“Deja Vu, All Over Again”: Every Day Is Groundhog Day For The GOP’s Obamacare Replacement
In a moment of irony not lost on observers, the GOP-led House Rules Committee will spend Groundhog Day considering the 114th Congress’s first destined-to-be-vetoed attempt to repeal Obamacare. Adding to the déjà vu is the fact that, despite promises to replace the health care law, Republicans still don’t have a firm plan.
The latest repeal bill, sponsored by Rep. Bradley Byrne, an Alabama Republican, doesn’t propose a replacement, but mandates that relevant committees “report to the House of Representatives legislation proposing changes to existing law.” Those proposals, in the language of the bill, should meet 12 provisions, all of which either rehash generic Republican priorities (“foster economic growth and private sector job creation by eliminating job-killing policies and regulations”) or repeat old conservative health care proposals, like medical liability reform.
Further to Byrne’s bill, Reps. Paul Ryan, Fred Upton, and John Kline are expected to lead a task force to create an alternative. “House Republicans’ most serious attempt thus far to develop their health care reform package,” Politico reported Friday.
Early last year, Republicans devoted considerable time to hyping up possible replacements. There was the proposal from Senators Tom Coburn and Orrin Hatch last January; then a March measure from the House Republicans, which The Washington Post described as a “conservative approach to fixing the nation’s health-care system”; and, a few weeks later, Louisiana Gov. Bobby Jindal’s Bobbycare.
And then in April 2014, Rep. Ryan released a budget for 2015 that repealed the law without endorsing any kind of replacement. When asked about his party’s plans, Ryan told The Washington Examiner that “we have lots of ideas of how to offer patient-centered health care… So you’ll see a lot of different comprehensive Republican alternative plans.”
Those alternatives never really solidified. The problem in 2014 was that Republicans couldn’t agree on one, or even on whether it was politically worthwhile to push an alternative that might distract from the Democrats’ Obamacare woes. The problem now is that the Supreme Court might completely gut the health care law in June by ruling that the three dozen states issuing Obamacare subsidies through federal exchanges are acting unlawfully.
Republicans have said that they want to be ready when the court decides—but they don’t seem to have a plan for that scenario. Then again, the Obama administration might not have a plan themselves.
By: Arit John, Bloomberg Politics, January 31, 2015
“Democrats Against Reform”: Democrats Should Be Celebrating The Fact That They Did The Right Thing
It’s easy to understand why Republicans wish health reform had never happened, and are now hoping that the Supreme Court will abandon its principles and undermine the law. But it’s more puzzling — and disturbing — when Democrats like Charles Schumer, senator from New York, declare that the Obama administration’s signature achievement was a mistake.
In a minute I’ll take on Mr. Schumer’s recent remarks. But first, an update on Obamacare — not the politics, but the actual policy, which continues to rack up remarkable (and largely unreported) successes.
Earlier this week, the independent Urban Institute released new estimates of the number of Americans without health insurance, and the positive results of Obamacare’s first year are striking. Remember all those claims that more people would lose coverage than would gain it? Well, the institute finds a sharp drop in the number of uninsured adults, with more than 10 million people gaining coverage since last year. This is in line with what multiple other estimates show. The primary goal of health reform, to give Americans access to the health care they need, is very much on track.
And while some of the policies offered under Obamacare don’t offer as much protection as we might like, a huge majority of the newly insured are pleased with their coverage, according to a recent Gallup poll.
What about costs? There were many predictions of soaring premiums. But health reform’s efforts to create meaningful competition among insurers are working better than almost anyone (myself included) expected. Premiums for 2014 came in well below expectations, and independent estimates show a very modest increase — 4 percent or less — for average premiums in 2015.
In short, if you think of Obamacare as a policy intended to improve American lives, it’s going really well. Yet it has not, of course, been a political winner for Democrats. Which brings us to Mr. Schumer.
The Schumer critique — he certainly isn’t the first to say these things, but he is the most prominent Democrat to say them — calls health reform a mistake because it only benefits a minority of Americans, and that’s not enough to win elections. What President Obama should have done, claims Mr. Schumer, was focus on improving the economy as a whole.
This is deeply wrongheaded in at least three ways.
First, while it’s true that most Americans have insurance through Medicare, Medicaid, and employment-based coverage, that doesn’t mean that only the current uninsured benefit from a program that guarantees affordable care. Maybe you have good coverage now, but what happens if you’re fired, or your employer goes bust, or it cancels its insurance program? What if you want to change jobs for whatever reason, but can’t find a new job that comes with insurance?
The point is that the pre-Obamacare system put many Americans at the constant risk of going without insurance, many more than the number of uninsured at any given time, and limited freedom of employment for millions more. So health reform helps a much larger share of the population than those currently uninsured — and those beneficiaries have relatives and friends. This is not a policy targeted on a small minority.
Second, whenever someone says that Mr. Obama should have focused on the economy, my question is, what do you mean by that? Should he have tried for a bigger stimulus? I’d say yes, but that fight took place in the very first months of his administration, before the push for health reform got underway. After that, and especially after 2010, scorched-earth Republican opposition killed just about every economic policy he proposed. Do you think this would have been different without health reform? Seriously?
Look, economic management is about substance, not theater. Having the president walk around muttering “I’m focused on the economy” wouldn’t have accomplished anything. And I’ve never seen any plausible explanation of how abandoning health reform would have made any difference at all to the political possibilities for economic policy.
Finally, we need to ask, what is the purpose of winning elections? The answer, I hope, is to do good — not simply to set yourself up to win the next election. In 2009-10, Democrats had their first chance in a generation to do what we should have done three generations ago, and ensure adequate health care for all of our citizens. It would have been incredibly cynical not to have seized that opportunity, and Democrats should be celebrating the fact that they did the right thing.
And one related observation: If more Democrats had been willing to defend the best thing they’ve done in decades, rather than run away from their own achievement and implicitly concede that the smears against health reform were right, the politics of the issue might look very different today.
By: Paul Krugman, Op-Ed Columnist, The New York Times, December 4, 2014
“The GOP’s 20-Year War On Health Care”: Republicans Are Going To Extraordinary Lengths To See That More Americans Die
Stop the presses: John Boehner admitted Thursday that the Republican Party’s long-awaited alternative to Obamacare needs a little more time in the oven. “You know, the discussions about Obamacare and what the replacement bill would look like continue. We’re trying to build consensus around one plan,” the Speaker told Hill reporters. “Not there yet.”
As if you even needed me to tell you, rest assured: It could be six months from now, a year from now, five years from now, or the day Bibi Netanyahu and Khaled Mashal share a Nobel Peace Prize—they aren’t going to have a plan. Oh, they might have a “plan.” They had a “plan” last year, or at least Oklahoma Sen. Tom Coburn and two others did. For about two days, they were really tooting its horn. Then it dawned on people that paying for it would involve a hefty middle-class tax increase, on higher-end insurance plans. You may have noticed since then that the Coburn “plan” has not exactly become a leading Republican talking point.
As conservatives continue to hail the Halbig decision, some historical context is called for. In my last column, I wrote that conservatives and Republicans are going to extraordinary lengths to see that more Americans die. Not every reader was won over by that opinion, as you might imagine. But I think it’s beyond dispute, as a little discussion of political history should show.
The problem of millions of uninsured has existed in this country since—well, since forever. But as a running news story that the media paid attention to, for the last 25 or 30 years. I remember when the then-horrifying number was 15 million uninsured. Then 20 million, then 30 million, on up to the 46 million figure we often saw bandied about before the Affordable Health Care was enacted (10 million new Americans are insured as a result of it—a very respectable dent, for just one year). So, 30 years, a full generation, tens of millions of people adversely affected. And what, in all that time, has the Grand Old Party proposed to do about it all?
Not. One. Thing. Republican presidents had (if we go back to 1984) 16 years to pass some kind of health-insurance law. But none of the three ever even proposed one. George W. Bush did pass his Medicare law, but that was about adding prescription-drug coverage for seniors; it didn’t insure any previously uninsured citizens. What the GOP did instead, of course, was to fight tooth-and-nail to stop the two Democratic attempts to insure more people, succeeding the first time, failing the second.
And “tooth-and-nail” hardly begins to describe the demented and nearly sociopathic reality of Republican and conservative opposition to trying to make health insurance affordable for working-class people. Opposition to doing so has been one of the four grand accomplishments of the Republican Party of our time, which I would rank as follows, one scratched on each side of the obelisk: one, start disastrous wars and commit torture; two, make people despise the government; three, nearly cause a new Depression; and four, deny health insurance to as many people as possible, as aggressively and nastily as possible. It’s a grim record generally, and with regard to health care specifically, inarguably one that has promoted insalubriousness and suffering and, indeed, deaths that might have been avoided or delayed if people had had insurance.
It is true that some conservative intellectuals have offered up some ideas—as we know, the same individual mandate that the right now calumniates was a conservative idea at first. And John McCain actually had a decent-ish health-care platform plank in 2008. But if McCain had been elected, it’s very unlikely that the constellation of interests and power centers in the GOP would have permitted him ever even thinking about pursuing it. It was just something he felt he had to say to have credibility with middle-of-the-road voters. And in any case he wasn’t elected, and those conservative intellectuals’ ideas were never seriously proposed by elected Republicans, so the historical record is what it is.
The 20-year war on health care—since their 1993 defeat of the Clinton plan—has been about Republicans’ hatred of government; their view of people who don’t have insurance as lazy or flawed and not worth lifting a finger for; and their fear that if a law is passed and succeeds in bringing health care to millions, they and their whole vision of society will be discredited in the eyes of millions. Of course, these days, all that is shot through with one more element: a heavy dose of Obama hatred.
I was on Hardball Wednesday evening with David Corn, and Chris Matthews showed poll numbers during our segment that surprised even me. The topic was “rooting for failure.” Back in 2006, he said, Democrats were asked in a Fox News poll whether they wanted President Bush’s policies to succeed or fail. Answers: 40 succeed, 51 fail. Not particularly generous. But earlier this year, he said, CNN asked Republicans the same question about President Obama. Answers: 14 succeed, 73 fail.
Think about that. Three-quarters of regular Republicans want Obama to fail. And just one in seven wants him to succeed. We pundits spend most of our time blaming politicians for inaction, but maybe it’s time to start blaming the people. If regular Republicans feel like this, there’s no way the elected officials who represent them are going to do anything that looks remotely like compromise or cooperation.
And no, they’re not going to offer a real health-care plan either. They first promised that in 2010, during the campaign season, so they could say “repeal and replace” instead of just “repeal” and sound like they had a positive side. Then they dropped “and replace,” and now that it’s election time again, it’s back. But it’s not in their DNA to do anything constructive about health care. Or—the VA crisis, the border crisis, the Middle East crisis, the wage-and-inequality crisis, et cetera—about much of anything.
By: Michael Tomasky, The Daily Beast, July 25, 2014
“The Incompetence Dogma”: So Much For Obamacare Not Working
Have you been following the news about Obamacare? The Affordable Care Act has receded from the front page, but information about how it’s going keeps coming in — and almost all the news is good. Indeed, health reform has been on a roll ever since March, when it became clear that enrollment would surpass expectations despite the teething problems of the federal website.
What’s interesting about this success story is that it has been accompanied at every step by cries of impending disaster. At this point, by my reckoning, the enemies of health reform are 0 for 6. That is, they made at least six distinct predictions about how Obamacare would fail — every one of which turned out to be wrong.
“To err is human,” wrote Seneca. “To persist is diabolical.” Everyone makes incorrect predictions. But to be that consistently, grossly wrong takes special effort. So what’s this all about?
Many readers won’t be surprised by the answer: It’s about politics and ideology, not analysis. But while this observation isn’t particularly startling, it’s worth pointing out just how completely ideology has trumped evidence in the health policy debate.
And I’m not just talking about the politicians; I’m talking about the wonks. It’s remarkable how many supposed experts on health care made claims about Obamacare that were clearly unsupportable. For example, remember “rate shock”? Last fall, when we got our first information about insurance premiums, conservative health care analysts raced to claim that consumers were facing a huge increase in their expenses. It was obvious, even at the time, that these claims were misleading; we now know that the great majority of Americans buying insurance through the new exchanges are getting coverage quite cheaply.
Or remember claims that young people wouldn’t sign up, so that Obamacare would experience a “death spiral” of surging costs and shrinking enrollment? It’s not happening: a new survey by Gallup finds both that a lot of people have gained insurance through the program and that the age mix of the new enrollees looks pretty good.
What was especially odd about the incessant predictions of health-reform disaster was that we already knew, or should have known, that a program along the lines of the Affordable Care Act was likely to work. Obamacare was closely modeled on Romneycare, which has been working in Massachusetts since 2006, and it bears a strong family resemblance to successful systems abroad, for example in Switzerland. Why should the system have been unworkable for America?
But a firm conviction that the government can’t do anything useful — a dogmatic belief in public-sector incompetence — is now a central part of American conservatism, and the incompetence dogma has evidently made rational analysis of policy issues impossible.
It wasn’t always thus. If you go back two decades, to the last great fight over health reform, conservatives seem to have been relatively clearheaded about the policy prospects, albeit deeply cynical. For example, William Kristol’s famous 1993 memo urging Republicans to kill the Clinton health plan warned explicitly that Clintoncare, if implemented, might well be perceived as successful, which would, in turn, “strike a punishing blow against Republican claims to defend the middle class by restraining government.” So it was crucial to make sure that reform never happened. In effect, Mr. Kristol was telling insiders that tales of government incompetence are something you peddle to voters to get them to support tax cuts and deregulation, not something you necessarily believe yourself.
But that was before conservatives had fully retreated into their own intellectual universe. Fox News didn’t exist yet; policy analysts at right-wing think tanks had often begun their careers in relatively nonpolitical jobs. It was still possible to entertain the notion that reality wasn’t what you wanted it to be.
It’s different now. It’s hard to think of anyone on the American right who even considered the possibility that Obamacare might work, or at any rate who was willing to admit that possibility in public. Instead, even the supposed experts kept peddling improbable tales of looming disaster long after their chance of actually stopping health reform was past, and they peddled these tales not just to the rubes but to each other.
And let’s be clear: While it has been funny watching the right-wing cling to its delusions about health reform, it’s also scary. After all, these people retain considerable ability to engage in policy mischief, and one of these days they may regain the White House. And you really, really don’t want people who reject facts they don’t like in that position. I mean, they might do unthinkable things, like starting a war for no good reason. Oh, wait.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 26, 2014
“Veterans And Zombies”: The Hype Behind The Health Care Scandal
You’ve surely heard about the scandal at the Department of Veterans Affairs. A number of veterans found themselves waiting a long time for care, some of them died before they were seen, and some of the agency’s employees falsified records to cover up the extent of the problem. It’s a real scandal; some heads have already rolled, but there’s surely more to clean up.
But the goings-on at Veterans Affairs shouldn’t cause us to lose sight of a much bigger scandal: the almost surreal inefficiency and injustice of the American health care system as a whole. And it’s important to understand that the Veterans Affairs scandal, while real, is being hyped out of proportion by people whose real goal is to block reform of the larger system.
The essential, undeniable fact about American health care is how incredibly expensive it is — twice as costly per capita as the French system, two-and-a-half times as expensive as the British system. You might expect all that money to buy results, but the United States actually ranks low on basic measures of performance; we have low life expectancy and high infant mortality, and despite all that spending many people can’t get health care when they need it. What’s more, Americans seem to realize that they’re getting a bad deal: Surveys show a much smaller percentage of the population satisfied with the health system in America than in other countries.
And, in America, medical costs often cause financial distress to an extent that doesn’t happen in any other advanced nation.
How and why does health care in the United States manage to perform so badly? There have been many studies of the issue, identifying factors that range from high administrative costs, to high drug prices, to excessive testing. The details are fairly complicated, but if you had to identify a common theme behind America’s poor performance, it would be that we suffer from an excess of money-driven medicine. Vast amounts of costly paperwork are generated by for-profit insurers always looking for ways to deny payment; high spending on procedures of dubious medical efficacy is driven by the efforts of for-profit hospitals and providers to generate more revenue; high drug costs are driven by pharmaceutical companies who spend more on advertising and marketing than they do on research.
Other advanced countries don’t suffer from comparable problems because private gain is less of an issue. Outside the U.S., the government generally provides health insurance directly, or ensures that it’s available from tightly regulated nonprofit insurers; often, many hospitals are publicly owned, and many doctors are public employees.
As you might guess, conservatives don’t like the observation that American health care performs worse than other countries’ systems because it relies too much on the private sector and the profit motive. So whenever someone points out the obvious, there is a chorus of denial, of attempts to claim that America does, too, offer better care. It turns out, however, that such claims invariably end up relying on zombie arguments — that is, arguments that have been proved wrong, should be dead, but keep shambling along because they serve a political purpose.
Which brings us to veterans’ care. The system run by the Department of Veterans Affairs is not like the rest of American health care. It is, if you like, an island of socialized medicine, a miniature version of Britain’s National Health Service, in a privatized sea. And until the scandal broke, all indications were that it worked very well, providing high-quality care at low cost.
No wonder, then, that right-wingers have seized on the scandal, viewing it as — to quote Dr. Ben Carson, a rising conservative star — “a gift from God.”
So here’s what you need to know: It’s still true that Veterans Affairs provides excellent care, at low cost. Those waiting lists arise partly because so many veterans want care, but Congress has provided neither clear guidelines on who is entitled to coverage, nor sufficient resources to cover all applicants. And, yes, some officials appear to have responded to incentives to reduce waiting times by falsifying data.
Yet, on average, veterans don’t appear to wait longer for care than other Americans. And does anyone doubt that many Americans have died while waiting for approval from private insurers?
A scandal is a scandal, and wrongdoing must be punished. But beware of people trying to use the veterans’ care scandal to derail health reform.
And here’s the thing: Health reform is working. Too many Americans still lack good insurance, and hence lack access to health care and protection from high medical costs — but not as many as last year, and next year should be better still. Health costs are still far too high, but their growth has slowed dramatically. We’re moving in the right direction, and we shouldn’t let the zombies get in our way.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 19, 2014
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