Hurray For Health Reform: “Protecting Those Who Are Falling Through The Cracks”
It’s said that you can judge a man by the quality of his enemies. If the same principle applies to legislation, the Affordable Care Act — which was signed into law two years ago, but for the most part has yet to take effect — sits in a place of high honor.
Now, the act — known to its foes as Obamacare, and to the cognoscenti as ObamaRomneycare — isn’t easy to love, since it’s very much a compromise, dictated by the perceived political need to change existing coverage and challenge entrenched interests as little as possible. But the perfect is the enemy of the good; for all its imperfections, this reform would do an enormous amount of good. And one indicator of just how good it is comes from the apparent inability of its opponents to make an honest case against it.
To understand the lies, you first have to understand the truth. How would ObamaRomneycare change American health care?
For most people the answer is, not at all. In particular, those receiving good health benefits from employers would keep them. The act is aimed, instead, at Americans who fall through the cracks, either going without coverage or relying on the miserably malfunctioning individual, “non-group” insurance market.
The fact is that individual health insurance, as currently constituted, just doesn’t work. If insurers are left free to deny coverage at will — as they are in, say, California — they offer cheap policies to the young and healthy (and try to yank coverage if you get sick) but refuse to cover anyone likely to need expensive care. Yet simply requiring that insurers cover people with pre-existing conditions, as in New York, doesn’t work either: premiums are sky-high because only the sick buy insurance.
The solution — originally proposed, believe it or not, by analysts at the ultra-right-wing Heritage Foundation — is a three-legged stool of regulation and subsidies. As in New York, insurers are required to cover everyone; in return, everyone is required to buy insurance, so that healthy as well as sick people are in the risk pool. Finally, subsidies make those mandated insurance purchases affordable for lower-income families.
Can such a system work? It’s already working! Massachusetts enacted a very similar reform six years ago — yes, while Mitt Romney was governor. Jonathan Gruber of the Massachusetts Institute of Technology, who played a key role in developing both the local and the national reforms (and has published an illustrated guide to reform) has surveyed the results — and finds that Romneycare is working pretty much as advertised. The number of people without insurance has dropped sharply, the quality of care hasn’t suffered, and the program’s cost has been very close to initial projections.
Oh, and the budgetary cost per newly insured resident of Massachusetts was actually lower than the projected cost per American insured by the Affordable Care Act.
Given this evidence, what’s a virulent opponent of reform to do? The answer is, make stuff up.
We all know how the act’s proposal that Medicare evaluate medical procedures for effectiveness became, in the fevered imagination of the right, an evil plan to create death panels. And rest assured, this lie will be back in force once the general election campaign is in full swing.
For now, however, most of the disinformation involves claims about costs. Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.
Because the truth does not, sad to say, always prevail, there is a real chance that these lies will succeed in killing health reform before it really gets started. And that would be an immense tragedy for America, because this health reform is coming just in time.
As I said, the reform is mainly aimed at Americans who fall through the cracks in our current system — an important goal in its own right. But what makes reform truly urgent is the fact that the cracks are rapidly getting wider, because fewer and fewer jobs come with health benefits; employment-based coverage actually declined even during the “Bush boom” of 2003 to 2007, and has plunged since.
What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can’t afford essential care. So this reform had better survive — because if it doesn’t, many Americans who need health care won’t.
By: Paul Krugman, Op-Ed Columnist, The New York Times, March 18, 2012
“Good Job Mitt”: Romneycare Is Making Massachusetts Healthier
In newly released research, Charles Courtemanche and Daniela Zapata ask perhaps the most important question about the Massachusetts health-care reforms: Did they improve health outcomes in Massachusetts?
The answer, which relies on self-reported health data, suggests they did. The authors document improvements in “physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity.” The gains were greatest for “women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law’s subsidies.”
Some of those results are a bit odd. Although it’s possible to tell yourself a story about how the Massachusetts health reforms affected the body mass indexes of the newly insured, you have to stretch a bit.
But most of them make perfect sense. The reforms led to more people having insurance, which is to say more people having more opportunities to see a doctor and get early and/or regular treatment for ailments. That led to improvements in health. If that hadn’t led to improvements in health, it would be the worth of going to the doctor and getting timely medical care that would be called into question. And if going to the doctor and getting timely medical care isn’t worth doing, the Massachusetts reforms are pretty far down the list of practices and policies we need to rethink.
The researchers end by asking whether the Massachusetts reforms provide a good guide to what will happen under the Affordable Care Act. “The general strategies for obtaining nearly universal coverage in both the Massachusetts and federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and mandates, suggesting that the health effects should be broadly similar,” they write. “However, the federal legislation included additional costcutting measures such as Medicare cuts that could potentially mitigate the gains in health from the coverage expansions. On the other hand, baseline uninsured rates were unusually low in Massachusetts, so the coverage expansions — and corresponding health improvements — from the Affordable Care Act could potentially be greater.”
I’d add one point to their discussion: The national reforms, unlike the Massachusetts reforms, included major investments in comparative-effectiveness research, electronic health records, accountable care organizations and pay-for-quality pilots. If any or all of those initiatives pay off, they could dramatically improve our understanding of which treatments work and force the health-care system to integrate that new knowledge into everyday treatment decisions very quickly.
If that happens, medical care could become substantially more effective than it is now, which should also improve health outcomes. Quality improvements like that could, for the already insured, be the largest payoff from the Affordable Care Act.
By: Ezra Klein, The Washington Post, March 12, 2012
“Changing Climate”: Santorum Says Mitt Romney “Doesn’t Tell The Truth” On Health Care…And Other Things
Ahead of two suddenly pivotal primaries in Alabama and Republican presidential candidate, former Pennsylvania senator Rick Santorum, speaks in Cape Giradeau, Mo., on Saturday. (Eric Gay – Associated Press) Mississippi on Tuesday, Republican presidential candidate Rick Santorum on Sunday stepped up his criticism of Mitt Romney, arguing that his primary rival has not told the truth when it comes to his record on health care.
In an interview on NBC’s “Meet the Press,” Santorum told host David Gregory that Romney has sought to mislead voters when it comes to his position on health-care reform as governor of Massachusetts.
“Governor Romney in the state of Massachusetts mandated every person in Massachusetts have to buy health care,” Santorum said. “He doesn’t tell the truth about that either. He said, ‘Oh, it’s only the 8 percent that didn’t have insurance.’ That is simply not true.”
Andrea Saul, a spokeswoman for the Romney campaign, said it was Santorum who was misrepresenting Romney’s position on health care.
“Rick Santorum has a habit of making distortions, exaggerations and falsehoods about Mitt Romney’s record,” Saul said. “Governor Romney has never advocated for a federal individual mandate. He believes in the Tenth Amendment and, as a result, has always said that states should be free to come up with their own health care reforms.”
Santorum charged that on both health care and on climate change, Romney “continues to go out there and tries to misrepresent what he did in Massachusetts because it’s not popular.”
“He was for climate change,”Santorum said. “Man-made global warming. He put caps on CO2. And now that it’s not popular, now that the climate changed, guess who changed along with it? Governor Romney.”
Republican presidential candidate Mitt Romney gestures while speaking to workers and supporters at Thompson Tractor in Birmingham, Ala., on Friday. (Marvin Gentry – Reuters) A Romney spokeswoman did not immediately respond to a request for comment on the interview. Romney has repeatedly defended his health care record by arguing that he supported reform in Massachusetts but does not back it at the federal level.
The ramped-up offensive by Santorum against Romney comes as some supporters of the former senator are urging former House speaker Newt Gingrich (R-Ga.) to drop out and allow Santorum to run a one-on-one race against Romney.
And as the four-way GOP primary slog continues, Santorum himself on Sunday again declined to call on Gingrich to step aside.
“Well, you know, that’s not my job,” Santorum told Gregory when asked whether he’d urge Gingrich to get out of the race. “I’m not going to tell people to get in and out of this race. I didn’t ask Speaker Gingrich to get in. I’m not going to ask him to get out.”
He noted that he hopes a two-man race will take place “sooner rather than later, but we’ll wait and see what the speaker decides.”
By: Felicia Sonmez, The Washington Post, March 11, 2012
“In An Awkward Spot”: How Mitt Romney Advocated Obamacare And Lied About It
In 2009, Mitt Romney had a problem. He was running for the Republican presidential nomination, and the towering achievement of his governorship in Massachusetts — health-care reform — had been embraced by President Obama. Romneycare played almost no role in Romney’s 2008 presidential run, but the emergence of the issue onto the national agenda threatened to link Romney with a president Republicans had already come to loathe.
His solution was simple. He seized upon the one major difference between his plan and Obama’s, which was that Obama favored a public health insurance option. The public plan had commanded enormous public attention, and Romney used to it frame Masscare as a conservative reform relying on private health insurance, and against Obama’s proposal to create a government plan that, Romney claimed, would balloon into a massive entitlement. Andrew Kaczynski collects several televised appearances and one op-ed in which Romney holds up Masscare as a national model.
This tactic backfired when Obama had to jettison the public plan, and Republicans came to focus on the individual mandate as the locus of evil in Obamacare. What was once a Republican idea in good standing was now, suddenly, unconstitutional and the greatest threat to freedom in American history.
This left Romney in an awkward spot.
It’s hard to run for president as the advocate of an idea that your party considers the greatest threat to freedom in history. His response was to simply revise the past, much as he did with abortion. Romney now claimed he had never advocated a federal version of his Masscare program. Here’s Romney at the December 11 GOP presidential debate:
Speaker Gingrich said that he was for a federal individual mandate. That’s something I’ve always opposed. What we did in our state was designed by the people in our state for the needs of our state. You believe in the 10th Amendment. I believe in the 10th Amendment. The people of Massachusetts favor our plan three to one. They don’t like it, they can get rid of it. (COUGH) That’s the great thing about (COUGH) a democracy, where individuals under the 10th Amendment have the power to craft their own solutions.
The coughs are in the original transcript, for what it’s worth. I’ll leave it to the psychiatrists to say whether we ought to read anything into them.
And here’s Romney at a January 23 debate:
My health care plan, by the way, is one that under our Constitution we’re allowed to have. The people in our state chose a plan which I think is working for our state.
At the time we crafted it, I was asked time and again, “Is this something that you would have the federal government do?” I said absolutely not.
I do not support a federal mandate. I do not support a federal one-size-fits-all plan. I believe in the Constitution.
This is clearly untrue. Romney, as Kaczynski has shown, repeatedly held up the Massachusetts model in 2009. For instance, from the USA Today op-ed:
There’s a better way. And the lessons we learned in Massachusetts could help Washington find it. ..
For health care reform to succeed in Washington, the president must finally do what he promised during the campaign: Work with Republicans as well as Democrats.
Massachusetts also proved that you don’t need government insurance. Our citizens purchase private, free-market medical insurance. There is no “public option.” …
Our experience also demonstrates that getting every citizen insured doesn’t have to break the bank. First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others. This doesn’t cost the government a single dollar.
The remarkable thing is that none of Romney’s opponents challenged these demonstrably false claims. If you check the transcripts of the debates, Romney simply lies about what he advocated, and then everybody lets it go.
Among other things, this underscores the sheer incompetence of his opposition. Kaczynski is an excellent researcher, but it’s not as if he had to comb the ends of the Earth to find these nuggets. He culled them from such sources as USA Today and Meet the Press. Every opposing campaign either failed to look up this basic stuff or failed to train the candidate to understand it. Romney is now on the verge of escaping with the party nomination having embraced a program his party considers inimical to freedom itself and blatantly lied about having done so without any major opponents pointing this out. It’s pretty incredible.
By: Jonathan Chait, Daily Intel, March 5, 2012
“Lessons Of A Severe Conservative”: Mitt Romney Urged President Obama To Propose Individual Mandate
Andrew Kaczynski digs up a remarkable July 2009 op-edfrom Mitt Romney in which Romney not only brags about the effectiveness of the individual mandate in Massachusetts, but urges President Obama to support it at the federal level:
Because of President Obama’s frantic approach, health care has run off the rails. For the sake of 47 million uninsured Americans, we need to get it back on track.Health care cannot be handled the same way as the stimulus and cap-and-trade bills. With those, the president stuck to the old style of lawmaking: He threw in every special favor imaginable, ground it up and crammed it through a partisan Democratic Congress. Health care is simply too important to the economy, to employment and to America’s families to be larded up and rushed through on an artificial deadline. There’s a better way. And the lessons we learned in Massachusetts could help Washington find it.
And what were those lessons?
First, we established incentives for those who were uninsured to buy insurance. Using tax penalties, as we did, or tax credits, as others have proposed, encourages “free riders” to take responsibility for themselves rather than pass their medical costs on to others.
That, my friends, is the individual mandate. And Mitt was proud of it:
The Massachusetts reform aimed at getting virtually all our citizens insured. In that, it worked: 98% of our citizens are insured, 440,000 previously uninsured are covered and almost half of those purchased insurance on their own, with no subsidy.
And if President Obama had been willing to move forward without the public option (which he was), then Mitt Romney said he was ready to move forward with a national plan:
Republicans will join with the Democrats if the president abandons his government insurance plan, if he endeavors to craft a plan that does not burden the nation with greater debt, if he broadens his scope to reduce health costs for all Americans, and if he is willing to devote the rigorous effort, requisite time and bipartisan process that health care reform deserves.
And, as Mitt Romney made clear at the top of his op-ed, the plan he supported was one built around what he said worked in Massachusetts—including the individual mandate.
Yet despite his clear embrace of the individual mandate as part of federal health care reform, Mitt Romney has faced such a weak set of rival candidates that not a single one of them has brought this up in the twenty Republican debates.
But as fortunate as Mitt Romney has been to face such a staggeringly incompetent Republican field, he won’t be so lucky next fall. And you can bet your bottom dollar that the very first time he tries to attack President Obama over health care reform in the debates, he’s going to get this thrown right back in his face. And he’ s not going to like how it turns out.
By: Jed Lewison, Daily Kos, March 2, 2012
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