“What Nonsense”: Blaming President Obama For Passing A “Partisan” Health-Care Bill?
Here’s one thing I absolutely cannot stand hearing: that President Obama is getting what he deserves now because he passed such a “partisan” health-care bill. The suggestion is truly beyond belief and, quite literally, totalitarian in spirit, in the way it flips the truth so perversely on its head, turning the perpetrated-upon into the perpetrator and the aggressor into the victim. As Obamacare flails, one hears the “partisan” line frequently these days on television and radio. More maddeningly still, the alleged liberals and fact-based reporters on various panels often permit it to go unchallenged. Let’s set the record straight.
Obama came into office trying to reach out to Republicans and their voters. Remember Pastor Rick Warren at the inaugural? Remember how the president met with pro-abortion rights and anti-abortion rights groups early on? (You may not, but he did.) He also tried to horse-trade with them on the stimulus. True, he would not compromise on a tax credit for low-wage workers that Republicans opposed. (Interesting to read this article in retrospect; Obama was trying to help here the later-famous 47 percent.) But he did offer movement on tax cuts, and the Senate did pass a Charles Grassley amendment about the alternative minimum tax. And, at the White House’s request, certain expenditures the White House thought would repel Republicans were stripped out in the hopes of winning GOP support. But that, of course, did not happen in any meaningful way.
In the late spring of 2009, Obama started talking health care. He sat down with Republicans over the summer. He invited a group of Republicans into his office and told them he’d put tort reform in the bill if it would get him Republican votes. They stared at him. Other administration officials met with Republicans a number of times to see if anything could be put in the bill to appease them. The answer was always no. Remember here that the Affordable Care Act is basically a Republican plan to begin with, as the individual mandate idea came from the Heritage Foundation. So you might have thought that some Republicans would be OK with that.
Outside the administration, Democrats in the Senate negotiated with Republicans for months. Those Democrats finally did decide, on August 17, that it was time to throw up their hands, and they reluctantly proceeded without Republicans. “Given hardening Republican opposition to Congressional health care proposals, Democrats now say they see little chance of the minority’s cooperation in approving any overhaul…” is how the Times opened its article on the matter. But it wasn’t for want of trying. Democrats tried, for ages.
Why did they stop trying? Maybe because of things like then-Sen. Jim DeMint’s vow July 9 to make health care Obama’s “Waterloo.” Or maybe Democrats took the hint July 16, when they heard Minority Leader Mitch McConnell say, “We’re doing everything we can to defeat it.” Or maybe it was July 22, when Orrin Hatch, once a reasonable conservative, walked out of the Senate negotiations and announced he would not back any bill. That was, of course, the summer of the Tea Party town hall madness.
It was obvious by then—really before, but certainly by the time of Hatch’s departure—that Republicans would never agree to anything about health-care reform. They would say Obama wouldn’t accept their ideas, and there would be about a half an iota of a smidgeon of truth in that protestation, but of course the reason Obama didn’t accept their ideas is that their ideas were far worse than what ended up in the bill. They put out a four-page set of broad principles in June 2009. Then they filled in some details, and the Congressional Budget Office went over it. Unsurprisingly, it was a joke. The CBO found that it would have increased the number of uninsured and raised premiums for millions. Oh, and get this: Under their plan, insurance companies could still have denied coverage to people with pre-existing conditions. Ending that is the main point of reform, and ending that is why reform is so hard.
So Republicans gave no support at all, by design, essentially from the beginning. And then they blame Obama for passing a “partisan” bill? It’s beyond Kafkaesque. It really is like an old communist secret-police trick: We will seize most of your farmland and then jail you for failing to live up to the production quotas.
And then they vote 40 times to repeal it. And then Kevin McCarthy, the No. 3 Republican in the House, goes on MSNBC on Thursday, and Chuck Todd asks him if the Republicans want the Affordable Care Act to fail, and he says: “Never.” Never! Can you imagine? Voting to repeal something 40 times is kind of an odd way for a group of people to express their desire to see it succeed.
At a moment when Obamacare is on the ropes, and in a country of people with memories shorter than Michele Bachmann’s future in public life, Republicans know that they can repeat such a dishonest talking point and get a fair percentage of Americans to believe Obama behaved like some raging partisan. The associated corollary point is that this was about his ego or some such nonsense.
Uh, no. Progressive-minded people have been wanting to pass universal health care in the United States for a century. Usually they were Democrats, although back in the day some were Republicans, including Teddy Roosevelt. It has been the major unmet policy goal of American liberalism for decades—not because Democrats want to overpower Republicans politically, but because Democrats want people to have access to health care. Republicans don’t. Since the policy goal makes utterly no sense to them, they assume everything is about politics. Obama wasn’t being “partisan.” He was fulfilling a long-held policy goal—and a central campaign promise, by the way. I thought we were supposed to like it when politicians keep their promises. But now that’s partisan, too, at least to people who see everything through partisan glasses.
By: Michael Tomasky, The Daily Beast, November 19, 2013
“A Process At The Breaking Point”: Republicans Are Hijacking The Judicial Nominating Process Without Cause
In June, President Obama nominated three qualified jurists to serve as judges on the D.C. Circuit, generally considered the nation’s second-most important federal bench. Each one of the nominees has excellent credentials, each one of the nominees sailed through the Judiciary Committee without incident, and each one of the nominees enjoys the support of a majority of the U.S. Senate.
And last night, each one of the nominees has been blocked by a Republican filibuster.
Senate Republicans on Monday denied President Obama his third nominee in recent weeks to the nation’s most powerful and prestigious appeals court and insisted they would not back down, inflaming a bitter debate over a president’s right to shape the judiciary.
By a vote of 53 to 38, the Senate failed to break a filibuster of a federal judge, Robert L. Wilkins, who was nominated to fill one of three vacancies on the United States Court of Appeals for the District of Columbia Circuit, falling short of the 60 votes needed.
Wilkins technically finished with 53 votes, but he had 54 supporters – Senate Majority Leader Harry Reid had to vote “no” for procedural reasons.
As was the case with last week’s filibuster, it’s important to recognize that the Republican obstructionism had nothing to do with Wilkins, his ideology, his temperament, or his background. On the contrary, just the opposite is true – senators in both parties agreed that Wilkins is a fine nominee.
The problem, rather, is that a minority of the Senate has decided to block every nominee for the D.C. Circuit, regardless of his or her qualifications, because Americans had the audacity to re-elect a Democratic president. Once there’s a Republican in the White House, Republican senators will presumably agree to lift the blockade.
This is important because it has simply never happened before in American history. Senators in both parties have, in a variety of instances, blocked judicial nominees they considered offensive or extreme for one reason or another, but there is nothing in the American tradition that says a minority of the Senate can maintain vacancies on an important federal bench – indefinitely – because they feel like it.
Indeed, perhaps the single most bizarre example of obstructionism run amok is Sen. John McCain (R-Ariz.), who said just a few months ago that each of Obama’s D.C. Circuit nominees deserve a vote in the Senate. McCain then proceeded to join the filibuster of the nominees he said shouldn’t be filibustered.
After yesterday’s obstructionism, Senate Democratic leaders began “taking the temperature of their caucus on whether to finally go ‘nuclear’ and change the Senate rules,” and by any fair measure, Republicans haven’t left the majority party with much of a choice.
Let’s make this plain: if Senate Democrats don’t force a confrontation over this, they will, for the first time in the institution’s history, have allowed a minority of the Senate to hijack the judicial nominating process without cause.
The status quo is, for lack of a better phrase, a simmering constitutional crisis of sorts. Either Democrats act or a precedent will be set.
What’s unclear is whether Dems will, or even can, proceed with the so-called “nuclear option.” Does the party have the votes to execute the plan? Do they have the intestinal fortitude to accept the blowback from Senate Republicans relying on obstructionist tactics that have never before been tried in the United States?
Last week, Sen. Pat Leahy (D-Vt.), the Senate Pro Tem and chairman of the Judiciary Committee, said, “I think we’re at a point where there will have to be a rules change.” Senate Majority Whip Dick Durbin (D-Ill.) added soon after, “I’ve said it before and I’ll say it again. There comes a tipping point, and I’m afraid we’ve reached that tipping point.”
If they were waiting to see what happened with Wilkins, now they know. Yesterday, Sen. Jeff Merkley (D-Ore.), a leading proponent of Senate reforms, asked, “When will we say enough is enough?”
In the short term, it’s up to Democrats themselves to answer this question. Republicans, whose support is not needed for the nuclear option, have effectively dared the majority party to end the blockade and return the Senate to its earlier traditions. In fact, Sen. Chuck Grassley (R-Iowa), whose antics have been more offensive than most in this debate, dared Democrats just a week ago to restore the original Senate process for judicial nominees.
Senate Republicans, for all intents and purposes, have broken the judicial confirmation process. They know they’re engaged in tactics with no precedent in the American tradition; they know it’s obstructionism on an unsustainable scale; they know it’s wholly at odds with every commitment they made during the Bush/Cheney era; and they just don’t give a darn.
Whether the Democratic majority is prepared to simply tolerate this crisis and allow the process to be hijacked for the indefinite future is unclear.
* Postscript: If you listened to the debate at all, you may have noticed GOP senators justifying their blockade by saying the D.C. Circuit handles fewer cases than the other circuits, and therefore can better tolerate indefinite vacancies. In case anyone was wondering whether the argument has merit, it doesn’t – this nonsense was debunked in September.
By: Steve Benen, The Maddow Blog, November 19, 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
“We Just Keep Short-Changing Women”: Same Job, Same Size Budget Equals Less Pay For Women
Hey, married men – wake up! Your working wives are getting shorted on pay and that means your family has less money than it should.
A new report on pay, made public today by Guidestar USA proves discrimination against women is pervasive.
The new report compares men and women with the same positions at similarly sized nonprofit enterprises, so the fact that women often work in lower-paid occupations such as waitressing, retail and clerical work is irrelevant in this study.
While women who become waitresses or retail clerks should expect to make less than lawyers and executives, there is no reason that women executives and lawyers should make less than men doing the same jobs — but they do.
Men holding the top spot at nonprofits averaged between 10 percent and a third more than women in the same jobs, Guidestar found.
In general, the bigger the organization and the bigger the job responsibilities, the greater the gap between what women and men are paid — and the greater the share of top jobs held by men.
Guidestar is a nonprofit organization that compiles data reported to the IRS, and the public, by all nonprofits. The 2010 data cover not just charities that solicit donations, but trade organizations, small mutual insurance operations and social welfare organizations among the 29 types of nonprofits authorized by Congress.
This is Guidestar’s 12th annual Nonprofit Compensation Report and it draws on disclosures by more than 77,000 nonprofits.
The report used names to determine sex. Androgynous names like Pat or Chris were excluded from the analysis, Charles McLean, Guidestar’s research director, told me.
At small nonprofits, those with an annual budget of less than $250,000, men in the top job averaged $53,389. That is 10 percent more than the $45,038 paid to women.
More than half of these small nonprofits, 57 percent, were led by women.
At the top, these gaps grew to chasms.
Among organizations with budgets of $50 million or more, men in the top job averaged $644,375. That is almost a third more than the $488,249 average for women CEOs.
Even more telling, women held just 1 in 6 of the CEO jobs at the biggest nonprofits.
The only CEOs who made more than $1 million a year on average were men at $50 million-plus nonprofits who, at the 90th percentile, averaged almost $1.2 million, compared to less than $924,000 for women at the same percentile of pay.
The pattern is pretty much the same for the top legal and finance jobs at nonprofits. However, pay disparities are smaller for public relations.
The same pattern of men dominating in the highest-paid jobs is found in the latest ORS data on wages reported on income tax returns.
Among people with wages of $10 million or more, just one in 29 was a woman. These 60 highly paid women workers averaged $18.8 million in wages in 2010, IRS data shows.
Men accounted for more than 96 percent of all top wage earners. The 1,664 men were paid on average $20.1 million or almost 7 percent more than the highest-paid women workers, the IRS data shows.
The IRS data also shows that as workers get older, the pay disparities between men and women increase. Among workers under age 26, the average pay of men was $16,000 in 2010, just 22 percent more than women of the same age.
But for workers ages 45 to 60, men averaged about $67,000, which was 70 percent more than women, who averaged slightly less than $40,000.
This may reflect occupational choices, but it may also indicate that as time passes, the gap between what men and women make will narrow.
Guidestar gets its figures from the Form 990 tax returns that all nonprofits must file with the IRS. It then analyzes them in many ways, including pay by gender and size of organization budget.
The data is exceptionally robust because Congress micromanages nonprofit pay, a cause championed by Senator Chuck Grassley of Iowa, a Republican who is the only pig farmer in the Senate and a longtime antagonist of charities and other nonprofits.
One benefit of Grassley’s instinctive suspicion of nonprofits is that he persuaded Congress to require much more complete disclosures on what nonprofits pay than corporations. Profit-making enterprises only have to disclose what their top five executives were paid, and then only if they have publicly traded stock or bonds.
Even more significant, Congress requires rigorous and costly review of pay comparability for nonprofit leaders.
The zone of discretion for paying nonprofit executives under the laws Grassley sponsored and rules the IRS issued is exceedingly narrow, unlike the wide-open rules for profit-making corporations. For nonprofits with budgets of $5 million to $10 million, the zone of discretion is perhaps $10,000 above or below what the Guidestar and other pay studies show, compensation consultants have advised me when I sought their advice because nonprofit boards on which I volunteered assigned me to recommend the top executive’s pay.
Discrimination against women is pervasive and significant. It is also only slightly less severe than it was in Guidestar’s first pay study in 2001.
McLean, the Guidestar research director, said, “There is progress being made, but it is very slow.”
Two ways to speed up that process:
—Women who are married should make sure their spouses know how much money the family loses because of gender discrimination.
—Men should be in the forefront of demanding for equal pay for women, especially the majority of married men with a working wife.
Or we could do nothing, and just keep shortchanging women.
By: David Cay Johnson, The National Memo, September 16, 2013
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