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“Hating Good Government”: We’re Living In A Political Era In Which Facts Don’t Matter

It’s now official: 2014 was the warmest year on record. You might expect this to be a politically important milestone. After all, climate change deniers have long used the blip of 1998 — an unusually hot year, mainly due to an upwelling of warm water in the Pacific — to claim that the planet has stopped warming. This claim involves a complete misunderstanding of how one goes about identifying underlying trends. (Hint: Don’t cherry-pick your observations.) But now even that bogus argument has collapsed. So will the deniers now concede that climate change is real?

Of course not. Evidence doesn’t matter for the “debate” over climate policy, where I put scare quotes around “debate” because, given the obvious irrelevance of logic and evidence, it’s not really a debate in any normal sense. And this situation is by no means unique. Indeed, at this point it’s hard to think of a major policy dispute where facts actually do matter; it’s unshakable dogma, across the board. And the real question is why.

Before I get into that, let me remind you of some other news that won’t matter.

First, consider the Kansas experiment. Back in 2012 Sam Brownback, the state’s right-wing governor, went all in on supply-side economics: He drastically cut taxes, assuring everyone that the resulting boom would make up for the initial loss in revenues. Unfortunately for his constituents, his experiment has been a resounding failure. The economy of Kansas, far from booming, has lagged the economies of neighboring states, and Kansas is now in fiscal crisis.

So will we see conservatives scaling back their claims about the magical efficacy of tax cuts as a form of economic stimulus? Of course not. If evidence mattered, supply-side economics would have faded into obscurity decades ago. Instead, it has only strengthened its grip on the Republican Party.

Meanwhile, the news on health reform keeps coming in, and it keeps being more favorable than even the supporters expected. We already knew that the number of Americans without insurance is dropping fast, even as the growth in health care costs moderates. Now we have evidence that the number of Americans experiencing financial distress due to medical expenses is also dropping fast.

All this is utterly at odds with dire predictions that reform would lead to declining coverage and soaring costs. So will we see any of the people claiming that Obamacare is doomed to utter failure revising their position? You know the answer.

And the list goes on. On issues that range from monetary policy to the control of infectious disease, a big chunk of America’s body politic holds views that are completely at odds with, and completely unmovable by, actual experience. And no matter the issue, it’s the same chunk. If you’ve gotten involved in any of these debates, you know that these people aren’t happy warriors; they’re red-faced angry, with special rage directed at know-it-alls who snootily point out that the facts don’t support their position.

The question, as I said at the beginning, is why. Why the dogmatism? Why the rage? And why do these issues go together, with the set of people insisting that climate change is a hoax pretty much the same as the set of people insisting that any attempt at providing universal health insurance must lead to disaster and tyranny?

Well, it strikes me that the immovable position in each of these cases is bound up with rejecting any role for government that serves the public interest. If you don’t want the government to impose controls or fees on polluters, you want to deny that there is any reason to limit emissions. If you don’t want the combination of regulation, mandates and subsidies that is needed to extend coverage to the uninsured, you want to deny that expanding coverage is even possible. And claims about the magical powers of tax cuts are often little more than a mask for the real agenda of crippling government by starving it of revenue.

And why this hatred of government in the public interest? Well, the political scientist Corey Robin argues that most self-proclaimed conservatives are actually reactionaries. That is, they’re defenders of traditional hierarchy — the kind of hierarchy that is threatened by any expansion of government, even (or perhaps especially) when that expansion makes the lives of ordinary citizens better and more secure. I’m partial to that story, partly because it helps explain why climate science and health economics inspire so much rage.

Whether this is the right explanation or not, the fact is that we’re living in a political era in which facts don’t matter. This doesn’t mean that those of us who care about evidence should stop seeking it out. But we should be realistic in our expectations, and not expect even the most decisive evidence to make much difference.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, January 18, 2015

January 21, 2015 Posted by | Climate Change, Federal Government, Health Care | , , , , | 1 Comment

“The Same Reasonable-Sounding Lies”: What Won’t The GOP Do To Keep The Poor Uninsured?

When it comes to healthcare, Southwest Virginia is a desperate place. Many of the state’s poorest and sickest live in that pocket of coal country between US Route 19 and the Kentucky and Tennessee borders, where it’s so hard to see a doctor that a free mobile health clinic held each July at a county fairground draws hundreds. “Southwest Virginia is one of the worst places we go to,” said Stan Brock, the founder and president of Remote Area Medical, which runs that clinic and others throughout the country.

That corner of Virginia also encompasses the district of Phillip Puckett, who served as a Democratic state senator until Monday, when he suddenly resigned. His decision to step down appears to have been the result of a bribe offered by Republican colleagues bent on stopping the expansion of Medicaid. Puckett’s resignation gave Republicans the one seat they needed to take control of the Senate; it also put him in the running for a paid post on a state tobacco commission that is controlled by some of the very same Republicans. And it cleared the way for the chamber to appoint his daughter to a state judgeship.

By stepping down, Puckett effectively ended a months-long battle over the fate of the 400,000 Virginians who are too poor to buy insurance but don’t meet the state’s restrictive eligibility requirements for Medicaid. The state Senate had been on course to vote to expand the program under the Affordable Care Act, setting up a budget showdown with the Republican-controlled House. But with the GOP now in control of the Senate, both chambers are expected to pass a spending plan on Thursday that does not include the expansion.

The advocacy group ProgressVA called for an investigation of allegations of a quid pro quo between Puckett and Republicans, who deny they made any sort of deal. Puckett cited “recent issues that have developed in our family” as grounds for his resignation, and said he would withdraw his name from consideration for the job on the tobacco commission. Virginia Attorney General Mark R. Herring announced that he does not see an “investigative role” for his office.

The question of what prompted Puckett’s mid-term resignation is tantalizing, and potentially important, but it’s also beside the point. The true scandal is that hundreds of thousands of Virginians—including more than 20,000 of Puckett’s own constituents—will be denied health insurance.

The Medicaid showdown in Virginia was particularly heated because the legislature was so closely split. But Republicans all across the country have gone to insane lengths to keep millions uninsured, or to justify doing so. In Louisiana, for example, the state sued MoveOn.org for a billboard criticizing Governor Bobby Jindal’s opposition to the Medicaid expansion. Republicans in Utah are trying to embed work requirements into a private alternative to the expansion, a stipulation that would likely make the plan unworkable. In Arkansas, Republicans tried to roll back the Medicaid alternative that passed last year by refusing to reauthorize its funding. Although the program was finally re-approved, conservative lawmakers—who are steadily gaining ground in the Arkansas legislature—indicated that they’ll attack it again next year.

For years now Republicans have trotted out the same reasonable-sounding lies to fight the expansion, namely the myth that states can’t afford it. The real callousness that undergirds their ideological campaign was made clear this year, however, by a handful of state senators in Missouri, who gathered on the Senate floor to make it clear that there would be “no path” forward for the expansion. “Why is this somehow our problem?” one lawmaker asked. “It’s not happening,” said another. “Go find something else to do.”

There simply isn’t anything else that the millions of Americans who fall into the coverage gap can do to afford healthcare. Expanding Medicaid won’t fix all of the health problems in Southwest Virginia; a shortage of providers serving rural and low-income patients also challenges the region. But that’s no reason to deny insurance to people, particularly when the costs of doing so will be born almost entirely by the federal government, not the state. The persistence of myriad other issues to be dealt with is simply an indicator that people would be better served if lawmakers spent less time devising elaborate schemes to keep the poor uninsured and found something else to do, themselves.

 

By: Zoe Carpenter, The Nation, June 10, 2014

June 11, 2014 Posted by | Health Care, Uninsured | , , , , , , , , | 1 Comment

“Content-Free Carping”: From VA To Obamacare To Medicare

At the moment most Republicans are looking at the VA scandal that broke out in Phoenix as a sheer political bonanza without any long-term significance: a federal agency responsible for an especially valued constituency (veterans) has screwed up fatally on Barack Obama’s “watch.” That’s enough to powerfully reinforce a number of important conservative memes about Obama (and indirectly, Democrats): he and his people are incompetent, they don’t have the normal patriotic impulse to take care of veterans, and when held accountable they stonewall and lie.

But a few voices are beginning to figure out how to link the VA mess not only to the overriding issues of Obamacare, but to the “socialized medicine” treatment of Obamacare that would be applied to Medicare, too, if the political climate was right.

Here’s the Cleveland Plan Dealer‘s Kevin O’Brien spelling it all out:

Putting a government bureaucracy in charge of one’s health is a gamble likely to end badly.

And yet, if Obamacare stands, that is precisely the gamble each and every American eventually will take.

There is no better predictor of the course of a single-payer medical system in the United States than the VA system, because it is a single-payer system….

Americans who watch this story play out and fail to make the clear and obvious connection to Obamacare will be guilty of willful ignorance. The systemic flaw is identical. It’s just magnified on a massive scale. Rather than making a false promise to treat all of the ills of a relatively few sick and injured military veterans, Obamacare has put the federal government on the path to taking responsibility for the medical needs — and the attendant costs — of the entire U.S. population.

Like most conservative attacks on “bureaucracy,” O’Brien’s ignores the powerful bureaucracies that operate in the private sector with even less accountability. As TNR’s Jonathan Cohn puts it:

It’s worth remembering that some of the problems veterans are having right now have very little to do with the VA and a whole lot to do with American health care. As Phil Longman, author of Best Care Anywhere, noted in his own congressional testimony last week, long waits for services are actually pretty common in the U.S.—even for people with serious medical conditions—because the demand for services exceeds the supply of physicians. (“It took me two-and-a-half years to find a primary care physician in Northwest Washington who was still taking patients,” he noted.) The difference is that the VA actually set guidelines for waiting times and monitors compliance, however poorly. That doesn’t happen in the private sector. The victims of those waits suffer, too. They just don’t get the same attention.

But nonetheless, the longer the VA scandal stays in the public eye, the more we will hear arguments the VA should be broken up and its services privatized with federal regulations and subsidies replacing federal bureaucracies–creating a system much like the one contemplated by Obamacare, as it happens. But at the same time, we’ll be told Obamacare itself is a failure because it involves the government in guarteeing heath care. And where conservatives speak to each other quietly, it will be understood that Medicare is subject to the same complaints and deserves the same fate.

No wonder most GOP pols confine themselves to content-free carping about Obama being responsible for the VA scandal.

 

By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal. May 22, 2014

May 31, 2014 Posted by | Health Care, Republicans, Veterans Administration | , , , , , , | Leave a comment

“What The VA Scandal Is Not About”: Conservative’s Desire To Privatize All Health Care

While the media furor over revelations of potentially death-dealing delays in eligibility determinations and care scheduling at the Veterans Administration is leading to all sorts of promiscuous talk by conservatives about the inherent incompetence of government and/or the need to privatize all government health-related services (presumably including the provision of insurance by Medicare), let’s be clear what the scandal is not about, as noted by CBS’ Rebecca Kaplan:

There…doesn’t appear to be a major quality problem among the agency’s doctors and nurses either, even though it appears that not enough veterans can get through the door to see them. Veterans’ advocates who appeared before Congress last week agreed that once veterans get access to care within the VA system, it is high-quality care. The problem is getting access to that care in the first place.

The American Customer Satisfaction Index (ACSI), the nation’s only cross-industry measure of customer satisfaction, ranks VA customer satisfaction among the best in the nation — equal to or better than ratings for private sector hospitals. When asked if they would use a VA medical center the next time they need inpatient or outpatient care, veterans in the 2013 ACSI survey overwhelmingly indicated that they would (96 and 95 percent, respectively).

Backlogs in eligibility determinations would exist whether veterans were being sent to VA hospitals for care, or to private hospitals with a voucher in their hands. And physician shortages and scheduling backlogs are hardly an unfamiliar phenomenon at private health care facilities.

Of course conservatives will try to use the issues at VA to undermine any and all public involvement in health care. But the only way to make absolutely sure veterans aren’t placed at risk by inefficient eligibility or scheduling systems is to deny them care altogether. Replacing public health care bureaucracies with private health care bureaucracies won’t fix the problems, and could make the care itself a lot worse and a lot more expensive.

 

By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, May 23, 2014

May 24, 2014 Posted by | Health Care, Veterans Administration | , , , , , , | Leave a comment

“The Comforting Feeling Of Rolling Heads”: It May Make You Feel Better, But Will The Issue Be Solved?

Since the firing of Health and Human Services Director Katherine Sebelius you no longer hear as much about repealing the Affordable Care Act (although certain candidates, most recently Scott Brown, continue to bring it up). But when her head rolled a lot of people seemed to feel better. Now the call is for the head of Veterans Affairs Secretary Eric Shinseki, after dozens of stories cited deaths allegedly related to delayed care for veterans at many of the nation’s 1700 veterans hospitals and treatment centers. If he is let go people may feel better. But will the issue be solved?

The so-called secret lists of veterans waiting for care is troubling, but if it is true then the system as a whole needs an overhaul. This has been apparent for some time and was previously highlighted by the conditions at Walter Reed Hospital and the delay in computerizing records. But these things most likely won’t follow merely by firing the secretary. And although Congress is calling for another investigation, at the same time recent budget proposals by the GOP reduce money for veterans, including cutting health benefits for veterans.

VA hospitals and clinics served 8.76 million veterans last year. In 2008, 37 percent of veterans sought treatment for PTSD and depression. But it is thought that at least half of all veterans suffer from these. Those who report PTSD usually also suffer from many other conditions, some of which do not manifest themselves until more than 5 years after service.

The VA is a huge bureaucracy which serves as the largest single health care system in the country. Along with men and women who served in Iraq and Afghanistan, it still serves veterans of World War II, Korea and Vietnam. Today’s veterans survive injuries that would have quickly killed veterans of earlier wars, including burns, amputations and traumatic brain injuries. And in the past ten years the numbers of vets seeking care has increased exponentially due to our most recent wars, with almost half of those veterans seeking disability compensation for their injuries.

For some perspective: In 2010 the Office of Inspector General for the Department of Health and Human Services reported that bad care contributed to 180,000 deaths of patients in Medicare alone. As many as 440,000 people nationwide suffer from some sort of preventable harm which could have contributed to their death. And that is in our civilian hospitals. Medical error is the third leading cause of death in the US.

Average wait time in hospital emergency rooms has risen. It can take two to four weeks to get an appointment with a specialist (In 2009 people waited an average of 20 days. In 2010 fifty percent of our population felt they could have avoided a trip to the ER if they had been able to get an appointment with their regular doctor People without insurance have received little or no care until recent changes with the implantation of the ACA. Before the passage of the ACA, as many as 45,000 uninsured died each year.

In many small towns, including Savannah, Georgia, waiting times to see a mental health specialist can be at least a month for a psychologist and three to six months for a psychiatrist. At the local VA clinic in Savannah, veterans wait no more than three weeks, and often less, for mental health care and walk-ins who are in crisis are treated immediately.

According to the Associated Press yesterday, a recent report indicated that the department’s internal watchdog found no evidence that delays have caused patient deaths. President Obama has appointed deputy White House chief of staff to review VA policies and procedures.

Further inquiries will be held and outrage will continue to mount until something concrete is done. This is not a new issue. But firing Shinseki is like providing palliative care for end-of-life patients: the patient will be more comfortable but he will still die. Any investigation into the VA has to result in major changes to the system as a whole which will not be possible if the problem is “solved” by yet another head rolling.

 

By: Lisa Solod, Washington Monthly Political Animal, May 17, 2014

May 18, 2014 Posted by | Health Care, Veterans | , , , , , , | Leave a comment

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