“We’ll Never Stop Arguing About It”: Obamacare Is Helping A Lot Of People. Not Everyone Thinks That’s Good News
In politics there are some issues where liberals and conservatives share the same goal, but disagree about how to achieve it — we all want to have as little crime as possible, for instance, but there are different ideas about how to accomplish that. Then there are issues where the two groups have different goals — liberals want to preserve women’s reproductive rights, and conservatives don’t. And sometimes, there are issues we think fall in the first category, but actually belong in the second.
Health care may just be that kind of issue, where we talk as though we all have the same fundamental goals, but we actually don’t. There’s an interesting article in the New York Times today on a major success of the Affordable Care Act that demonstrates why we’ll never stop arguing about it. Here’s how it begins:
The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.
Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains.
Before we go farther, we should remember that the ACA is a complex piece of legislation that affects every area of American health care, but for now we’re going to talk just about insurance coverage. When liberals see a report like this one, they say, that’s terrific — some of the most vulnerable people in America, and those who had the hardest time getting covered before, now have health insurance. They offer this as practical evidence of the law’s success.
But conservatives (not all conservatives, but many of them) don’t see that as a success at all. If the government is helping an immigrant who washes dishes for a living get health coverage, then to them that means that government is redistributing tax money from deserving people to undeserving people. The two groups look at the same practical effect, and interpret it in opposite ways.
That isn’t to say that the ACA didn’t give benefits to everyone, because it did. Millions of middle-class and even upper-class people were hurt by the fact that insurance companies used to be able to deny you coverage if you had a pre-existing condition, but the ACA outlawed that. And if the payment reforms in the law bring down overall health spending, we all benefit. But the most visible and dramatic parts of the law relate to the tens of millions of Americans who used to be without health coverage but now have it.
This is why Republicans continue to call the ACA a “disaster” and a “catastrophe” despite the good it has done. Liberals hoped that once the law was implemented and its practical effects became clear, the law would become hugely popular. Instead, views of the law divide closely on ideology and partisanship, and that hasn’t changed and won’t change.
That’s because there’s a fundamental clash of values at work, which means that liberals and conservatives will always judge it according to different standards. Because the law did a large amount to bring coverage to those who couldn’t afford it (through both the expansion of Medicaid and subsidies), and because it included a raft of new regulations meant to solve a variety of problems within the health care system, conservatives will always oppose it, whether it succeeds on its own terms or not. To doctrinaire conservatives, a government regulation that accomplishes what it sets out to isn’t a success at all; it’s a moral failure by definition. That’s why liberals will never convince them to support the ACA by pointing to its practical successes.
That isn’t to say that conservatives don’t make practical arguments against the ACA, because they do. But they’re mostly window dressing placed atop their moral objections to government involvement in health care. So yes, they predicted that Obamacare would destroy the economy, and cost millions of jobs, and lead to fewer people with health coverage, and balloon health care spending, and make premiums skyrocket. When they turned out to be wrong about all these things, conservatives didn’t say, “Well gee, I guess this law was a pretty good idea after all.” Because the fundamental moral objection remains, whatever the practical impact.
You can see it in the decision to accept or reject the law’s expansion of Medicaid. The federal government offered states a huge pot of free money to provide coverage to their poor citizens, and though some conservative governors tried to argue that it would be too expensive, those arguments were laughably weak. As one independent analysis after another has shown — from groups like the Rand Corporation, not exactly a bunch of lefties — taking the expansion leads to healthier state finances and better economic growth, on top of helping your state’s constituents. But for many governors, insuring poor people isn’t a moral good at all; just the opposite, in fact. So they were even willing to incur economic damage in order to avoid it (and to give Barack Obama the finger, of course).
Where this all leaves us is that the ACA will never become something we agree on, no matter what it does or doesn’t do in the real world. But even that’s not the whole story, because there are political factors at work. Smart Republicans understand that with each passing year, the law becomes more and more entrenched and harder to unwind, no matter how much they hate it. It’s one thing to keep people from getting insurance, but it’s something quite different, and far more politically dangerous, to take away insurance people already have — and if they really repealed the law, that’s what they would be doing, not just to a few people but to 20 million or so.
That’s why Republicans have so much trouble coming up with their “repeal and replace” plan. It’s not because there aren’t conservative health care wonks who could give them an outline. It’s because any real repeal would be so spectacularly disruptive to the system that it would a political nightmare. Just today there’s an article in The Hill on the efforts of the Republican task force charged with producing the new repeal-and-replace legislation, under the title, “GOP group promises ObamaCare replacement plan — soon.” If you’ve been following this issue, you know that title is a joke. As the piece says:
Coming up with a plan to replace ObamaCare has been an aim for the Republican Party for so long that it’s become a laugh line even in conservative circles. Despite voting more than 50 times in the House to repeal the law, the GOP has not once voted on legislation to take its place.
But every couple of months, they say that they’ll be releasing their plan any day now.
If Republicans actually took the White House and held Congress, my guess is that they’d pass something they called “repeal and replace” but which would leave the ACA largely intact. Just as they propose to privatize Medicare but rush to tell seniors who love it that their own coverage wouldn’t be affected, it would be some kind of time-delayed change that would avoid kicking people who now have insurance off their coverage. And if Hillary Clinton gets elected in the fall, it’ll be another four or eight years before they could even try this. No matter what happens between now and then, conservatives won’t ever decide that the ACA has worked out well, whether it actually did what it was designed to do or not. As far as they’re concerned, the design itself was the problem. But they may decide, as they did with Medicare, that doing away with it isn’t worth the bother — at least not worth bothering to to try all that hard.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, April 18, 2016
“A Brutal General Election”: Bernie Sanders’ Supporters Are Convinced He Could Win A General Election. They’re Wrong
Bernie Sanders’ rather unconventional personal style and characteristics are part of his appeal. Not some blow-dried politician who could fill in doing the weather on your local newscast, Sanders looks different from other candidates. A 74-year-old socialist with wild hair, frumpy suits, and an old-timey Brooklyn accent thicker than a pastrami sandwich, Sanders seems like the last guy who’d be able to assemble a national majority. But if that’s what you think, his supporters will tell you, you’ve got it all wrong. In fact, they say, Bernie is the only Democrat who can win in the fall. It’s only if the party screws up and nominates Hillary Clinton that Democrats are doomed.
It may be getting late in the process for arguments about electability, particularly when Clinton will almost have the nomination in hand if she wins in New York. But since Sanders supporters are so insistent on this point, it’s worth exploring.
Before we begin, we should acknowledge that all judgments about electability are imperfect, to say the least. That’s partly because politics is inherently unpredictable, and you never know what issues will emerge, what events will occur, what the other side will do, and how your candidate might screw up. It’s also because all of us have a hard time putting ourselves in the mindset of people who think differently than we do. In particular, people who care a great deal about politics and have clearly thought-out and ideologically coherent beliefs often find undecided voters positively baffling. How on earth can a person look at two candidates representing parties with profoundly different agendas and values, and say, “Gee, I just don’t know who to pick”?
But they do, and as we’ve seen before, the voting public’s judgments about candidates they don’t know much about beforehand can be radically altered by what happens in the fall campaign.
Sanders supporters, however, say not to worry. Their primary evidence for the superior electability of their candidate comes from “trial heats,” polls that ask voters whom they would choose in the general election between each Republican and each Democrat. And it’s true that in those polls, Sanders usually does better than Clinton. Trial heats show her beating Donald Trump, roughly tied with Ted Cruz, and behind John Kasich, while Sanders beats all three.
But is that much of an indication of what would happen in the general election? Clinton and Sanders come to this race with very different profiles. He was a completely novel character to most Americans, while she has been one of the country’s central political figures for over two decades. So in the eyes of most Americans — who are paying only intermittent attention to the primary campaign — Bernie Sanders seems like a kindly if eccentric uncle. He doesn’t sound like a typical politician (always a bonus), he speaks some uncomfortable truths, and he has an air of purity about him.
But what hasn’t happened yet is anyone really attacking Sanders. Clinton’s criticisms have been mild, and have largely come from the left, on those few issues like guns where she could position herself there. But you can barely get a Republican to utter an unkind word about Sanders, and that’s precisely because they know how they’d be able to go to town on him if he became the nominee.
So let’s consider the kinds of attacks Sanders would face from Republicans. They wouldn’t just call him a socialist — in fact, that’d be about the nicest thing they’d say about him. They’d say he’s coming to raise your taxes to fund big-government schemes. They’d say he wants to cripple the military. They’d say he’s advocated eliminating our intelligence capabilities. They’d say he was part of a Trotskyite party that expressed “solidarity” with the theocratic government of Iran while it was holding Americans hostage. They’d say he wants government to seize the means of production. They’d say he hates America. They’d say he’s the author of smutty rape fantasies.
These attacks would be unfair, exaggerated, distorted, dishonest — and when Sanders protests, the Republicans would laugh and keep making them. By the time they’re done with him, most Americans would think Sanders is so radical and dangerous that they wouldn’t want him running their local food co-op, let alone the United States government.
Sanders supporters tend to wave away the possibility that these attacks would hurt him in much the same way the candidate himself dispenses with questions of practicality, by saying that his revolution will be so extraordinary that it will sweep all opposition away. Millions of heretofore absent voters will turn up at the polls, Americans will see the wisdom of his ideas, this election will be different than any that came before! But there’s little reason to believe that will happen, particularly when even within the Democratic Party, Sanders hasn’t been persuasive enough to overcome Hillary Clinton, who is supposed to be so weak.
And there’s no doubt that Clinton does indeed have plenty of weaknesses as a candidate. Twenty-five years of attacks from the right have taken their toll on her public image, and she’s made plenty of her own mistakes along the way. But there’s nothing new that the GOP is going to throw at her — we know what Republicans will say, and we have a good idea of how the public will react.
On the other hand, the Democrats haven’t nominated a candidate as far to the left as Bernie Sanders since George McGovern in 1972 (and maybe not even then). I’d love to think that a candidate with his ideological profile could get through a brutal general election and still assemble a national majority. But it’s an awfully hard thing to believe.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Week, April 19, 2016
“Because They’re Actually Not”: Why Republicans Struggle To Convince Ordinary Americans The GOP Is On Their Side
Attention, Republicans: if you want to know why Americans never seem to believe you when you say you have ordinary people’s interests at heart, look no further than the new regulation governing investment advisers the Obama administration has now released.
I realize that few readers will lean forward with excitement upon reading the words “fiduciary standard,” but this is actually an important topic, both substantively and politically, so stay with me. The new regulation, which had been in the works for some time, says that investment advisers are required to follow a fiduciary standard, which means nothing more than that they have to be guided by what’s in their client’s best interests, just like a doctor or lawyer must.
You might ask, who on earth could possibly object to that? Other than the investment advising industry, of course. The answer is…the Republican Party.
Not the whole party, actually. Most Republicans would rather not discuss this issue at all, because doing so puts them in an uncomfortable place. But I have yet to find a single elected Republican who comes down on the side of the fiduciary standard.
To explain briefly: As things exist today, when you hire a financial adviser, they’re under no obligation to actually give you advice that’s in your best interests. What they often do instead is sell you products from which they’ll obtain bigger commissions, pushing you into investments that make them more money but won’t necessarily be good for you. The new regulation changes that, imposing the fiduciary standard on those advisers. This is a very big deal, because we’re talking about an industry that manages trillions of dollars in Americans’ money.
This morning I spoke to University of Chicago professor Harold Pollack, co-author (with Helaine Olen) of The Index Card: Why Personal Finance Doesn’t Have to be Complicated and a longtime advocate of the fiduciary standard. He was, unsurprisingly, enormously pleased by the administration’s move.
“People are unaware of the many conflicts of interest that exist in the financial advice industry and how much money it costs them over the course of their lives,” Pollack said, noting that selling clients products they don’t need is a core part of the industry’s business model.
But Pollack is quick to note that financial advisers provide an essential service, since most of us don’t have the expertise to make good investments and save properly for retirement or our children’s education. It’s also an extremely intimate relationship — Americans are notoriously secretive about their finances, which means you’ll share details of your life with your financial advisor that you wouldn’t tell friends or even some family members. That’s why it’s essential that the relationship is based on a core of trust.
“When people are dealing with financial advisers,” Pollack says, “they need to know that what they are getting is actual advice and not a sales pitch.” He also pointed out: “The research that has come out about the poor performance of actively managed investments has had a huge impact.” More and more people are becoming aware that the best investment strategy is often to simply park most of your money in a low-fee index fund; no matter how smart your adviser is, you aren’t going to beat the market.
So what are the political implications of this new rule? On the surface, you’d think that a position in opposition to the administration’s move would be almost impossible to defend. Who’s going to argue that your financial adviser ought to be able to push you into buying something you don’t need? That’s just a couple of steps away from outright fraud.
But if you listen to Republicans, it becomes clear they don’t like the rule, but not for any specific reason relating to the rule itself. They’ll talk about Washington bureaucrats and Obama overreach, but the tell is in their repeated use of the phrase “Obamacare for financial planning!” (here’s an example from Paul Ryan). Whenever Republicans say something is “Obamacare for X,” it’s a way of saying, “We don’t like this thing, but we don’t want to say exactly why, so we’ll just say it’s like that other thing we don’t like.”
This gets to the heart of the different perspective the two parties bring to questions of the economy and government’s role in regulating it. The conservative perspective is essentially laissez-faire: if financial advisers take advantage of their clients, well, that may be regrettable, but we don’t want the government to actually do anything to prevent it, because we have to let the market do what it will. And when it comes to the affirmative policy changes they want to make, for ordinary people most of it involves waiting for things to trickle down. Let us cut taxes on the wealthy and reduce regulations on corporations, they say, and that will create the conditions that will foster economic growth, so that at some time in the future it will be easier for you to find a good-paying job (those getting the tax cuts and regulatory breaks, on the other hand, get their benefits right away).
Liberals, in contrast, are comfortable with making policies like the fiduciary rule — or increases in the minimum wage, or paid family leave, or more inclusive overtime rules — that are designed to deliver immediate benefit to ordinary people. And as complicated as economic policy can sometimes get, most voters can understand this fundamental difference. That’s why Republicans constantly have to struggle to explain why they actually have ordinary people’s interests at heart, and why Democrats can just say, “Yep, there go the Republicans again, just trying to help the rich and screw the little guy,” and voters nod their heads in recognition. Republicans may think it’s unfair, but when they oppose things like the fiduciary rule or try to shut down the Consumer Financial Protection Bureau (protecting consumers, egad!), what do they expect voters to conclude?
Both Hillary Clinton and Bernie Sanders came out in favor of the fiduciary rule last fall; it remains to be seen whether they’ll bring it up again on the campaign trail. But as Pollack notes, the change might not have been possible without the attention it has already gotten. Though people in positions of power often say, “good policy is good politics” as a way of claiming that they have only the purest of (non-political) intentions for their decisions, sometimes exactly the opposite is true.
“This is an example where good politics is actually critical to good policy,” Pollack says, “because if this had been decided quietly in Congress, there’s a good possibility it would have been weakened.” The more attention it got, the more room the administration had to do the right thing. And now that they have, Democrats should keep talking about it.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Plum Line Blog, The Washington Post, April 7, 2016
“Caught Red Handed”: The Latest On Efforts To Privatize The VA
A few weeks ago, the Washington Monthly published a story by investigative reporter Alicia Mundy that challenged the whole narrative about 2014 VA “scandal,” the one in which dozens of veterans were said to have died as a result of lengthy wait times to see VA doctors. In fact, Mundy shows, the department’s inspector general, after an exhaustive review of patient records, could not say with any confidence that even one veteran had suffered that fate. There were certainly problems at some VA facilities; the wait list numbers were definitely being gamed by VA personnel who, like Charlie Chaplin’s factory worker, struggled to keep up with unmeetable performance metrics. The “death wait” allegations, however, turn out to be bogus–cooked up by a Koch brothers-funded group, Concerned Veterans for America (CVA), working with Hill Republicans, in order to panic Washington lawmakers into passing legislation in 2014 to outsource VA care to private sector providers.
In reaction to our story, the chairman of the House Committee on Veterans Affairs Jeff Miller (R-Tea Party) wrote an intemperate letter attacking the story’s key findings as “completely false,” allegations we rather easily countered. Then Miller appeared before the commission his legislation mandated and made a damned fool of himself. Then a faction of the conservatives on the commission were outed for writing up a secret draft of the commission’s recommendations–in which they call for full privatization of the VA—in possible violation of the Sunshine and Federal Advisory Committee Acts.
The latest news on this is that leaders of eight prominent veterans’ groups, including the American Legion and Veterans of Foreign Wars, sent a letter to the commission chair slamming the secret draft and expressing their united opposition to privatizing the VA. This is an important development. As Mundy explains in her piece, a big reason the privatization push has gotten as far as it has is that the traditional veterans groups allowed themselves to be sidelined politically by CVA. Now, finally, those groups are fighting back. And while they don’t have seats on the commission, they do have 5 million members.
So far, this story has gotten virtually no mainstream press coverage–in part, no doubt, because it contradicts the “scandal at the VA” narrative that the press itself originally reported. But I don’t think this hesitancy will last long–the story’s way too juicy. Independent research mandated by that 2014 legislation not only undermines claims about dozens of veterans dying because of wait times, but also shows that the VA provides the same or better quality care than does the private sector. Yet here you have commission members, many of whom represent corporate medical centers that stand to gain billions of dollars in revenue from outsourcing VA care, caught red handed crafting secret recommendations to outsource VA care at the expense of quality care for veterans.
If I had to bet on who’s going to win this policy war, I wouldn’t, at this point, put my money on the outsourcers.
By: Paul Glastris, Political Animal Blog, The Washington Monthly, April 7, 2016
“Republicans Are Plotting Economic Disaster For 2016: The American People Will Be The Collateral Damage
Since George W. Bush’s presidency, Republican economic ideas have become drastically more conservative. Instead of massive tax cuts for the rich coupled with a general tolerance of the rest of government (or even new welfare programs), the party is now committed to much larger tax cuts coupled with eye-watering cuts to government.
Every Republican presidential candidate proposes staggering tax cuts heavily weighted toward the rich. Donald Trump would give the top one-thousandth of taxpayers $1.3 million apiece per year, while Ted Cruz would give them an even $2 million. Trump does favor preserving the welfare state, but he is a marked outsider in this respect. The entire rest of the party is committed to gigantic cuts to welfare, as shown by the budget formulated by House Republicans. Their most recent plan would slash $5.3 trillion in spending over a decade, 69 percent of which would come from programs for the needy.
The party’s intellectual apparatus (distinct from the Trumpist insurgency) has more-or-less fully regressed to an economic libertarianism straight out of the 1920s. They view basically all government programs outside of the military and the courts as illegitimate, to be slashed or eliminated wherever possible. The only problem with this is that when you try it, the results are immediate disaster.
Republicans haven’t been able to fully implement their plan of tax and service cuts on the federal level, but they have tried it in a few places on the state level. Louisiana under Gov. Bobby Jindal has had it the worst. Jindal’s massive cuts to education and services were not nearly enough to cover his gigantic tax cuts, and draining every rainy day fund in the state only delayed the day of reckoning. Eventually the results were so disastrous that the unthinkable happened — a Democrat replaced Jindal. Now Gov. John Bel Edwards is scrambling to deal with the most extreme budgetary emergency of any state government in decades, working feverishly just to keep the state from literal financial collapse.
Kansas is also suffering from Republican quack economics. Gov. Sam Brownback (who barely scraped through re-election in 2014 and now sits at a 21-percent approval rating) tried the same tricks as Jindal, though to a somewhat lesser degree, and the results were similar: a huge budget deficit with none of the promised explosive growth or job gains. Now Kansas conservatives are running into problems with the state’s Supreme Court, which found legal problems with the distribution of education cuts. Their solution: Attack the justices politically, by drawing up a new impeachment law and trying to get them thrown out in an upcoming confirmation election.
It’s the same story in Wisconsin with both deficits and lousy economic performance. Gov. Scott Walker’s major innovation has been an effort to basically destroy the Wisconsin state university system with drastic cuts and the abolishment of tenure, which is already leading to serious problems at the flagship school in Madison.
However, it could have been worse for all these states. The federal government, with its grants, its spending on social programs, and its employment of in-state government workers and contractors, provides a buffer of spending state governments cannot cut. For example, Louisiana gets over 40 percent of its state budget from the feds, as well as $5,917 per person in social spending, $3.5 billion in federal contracts, and $5.3 billion in compensation paid to almost 68,000 federal workers (as of the most recent data). That’s $48 billion in income against $39 billion paid in federal taxes (other states don’t make out so well).
This means that the results would be far more disastrous should Republicans get to implement their ideas on a federal level. Great chunks of the federal programs — food stamps, federal health programs, the Earned Income Tax Credit, and so on — that have provided inadequate but vital economic stabilization would be cut or eliminated altogether.
The results would be just as what happened on the state level, only worse.
It took many years for Republicans to talk themselves out of the fact that Herbert Hoover’s presidency was a disastrous failure, but with the exception of Trump, Hooverism is where they stand. It’s an ideology that can gain wide popularity only insofar as it is not actually tried on a wide scale. It turns out that a vision of government that was already outdated a century ago (when farmers were over a quarter of the workforce) is not very well-suited to a modern economy. It’s just too bad the American people might have to be the collateral damage in re-learning that lesson.
By: Ryan Cooper, The Week, April 4, 2016
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