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“Not A Bad General Election Issue”: Should Democrats Press The Public Option?

There’s no question that the Affordable Care Act’s rollout has been “rocky,” to borrow the common parlance of the Beltway. The Web site troubles and shifting health coverage for some Americans, despite over-assurances from President Obama during the 2010 political debate, have naturally turned off some people. A much-ballyhooed poll from CNN yesterday shows that support for “Obamacare” has dropped to an all-time low.

But conservatives toasting the apparent turn in public opinion ought to look a little closer at the polling data. It’s true that only 35 percent of Americans favor the law, while 43 percent oppose it. But there’s a crucial third group: 15 percent oppose the ACA because it’s “not liberal enough.” That means that 50 percent of Americans either support the law or want policy changes that shift leftward.

Looking at the polls in that light suddenly shifts the political calculus. Republicans who want to repeal and “replace” the legislation — with measures that have never been entirely clear, especially when it comes to the most popular provisions of the ACA — are suddenly facing an uphill battle with the public.

This presents a pretty clear road map for Democrats worried that the biggest legislative achievement of the Obama era might turn against them. The CNN/ORC poll didn’t press people on what, exactly, “not liberal enough” meant, but it’s not hard to imagine what those people might want. Recall that while the legislation was being crafted, the public broadly supported a “public option” in the bill that would allow people purchasing insurance on the exchanges to select a federal health insurance plan.

So what if Democrats pushed for it? A public option would save $100 billion over 10 years, according to the Congressional Budget Office, and could offer respite from the plan cancellations and rate hikes that still persist with private insurers with the ACA in place.

There’s essentially no chance President Obama will take another bite at the health-care apple, especially with so many other priorities to tackle: his professed desire to combat climate change and income inequality before he leaves office, along with getting comprehensive immigration reform passed. But strategists on 2016 presidential campaigns ought to take heed.

Imagine a candidate who comes out early, and strong, for adding a public option to the ACA exchanges. It could become a signature issue with the liberal grass roots during the primaries, and it wouldn’t be a bad general election issue either — the polls in 2010 showed support for a public option among Republicans and independents as well as Democrats. As Ezra Klein has noted, the sudden disappearance of the public option from Democratic politics has been “a bit curious,” but perhaps its day is coming.

By: George Zornick, The Plum Line, The Washington Post, December 24, 2013

December 26, 2013 Posted by | Affordable Care Act, Public Option | , , , , , , , | Leave a comment

“Purposely Stripped Of Context”: When Obamacare Polls Are Accurate Without Being True

As Republicans form a circular firing squad, nervous Democrats continue to believe that this is a depressing time when the future of Obamacare is on the line.

There is some reason for worry: the Koch brothers are spending millions trying to get young people to “opt out” of seeking health insurance at the state level, which could wreck the risk pool essential for the program’s success.

But young people, who as a group support President Obama, aren’t likely to buy Koch lies. And Hollywood progressives are about to unveil a strange-bedfellows alliance with insurance companies that will spend tens of millions of dollars telling Americans the truth — that they are better off with Obamacare being fully implemented.

Meanwhile, the chances of the Affordable Care Act being defunded in Washington are between zero and none, as many Republicans are now acknowledging. Senator Ted Cruz (R-TX) doesn’t have the votes for his strategy of threatening a government shutdown over Obamacare, and everyone but Cruz knows it. Karl Rove wrote an impassioned plea to Republicans not to use this “ill-conceived tactic.” Some analysts believe a government shutdown, which would almost certainly be blamed on the GOP,  could even give Democrats an outside shot at winning back the House in 2014.

So why the jitters on the left? At least part of the explanation lies in polls on Obamacare that have been misunderstood or stripped of context. Over and over, Americans have been told that the public doesn’t support the president’s signature achievement. This is true in only the most literal sense of the word. It turns out that the idea behind the new law — universal coverage — is backed by a strong majority.

To get a sense of how the media are misreporting the story, consider a September 15 NBC News/Wall Street Journal poll. As David Weigel has noted in Slate, this is one of the most reliable polls around.  It found public widespread ignorance about the law, which will be implemented beginning October 1, and a high level of skepticism about Obamacare’s ability to improve people’s lives The poll reported that 30 percent of respondents thought it would have a negative impact on their families and only 12 percent were convinced it would be positive. More than half felt — accurately — that it would have no impact on their families.

But those weren’t the results that made headlines. It was the overall figure — 43 percent support Obamacare and 54 percent oppose it — that received wide coverage, just as similar poll numbers have in the past.

This is a classic example of something being accurate without being true.

As New York Times columnist Charles Blow has noted, a new CNN/ORC Poll shows that while 35 percent of the public (the conservative base) oppose Obamacare because it’s too liberal, 16 percent oppose it because it isn’t liberal enough.

In other words, 59 percent of the American public either supports Obamacare or wants it to go further.

This casts an entirely new light on the health care debate and further isolates the obstructionists. They are now exposed as radicals who believe in extortion rather than elections — a fringe group of what John McCain in another context called “wacko birds.”

More evidence to bolster that point comes from a CNBC poll that shows the public opposed to cutting off funding for Obamacare by 44 to 38 percent. If it meant a government shutdown, nearly 60 percent oppose defunding. Surely if a majority opposed the idea of Obamacare, a similar majority would oppose the funding of it.

Liberals are justifiably upset about the way public opinion has been misreported on this issue, and most of the blame rests with reporters who don’t probe the internals of polls deeply enough.

But progressives have a role to play in changing the way the polling looks.

Longtime supporters of a single-payer system (I am among them) need to stop telling pollsters that they don’t like Obamacare, even if its provisions seem inadequate to them. Otherwise they will continue to be lumped in with Tea Party types and depicted as standing against a landmark achievement that liberals have been seeking since universal coverage first appeared in Theodore Roosevelt’s Progressive Party (Bull Moose) Platform of 1912.

 

By: Jonathan Alter, The National Memo, September 23, 2013

September 25, 2013 Posted by | Affordable Care Act, Public Option | , , , , , , , | Leave a comment

GOP Supported Individual Mandate To Prevent ‘Government Takeover’ Of Health Care

The Los Angeles Times’ Noam Levey looks at the history of the individual health insurance mandate and discovers that not only was the provision designed by Republicans as an alternative to President Bill Clinton’s health care reform plan in the 1990s, but it was specifically seen as a way to prevent a “government takeover” of health care:

“We were thinking, if you wanted to achieve universal coverage, what was the way to do it if you didn’t do single payer?” said Paul Feldstein, a health economist at UC Irvine, who co-wrote the 1991 plan with Pauly.

Feldstein and Pauly compared mandatory health insurance to requirements to pay for Social Security, auto insurance, or workers’ compensation.

So too did the Heritage Foundation’s Stuart Butler, who in 1989 wrote a health plan that also included an insurance requirement.

“If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car,” Butler told a Tennessee health conference that year.

But healthcare is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance.… A mandate on individuals recognizes this implicit contract,” said Butler, who was the foundation’s director of domestic policy studies.

Levey notes that fully a third of Republicans supported a bill that included a national individual requirement, introduced by then-Senator and current Rhode Island Gov. Lincoln Chafee. Sens. Bob Dole (R-KS), Charles Grassley (R-IA), Orrin Hatch (R-UT), and Richard Lugar (R-IN) all backed that measure. The National Federation of Independent Business, a conservative small-business group, even “praised the bill ‘for its emphasis on individual responsibility.’”

And this wasn’t some fluke of the ’90s either. As recently as 2007, “[t]en Republican senators — including Tennessee’s Lamar Alexander, now a GOP leader — signed on to a bill that year by Bennett and Sen. Ron Wyden (D-Ore.) to achieve universal health coverage.” The legislation penalized individuals who did not purchase insurance coverage.

Listing all of the GOP presidential candidates who have previously supported the mandate (Romney, Gingrich, Huntsman, Pawlenty) would only belabor the point, which is that the GOP’s new-found religion on the mandate and its constitutionality is driven by the political need to unravel the Democrats’ crowning social achievement, not any great concerns about policy, constitutionality, or freedom.

 

By: Igor Volsky, Think Progress, May 31, 2011

June 1, 2011 Posted by | Businesses, Class Warfare, Conservatives, Constitution, Democracy, Democrats, Freedom, GOP, Government, Health Care, Health Reform, Human Rights, Ideologues, Ideology, Individual Mandate, Insurance Companies, Lawmakers, Liberty, Middle Class, Politics, Public Option, Republicans, Right Wing, Single Payer | , , , , , , , , , , , , , , | Leave a comment

RyanCare vs. The Public Option

If you want to understand why the budget debate so infuriates people who actually care about deficits — and, in particular, people who actually care about health-care spending — consider this: The central health-care reform in Paul Ryan’s budget, the one that’s got him so many plaudits for courage, would actually increase costs. The health-care reform that progressives have been pursuing for more than two years would cut them. And yet calling for Medicare to be privatized and voucherized is considered serious, while calling for a public option is considered tiresome. But let’s go to the tape.

Back during the health-care reform fight, the Congressional Budget Office looked at the likely effect of adding a public option that paid Medicare rates. “In total, a public plan based on Medicare rates would save $110 billion over 10 years,” the agency concluded. Importantly, the savings would come because premiums would be lower. The basic mechanism here is not complicated: Just as you get better deals by shopping at a mega-retailer like Wal-Mart, you get better deals by working with a mega-insurer like Medicare. Size matters.

As for Ryan’s plan, CBO’s take was just the opposite. “Under the proposal,” they said, “most elderly people would pay more for their health care than they would pay under the current Medicare system.” That is to say, health-care costs go up. Now, federal health-care spending goes down, as seniors are paying 70 percent of their costs out-of-pocket rather than 30 percent. Or, in CBO-ese, Medicare beneficiaries “would bear a much larger share of their health care costs than they would under the current program.” Of course, back in the real world, seniors are going to react poorly to being unable to afford health-care insurance, and those savings won’t manifest.

But even putting that aside, it makes for a very stark contrast. The progressive reform that won’t happen would cut health-care costs. The conservative reform that won’t happen would increase health-care costs. One idea makes insurance cheaper and one makes it more expensive. And yet the idea that makes insurance cheaper is pretty much off the table, while the idea that makes it more expensive — and that almost certainly wouldn’t work — is considered a very serious proposal worthy of brow-furrowing debate.

By: Ezra Klein, The Washington Post, April 25, 2011

April 25, 2011 Posted by | Affordable Care Act, Health Care Costs, Health Reform, Public Option | , , , , , , , | Leave a comment

Remember The Health-Care Reform Debate?: How The Landscape Has Changed

As a participant in the great health-care wars of 2010, it’s been — I don’t know: Amusing? Depressing? Annoying? Vindicating? — to watch Rep. Paul Ryan’s budget run over every principle or concern that Republicans considered so life-or-death a mere 400 days ago. A partial list:

Big changes need to be bipartisan changes. “The only bipartisanship we’ve seen on [the health-care] bill is in opposition to it,” said Eric Cantor, now the House majority leader. “When the stakes are this high – reforming 20 percent of the U.S. economy – there must be constructive conversations and negotiations from Republicans and Democrats in both houses of Congress,” wroteformer representative Tom Davis. The Ryan budget, which is unquestionably a more ambitious document than the Affordable Care Act, passed the House with no Democratic votes and four Republicans voting no. The only thing bipartisan was the opposition, etc. This appears to have given no Republicans anywhere any pause.

Polls matter. In March 2010, John Boehner was very, very upset that Democrats were working to pass a health-care law that a slight plurality opposed in polls. “President Obama made clear he is willing to say and do anything to defy the will of the people and force his job-killing health care plan through Congress,” he thundered. Last week, Speaker Boehner and the Republicans passed Ryan’s budget. How do its elements poll? Much, much worsethan the Affordable Care Act.

The Affordable Care Act’s Medicare cuts will devastate hospitals! Last fall, Ryan’s health-policy guru was saying,“The official Medicare actuaries have determined that approximately 15 percent of hospitals will be driven out of business in less than ten years if these cuts go through and called the cuts ‘clearly unworkable and almost certain to be overridden by Congress.’” Now those same cuts are in Ryan’s budget. C’est la vie, I guess (that’s French for “only Democratic cuts hurt hospitals”).

The Affordable Care Act’s savings don’t begin quickly enough! When the tax on expensive employer-provided insurance plans was pushed back to 2018, conservatives were outraged. “The odds are high that the excise tax will never actually happen,” wrote David Brooks. “There is no reason to think that the Congress of 2018 will be any braver than the Congress of today.” It was a fair argument: Cost savings that begin in the future are less certain than cost savings that begin now. So when does, say, Ryan’s voucherization of Medicare begin? Not 2012. And no, it’s not 2018. It’s 2022.

There’s no reform in the Affordable Care Act. “It would take Sherlock Holmes armed with the latest GPS technology and a pack of bloodhounds to find ‘reform’ in the $2.5 trillion version of the health-care bill we are supposed to vote on in the next few days,” then-Sen. Judd Gregg wrote. But apparently Holmes got his iPhone out, because now the Affordable Care Act is chock-full of reforms. In fact, it’s the model Republicans are following. “It’s exactly like Obamacare,” Sen. John Cornyn saidof the Ryan plan. “It is. It’s exactly like it.” And he meant that as a compliment!

The Congressional Budget Office will score anything you tell it to. “Garbage in, garbage out,” Sen. John McCain said. “Can you really rely on the numbers that the Congressional Budget Office comes out with?” asked Fox’s Steve Doocy. Now, of course, Republicans are touting CBO’s estimates of Ryan’s savings.

First, “do no harm.” That was former Republican National Committee Chairman Michael Steele’s big applause line. “Republicans want reform that should, first, do no harm, especially to our seniors,” he wrote in The Washington Post. Cantor said the Affordable Care Act would “cut Medicare for our seniors and increase premiums for many Virginians.” Say what you will about Ryan’s budget, but going from paying 25-30 percent of your Medicare costs to 70 percent cuts your Medicare while increasing your premiums. Steele also said that “we need to protect Medicare and not cut it in the name of ‘health-insurance reform.’ ” Instead, it’s getting cut in the name of tax cuts. To be fair, Ramesh Ponnuru saw this one coming, so I can’t say conservatives were denying it at the time.

I’m sure I’ve forgotten a couple, but that’s what the comment section is for. The natural next question is whether Democrats have been similarly hypocritical in their opposition to Ryan’s plan. So far as I can tell, we’ve not seen it: Democrats think the plan puts too much of a burden on the backs of seniors and the poor — two things they worried about constantly during the Affordable Care Act — and cuts too many taxes for the rich. They also note that the Congressional Budget Office says privatizing Medicare will make it more expensive — the same finding that led to liberal advocacy for a public option. But if I’m missing something here, I imagine it, too, will come up in comments.

By: Ezra Klein, The Washington Post, April 21, 2011

April 22, 2011 Posted by | Affordable Care Act, Congress, Conservatives, Deficits, Democrats, Economy, GOP, Government, Health Care, Health Care Costs, Health Reform, Medicare, Politics, President Obama, Public Option, Rep Paul Ryan, Republicans, Right Wing, Seniors, Single Payer | , , , , , , , , , , , , , | Leave a comment

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