“When Ideology Collides With Reality”: Irrational Republican Exuberance Over Obamacare’s Problems
In these days of hyper-polarization, some readers may wonder why I always treat with great respect the findings and analysis of conservative number-cruncher Sean Trende of RealClearPolitics. I don’t always agree with what he says, but he’s willing to say uncomfortable things to people on his side of the barricades when data and history so indicate, as he did in a column today pouring ice water on the popular conservative idea that a collapse of Obamacare would lead to some sort of “existential crisis” for liberalism or “the welfare state.”
I’ve said before that our press corps suffers from histrionic personality disorder, and this is but the latest example. Wasn’t it just weeks ago that we were told the government shutdown could cost Republicans the House? But elections and the ideological orientation of the country don’t turn on such immediate, short-term events. The arc of history is long. Both parties, and both ideologies, have plenty of wins ahead of them, and neither is likely to suffer a knockout blow.
Let’s start by observing that we’re barely 50 days into Obamacare’s launch. While the program is clearly in much graver political danger than was the case a month ago, it’s still unclear that the ship won’t eventually be righted. Maybe the so-called “young invincibles” will sign up in droves, or maybe they won’t and the program will go into a death spiral. We just don’t know yet.
But even if the Affordable Care Act does collapse, I’m not sure that the liberal project will be kneecapped, much less destroyed. Americans have very short memories, and the pendulum will swing back quickly if Republicans mess up their next opportunity to govern.
Trende then goes through a long series of historical examples (dating back to 1890) of big political calamities for one party or the other that was followed in relatively short order, and sometimes almost instantly, by a big recovery, often because the other party over-estimated its advantages and overreached. And he notes that even in specific policy areas a misstep or defeat doesn’t necessarily take issues off the table:
Even the last failed attempt at health care reform, in the early 1990s, didn’t actually spell the end of reform efforts for the next two decades, as many suggest. It just proceeded incrementally, with some fairly significant steps. Congress in 1996 passed the Kennedy-Kassebaum bill, which established health insurance portability. The following year, Republicans helped to establish the State Children’s Health Insurance Program, which today provides health care for almost 8 million children. In 2001, before the 9/11 attacks, Congress was consumed with a debate over the Patient’s Bill of Rights, with the only major disagreement involving whether plaintiffs should be able to collect punitive damages while suing their HMO.
Sean even suggests an Obamacare “disaster” could produce an even more ambitious Democratic health care initiative:
[E]ven if Obamacare does collapse, the most liberal aspects of the American health care system — Medicare and Medicaid — will still be around. Democrats have already been pretty straightforward about what their “Plan B” will be: Medicare/Medicaid for all. Both programs are still very popular, and the Democratic standard-bearer in 2016 would almost certainly campaign on expanding them, perhaps to those over 55 for Medicare and under 25 for Medicaid. I’m not sure that would be a losing issue, even with an Obamacare collapse. In 10 years, I think it’d be a winner.
That is indeed the “silver lining” that a lot of single payer advocates have been seeing in the troubles involving the Obamacare exchanges, which are complex and hard to administer in no small part because of their reliance on a managed competition model many liberals never favored in the first place.
Trende thinks the major lesson here is that the ideological clash of ideas that activists often perceive in political events just isn’t shared by that many voters:
The American electorate is not intensely ideological, and is more motivated by things such as the state of the economy, whether there is peace abroad (or whether we’re winning a war), and whether the president is suffering from a major scandal.
I would agree in part, but would go further to say that today’s radicalized Republican Party has goals that have never commanded a majority of the electorate, and are even less likely to do so in the future. It is capable of making big gains when Democrats screw up, but is determined to risk them immediately to pursue an unpopular agenda. If the worst (or from their point of view, the best) happens and conservatives gain the power to implement that agenda, then the odds are extremely high they will, as Trende puts it, “mess up their next opportunity to govern.” And in that respect, ideology really does matter–when it collides with reality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, November 20, 2013
“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
“Feigning Outrage”: The GOP’s Health Reform Playbook
The last thing Republicans want right now is to repeal the Affordable Care Act.
They may claim it is destroying the country, but they need it, and desperately, to rebuild their party. They even have a detailed playbook to exploit it, outlining how and when to stage attacks against Democrats who support it in order to inflict maximum damage in the months before the 2014 midterm elections.
As Jonathan Weisman and Sheryl Gay Stolberg reported in this morning’s Times, House Republicans have been organizing their strategy behind closed doors for the last month. They began by capitalizing on the gifts given them by the White House in the form of the malfunctioning health care website and President Obama’s false promise that no one need lose an insurance policy. Then they moved on to claims that personal data is insecure on the insurance exchanges.
Next, according to the playbook, will come criticism of premium price hikes, and breast-beating about changes to Medicare Advantage plans, as well as the possibility that people will lose their doctors under some policies.
Republicans will also hold hearings, and come armed with anecdotes from outraged citizens who suddenly find their new health insurance options aren’t perfect.
Reform has given new life to a party that was in the depths after the shutdown debacle just last month.
This deep concern about Americans’ access to quality insurance is entirely new and utterly insincere, of course. Nearly one in 10 people on Medicare — 4 million people — are dissatisfied with that program, according to surveys, but you don’t hear their complaints broadcast at hearings or at Republican news conferences. In 2010, long before the health reform law took effect, 20 percent of people on employer-based insurance expressed dissatisfaction with their plans, as did a third of people on the individual market. They complained about high deductibles and constrained networks of doctors and hospitals, just as many of them will under the new system. And they complained about cancelled policies.
Republicans never cared about those concerns before the Affordable Care Act came around, and they don’t really care now, even though they’re doing a great job of feigning outrage. They’re simply using these grievances, magnified by anecdotal media coverage, to batter Democrats who are still standing up for the president’s program.
Some of those Democrats are fighting back. They’re pointing out, as the White House did yesterday, that the growth in health care costs is slowing significantly. They’re trying to highlight people who are saving money on their new policies, or who can buy insurance even if they are sick. And they will try to broadcast the voices of the previously uninsured, who have never appeared in a Republican diatribe and never will.
But the most attention, as always, will be paid to the shrillest critics. Just remember, as their attacks pick up in volume in the months to come, that they were prepared long in advance, as cheap as canned laughter.
By: David Firestone, Editors Blog, The New York Times, November 21, 2013
“This Is Sabotage, Plain And Simple”: The Unprecedented GOP Efforts To Undermine A Federal Law
Sen. Joe Manchin (D-W.Va.), who’s never been the Affordable Care Act’s biggest fan, appeared on MSNBC yesterday to join the critical chorus. In reference to the Obama administration, the conservative Democrat said, “The bottom line is that they messed up, they messed up royally. There’s no excuse for this.”
The administration’s missteps have been well documented, and officials have earned much of the criticism they’ve received. But to say there’s “no excuse” is to overlook Republican sabotage efforts that have made a real difference.
Todd Purdum recently made the case, for example, that “calculated sabotage by Republicans at every step” is a “less acknowledged cause” of the rollout’s troubles. Jamelle Bouie added this week, “If Republicans have shown anything over the last four years, it’s that they’ll do anything to stop the Affordable Care Act, even if it amounts to legislative sabotage.”
We’ve talked before about the scope of these unprecedented efforts to undermine a federal law, which include blocking necessary resources needed for implementation, public misinformation campaigns, discouraging public-private partnerships, blocking Medicaid expansion, blocking CMS nominees, refusing to create marketplaces, and prohibiting “Navigators” from doing their jobs. But the campaign is arguably intensifying now.
Dana Milbank reports on House Republican leaders who emerged from their weekly meeting yesterday and tried to scare the bejesus out of Americans.
The Republicans’ scary-movie strategy has some logic to it: If they can frighten young and healthy people from joining the health-care exchanges, the exchanges will become expensive and unmanageable. This is sabotage, plain and simple – much like the refusal by red-state governors to participate in setting up the exchanges in the first place.
The quotes from House GOP leaders are rather remarkable. Majority Leader Eric Cantor (R-Va.) said health care reform may lead to identity theft; Speaker John Boehner (R-Ohio) falsely claimed “premiums are going right through the roof”; Majority Whip Kevin McCarthy (R-Calif.) warned that consumers who visit healthcare.gov may become victims of fraud; and Caucus Chair Cathy McMorris Rodgers (R-Wash.) said vulnerable constituents may be put “on the casualty list.”
Milbank added, “Let’s hope the new health-care plans have generous coverage for anti-anxiety medication.”
Let’s not forget that the difference between a lie and a falsehood is intent – if you know the truth and say the opposite because your goal is deceit, you’re lying. And for the most part, congressional Republicans, whose interest in helping provide greater health security for Americans is easily trumped by their interested in destroying a Democratic law, have been reducing to lying.
But for saboteurs, honesty and serious policy debate are easily sacrificed for the larger goal. Indeed, they’re a small price to pay.
Also note, we’re looking at quite a one-two punch from the far-right – on the one hand we see the Koch brothers and their allies urge the uninsured to stay that way on purpose, in order to advance conservatives’ ideological goals, and on the other we see congressional Republicans try to terrify the public in the hopes that people who stand to benefit from “Obamacare” steer clear of the system.
President Obama added yesterday, during an interview with the Wall Street Journal, that if both parties were “invested in success,” the rollout wouldn’t have been quite so rocky. “One of the problems that we’ve had is that one side of Capitol Hill is invested in failure and that makes the kind of iterative process of fixing glitches as they come up and fine tuning the law more challenging,” he added.
There’s no denying that the dysfunctional health care website matters, and the administration’s missteps deserve criticism. But Republican sabotage matters, too.
Kevin Drum recently explained, “No federal program that I can remember faced quite the implacable hostility during its implementation that Obamacare has faced. This excuses neither the Obama administration’s poor decisions nor its timidity in the face of Republican attacks, but it certainly puts them in the proper perspective.”
By: Steve Benen, The Maddow Blog, November 20, 2013
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