“Like It Or Not, Obamacare Is Moving Forward”: For Certain People, This Isn’t As Good A Story As The Website’s Implosion Was
HealthCare.gov just tweeted that more than 375,000 had visited the refurbished federal website as of noon today. White House press secretary Jay Carney confirmed the figure shortly after.
So demand still appears to be there, despite weeks of deservedly awful press about the website and the law, and weeks of Republican claims that the law is so disastrously flawed that it cannot be rescued.
Along those lines, Kevin Drum captures what matters most about the news of the moment in one half a sentence:
if you need to buy health coverage via healthcare.gov, you can do it
This really is the rub. Sure, there will be continued problems. Charles Ornstein personally had a terrible experience. Sarah Kliff found the site is still not working for everybody. And the snafus at the back end may persist, too.
But the big picture is that far more people who need health insurance — whether they were bumped from plans or whether they were previously uninsured — will now be mostly able to go online, do some shopping, and buy health insurance. Before, they couldn’t.
This isn’t as good a story as the website’s implosion was, and if the site continues to function as expected, it will mostly stop getting media coverage. The press will move on to the next Obamacare disaster story, should it materialize: The “keep your doctor” saga, coming soon via Republican press release directly to reporters’ inboxes.
But the current fix has mostly tamped down concerns among Democratic lawmakers, and barring some truly catastrophic change, they just aren’t going to abandon the law in any meaningful sense. Meanwhile, demand looks likely to continue, even as insurance companies redouble their efforts to entice people on to the exchanges, which means enrollment will continue piling up, too.
Will it be enough? It’s too soon to say. Republican lawmakers and their voters have been 100 percent certain for some time now that Obamacare has already collapsed, but for everyone else, the law’s long term prospects will turn mostly on what that enrollment looks like over time. And for that, we’ll just have to wait.
By: Greg Sargent, The Washington Post, December 2, 2013
“The Death Panels Are Coming”: Conservatives Are Going To Have To Turn Somewhere, And I’m Guessing “Rationing” Will Be On Their Lips
Now that Healthcare.gov seems to be working reasonably well (at least on the consumer end), Republicans are going to have to find something else they can focus on in their endless war against the Affordable Care Act. So get ready for the return of “death panels.”
They never really went away. Those who aren’t immersed in the fantasy world in which conservatives move were reminded of that last week, when chronicler of changed games Mark Halperin, the embodiment of most everything that’s wrong with contemporary political journalism, did an interview with the conservative news organization Newsmax. When the interviewer mentioned “death panels, which will be coming,” Halperin responded, “I agree, it’s going to be a huge issue, and that’s something else about which the President was not fully forthcoming and straightforward.” Halperin didn’t explain what lie he imagines Obama told about death panels (perhaps he thinks that when Obama said the government wouldn’t declare your grandmother unfit to live and have her murdered, he wasn’t telling the truth), but what matters isn’t Halperin’s own ignorance of the law (after all, understanding policy is for nerds, right?), but the fact that it came up in the first place. Which, if you pay attention to places like Newsmax, it still does. A lot.
But wait, you say. Wasn’t this all debunked years ago? Yes, it certainly was. But why should that matter?
It’s important to remember the switcheroo conservatives pulled on the “death panel” issue. They started off complaining that one provision in the law constituted “death panels,” then when their unequivocal lie was exposed and condemned roundly even by neutral observers, they switched to asserting that all along they had been talking about an entirely separate and unrelated provision, and when they say “death panels” they aren’t talking about death, or panels for that matter, but about health care “rationing.”
Here’s how it happened. The ACA originally included a provision allowing doctors to get reimbursed by Medicare for sessions in which they counseled their patients about their end-of-life options and how to make sure their wishes were properly carried out. The problem is that most of the time, when a patient shows up in the hospital in crisis, the staff has no idea what the patient wants if they can’t communicate. Do they want to be resuscitated, or intubated, or have every heroic measure taken until the moment they expire? All of us have different ideas about this, and it’s important that we think about it beforehand. So the ACA said, if a doctor spends a half hour talking to a patient about it, they’ll be paid for their time. It didn’t say what they had to tell them, it just said they could get paid for doing it, because right now if they do that counseling, they’re doing it for free, which makes it much less likely to occur, which is not only bad for the system but bad for individual patients.
So that part of the law said simply that doctors can bill Medicare for the time they spend doing that kind of counseling, just like they do for a physical exam or performing a procedure. To the people who supported it, the idea seemed commonsensical. Wouldn’t you want doctors and patients to have those kinds of conversations? You’d think. But turning that into the “death panel” lie began, as a remarkable number of health care lies have in the last couple of decades, with policy fraudster Betsy McCaughey, who went on Fred Thompson’s radio show in 2009 while the law was being debated and told his listeners, “Congress would make it mandatory—absolutely require—that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner.” That would be terrible! It would also be terrible if our beloved elders were then hurled from hot air balloons hovering over volcanoes, but the law doesn’t require that either.
Unlike most deceptions in politics, which can be justified by pleading that there was some misinterpretation of ambiguous language, or that what the speaker meant just got garbled in the articulation, this was a clear and specific lie—or two lies, in truth—that McCaughey simply made up in her attempt to subvert the law and then repeated multiple times. There was nothing mandatory or required about counseling, every five years or ever, for any patient, and the counseling was not about “how to end their life sooner.”
To continue our story, then Sarah Palin took things the next step, turning a blatant lie (but at least one with some connection to what the law was about) and spinning it out into an extravagant fantasy one can only imagine came from some obscure 1970’s dystopian sci-fi movie she saw at four in the afternoon one day while the snow fell gently in Wasilla. “The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s ‘death panel,'” she wrote on her Facebook page, “so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.” 11 The quotation marks were a nice touch, since we in the English-speaking world use them to denote actual quotes from a specific person or document, not just something you make up. For instance, I could write, “I wouldn’t like to go to Sarah Palin’s house, where ‘heroin is given to children’ and ‘homeless men are hunted for sport.'” But that would be extremely misleading, since as far as I know, no one has said those things about Sarah Palin’s house, least of all Palin herself. And thus “death panels” were born.
And of course, the charge was picked up by Fox News, and Rush Limbaugh, and all the other far-flung outlets of the conservative media universe. But then the existence of any such panel was debunked and debunked and debunked again. The fact that the evocative phrase originated with Palin probably made it more difficult for conservatives to make it stick beyond their own self-contained world, since Palin is widely understood to be one of America’s most celebrated nincompoops. In addition, cowardly Democrats removed the provision on end-of-life counseling from the bill (to their unending shame) so even the entirely worthy provision of the law was gone. In response, conservatives cast about, and decided that the “death panels” they so feverishly warned of never referred to end-of-life counseling, but to the Independent Payment Advisory Board (IPAB), which did end up in the final bill and which has the benefit of resembling an actual panel.
In brief: the IPAB is a group of 15 health-care experts appointed by the president and confirmed by the Senate who will make recommendations on how Medicare could save money. Those recommendations are due at the beginning of each year, and Congress has until August to overrule them. If Congress doesn’t, the Secretary of Health and Human Services will implement the recommendations. But the IPAB only makes the recommendations if Medicare’s growth exceeds certain target rates.
Now listen to this part carefully: the text of the ACA prohibits the IPAB from recommending that care be rationed. It also prohibits them from recommending other things, like increasing premiums or cutting benefits. And perhaps most importantly, if Medicare’s growth is modest, IPAB won’t make any recommendations at all. And if things go the way they’ve been going and the way they will if many of the other reforms contained within the ACA succeed (including steps to transition from a purely fee-for-service model in which sicker patients means more revenue for providers to one in which they have incentives to keep people healthy), the IPAB might never have to make cost-cutting recommendations. Although things could change of course, the Congressional Budget Office believes that for the next decade Medicare’s growth is unlikely to be large enough to trigger any IPAB recommendations.
You may wonder why conservatives, who are constantly saying we need to control the cost of Medicare, are so vehemently opposed to the existence of a panel of experts whose job it is to come up with ways to control the cost of Medicare. That just shows how little you understand. IPAB, they will tell you, will ration care, which will kill your grandmother, no matter what the law says. 22These kinds of claims, and a general feeling of hysteria around end-of-life issues, circulates relentlessly throughout the conservative world. You may remember that during the 2012 presidential primaries, Rick Santorum told an audience that in the Netherlands, which has a tightly regulated system of physician-assisted suicide, “people wear different bracelets if they are elderly. And the bracelet is: ‘Do not euthanize me.’ Because they have voluntary euthanasia in the Netherlands but half of the people who are euthanized—ten percent of all deaths in the Netherlands—half of those people are euthanized involuntarily at hospitals because they are older and sick.” This was about as true as if he had said that all Portugese people have ESP or that Mongolia is ruled by a parliament made up of dogs and cats. But he didn’t get his fantasy bracelets and fantasy statistics from nowhere—the idea surely arrived to him via the cretinous version of the “telephone” game that is the conservative information bubble, where such things circulate and mutate until they come out the mouths of candidates for president. Just as a for instance, go on over to National Review and search for IPAB, and you come up with articles with titles like, “AARP Betrays Seniors By Supporting IPAB,” and “IPAB, Obama, and Socialism,” and “New England Journal of Medicine Supports Unamerican Expansion of IPAB.” As I said, once they can no longer complain about healthcare.gov, and once those people who had their junk insurance cancelled turn out to be getting much better insurance, conservatives are going to have to turn somewhere, and I’m guessing “rationing” will be on all their lips.
So what started as “Obama is forcing doctors to encourage their patients to die,” then became “Obama’s death panel will assess individuals one by one and withhold treatment from those they find unworthy, leaving people like Sarah Palin’s kid to plead for their very lives,” ends up as “Obama’s IPAB death panel will force health-care rationing on us.”
I do think that the chances that renewing the “death panel” scare will successfully undermine the ACA are slim. The fact that they don’t exist does matter. If you’re a reporter wanting to write a story about someone who lost their junk insurance and will have to buy real coverage, at least there are individuals you can focus on, even if you do a poor job of telling their stories. But there’s no one you can interview who went before a death panel, or whose relative went before a death panel. Because, to repeat myself, they don’t exist. So this whole discussion is likely to remain very abstract. Eventually, conservatives will find something else to cry wolf about. Did you know that under Obamacare, if you kiss a person with herpes, you could get herpes? That’s right: Obamacare will give you herpes. Pass it on.
By: Paul Waldman, Contributing Editor, The American Prospect, December 2, 2013
“A Double Standard For Gun Use”: The Culprit In Florida Is A Set Of Gun Laws That Are Far Too Murky
Two Floridians accused of misbehaving with a gun are out on bond. The similarities end there.
George Zimmerman, who famously shot and killed an unarmed teenager in a racially-charged case, was acquitted of the killing because jurors determined he acted in self-defense. No one can know exactly what transpired when Zimmerman and young Trayvon Martin tussled on the street in the twilight, but we do know that Zimmerman got out of his car to follow or confront Martin before the shooting.
And if Zimmerman (whose previous aggressive behavior was not disclosed to the jury) was trying to convince the world he is simply a gentle, law-abiding person who felt threatened and shot a dangerous teenager, he’s blown that strategy. Since the acquittal, Zimmerman has posed for pictures at a gun manufacturer, been arrested for speeding (seeming stunned when the officer didn’t recognize him) and gotten into a domestic dispute with his estranged wife. And recently, Zimmerman was at it again, charged with pointing a gun at his girlfriend, breaking a glass table, forcing her out of her home and barricading himself in the house. Perhaps more telling, Zimmerman then called 911 himself – even though police were already on the way – to, as he said, tell his side of the story. He called his girlfriend “crazy.”
That she may be, colloquially speaking, given her decision to get involved with someone with a violent past. But the event certainly indicates a pattern, one in which Zimmerman uses guns to get his way. He’s out on $9,000 bond as he awaits the adjudication of the domestic abuse case (and has asked for police to return his phones, flashlight and knife).
Another Floridian, Marissa Alexander, has not had it so easy.
Alexander, too, is now out on bond in a case involving alleged domestic violence. But she’d been in jail since last year waiting for it.
Alexander says she, too, was feeling threatened by her husband when she fired what she said was a “warning shot” to fend him off. The bullet hit a wall and no one was hurt, but Alexander was nonetheless sentenced to a mandatory 20 years behind bars for her behavior. The judge rejected her assertion of Florida’s “stand your ground” law, saying that Alexander could have simply run off instead of going to fetch her gun.
That sounds reasonable – except this: Why is it that Zimmerman, after calling police to report the allegedly suspect Martin, nonetheless got out of his car to follow the teenager? Zimmerman isn’t a police officer (though it’s clear he wanted to be one). He could have not just run away, but actually driven away, to avoid a confrontation. Nor was there any indication Martin had ever threatened Zimmerman before that time.
So why would Alexander get 20 years in prison while Zimmerman was let free to point his gun, again, at another person? Certainly, juries react differently to different people and circumstances (and race and gender, too). But in this case, the culprit is not the peculiarity of the juries. It’s a set of gun laws that are far too murky for anyone – be it the carrier of the gun or the jury judging him or her – to determine when it’s OK to defend yourself with a gun and when it is not.
Alexander was released on bond last week as she awaits a new trial on the gun charge. She’ll be under house arrest and electronic monitoring. Zimmerman, meanwhile, is readying for another episode of the Zimmerman Show – a storyline that is getting alarmingly predictable.
By: Susan Milligan, Washington Whispers, U. S. News and World Report, December 2, 2013
“Better Pay Now”: Let’s Give It A Try For The Person On The Other Side Of The Cash Register
’Tis the season to be jolly — or, at any rate, to spend a lot of time in shopping malls. It is also, traditionally, a time to reflect on the plight of those less fortunate than oneself — for example, the person on the other side of that cash register.
The last few decades have been tough for many American workers, but especially hard on those employed in retail trade — a category that includes both the sales clerks at your local Walmart and the staff at your local McDonald’s. Despite the lingering effects of the financial crisis, America is a much richer country than it was 40 years ago. But the inflation-adjusted wages of nonsupervisory workers in retail trade — who weren’t particularly well paid to begin with — have fallen almost 30 percent since 1973.
So can anything be done to help these workers, many of whom depend on food stamps — if they can get them — to feed their families, and who depend on Medicaid — again, if they can get it — to provide essential health care? Yes. We can preserve and expand food stamps, not slash the program the way Republicans want. We can make health reform work, despite right-wing efforts to undermine the program.
And we can raise the minimum wage.
First, a few facts. Although the national minimum wage was raised a few years ago, it’s still very low by historical standards, having consistently lagged behind both inflation and average wage levels. Who gets paid this low minimum? By and large, it’s the man or woman behind the cash register: almost 60 percent of U.S. minimum-wage workers are in either food service or sales. This means, by the way, that one argument often invoked against any attempt to raise wages — the threat of foreign competition — won’t wash here: Americans won’t drive to China to pick up their burgers and fries.
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.
So a minimum-wage increase would help low-paid workers, with few adverse side effects. And we’re talking about a lot of people. Early this year the Economic Policy Institute estimated that an increase in the national minimum wage to $10.10 from its current $7.25 would benefit 30 million workers. Most would benefit directly, because they are currently earning less than $10.10 an hour, but others would benefit indirectly, because their pay is in effect pegged to the minimum — for example, fast-food store managers who are paid slightly (but only slightly) more than the workers they manage.
Now, many economists have a visceral dislike of anything that sounds like price-fixing, even if the evidence strongly indicates that it would have positive effects. Some of these skeptics oppose doing anything to help low-wage workers. Others argue that we should subsidize, not regulate — in particular, that we should expand the Earned Income Tax Credit (E.I.T.C.), an existing program that does indeed provide significant aid to low-income working families. And for the record, I’m all for an expanded E.I.T.C.
But there are, it turns out, good technical reasons to regard the minimum wage and the E.I.T.C. as complements — mutually supportive policies, not substitutes. Both should be increased. Unfortunately, given the political realities, there is no chance whatsoever that a bill increasing aid to the working poor would pass Congress.
An increase in the minimum wage, on the other hand, just might happen, thanks to overwhelming public support. This support doesn’t come just from Democrats or even independents; strong majorities of Republicans (57 percent) and self-identified conservatives (59 percent) favor an increase.
In short, raising the minimum wage would help many Americans, and might actually be politically possible. Let’s give it a try.
By: Paul Krugman, Op-Ed Columnist, The New York Times, December 1, 2013
“No Sense Of Irony”: Don’t Be Fooled, Scott Walker Is No Reformer
Could there be irony greater than that of a career politician appearing before a gathering of political donors in a city far from his home state to declare that he is an outsider and a “reformer”?
Not likely.
Indeed, it would take a mighty tone-deaf politician to miss the surreal moment in which he found himself.
Meet Scott Walker.
The Wisconsin governor has spent much of the month of November scrambling around the television studios, luxury hotel suites and corporate-funded “think tanks” of Washington and New York, desperately attempting to position himself as a Republican presidential prospect. And he has done so without any sense of irony.
And an expectation that the national media will be gullible enough to believe that the most divisive governor in the modern history of Wisconsin—polls show that his classic swing state is almost evenly divided between those who approve and disapprove of the governor—can somehow run for the presidency as a consensus builder. Walker is now being pitched by the co-writer of the governor’s 2016 campaign book—Unintimidated: A Governor’s Story and a Nation’s Challenge—as the ideal GOP candidate for the presidency.
Of all the “compelling potential standard-bearers” for the party, argues Washington Post columnist Marc Thiessen, “none is better positioned to energize the conservative grassroots while winning the center than Scott Walker.”
Thiessen imagines Walker “as an across-the-board, unflinching, full-spectrum conservative” with an ability to appeal “to persuadable, reform-minded, results-oriented independents.”
That may be what Walker says. But that’s not the assessment of state Senator Dale Schultz, a Republican who has worked with Walker for two decades and who enthusiastically backed Walker in 2010.
This year, Schultz opposed Walker’s approach to a state budget process that the senator said veered—on everything from school funding to academic freedom to tax policy to local control—into territory that was “way too extreme.”
Schultz, a veteran legislator from rural western Wisconsin, criticized Walker for “passing up an opportunity to show independent leadership.”
“No amount of rhetoric or sloganeering will cover up the influence of an out of state billionaire funded and driven agenda,” declared Schultz. “This is not the Wisconsin agenda I’ve fought for over 30 years, and it’s not the Wisconsin agenda I hear from people as I travel around my district and across the state.”
Walker and his allies are doing everything they can to foster the fantasy that the governor as an outsider, a reformer, the antithesis of poilitics as usual. That was certainly the agenda last week, when Walker appeared in New York City before a November 18 gathering of top check writers for Republican candidates, Walker ripped the Democrat he hopes to run against in 2016—Hillary Clinton—for her long record of public service. Hillary Clinton “wasn’t just secretary of state, wasn’t just a U.S. senator, wasn’t just the first lady. She’s been a product of Washington for decades.”
Always at the ready for some self-promotion, Walker told the Republican crowd in New York that “if we’re going to beat somebody like Hillary Clinton, we’ve got to have somebody from outside of Washington, who’s got a proven record of reform.”
So, let’s review: Clinton’s the insider and Walker’s the outsider, right?
Not so fast.
Though she spent many years in Arkansas, Clinton has certainly done her time in Washington. And she is certainly no innocent when it comes to the maneuverings and manipulations that take place in the capitals of states and nations. So even if she is not a “product” of Washington, she is certainly no newcomer to the political game.
And what of Walker?
The governor conveniently forgot to mention that he began his own political career at age 22 and has, since then, run twenty-three years primary and general election campaigns in twenty-three years—making him one of the most determined careerists in American politics. And even before he finishes his first term as one of the nation’s most embattled governors, Walker is bidding for the presidency—so much so that he did not bother to correct a questioner in New York who began: “Since you’re clearly running for president…”
The problem with careerists is that they are often more interested in their careers than in challenging power.
In a word, they are: intimidated.
But Walker says that’s not him.
The governor’s new book seeks to portray this would-be presidential contender as an fearless political warrior, ever at the ready to advance his ideals.
That, like Walker’s suggestion that his austerity agenda has been successful, is a fantasy grounded in his ambition rather than reality.
In fact, Walker is one of the most intimidated politicians in America.
When Walker ran for governor in 2006, he framed a reform message that talked about ending crony capitalism and addressing the influence of special-interest campaign money and lobbying on the state budget process. In meetings with the state’s newspaper editorial boards, he pitched himself as a different kind of Republican who would not play insider political games. Walker earned some high marks when he “vowed to run as an underdog battling party insiders”—except from party insiders, who were unimpressed with his campaign.
In March 2006, just days after Republican National Committee Chairman Ken Mehlman visited Wisconsin, and barely a week after a visit to the state by Vice President Dick Cheney, Walker folded his gubernatorial campaign.
No “unintimidated” stand against the Washington power brokers. No fight to the end on behalf of his ideals. No faith that a grass-roots campaign could beat the money power.
Four years later Walker was back, with a better fundraising operation. This time, he had all the right connections. National donors, like Charles and David Koch, made maximum contributions to his campaign, and then gave even more money to groups making “independent” expenditures on Walker’s behalf.
He won, and in February 2011, when he got a call from someone he thought was David Koch, Walker played along with the caller’s talk about “planting some troublemakers” to disrupt peaceful protests against the governor’s anti-labor policies. Walker writes in his book that “we never—never—considered putting ‘troublemakers’ in the crowd to discredit the protesters.” Yet, when he was talking to someone he thought was a billionaire campaign donor, the governor said: “We thought about that.” If we take Walker at his word—that he never considered using agents provocateurs—then why didn’t he say so at the time? Was he intimidated by someone he thought was a major campaign donor?
The same question arises regarding Walker’s conversation with Beloit billionaire Diane Hendricks, who gave $500,000 to his 2012 campaign. Walker has said he has “no interest in pursuing right-to-work legislation” to weaken private-sector unions. Yet, when Hendricks asked him about right-to-work legislation, Walker did not say, “We’re not going to do that.” Rather, he told Hendricks his “first step” would be to attack public-sector unions as part of a “divide-and-conquer” strategy.
Walker wants a frequently obtuse national media and grassroots Republicans to imagine that he is “unintimidated.” And perhaps that is the case when he is picking on teachers and nurses and anyone who might dare to join a public-employee union. But when the party bosses and billionaire donors come calling, he’s just another politician telling the money power what it wants to hear.
By: John Nichols, The Nation, November 26, 2013
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