“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
“Not A Bad General Election Issue”: Should Democrats Press The Public Option?
There’s no question that the Affordable Care Act’s rollout has been “rocky,” to borrow the common parlance of the Beltway. The Web site troubles and shifting health coverage for some Americans, despite over-assurances from President Obama during the 2010 political debate, have naturally turned off some people. A much-ballyhooed poll from CNN yesterday shows that support for “Obamacare” has dropped to an all-time low.
But conservatives toasting the apparent turn in public opinion ought to look a little closer at the polling data. It’s true that only 35 percent of Americans favor the law, while 43 percent oppose it. But there’s a crucial third group: 15 percent oppose the ACA because it’s “not liberal enough.” That means that 50 percent of Americans either support the law or want policy changes that shift leftward.
Looking at the polls in that light suddenly shifts the political calculus. Republicans who want to repeal and “replace” the legislation — with measures that have never been entirely clear, especially when it comes to the most popular provisions of the ACA — are suddenly facing an uphill battle with the public.
This presents a pretty clear road map for Democrats worried that the biggest legislative achievement of the Obama era might turn against them. The CNN/ORC poll didn’t press people on what, exactly, “not liberal enough” meant, but it’s not hard to imagine what those people might want. Recall that while the legislation was being crafted, the public broadly supported a “public option” in the bill that would allow people purchasing insurance on the exchanges to select a federal health insurance plan.
So what if Democrats pushed for it? A public option would save $100 billion over 10 years, according to the Congressional Budget Office, and could offer respite from the plan cancellations and rate hikes that still persist with private insurers with the ACA in place.
There’s essentially no chance President Obama will take another bite at the health-care apple, especially with so many other priorities to tackle: his professed desire to combat climate change and income inequality before he leaves office, along with getting comprehensive immigration reform passed. But strategists on 2016 presidential campaigns ought to take heed.
Imagine a candidate who comes out early, and strong, for adding a public option to the ACA exchanges. It could become a signature issue with the liberal grass roots during the primaries, and it wouldn’t be a bad general election issue either — the polls in 2010 showed support for a public option among Republicans and independents as well as Democrats. As Ezra Klein has noted, the sudden disappearance of the public option from Democratic politics has been “a bit curious,” but perhaps its day is coming.
By: George Zornick, The Plum Line, The Washington Post, December 24, 2013
“Bring On The Pajama Bashing”: Conservatives Can’t Help But Give Vent To Their Ugliest Impulses And Anxieties
Just as we understand the world through stories, our political narratives often revolve around characters, ordinary people who become momentarily famous as supposedly representative of some policy issue or cultural trend. Sometimes they’re fictional, and sometimes they’re people who have chosen to push themselves into a political debate. But often it’s someone who dips a toe into the political waters, then finds the cameras swinging on to them in what surely is a bracing lesson in the contemporary media’s appetites.
What ensues is a debate about just what this person is supposed to represent. Is she the embodiment of a problem conservatives refuse to solve? Is he the truest of Americans, held down by liberal meddling? Or is this person, down to his or her very soul, everything we want the public to hate about the other side?
I’ve written before about the standard media practice of offering “exemplars,” or ordinary people used as the vehicle through which to tell the story of a policy issue or an event. The kind of political exemplars pushed by the parties aren’t as common, but each one gets much more attention. Last week saw another episode of these exemplar controversies, and certainly one of the oddest ones yet. Despite some of the weird details, it was familiar in the way it wound up: with conservatives showing the worst of themselves. They haven’t seemed to realize that no matter who starts these arguments, the right almost always loses them. That isn’t because liberals are so brilliant at choosing these exemplars, or because liberals control the media in which the argument plays out. It’s because once things get going, conservatives can’t help but give vent to their ugliest impulses and anxieties, driven on by the mistaken belief that all Americans will see things the way they do.
Last week, the pro-Obama group Organizing for America put up a web ad with a photo of a 20-something man wearing pajamas and drinking hot chocolate in what looked like a Christmas-morning scene, to encourage young people to sign up for health insurance. Immediately, many in the conservative media reacted as though just looking at this young fellow had transported them back to the junior high schoolyard where the class bully had called them sissies. The only way to restore their manhood, apparently, was to go after some random kid in a web ad by saying he’s kinda gay.
The National Review‘s Rich Lowry kicked things off with a column imputing to this fictional character, now named “Pajama Boy,” an entire history and a series of character flaws. “He might be glad to pay more for his health insurance to include maternity benefits he doesn’t need as a blow against gender stereotyping,” Lowry wrote. But that was one of the more restrained assaults on Pajama Boy’s masculinity. A writer for the popular conservative site Pajamas Media (so named as a tongue-in-cheek reference to the belief that bloggers are just people sitting in their pajamas spouting off, though by now they seem to have changed their stance on pajamas), wrote a piece beginning, “Whatever horrifying condition deprived Pajama Boy of his genitals, I suppose we must be thankful he can’t pass it along to future generations.” He went on to assert cleverly that left-wing academics also “have no genitals” and concluded, “Side with the left long enough, and your genitals fall off. As well they should.” Lowry’s National Review colleague Mark Steyn wrote, “Obamacare pajama models, if not yet mandatorily gay, can only be dressed in tartan onesies and accessorized with hot chocolate so as to communicate to the Republic’s maidenhood what a thankless endeavor heterosexuality is in contemporary America.” Don’t even ask what happened on Twitter.
It should go without saying that if you see a photo of a somewhat nerdy-looking young man and your first impulse is to shout, “Gay! Gay! That guy’s gay!” then maybe you should do some hard thinking about where this powerful sexual anxiety comes from.
So what happens when this is all said and done? Democrats put up a web ad, then conservatives blow a gasket and end up looking shrill and homophobic. This kind of pattern has repeated itself many times. Recall Sandra Fluke, the activist who became briefly famous when she testified before Congress about a controversy over insurance coverage for birth control at the university where she was a law student. Though she said nothing about her personal life, conservatives immediately attacked her for believing that women should have the right to a sex life. Rush Limbaugh, the most powerful conservative media figure in America, called called her a “slut” and a “prostitute,” and said, “if we’re going to pay for your contraceptives and thus pay for you to have sex, we want something for it. We want you to post the videos online so we can all watch.” And they wonder why there’s a gender gap.
It isn’t that Democrats aren’t willing to criticize the exemplars Republicans elevate. You remember Joe the Plumber, whom John McCain loved so dearly he brought him up in a debate with Obama, praised him in stump speeches, and even produced an ad with salt-of-the-earth Americans proclaiming “I’m Joe the Plumber” as though he was Spartacus. Liberals certainly chuckled when Joe turned out to not actually be a licensed plumber, and took some satisfaction when he failed to turn his celebrity into a career as a lawmaker, losing his 2012 campaign for an Ohio congressional seat by a razor-thin 49-point margin. Liberals were happy to note that the small business owner who starred in a Mitt Romney ad attacking Barack Obama for “you didn’t build that” actually got nearly a million dollars in government loans and contracts.
But there’s a particular venom that characterizes the approach many conservatives take to the liberal exemplars. For example, it’s hard to imagine a prominent liberal columnist driving to Baltimore to poke around the home and business of the family of a 12-year-old boy who advocated for the S-CHIP funding that helped his family afford medical treatment for him and his sister after a serious car accident. But that’s what conservative celebrity Michelle Malkin did in 2007, in an attempt to prove that the boy’s family didn’t deserve the help. It certainly seems as though whenever we meet a new ordinary citizen liberals are touting, the first thought some conservatives have is, “This person must be destroyed.”
There’s also often a disconnect between the attempt to undermine the exemplar and the policy argument conservatives are making. Let’s say Malkin had succeeded in uncovering some dirt on that young boy’s family. What would that have shown—that poor children shouldn’t get health coverage? It was reminiscent of something we learned more about this week, one of the most well-known exemplars in American political history: the “welfare queen” whose bilking of the system Ronald Reagan touted as proof that poor people didn’t deserve help from the government. While liberals believed for many years that Reagan had simply made up the tale (like so many others), Slate has the fascinating backstory of Linda Taylor, who not only defrauded welfare in the 1960s and 70s but may have also committed multiple acts of murder and kidnapping. The problem with Reagan’s use of her story is that he wasn’t arguing that it showed that we needed to do more to crack down on fraud so con artists couldn’t take advantage of the system. Reagan was arguing that this career criminal was actually a typical welfare recipient, and her story showed that benefits should be cut for everyone.
Reagan’s “welfare queen” story had real political potency. These days though, conservatives are more likely to get worked up over some individual liberal (or the photo of someone they presume is a liberal) and eventually find that the public doesn’t share their excitement. Just like they thought Joe the Plumber was going to win them the 2008 election, I guess they think a photo of a guy wearing pajamas is going to get Americans mad at Barack Obama and make them not want to get health insurance. To which liberals should probably respond: Go ahead. Keep telling us about how liberal men aren’t as manly and strong as you are, and how single women are a bunch of sluts, and how racial minorities are ungrateful moochers. How’s that been working out for you lately?
By: Paul Waldman, Contributing Editor, The American Prospect, December 23, 2013
“Enough Already”: The New York Times And The ACA, The Yuppie Whine-Athon Continues
I see the New York Times has published yet another article about very privileged people whining about the ACA.
In this case, said article features a couple making $100,000 a year who, under the ACA, will be paying $1,000 a month for health care. Take it away, Dean Baker:
Here they are with a front page story telling us about the tragic situation of the Chapmans, a New Hampshire couple making $100,000 a year who will have to spend $1,000 a month for insurance with Obamacare. This would come to 12 percent of their income. The piece tells readers:
“Experts consider health insurance unaffordable once it exceeds 10 percent of annual income.”
That’s interesting. If we go to the Kaiser Family Foundation website we find that the average employee contribution for an employer provided family plan is $4,240. The average employer contribution is $11,240. That gives us a total of $15,470. Most economists would say that we should treat the employers payment as a cost to the worker since in general employers are no more happy to pay money to health insurance companies than to their workers. If they didn’t pay this money as health insurance then they would be paying it to their workers in wages.
A couple of years ago, when my ex-husband and I were paying for health insurance under COBRA, we were shelling out something like $1,200 a month for just the two of us — and we were making far less than 100K a year. In fact, we were earning more like half that.
Enough already. In the real world we live in, $1,000 a month for good health insurance for two people in the top quintile of U.S. household income is pretty damn good. Upper middle class people, quitcher whining already — and New York Times, please stop enabling this nonsense.
By: Kathleen Geier, Washington Monthly Political Animal, December 21, 2013
“Extending The Hardship Exemption”: You Can Still Have Weak Health Insurance Under Obamacare, For Now
If you liked your old skimpy health plan, you may not be able to keep it. But now you can get a new, somewhat skimpy health plan instead, at least for a little while.
That’s a rough translation of an Obamacare policy change that the Administration announced on Thursday. The change, first reported by Louise Radnofsky of the Wall Street Journal, represents yet another effort to help people about to lose their existing insurance policies, usually because those policies do not comply with the Affordable Care Act’s standards for benefits and pricing. Those old policies left out major benefits, were sold only to people without pre-existing conditions, and so on.
As you know, plan cancellations have been a source of tremendous controversy—and, for the president, immense political grief. Some estimates have suggested several million people received these cancellation notices. The vast majority of those people have already found new coverage, either directly through insurers or through one of the Obamacare exchange websites, according to the Administration. While some are paying more money, others have discovered that the new policies are cheaper—or, at least, are grateful for the extra protection. Lucia Graves of National Journal wrote about some of their stories the other day.
But some people still haven’t found insurance. Administration officials think, based on conversations with state regulators and insurers, that about half a million people fall into this category. That’s half a million people who could, because of the individual mandate, face tax penalties because they have declined to get affordable coverage.
Now, however, people with cancelled policies have a new option. The individual mandate has always contained a hardship exemption: If you qualify for it, you don’t have to pay the penalty and you have access to the cheaper, slightly less comprehensive catastrophic insurance plans otherwise available only to people under 30. The only question with the hardship exemption has been who gets it. The law gives the administration flexibility over that question and, on Thursday, Health and Human Services Secretary Kathleen Sebelius announced that it would apply to people who just lost their policies and are unable to find replacements that cost the same or less money.
HHS made the announcement by posting a guidance and sending a letter to a half-dozen more conservative members of the Senate Democratic caucus. And neither document answers all of the relevant questions, like how strictly the government will apply the new criteria or for how long this exemption will last. (Administration officials say it will be temporary.)
Conceptually, making the change is not so different from allowing more people to have grandfather protection for their existing coverage—after all, it’s basically telling people who have bare-bones coverage now that they can take out bare-bones policies next year. And imposition of the individual mandate was always supposed to be a gradual process. The financial penalty starts out relatively low, but will increase in 2015 and 2016. The administrative flexibility over the hardship exemption was designed to give the administration some leeway over enforcing the mandate, particularly early on, in order to ease the transition to a new and reformed insurance market. (The Massachusetts reforms, which were a model for the Affordable Care Act, also included a hardship exemption and called for increasing penalties over time.)
Administration officials don’t seem to think many people will take up this new option. They are probably right about that. Catastrophic policies aren’t dramatically different in coverage from the “bronze” policies, which cover 60 percent of the typical person’s medical expenses and comply with all Obamacare requirements. But if you buy a catastrophic policy, you’re not eligible for federal tax credits. If you buy a bronze policy, you are. As a result, most lower- and middle-income people would probably still find the bronze policies a better deal.
Still, some people—primarily, the ones who don’t qualify for subsidies—will opt for the catastrophic policies because they will be moderately cheaper. And some people will opt not to get insurance at all. That will mean fewer people in good health paying premiums for the exchange policies. That’s a potential problem for insurers, who count upon those premiums to offset the medical bills of people in poor health. (For health policy wonks: The catastrophic policies are an independent risk pool, separate from other policies in the exchanges. So for every person who selects one of those policies, that’s one fewer person putting premiums into the larger pot of money for the exchange policies.) There’s also a danger that, as Ezra Klein points out, the administration will come under more pressure to pull back on the mandate for other people. “This latest rule change could cause significant instability in the marketplace and lead to further confusion and disruption for consumers,” said Karen Ignani, president of America’s Health Insurance Plans.
Yes, insurers say those sorts of things all the time. And this singular change probably won’t cause serious, irreparable harm, any more than any of the previous ones did. The number of people whose behavior changes is likely to be small and the new system is more resilient than most people realize. But even minor changes can become major if there are enough of them.
Note: This item has been updated. As a friend reminds me, even the catastrophic plans under Obamacare aren’t that skimpy. They still cover all essential benefits, for example, and the actuarial value really isn’t much different from bronze plans.
By: Jonathan Cohn, The New Republic, December 21, 2013
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