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“Who Hates Obamacare?”: Progressives Should Not Be Trash-Talking Progress And Impugning Motives Of People On Their Side

Ted Cruz had a teachable moment in Iowa, although he himself will learn nothing from it. A voter told Mr. Cruz the story of his brother-in-law, a barber who had never been able to afford health insurance. He finally got insurance thanks to Obamacare — and discovered that it was too late. He had terminal cancer, and nothing could be done.

The voter asked how the candidate would replace the law that might have saved his brother-in-law if it had been in effect earlier. Needless to say, all he got was boilerplate about government regulations and the usual false claims that Obamacare has destroyed “millions of jobs” and caused premiums to “skyrocket.”

For the record, job growth since the Affordable Care Act went fully into effect has been the best since the 1990s, and health costs have risen much more slowly than before.

So Mr. Cruz has a truth problem. But what else can we learn from this encounter? That the Affordable Care Act is already doing enormous good. It came too late to save one man’s life, but it will surely save many others. Why, then, do we hear not just conservatives but also many progressives trashing President Obama’s biggest policy achievement?

Part of the answer is that Bernie Sanders has chosen to make re-litigating reform, and trying for single-payer, a centerpiece of his presidential campaign. So some Sanders supporters have taken to attacking Obamacare as a failed system.

We saw something similar back in 2008, when some Obama supporters temporarily became bitter opponents of the individual mandate — the requirement that everyone buy insurance — which Hillary Clinton supported but Mr. Obama opposed. (Once in office, he in effect conceded that she had been right, and included the mandate in his initiative.)

But the truth is, Mr. Sanders is just amplifying left-wing critiques of health reform that were already out there. And some of these critiques have merit. Others don’t.

Let’s start with the good critiques, which involve coverage and cost.

The number of uninsured Americans has dropped sharply, especially in states that have tried to make the law work. But millions are still uncovered, and in some cases high deductibles make coverage less useful than it should be.

This isn’t inherent in a non-single-payer system: Other countries with Obamacare-type systems, like the Netherlands and Switzerland, do have near-universal coverage even though they rely on private insurers. But Obamacare as currently constituted doesn’t seem likely to get there, perhaps because it’s somewhat underfunded.

Meanwhile, although cost control is looking better than even reform advocates expected, America’s health care remains much more expensive than anyone else’s.

So yes, there are real issues with Obamacare. The question is how to address those issues in a politically feasible way.

But a lot of what I hear from the left is not so much a complaint about how the reform falls short as outrage that private insurers get to play any role. The idea seems to be that any role for the profit motive taints the whole effort.

That is, however, a really bad critique. Yes, Obamacare did preserve private insurance — mainly to avoid big, politically risky changes for Americans who already had good insurance, but also to buy support or at least quiescence from the insurance industry. But the fact that some insurers are making money from reform (and their profits are not, by the way, all that large) isn’t a reason to oppose that reform. The point is to help the uninsured, not to punish or demonize insurance companies.

And speaking of demonization: One unpleasant, ugly side of this debate has been the tendency of some Sanders supporters, and sometimes the campaign itself, to suggest that anyone raising questions about the senator’s proposals must be a corrupt tool of vested interests.

Recently Kenneth Thorpe, a respected health policy expert and a longtime supporter of reform, tried to put numbers on the Sanders plan, and concluded that it would cost substantially more than the campaign says. He may or may not be right, although most of the health wonks I know have reached similar conclusions.

But the campaign’s policy director immediately attacked Mr. Thorpe’s integrity: “It’s coming from a gentleman that worked for Blue Cross Blue Shield. It’s exactly what you would expect somebody who worked for B.C.B.S. to come up with.” Oh, boy.

And let’s be clear: This kind of thing can do real harm. The truth is that whomever the Democrats nominate, the general election is mainly going to be a referendum on whether we preserve the real if incomplete progress we’ve made on health, financial reform and the environment. The last thing progressives should be doing is trash-talking that progress and impugning the motives of people who are fundamentally on their side.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, February 5, 2016

February 6, 2016 Posted by | Affordable Care Act, Bernie Sanders, Obamacare, Progressives | , , , , , , , | 1 Comment

“Expand Medicare, You Damn Idiots”: On Its Anniversary, We’re Going To Start Hearing The Usual Attacks On Medicare

Every so often—okay, not very often actually, but more often than I hunt, or “take” (what a verb!), lions—I feel a little wistful about the Republican Party we all once knew. And that feeling is never stronger than when I reflect on the history of Medicare and Medicaid, which I spent part of yesterday doing, what with it being the 50th anniversary of the passage of the bill and all.

Lyndon Johnson went into the 1964 election knowing that he wanted to pass a universal health-care bill. He figured he couldn’t get full-bore socialized medicine, so he settled on socialized medicine for old people, reckoning that was a winner. Immediately upon winning election, he directed aides to get cracking, saying as I recall something to the effect that he was going to lose a little political capital every day, so the sooner the better.

It was big and messy and complicated, just like Obamacare, and frankly, Johnson lied about the cost, back in those pre-Congressional Budget Office days. But it passed, and it passed in a way that wasn’t just like Obamacare at all. Thirteen Republican senators voted for it, and 17 against; and in the House, 70 Republicans supported it, while 68 voted no. In other words, almost exactly half of all voting congressional Republicans, 83 out of 168, voted for the program that Ronald Reagan at the time was warning heralded the arrival of Marxism on our shores.

Pretty different GOP, eh? Well, now check out the numbers from 1983. This was, to be sure, more of a compromise piece of legislation. The Social Security Trust fund was in trouble at the time, so the 1983 amendments raised the payroll tax while increasing the retirement age to 67 for those born in 1960 or after, with the new revenue going to Medicare and Social Security. And of course you had a Republican president then, and not just any Republican president; so if Ronald Reagan was okay with a tax increase, they were, too. It passed both chambers overwhelmingly; House Republicans backed the 1983 changes 97-69, while Republican senators supported them by 47-6. (PDF)

It’s worth recalling all this on the anniversary of this great law because soon enough, we’re going to start hearing the usual attacks on Medicare. Wait, did I say soon enough? We already are! And not from the wingnut caucus. It was the, uh, moderate, Jeb Bush, who said just last week that Medicare is “an actuarially unsound system” and that “we need to figure out a way to phase out this program.”

All right. Now I’ll grant that times have changed since 1965 and 1983, and that we’re going to see all those Baby Boomers retire in the coming years. But let’s be clear about a central fact. The Medicare Trust Fund is not in big trouble right now. A few years ago, it was; there were desperate predictions that it was going to go broke in five years, three. I remember 2017 being mentioned as the ominous year, and 2017 is pretty close.

But that has changed. Now, the experts say Medicare is stable until 2030. Now 2030 isn’t infinity and beyond, but it’s not tomorrow either. The crisis has eased, and it has eased considerably.

What changed? Some of the reasons are just too wonky for me to go into with you in any detail, having to do with things like new strategies to reduce preventable hospital admissions. But another seems to be…wait for it…Obamacare. Ever since the passage of the Affordable Care Act, per-enrollee Medicare costs have decreased a little and are rising more slowly than overall health-care costs, and somehow or another the Medicare trustees have added 13 years to the program’s solvency.

In fact, let’s go mildly wonky here. This is worth knowing. Before the ACA passed, projections of Medicare bankruptcy were pegged, as noted, at 2017. Then shortly after the ACA became law, that was pushed to 2024. Then in 2013, it was nudged to 2026. Now it’s at 2030. See a pattern here? The main reason is simple. Overall spending is lower. You might remember Mitt Romney’s famous attacks on Obama for cutting $716 billion from Medicare, which took some cheek given that a) Republicans’ own projected cuts under Paul Ryan’s budget were far more severe and b) Ryan and other Republicans used the same budgetary assumptions Obama used for all their Medicare “reform” plans.

Just remember all this, will you, as you hear more from the Republicans on this topic. They are all going to say: Medicare is a disaster; it’s broke; Obamacare has made it far worse. They’ll say things that one can hardly believe can be said by a person we’re allegedly supposed to be taking seriously, like Marco Rubio’s amazing comment that Social Security and Medicare “weakened us as a people.”

None of what they say will be true. But they’ll say it and say it, and the conservative media will repeat it and repeat it, and we’ll be in that “no, the sky is green and the grass is blue” territory that we know so well. And of course, their “reform” plans are, aside from being just mean, a total fantasy. The way Medicare works is so complicated and so embedded into our national life that the disruptions to doctors and hospitals and service providers of all kinds would be horrific. Only rich people, who don’t really need Medicare, and ideologues, who despise it, think you can do this. They might as well propose rerouting every single Interstate highway in America.

But most of all, it doesn’t need changing. Or actually it does, but in the direction of being expanded, as Bernie Sanders says. That’s probably not in the cards for the foreseeable future, although it will certainly come one day, perhaps by the time of Medicare’s own 65th birthday, when the people will surely be due for another “weakening.”

 

By: Michael Tomasky, The Daily Beast, July 31, 2015

July 31, 2015 Posted by | Jeb Bush, Medicare, Republicans | , , , , , , | 3 Comments

“Hooray For Obamacare”: The Great Conservative Nightmare Has Come True, And It’s A Beautiful Thing

Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.

It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?

The answer is, better than even many supporters realize.

Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance.

But isn’t that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.

Beyond that, you need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.

Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there. Most of the way with the A.C.A.!

But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.

What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.

And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.

What about economic side effects? One of the many, many Republican votes against Obamacare involved passing something called the Repealing the Job-Killing Health Care Law Act, and opponents have consistently warned that helping Americans afford health care would lead to economic doom. But there’s no job-killing in the data: The U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.

Finally, what about claims that health reform would cause the budget deficit to explode? In reality, the deficit has continued to decline, and the Congressional Budget Office recently reaffirmed its conclusion that repealing Obamacare would increase, not reduce, the deficit.

Put all these things together, and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure.

Now, you might wonder why a law that works so well and does so much good is the object of so much political venom — venom that is, by the way, on full display in Justice Antonin Scalia’s dissenting opinion, with its rants against “interpretive jiggery-pokery.” But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.

That’s why the right went all out to destroy the Clinton health plan in 1993, and tried to do the same to the Affordable Care Act. But Obamacare has survived, it’s here, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.

 

By: Paul Krugman, Op-Ed Columnist, The New York Times, June 25, 2015

June 26, 2015 Posted by | Affordable Care Act, King v Burwell, Uninsured | , , , , , , , , | Leave a comment

“A Bold Truth-Teller”: What If A 2016 GOP Candidate Told The Truth About Obamacare?

If you’re a Republican presidential candidate, there aren’t too many ways you can distinguish yourself from your primary opponents on the issue of health care — I hate Obamacare, you hate Obamacare, we all hate Obamacare. But maybe there’s another way, for someone who has the courage to shift his rhetoric and present themselves as a bold truth-teller.

To put that in context, let’s look at some new developments on the Obamacare front.

A study just out from the Rand Corporation — not exactly a hotbed of socialist thinking — finds that after the coverage provisions in the Affordable Care Act took effect: “we estimate that 22.8 million people became newly insured and that 5.9 million lost coverage, for a net increase of 16.9 million with insurance as of February 2015.”

In addition, a new Gallup poll shows that 43 percent of Americans say they’re satisfied with the government’s work in health care, which doesn’t sound so great until you learn it’s the highest number this question has received since the organization began asking it in 2001.

We already know that all the predictions Republicans made about the ACA — a decline in health coverage, skyrocketing medical spending and premiums, massive job losses — failed to come true. One seemingly sensible response to the facts about Obamacare is to pretend they aren’t true, which is how prominent Republicans have handled things until now. After all, there hasn’t been much punishment for spreading falsehoods about the law, and the public is still woefully uninformed about it. For example, for every American who knows that the law has proven much less expensive than was originally estimated, there are eight who mistakenly believe it ended up being more expensive.

Nevertheless, the good news continues to pile up, and at least some of it may be penetrating to the public, albeit slowly (approval of the law has been ticking up of late). Which could create the opening for a Republican willing to say something different from his peers.

Let’s imagine a presidential candidate who said something like this to GOP primary voters:

“I know that just saying ‘Repeal Obamacare!’ is a good applause line. And believe me, I wish it had never passed. But we’ve had over 50 votes to repeal it in Congress, and it’s still here. Like it or not, it’s becoming entrenched. If we repealed it tomorrow, it would mean that millions of Americans would lose the coverage they’ve got. We can’t object to people losing their plans because of Obamacare, and then say it’s no big deal if a much larger number of Americans lose their coverage when we repeal the law. And Obamacare does a few things that we Republicans favor.

“So instead of just saying ‘Repeal it now!’, I’m going to give you a plan to keep the good things, ditch the bad things, and move toward a better health care system. We’ve spent the last five years banging our heads against the wall over this law, and some of my opponents think more banging is the answer. But I want to solve the problem.”

The Republican who said that would, of course, be branded a traitor by some. But he’d also get a wave of adoring press coverage, in which he’d be characterized as a straight-talking man of courage and the only one willing to have an adult conversation about health care.

The outcome of the King v. Burwell lawsuit could also help make his case. If the Supreme Court rules in Republicans’ favor, millions of Americans will lose their health coverage when subsidies are taken away, and efforts for a legislative fix are uncertain at best. The experience will make it clear even to many Republicans that “Burn it down!” isn’t always the wisest approach.

Yes, a Republican who turned his back on “repeal” to focus on “replace” would be taking a huge risk, since GOP primary voters are not necessarily going to be thoughtful and measured in their response to someone proposing something less than all-out war against Barack Obama and everything he ever touched. But it might just be crazy enough to work.

 

By: Paul Waldman, Senior Writer, The American Prospect; The Plum Line Blog, The Washington Post, May 7, 2015

May 11, 2015 Posted by | Affordable Care Act, GOP Presidential Candidates, Obamacare | , , , , , , | 2 Comments

“Obamacare Opponents Still Await The Apocalypse”: Opponents Are As Wrong About Obamacare As Reagan Was About Medicare

A while back, progressive activists and politicians pushed for legislation to provide health insurance for a cohort of Americans who could not easily pay for their doctors’ visits and medications. Predictably, that effort was met with fierce resistance from conservatives, who didn’t seem concerned about those less-fortunate citizens who couldn’t afford medical care.

Conservatives denounced the plan as “socialized medicine” or a “communist takeover” of the American health care system. One notable conservative was especially alarmist, declaring that if the proposal passed Congress, “… you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”

No, that hysterical tirade didn’t come in response to the Affordable Care Act. Those words were spoken in 1961 by Ronald Reagan, who was crisscrossing the country to campaign against the adoption of Medicare. Yes, Medicare, which Congress passed in 1965 and is widely considered a resounding success.

Fast-forward a few decades. The same alarms were sounded more recently, as progressive activists and politicians pushed for legislation to provide inexpensive health insurance for those who couldn’t afford it. Actually, the denunciations of the Patient Protection and Affordable Care Act, usually called “Obamacare,” may have been even more hysterical.

As the law neared passage, I watched angry crowds gather near the White House — many holding vicious, racially charged signs lambasting the president — to chant about “socialism” and “communism.” Strangely, the most vehement criticisms came from Americans 65 and older, the very cohort that benefits from Medicare.

President Obama signed the Affordable Care Act in March 2010, so it has been the law of the land for five years. Given that, it’s possible to make a reasoned assessment of its strengths and weaknesses.

First off, let’s note that there has been no “socialist takeover” of American medicine. Obamacare uses private health insurance providers; the law merely sets requirements for health insurance plans and issues subsidies to patients who cannot afford to purchase policies.

As you might expect, the number of Americans with health insurance — and, therefore, with access to preventive medical care — has increased in the last five years. Before the law went into effect, there were 48 million uninsured Americans. Now, with 16 million people having signed up for Obamacare, that number has been cut by a third.

Furthermore, health insurance companies are no longer allowed to deny coverage to patients who are already sick or to set a “lifetime cap” on the amount of money a company will pay for medical care. Adult children, who might be in college or working at low-paying jobs without benefits, can stay on their parents’ policies until they are 26.

The Affordable Care Act may also have decreased the rate at which health care costs were escalating. Five years ago, medical care costs were skyrocketing, well beyond the rate of general inflation. Now, those costs are still going up — but at the lowest rate in 50 years. While economists aren’t certain that Obamacare’s cost-containment measures are responsible, many of them give the law credit.

To be sure, the Affordable Care Act has been no panacea. There are still 32 million Americans without health insurance. And, despite the president’s early pledge that people already insured could retain their policies, a tiny but vocal group lost their insurance because Obamacare deemed those policies inadequate. Many in that group ended up paying more for insurance, hardly a happy outcome.

But the worst failings of the Affordable Care Act are beyond its supporters’ control. Because of persistent, irrational Republican opposition, more than 20 states have refused to expand Medicaid — even though the feds would pay the lion’s share of costs. That means that millions of working-class Americans are not getting the health care they need. Furthermore, Obamacare’s unrelenting antagonists have mounted yet another challenge to the law before the U.S. Supreme Court.

It’s hard to fathom. The Affordable Care Act has failed to produce the apocalypse (remember “death panels”?) its fiercest critics predicted; instead, it has given millions of people access to decent health care. Its opponents are as wrong about Obamacare as Ronald Reagan was about Medicare.

 

By: Cynthia Tucker, Pulitzer Prize for Commentary in 2007; The National Memo, March 28, 2015

March 29, 2015 Posted by | Affordable Care Act, GOP, Uninsured | , , , , , , | Leave a comment

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