“Deadly Consequences”: Public Health Experts Have Estimated How Many Americans Will Die If The Supreme Court Repeals Obamacare
When conservative American Enterprise Institute scholar Michael Strain published an article last week titled, “End Obamacare, and people could die. That’s okay.” he made two critical errors: He embedded a genuinely extreme view into a banal one, and then demanded absolution for both without defending the former.
Strain’s larger point is so uncontroversial, it barely needs reprising: Obamacare was not the final word in U.S. health policy, and if Republicans want to replace the Affordable Care Act with a different, less redistributive set of reforms, they should be able to try, without necessarily catching hell for preferring a system that tolerates marginally more avoidable deaths than Obamacare does (especially if they ply fiscal savings into different programs that alleviate poverty, or improve general welfare).
This is an unobjectionable point. Had Strain argued that the Republican presidential nominee should make an Obamacare alternative the centerpiece of his 2016 platform, nobody would have called it immoral. But the premise of his article is that conservatives (including himself, presumably) will be pleased if the Supreme Court intervenes to gut Obamacare, because it would provide Republicans the missing leverage they’ll need to impose a replacement through the political branches.
First comes god from the machine, and only then comes an Obamacare replacement.
If such a dramatic predicate carried no consequences, Strain’s cost-benefit argument would stand on its own. But when you account for the damage the Supreme Court would incur in order to provide Republicans their missing leverage, it collapses completely.
In a brief to the Supreme Court, dozens of public health scholars, along with the American Public Health Association, detail the harm the Court would create by ruling for the challengers in King vs. Burwell. Most of their analysis is rooted in the basic point that stripping insurance away from eight million people would dramatically impede their access to the health system. But they also flesh out the corollary argument that an adverse ruling would have deadly consequences, and ballpark the number of avoidable deaths such a ruling would cause.
“Researchers found that, in the first four years of the [health care reform] law in Massachusetts, for every 830 adults gaining insurance coverage there was one fewer death per year,” the brief reads. “Using the national estimate that 8.2 million people can be expected to lose health insurance in the absence of subsidies on the federal marketplace, this ratio equates to over 9,800 additional Americans dying each year. Although the specific policy context and population impacts of any policy cannot be directly extrapolated from one setting to another, the general magnitude and power of these findings from the Massachusetts study demonstrate that even when approached cautiously, these earlier findings carry enormous public health implications for withdrawing subsidies and coverage from millions of Americans.”
The Massachusetts story wouldn’t unfold precisely in reverse everywhere the subsidies disappeared, but the experience there suggests the Supreme Court ruling would have measurable mortality implications. These costs (read: deaths) couldn’t be paired against the benefits of increased spending on anti-poverty programs. These are the costs conservatives are eager to inflict on others simply to gain the leverage they need to advance an alternative that the status quo forecloses.
Responding to critics in a followup article, Strain brushes this all aside by stipulating that Republicans would never allow all this suffering. “I think it’s very likely that the congressional GOP would enact some sort of replacement if the Supreme Court strikes down Obamacare,” he writes. “They would very likely take measures to address the needs of those who lost their subsidies as a result of the Court’s action.”
To back up his suspicions, he cites a suspiciously limited set of news reports, quoting Republicans who claim to be working on such a plan—or, at least “talking about how to build consensus on a replacement.”
He does not quote from this Wall Street Journal article titled, “Republicans to Block Legislative Fix to Health-Care Law,” or this article by TPM’s Sahil Kapur titled, “Republicans Are At A Loss On What To Do If SCOTUS Nixes Obamacare Subsidies.”
For those who haven’t been keeping score all along, Republicans have spent the past several years cyclically promising and then failing to deliver an Obamacare alternative. They didn’t have an alternative prepared in 2012 when conservatives asked the Court to declare Obamacare unconstitutional. They didn’t have an alternative prepared later in the year, when Mitt Romney was their presidential candidate. They didn’t have an alternative prepared when they shut down the government as part of an ill-fated effort to defund Obamacare. They didn’t run on an Obamacare alternative in 2014. And they don’t have an Obamacare alternative prepared this week, though they’re scheduled to pass another repeal bill on Tuesday.
The story’s a little different today in that the subsidies really could disappear by fiat, harming millions of people, under GOP control of Congress. Republicans genuinely haven’t encountered a motivating force this strong in the five years since Obamacare became law. If in defiance of such a remarkable pattern, Republicans manage between now and June to come up with a workable plan or a stopgap—one that President Obama will sign—they will have filled the hole in Strain’s argument. Five months might seem like a long time in politics, but remember: It took Democrats more than twice that to pass Obamacare, and almost 10 times as long thereafter to implement it.
By: Brian Beutler, The New Republic, February 2, 2015
Incoming Senate Majority Leader Mitch McConnell (R-Ky.) said the other day that he hopes the Republican-led Congress can prove to the electorate that his party can be a responsible “governing majority.” And on the surface, that’s a perfectly worthwhile goal.
But it’s been quite a few years since GOP policymakers actually tried to govern effectively, and there’s reason to believe the party no longer remembers how. This week, for example, Republican lawmakers will get right to work, pushing the Keystone oil pipeline and a measure to redefine a full-time worker under the Affordable Care Act. Jonathan Weisman had a good piece on the latter.
The House will take up legislation on Wednesday, the first major bill of the 114th Congress, that would change the definition of a full-time worker under the health law from one who works 30 hours a week to one who works 40 hours. A vote is scheduled for Thursday.
Weisman’s report did a nice job noting that even conservatives seem to realize this is a bad idea, with National Review’s Yuval Levin arguing over the weekend that the legislation “seems likely to be worse than doing nothing.”
Republicans, at some level, must understand this. Indeed, they pushed this exact same idea 11 months ago – in a bill they called the “Save American Workers Act” – and it was deemed ridiculous at the time.
An analysis of the bill, released Tuesday by the nonpartisan Congressional Budget Office and Joint Committee on Taxation, found that it would cause 1 million people to lose their employer-based insurance coverage. The report projected that more than 500,000 of them would end up getting coverage through Medicaid, the Children’s Health Care Program or the Obamacare exchanges. The rest, CBO and JCT said, would become uninsured.
The legislation would also lower the amount the federal government collects in penalties from businesses who don’t abide by the employer mandate. As a result, the report found, the deficit would go up by $74 billion over 10 years.
Jonathan Cohn explained a while back, “The Congressional Budget Office just taught the Republican Party a lesson. Governing is hard…. [T]hat’s the reality Obamacare’s critics are never willing to confront. They’re great at attacking Obamacare. But they’re lousy at coming up with alternatives that look better by comparison. There’s a reason for that. The downsides of Obamacare are real, but, in many cases, they make possible the upsides. Take away the former and the latter go away, too.”
Faced with this knowledge, the new, massive House Republican majority has effectively declared, “Well, let’s just pass it anyway.”
And what about Keystone? I’ll dig into this in more detail when the vote draws closer, but for now, I’m reminded of President Obama’s comments at his year-end press conference a few weeks ago:
“At issue in Keystone is not American oil. It is Canadian oil that is drawn out of tar sands in Canada. That oil currently is being shipped out through rail or trucks, and it would save Canadian oil companies and the Canadian oil industry an enormous amount of money if they could simply pipe it all the way through the United States down to the Gulf. Once that oil gets to the Gulf, it is then entering into the world market, and it would be sold all around the world.
“So there’s no – I won’t say ‘no’ – there is very little impact, nominal impact, on U.S. gas prices – what the average American consumer cares about – by having this pipeline come through. And sometimes the way this gets sold is, ‘Let’s get this oil and it’s going to come here.’ And the implication is, is that’s going to lower gas prices here in the United States. It’s not. There’s a global oil market. It’s very good for Canadian oil companies and it’s good for the Canadian oil industry, but it’s not going to be a huge benefit to U.S. consumers. It’s not even going to be a nominal benefit to U.S. consumers.
“Now, the construction of the pipeline itself will create probably a couple thousand jobs. Those are temporary jobs until the construction actually happens. There’s probably some additional jobs that can be created in the refining process down in the Gulf. Those aren’t completely insignificant – it’s just like any other project. But when you consider what we could be doing if we were rebuilding our roads and bridges around the country – something that Congress could authorize – we could probably create hundreds of thousands of jobs, or a million jobs. So if that’s the argument, there are a lot more direct ways to create well-paying Americans construction jobs.”
Again, the Republican Congress knows all of this. They know gas prices have already plummeted and that Keystone won’t push them any lower. They know that the project would create a few dozen permanent U.S. jobs. They know this is all about Canadian oil.
But this new “governing majority,” eager to prove how capable they are, have once again effectively declared, “Let’s pass it anyway” – whether it actually makes sense or not.
Republican lawmakers have had months – and by some measures, years – to come up with a policy agenda they’d implement once they controlled all of Congress. This, alas, is what they’ve come up with.
By: Steve Benen, The Maddow Blog, January 6, 2014
“Doesn’t Even Rise To The Level Of Pitiful”: Sorry, Republicans; The Keystone XL Pipeline Is Not A Jobs Agenda
In the new Congress, Republicans will have the majority in both the Senate and the House for the first time in eight years. As they get ready to take power, their rhetorical focus is clear: jobs, the economy, and more jobs.
So far, there are two main proposals on deck for the GOP. First, the Hire More Heroes Act, which would make it easier for small businesses that hire veterans to deny health care to their employees. Second, they want to immediately build the Keystone XL pipeline, a project that would transport oil from Canada to the Gulf Coast.
On their own, these are both extremely small-bore policies. But as a jobs agenda, this doesn’t even rise to the level of pitiful. It’s the latest evidence that Republicans continue to struggle with basic macroeconomics — and it does not bode well for the nation should they win the White House in 2016.
Let’s examine the Hire More Heroes Act first. ObamaCare requires that all businesses that have over 50 full-time employees provide health-insurance benefits. This law would exempt veterans from counting toward that cap, thus making it easier to expand a business over 50 employees if you hire veterans.
On its face, this might not even be a terrible idea. Health-care policy experts have long argued that funneling American health care through employer subsidies is bad, locking people into jobs they don’t like for fear of losing coverage, and increasing health-care spending. Rolling that system back very slightly might be a good thing. My problem is that there’s no reason to direct general social spending to veterans so preferentially.
But make no mistake, this is a tiny, tiny policy involving a relative handful of people and jobs.
Keystone XL is bigger in one respect. Generous estimates predict that the pipeline would create around 42,000 temporary jobs — about 2,000 construction jobs and the rest in supplying goods and services.
How many long-term jobs? Fifty. That’s right, 50 whole long-term jobs. (One more, and the pipeline would have to get health insurance for them! Unless they hired veterans, I suppose.)
Furthermore, the argument that Keystone XL would help by lowering gas prices just had the legs kicked out from under it, with the price of oil plummeting toward $50 per barrel with no sign of stopping. This was always a bogus argument, since the pipeline is a drop in the bucket compared with world supply, but now it makes even less sense.
To get a sense of the bigger picture, the U.S. economy pumped out probably close to 3 million jobs total last year. The GOP’s proposals, if enacted, will fail to make more than a small ripple in the job market.
The problem with the American economy is the same problem we’ve had since 2007: a lack of demand. With factories idle and workers unemployed, there’s not enough spending and not enough investment. Nations have two options for attacking this problem. First, spend money, through government investment in things like infrastructure, or handouts to citizens in the form of checks or tax cuts (fiscal policy). Second, use control of the money supply to ease credit and stimulate lending (monetary policy).
Republicans used to accept this framework, proposing a $713 billion government stimulus bill as recently as 2009. But they’ve since regressed intellectually to the pre–Great Depression era. The economic policy of the GOP today is almost indistinguishable from the days of Herbert Hoover and Andrew Mellon. Their platform is muddled on fiscal policy, proposing massive spending-side cuts coupled with large tax cuts for the rich — which in macro terms would cancel each other out. On monetary policy, they propose tighter money and reexamining the gold standard — which would slow the economy and throw people out of work. At best, it’s a large net negative for workers.
After the colossal failure of Hoover, when the Republican Party was largely locked out of national politics for a generation, they learned that parties ignore the lessons of Keynes at their peril. But it seems they will have to learn them again — and if they win full power in 2016, it will be at everyone’s expense.
By: Ryan Cooper, The Week, January 6, 2014
Is there absolutely nothing left in this country that we can take on as a nation without someone heading for the nearest cable TV news studio or on-line publication to lay the blame for our latest problem on the President, the government, racism or some other convenient entity?
Yes, we know there were mistakes made at Texas Health Presbyterian Hospital who sent Thomas Eric Duncan home upon his initial visit where he complained of symptoms that turned out to be the earliest stages of an Ebola infection.
The result for Mr. Duncan was tragic. But with just one human having passed away in the United States as a result of the Ebola virus, does the situation truly merit the whining and blaming that is now very much underway?
Sadly, the public dialogue, in this instance, began with cries of racism alleged by Mr. Duncan’s nephew—allegations quickly adopted by others despite there being no proof that racism played a role in any way whatsoever.
It is certainly true that an error was made when Mr. Duncan was sent home with a 103 fever, despite having informed the receiving desk at the ER that he had come to Dallas from Africa. It is also just as true that hospital error is estimated to cause some 210,000 deaths per year in this country, involving victims of all races.
Still, we know that blood tests were performed on Mr. Duncan in the emergency room on the day of Duncan’s first arrival. We know that he was not simply given an aspirin and a prescription for antibiotics and sent on his way without a full exam and a blood panel in order to hold down the price tag to the hospital or in response to his not mattering because of skin color.
I’ve shown up at an ER with a high fever and feeling quite badly. I was given an exam by the attending physician who also took a blood panel. After six hours, most of which was spent waiting to see the Doc, I was sent home with an antibiotic, told to drink lots of liquid so I would not become dehydrated and told to stay down for a few days.
Never was it contemplated that I be admitted to the hospital for what appeared to be a bad case of the flu.
Unfortunately, because the receiving desk at the hospital did not communicate to the physicians that Duncan had recently arrived from Africa, despite having been given this information, his blood tests did not include an Ebola test and he was treated just as I was when presenting with similar symptoms.
Next, contrary to what many have claimed, Mr. Duncan was given the experimental anti-viral drug, brincidofovir, shortly after his ultimate admission to the hospital. Tragically, his case was, by then, too far along for the drug to have a positive impact.
Finally, in answer to the complaint that Duncan was not prescribed a blood transfusion from one of the Americans who has survived the disease, in the hopes that the antibodies in the donor’s blood would be of assistance, this allegation turns out to be untrue. Unfortunately, the donor blood type did not match Mr. Duncan’s type, taking the possibility of such a transfusion off the table.
Accordingly, for someone to assert that racism or lack of health insurance was at work here, one would have to determine that racism or health insurance played a role in the communication failure that kept the treating physician(s) from considering Ebola as a possibility.
I don’t know about you but that seems like quite a stretch to me.
Aside from the actual evidence that would argue against a racial bias in this instance when it comes to the best possible treatment, there is a strong, compelling and virtually irrefutable logic to the argument that Thomas Duncan was not treated differently because of either race or a lack of health insurance.
One can reasonably assume that most everyone who was working at Texas Health Presbyterian on the day Mr. Duncan first appeared complaining of his symptoms lives in the Dallas area—meaning that each of them, and their families, would find themselves at ground zero for the spread of Ebola due to the presence of Duncan in their area.
What’s more, as I suspect that everyone from the clerks and nurses at the receiving desk to all remaining health professionals at the hospital were quite aware that Ebola does not only spread among the same race as the initial victim, it would make absolutely no sense whatsoever to take less of an interest in one individual presenting with Ebola who might be black than it would someone who is white—unless Ebola did not cross their minds as a possible diagnosis. And if that is the case, we should all be able to agree, based on the population of West Africa, that a white person coming into the ER with the same symptoms would be even less likely to capture the medical staff’s imagination and point it towards a possible case of Ebola.
By: Rick Ungar, Op-Ed Contributor, Forbes, October 13, 2014