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“Obamacare By Any Other Name”: An Unnecessarily Complicated Way To Undo Harm Caused By A Crisis Of Their Own Creation

This is kind of brilliant; it might be the perfect illustration of the state of the modern GOP. The Examiner’s Byron York is reporting that a group of GOP senators is working on a plan to undo the damage that would be done if the Supreme Court rules against the government in King v. Burwell.

For those not familiar with it, the case, which the court will hear next week, turns on the question of whether people who buy health insurance in federal exchanges (in the 34 states that didn’t set up these Obamacare-mandated marketplaces) are eligible for tax subsidies to help pay for health care.

If the court does knock out the subsidies, it could cause havoc in insurance markets – a recent RAND Corporation study estimated that 8 million people could lose their insurance, while the American Academy of Actuaries warned Secretary of Health and Human Services Sylvia Burwell this week that companies could be facing insolvency if the King ruling drives the markets into death spiral territory.

So on the one hand conservatives would come close to achieving their goal of wrecking Obamacare at any cost; on the other hand, they’re starting to realize there would actually be, you know, a cost, both in human and political terms. “We’re worried about ads saying cancer patients are being thrown out of treatment, and Obama will be saying all Congress has to do is fix a typo,” one senior GOP aide told York. (No doubt the actual fact of cancer patients being thrown out of treatment would also be upsetting to this aid.)

So Republicans are looking for a way to restore the government expenditures they have worked so hard to eliminate. Well, not the actual expenditures; a totally different set that would perform the same function but – this is important – would be called something else that didn’t have the word “Obamacare” in it. “GOP lawmakers have decided to keep the money flowing,” York wrote. “Maybe the payments won’t be called subsidies, but they will be subsidies. The essence of Obamacare – government subsidizing the purchase of health insurance premiums – will remain intact.”

Of course, the senior GOP aide’s hypothetical Obama would be correct: All Congress would have to do to fix a harmful King decision would be to pass a law saying that people in the federal exchanges are in fact eligible for the subsidies. But the modern GOP isn’t big on taking the most direct route to the conclusion at which they’ll inevitably arrive. (See, for example, the current ritualistic huffing and puffing from House Republicans – yes, we’ve seen this show before – and various fallback positions en route to the inevitable full, clean funding of the Department of Homeland Security.)

This is the apotheosis of the 21st century GOP Congress: It is seeking an unnecessarily complicated way to undo or prevent harm caused by a crisis of its own creation. This is the fiscal cliff, again; this is the shutdown fight, again; this is the debt ceiling fight(s) all over again.

And it’s also important to keep in mind that this effort to undo the GOP’s avowed goal is angels-on-the-head-of-a-pin stuff. Five years on, the GOP has yet to produce a plan encompassing the latter half of their “repeal-and-replace” mantra; merely ensuring insurance for 8 million people is presumably an easier lift, but no one should hold their breath waiting for a unified Republican plan. This is especially true given that the party’s activist base will label any such effort as an embrace of Obamacare.

Probably nothing will see the light of day. But if the GOP can produce a bill to fix its problem, you can bet that first we’ll repeat the same kabuki where GOP hardliners dream up the demands they’ll make in exchange for ending ongoing harm to the economy. To borrow a maxim from “Battlestar Galactica,” all of this has happened before, and will happen again.

 

By: Robert Schlesinger, U. S. News and World Report, February 27, 2015

March 3, 2015 Posted by | Affordable Care Act, GOP, King v Burwell | , , , , , , | Leave a comment

“The Internet Of Every Damn Thing”: Face It, Personal Gadgetry Tied To The Internet Is Selling Data About Your Habits To Businesses

Federal Trade Commission head Edith Ramirez put the matter plainly: “If I’m wearing a fitness band that tracks how many calories I consume, I wouldn’t want to share that data with an insurance company.”

In a study last year, the FTC found that 12 mobile fitness apps shared information with 76 enterprises. Face it; personal gadgetry tied to the Internet is selling data about your habits to businesses — and in ways you have no idea about.

These devices now range from home burglar alerts to apps that turn off the porch light to toothbrushes. As of this year, there will be 25 billion such things.

Hence, the FTC has just suggested some guidelines for neat but sneaky gear. They’re in a new report, titled “Internet of Things: Privacy & Security in a Connected World.”

I’d sort of given up on the privacy part. The choices have become so complex that I apply a simple rule. Anything I absolutely don’t want the world to see, I don’t put online. Period.

My Facebook friends know they will never see a look-what-I-just-bought post. As for my Web surfing, my life is not an open book, but if someone should disclose my interests, I’d be OK. I have an excuse for everything.

The potential problems arise with those very useful apps that need my personal information to do their job. Sure, I want Google Maps to know where I am. And if I had some serious medical condition, I’d want a monitoring device communicating with my doctor. But there’s a dark side: Some evil being could invade this data flow and change the medical settings.

I don’t see why my movie ticket app should always know my whereabouts. Fandango gives us two choices on giving it access to our location. One is “Never,” and the other is “Always. Access to your location will be available even when this app is in the background.”

Fandango thoughtfully provides a five-page privacy policy written in fluent legalese. It includes a discourse on its use of “Pixel Tags,” invisible files on the Web pages you visit. The point is that few consumers wade through these privacy policies, and even fewer have the faintest idea what they’re talking about.

The electric company sends me reports on my energy use and how it compares with that of neighbors. My most virtuous months seem to be those in which I’m not at home. My vacation schedule is unbeknownst to the company, I hope.

The FTC report calls for new rules governing the sort of information Internet-connected devices may collect, how it is used and how secure it is. This is a valiant effort, and I wish the regulators luck. But if hackers can break in to movie stars’ private photo files, what can we realistically do to protect our secret stashes from prying eyes?

Smartphone sensors can already guess a user’s sour mood, aggressive personality, pathetically low level of physical activity, sleeping difficulties and other behavioral patterns. And such snooping is perfectly legal.

In the end, consumers will have to decide: How much is the convenience of turning up the heat at home before leaving the office worth? What drives me nuts is all the thinking and research we have to do in balancing the trade-offs — and the attention that must be paid to various app settings.

The only current solution is to unscrew what you want kept private from the Internet. If you’ve forgotten how to use paper, you can put the information on a device not connected to the Internet — and then trip over the plug. Five minutes spent on some app’s privacy policy may convince you of the wisdom of primitive living.

 

By: Froma Harrop, The National Memo, February 29, 2015

January 29, 2015 Posted by | Federal Trade Commission, Internet, Social Media | , , , , , , | Leave a comment

“Playtime Is Over For Obamacare’s Foes”: And Still, Republicans Don’t Have A Serious Plan B

Friends of Obamacare, horrified that the Supreme Court has taken a case that could blow up the federal health insurance exchanges, should recalibrate their dread. While the health reforms were safely humming along, there was little political price for demanding their demise. Thanks to the Supreme Court, now there is.

Years of carpet-bombing assaults on Obamacare have left many Americans thinking that they don’t like the Affordable Care Act. But close down the federal exchanges covering 6 million people (so far) in 36 states and they may think otherwise. With a vengeance.

Here are the stakes in King v. Burwell: Should the justices strike down subsidies for coverage in the federal exchanges, only the very sick would hang in. That would be the end of the federal exchanges.

Donald Taylor, a health policy expert at Duke University, likens the Obamacare attackers to a dog chasing a car. “What’s the dog going to do if it catches the car?” he said to me.

Subsidies would be untouched in the 12 or 14 state-run exchanges (depends on how you define them), the majority of which are in blue states. Red-state politicians — oddly the biggest foes of a law that in effect transfers tax dollars from high-income liberal states to poor conservative ones — would have a mess on their hands.

“Some Southern states will be back up to 20 percent uninsured,” Taylor said, “and that doesn’t sound politically stable.”

The solution for Republicans would be a plan B. But they don’t have a serious plan B.

Republicans do have a proposal of sorts, composed early last year by three senators — Richard Burr of North Carolina, Orrin Hatch of Utah and now-retired Tom Coburn of Oklahoma. But it was written mainly as a political document with which to hit Obamacare over the head during the 2016 campaign — not as a ready-to-plug-in substitute.

Let’s look at the Republican plan that we aren’t supposed to examine too closely.

For starters, it would empower private insurers to play a bigger role in the relationship between you and your doctor — encouraging them to shrink the network of doctors and hospitals you may visit. So much for “choice.”

It also would cut government subsidies for many working stiffs who earn too much to claim poverty but too little to afford decent private coverage. And it would enable insurers to charge older people far more for their insurance. Obamacare lets them charge three times as much. The Republican plan would let them charge five times as much.

Gone would be the minimal coverage standards. That means the insurers could more easily deny payment for services that Obamacare considers basic. For all these gifts to private insurers, the industry actually prefers Obamacare because its subsidies create many more customers for their products.

The Republican replacement plan (as written so far) contains lots of other controversial elements pretty much ignored because few have taken it seriously. For example, it would tax employer-sponsored health benefits. (Obamacare’s “Cadillac tax” on luxurious coverage does some of that, for which it continues to take a beating.)

A group of conservative economists, led by Douglas Holtz-Eakin, has scored the Burr-Hatch-Coburn plan and claims that it would cut deficits by $1 trillion. These are reputable economists, Taylor says, but the text they were working with was “incredibly vague” on where the cap on the taxes would be put.

“The score is a number, and the text on which they did the score was ambiguous,” he said. “It shows just how hard this is.”

So now Obamacare won’t be the only piñata in town.

The Supreme Court will take up King v. Burwell in March. We do live in interesting times.

 

By: Froma Harrop, The National Memo, January 8, 2015

January 9, 2015 Posted by | Affordable Care Act, Health Exchanges, Republicans | , , , , , , | Leave a comment

“When Will They Ever Learn?”: Republicans Finally File Lawsuit Against Obama – And Stand To Gain Almost Nothing

Back in June, House Republicans announced, with deep regret yet great fanfare, that they were going to sue Barack Obama over his tyrannical usurpation of power. The suit was never actually filed; two lawyers the House had hired ended up quitting, and it looked as if it would fade away.

Then this week Republicans announced that they had found another lawyer to take the case, George Washington University law professor Jonathan Turley, who says he’s a liberal but has become an intense critic of the Obama administration. Just four days later, the lawsuit has finally been filed:

House Republicans filed a long-threatened lawsuit Friday against the Obama administration over unilateral actions on the health care law that they say are abuses of the president’s executive authority.

The lawsuit — filed against the secretaries of the Health and Human Services and Treasury Departments — focuses on two crucial aspects of the way the administration has put the Affordable Care Act into effect.

The suit accuses the Obama administration of unlawfully postponing a requirement that larger employers offer health coverage to their full-time employees or pay penalties. (Larger companies are defined as those with 50 or more employees.)

In July 2013, the administration deferred that requirement until 2015. Seven months later,the administration announced a further delay, until 2016, for employers with 50 to 99 employees.

The suit also challenges what it says is President Obama‘s unlawful giveaway of roughly $175 billion to insurance companies under the law. According to the Congressional Budget Office, the administration will pay that amount to the companies over the next 10 years, though the funds have not been appropriated by Congress. The lawsuit argues that it is an unlawful transfer of funds.

Call me cynical, but I can’t help but think that the newfound urgency to move ahead with the suit has something to do with President Obama’s immigration order. If conservative Republicans aren’t satisfied with whatever confrontation their leaders manage to create with Obama over immigration, John Boehner can say, “Don’t forget, we’re suing him!”

But what do Republicans get if they win this suit? Not much more than a symbolic victory. The actual complaints in the suit were always strange — they’re suing Obama for delaying the employer mandate, a provision they despise. If they won, he’d be forced to speed up implementation of the mandate, even as Republicans are pressing to eliminate it altogether. And by the time the suit winds its way through the courts, the issue will probably be moot. The mandate for employers with over 100 workers goes into effect in January (though they are only required to cover 70 percent of their employees, and almost all companies of that size already provided coverage even before the law was passed). And the mandate for the mid-size companies goes into effect in a year. By the time the case is heard by a high court, the remedy it’s seeking will probably have already taken place.

As for the other of the suit’s complaints, on cost-sharing subsidies, if Republicans are successful in killing them it would mean that poor people would have to pay more in copays and deductibles. But unlike the subsidies in three dozen states that are at issue in the King v. Burwell lawsuit, which the Supreme Court recently agreed to hear, this provision isn’t critical to the law’s basic functioning. So apart from the satisfaction some Republicans might receive from making life harder for the working poor, even if they win this lawsuit they won’t have dealt the ACA a serious blow.

Legal experts who have looked at this suit haven’t found much merit in it, particularly on the claim about the employer mandate. Federal agencies frequently delay the implementation of far-reaching regulations while practical problems are worked out. But even if they prevail, all Republicans stand to gain is the ability to say that they beat Barack Obama in court. Which may be more than nothing, but it isn’t much more than that.

 

By: Paul Waldman, Contributing Editor, The American Prospect; The Plum Line, The Washington Post, November 21, 2014

November 23, 2014 Posted by | Affordable Care Act, House Republicans, John Boehner | , , , , , , , , | Leave a comment

“Veterans And Zombies”: The Hype Behind The Health Care Scandal

You’ve surely heard about the scandal at the Department of Veterans Affairs. A number of veterans found themselves waiting a long time for care, some of them died before they were seen, and some of the agency’s employees falsified records to cover up the extent of the problem. It’s a real scandal; some heads have already rolled, but there’s surely more to clean up.

But the goings-on at Veterans Affairs shouldn’t cause us to lose sight of a much bigger scandal: the almost surreal inefficiency and injustice of the American health care system as a whole. And it’s important to understand that the Veterans Affairs scandal, while real, is being hyped out of proportion by people whose real goal is to block reform of the larger system.

The essential, undeniable fact about American health care is how incredibly expensive it is — twice as costly per capita as the French system, two-and-a-half times as expensive as the British system. You might expect all that money to buy results, but the United States actually ranks low on basic measures of performance; we have low life expectancy and high infant mortality, and despite all that spending many people can’t get health care when they need it. What’s more, Americans seem to realize that they’re getting a bad deal: Surveys show a much smaller percentage of the population satisfied with the health system in America than in other countries.

And, in America, medical costs often cause financial distress to an extent that doesn’t happen in any other advanced nation.

How and why does health care in the United States manage to perform so badly? There have been many studies of the issue, identifying factors that range from high administrative costs, to high drug prices, to excessive testing. The details are fairly complicated, but if you had to identify a common theme behind America’s poor performance, it would be that we suffer from an excess of money-driven medicine. Vast amounts of costly paperwork are generated by for-profit insurers always looking for ways to deny payment; high spending on procedures of dubious medical efficacy is driven by the efforts of for-profit hospitals and providers to generate more revenue; high drug costs are driven by pharmaceutical companies who spend more on advertising and marketing than they do on research.

Other advanced countries don’t suffer from comparable problems because private gain is less of an issue. Outside the U.S., the government generally provides health insurance directly, or ensures that it’s available from tightly regulated nonprofit insurers; often, many hospitals are publicly owned, and many doctors are public employees.

As you might guess, conservatives don’t like the observation that American health care performs worse than other countries’ systems because it relies too much on the private sector and the profit motive. So whenever someone points out the obvious, there is a chorus of denial, of attempts to claim that America does, too, offer better care. It turns out, however, that such claims invariably end up relying on zombie arguments — that is, arguments that have been proved wrong, should be dead, but keep shambling along because they serve a political purpose.

Which brings us to veterans’ care. The system run by the Department of Veterans Affairs is not like the rest of American health care. It is, if you like, an island of socialized medicine, a miniature version of Britain’s National Health Service, in a privatized sea. And until the scandal broke, all indications were that it worked very well, providing high-quality care at low cost.

No wonder, then, that right-wingers have seized on the scandal, viewing it as — to quote Dr. Ben Carson, a rising conservative star — “a gift from God.”

So here’s what you need to know: It’s still true that Veterans Affairs provides excellent care, at low cost. Those waiting lists arise partly because so many veterans want care, but Congress has provided neither clear guidelines on who is entitled to coverage, nor sufficient resources to cover all applicants. And, yes, some officials appear to have responded to incentives to reduce waiting times by falsifying data.

Yet, on average, veterans don’t appear to wait longer for care than other Americans. And does anyone doubt that many Americans have died while waiting for approval from private insurers?

A scandal is a scandal, and wrongdoing must be punished. But beware of people trying to use the veterans’ care scandal to derail health reform.

And here’s the thing: Health reform is working. Too many Americans still lack good insurance, and hence lack access to health care and protection from high medical costs — but not as many as last year, and next year should be better still. Health costs are still far too high, but their growth has slowed dramatically. We’re moving in the right direction, and we shouldn’t let the zombies get in our way.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, June 19, 2014

June 23, 2014 Posted by | Health Care Costs, Health Reform, Veterans Administration | , , , , , , | Leave a comment

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