“Irrational Hatred Of Obamacare Is Hard To Fathom”: The GOP’s Relentless Opposition Has Been Puzzling
My friend Isatou has just received an invoice from Kaiser Permanente, testament to her new coverage through the Affordable Care Act — usually called “Obamacare.” She’s thrilled to finally have health insurance so she can get regular checkups, including dental care.
A reasonably healthy middle-aged woman, she knows she needs routine mammograms and screenings for maladies such as hypertension. But before Obamacare, she struggled to pay for those things. She once had to resort to the emergency room, which left her with a bill for nearly $20,000. (She settled the bill for far less, but it still left her deeply in debt.)
She is one of more than 7 million people who have signed up for health insurance through the ACA, stark evidence of the overwhelming market demand. Despite a badly bungled initial rollout, a multimillion-dollar conservative media campaign designed to discourage sign-ups, and a years-long Republican crusade against it (50 votes to change the law), millions got health insurance.
That hardly means Obamacare is a raging success. It’s much too early to know how it will affect health outcomes for the previously uninsured. But it’s abundantly clear that the ACA has already made great strides in improving access to health care. And that alone is quite an accomplishment.
Now, young adults can stay on their parents’ health insurance policies until they are 26 years old — a boon in an economy where many young folks are struggling to find decent jobs. Now, patients with previously diagnosed illnesses (“pre-existing conditions,” in insurance lingo) can’t be denied coverage. Now, the chronically ill don’t have to worry about hitting a lifetime cap that would deny them essential procedures or pharmaceuticals. Now, working folks who don’t get insurance through their employers can purchase affordable policies.
Factoring in the Medicaid expansion, the ACA has extended health care coverage to an additional 9.5 million people, according to the Los Angeles Times, which gathered data from national surveys. Needless to say, millions more would have been covered if so many Republican governors, mostly located in Southern states, had not callously refused to accept the Medicaid expansion despite the fact that it is largely paid through federal government funds.
The GOP’s relentless opposition has been puzzling. Republicans have resorted to extreme measures to try to derail Obamacare, including an implicit threat to prevent the National Football League from participating in a marketing campaign to encourage people to sign up.
Oh, did I mention 50 votes to repeal or alter the law?
Even acknowledging that our politics have become bitterly polarized, I don’t understand this one. Even taking into account the GOP’s irrational hatred for President Obama, I don’t get it. Even though I know that Republicans believe in less government, I don’t understand their approach to Obamacare.
First off, the ACA adheres to market-based ideas, many of which were first suggested by conservatives. Instead of a single-payer system like, say, Medicare, the ACA relies on private insurance companies. It adopts the individual mandate that was supported by many Republicans, including Newt Gingrich, back in the 1990s and later adopted by Mitt Romney in Massachusetts.
Second, Republicans are free to offer up a health care scheme that is more in keeping with conservative principles. But the “repeal and replace” mantra is rarely heard anymore since it has become increasingly clear that the GOP has no intention of coming up with a plan to replace Obamacare. While there are various counter-proposals floating about, none has garnered the support of a majority of Republicans in Congress.
Is the ACA perfect? Absolutely not. There is much in the law that needs to be worked on, refined, improved. But the GOP doesn’t seem interested in that. Instead, its members have taken to engaging in increasingly ridiculous criticisms, including the charge that the White House has made up the number of successful enrollees.
It’s strange. Could it be that Republicans are simply furious that millions of Americans like Isatou finally have health insurance?
By: Cynthia Tucker, Winner of the 2007 Pulitzer Prize for Commentary, is a Visiting Professor at the University of Georgia; Published in The National Memo, April 5, 2014
“Reared In The Game”: On Our Highest Court, A Former Lobbyist Guts Campaign Finance Reform
For a large and bipartisan majority of Americans, the increasing power of money in politics is alarming, but not for the conservative majority of the United States Supreme Court, whose members appear to regard the dollar’s domination of democracy as an inevitable consequence of constitutional freedom — and anyway, not a matter of grave concern. Expressed in their decisions on campaign finance, which continued last week to dismantle decades of reform in the McCutcheon case, the Court’s right wing sees little risk of corruption and little need to regulate the flamboyant spending of billionaires.
Given the behavior of certain conservative justices, such as Antonin Scalia, Clarence Thomas, and Samuel Alito – who flout the rules that govern partisan behavior among lower-court judges – it is easy to regard their rulings as partisan cynicism. But there is also an element of willful naiveté when the conservatives claim, for instance, that corrupt donations will be exposed by the instant transparency of publication on the Internet. Any reporter who has covered elections can attest that there are dozens of ways for wealthy donors to avoid public scrutiny until it is much too late to matter.
But if right-wingers like Scalia and Thomas are simply pursuing ideological objectives, what about Anthony Kennedy, the Reagan appointee from California who was long seen as a moderating influence and a “swing vote”? On the issue of campaign finance, Kennedy has marched along with the majority, seeming just as fervent in his urge to destroy every regulation and protection against the “malefactors of great wealth” erected since the days of Theodore Roosevelt.
It was Kennedy who wrote the majority opinion in Citizens United, which dismissed the notion that corruption will arise from unlimited political campaign contributions because they will all be disclosed. “Citizens can see whether elected officials are ‘in the pocket’ of so-called moneyed interests …and disclosure permits citizens and shareholders to react to the speech of corporate entities in a proper way,” he wrote. “This transparency enables the electorate to make informed decisions and give proper weight to different speakers and messages.”
But if any Supreme Court justice knows how ridiculous that sounds, it must be Kennedy – whose own background as a corporate lobbyist and son of a lobbyist has been forgotten in nearly three decades since his Senate confirmation in 1987.
Yes, Kennedy was a respected appellate court judge before Reagan appointed him to the high court. But before that, he grew up and then worked as an attorney in Sacramento, where his father became a “legendary” lobbyist in a state capital renowned as “freewheeling” (a polite term that means “routinely corrupt”).
His father, Anthony “Bud” Kennedy, was a backslapping, hard-drinking partner in a powerful lobbying law firm run by one Arthur “Artie” Samish, “the “secret boss of California” who finally went to prison on tax charges in the mid-1950s, while young Tony was studying to enter law school. Samish liked to brag that he had amassed more power than anyone else in the state, including the governor, that he could buy any legislator with “a baked potato, a bottle, or a broad,” and that he was able to “unelect” any lawmaker who didn’t vote his way.
The major clients of Samish and Kennedy were racing, entertainment, and liquor interests, notably including Schenley Industries, then run by J. Edgar Hoover’s mobbed-up pal Lewis Rosenstiel. When Bud Kennedy died suddenly in 1963, young Tony was only two years out of law school. But he went into the family business and inherited his late father’s clientele.
While Kennedy always insisted that lobbying was only a “sideline” in his law practice, his billings were substantial – the equivalent of hundreds of thousands or more in today’s dollars. In 1974, he pushed through a bill for Capitol Records that saved the company (and cost the state) millions in sales taxes.
How did he do it? The same way that special interests work their will today – by doling out huge wads of cash to lawmakers on behalf of his clients. The single largest recipient of Kennedy lobbying largesse, according to the Los Angeles Times, was a legislator who introduced a bill to benefit the opticians’ lobby that Kennedy himself had drafted (it passed). He gave that guy alone about $6,500 in campaign contributions over six years, or roughly $40,000 in today’s dollars.
So if anybody on the Court knows how the political and legislative process is greased in this country, that would be Anthony Kennedy. After all, he was reared in the game. And it shouldn’t deceive anyone when he sounds as if he doesn’t understand how things work or who wins in that perverse process – and how everyone else loses.
By: Joe Conason, Editor in Chief, The National Memo; Author, Big Lies: The Right-Wing Propaganda Machine and How It Distorts the Truth; Published in The National Memo, April 4, 2014
“Rube Goldberg Survives”: Face It Republicans, Health Reform Has Won
Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.
But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.
Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.
So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.
The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.
Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.
But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.
So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.
Now, the complexity shouldn’t be exaggerated: The basics of reform only take a few minutes to explain. And it has to be as complicated as it is. There’s a reason Republicans keep defaulting on their promise to propose an alternative to the Affordable Care Act: All the main elements of Obamacare, including the subsidies and the much-attacked individual mandate, are essential if you want to cover the uninsured.
Nonetheless, the Obama administration created a system in which people don’t simply receive a letter from the federal government saying “Congratulations, you are now covered.” Instead, people must go online or make a phone call and choose from a number of options, in which the cost of insurance depends on a calculation that includes varying subsidies, and so on. It’s a system in which many things can go wrong; the nightmare scenario has always been that conservatives would seize on technical problems to discredit health reform as a whole. And last fall that nightmare seemed to be coming true.
But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.
And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans — who were planning to run against a debacle — have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.
So my advice to reform supporters is, go ahead and celebrate. Oh, and feel free to ridicule right-wingers who confidently predicted doom.
Clearly, there’s a lot of work ahead, and we can count on the news media to play up every hitch and glitch as if it were an existential disaster. But Rube Goldberg has survived; health reform has won.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 3, 2014
“A Most Revealing Week For Republicans”: What Matters Most To The GOP, Protect The Rich, Injure The Poor
If you haven’t done so yet, I urge you to take three minutes here with me to reflect on this unusually revealing week. Three big developments—the Obamacare enrollment deadline, the Paul Ryan budget, and the Supreme Court’s McCutcheon decision—return us to first principles, so to speak; remind us of what our two parties (and the philosophical positions behind them) are really and truly about. And they remind me, at least, of why the Republican Party, on a very basic level, can’t ever be truthful with the American people about what matters to it most at the end of the day.
So what is it that matters most to the Republican Party? A lot of things do, and for different Republicans, the answer will be different: abhorrence of abortion, disgust at social relativism, hatred of big government. These things matter. But they don’t, in my view, matter most. What matters most, especially to elected Republicans in Washington (that is, more so than the rank-and-file), is this: Protect the well-off from redistribution of their wealth to those who don’t deserve it.
On what basis do I make this claim? Well, I’ve been watching Republicans on Capitol Hill pretty closely for many years now. There are, Lord knows, a number of topics on which they are not exactly what you’d call amenable to compromise. The climate-change denialism, the constant attempts to chop away at reproductive rights (which are constitutional rights), et cetera.
But I think it’s fair and accurate to say that, especially in the Obama era, two issues have obsessed the party more than all the others: opposition to tax increases, especially on the wealthy; and a zeal for cutting the budget, which really means cutting domestic spending programs.
In other words—protect the rich, and injure the poor. These are the points on which they’ve fought tooth and nail. After all, think about this: They could have had a major concession from Obama on entitlements (chained CPI) if they’d been willing to allow an income-tax increase on dollars earned above $250,000. But even that couldn’t reel them in. It’s true they did allow an increase on dollars earned above $450,000 (for families) in the fiscal-cliff deal, but their backs were really against the wall on that one: They relented to that small increase only because the country was hours away from a major tax increase (the expiration of the Bush tax cuts), and it was clear to everyone that the Republicans were going to shoulder most of the blame.
As for cutting the federal budget, downsizing government—and we all know doing that hurts poor and working-class families most directly—well, wasn’t that the chief impetus behind the creation of the Tea Party? Remember Rick Santelli’s creation-myth rant, about the anger at the people who took mortgages they couldn’t afford. (Classic liberal-conservative divide, rooted almost entirely in psychological outlook: Liberals tended to blame the banks that hornswoggled people, while conservatives tended to blame the people who let themselves be hornswoggled.)
That’s the game. Redistribution, as in loathing of. That’s the glue of the Washington Republican Party. And it’s wrong to think of it as just an “economic” issue. It is, to them, a moral one. Don’t believe me? Take it from Arthur Brooks, head of the American Enterprise Institute, who wrote a famous Wall Street Journal column back in April 2009 headlined “The Real Culture War Is Over Capitalism.” Reread that. Money, a cultural issue. Defenders of free enterprise, he wrote, “have to declare that it is a moral issue to confiscate more income from the minority simply because the government can.” He also charged these same defenders with the task of defining true “fairness” as “protecting merit and freedom.” I shouldn’t have to decode those two words for you, I shouldn’t think.
But here’s the thing: Brooks’s candor was and is rare. It wasn’t a risk of any kind for him to express those views to the readers of the Journal’s Op-Ed page, who would strongly agree. But most Americans don’t agree. Most Americans support redistribution to one degree or another. They support progressive taxation, they support many or even most categories of government spending, and so on. We—liberal Democrats, centrist Democrats, and moderate Republicans, to the extent that they exist—argue about how much spending, but not about the very notion of spending. Real conservatives stand outside this conversation: They believe that virtually no redistributive spending is justified. But they know that’s a highly unpopular position, so most of the time, they can’t say that. They have to say other things.
Now let’s circle back to this week. What Republicans really think about Obamacare, as E.J. Dionne put it in The Washington Post yesterday, is that “they don’t want the federal government to spend the significant sums of money needed to get everyone covered.” But they know that sounds cruel, so they can’t say that. So instead of inveighing against redistribution directly, they’ve spent months talking about its unworkability. Well, that’s been proven wrong (so far), and so now they’ll just say, as they have been this week, that they don’t believe the numbers. Then they’ll fish out more alleged horror stories that don’t check out. But they won’t say what they actually think.
In the same way, Paul Ryan puts out a budget document that makes dramatic cuts on programs for poor and working people, which makes four domestic promises in the summary—“Expand Opportunity,” “Strengthen the Safety Net,” “Secure Seniors’ Retirement,” and “Restore Fairness”—but in its numbers does the opposite. Ryan’s budgets have always been first and foremost about attacking redistribution aggressively. But he can’t say that. So he just says the opposite.
And what does the McCutcheon decision have to do with all this? Very simple. Redistribution happens because redistributionist politicians have the nasty habit of getting elected. They get elected, in part, because of campaign-finance laws that limit wealthy conservatives’ ability to influence outcomes. In this sense the campaign-finance reform laws of the 1970s are themselves redistributionist—they were explicitly designed to level the playing field, which is a hoary cliché but expresses a proper goal, i.e., not letting the wealthy own Congress lock, stock, and barrel.
McCutcheon tells us, to an extent that even Citizens United hadn’t quite, that Chief Justice John Roberts detests this electoral redistributionism, and as Jeffrey Toobin wrote this week, has as his goal “the deregulation of American political campaigns.” Roberts’s opinion says: “It is not an acceptable governmental objective to ‘level the playing field.’” You can’t ask for it to be put more plainly than that. (Roberts doesn’t face voters and has a job for life and can speak with more candor than senators.)
Savagely fighting the delivery of health care to financially struggling people; slashing the federal programs that help these people get by; rigging elections so that rich conservatives (who outnumber rich liberals substantially) have more control over who wins them. These may seem disparate battles, especially the third one, but the motivation in each case is the same: Protect the well-off from redistribution of their wealth to those who don’t deserve it.
You’ll rarely hear an elected Republican admit this. But it’s usually the motivation. And we saw it this week in starker relief than we usually do. But don’t despair too much: They may yet prevail on campaign spending, but Ryan is going to lose, and Obamacare is going to win. So maybe, even though they won’t talk about it openly, people are onto them anyway.
By: Michael Tomasky, The Daily Beast, April 4, 2014
“A Vile And Wicked Plot”: How Barack Obama Trapped The GOP On Health Care
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy.
By now you’re well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as “guaranteed issue”), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use of markets. When Mitt Romney installed it in Massachusetts, it worked quite well and everybody was pleased. But then Barack Obama came along and embraced it, so all good and true conservatives had to conclude that it was not only a terrible idea in practical terms but a vile and wicked plot to rob Americans of their freedom.
And that has left Republicans in a difficult spot. They would very much like to have market-based health care ideas they could rally around, if nothing else than to demonstrate to the public that they sincerely want to fix what’s wrong in America’s health care system. But the theft of the guaranteed issue-plus-mandate-plus-subsidies framework has left them with nothing but unappetizing scraps off the health care table, none of which will do much of anything to address problems like the large number of uninsured Americans.
There’s a ritual people like me have taken to of late. Republicans announce that they’re about to release a health care plan. Then we say sarcastically, “Gee, let me guess. It involves 1) tort reform; 2) letting people buy insurance across state lines; 3) incentives for more use of health savings accounts, and 4) high-risk pools for people with pre-existing conditions” (here’s a recent example). And we’re always right, because those are the Big Four conservative health care ideas, and nobody can come up with anything different.
Here’s the thing about these ideas: neither any of them individually, nor all of them collectively, would even begin to tackle the things that ail the American health care system, the things the Affordable Care Act was meant to address. Tort reform—which means making it difficult or impossible for patients to sue for malpractice—won’t bring down costs like conservatives think it will. We know this because a number of states have enacted the kind of tort reform Republicans advocate for the whole nation, and it had no impact on spending. Realistic assessments of the effect of tort reform on medical spending conclude that if there’s any impact at all, it would be tiny (I discussed this issue at length here).
Letting people buy insurance across state lines would be fine if it was accompanied by national standards for policies; you’ve surely forgotten it by now, but the more liberal House version of the ACA created a national insurance exchange instead of 50 state exchanges, in which you could have bought insurance from anywhere. But a well-regulated system isn’t what conservatives want; they propose to remove the ACA’s regulations and then initiate a race to the bottom, where the least-regulated state would offer cheap insurance to lure customers who wouldn’t realize the limits of what they had bought until they got sick (here’s an explanation of just how bad an idea this is).
As for health savings accounts, we already have them. They’re a great deal for people who are healthy, but not so much when you actually need care. And high-risk pools are a terrible solution as anything other than a temporary stopgap—they put all the sick people in the same pool, meaning covering them is extremely expensive. That’s no help to the tens of millions of Americans with pre-existing conditions.
Which brings us to Louisiana governor Bobby Jindal, who is almost certainly running for president in 2016. There aren’t a lot of Republicans who have a good understanding of health care policy, but Bobby Jindal is one of the ones who do. Back in 1996, at the tender age of 24, he was appointed the head of the Louisiana Department of Health; George W. Bush later made him an assistant secretary of health and human services. So he’s well familiar with this issue, and surely has a reasonably good understanding of which policies are likely to have a large impact and which are likely to make no difference at all.
But Jindal is hamstrung, like all Republicans, by the fact that they can’t advocate anything Barack Obama has ever supported. So when he released a health care plan yesterday, it was a predictable mixture of small-bore proposals (Wellness incentives! Eliminate fraud!), and the Big Four conservative ideas. For good measure, he threw in a version of Paul Ryan’s plan to turn Medicare from an insurance program into a voucher program, where the government would give seniors a certain amount of money and then they’d seek private insurance, with the invisible hand of the market bringing prices down, all previous evidence to the contrary notwithstanding.
In fairness to Jindal, he has tweaked a few things from the standard conservative playbook. He would require insurance companies, once they’ve sold you insurance, to continue your plan even if you get sick—but doesn’t say how he’d protect the tens of millions of Americans with pre-existing conditions who would have trouble getting covered in the first place, other than state high-risk pools. And there are a few smaller features of his proposal that make sense. For instance, he’d change the tax treatment of health insurance so everyone could get the same favorable treatment that people with employer-provided insurance get. That would increase the fairness of the system, even if Jindal’s assertions that it would magically cut the ranks of the uninsured by 9 million and dramatically slow health care spending are absurd on their face.
But if we repealed the ACA and instituted all of Jindal’s proposed reforms, we’d still have all the problems we had before the ACA was passed. And I suspect that if you gave him a truth serum, he’d admit that none of what he proposes would have much of a salutary effect. But that’s where conservatives are. Barack Obama stole the one market-based idea they had that might actually bring us to something close to universal coverage. They have no idea where to go from there, and that’s how it’s going to be for the foreseeable future. They’ll feel the need to keep saying, “We have a plan too!” And when everyone says, “OK, tell us what it is,” it will be the same old thing, and no one will take them seriously.
By: Paul Waldman, Contributing Editor, The American Prospect, April 3, 2014
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