“About As Screwed As You Can Get”: The Uninsured Continue To Annoy Us With Their Pain
There are a lot of reasons why the United States is the only advanced democracy that does not guarantee basic medical services to all its citizens. One reason is that the convoluted construction of the U.S. health-care system has made it hard to fix the dysfunctional elements without threatening to change existing arrangements for people who profit from the status quo, or at least fear change. (That’s why both Presidents Obama and Clinton have tried so hard to convince Americans with health insurance they could keep what they have.)
Another reason is that people without health insurance are politically weak. They lack political organization, and many, reports Alec MacGillis, lack even the awareness that there was this big health-care law that gives them help:
As Robin Layman, a mother of two who has major health troubles but no insurance, arrived at a free clinic here, she had a big personal stake in the Supreme Court’s imminent decision on the new national health care law.
Not that she realized that. “What new law?” she said. “I’ve not heard anything about that.”
The circumstances of MacGillis’s story itself tell you something else about the weakness of the uninsured: Their cause is slightly disreputable. MacGillis straightforwardly and without advocacy examines up-close the conditions of the uninsured and their level of awareness, or lack thereof, of the Affordable Care Act. MacGillis reported the story for Kaiser Health News, and offered it to the Washington Post, which planned to run it on its front page but decided against it.
It is certainly true that a story examining the plight of the uninsured, and one that notes that they would stand to gain from a law subsidizing their health insurance, would tend to make readers think more favorably of such a law. But that is not the sort of objection a newspaper normally considers fatal. It all depends on whose plight we’re talking about. The complaints of business leaders who want more favorable regulatory and fiscal policies have received blanket coverage. Even when such complaints have a strong partisan tilt, beliefs like “we need less regulation” or “we must focus on reducing the deficit” carry a presumption of public-spiritedness.
The uninsured are in such bad political shape that even describing their physical suffering in a political context is considered dangerously partisan. That’s about as screwed as you can get.
By: Jonathan Chait, Daily Intel, June 18, 2012
“Illusions Of Care”: Romney’s Healthcare Plan That Isn’t
If someone asked you to come up with a good reason that Mitt Romney—the boring one-term governor of a state he left with high debt, poor job-creation and low approval ratings—became a credible national candidate, you might have a hard time doing so. The fact that he is wealthy and could self-finance his way into the top tier of Republican presidential contenders helped, as did the fact that he had won in the bluest of states, Massachusetts.
But the main reason, ironically, is that he was associated with a policy achievement—healthcare reform—that he has completely come to oppose. Back in 2007, Republicans still pretended to care about the crisis of 45 million uninsured Americans and costs that keep spiraling upwards. And so they looked to the one Republican who had tackled that problem at the state level and had done so with a program that harnessed the private sector rather than creating a massive new entitlement program. Conservative organs such as National Review, which would later inveigh against the Affordable Care Act (ACA), cited Romney’s experience with reforming the health insurance system as one of his most valuable credentials.
Throughout this campaign Romney has walked a tiny tightrope on healthcare: he attempts to make amends for passing the state level template for the ACA by issuing over the top denunciations of socialist, unconstitutional “Obamacare.” Meanwhile he has studiously avoided saying anything of substance about how he would address the massive market failure that defined the pre-reform American healthcare system.
On Tuesday in Orlando Romney gave a speech intended to create the false impression that he intends to replace the ACA with something that would provide the same benefits through other means. Here is how the Washington Post summarized the speech: “Romney fleshed out a plan he proposed earlier that would apply free-enterprise principles to the nation’s health-care system rather than operate it like a ‘government-managed utility,’ letting competition drive down prices and increase quality.” The “earlier” they refer to is Romney’s big healthcare speech last May that was meant to make it clear how different he is from Obama on the subject.
That was the main thrust again on Tuesday. Romney repeated the usual right-wing shibboleths: that the ACA has hamstrung the economic recovery by placing “unaffordable” cost burdens and new taxes on families and businesses. He has been at this for a while, using misleading anecdotes, such as his blatant misrepresentation of a passage from Noam Scheiber’s book that he claims shows the White House knew healthcare reform would damage the recovery, when it only shows that it knew more stimulus might have been more valuable to the short-term recovery. Of course, had Obama proposed more stimulus spending instead of healthcare reform in the fall of 2009, Romney and other Republicans would have opposed it.
In fact, the Romney campaign appears to disagree with the Post that Romney offered much more substance than he did last May. When I asked for details of what he is proposing, the campaign said he laid it out last year and the program is available on the campaign website.
The healthcare page on Romney’s site does not, in fact, tell you much about what Romney would do. Instead it mostly offers vague, inoffensive sounding principles such as “Ensure flexibility to help the uninsured, including public-private partnerships, exchanges, and subsidies” and “Offer innovation grants to explore non-litigation alternatives to dispute resolution.”
Some of the principles are more blatantly ideological and potentially quite troubling, such as “Limit federal standards and requirements on both private insurance and Medicaid coverage.” Those federal standards and requirements are in place to protect citizens from rapacious companies and miserly state governments that would deprive recipients of necessary treatments. Any given federal requirement might be too costly or unnecessary. But Romney doesn’t specify which federal requirements he would eliminate so as to avoid inviting scrutiny of what his policy would do to the vulnerable.
The few specifics Romney offers could reduce, rather than expand, medical coverage. Romney would turn Medicaid into a block-grant program. That way, if poverty increases the federal government would not be on the hook for covering more Medicaid recipients. It would be the state’s problem. And what would the states do? Reduce the quality of coverage, or tighten eligibility rules to reduce the number of people covered.
The only other major change to the health insurance delivery system Romney offers is this: “End tax discrimination against the individual purchase of insurance.” That’s a euphemism for creating an expensive new tax deduction. That’s pretty hypocritical coming from someone who promises to cut tax rates and somehow magically make up for the lost revenue by eliminating tax expenditures.
Currently employer-provided health insurance is not taxed as income. Consequently, we overspend on health insurance by favoring that compensation over money employers pay to workers and the workers spend on anything else. This is actually not a very good policy for anyone. Employers are stuck with escalating healthcare costs, employees see their wage increases get diverted to healthcare, and the individual insurance market offers inferior, expensive coverage that unfairly disadvantages the self-employed and thus discourages risk taking.
These are all good reasons to get rid of our current system and switch to a universal, single-payer approach, such as making everyone eligible for Medicare. The alternative way to eliminate the current market distortion would be to end the tax deductibility of employer-based health insurance. That’s the program John McCain ran on in 2008. Back then, conservatives made sensible arguments in favor of doing so. For example, the Family Research Council complained in 2007 that employer-sponsored health insurance enjoys the single largest subsidy in our tax code.
But Mitt Romney is not John McCain. He is a coward, who lacks an iota of McCain’s political bravery. Consequently, Romney fears the backlash that would ensue if he took the principled position in favor of removing this inefficiency. So instead he proposes to equalize the treatment by making it also tax-deductible for individuals to buy their own insurance. That’s good for them, but it does nothing for the market. (The advantage to the market of McCain’s proposal was that it would move millions of health working-age Americans into the individual insurance market, much as the individual mandate would.) The ACA creates a flat tax credit for buying insurance. Romney would repeal that and offer a tax credit based on how much you spend on health insurance, so it would disproportionately benefit richer people who can afford more expensive tax plans.
In a similar act of falsely telling voters they can have their cake and eat it too, Romney promises to keep the most popular provision of the ACA, the rule preventing insurers from excluding prior conditions, without explaining how he would prevent the insurance market from a death spiral of cost increases. (The current mechanism for preventing that, the individual mandate, is the core of what Romney promises to repeal if the Supreme Court doesn’t do so first.)
As a freelancer who pays for his own insurance, I stand to benefit. But as American citizens, we all stand to lose.
By: Ben Adler, The Nation, June 12, 2012
“Swiss Cheese Candidate”: Mitt Romney’s Campaign Places Most Of His Life Off Limits
It’s hard to escape the impression that Mitt Romney’s campaign is about everything but Mitt Romney.
In an era of personality-driven politics, he is running on a central idea—fixing the economy—without the personal flair and calculated charisma that often define White House contenders.
It’s not the world’s worst strategy for a guy who is never going to match Barack Obama on the charm front or feel comfortable chatting with the ladies of The View. Romney is nonetheless running almost neck and neck with the incumbent after a bruising primary battle.
But to the extent that many Americans remain uneasy with Romney, it may be because he reveals so little of himself.
Indeed, Romney has cordoned off major sections of his life, leaving him little to share beyond policy talking points.
If he has one passion in life, it’s business. But Romney barely talks about his experience at Bain Capital, because he doesn’t want to engage on the thousands of jobs lost when his former firm took over ailing companies and sometimes pushed them into bankruptcy. When he talks about Bain, it’s to play defense, as when the Obama campaign put out last week’s video featuring steelworkers who were cut loose when their Bain-owned factory shut down. (Yes, Newark, N.J., Mayor Cory Booker didn’t help the team by saying on Sunday that he is uncomfortable with such attacks on private equity, though he backtracked within hours. But how can Bain not be fair game for the president, given the nature of Romney’s campaign?)
The problem for Romney is that his job was to generate big profits for himself and his partners, not to serve as a job-creating agency, which is not exactly bumper-sticker material. So if Romney can’t talk with enthusiasm about his career as a capitalist—his central credential as a candidate—what can he talk about?
Well, he had a reasonably successful term as Massachusetts governor, the only elective office he’s ever held. But we don’t hear much about that. And the reason is hardly a mystery.
The centerpiece of his four years in Boston was a health-care plan passed with bipartisan support. But since Romneycare was the model for Obamacare, which brought the candidate so much grief during the primaries, he now treats it as radioactive.
As for the rest of his Massachusetts tenure, well, Romney doesn’t seem to be selling that either. He ran as a moderate—a pro-choicer, for example—and governed pretty much in that mold. In today’s Tea Party climate, Romney doesn’t want to remind Republicans that he was anything less than severely conservative. So that’s off the table, too.
What’s left? Romney seems determined not to talk about his faith. And there is a political downside. While The New York Times ran a largely positive and respectful front-page story on his Mormonism, it did include details that some would find off-putting, such as that he encouraged a working mother to quit her job so the church would bless her efforts to adopt a child.
My own feeling is that no one has any business demanding that Romney talk about his religion. But I don’t think he’s avoiding the subject solely because, say, evangelical Christians regard Mormonism with suspicion. He is essentially a private guy who believes that such matters are between him and his church, to the point that he won’t even boast about his missionary work as a young man.
But the expectations in our Oprahfied culture are that candidates are supposed to share, even overshare, on such matters. Asked about his favorite philosopher in one of his earliest debates, George W. Bush answered: “Christ, because he changed my heart.” (Bush also spoke about kicking the drinking habit.) Obama’s embrace of religion is such that he took his book title, The Audacity of Hope, from his pastor, Jeremiah Wright. (He also wrote about taking drugs as a young man.)
But Romney’s religion is more closed to outsiders than most, and he doesn’t seem to have many sins to confess, as Mormons don’t drink or smoke. So that part of Mitt also remains behind a curtain.
What remains is a kind of Swiss-cheese cutout of a life. Yes, Romney helped turn the Salt Lake City Olympics into a success, but that’s not enough to win the gold medal.
Romney doesn’t even talk much about his hobbies. Sports fan? I have no idea. Movie buff? Who knows? He once talked about hunting varmints, but that drew ridicule. Romney’s wife, Ann, brings a warm touch to describe the unzipped Mitt, but her husband remains decidedly zipped up.
Maybe Romney is running as the anti-charisma candidate. Maybe his team has decided to turn a weakness into a strength: if he can’t match the lofty orator, perhaps he can PowerPoint his way to the presidency by promising results. But on some level, Romney needs to find a way to move beyond bullet points in painting a picture of who he is.
By: Howard Kurtz, The Daily Beast, May 22, 2012
“On The Government Dole”: The Supreme Court And The GOP’s Healthcare Hypocrisy
There’s always hypocrisy in Washington but past and present Republican presidential candidates have used the debate on healthcare to take it to heights unimaginable even in the nation’s capital. This week the Supreme Court heard arguments on the Affordable Care Act and the GOP tried again to cripple Medicare, the federal health insurance program for seniors.
What do Rep. Michele Bachmann, former House Speaker Newt Gingrich, former Sen. Rick Santorum, and Rep. Ron Paul have in common? They were or are candidates for the 2012 GOP presidential nomination. They all oppose the Affordable Care Act, and they’re all hypocrites. Michele Bachmann feels so strongly about the law that she has been present in the Supreme Court during the oral arguments this week. Rick Santorum is so hostile to the Affordable Care Act that he took time away from the campaign trail to appear on the steps of the Supreme Court building on the first day of arguments. But Bachmann still enjoys the benefits of the gold plated federal healthcare insurance for members of Congress. Rick Santorum enjoyed the same government health benefits when he was a senator.
All of them say they oppose the Affordable Care Act because they claim it is “government run healthcare.” But don’t panic, because they’re wrong. Since President Obama decided not to fight for a single payer plan or even for the public option, healthcare is still in the deadly clutches of the insurance companies.
Even if the Republicans candidates were right, they have some nerve even making the argument. While they all criticize government run healthcare and Medicare, as members of Congress they took full advantage of the gold plated healthcare insurance provided by the United States government. What the Republicans are really saying is that government run healthcare is fine for them but too good for working families. Since Michele Bachmann and Ron Paul are still members of Congress, they could easily refuse their government run healthcare insurance and go into the private market like everybody else. But don’t hold your breath waiting for them to opt out. Bachmann and Paul are still on the government dole, and so are all the others members of Congress who opposed the Affordable Care Act. Hypocrites all.
Then there’s former governor and former liberal Mitt Romney who also has been very critical of the mandate in the new federal health insurance law. But the healthcare reform bill that he signed into law in Massachusetts has the same government mandate for everyone to have health insurance that is in the Affordable Care Act. After the reform bill became law in the Bay State, Romney said it was a model for the rest of the nation. Well he was right. Romneycare became Obamacare.
It’s not really surprising that Romney supported the insurance mandate in Massachusetts. The mandate was originally a Republican idea. Even Newt Gingrich supported the mandate in the 1990s. Republicans felt that people who didn’t buy health insurance were freeloaders. When people who don’t have health insurance are hurt or get sick, they go to emergency rooms and hospitals bill the taxpayers for the cost of treatment. The idea is that uninsured people should take financial responsibility for their own actions. That sounds pretty conservative to me, but it’s still a good idea.
So why do politicians like Romney and Gingrich oppose the mandate after they supported it. They thought it was a great idea when conservative think tanks developed it, but once a Democratic president used their idea in his bill, it became radioactive.
Rick Santorum is right about one thing. Mitt Romney will have a lot of trouble trying to explain why his mandate was such a good idea and why the president’s mandate is such a bad idea.
By: Brad Bannon, U. S. News and World Report, March 29, 2012
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