“Yes, A Birthright To Health Care”: America Joins The Developed World, Thanks To Obamacare
I’m sitting here very early Christmas Eve morning staring at a chart from the Organization for Economic Cooperation and Development. You know the OECD—they’re the people who keep all those annoying stats about how the United States is 17th in this and 32nd in that, the kind that alas aren’t very surprising anymore except that they do make us shake our heads and wonder how we managed to come in behind even Belarus.
This chart is on an Excel spreadsheet, so I can’t provide a link, but it shows access to “health insurance coverage for a core set of services, 2009.” It then lists the 34 OECD member states, showing percentages of citizens with “total public coverage” and with “primary private health coverage.”
In 19 countries, 100 percent of the population is covered via public insurance. In 11 more, more than 95 percent are covered the same way. So all but four countries basically provide universal or near-universal public coverage. In Turkey, Mexico, and Chile, between 70 and 80 percent are covered—also publicly. In the United States, that number is 26.4 percent. That’s the seniors, the veterans, and the very poor who get direct public health care. We then add 54.9 percent who get private coverage. No other country even bothers with private coverage at all, except Germany a little bit (10.8 percent). Our two numbers add up to 81.3 percent, ranking us 31st out of the 34. The rest of the advanced world, in other words, with not all that much fuss and contention, has come around to the idea that health coverage is a right.
As I think back over 2013, in my sunnier moments, I try to think of it as the year that future historians will point to as the time when the United States finally and grudgingly started joining this world consensus. Sometime in the 2030s, after Medicare for all has passed and we’re finally and sensibly paying taxes for preventive cradle-to-grave care, people will note—with pride!—that the long process started with Obamacare (yes, conservatives: I’m admitting gleefully that the elephant’s nose is under the door, so spare yourselves the trouble of thinking you’re clever by tweeting it!).
There were of course other important stories in the year now ending. For my number two, I’d choose Iran and Syria; that’s certainly one to watch heading into next year. Barack Obama mishandled Syria with all that talk of red lines that ended up being unenforced, badly letting down the small-d democrats in the region who count on the United States to countervail Iran. On the other hand, those chemical weapons actually are being destroyed, evidently. On the other other hand, the slaughter continues, and we will do nothing. Even a deal with Iran on nuclear technology, certainly a thing to be celebrated in one respect, will also allow Iran to show the region (that is, Saudi Arabia, its main competitor for regional domination) that it’s in the big leagues now too. As is typical in that part of the world, no diplomatic development is all good or all bad.
But this has been the year of Obamacare first and foremost. And next year pretty much will be, too. I’m glad the website was fixed, and glad for the apparent surge in the enrollment numbers. But it’s still the case for the change to take root and really succeed, Democrats from Obama on down have to defend this policy on principled terms, not just practical ones.
That is—right now, Democrats and progressive groups are mostly trying to get people to sign up for coverage by scaring them into thinking they might break their leg. But there are two problems with this approach. One, most people don’t break their leg. I’ve been on this planet 53 years and I’ve never broken a bone.
Two, it’s not completely honest as a selling point. Yes, liberals are concerned that people who face injury have coverage. But that’s not the main reason liberals support health care reform. We support it because we think health care coverage should be a right, and this is a big step down that road, or the best step we could make under current reality. Like any right, it comes with responsibility, so that’s why you have to buy it. But it’s a right. It’s not an extravagance or something you earn by having a better-than-Walmart-level job. You “earn” it by doing something a lot simpler than that—you earn it by being born.
This is one of those occasions where I wish desperately that Democratic politicians would just say what they believe without worrying how it’s going to be played in Politico or what those fat-mouth propagandists on the right are going to say about it. Obamacare isn’t just about getting people to fear illness or injury. It’s about changing people’s minds about what health coverage fundamentally is. And they’re not going to change any minds unless they’re willing to say that.
Hey, I’ve kept flipping through those OECD spread sheets and I’ve found some things we’re number one in. Male obesity—70.3 percent in 2011! Female obesity, too—56.1 percent! Infant mortality rate of 6.1 per 1,000 live births! Okay, we trail Mexico and Turkey there, but still. Income inequality—well, thank God for Turkey, Mexico, and Chile. Whoever let them in was really thinking ahead, so at least we’d look OK compared to someplace.
Something like reducing obesity can be best done through preventive care that kicks in well before a person has a BMI in the 40s. Obamacare already has started the process of changing this. More than 5 million Medicare recipients are getting free preventive treatments across a range of categories (PDF). That’s health care as a right. Democrats need to be unapologetic in talking like that.
By: Michael Tomasky, The Daily Beast, December 26, 2013
“The “I Hate Everything” Vote”: The GOP Base That’s Always Been Around, But Given A Fresh Identity By The Tea Party Movement
There’s a new ABC-WaPo poll out showing about what you’d expect: the president’s job approval rating is at 43%, about what it was last month but way down from a year ago.
But at The Fix, Sean Sullivan and Scott Clement look at a large slice of the electorate they call “haters,” and see a potential GOP landslide coming. The “haters” are people who disapprove of the president and both congressional parties.
Seventy-two percent of voters who disapprove of the job Obama, congressional Democrats and congressional Republicans are doing say they’d vote for the GOP candidate for U.S. House in their district if the election were held today, according to a new Washington Post-ABC News poll released Tuesday. Just 14 percent say they’d vote for the Democrat….
[T]he haters don’t tilt as heavily toward the GOP now as they did on the eve of the GOP wave election of 2010, when 85 percent said they planned to vote for the GOP candidate.
Now you might look at some of these numbers and conclude that Democrats should be frantically appealing to the “haters,” since they are “between” the two parties and open to both. But you’d be wrong: the people we are talking about are largely GOP “base” voters if they vote at all. They’ve always been around, but the Tea Party Movement has given them a fresh identity: people who will vote for any Republican over any Democrat 99 out of 100 times, but can’t bring themselves to say they approve of any major party that’s not busily tearing down the welfare state or eliminating taxes. To their credit, Sullivan and Clement note the “haters” strong right-ward tilt:
Thirty-four percent identify as Republicans and another 38 percent are independents who lean Republican. Just 13 percent are independents with no lean and just 10 percent are Democrats.
So in any poll of the popularity of the two parties, you have to put a fat thumb on the scale for Republicans because so many of their own just won’t admit their proclivities. Yes, haters are gonna hate both parties, but they’re sure not up for grabs at the ballot box.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 17, 2013
“Pure Cultural Hatred”: Why Obama’s Haters Are Worse Than Bush’s
Permit me to share with you my favorite set of headlines from Thursday.
USA Today: Official who OK’d Obama birth papers dies in crash.
NPR: Hawaiian Official Who Released Obama’s Birth Certificate Dies in Plane Crash.
NBC News: Health care director who approved Obama birth certificate dies in plane crash.
And finally, National Review, and note the difference, which rests in just one word, but what a word it is: Official Who Released Obama’s Birth Certificate Dies in Mysterious Plane Crash.
Ah, of course. “Mysterious.” Well, I mean, it had to be, didn’t it? Poor Loretta Fuddy, 65 and a longtime public servant, was evidently a beloved figure in Aloha State political circles, at least based on the tributes I’ve read over the last couple of days from Hawaii officials, who seem to be absolutely grief-stricken at her passing. But to certain of their fellow Americans, Fuddy’s tragic death provides the occasion for only one thing—sly suggestions that her death might not quite have been an accident. You see, she was the only person of nine on board the small Cessna who perished. Hence, “mysterious.”
In fairness, the National Review writer was having a bit of a laugh. But even so, that word did appear in the headline, and that headline happened to appear toward the end of the most flagrantly batshit-crazy week of Obama obsession we’ve seen in a long, long time. I needn’t rehearse all the ridiculous and false and not-a-little-racist things that have been said. But let’s look into this dementia a little more broadly.
Of course, some on the left said nutty things about Bush too, and for the arbiters of conventional wisdom, that mere fact makes for “equivalence.” Both sides do it. Well… OK. But that depends on how you define “it.”
In fact, both sides do different things. My assertion is this: Baseless left-wing attacks on Republicans differ in character from baseless right-wing attacks on Democrats in two ways. First, most liberal-left attacks on Republicans are more political than cultural, while virtually all right-wing attacks on Democrats are about culture. And second, those liberal-left attacks that are about culture tend to be mocking in tone, expressing derision, while the right’s attacks are fearful, expressing deep paranoia.
Let’s take them one by one. Bush and his top men were often called fascists on the left. That’s an attack that certainly has its cultural elements, but it is first and foremost political. The worst thing people on the left could think to do, in other words—call Bush a fascist—is a political smear, not a cultural one. This reflects the way most people on the left see the world—through a political lens primarily, and through a cultural one only secondarily. There are exceptions to this, but in the main, for the broad liberal-left, politics is primarily about politics, not culture.
On the right, politics is much more about culture, because the right feels itself to be an aggrieved minority whose culture (industriousness, self-reliance, Godliness, etc.) is under constant attack from the libertines and relativists, who of course far outnumber and surround the righteous few. Culture is where people on the right live, and so the worst thing they can think to do is to make attacks that are about culture, about the Democrats hating God, destroying America, and so on.
Sometimes, of course, the left goes cultural. Calling Bush a chimp and an idiot and a cowboy, say; those trafficked in liberals’ stereotypes about Texans, Southerners in general, back-slapping oil men, and so on (well, chimp just had to do with certain facial features). That wasn’t nice, I suppose, but here’s the thing. It was done to laugh at him.
By and large, the right doesn’t laugh at Obama. Oh, sometimes. There’s the absurd teleprompter meme from early on, which held that he couldn’t put two sentences together without huge transcripts placed in front of him. And there’s a strain of criticism that he’s in over his head. But those tropes are far outweighed by the ones that assign to Obama a world-historical level of devious intelligence—indeed, he’s so maliciously brilliant that he managed to fake a birth certificate decades ago, all as just the opening salvo of a grand scheme to bring America and/or the white race to ruin.
If that’s how they see him, and it is, it stands to reason that the most out-there attacks will be pegs that will fit nicely in that hole. And, always, race will be ladled on top, like, well, chocolate syrup. Both elements were at work in this ridiculous thing about the Danish prime minister, with whom Obama was allegedly bringing dishonor upon America and behaving the way black men behave in Concerned Citizens’ Council newsletters, unable to keep his libido on a leash and so forth.
To people on the left, Bush was embarrassing, ever a threat to behave boorishly or be asked to appraise a Kandinsky on a European visit and crack that it looked like yesterday’s breakfast leftovers. To people on the right, though, Obama is a menace. They are different—and yes, the latter is worse than the former, because it does breed a more intense hatred.
Did you know, for example, that Obama has “ordered” the deaths and executions of some 30 or more people? Here’s the list, have a look. One of them is particularly impressive—apparently, a 10-year-old Obama iced an Indonesian classmate, decapitating him as part of an initiation ritual, “since Islam demands that a boy spill another’s blood before the age of 10 to prove their loyalty to Allah.” The Clintons, of course, were accused of murder, too. Whereas no one had to make crazy murder accusations against Bush. He actually did kill people (not with his own hands, obviously, but by starting a war of choice whose death tally will never be fully known).
One can only roll one’s eyes, but in fact, all this is psychotic and sickening, and it has power in the media, which can’t resist talking at length about The Handshake or The Selfie, even if it’s to defend Obama, because the mere fact of talking about those things really only fuels the fire. Yes, Obama will be out of office one day—which only raises the question what they might say (that they haven’t already) about Hillary.
By: Michael Tomasky, The Daily Beast, December 14, 2013
“A Year After Newtown, Little Has Changed”: Don’t Blame Fate, Blame These Politicians
The first anniversary of the massacre of 20 children and six adults at Sandy Hook Elementary School weighs heavily, above all, for the unfathomable nature of the crime and unfathomable grief of the families. Adding to that weight, though, is the demoralization over the fact that the massacre has not led to any broad national policy response to the problem of gun violence. If there is any doubt that this failure had exacerbated the pain of the families, consider this haunting line from one of the reports on the April failure of the post-massacre gun-law reform bill: “Mr. Obama hugged the brother of one victim, Daniel Barden, who was 7, and told him to take care of his mother, who was sobbing quietly.”
Since April, there has been all manner of rationalization and second-guessing about how this failure happened. The administration should never let itself get sidetracked by the gun issue to begin with. The president should have done more to push for the legislation, which was dubbed Manchin-Toomey. Or perhaps he should have done less. Maybe, though the Newtown families fell in line with the law enforcement and gun control groups who wanted expanded background checks, the bill should have focused more narrowly on reforms that directly addressed what had happened in Newtown.
In the coming New York Times Magazine, Robert Draper does us all a service by breaking through some of the second-guessing in order to analyze just how the National Rifle Association and other gun-rights groups managed to block a measure that polls showed were supported by some 90 percent of Americans. His conclusion is not so different from the one I reached, in slightly more optimistic tones, last spring: As confounding as the NRA’s win was, there’s reason to believe that, in “unsteady little increments,” its influence is being reduced.
However, even Draper’s deeply-reported look at the NRA runs the risk of diverting attention from this simple fact: Last April, 100 senators had the opportunity to vote on sensible gun-law reforms that many Newtown families were pleading for. And 46 of them decided to vote against it, which in the contemporary Senate was enough to kill the bill. Each vote counts the same, but here, for posterity’s sake, are some “no’s” that stood out in particular:
Kelly Ayotte
The first-term Republican from New Hampshire is a former prosecutor and state attorney general and thus well acquainted with the porousness of gun laws, which require background checks at licensed dealerships to screen for past felonies or dangerous mental illness, but not at the gun shows or private sales where an estimated 40 percent of transactions occur. Voting for background checks would hardly hurt Ayotte’s general election chances in New Hampshire, a state Obama won by six points against a part-time New Hampshire resident, which has prompted speculation that her vote was cast to protect her prospects for a national GOP ticket. Confronted after the vote by Erica Lafferty, the daughter of the slain Sandy Hook principal, Ayotte gave a dissembling explanation that sent Lafferty striding from the room.
Max Baucus
The Montana Democrat has been allied with the NRA ever since voting for the 1994 assault weapons ban, an experience that he “felt he had paid dearly for,” according to a Baucus staffer quoted by Draper. Gun control supporters hoped they would get Baucus on this bill, though, given its moderation and the fact that he is nearing the end of his career – indeed, shortly after casting his vote, he announced that he is retiring. But he voted no nonetheless, a decision he explained thusly: “Montanans have told me loud and clear that they oppose any new gun controls.” These must not be the same Montanans who told pollsters, by a solid majority, that they backed expanded background checks, or the ones being listened to by Jon Tester, Baucus’s fellow Montana Democrat, who has many more elections ahead of him. He voted yes.
Jeff Flake
The freshman Republican from Arizona is quite conservative, but gun control advocates had high hopes for him because of his close relationship with his fellow Arizonan Gabrielle Giffords. When the congresswoman was shot in the head by a gunman in 2011, Flake was one of the first to rush to her side in the hospital. In early April, he sent a hand-written note to another Arizonan touched by gun violence, the mother of a young man killed in the Aurora cinema shooting, writing that “strengthening background checks is something we agree on.” In a Capitol hallway just before the vote, as the New York Times reported, “Ms. Giffords, who still struggles to speak because of the damage that a bullet did to her brain, grabbed Mr. Flake’s arm and tried — furiously and with difficulty — to say that she had needed his vote. The best she could get out was the word ‘need.’” She didn’t get it. Flake faced a serious backlash back home, but, not facing reelection until 2018, shrugged it off: “That’s the beauty of a six-year term.”
Heidi Heitkamp
The freshman Democrat from North Dakota hails from a red state, but does not face reelection again until 2018. That puts her in a similar position as Joe Donnelly, the conservative Democrat from Indiana. He voted for Manchin-Toomey. Heitkamp voted against it, citing the many phone calls she’d gotten against the bill: “I’ve heard overwhelmingly from the people of North Dakota; and at the end of the day my duty is to listen to and represent the people of North Dakota.” According to one poll, 79 percent of North Dakotans surveyed backed expanded background checks – a far higher rate than even in Montana.
Rob Portman
The Ohio Republican, George W. Bush’s former budget director, is considered one of the more moderate members of the Republican caucus, a reputation affirmed when he came out in support of same-sex marriage after learning that his son is gay. But, as Draper notes, it was this very announcement that helped set Portman against Manchin-Toomey:
Portman told [parents of slain Sandy Hook children who came to talk to him], “You know, I have an A rating from the N.R.A., so I’m probably not going to support this.” At some point, 13-year-old James Barden, a brother of one of the victims, spoke up. “Senator, there’s over a thousand deaths from gun violence in Ohio every year,” he said. “I’m here on behalf of my little brother, Daniel. Do you think that this bill would save some of those lives?”
Portman sat quietly for a moment. Then he said: “It could. It could.” But what the Republican senator did not say was that he had already disappointed conservatives by coming out in favor of same-sex marriage because of his openly gay son. By the spring of 2013 it had become axiomatic in the Senate that among the three incendiary social issues of the moment — gun restrictions, same-sex marriage and comprehensive immigration reform — a moderate Democrat could afford to vote for two of them, and a conservative Republican only one. Portman had already selected his hot-button issue.
Also worth noting: having an A-rating from the NRA rating did not stop six other senators from backing the legislation, among them its co-sponsors, West Virginia Democrat Joe Manchin and Pennsylvania’s Pat Toomey, one of four Republicans to back the bill.
Mark Pryor
The Arkansas Democrat is up for reelection next year in a red state. That puts him in the same boat as Democrats Kay Hagan of North Carolina and Mary Landrieu of Louisiana. They voted for Manchin-Toomey nonetheless; he did not. Draper reports that Pryor was, like Baucus, haunted by the ghost of 1994, when his father, Senator David Pryor, voted for the assault weapons ban and “incurred the animus of the N.R.A.” But Pryor may have miscalculated – whereas Hagan and Landrieu enjoyed polling boosts from their vote for the bill, he did not, and all three now find themselves in trouble for unrelated reasons: the Obamacare rollout woes.
There are so many others that one could scrutinize as well: Ron Johnson and Dean Heller, Republicans from blue-state Wisconsin and Nevada; Mark Begich, Democrat of Alaska, who had declared a “sea change” in the politics of gun control after Newtown; Tom Coburn, Republican of Oklahoma, who was leading the way in drafting a background-checks bill before a group to the right of the NRA started flooding his phones…All 46 had a choice and opted as they did.
I reached out to all of the above-mentioned no votes over the past two days to see if any of the senators were reassessing the issue and open to supporting a revised version of the bill. The only one that responded to the question on the record was the office of Senator Flake. Wrote his spokeswoman: “No, he’s not reassessing, and no, not open to a revised version.”
It’s not handwritten, but that Aurora mom Flake corresponded with surely gets the message.
By: Alec MacGinnis, The New Republic, December 12, 2013
“The First Step Of A Long Journey”: Now’s Not The Time For Liberals To Say “I Told You So” About Obamacare
It has been a rough two months for the Affordable Care Act and its defenders. Having spent years fighting ridiculous allegations about socialized medicine and “death panels,” supporters of near-universal coverage now face something different. The performance failures in the rollout of healthcare.gov have triggered cries of “I told you so!” from some liberals. This wouldn’t have happened, they say, if only Obama had supported some form of single-payer plan, such as Medicare for all. The anger over the botched rollout is understandable, but these recriminations are poorly timed—and just plain wrong.
For starters, the ACA is working reasonably well in some places—California, Connecticut, Kentucky, Washington, and the District of Columbia, for example. These under-reported success stories show that insurance exchanges can work, if properly administered. Exchanges are successfully determining applicants’ eligibility for Medicaid or private insurance, enabling consumers to choose among competing plans, and computing the tax credits to which people are entitled. The human benefits are real, from California to Breathitt County in rural Kentucky. These successes make the federal government’s dismal rollout even more embarrassing. Republicans may have done everything within their power to dynamite the ACA, but the administration fell inexcusably short in launching Obama’s domestic-policy centerpiece.
It doesn’t help that health reform is really complicated. The U.S. health-care system is far and away the most complex in the world, one that includes employer-sponsored coverage, Medicare, Medicaid, Tricare, the Indian Health Service, and small-group and individual insurance coverage—and that’s before Obamacare was implemented.
Given that complexity, some on the left say, life would be simpler if only Congress had been willing—which it was not—to scrap all current arrangements and replace them with a single, federally administered health insurance plan. Those on the right regard this complexity and say that life would be simpler if only Congress had been willing—which it was not—to scrap all current arrangements and replace them with income-related vouchers people could use to help pay for private insurance of their choice.
Those positions enjoy loud support in the blogosphere, Twitter, and cable TV, but only niche support at each end of the political spectrum. Although their ideological values could hardly be more different, these polar-opposite camps each disdain the kludgy fixes of incremental politics. And yet, incrementalism is what most Americans want. Most people are reasonably well-insured. They like their coverage, and they want it to remain affordable. They fear legislation that threatens it. Proposals, whether from the left or right, that force most people into radically different arrangements are fated to remain politically marginal in America.
That the right, which predicted Obamacare would mean the death of liberty and ruination of the U.S health care system, feels vindicated by Obamacare’s initial woes is no surprise. But the troubles with healthcare.gov have rekindled attacks from the left, too. Consider a recent essay by American Prospect co-editor Robert Kuttner, in which he writes, “The colossal mess that Obamacare has become reflects both the character of the legislation and that of the president who sponsored it.”
We understand Kuttner’s frustration. We do not share his disdain for the ACA or for Obama. The law ended a century of legislative failures in the search for universal health insurance coverage, and enacted important reforms of our healthcare delivery system. Obama bet his historic legacy on a reform that, however imperfect, brings health insurance to millions, improves its quality, and helps slow spending growth.
The real beef of those who seek a more radical rewiring of our healthcare system is not with the president. It is with the coalition of labor, healthcare, disability, and anti-poverty groups that coalesced during 2007 and 2008 around a health reform model that later became the ACA. Candidates Hillary Clinton, Obama, and John Edwards endorsed similar health plans. They all included Medicaid expansion, regulated markets (health insurance exchanges), premium subsidies, strengthened insurance regulation, and an explicit or de facto individual mandate. Many Democrats would have preferred single-payer, but the candidates and even most single-payer supporters understood that politically this just wasn’t possible.
We wish ACA had gone farther. It could have provided more generous premium assistance and cost-sharing for working families. It could have allowed people near retirement to buy into Medicare. Alas, senators such as Joe Lieberman—not Obama—scuttled these possibilities. The ACA is only the first step in a long journey of needed health reforms.
Kuttner goes on to write: “Medicare for All would be simpler to execute, easier to understand, and harder for Republicans to oppose.” Nancy Folbre, writing in The New York Times, took the same position. Kuttner and Folbre are correct that Medicare for All would be much easier to understand. Perhaps, as Obama among others has said, Medicare for All would be preferable to our current system, were we designing that system from scratch.
But we aren’t. The slogan “Medicare for all” was never incorporated in a well-crafted legislative proposal. Had it been, it would have been even easier than Obamacare for Republicans to oppose. And implementation would have been formidably difficult. Had the transition to single-payer ever been specifically mapped out, it would immediately have become apparent that this process requires wholesale replacement or rewiring of employer-based coverage, major changes in the relations between states and the federal government. Hundreds of billions of dollars in transfers and new taxes would have been necessary. Enterprising constitutional conservatives surely would have identified plausible court challenges. What’s more, a phalanx of providers—hospitals, doctors, insurers, drug companies and device manufacturers—opposed single-payer proposals. Even such incremental moves as the public option evoked profound unease among insurers, community hospitals, and other key parts of the coalition that supported the ACA.
The backlash against the ACA is occurring because it disrupts coverage of several million people in the individual and small-group insurance market. Transition to single-payer would have been far messier, disrupting coverage for hundreds of millions of Americans, with a much larger and more explosive mix of winners and losers.
There was and is no alternative to the messy incremental politics that produced Obamacare. Liberals such as then–House Majority Speaker Nancy Pelosi didn’t make unpalatable compromises because they held pallid aspirations for health reform. They compromised because they knew that they could not impose their will on querulous colleagues, because they needed 60 Senate votes, because millions of Americans needed help, and because it is better to win messily than to lose gloriously.
Much now rides on the government’s ability to fix healthcare.gov. Definite progress has been made. The federal exchange will be better by year’s end, but it will be months, not a few weeks, before the website really works the way it should. The White House’s cautionary messages on enrollment efforts and its one-year delay in online small business enrollment exemplify the many challenges with getting Obamacare off the ground. So these are anxious times. If the ACA fails, hopes for universal coverage will be set back a generation. Now’s not the time for liberals supporters to turn against Obamacare, or against each other.
By: Henry Aaron and Harold Pollack, The New Republic, November 28, 2013
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