“Hello Public Option”: The Public’s Inch-Deep Hate Affair With The Individual Mandate
Maybe the individual mandate is doomed, as an agitated-slash-celebratory Twitterverse seemed convinced after conservative Supreme Court justices posed challenging questions about it (shocking!) on the second day of arguments on the Affordable Care Act. If the justices vote later this year to kill it, with the possibility that the whole law will collapse as a result, Republicans would be vindicated in their fight against “big government.” But in practical terms, would the country really know what it has lost?
From a political standpoint, the mandate invented by the GOP of yore (“yore” being a dozen years ago) has been manna for today’s GOP. Polling shows the requirement to buy insurance or pay a fine — meant to discourage freeloaders — has become highly unpopular. Strangely, the dreaded mandate is not particularly unpopular in Massachusetts, the only state that charges penalties for not buying coverage.
Disapproval of the individual mandate nationally, meanwhile, seems to be a mile wide but not all that deep. There’s evidence that many people don’t understand what it is, why it is, and how it would affect them, and that their answers change depending on word choice and word sequence.
They like it better – about even with disapprovers in a Pew poll — if the last thing they hear is about subsidies to help lower-income people buy insurance. They like it somewhat when it’s explained that without it, people would just buy insurance when they got sick (driving up costs for everyone) or alternatively, insurance companies could not be required to cover people with existing medical problems (because without a mandate, there wouldn’t be enough healthy people in the pool). They like it best – 61 percent approval in a Kaiser Family Foundation poll — when they’re told it won’t apply to most people because they have insurance through work.
That spike to 61 percent, nearly twice as high as the 33 percent who support the mandate when asked a simple up-or-down question, is telling. It suggests many Americans aren’t comrades-in-arms with conservatives waging an ideological battle – they’re just people nervous about change and relieved to hear it won’t affect them.
Attitudes toward the overall health law are just as complicated as those toward the mandate. A new CNN/ORC International poll, like most polls, finds that the law is unpopular – favored by 43 percent, opposed by 50 percent. Breaking down the numbers further, CNN found 43 percent favor it, 37 percent oppose the law because it’s too liberal, and 10 percent oppose it because it’s not liberal enough. Hello public option!
You have to wonder if that 10 percent – which has gone as high as 14 percent in earlier CNN polls – keeps doggedly voicing opposition to the law in hopes the Supreme Court will strike it down and force Congress to regroup. At some point, as 50 million uninsured rises to 60 million and 70 million and higher, as more states approach the astonishing Texas rate of 26 percent uninsured, Congress may decide it has to do something. And, barred from effectively regulating the private market, there will be no options except the public option – Medicare for all.
That should be a safe course. After all, the policy already exists. But in the current climate it’s not hard to envision a conservative challenge to Medicare, and who knows what the Supreme Court might do?
By: Jill Lawrence, The National Journal, March 27, 2012
Don’t Blame The GOP For Mitt Romney’s Flip-Flops
As former Gov. Mitt Romney gets battered by the likes of George Will, expect to hear a lot more arguments along the following lines.
It’s not Romney who is the flip-flopper. It’s the conservative movement. It was only three years ago that Jim DeMint was praising the Massachusetts healthcare plan. Post-2009, conservatives have flip-flopped on individual mandates, they have flip-flopped on monetary policy, in these cases they have adopted ever more extreme positions.
Yes Romney has had to shape-shift to keep pace, and that’s unfortunate. But don’t blame him—blame them.
God bless David, but this is too cute. It’s impossible to deny, at this point, that the idea of an individual mandate emerged from the right. Former Speaker of the House Newt Gingrich was forced to admit this onstage in the primary debate in Las Vegas.
But that hardly means the conservative movement has flip-flopped on the issue.
Sure, it was a feature of the Senate Republican alternative to Hillarycare, but that was spearheaded by Sens. Lincoln Chafee and Bob Dole. If Frum would like to make the case that those guys were emblematic movement conservatives, he can go right ahead.
I was around Capitol Hill in the late-’90s and, truth be told, I don’t remember hearing much about the mandate at all.
After Hillarycare unraveled, the healthcare debate came to focus on the late Rep. Charlie Norwood‘s “patients’ bill of rights.”
It was a genteel, middle-of-the-road proposal, sure to appeal to women voters (guaranteed access to OB-GYNs was a frequent talking point). It rattled around for a few years, garnered bipartisan support, but most Republicans were happy to see it wither.
On substance, conservatives pointed out, rightly, that the bill wouldn’t do anything to increase access to insurance. And so they proposed market-friendly solutions (“association health plans,” for example) that would have reduced the number of uninsured citizens by a few million.
That the patients bill of rights did nothing for the uninsured was always slightly embarrassing for Democrats to admit—but this was the safe, piecemeal strategy they had embraced until 2009, when they got regulations of that sort on insurance companies and coverage for most of the uninsured, the costs for which would have to be borne by healthy people not paying into insurance pools (hence the need for an individual mandate).
Look: I’m not denying that some Republicans have been more than a little squirrelly on the mandate. I’m just saying it was never an issue that movement conservatives seriously fought for, to the extent that they thought about it all.
Now, onto Michael Gerson, who praises Romney’s pragmatism and downplays the risk that he’ll flip-flop away from the movement after Inauguration Day. Moreover, Gerson argues that Romney’s “multiple choice” reputation will actually strengthen the movement’s grip on his presidency:
Precisely because he has a history of ideological heresy, it would be difficult for him to abandon his current, more conservative iteration. He has committed himself on key conservative issues. Having flipped, he could not flop without risking a conservative revolt. As a result, conservatives would have considerable leverage over a Romney administration.
This is interesting, I’ll admit.
I would agree with Gerson that the chances of Romney switching back to pro-choice on abortion is vanishingly small. Ditto for embryonic stem-cell research. There really is no plausible way for Romney to climb back from these positions.
And when Romney said recently that “the idea of spending trillions and trillions of dollars to try to reduce CO2 emissions is not the right course for us,” I was inclined to believe him. I can’t see his administration spending a penny on climate change.
The problem with Romney isn’t that he’s changed his mind on this or that issue. Every politician not named Rep. Ron Paul has done this.
The question Gerson and movement conservatives should be asking themselves about Romney isn’t whether, having checked the right box now, he’ll uncheck it later. It should be: Do you think he’d spend political capital or risk his presidency on any issue that you care about?
Put another way: Do you believe that Mitt Romney is more than nominally pro-life? Will he fight to change the status quo on abortion?
I suppose Gerson’s assurance depends, too, on what constitutes a “key issue.” Does the building of a border fence count? If so, does Gerson really believe that President Romney is going to build a “high-tech fence” to “secure the border”?
How about gays in the military? Romney’s most recent position on the issue is that he didn’t think “Don’t ask, don’t tell” should have been interfered with. Does Gerson think Romney, a la former Sen. Rick Santorum, will fight to reinstate the policy?
Does Gerson think that Romney will try to dismantle Obamacare in its entirety—or just the “worst aspects” of it?
Romney isn’t just a flip-flopper. He’s just downright weaselly.
By: Scott Galupo, U. S. News and World Report, November 2, 2011
The Candidates Weren’t The Only Ones On Display In Tampa
The point of presidential candidate debates is to offer the public a chance to scrutinize and evaluate those seeking national office. Occasionally, though, voters get the chance to scrutinize and evaluate those in the audience, which is nearly as interesting.
The candidates seeking the Republican presidential nomination are a pretty scary bunch — remember, one of them stands a reasonably good chance of becoming the leader of the free world in about 17 months — and the two-hour display on CNN last night was a depressing reminder of what’s become of the GOP in the 21st century. That said, maybe it’s just me, but I’m starting to find the audiences for these debates even more disconcerting.
Wolf Blitzer posed a hypothetical scenario to Ron Paul, asking about a young man who makes a good living, but decides to forgo health insurance. Then, tragedy strikes and he needs care. Paul stuck to the libertarian line. “But congressman,” the moderator said, “are you saying that society should just let him die?”
And at that point, some in the audience shouted, “Yeah,” and applauded.
Earlier in the debate, Blitzer asked Rick Perry about his attacks on Federal Reserve Chairman Ben Bernanke. “I said that, if you are allowing the Federal Reserve to be used for political purposes, that it would be almost treasonous,” Perry said. “I think that is a very clear statement of fact.”
The audience loved this, too.
What’s more, note that in last week’s debate, the mere observation that Perry has signed off on the executions of 234 people in Texas, more than any other governor in modern times, was enough to generate applause from a different GOP audience.
Taken together, over the last five days, we’ve learned that the way to impress Republican voters, at least the ones who show up for events like these, is to support letting the uninsured die, accusing the Fed of treason for trying to improve the economy, and executing lots of people.
There’s a deep strain of madness running through Republican politics in 2011, and it appears to be getting worse. Those wondering why the GOP presidential field appears weak, insipid, and shallow need look no further than the voters they choose to pander to.
By: Steve Benen, Contributing Writer, Washington Monthly Political Animal, September 13, 2011
“The Rising”: Return Of The Big GOP Medicare Lie
The participant’s in last night’s GOP presidential debate once again took the opportunity to pretend that the Affordable Care Act (“Obamacare”) put a massive dent in Medicare by cutting $500 billion from the program.
Michele Bachmann told us that “We know that President Obama stole over $500 billion out of Medicare to switch it over to Obamacare.” Mitt Romney intoned “He cut Medicare by $500 billion. This is a Democratic president the liberal, so to speak, cut Medicare.”
Yeah…except that nobody stole anything and Medicare was not cut by $500 billion.
Here are the facts:
For starters, nobody cut anything from the Medicare budget in the health care reform bill. The actions taken in the legislation are designed to slow the growth of Medicare spending without cutting benefits. Further, not one cent that would have gone to Medicare is somehow being shifted over to a program created by Obamacare (for first time readers, I readily use the term Obamacare because I believe that this name will ultimately stand as an honor to the President who made it happen.)
With respect to the infamous $500 billion, the non-partisan Congressional Budget Office has made it clear that the bulk of the projected savings will come from two primary sources—ending the subsidies to health insurance companies who offer Medicare Advantage programs and reining in the growth of payments to physicians. The remainder will, hopefully, come from cutting back on the waste and fraud that have long been rampant in the Medicare system.
Let’s begin with the Medicare Advantage program. Established via the Medicare Modernization Act of 2003. the program—a Bush/GOP creation—was ostensibly invented to encourage Medicare beneficiaries to gravitate towards privately operated insurance programs pursuant to the theory that the private sector could do a better job of delivering care to our seniors than the government.
I say ‘ostensibly’ because the true purpose was to create a windfall for the private insurance companies who have done so much for so long for so many Republican elected officials.
The way the script played out, the private insurance companies said that they would only be able to paricipate in the program if, and only if, the government gave them a head start by agreeing to subsidize their “start up costs” until the year 2010.
As a result of the deal, Medicare found itself paying, on average, an 11% surcharge on medical services and procedures provided by Medicare Advantage plans. This was enough to guarantee the insurance providers a tidy profit fully comprised of the government subsidies, creating one of the greatest examples of corporate welfare in the history of the nation.
Not surprisingly, the health insurers took advantage of the windfall to attract customers by offering very low premium charges, not to mention free gym memberships, one pair of eyeglasses per year, spa treatments, zero co-pays and assorted other benefits not available to those who opted to take their Medicare directly from the government. And why not? The insurers don’t need to make a penny from those who were insured as each customer guarantees them an 11 percent return on any medical benefit receieved courtesy of the Medicare program. Thus, they are more than happy to offer a free toaster to anyone who agrees to sign up.
What Obamacare did was put an end to the subsidies, thereby reducing future costs to the program by billions while continuing to provide Medicare beneficiaries with the benefits promised.
By any standards, this was a no-brainer in terms of reigning in the growing costs of Medicare and creating a system that is fair to all beneficiaries.
Now, the doctors.
This gets a bit tricky and, to be honest, I don’t really believe that these savings will ever materialize.
At the heart of the discussion is a formula that was designed during the Clinton Administration called the Medicare Sustainable Growth Rate, or SGR. The approach was created in an attempt to control Medicare spending for physician services with the idea being that the yearly increase in the expense per Medicare beneficiary should be tied to the growth in GDP. Thus, when actual Medicare spending exceeds the annual target in a given year, the SGR requires that physicians, and other system providers, must take a cut in order to bring the spending back in line with the annual spending targets.
The docs, understandably, do not like the idea of taking less in their Medicare payments. As a result, Congress has been delaying the cuts for years, constantly rolling them over into the next year at which time they roll them over again and again. Were Congress to ever stop delaying the SGR cuts, the physicians would find themselves feeling the cumulative pain of the delays with a one time Medicare rate reduction in excess of 20 percent.
These cuts are factored into the Medicare savings projections, along with hoped for savings to come by encouraging physicians to try some different approaches to practicing medicine.
Will this ever happen? Probably not.
So, while a skeptic can argue that these projected savings may never materialize, one cannot argue that this is, somehow, a cut to the Medicare program.
The bottom line is that there is nothing in the ACA that takes anything away from Medicare beneficiaries, now or in the future. Yet, the GOP continues to do its best to scare the hell out of seniors, the most reliable voter block in the nation.
We need to take this very seriously.
If the 2010 elections taught us anything, it is that a frightened voter population will do some crazy things. So, it’s on us to make sure that our grandparents and parents understand that Repubican fear peddlers are selling nothing but lies and that falling for the lies could result in the end of Medicare as we know it if the Republicans are permitted to gain full control of the government.
If you would like more information on this to share with family and friends, just let me know. The effort to mislead our senior citizens worked well in 2010. We simply cannot permit it to work again in 2012.
By: Rick Ungar, Mother Jones, September 13, 2011
Texas-Style Tort Reform: Rick Perry’s Texas Health Care Hoax
In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reformwould go a long way toward curing what ails the U.S. health care system.
Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected.
Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.
“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide,” Perry wrote in a newspaper commentary in 2009. “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”
Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.
But if Perry had his way, all the states would do as Texas did in 2003 when lawmakers enacted legislation, which he championed, limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The legislation capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. A few months after he signed the bill into law, the state’s voters narrowly passed a constitutional amendment, also endorsed by Perry, which had the same effect. Proponents of the amendment wanted to be sure the new law would be constitutional.
Texas, he wrote in that 2009 commentary “stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.”
As a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, according to Perry, the number of doctors applying to practice medicine in the state “skyrocketed.”
He says that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing there for the first time.
Tort Reform Backfires in Texas
That certainly sounds impressive — so long as you look at that number in isolation. But when you look at how Texas stacks up with the rest of the country in terms of physician growth in direct patient care, tort reform appears to have given Texas no leg up in competition with others states for doctors. In fact, according to statistics compiled by the American Medical Association and other physician organizations, Texas has actually lost ground when it comes to the number of doctors practicing in the state since tort reform was enacted. Big time.
In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states. In fact, only nine states fared worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not as badly. Back then, 11 states fared worse than the Lone Star state.
Even more revealing, the number of doctors in patient care increased 13.2 percent nationwide from 2000 to 2008. It increased only 12.8 percent in Texas. The rate of growth was actually greater in 41 other states and in Washington, D.C. than it was in the Lone Star state.
It is true that malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit from that drop — except, that is, Texans who are doctors.
The Dallas Morning News published a chart earlier this year showing that the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. The paper reported drops of similar percentages for doctors in family practice and general surgery.
Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is the “defensive medicine” doctors practice, such as over-treating and prescribing more medications and diagnostic tests than necessary, out of fear of being sued. Well, if Texans believed their own health insurance rates would go down once tort reform made defensive medicine less prevalent, they have by now been disabused of that notion. The chances of a Texas family saving a few bucks on premiums would actually be greater if they moved to another state.
In 2010, the average premium for family coverage in Texas was $14,526. That’s $655 higher than the U.S. average. Those numbers seem to indicate that doctors have not passed on their own insurance savings to their patients and that they are not practicing medicine any less defensively than before tort reform was enacted.
Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived in another state. The Dallas Morning News, citing statistics from the Agency for Healthcare Research and Quality and other sources, reported that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively). And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was much lower: $3,721.
Another statistic Perry is not likely to mention when he talks about the benefits of tort reform is the number of Texans who are uninsured. The U.S. Census Bureau reports that Texas continues to be the state with the highest percentage of its residents without coverage, a whopping 25 percent last year, compared to about 16 percent nationwide. It was dead last in 2003 and it is dead last now.
All this should leave us wondering what “thing or two” states have come up with to solve the problems that affect their citizens. Considering the dismal state of health care in Texas, perhaps Perry had Massachusetts in mind.
By: Wendell Potter, Center for Media and Democracy, September 1, 2011
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