“What If We Just Called It NixonCare?”: Republicans Have No Business Being Upset About Obamacare
House Majority Leader Eric Cantor says Republicans will seek to delay a requirement of the 2010 Affordable Care Act that all Americans obtain health insurance or face a tax penalty. “With so many unanswered questions and the problems arising around this rollout, it doesn’t make any sense to impose this one percent mandate tax on the American people,” Cantor said last week.
While Republicans plot new ways to sabotage the Affordable Care Act, it’s easy to forget that for years they’ve been arguing that any comprehensive health insurance system be designed exactly like the one that officially began October 1st, glitches and all.
For as many years Democrats tried to graft healthcare onto Social Security and Medicare and pay for it through the payroll tax. But Republicans countered that any system must be based on private insurance and paid for with a combination of subsidies for low-income purchasers and a requirement that the younger and healthier sign up.
Not surprisingly, private health insurers cheered on the Republicans while doing whatever they could to block Democrats from creating a public insurance system.
In February 1974, Republican President Richard Nixon proposed, in essence, today’s Affordable Care Act. Under Nixon’s plan all but the smallest employers would provide insurance to their workers or pay a penalty, an expanded Medicaid-type program would insure the poor and subsidies would be provided to low-income individuals and small employers. Sound familiar?
Private insurers were delighted with the Nixon plan but Democrats preferred a system based on Social Security and Medicare and the two sides failed to agree.
Thirty years later a Republican governor, Mitt Romney, made Nixon’s plan the law in Massachusetts. Private insurers couldn’t have been happier although many Democrats in the state had hoped for a public system.
When today’s Republicans rage against the individual mandate in the Affordable Care Act, it’s useful to recall this was their idea as well.
In 1989, Stuart M. Butler of the conservative Heritage Foundation came up with a plan that would “mandate all households to obtain adequate insurance.”
Insurance companies loved Butler’s plan so much it found its way into several bills introduced by Republican lawmakers in 1993. Among the supporters were Senators Orrin Hatch (R-UT) and Charles Grassley (R-IA). Both now oppose the mandate under the Affordable Care Act. Newt Gingrich, who became Speaker of the House in 1995, was also a big proponent.
Romney’s heathcare plan in Massachusetts included the same mandate to purchase private insurance. “We got the idea of an individual mandate from [Newt Gingrich] and [Newt] got it from the Heritage Foundation,” said Romney, who thought the mandate “essential for bringing the health care costs down for everyone and getting everyone the health insurance they need.”
Now that the essential Republican plan for healthcare is being implemented nationally, health insurance companies are jubilant.
Last week, after the giant insurer Wellpoint raised its earnings estimates, CEO Joseph Swedish pointed to “the long-term membership growth opportunity through exchanges.” Other major health plans are equally bullish. “The emergence of public exchanges, private exchanges, Medicaid expansions … have the potential to create new opportunities for us to grow and serve in new ways,” UnitedHealth Group CEO Stephen J. Hemsley effused.
So why are today’s Republicans so upset with an Act they designed and their patrons adore? Because it’s the signature achievement of the Obama administration.
There’s a deep irony to all this. Had Democrats stuck to the original Democratic vision and built comprehensive health insurance on Social Security and Medicare, it would have been cheaper, simpler and more widely accepted by the public. And Republicans would be hollering anyway.
By: Robert Reich, The Robert Reich Blog, October 29, 2013
“Happiness Today, Bankruptcy Tomorrow”: Why Letting Everyone Keep Their Health-Care Plan Is A Terrible Idea
The current furor over President Obama’s broken “keep your plan” promise confusingly melds together two very different claims. The first is a simple question of accuracy and honesty: Obama made a promise about his legislation, the promise has not come true, and a certain level of abuse is deserved. (Karl Rove huffs, “This is a serious breach of trust with the American people.” And you know that Karl Rove takes breaches of presidential trust with the utmost seriousness.)
The justifiable scrutiny of Obama’s veracity has melded seamlessly into a second and very different claim: That Obama’s broken promise is not merely a violation of trust, a fair enough charge, but an act of unfairness to those who have lost their plans.
The health-care debate has suddenly come to focus almost obsessively on the alleged victims of Obamacare, who have lost their cheap individual insurance. Here’s Matthew Fleischer mourning the loss of his bare-bones plan in the Los Angeles Times; here’s David Frum doing the same for the Daily Beast. Mary Landrieu, a vulnerable red-state Democrat, is introducing legislation to ensure that nobody can lose their individual health-care plan.
The idea underlying this notion, while facially appealing, is in fact misguided and morally perverse. No decent health-care reform can keep in place every currently existing private plan.
The New York Times has a helpful graphic displaying the structure of the insurance market:
The left and top-right squares show the four fifths of Americans who get coverage through the government. Those on the left who get covered through their employer get tax-subsidized insurance, and those in the top right get insured by the government directly. Obamacare leaves that structure in place (though it has a series of mechanisms designed to hold down their cost inflation).
The main coverage provisions affect the people in the bottom right quadrant. Most of that quadrant lacks any insurance at all, which points to the dysfunctionality of buying individual insurance before Obamacare. Some of them — 5 percent of the population — have a health-insurance plan. Health-care reforms have always thought of the people within that segment as being essentially the same group of people. Those are mainly healthy, non-poor people who have been skimmed out of the insurance pool, leaving behind those too poor, or too likely to need medical care.
Obamacare is designed to pool the bottom-right quadrant into risk pools, somewhat like the people on the left and the upper right. The poorest of the uninsured are eligible for Medicaid, though a Republican Supreme Court and Republican state governments collectively decided to leave them uninsured. The rest have coverage through the new health exchanges. By design, those exchanges prevent insurers from skimming out the healthy and excluding the sick. Some of the 5 percenters will get less expensive health care, mainly because they qualify for tax credits. Others think they will have to pay higher costs but, upon inspection, will be getting cheaper coverage on the exchanges.
But some other portion — an as-yet-undefined fraction of the 5 percent — will actually be paying higher insurance premiums in the exchanges, and their complaints are echoing across the land. Should we feel concerned for their plight? No, we should not, for three reasons.
First, a great many of the people who are happy with their individual health-insurance plan are happy only because they are unaware of its actual value. This sounds patronizing, but it also happens to be demonstrably true. Even highly educated consumers within this market were frequently snookered by insurance plans that turned out to leave them exposed to surprise costs — they incur a sudden high medical cost and discover their plan does not actually cover them. The fine print is a game of wits between insurer and customer that the insurer always wins. A large share of the people telling us now they’re happy with their individual insurance simply haven’t been exposed to a negative surprise. The handful of reporters who closely followed the individual-insurance market before last week are all watching the eulogies for the lost individual plans and having their brains explode.
Second, it is true that some people actually are getting decent individual health insurance, and have to pay more under Obamacare. Before, insurers could charge them a rate based on their individual likelihood of needing medical care, and some people are lucky enough to present a very low actuarial health risk. Now those people will have to pay a rate averaging in the cost of others who are less medically fortunate.
Have those healthy 5 percenters who do have decent insurance “lost” under Obamacare? In the very immediate sense, yes. That is what Obamacare advocate Jon Gruber is getting at when he concedes that 3 percent of Americans will be worse off under the new law. They’ll be paying higher rates in 2014 than they would have.
Yet this takes an oddly narrow view of their self-interest. You may pose a low actuarial risk today, but you cannot be certain your luck will continue for the rest of your life (or until you qualify for Medicare). Even people living the healthiest lifestyles suffer illnesses and accidents, or marry people who have a uterus. Those who are paying a higher rate are getting something for their money: a guarantee that some future misfortune won’t lock them out of the market. You might call such a guarantee “insurance.”
So some of the 5 percenters are wrong, some of them are short-sighted, but they have identified a basic moral principle: Why is it fair to steal from them, the healthy, and give to others, who are sick? If they have truly mastered the fine print of the individual insurance market and want to gamble on remaining a good actuarial risk forever, should they be permitted to keep their winnings? Having drilled down through the practical arguments, here we get to the final reason, the moral bedrock of the issue.
Their objection has an intuitive, libertarian appeal that obscures the fact that the vast majority of insured Americans already submit to this form of redistribution. Indeed, they’re submitting to a much more stringent form of this redistribution. The exchanges are allowed to charge older people up to three times the premium they charge the young. But in the employer system, they’re not allowed to charge older people any higher rate at all. The shift from healthy to sick in the employer insurance pool is massive. Adrianna McIntyre, a 24-year-old wonk prodigy, notes that her employer-based coverage charges her more than three times the rate she could get in the new exchanges.
People accept this transfer from the healthy to the sick because it is the only way to make medical care affordable to the sick. This is a simple mathematical truism. If your medical care costs more than you can afford to pay, the difference must be borne by those whose medical care costs less than they can afford to pay. There are any number of ways to handle this transfer. One is taxes, and Obamacare does use taxes to make insurance more affordable for many of its recipients. There are other potential methods — conservatives like to tout high-risk pools, at least in the abstract — but none escape the basic math.
The healthy 5 percenters do recognize that Obamacare carries out this transfer. Fleischer complains he is “being taken advantage of.” Frum, writing in the same spirit, complains that he must pay $200 more now that insurers can no longer reward him for his excellent health:
That $200 a month differential seems to be the cost of community rating: I had to answer a bunch of questions about my health before qualifying for my prior plan; the new plan will be issued, no questions asked. Presumably somewhere there is a D.C. resident who smokes or who has some pre-existing condition who will receive a corresponding $200 a month windfall.
The complainers are right. But they won’t quite face up to the full implications of their complaint. If you believe the healthy are entitled to keep the financial benefits of their good health, then you must also believe the sick must be denied medical care. Should that principle be the foundation of our health-care system?
By: Jonathan Chait, New York Magazine, November 1, 2013
“Small Towns Have Their Darkside Too”: Maryville, Missouri Is A Lawless Hellhole
Earlier this week, the New Republic’s Michael Schaffer published an immensely satisfying smackdown of the frustrating double standard the media tends to invoke when it comes to reporting about small towns. Culture war rules have firmly established that it’s fine for “real Americans” to slander cities as ungodly, anti-American dens of crime and iniquity.
Yet it’s all but compulsory for reporters writing about small town life to glop on the pious cliches about the honest, pure-hearted folk who allegedly populate these places, with their supposedly unwavering fidelity to family values, tradition, and the simpler things in life. These sepia-toned journalistic portraits of small-town life can be so treacly they run the risk of sending you into a diabetic coma.
But in reality, small towns are no simpler than anywhere else. And as anyone who grew up in such a place can tell you, small towns have their dark side. They can be vicious, bigoted, hateful places, and every bit as corrupt as cities. There’s a reason why Shirley Jackson set her chilling short story “The Lottery” in a small town. The town in the story was based on the place she was living in at the time; she and her family experienced ugly acts of ostracism and anti-Semitism there.
Thus we come to Maryville, Missouri, site of a now-infamous rape case, and various journalists’ not terribly persuasive attempts to whitewash the place, most notably the New York Times. But all the air freshener in the world can’t perfume the overpowering stench which practically wafts off my computer screen every time I read about the godforsaken place. As Schaffer usefully points out:
There are two ways the town could have lived up to the Times’ rose-colored description of its status quo ante:
1. Beforehand, by not sexually assaulting ninth-graders, videotaping the incident, and leaving a victim asleep on her front lawn in freezing weather.
2. After the fact, by not ostracizing the victim’s siblings, firing her mom from her job, dropping the case inexplicably, and burning the family’s house down.
Schaffer goes on to argue, persuasively, that both of the above scenarios are actually more likely, not less so, in a small town than in a more densely populated urban area. Among other things, there’s the problem of the quasi-feudalistic nature of rural life:
Turns out all that “close knit” small-town stuff turns out to kind of suck if you’re trying to get justice: When you’re so close-knit that your boss knows some of the families whose kids you’re trying to put in jail, and you just happen to get fired—that’s not a good thing.
The anonymity of city life comes with its own troubles, of course, including high crime rates. I wouldn’t want, or expect, journalists to gloss over these well-known problems. Why, then, is it okay for them to create absurdly idealized portraits of small-town life? Especially when, as is the case with Maryville, such portraits sugarcoat horrendous and widespread anti-social behavior and what appears to be a systematic attempt at obstruction of justice?
By: Kathleen Geier, Washington Monthly Political Animal, October 26, 2013
“A Total Perversion Of The American System Of Government”: The GOP Once Again Proves Too Irresponsible To Handle The Filibuster
What does a political party do when they are badly in need of expanding their base to include women and minorities?
I’m fairly sure that exercising its right to filibuster the nominees of a president—one a highly respected woman nominated to the United States Court of Appeals for the District of Columbia Circuit and one a highly respected and well liked African American Congressman nominated to run the Federal Housing Finance Agency—would not be at the top of the list of recommend behavior.
Yet, this is precisely what the Senate Republicans did today.
What makes the blocking of these nominees so remarkable is that there is no shortage of support when it comes to the quality of the nominees among the very GOP Senators that voted to deny the Senate the opportunity to vote up or down on their nomination. Rather, the Republicans’ problem is with the president and the reality that a Democratic appointment to the United States Court of Appeals for the District of Columbia will give Democrats a majority on that important judicial body.
Patricia Ann Millet is the Obama nominee to join the US Court of Appeals.
When Ms. Millet appeared before the Senate Judiciary Committee, the committee charged with investigating and considering her nomination, not so much as one Republican Senator on the panel had a concern with or so much as a bad word to say about Millet’s qualifications.
Indeed, Ms. Millet was described by none other than Senator Ted Cruz as possessing “very fine professional qualifications.”
Yet, when the matter came to a cloture vote, the Democrats were unable to succeed in rounding up 60 votes and Ms. Millet’s nomination was blocked by a filibuster of the Senate Republicans.
The use of the filibuster to deny Millet’s nomination is but one more example of the Republicans simply refusing to recognize and accept that Barack Obama won the 2012 election and, having done so, gets to appoint people to fill vacancies in the federal court system.
You know, just like the Republican president who was able to appoint a few Justices to the United States Supreme Court, handing conservatives the majority vote in that body.
Currently, there are three vacancies on the DC Circuit Court which is generally regarded as the second most influential court in the nation following the Supreme Court. With the makeup of the DC Circuit Court currently split evenly between conservative appointees and liberal appointees, Senate GOPers cannot bring themselves to approve the nomination of someone they have deemed eminently competent for the job as to do so would give the appointees of Democratic presidents the edge in the vote count—although history confirms that one never knows how a judge will vote once they are seated on the bench.
While I understand that conservatives would prefer not to see the balance tip in favor of more liberal judges on so important a court—just as liberals squirmed as President Bush appointed hard-line conservatives to SCOTUS—anyone who would support this type of Senate behavior has completely rejected one of the most fundamental of Constitutional directives. While the Senate possesses the right to advice and consent on presidential nominees, that obligation was created to insure that high quality candidates with proper qualifications would fill these important roles.
Note that the filibuster is not provided for in our Constitution. The Founders intended that the Senate would take a vote on nominees and the majority would carry the day.
The vote on Ms. Millet’s nomination in the full Senate was 55-38 in favor of bringing the nomination to the floor for a full vote where Ms. Millet is expected to easily achieve confirmation. This vote included all of the Democrats voting for cloture along with two Republicans who also voted to bring up the nomination while three Republicans dogged it and voted “present”.
Yes, I get the irony of the GOP Senators voting ‘present’ after hammering the President for doing the same during his term in the Illinois legislature.
Remarkably, the Senate GOP leadership is not even pretending they have personal or competency issues with Ms. Millet as a candidate.
Said Senate Minority Leader, Mitch McConnell—
“Our Democratic colleagues and the administration’s supporters have been actually pretty candid. They’ve admitted they want to control the court so it will advance the president’s agenda.”
What a shocker! A Democratic president wants to appoint someone to the court who shares his point of view. Who would have thought such a thing would be possible here in America—excepting, of course, every single American President who has ever made his own appointments to the federal bench.
The mere fact that Minority Leader McConnell could make such a comment with a straight face should provide ample evidence of the fact that the filibuster does not belong in the hands of a party that would so abuse both the privilege and their constitutional obligations.
For those senators who justify their actions by claiming that they owe deference to the President when it comes to approving the appointment of cabinet members and other executive branch roles but believe more scrutiny should be exercised when it comes to judges appointed to lifetime terms, one wonders how they explain their filibustering of Congressman Melvin Watts to become the head of Federal Housing Finance Agency.
The refusal to confirm Watts is particularly remarkable when considering that a sitting member of Congress appointed by a President to an executive position has not failed to be confirmed since before the American Civil War.
Mr. Watt’s personal competency, temperament or character has never been questioned by Republicans who oppose his nomination.
Instead, Republican opponents have suggested that they are displeased that Obama appointed a politician for the job. In other words, the senators who are opposed to Rep. Watts on this basis are saying that they wouldn’t even vote for themselves if appointed.
Anyone believe that?
Of course, this might be their best argument given that these Republican politicians likely have special insight into how they are each unfit to hold a position of responsibility.
Some GOPers have suggested that the office to which Mr. Watts has been chosen—one that oversees two rather complex financial institutions—would be better run by a “technocrat”.
That’s a tough argument to make considering that the President’s first nominee for this job back in 2010 —Joseph A. Smith, Jr. the North Carolina banking commissioner—was such a technocrat. Still, there was so much objection to Smith’s nomination by Republicans that Smith eventually chose to withdraw from consideration.
The time has come for the Democratic majority in the Senate to revise the rule and change when and how the filibuster can be used. While I would not recommend complete destruction of the device, it seems clear that it must be modified to bar the use of the filibuster when it comes to Presidential nominees.
As for those who argue that this could ‘backfire’ on Democrats should the GOP gain control of the Senate, I have no problem with this whatsoever. When it comes to presidential appointees—even if that president is a Republican—there ought to be some specific problem with the candidate if the nominee is to be rejected. It cannot be about one party in the Senate or the other getting to deny a presidential appointment because it may shift the balance on a particular federal court.
If a candidate is unfit for the office—think Harriet Meyers—then the Senate should reject that candidate. But if it simply is a matter of denying a highly qualified position because the opposition party doesn’t want anyone but someone sympathetic to their own beliefs, that is just not the way things were intended to operate and represents a total perversion of the American system of government.
By: Rick Ungar, Op-Ed Contributor, Forbes, October 31, 2013
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