long-term transportation bill ended in 2009, and here we are, three years later, with no replacement.
It looked, this week, like perhaps we had finally broken the impasse when 72 senators joined together to pass the Boxer-Inhofe transportation bill. But Hill staffers tell Politico that the House won’t take the Senate bill up before the end of the month. Which means, yes, a ninth transportation stopgap. A ninth bill that doesn’t give states any predictable framework in which to make long-term investments. A ninth failure, in other words.
Congress, sometimes you guys are an embarrassment.
And so long as we’re taking the dim view here at Wonkbook, let’s just be honest about it: Boxer-Inhofe won’t solve our transportation problems, either. It’s much better than nothing, of course. And it’s better than yet another stopgap. But both on the spending and funding sides, it’s inadequate.
On the spending side, it only lasts for two years — the House wants a five-year bill, as does the White House — and, at $109 billion, it’s only about two-thirds the size of the president’s budget request for infrastructure, which was, in turn, smaller than what most infrastructure experts thought was needed.
This is a bad time to do a half-measure on infrastructure. We have literally trillions of dollars in unmet infrastructure needs. We have massive unemployment in the construction sector. Materials are unusually cheap because of a depressed global economy. Borrowing is unusually cheap because we’re one of the few safe havens left in the global financial market. And it’s cheaper to repair an aging bridge today than rebuild a crumbled one 10 years from now. So waiting to do the bulk of our infrastructure passing a half-measure on infrastructure investment later is like waiting till after the big sale ends to buy your groceries. It’s just bad financial planning.
Further, as my colleague Brad Plumer reports, Boxer-Inhofe does nothing to stop the Highway Trust Fund, which is paid for by the federal gas tax, from going broke. There are all sorts of reasons the fund is going broke — more fuel-efficient cars, the gas tax isn’t indexed to inflation, etc — but the bottom line is that the primary mechanism we use to pay for infrastructure in this country is in crisis. President Ronald Reagan, you’ll recall, actually raised the gas tax to fund his infrastructure bill, and Sen. Mike Enzi (R-WY) offered an amendment to index the gas tax to inflation in this bill. But that amendment was defeated, and so rather than actually fixing the Highway Trust Fund, we’re exhausting it, and patching the rest of the bill with one-time pay-fors and gimmicks. So the central problem in transportation funding — the problem that has arguably led to these nine stopgaps — will be left for another day.
Boxer-Inhofe is a lot better than doing nothing. It’s a lot better than another stopgap. And Sens. Barbara Boxer and James Inhofe deserve credit for actually moving a bipartisan infrastructure bill through the Senate. But it’s a reminder that, these days, even when Congress does get around to doing its job, it doesn’t do it particularly well.
By: Ezra Klein, The Washington Post Wonkbook, March 16, 2012
It’s not uncommon for the über-wealthy to equip their mega-mansions with pricey private home theaters, spa-worthy washrooms, and palatial pools. Now an increasing number of the super-rich are setting aside space in their homes for another purpose: top-notch medical care.
According to Bloomberg, more well-off families are paying up to install at-home emergency rooms, which can cost upwards of $1 million, and forking over as much as $30,000 a year for “concierge care,” which puts the best-of-the-best physicians at their disposal anytime, anywhere.
“Wealthy people want to have a little exclusivity and want better service than they can get at their normal healthcare facility, and they’re willing to pay for it,” Rick Flynn, principal and head of the Family Office Group with Rothstein Kass, told Bloomberg.
Guardian 24/7, a Virginia-based medical care company founded by former White House physician Sean O’Mara, charges as much as $12,000 a month for its ReadyRooms, Bloomberg reported, which feature discreetly installed medical equipment available at the touch of a button.
If a medical emergency arises, homeowners can immediately contact an on-call emergency physician—a much faster response than waiting for an ambulance to arrive and transport the ailing homeowner to the hospital, the company’s website notes.
“Before Guardian, this kind of medical protection was only available to one person,” the company’s website says. “Now, presidential-level care can be yours—on your schedule and your terms.”
And if you thought for a minute the super-rich might have to be without immediate access to medical care outside the confines of their estates, think again. Guardian 24/7 installs any number of medical apparatuses from X-ray machines to CT scanners on yachts, motor coaches, and aircraft.
By: Meg Handley, Washington Whispers, U. S. News and World Report, March 16, 2012