“You’re Welcome Ladies”: What Mitt Romney Will Actually Do On Abortion
During Tuesday’s debate, Mitt Romney did a sneaky little pivot on the issue of contraception coverage that surely went over the head of most of the people watching. What Romney supports is a Republican bill, the Blunt amendment, that would allow any employer to refuse to include coverage for contraception in employees’ health insurance. For many women, that would mean they would be shut out of getting contraception through the plans that, we should note, they paid for themselves (insurance coverage isn’t a favor your employer does for you, it’s part of your compensation that you get in return for your labor, which means you paid for it). But when it came up in the debate, Romney said this:
“I don’t believe that bureaucrats in Washington should tell someone whether they can use contraceptives or not. And I don’t believe employers should tell someone whether they could have contraceptive care of not. Every woman in America should have access to contraceptives. And—and the—and the president’s statement of my policy is completely and totally wrong.”
See what he did there? Instead of answering the actual question of whether your boss should be able to take your coverage for contraception away, he answered a question nobody ever asked, which is whether the government should ban contraception, or whether your boss should be able to literally come to your doctor’s office during your appointment and grab the prescription for birth control pills out of your hand. In other words, Romney thinks your boss should be able to cancel your coverage for contraception, but he generously acknowledges that your boss shouldn’t actually tell you whether you can use contraception or not. You’re welcome, ladies.
Romney is doing something similar on abortion. On the one hand, he has said multiple times that he wants to see Roe v. Wade overturned and wants to cut off funding for Planned Parenthood; on the other he’s been claiming that he really has no abortion agenda at all; nothing to see here, everything will stay as it is (here’s an ad pitched at women, making the case for Mitt the Moderate on both issues). As Michelle Goldberg tells us, social conservatives haven’t said a peep about Romney’s new abortion moderation. Why? Because they know it’s just for show, and they know what really matters.
I’m sure there are more than a few voters who listen to Romney and say, “Well, he doesn’t seem like one of those radical pro-lifers, so I guess I’m OK with him.” But this is a helpful reminder that what’s in the president’s heart is of only minimal importance. The question “Is Mitt Romney really pro-life?” is all but meaningless, not only because it’s Mitt Romney we’re talking about, and when it comes to policy he has no “real” beliefs that exist outside of the pressures and incentives he has at a given moment. More importantly, when we elect a president we effectively elect an entire party, and the party Mitt Romney represents is the GOP circa 2012, a party more conservative than it has ever been before. There are 3,000 appointed positions in the federal government. Who’s going to fill these positions? Why, Republicans, of course. Who’s going to be running the Department of Health and Human Services? People who are committed to undermining the Affordable Care Act, because that’s what Republicans who work on health care policy believe. Who’s going to be running the Department of Labor? Representatives of business who are committed to destroying unions and reducing protections for workers, because that’s what Republicans who work on labor issues believe. Who’s going to be running the EPA? People who are committed to undermining environmental protections and making it easier for industry to pollute, because that’s what Republicans who work on environmental issues believe.
And if Stephen Breyer or Ruth Bader Ginsburg decides to retire in two years, would President Romney say, “Just find me the best candidate; I don’t really care if they may vote to uphold Roe v. Wade“? Hell no. He’ll do exactly what everyone on both sides expects, which is to locate the next Samuel Alito, someone who went to the best schools of course and has an admirable elite pedigree, but who also was nurtured within the conservative movement, someone who will make the right wing weep with joy. During his confirmation hearings this prospective justice will say solemnly that he shouldn’t comment on issues that might come before the Court, so he really can’t comment specifically on Roe, but rest assured that he’ll faithfully apply the Constitution and just call those balls and strikes, as John Roberts so memorably put it in his own hearings. Democrats will complain, most will vote against the nominee, but he’ll be confirmed. And within weeks, a dozen lawsuits will be filed with the intention of forcing the Court to revisit Roe. Those cases will fly up the judicial ladder with all deliberate speed, and the four conservatives on the Court and their new colleague will finally get the opportunity they’ve been waiting for. And that will be that.
By: Paul Waldman, Contributing Editor, The American Prospect, October 18, 2012
“A Man Of No Convictions”: You Can Never Meet The Same Mitt Romney Twice
To a skeptic, the most remarkable aspect of Mitt Romney’s presidential campaign has been how so flexible a politician can represent so dogmatic a party. Contemporary Republicanism is ideological to its core. Everybody who watched the GOP primary debates between Mitt and the Seven Dwarves (or were there nine? I forget) understands that there’s a black-and-white party line on almost every imaginable topic from tax policy to global warming.
Romney, on the other hand, appears to have no firm convictions at all. How anybody purports to know what the GOP candidate actually thinks about any issue other than the size of his own offshore bank accounts beggars my poor imagination. That most Republicans have temporarily persuaded themselves to trust him reflects mainly their fear and loathing of President Obama.
Equally remarkable, however, is the way the Obama campaign has let Romney get away with it. How can his evasiveness not be an issue? For that matter, how can it not be THE issue? Early on, a strategic decision was apparently made to depict the GOP candidate as the “severely conservative” politician he affected to be during the Republican primaries.
Well, it ain’t working. So many and so various are the GOP candidate’s self-contradictions and reinventions that the proverbial “low information” citizens who appear to constitute much of the swing vote are pretty much free to imagine any Mitt Romney that strikes their fancy.
Maybe it’s unpatriotic to say so, but an awful lot of people who manage their personal affairs competently enough simply refuse to understand the most elementary facts when they’re part of a political argument.
Sometimes you have to tell them a story. It helps if that story connects to something close to home; something they’ve had to think about realistically in their own lives.
Such as, what happens if you lose your health insurance and then get sick? Millions live in fear of this every day.
CBS News’ Scott Pelley recently asked Romney a simple question on 60 Minutes: “Does the government have a responsibility to provide health care to the 50 million Americans who don’t have it today?”
“Well, we do provide care for people who don’t have insurance,” Romney allowed. “If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”
“That’s the most expensive way to do it,” Pelley observed. Indeed, government figures show the average emergency room visit costs $922, vs. $199 for a doctor’s office visit.
Nor is it free. People do know that. Under the Emergency Medical Treatment and Active Labor Act signed by President Reagan, hospitals must treat sick and injured patients regardless of their ability to pay. A civilized society can do no less; much less one that hopes to head off deadly epidemics.
But the law doesn’t say the hospital can’t perform what’s cynically called a “wallet biopsy” and send you a bill. Indeed, many states allow hospitals to hire collection agencies, garnish wages and seize assets in pursuit of payment. For this reason, many people stay away until they’re at death’s door.
Others abuse the privilege and stick the rest of us with the bill.
Back in 2006, the politician Bill Clinton calls “Moderate Mitt” recognized the problem. Hewrote a Wall Street Journal column objecting to the way deadbeats game the system.
“By law, emergency care cannot be withheld,” he wrote. “Why pay for something you can get free? Of course, while it may be free for them, everyone else ends up paying the bill, either in higher insurance premiums or taxes.”
Writing in Time, Kate Pickert catches Moderate Mitt as recently as 2008, explaining the conservative origins of “Romneycare” in Massachusetts.
“They shouldn’t be allowed just to show up at the hospital and say somebody else should pay for me, so we said no more free riders… We said if you can afford insurance, then either have the insurance or get a health savings account, pay your own way, but no more free ride… I think it’s the conservative approach—to make sure that people who can afford insurance are getting it at their expense, not at the expense of the taxpayers or the government. That, I consider a step towards socialism.”
Ah, but then came “Obamacare,” basically Romneycare with a less expensive per capita price tag. Yesterday’s conservative solution turned into today’s Bolshevism. Severely Conservative Mitt played along.
So what would Romney do if elected?
Who knows? To paraphrase the ancient Greek philosopher Heraclitus: You can never encounter the same Mitt Romney twice. Whatever he says today, he’ll say something different tomorrow.
Here’s the question President Obama should be asking: Would you buy a used health insurance policy from this man?
By: Gene Lyons, The National Memo, October 17, 2012
“Wrong Again Mitt”: Romney Says People Don’t Die Because They Lack Insurance
In an interview with the Columbus Dispatch in Ohio published Thursday, Mitt Romney repeated a claim that already got him in trouble once this cycle and has reflects an enduring belief among Republicans: that people in the U.S. don’t die because they lack health insurance.
“[Y]ou go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital,” Romney said. “We don’t have people that become ill, who die in their apartment because they don’t have insurance.”
It’s eerily reminiscent of a statement President George W. Bush made in 2007 that haunted Republicans during the 2008 campaign — “[P]eople have access to health care in America. After all, you just go to an emergency room.”
There’s just one problem: It’s not true.
Numerous studies over the past 10 years conclude that tens of thousands of Americans die each year because they lack insurance.
A 2009 study conducted at Harvard Medical School and Cambridge Health Alliance, and published in the American Journal of Public Health concluded that “[l]ack of health insurance is associated with as many as 44,789 deaths per year in the United States, more than those caused by kidney disease. … The increased risk of death attributable to uninsurance suggests that alternative measures of access to medical care for the uninsured, such as community health centers, do not provide the protection of private health insurance.”
A 2012 report by the health care reform advocacy group Families USA concluded that 26,100 people died prematurely in America in 2010 due to lack of insurance. That report extrapolated from a 2002 Institute of Medicine study — conducted when the uninsurance rate was lower — which concluded that 18,000 people died prematurely because they weren’t covered.
In a 2009 update, the IOM concluded that uninsured patients are at higher risk of mortality or poor health outcomes in the aftermath of both acute medical issues (heart attacks, serious injury, stroke) and chronic ones (cancer, diabetes).
In 2008, the Urban Institute’s Stan Dorn concluded that “[b]ased on the IOM’s methodology and subsequent Census Bureau estimates of insurance coverage, 137,000 people died from 2000 through 2006 because they lacked health insurance, including 22,000 people in 2006. Much subsequent research has continued to confirm the link between insurance and mortality risk described by IOM. In fact, subsequent studies and analysis suggest that, if anything, the IOM methodology may underestimate the number of deaths that result from a lack of insurance coverage.”
Conservatives have attacked these findings and methods and argued that, controlling for health status, there’s no difference in survival probabilities between insured and uninsured people. When the Families USA report came out, Avik Roy, a Romney health adviser, called its findings “statistical hogwash.”
To buttress his argument, he cited a thorough study by Richard Kronick — a University of Rochester health policy expert who served in the Obama administration and was a senior adviser to Bill Clinton during his push for health care reform. His conclusion? “[I]f two people are otherwise similar at baseline … but one is insured and the other uninsured, their likelihood of survival over a 2-16-year follow-up period is nearly identical.”
Further, I show that survival probabilities for the insured and uninsured are similar even among disadvantaged subsets of the population; that there are no differences for long-term uninsured compared with short-term uninsured; that the results are no different when the length of the follow-up period is shortened; and that there are no differences when causes of death are restricted to those causes thought to be amenable to the quality of health care.
However, Kronick conceded that “[g]iven the inherent uncertainties in inferring causality from the results of observational analyses, the results presented here are not able to provide a definitive answer to the question, ‘How many fewer deaths would there be in the United States if all residents were continuously covered by health insurance?’”
In an interview, Urban’s Stan Dorn praised Kronick but defended his and his colleagues’ conclusion.
“I’m aware of Rick’s study and he’s a great researcher. And I guess what I’d say is it’s an outlier,” Dorn said in an interview. “There’s a lot of research that goes beyond what we did, and it’s an outlier.”
Dorn noted that other studies focusing on particular ailments make the link between uninsurance and death quite clear. “We know that women with cervical cancer who are uninsured get their cancer detected later…. We know that people with heart disease don’t take their medicine because they can’t afford it…and sometimes die.”
And as Boston University health economist Austin Frakt noted when he engaged this same controversy in February 2010, “among recent studies in this area the evidence is greater than three-to-one in favor of an insurance-health outcome link, including mortality.”
In 2006, then-Massachusetts governor Romney himself agreed — at least to an extent. Though he did not address the mortality issue specifically, in an April 2006 presentation before the Chamber of Commerce he conceded that uninsured people who seek health care at emergency rooms experience worse outcomes.
“There ought to be enough money to help people get insurance because an insured individual has a better chance of having an excellent medical experience than the one who has not. An insured individual is more likely to go to a primary care physician or a clinic to get evaluated for their conditions and to get early treatment, to get pharmaceutical treatment, as opposed to showing up in the emergency room where the treatment is more expensive and less effective than if they got preventive and primary care.”
By: Brian Beutler, Talking Points Memo, October 12, 2012
“Romney’s Sick Joke”: An Attempt To Deceive Voters On His Healthcare Proposal
“No. 1,” declared Mitt Romney in Wednesday’s debate, “pre-existing conditions are covered under my plan.” No, they aren’t — as Mr. Romney’s own advisers have conceded in the past, and did again after the debate.
Was Mr. Romney lying? Well, either that or he was making what amounts to a sick joke. Either way, his attempt to deceive voters on this issue was the biggest of many misleading and/or dishonest claims he made over the course of that hour and a half. Yes, President Obama did a notably bad job of responding. But I’ll leave the theater criticism to others and talk instead about the issue that should be at the heart of this election.
So, about that sick joke: What Mr. Romney actually proposes is that Americans with pre-existing conditions who already have health coverage be allowed to keep that coverage even if they lose their job — as long as they keep paying the premiums. As it happens, this is already the law of the land. But it’s not what anyone in real life means by having a health plan that covers pre-existing conditions, because it applies only to those who manage to land a job with health insurance in the first place (and are able to maintain their payments despite losing that job). Did I mention that the number of jobs that come with health insurance has been steadily declining over the past decade?
What Mr. Romney did in the debate, in other words, was, at best, to play a word game with voters, pretending to offer something substantive for the uninsured while actually offering nothing. For all practical purposes, he simply lied about what his policy proposals would do.
How many Americans would be left out in the cold under Mr. Romney’s plan? One answer is 89 million. According to the nonpartisan Commonwealth Foundation, that’s the number of Americans who lack the “continuous coverage” that would make them eligible for health insurance under Mr. Romney’s empty promises. By the way, that’s more than a third of the U.S. population under 65 years old.
Another answer is 45 million, the estimated number of people who would have health insurance if Mr. Obama were re-elected, but would lose it if Mr. Romney were to win.
That estimate reflects two factors. First, Mr. Romney proposes repealing the Affordable Care Act, which means doing away with all the ways in which that law would help tens of millions of Americans who either have pre-existing conditions or can’t afford health insurance for other reasons. Second, Mr. Romney is proposing drastic cuts in Medicaid — basically to save money that he could use to cut taxes on the wealthy — which would deny essential health care to millions more Americans. (And, no, despite what he has said, you can’t get the care you need just by going to the emergency room.)
Wait, it gets worse. The true number of victims from Mr. Romney’s health proposals would be much larger than either of these numbers, for a couple of reasons.
One is that Medicaid doesn’t just provide health care to Americans too young for Medicare; it also pays for nursing care and other necessities for many older Americans.
Also, many Americans have health insurance but live under the continual threat of losing it. Obamacare would eliminate this threat, but Mr. Romney would bring it back and make it worse. Safety nets don’t just help people who actually fall, they make life more secure for everyone who might fall. But Mr. Romney would take that security away, not just on health care but across the board.
What about the claim made by a Romney adviser after the debate that states could step in to guarantee coverage for pre-existing conditions? That’s nonsense on many levels. For one thing, Mr. Romney wants to eliminate restrictions on interstate insurance sales, depriving states of regulatory power. Furthermore, if all you do is require that insurance companies cover everyone, healthy people will wait until they’re sick to sign up, leading to sky-high premiums. So you need to couple regulations on insurers with a requirement that everyone have insurance. And, to make that feasible, you have to offer insurance subsidies to lower-income Americans, which have to be paid for at a federal level.
And what you end up with is — precisely — the health reform President Obama signed into law.
One could wish that Mr. Obama had made this point effectively in the debate. He had every right to jump up and say, “There you go again”: Not only was Mr. Romney’s claim fundamentally dishonest, it has already been extensively debunked, and the Romney campaign itself has admitted that it’s false.
For whatever reason, the president didn’t do that, on health care or on anything else. But, as I said, never mind the theater criticism. The fact is that Mr. Romney tried to mislead the public, and he shouldn’t be allowed to get away with it.
By: Paul Krugman, Op-Ed Columnist, The New York Times, October 4, 2012
“Lest We Forget”: Medicaid, Not Medicare Is Biggest Target For Conservatives
At the risk of sounding like a broken record on this subject, I devoutly hope that in their rush to tie Mitt Romney to Paul Ryan’s Medicare proposal, progressives don’t forget that there has never been much space between the two running-mates on the national health care program Ryan’s budget would really destroy: Medicaid. Wonkblog’s Suzy Khimm has a reminder today:
Paul Ryan’s Medicare overhaul may be the most controversial part of his budget.But the proposed cuts to the program are not the biggest cuts in the plan.
As Ezra notes, Ryan’s cuts to Medicare “are only 60 percent as large as the cuts to Medicaid and other health-care programs.” What’s more, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation.
Over the next 10 years, the Ryan plan would cut Medicaid by $642 billion by repealing the Affordable Care Act and by $750 billion through new caps on federal spending—a 34 percent cut to Medicaid spending over the next decade, according to Edwin Park of the Center and Budget and Policy Priorities.
Who would that impact? First, by overturning the ACA, the Ryan plan would prevent 11 million people from gaining Medicaid coverage by 2022, according to the Congressional Budget Office’s latest estimates….
If states maintained their current level of spending for each Medicaid patient, 19 million more people would have to be cut from the program in 2021 because of Ryan’s block-grant reform, according to the Kaiser Family Foundation. If states managed to curb health-care spending growth in Medicaid, 14 million beneficiaries would still lose Medicaid coverage under the Ryan plan. And that’s on top of the 11 million Americans who would lose Medicaid coverage because the Ryan plan would repeal Obamacare. So all in all, Ryan’s cuts could mean as many as 30 million Medicaid beneficiaries lose their coverage.
Yeah, yeah, I know, old folks vote and in the last two cycles a majority have voted Republican, and po’ folks don’t vote so much, and far more already vote Democratic. But Lord a-mighty: 30 million people potentially losing their health insurance because Romney and Ryan think they need to show more moral fiber. Given Romney’s support for the entire Ryan Budget, that doesn’t even get into the damage wreaked on efforts to help the poor escape from total dependence on cash assistance or private charity by the combined cuts to Medicaid, food stamps, and the earned income tax credit that budget contemplates. And on top of all that, many millions of indigent seniors depend on Medicaid for nursing home care.
So before progressives decide to devote all their time to endless arguments over exactly which term to use for what the Ryan Budget proposes to do to Medicare—vouchers, cost-shifts, abandonment, abolition-of-Medicare-as-we-know it—don’t forget about Medicaid. That’s the Great Society safety net program with the biggest bullseye painted on it.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, August 13, 2012
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