“The South’s New Lost Cause”: A Mason-Dixon Line Of Health Care Dispair
Before he was immortalized for saving the union, freeing the slaves and giving the best political speech in American history, Abraham Lincoln was just an unpopular new president handed a colossal crisis. Elected with 39.7 percent of the vote, Lincoln told a big lie in his inaugural address of 1861.
“I have no purpose, directly or indirectly, to interfere with the institution of slavery in the states where it exists,” he said, reaching out to the breakaway South. “I believe I have no lawful right to do so, and I have no inclination to do so.”
He was saying to a Confederacy that would enshrine owning another human being in its new constitution: If you like the slaves you’ve got now, you can keep them. It was a lie in the sense that Lincoln made a promise, changed by circumstances, that he broke less than two years later — and probably never meant to keep.
The comparisons of President Obama to Lincoln fade with every day of the shrinking modern presidency. As for the broken-promise scale: Lincoln said an entire section of the country could continue to enslave more than one in three of its people. Obama wrongly assured about five million people that they could keep their bare-bones health plans if they liked them (later amended when it turned out not to be true).
As inapt as those comparisons are, what is distressingly similar today is how the South is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States.
And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
But in the states that have embraced a program that reaches out to low-wage workers, almost 500,000 people have signed up for health care in less than two months time. This is good for business, good for state taxpayers (because the federal government is subsidizing the expansion) and can do much to lessen the collateral damages of poverty, from crime to poor diets. In Kentucky, which has bravely tried to buck the retrograde tide, Medicaid expansion is projected to create 17,000 jobs. In Washington, the state predicts 10,000 new jobs and savings of $300 million in the first 18 months of expansion.
Beyond Medicaid, the states that have diligently tried to make the private health care exchanges work are putting their regions on a path that will make them far more livable, easing the burden of crippling, uninsured medical bills — the leading cause of personal bankruptcy.
And those states aren’t going to turn back the clock and revert to the bad old days, no matter how Republicans try to kill health care reform in the wake of the federal rollout. Many are refusing to accept Obama’s “fix” of allowing people to keep sketchy health care policies. If they follow the pattern of Massachusetts — where a mere 123 people enrolled in the first month of Romneycare, after which it gradually took off — the progressive states could end up with more than 95 percent of their residents insured.
What we could see, 10 years from now, is a Mason-Dixon line of health care. One side (with exceptions for conservative Midwest and mountain states) would be the insured North, a place where health care coverage was affordable and available to most people. On the other side would be the uninsured South, where health care for the poor would amount to treating charity cases in hospital emergency rooms.
Texas, where one in four people have no health care and Gov. Rick Perry proudly resists extending the Medicaid helping hand to the working poor, would be the leading backwater in this Dixie of Despair. In the 11 states of the old Confederacy, only Arkansas and Tennessee are now open to Medicaid expansion.
The South, already the poorest region in the country, with all the attendant problems, would acquire another distinction — a place where, if you were sick and earned just enough money that you didn’t qualify for traditional Medicare, you might face the current system’s version of a death panel.
The only good news is that a handful of political leaders down South have grasped the utter stupidity of refusing to help their own people, or even giving the state exchanges a chance. In this month’s recent special election for a congressional seat in a solidly Republican Louisiana district, a pragmatic businessman, Vance McAllister, beat a Tea Party candidate with the full Obama derangement syndrome. The winner said Obamacare was the law of the land and might as well be applied in Louisiana, the nation’s third poorest state. (It didn’t hurt that he had the backing of a “Duck Dynasty” star.)
But most of the South is defiant — their own Lost Cause for the 21st century.
By: Timothy Egan, Op-Ed Contributor, The New York Times, November 21, 2013
“Stupid Obamacare!”: Profit Maximizing Private Insurance Companies Got You Down, Blame Obama
It has been said many times over the last few years that now that Democrats successfully passed a comprehensive overhaul of American health insurance, they own the health-care system, for good or ill. Every problem anyone has with health care will be blamed on Barack Obama, whether his reform had anything to do with it or not. Your kid got strep throat? It’s Obama’s fault! Doctor left a sponge in your chest cavity? Stupid Obama! Grandma died after a long illness at the age of 97? Damn you, Obama!
OK, so maybe it won’t be quite as bad as that, but pretty close. Here’s an instructive case in exactly how this plays out. Take a look at this article that ran in yesterday’s Washington Post, telling how in order to keep premiums down and attract customers, some insurers are limiting their networks. “As Americans have begun shopping for health plans on the insurance exchanges,” the article tells us, “they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.”
So insurance companies—private actors seeking to maximize profit—are making decisions that some potential customers find less than perfectly appealing. The article itself is clear about why this is happening, but in the newspaper’s print edition, the subtitle read, “Exchanges Exclude Doctors, Hospitals.” Of course, that’s completely false. The exchanges haven’t excluded any doctors and hospitals, the insurance companies offering plans on the exchanges have made a decision to exclude them. The insurance companies are perfectly free to make a different decision, but they’ve decided not to.
So the newspaper runs this story, with the headline writers mistakenly portraying what for some small number of people is an unwelcome development as a decision made by the Obama administration. Conservatives will then take articles like this and others like it, and say, “See? Obama said you could keep your doctor! He lied! This law is a disaster!” Barack Obama never said that he’d forbid any insurance company from ever changing anyone’s policy or offering policies that provide something less than spectacularly gold-plated coverage at absurdly low prices. But now, every profit-maximizing decision by a corporation becomes Barack Obama’s fault.
The second component of Barack Obama coming to own all the problems with the health-care system is that with the rollout of the ACA, you suddenly have a lot of political reporters doing stories on health care, and many of them have only the thinnest understanding of the law. That limited understanding makes it easier for them to just focus on whatever negative things are happening in health care, blaming them on the ACA, and assuring themselves that they’ve been appropriately “tough” in their reporting.
There’s nothing wrong with reporters fully exploring all the changes our ever-evolving health-care system goes through, so long as they do it accurately. But you might notice that they are completely uninterested in the stories of people who are being helped by the Affordable Care Act. Harold Pollack estimates that there are over 10 million uninsured Americans who have significant medical issues like a cancer diagnosis or diabetes, and thus find it difficult or impossible to get insurance on the individual market under the pre-ACA system. These people will now be able to get reasonably priced insurance, which for many will be literally life-saving. But journalists find these people boring and not worth talking about. They’re much more interested in people who find something problematic in the new system, and they’re working hard to find every last one of those people’s stories and share them with the country. And that’s how Barack Obama ends up owning the health-care system.
By: Paul Waldman, Contributing Editor, The American Prospect, November 22, 2013
“From The Party Of No To The Party Of Oops”: How Republican Intransigence Keeps Backfiring
Exasperated with repeated Republican stonewalling of President Obama’s executive and judicial nominees, Senate Democrats on Thursday went nuclear, striking down two centuries of precedent regarding the chamber’s arcane filibuster rules.
By a 52-48 vote, the Senate voted to allow confirmation of federal judge and Cabinet nominees with a simple majority vote. The move did not, however, change the filibuster rules regarding legislation and Supreme Court nominees.
For Republicans, it was the latest defeat to come as a result of the party’s refusal to engage with their Democratic colleagues on even minor issues. The GOP has earned a reputation under Obama as the “party of no” for its intransigence, which in recent months has proven self-defeating more than once.
Take the filibuster.
For a full year, Senate Majority Leader Harry Reid (D-Nev.) threatened the nuclear option to circumvent Republican inaction. Most recently, Republicans blocked three nominees to the powerful U.S. District Court of Appeals, not because of any qualms with the candidates’ credentials, but merely because they didn’t want Obama filling vacancies on an influential court that tilts conservative.
With the GOP refusing to back down, Reid finally dropped the bomb, ensuring Obama’s nominees could get an up-or-down vote — and, as a bonus, handing liberals a procedural reform they’ve long sought.
“The American people believe the Senate is broken,” Reid said on the Senate floor Thursday, “and I believe the American people are right.”
Outraged Republicans vowed retribution, saying they would use the process to stack future courts in their favor once they’re back in control. Except to do that, they would need to first retake the Senate and White House, which may not be so easy by 2016.
In the meantime, Democrats have a little extra muscle to help Obama staff his administration as he sees fit (which, let’s remember, used to be common practice). That could be immensely important, since House Republicans have shown no interest in dealing with the president on anything substantive like immigration reform.
As New York‘s Jonathan Chait detailed more thoroughly here, “Obama has no real legislative agenda that can pass Congress,” so his “second-term agenda runs not through Congress but through his own administrative agencies.”
With the filibuster tweak, Obama can now more readily advance his administrative agenda — and Republicans allowed that to happen by forcing Reid’s hand on the filibuster. At that point, he didn’t have much choice: Had he set the precedent of allowing the minority party to prevent judicial vacancies from being filled, Republicans would only have been encouraged to do it again.
“Eventually this escalation would have become untenable,” wrote Salon’s Brian Beutler, “and somebody would have had to go nuclear.”
That’s the same argument Democrats made during the government shutdown, another instance of GOP obstinacy backfiring spectacularly. Had Democrats and President Obama acceded to the GOP’s hostage-taking, it would have established a precedent that government shutdowns and threats of debt default were the norm for legislative negotiations.
And by letting Republicans dig in, Democrats reaped the political benefits of seeing the GOP’s approval ratings tank.
The same dynamic could soon play out on health care, too.
ObamaCare face-planted out of the gate, and Republicans have rightly criticized the administration’s extensive failings in implementing it. However, the GOP has yet to offer a credible alternative health-care plan. The party’s playbook for winning the PR battle over the law, outlined Thursday by the New York Times, is heavy on strategy but light on substance.
“Rather than get out of Obama’s path of self-destruction and focus energy on creating and promoting a positive, forward-looking health-care agenda” wrote National Journal’s Ron Fournier, “the GOP has chosen to cement its reputation as the obstructionist party.”
Republicans will keep stepping on rakes if they opt merely for “no” instead of “no, but instead.” And with ObamaCare possibly set to make something of a comeback in the coming weeks, the clock is ticking.
By: John Terbush, The Week, November 22, 2013
“Ignoring The Elephant In The Room”: No, President Obama’s Policies Are Not Holding Back The Economy
Wall Street Journal columnist Daniel Henninger had fun this week arguing that President Obama’s problems implementing health reform pale next to his problems getting the economy back to health. The attack on Obama’s economic stewardship, however, looks just like the standard conservative attack on health reform: it’s light on sound arguments and ignores the elephant in the room — Republican obstructionism.
First, health care. As the president says, it’s on him that the rollout of HealthCare.gov and the health insurance marketplaces — where individuals can purchase health insurance to avoid the fine for not having it — has been, to put it kindly, rocky. But Republicans have provided no clear alternative to expand access to good quality, affordable health care, and they have made the rollout more difficult.
Many Republican governors and state legislatures have left implementation of their health insurance marketplaces (also known as exchanges) to the federal government rather than do it themselves — hardly the usual position of a party that believes in devolving as much power as possible to the states. And, at the moment, 25 states are not moving forward to implement the Medicaid expansions — which are a very good deal for them — leaving a significant coverage gap among low-income adults and complicating the determination of eligibility for coverage on the exchanges.
Finally, Republican proposals to “fix” the problem would undermine, not improve, health reform. The president’s proposal, while not perfect, is the best on the table.
Like problems with the health care rollout, the problems in the economy are plain to see. Henninger plays fair when he notes that the president did not cause the Great Recession, which is the source of the problems with which we’re still grappling. But, he’s wrong to say it’s the president who “has the economy on lockdown.”
First, he ignores what many economists and policymakers see as the main problem we still face – inadequate demand for goods and services. Second, he cavalierly dismisses the benefits of economic stimulus in such an economy. Third, he insists the main thing holding back the recovery is excessive business regulation. With that mindset, he naturally doesn’t acknowledge the drag on economic activity and job creation from the premature austerity that Congress has imposed on the economy since Republicans regained control of the House in the 2010 mid-term elections and the barriers that Republicans have put in the way of a budget plan that could boost the recovery in the short run while still putting deficits and debt on a sustainable longer-run trajectory.
Just a reminder to all who, like Henninger, parrot the shibboleth that stimulus did not work: the Congressional Budget Office finds that gross domestic product has been higher each year since 2009 than it would have been without the 2009 American Recovery and Reinvestment Act and unemployment has been lower (see chart).
CBO includes a broad range of estimates about the recovery act’s impact to encompass the views of economists who continue to doubt the mounting evidence that stimulus is highly effective under the economic conditions prevailing in recent years. But, that evidence suggests that act’s impact is quite likely much nearer the high than the low estimate.
Here’s what the International Monetary Fund says about that research, the expansionary effects of fiscal policy (tax cuts and increases in government spending) and the “old Keynesian mulitplier” that Henninger mocks: “While debate continues, the evidence seems stronger than before the crisis that fiscal policy can, under today’s special circumstances, have powerful effects on the economy in the short run [and] that fiscal multipliers are larger.”
The powerful effects of fiscal policy in today’s special circumstances work both ways. The economic forecasting firm Macroeconomic Advisers estimates that the economic uncertainty and policy choices to raise taxes and cut spending that we’ve made since 2010 have cost the economy up to a percentage point per year of slower economic growth and up to 2 million jobs.
It’s Republicans whose policy preferences have pulled policy toward greater near-term fiscal austerity through spending cuts; Democratic plans look more like bipartisan proposals for less spending restraint in the short term and more deficit reduction that’s balanced between revenues and spending down the road when the economy is stronger.
It’s Republicans who have the U.S. economy on lockdown.
By: Chad Stone, Chief Economist, Center on Budget and Policy Priorities, U. S. News and World Report, November 22, 2013
“The Party Of Zilch”: The GOP Is Out To Destroy The Country
Yes, the headline is rather hyperbolic. It’s as over-the-top as some of President Obama’s most unhinged critics, who believe he is running the nation without care or concern for the Constitution. But when you look at the actions of the Republican Party, particularly its members in Congress, my headline seems appropriate.
Three different pieces highlighted how the GOP is grinding just about every sector of the federal government to a halt. And it is doing it through a cynical combination of obstruction, saying no and failing to have viable alternative proposals worthy of national debate. Whatever political gains Republicans achieve in the short-term come at the long-term expense of the country. That’s simply unacceptable.
Even though the Affordable Care Act (a.k.a. Obamacare) is much more than a Web site, the disastrous roll out of Healthcare.gov has done a number on the president’s standing with the American people. According to the latest Post-ABC News poll, Obama’s overall approval rating sits at 42 percent. His 55 percent disapproval rating is the highest of his presidency. This would be the perfect time for the opposition to step forward with those alternative proposals. But the GOP is “The Party of Zilch,” as Ron Fournier so accurately described.
Rather than be the party of solutions in a gridlocked capital, appealing to a leadership-starved public, the GOP is the party of obstruction, ensuring that its putrid approval ratings nose dive apace with Obama’s.
The country needs sensible immigration reform that brings 11 million or so undocumented residents out of the shadows. No, says the GOP
The country needs to tame a massive debt that will be 100 percent of the gross domestic product by 2038 unless Congress raises revenue and trims entitlements. No, says the GOP.
The country needs fair debate and compromise around existential issues such as climate change, income inequality, and a deteriorating 20th century infrastructure. No, says the GOP.
“Other than hard partisans on the left and right, the majority of the public—moderate, fix-it Americans who simply want a sensible government—now have nowhere to turn, because the GOP is the party of nothing,” Fournier correctly concludes.
The New York Times editorial board delivered its own party-of-zilch disquisition using opposition to the ACA as the jumping off point.
What is the Republican alternative to this government program, flawed as it is right now? There is none. Party members simply want to repeal the health law and let insurers go back to canceling policies at the first sign of a shadow on an X-ray. They have no immigration policy of their own. They have no plan that will stimulate job growth. They are in favor only of shutdowns and sequesters and repeals, giving the public no reason to believe they have a governing vision or even a legislative agenda.
That congressional Republicans have no “governing vision or even a legislative agenda” was proven in a Politico story on Sunday. The headline said it all: “House GOP 2014 agenda starts with blank slate.”
Last Thursday, a group of House Republicans filed into Majority Leader Eric Cantor’s Capitol office suite and received a blank piece of paper labeled “Agenda 2014.”
The blank slate just about sums up where Republicans find themselves after a year marked by the first government shutdown in 17 years, futile efforts to repeal Obamacare and the inability to pass spending bills at the levels set by Republican leaders.
As bad as that is, what a Republican aide said is worse. “What we have done so far this year clearly hasn’t worked,” the GOP aide involved in the planning sessions told the Politico reporters. “Cantor wants to take us in a new direction, which is good. The problem is we don’t know where we are headed, and we don’t know what we can sell to our members.” This no way to run an enterprise as large and as important as the United States.
The judicial branch is crippled as qualified nominees go unconfirmed due to “unfair hurdles in the Senate.” As a result, the U.S. Court of Appeals for the District of Columbia, the nation’s second-highest court, has three vacancies on the 11-seat court that handles cases involving federal regulations and national security. Half of the legislative branch is in thrall to a band of right-wing zealots unmoved by facts as much as they are motivated by hatred of the president. As a result, the threat of government shutdowns and default is constant. Inaction on pressing issues is now routine. And the executive branch finds its agenda held hostage by an opposition that schemed against it since before its inauguration in 2009, even though said agenda was approved by the American people — twice.
That the Obama administration has been able to get as much done as it has speaks to the president’s determination to move this nation forward. Yet it’s not enough. Ours is a government that requires two functioning parties that produce good public policy through the necessary friction of governing. Neither party is perfect nor has all the ideas or the answers. But no good comes from a party that gives up completely on governing.
At the end of its editorial, the Times noted, “Democrats may be stumbling right now, but at least they are trying.” Would that Republicans did the same. It is long past time they did.
By: Jonathan Caphart, The Washington Post, November 20, 2013
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