“An Alternate Bizzaro Universe”: Ted Cruz’s “American People” Remain Imaginary And Elusive
Give Ted Cruz this much: He remains unbowed in the face of both substantive defeat and public opinion, which he ceaselessly claims to have on his side.
For example, yesterday Cruz addressed the press (the man seems to only communicate in formal speeches – can you imagine dining with him?) on the shutdown and its conclusion, declaring the whole thing a massive expression of the will of “the American people.” He said:
Unfortunately, once again, it appears the Washington establishment is refusing to listen to the American people.
It is unfortunate that Washington is not listening to the people.
And I want to commend the House of Representatives. The House of Representatives has taken a bold stance listening to the American people.
Months ago, when the – when the effort to defund “Obamacare” began, official Washington scoffed – they scoffed that the American people would rise up. They scoffed that the House of Representatives would do anything, and they scoffed that the Senate would do anything.
We saw, first of all, millions upon millions of Americans rise up all over this country. Over two million people signing a national petition to defund “Obamacare.” We saw the House of Representatives take a courageous stand listening to the American people …
As I have argued before, it raises the question of precisely which “American people” Cruz is speaking for, because it’s not the ones who are answering pollsters. For example, an ABC News/Washington Post poll released Monday found that 74 percent – 74 percernt! – of Americans disapproved of the way Congressional Republicans were handling the budget negotiations, an 11 percent increase from a few weeks earlier. That came after an NBC News/Wall Street Journal poll last week found only 24 percent of those surveyed approving of congressional Republicans – a result which Republican pollster Bill McInturff (who along with Democrat Peter Hart conducted the survey) said made it, “among the handful of surveys that stand out in my career as being significant and consequential,” along with polls taken in the wake of 9/11, Hurricane Katrina, the Lehman collapse and the last debt ceiling crisis. (Cruz tried to “unskew” the NBC/Wall Street Journal poll, but was unsuccessful.)
Further, polls have shown that Obamacare has become more popular and that the intensity among its opponents has ebbed. And while polls show that more Americans disapprove of Obamacare than like it (though those numbers are deceptive if you don’t take out the people who disapprove because the law doesn’t go far enough), surveys also show that most Americans prefer to have Congress work to improve the law rather than repeal or defund it, a la Cruz.
And all of this after polls showed overwhelming numbers of Americans disapproved of shutting down the government in order to win policy concessions from the other side … which brings me to Cruz on Fox News last night. “But we’ve also seen a model that I think is the model going forward to defeat Obamacare, to bring back jobs, economic growth, to abolish the IRS, to rein in out-of-control spending,” he said. A model going forward – that’s right folks, Ted Cruz enjoyed this shutdown so much that he wants to do it again.
Presumably he’ll claim then to be acting in the name of the American people as well. Ted Cruz was elected from Texas, but it’s clear he really hails from some bizarro alternate universe. Where else could Obama winning a comfortable re-election and poll after poll after poll showing that Americans like neither shutdowns nor the party behind the specific shutdown that just ended all add up to a by-any-means-necessary mandate to pursue Cruz’s narrow right-wing agenda?
By: Robert Schlesinger, U. S. News and World Report, October 17, 2013
“Cloaked In Secrecy”: The Myth Of The Medical-Device Tax
In the last few days of negotiations in Congress, repeal of the Affordable Care Act’s tax on medical devices emerged as a key Republican demand. The medical-device industry waged an intense lobbying campaign — even garnering the support of many Democrats who favored the law — arguing that the tax would stifle innovation and increase health care costs.
This argument is doubly disingenuous. Not only can the medical-device industry easily afford the tax without compromising innovation, but the industry’s enormous profits are a result of anticompetitive practices that themselves drive up medical-device costs unnecessarily. The tax is a distraction from reforms to the industry that are urgently needed to lower health care costs.
The medical-device industry faces virtually no price competition. Because of confidentiality agreements that manufacturers require hospitals to sign, the prices of the devices are cloaked in secrecy. This lack of transparency impedes hospitals from sharing price information and thus knowing whether they are getting a good deal.
Even worse, manufacturers often maintain personal relationships (sometimes involving financial payments like consulting fees) with physicians who choose the medical devices that their hospitals purchase, creating a conflict of interest. Physicians often don’t even know the costs of the devices, and individual physicians often choose devices on their own, which weakens a hospital’s ability to bargain for volume discounts.
Such anticompetitive practices help generate a wide variation in the prices of medical devices — and contribute to higher prices in general. For example, the Government Accountability Office found that prices for cardiac implantable medical devices in the United States vary by several thousand dollars. And even the lowest-priced devices in the United States are expensive compared with those in other developed countries. According to the consulting firm McKinsey & Company, the United States spends about 50 percent more than expected on the top five medical devices, compared with Europe and Japan. McKinsey calculates that this amounts to $26 billion in excessive spending each year. Medicare, private health insurers and patients end up paying these inflated prices.
Excessive prices fuel enormous profits — profits that dwarf both the medical-device tax and the industry’s investments in research and development. Consider the device division of Johnson & Johnson, which in 2012 had an operating profit of $7.2 billion. By the company’s own estimate, the device tax would amount to at most $300 million, and its investment in research and development amounts to only $1.7 billion.
There are several ways policy makers could lower device costs. The first step would be to end the anticompetitive practices that prevent hospitals from getting the best deals. Senator Charles E. Grassley, Republican of Iowa, has sponsored legislation that would foster transparency by posting online price information for implantable medical devices.
In addition, instead of simply paying hospitals based in part on what they have spent on devices, Medicare should force manufacturers to compete for business based on a product’s price and quality.
Medicare should also pay hospitals a single lump sum for all of the associated costs of a given procedure (like a hip replacement). This approach, known as “bundling” the costs, would create incentives for hospitals to lower device costs. Savings should be shared with the physicians, so that their incentives are aligned with the hospital’s.
Bundling has been used successfully in pilot programs. Under Medicare’s Acute Care Episode Program — which bundled payments for cardiac and orthopedic procedures — physicians worked together to choose high-quality, cost-effective devices. Baptist Health System in Texas, which participated in the program, used clinical evidence to choose devices and negotiated lower prices for both Medicare and non-Medicare patients.
States could adopt similar payment reforms for private insurance and their Medicaid programs. In Arkansas, the Medicaid program and private payers — including Walmart — have collaborated to adopt bundled payments for several procedures, including hip and knee replacements.
To complement these efforts, the new Patient-Centered Outcomes Research Institute, a nongovernmental body created by the Affordable Care Act, should pay for research that compares the effectiveness of devices so physicians can make informed choices. (Three years into its existence, the institute has initiated few, if any, studies of medical devices.) Medicare or the Food and Drug Administration should also require the use of registries that track when devices fail.
Currently, medical-device manufacturers allocate only a sliver of profits to research and development and often focus on “tweaks” to existing devices, without providing any evidence that they are of better quality. Competitive pressures from public and private payers would provide incentives for the industry to become more innovative, producing technologies that actually lowered costs and offered truly advanced breakthroughs.
Instead of using its clout to lobby against the device tax — which helped foment opposition to the Affordable Care Act — the medical-device industry needs to share the responsibility of lowering costs for patients, businesses and taxpayers.
By: Topher Spiro, Op-Ed Contributor, The New York Times, October 16, 2013
“The ‘Fraidy Cat Group”: Why We Probably Won’t Get Another Government Shutdown In January
So we probably now have a short-term continuing resolution set to expire in January. Does that mean another shutdown in January, after the two sides can’t reach an agreement? After all, that’s what happened in 1995 and 1996: a relatively brief shutdown in the fall was followed by a five-week deadlock in the winter. Is that what we’re going to get?
Probably not.
What the shutdown that appears to be ending today and the 1995-1996 episodes had in common was important: in both cases, one side really wanted the shutdown. In 1995, Newt Gingrich and many Republicans sincerely believed that Bill Clinton was personally weak and would fold if pressed hard enough. That turned out to be wrong; whether it was a foolish idea to test it in the way Gingrich did remains, I suppose, an open question.
This time around, the logic of the showdown gang was clearly foolish; no objective observers believed their stated plan would work; it would have required a massive surge of anger at the Democrats for allowing the government to be shut down over the Affordable Care Act (ACA), but most Democrats like the ACA, and polling indicated that practically no one outside of tea party circles favored a shutdown over it.
There have been a lot of very contentious budget arguments over the last few decades, but none of the others ended with a prolonged shutdown; the next-longest one after those was only three days.
What causes an extended shutdown, then, isn’t missing a deadline. In fact, deadlines are probably needed to get deals done. As long as neither side actively seeks a shutdown, one of three things will happen: they’ll make a deal by the deadline; they’ll miss the deadline but going over the deadline will be enough to get it done; or, they’ll agree to move the deadline.
The question as we approach the next finish line, then, isn’t whether we’ll go close to the edge. Of course we will, but that’s a feature, not a bug (on a shutdown; flirting with the brink on debt limit is a far riskier thing to do). Real negotiations are hard; it takes time to sort out what the real asks are and what’s just bluff. The question is whether a significant faction of the Republican Party wants to do this again, and, if so, whether the rest of the party will accommodate them again.
My guess, as of now, is that this one was devastating enough that we won’t see a repeat. That doesn’t mean that Republicans will back off their demands; it just means that they won’t see any additional utility in fighting through a shutdown.
My biggest worry? This wasn’t 1995-1996, when the GOP was generally united behind the belief that a shutdown would work for them. Instead, the dynamic this time was that a relatively small group wanted it, and a much larger ‘fraidy cat group was terrified of allowing any visible difference between themselves and the radicals. That could repeat itself next time — and the radicals, especially those in outside groups, may actually be pleased with the fundraising results of this fight, even if it hurt the party overall.
However, it’s reasonable to hope that mainstream conservatives learned their lesson from this one and won’t do it again; there’s also the hope that those radicals who are actually driven by policy goals may also have learned something.
Overall? One way or another, budget deadlines are absolutely necessary. And we won’t get a shutdown unless one side wants it.
By: Jonathan Bernstein, The Washington Post, October 16, 2013
“Tyranny Over The Most Vulnerable”: Women Are Bearing The Brunt Of The GOP Shutdown Fallout
The “non-essential” programs that are currently unfunded due to the shutdown are in fact essential for many women and children.
The GOP likes to say the war on women is a myth. But the government shutdown, now in its 11th day, is just the latest evidence that it is indeed alive and well. It should be no surprise that women are among those hurt most by the closure, which, predictably, is in part a reaction to the benefits that the Affordable Care Act, President Obama’s signature achievement, guarantees women, as we wrote last week.
From the nation’s elite institutions to the oft-neglected rural areas of this country, women and their families are caught in the middle of a political impasse that has furloughed an estimated 800,000 government workers, threatens to upend the global economy, and has left critical government programs and services scrambling to secure emergency funds in order to serve America’s most vulnerable populations.
The shutdown threatens a number of programs and funding streams, including domestic violence shelters and service centers; Temporary Assistance for Needy Families (TANF); the Woman, Infants, and Children Program (WIC); School Lunch; Head Start; and Title IX investigations of sexual assault on college campuses. This will have a serious impact on the health, physical safety, food security, and economic stability of women and their families.
Physical Safety
As Bryce Covert wrote last week, funds for domestic violence programs designated under the Violence Against Women Act (VAWA) have been suspended since October 4. (It should be no surprise that many of the House members leading the shutdown also voted against VAWA itself earlier this year.)
Small centers without access to independent funding – those that serve women with the fewest options – will only be able to weather the storm for so long. In the wake of the 2008 financial crisis and the ensuing economic downturn, violence against women has been on the rise, with eight out of 10 shelters reporting increases in the number of women seeking help, and 74 percent of domestic violence victims staying in unsafe situations because of economic insecurity. Demand for these services is increasing, while funding is being cut from every source. Nearly four out of five of domestic violence service providers have reported decreases in government funding over the past five years, and since October 1, many have closed their doors completely or limited their services.
The shutdown is also affecting the safety of women on college and university campuses across the country. An increasing number of institutions are under investigation for ineffective handling of sexual assault cases adjudicated under Title IX.
And with the shutdown, the Department of Education’s Office of Civil Rights has suspended investigations into alleged violations and has halted campus visits necessary for holding institutions accountable.
Food Security
The shutdown threatens the food assistance on which millions of America’s most vulnerable women and children rely. At this point, federal funding for TANF, WIC, and school lunches has been suspended. State and USDA reserve funds are being reallocated so that states can continue to provide these essential services, but they will only be able to function with these limited resources for a short time.
States are shouldering the burden to keep TANF running while the government is shuttered, but last week, 5,200 eligible families in Arizona did not receive their monthly check. Thus far Arizona has been the only state to deny this important benefit for families in need, but every day the program is more strained.
WIC, the federal program that most crucially provides formula and breastfeeding assistance for mothers in need, has also been left in the lurch. On Tuesday, officials announced that no additional WIC vouchers would be issued in the state of North Carolina, where approximately 264,000 women rely on the program. In Utah, the WIC program shut its doors and only reopened four days later because the USDA provided a $2.5 million emergency grant. Other centers are sure to face the same challenges so long as workers are furloughed and grants are on hold.
Economic Security
Head Start programs that provide childcare and education for 7,200 low-income children ages 0-5 did not receive grants due on October 1. Thousands of low-income women are able to go to work every day because their children participate in Head Start programs. Without them, women already struggling in low-wage jobs and lacking benefits are forced to miss work, because no one else is able to care for their children. For women, secure employment is contingent on secure childcare and education for their families. The New York Times reported that programs in six states had closed due to the shutdown and then reopened temporarily thanks to a $10 million gift from a couple in Texas. Head Start will continue as a result of this short-term rescue, but private philanthropy will not be able to do the job of the government over the long term.
In sum, what some define as non-essential government services are, in fact, essential to the economic and physical well-being of America’s most vulnerable women and their families. It’s just another variation on the old adage that one man’s public interest may be another’s tyranny – in this instance, largely tyranny over women and children.
By: Andrea Flynn and Nataya Friedan, The National Memo, October 13, 2013
“From Day To Desperate Day”: John Boehner Is Adrift, Without Any Idea Of How To End The Crisis
At this point, I’m starting to get the feeling that John Boehner spends a good portion of each day sitting around in his office with a bunch of aides as they all stare at the ceiling. “Anybody got any ideas yet?” he says periodically. “No?” Heavy sigh.
Every couple of days they come up with something, float it to reporters, and find that it only serves to confuse things, to the point that nobody knows what they’re demanding anymore. First they’d only open the government and raise the debt ceiling if the Affordable Care Act were defunded. When that didn’t fly, they suggested they’d release the hostages if the ACA were delayed for a year. No go on that, so they suggested that they’d accept some kind of “grand bargain” as long as it included “entitlement reform,” which is Republican code for cutting Social Security and Medicare. Nope. Then they said they’d take some package of unnamed budget cuts and tax cuts. They aren’t getting that either, and now it seems they’ve finally come to terms with the fact that when President Obama says he isn’t going to pay any ransom, he means it.
So the latest proposal is that they’ll allow an extension of the debt ceiling, for … six whole weeks! During which time they’ll still be holding the government hostage, but will temporarily delay defaulting on the debt. The question is, to what end? What is supposed to happen in that time? Is President Obama going to change his position and decide that he’ll give in to their demands after all? is the public going to decide that they’re a bunch of reasonable fellows who should be rewarded for this nightmare with a chance to govern the country? What?
I suspect the answer is this: They have no idea. As Chris Hayes tweeted earlier today, it seems that “Boehner’s only goal on any given day is just to survive that day.” In a similar vein, Jonathan Chait wrote, “Here’s the best rule for determining what John Boehner will do in any situation: If there is a way for him to delay a moment of confrontation or political risk, he will do it.” Boehner is just not equipped to deal with this situation. Maybe nobody could, but Boehner cut his political teeth at a time when these things could be worked out between gentlemen. You go out on the golf course or into the (literally) smoke-filled room, and have a frank discussion about what everybody wants and what they’re willing to give. Then you find a way to make it happen—you can have a new bridge in your district, that guy can have a plumb committee assignment, I’ll promise to do a fundraiser for that other guy. The votes add up one by one, and eventually the deal is done. But those rules don’t apply anymore, not with this Republican caucus and not in this situation.
One thing we can be sure of is that Boehner has no plan. He’s making this up as he goes along. The White House has a plan, which is not to make the same mistake they made before of negotiating over the debt ceiling. They’re just not paying the ransom, period. It’s a pretty good plan for a number of reasons, and it means they don’t wake up every day of the crisis wondering what the hell they’re going to do or say that day. But Boehner is utterly adrift. You get the feeling he’s waiting for some deus ex machina to fly down from above and save his bacon at the last minute.
Maybe the White House will accept this proposal for a six-week debt-ceiling extension. But that brings us no closer to an end to the crisis. And it brings Boehner no closer to an end to his nightmare.
By: Paul Waldman, Contributing Editor, The American Prospect, October 10, 2013
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