“When The Worm Turns”: Republican Fallacies On Obamacare, The Greatest Hits
Before the holiday spirit makes Republican-bashing a little unseemly, it’s time to get in a last ornery blast at the party’s Obamacare stance. Republicans have enjoyed themselves immensely during the Affordable Care Act’s bungled rollout, but most of the claims they’re making are preposterous and phony. Since anyone able to take a longer view knows we’ll one day be well past Obamacare’s self-inflicted wounds, I’d like as a public service to catalog the GOP’s shabbiest arguments, so we’ll all have a handy reference once the worm fully turns.
The selective “humanitarian crisis.” Conservatives have warned of the “humanitarian disaster” that will ensue if several million people with cancelled policies are unable to secure new coverage before January 1. But this theoretical woe (which will almost certainly be avoided thanks to Web site fixes and policy extensions) pales next to the much larger humanitarian disaster of America’s nearly 50 million uninsured — a crisis that’s persisted for decades without conservatives caring a whit. I can’t be the only one who finds the right’s sudden concern for a small subset of the uninsured a bit rich.
The bogus oppression of the young and healthy. Another confused conservative trope bemoans the enslavement of younger or healthier Americans, who’ve supposedly been conscripted to subsidize their older, sicker countrymen. “Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions,” the Wall Street Journal editorialized last Saturday. “But government usually helps the less fortunate honestly by raising taxes to fund programs.” Actually, the Journal has the American way of health subsidy exactly wrong. Most people aged 19 to 34 who have health coverage get it from their employer. And, as I’ve noted before, at nearly every firm, young people pay the same premiums as employees who are older and get more expensively sick. In other words, Obama’s scheme to rob Peter to fund health care for Paul already exists, at vastly larger scale, in corporate America. And while Obamacare is only hoping to sign up 2 million or so young people, 20 million Americans aged 19 to 34 get their coverage on the job. Where’s the Wall Street Journal’s rant against corporate America’s “coercive cross-subsidies”? And while we’re at it, when will we stop making all those people whose houses don’t burn down subsidize those whose do?
The “men and 55 year old women don’t need maternity care” fallacy. Well, yes, and people whose genes don’t predispose them to cancer (which tests will reveal soon enough) don’t need cancer coverage. As Bob Kocher, a doctor and former senior Obama health care advisor, explained, if one of our goals is to not charge women higher premiums than men, all plans have to cover maternity. Among younger women, moreover, maternity is the biggest driver of costs — so if you allow optional coverage, the plans young people buy would be super-expensive. “For insurance to work, you can’t allow people to opt into benefits like maternity right before they get pregnant,” Kocher adds. “When spread across the population, it’s not expensive.” Sounds like Insurance 101. Which in the social insurance context, conservatives can’t abide.
Insurance “bailout” baloney. Sen. Marco Rubio talks opportunistically (but I repeat myself) of Obama’s pledge to “bail out” health plans if the folks they sign up end up being unduly costly to treat. Once again, conservatives eat their own. Such “risk adjustment” — after-the-fact payments to reflect the actual vs. expected risk experience of health plans — has been a sensible staple of conservative insurance market reforms since George H.W. Bush proposed it in 1992. Little known but true: Before Romneycare begat Obamacare, Bushcare begat Romneycare. Rubio was only 21 then. He must not know. Or care.
The “Obama is taking over one-sixth of the economy” ruse. In the Fox News cocoon, this truth is self-evident. But it makes as much sense as crying that Ben Bernanke is “remaking 6/6ths of the economy” every time the Fed touches interest rates. The fact that health-care spending is 18 percent of GDP doesn’t mean Obama is “remaking” or “taking over” anything. He’s tweaking a dysfunctional corner of the market where 5 percent of us get our health coverage. He’s also testing ideas that health gurus in both parties have long suggested might help reign in future costs.
Worse than these GOP fallacies is the party’s smug sanctimony. It’s as if conservatives have decided to parody the moral preening they loathe in liberals, except that the right is serious. As one pundit lectured, “the administration didn’t care enough to make sure the people of their country were protected. In the middle of a second age of anxiety they decided to make America more anxious.”
Yes, the rollout was botched. But what is this person talking about? Finally assuring that illness in the United States can’t be the cause of financial ruin is the very essence of “protection.” How galling that conservatives can make such hollow charges while putting forward no plan of their own to “protect” anyone from anything!
Or take the pundit who wrote that “extending enrollment periods does nothing but provide Americans more time to contemplate their miserable choices.” Only someone with no empathy — someone who has never tried and failed to get coverage in the individual market — could possibly say such a thing.
I’ve spent a lot of time over the years arguing that we can solve big problems such as providing insurance coverage in ways that honor both liberal and conservative values. It’s entirely doable — John Rawls and Milton Friedman can be reconciled, trust me. Apart from being sound policy, I’ve assumed such approaches would also be necessary, because with power closely divided in the United States, we’d need to strike big cross-party deals to make progress. The breathtaking intellectual and moral dishonesty of those driving the Obamacare debate in the GOP today makes me feel foolish for having tried.
By: Matt Miller, Opinion Writer, The Washington Post, December 4, 2013
“The Wages Are Too Damn Low”: Hiking The Minimum Wage Has Little Or No Adverse Effect On Employment
As I mentioned in the lunch link roundup, increasing the minimum wage is all the rage in lefty precincts today. DC is considering a raise, and Democrats generally are smelling a winning issue. (For a deeper look, Arindrajit Dube had a long piece on it over the weekend.)
Conventional economists tend to despise minimum wage laws, because they’re a form of price control, and that gives The Market a sad. Setting a minimum price of labor, according to Econ 101, should increase unemployment, because some people won’t have a marginal product above the wage floor. But as Paul Krugman pointed out in his column this morning, the evidence just doesn’t support this conclusion:
Still, even if international competition isn’t an issue, can we really help workers simply by legislating a higher wage? Doesn’t that violate the law of supply and demand? Won’t the market gods smite us with their invisible hand? The answer is that we have a lot of evidence on what happens when you raise the minimum wage. And the evidence is overwhelmingly positive: hiking the minimum wage has little or no adverse effect on employment, while significantly increasing workers’ earnings.
It’s important to understand how good this evidence is. Normally, economic analysis is handicapped by the absence of controlled experiments. For example, we can look at what happened to the U.S. economy after the Obama stimulus went into effect, but we can’t observe an alternative universe in which there was no stimulus, and compare the results.
When it comes to the minimum wage, however, we have a number of cases in which a state raised its own minimum wage while a neighboring state did not. If there were anything to the notion that minimum wage increases have big negative effects on employment, that result should show up in state-to-state comparisons. It doesn’t.
As others have noted, there’s good reason to believe that increased wages at large businesses would work out well for the businesses themselves. Businesses would both reduce turnover—the hiring process is expensive, and there is a great deal of churn at the bottom of the labor market—and increase their employees purchasing power, a hefty fraction of which would likely be spent at their own place of employment or somewhere similar. I’d guess that wages are held down out of class panic and a desire for increased profits for their own sake rather than some strict business reason.
Personally, if I had to choose, I would rather see more broad-based economic stimulus through fiscal and monetary action rather than a minimum wage hike. (Though I would still support one on its own merits.) But if they don’t like it, American elites have no one to blame for this but themselves. If the power structure can’t ensure full employment through normal channels, then demands for economic justice through more easily-understood channels will only become more common.
By: Ryan Cooper, Washington Monthly Political Animal, December 2, 2013
“The Could-Be Columns”: Why The Misogynist Media Are Trying To Create A Hillary Clinton-Elizabeth Warren-Caroline Kennedy Catfight
How terrifying is it to the political establishment that a woman might actually have a clear shot to becoming the next president?
Enough that the parlor game of the moment in Washington is to start listing the Other Women – that is, the scary females (“scary” being a function of “female” in this case) who might end up challenging Hillary Clinton in a Democratic primary. Or a Jell-o fight or mud wrestling match, to go by the absurd speculation in the media.
First, we have Massachusetts Democratic Sen. Elizabeth Warren, who for some reason is seen as Clinton’s dangerous threat from the left. Warren is a real rising star, to be sure, and arrived to the Senate with an already-elevated status, given her knowledge of financial regulation and consistent commitment to consumer rights and other liberal causes. She’s not showy; she’s smart and a solid workhorse –like the senator who pre-preceded her, Edward M. Kennedy. There’s nothing she has said or done to indicate she has her eye on the White House in 2016. Her former national finance chairman has told donors she is raising no cash for a 2016 run, which pretty much ends it there – you can’t run a presidential campaign without money. And Warren herself has told the Boston Globe “no, no, no no” in response to the question.
Ah, but even in politics, when a woman says no, some in the media think she means yes. We have The New Republic speculating about a possible Warren-Clinton showdown. And we have the Washington Post’s Richard Cohen, always up for a woman-bashing column, talking about how a Warren presidency would be, in his mind, even worse than an Obama presidency. At least Cohen has the journalistic integrity to note parenthetically that Warren has expressed no interest in the job.
Then we have Caroline Kennedy, whom Post blogger Jennifer Rubin suggests might also be up for a run, noting Kennedy’s deft start to her new job as ambassador to Japan. That – plus the Kennedy name and experience watching family members in politics – seems to be the only justification for such random speculation. And it’s absurd on its face. Kennedy is indeed deeply committed to public service, but she is a somewhat shy person who does not enjoy being the center of attention. It’s one of the reasons she did not run for the Senate in New York. The idea that she could stomach the nonstop attention and scrutiny of a presidential run is nonsense. She is gracious and diplomatic, which makes her a perfect pick for an ambassadorship – not a presidential candidate.
So why the could-be columns? Part of it is the natural tendency in the media to find someone – anyone – to create a conflict or fight where there currently exists none. Clinton is the clear early front-runner for the Democratic nomination, should she decide to run. Vice President Joe Biden might give her a challenge, if he decides to run. But that’s not enough for the Clinton-wary, who want to diminish her potential candidacy by reducing it to some kind of brewing girlfight. Clinton with a clear path to the nomination is infuriating to this group, and a potential challenge from a man only gives credibility to her as a candidate. Ah, but present her future as one where she has to kick Warren or Kennedy with her kitten heels and scratch out their eyes to be the Democratic nominee – now that’s a storyline misogynist America finds appealing. Fortunately, the three women in question aren’t agreeing to those roles.
By: Susan Milligan, U. S. News and World Report, December 3, 2013
“The Blurred Line Between Caricature And Reality”: Republicans Are Nothing If Not Predictable
It’s become a running joke: when Republican get bored with the latest manufactured outrage of the day, they turn to the Benghazi and IRS “scandals” as a standby. Indeed, it’s been widely assumed over the last several weeks that as the Affordable Care Act improves, GOP lawmakers would have no choice but to return to their favorite faux political controversies.
They are nothing if not predictable. Here’s Senate Minority Whip John Cornyn (R-Texas) yesterday:
“Since the terrible tragedy that took four American lives in Benghazi, we’ve had difficulty, to put it mildly, trying to get to the bottom of this,” the second-ranking Senate Republican said during a Google Hangout session he held while the Senate is on recess. ”Now the goal is to talk to the Benghazi survivors – people who were actually there who could tell the truth and expose what happened and hold the people responsible accountable. This has been a cover up from the very beginning.”
And here’s House Oversight Committee Chairman Darrell Issa (R-Calif.) soon after:
The House’s chief investigator says the FBI is stonewalling his inquiry into whether the agency and the Internal Revenue Service targeted conservative group True the Vote for special scrutiny, and Rep. Darrell E. Issa is now threatening subpoenas to pry loose the information from FBI Director James B. Comey Jr.
Mr. Issa, California Republican, and Rep. Jim Jordan, Ohio Republican, are leading the House Oversight and Government Reform Committee’s IRS inquiry. They also said the FBI is refusing to turn over any documents related to its own investigation into the IRS, which began in the days after an auditor’s report revealed the tax agency had improperly targeted tea party groups for special scrutiny.
The White House should probably consider this a good sign. Remember, as recently as last week, congressional Republicans were reluctant to talk about literally any issue other than the Affordable Care Act, afraid that any distraction from the dysfunctional website might let Democrats off the hook. Even the reaction to the “nuclear option” was muted because Republicans wanted all of the political world’s focus solely on health care – and nothing else.
And it now appears that phase is ending and far-right lawmakers are back to Benghazi and the IRS. If that isn’t affirmation of the White House’s health care initiative getting back on track, nothing is.
By: Steve Benen, The Maddow Blog, December 3, 2013
“$2,229.11 For Three Stitches?”: We Don’t Have To Wonder What The Unfettered Market In Health Care Produces, We’ve Been Living It
Twenty years ago I had my first knee surgery, after tearing some cartilage while skying for a thunderous dunk on the basketball court (or it might have been just falling backward while getting faked out on defense—who remembers the details?). Although I had insurance, I was responsible for a substantial copay, and I vividly recall the one item that stood out among the dozens on the bill. For the two steri-strips that covered an incision—tiny pieces of tape that even today cost about 20 cents retail, and which hospitals buy in bulk so surely cost them just a couple of pennies—I and my insurance company were charged $11, or $5.50 per strip. A miniscule amount in a five-figure bill, but it struck me as the most absurd, since it represented a markup of approximately 10,000 percent, if not more. More recently, I was getting some physical therapy for the same knee, and in what turned out to be a session that wasn’t covered by my insurance, a therapist put a piece of kinesio tape around my kneecap. The retail price for that length of tape is around 40 cents (though again, they buy it in bulk so it’s probably a quarter of that); and there was the therapist’s time to retrieve, cut, and apply the tape, which took about 60 seconds all told. Total tape charge: $75.
My experience is not at all uncommon, as an excellent piece in today’s New York Times explains. The article discusses things like people getting charged thousands of dollars to have a couple of stitches put on a finger, or my personal favorite, the $137 charge for an IV bag that costs the hospital one dollar. There are a number of reasons why they can get away with this, including the fact that nobody tells you what the charges are going to be before you’re treated, and the fact that information is diluted through the insurance system.
But since we’re now talking about what government is and isn’t capable of handling when it comes to health care, allow me to repeat something I’ve argued elsewhere: The government didn’t give us this kind of price-gouging, just like the government didn’t give us 50 million uninsured Americans. Nor did the government give us lifetime and yearly caps on coverage. Nor did the government give us now-outlawed “rescission,” in which your insurer cancels your coverage because you got sick. Nor did the government gave us denials for pre-existing conditions. You know what gave us all that? The free market. Government can certainly cause problems, but just about all the major reasons our health-care system is so expensive and serves so many people so poorly (or not at all) are the result of the free market.
Or more specifically, the health-care market, which is so different from other kinds of markets. The unique features of health care are what makes a far higher level of government involvement than exists in the markets for wristwatches or shoes necessary. If we don’t want to have a system that costs so much more than every other one in the world while giving us crappy results, then we’re just going to have to accept that. In other industrialized countries, the government says, “We can’t sustain a system in which an MRI costs $1,200. So an MRI is going to cost $300.” And guess what? The MRI manufacturers and the hospitals accommodate themselves to that reality, and not only do they manage to survive, but people still get MRIs when they need them.
If maintaining the ability of certain people to suck as much profits from the health-care system as possible is your highest value, you find that unacceptable. But if having a system that serves everyone, maximizes health, and is affordable rank higher for you than making sure there are hospital systems with 28 different executives pulling down salaries of over $1 million a year, you have to make a different choice.
And let’s be clear about this: what conservatives are arguing for is the maintenance of the status quo that gives us the $2,229.11 hospital charge for putting in three stitches. It was their devotion to the primacy of market freedom in health care that put us where we are now. When the government doesn’t work properly, by, say, making a terrible website that took months to fix, the answer is to make it work better. Because we don’t have to wonder whether the alternative is worse. We’ve been living it.
By: Paul Waldman, Contributing Editor, The American Prospect, December 3, 2013
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