“We Invent, Experiment, And Fix What Has To Be Fixed”: Why You Shouldn’t Succumb To Defeatism About The Affordable Care Act
Whatever happened to American can-do optimism? Even before the Affordable Care Act covers its first beneficiary, the nattering nabobs of negativism are out in full force.
“Tens of millions more Americans will lose their coverage and find that new ObamaCare plans have higher premiums, larger deductibles, and fewer doctors,” predicts Republican operative Karl Rove. “Enrollment numbers will be smaller than projected and budget outlays will be higher.”
Rove is joined by a chorus of conservative Cassandra’s, from Fox News to the editorial pages of the Wall Street Journal, all warning that the new law will be a disaster.
Robert Laszewski, president of Health Policy and Strategy Associates, anticipates a shortage of doctors. “There just aren’t going to be enough of them.”
Professor John Cochrane of the University of Chicago predicts the individual mandate will “unravel” when “we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance.”
The round-the-clock nay-saying is having an effect. Support for the law has plummeted to 35 percent of those questioned in a recent CNN poll, a 5-point drop in less than a month. Sixty-two percent now say they oppose the law, up four points from November.
Even liberal-leaning commentators are openly worrying. On ABC’s “This Week,” Cokie Roberts responded to my view that the law eventually would prove popular by warning of “a whole other wave of reaction against it” if employers start dropping their insurance.
Some congressional Democrats are getting cold feet. West Virginia Senator Joe Manchin recently fretted that “if it’s so much more expensive than what we anticipated and if the coverage is not as good as what we had, you’ve got a complete meltdown.”
Get a grip.
If the past is any guide, some fixes will probably be necessary – but so what? Our current healthcare system is the real disaster — the most expensive and least effective among all developed countries, according Bloomberg’s recent ranking. We’d be collectively insane if we didn’t try to overhaul it.
But we won’t get it perfect immediately. What needs fixing can be fixed. And over time we can learn how to do it better.
If enrollments are lower than anticipated, the proper response is to keep at it until larger numbers are enrolled. CHIP, the Children’s Health Insurance Program, got off to a slow start in 1998. The Congressional Research Service reported “general disappointment … with low enrollment rates early in the program.” CHIP didn’t reach its target level of enrollment for five years. Now it enrolls nearly ninety percent of all eligible children.
Richard Nixon’s Supplemental Security Income program of 1974 – designed to standardize welfare benefits to the poor — was widely scorned at the time, and many states were reluctant to sign up. Even two years after its launch, only about half of eligible recipients had enrolled. Today, more than 8 million Americans are covered.
If mistakes are made implementing the Affordable Care Act, the appropriate response is to fix them. When George W. Bush’s Medicare Part D drug benefit was launched, large numbers of low-income seniors had to be switched from Medicaid. Many needed their prescriptions filled before the switch had been completed, causing loud complaints. The website for the plan initially malfunctioned. Pharmacies got the wrong information. Other complications led even Republican Representative John Boehner to call it “horrendous.” But the transition was managed, and Medicare Part D is now a firm fixture in the Medicare firmament.
If young people don’t sign up for the Affordable Care Act in sufficient numbers and costs rise too fast, other ways can be found to encourage their enrollment and control costs. If there aren’t enough doctors initially, medical staffs can be utilized more efficiently. If employers begin to drop their own insurance, incentives can be altered so they don’t.
Why be defeatist before we begin? Even Social Security — the most popular of all government programs — had problems when it was launched in 1935. A full year later, Alf Landon, the Republican presidential candidate, called it “a fraud on the workingman.” Former President Herbert Hoover said it would imprison the elderly in the equivalent of “a national zoo.” Americans were slow to sign up. Not until the 1970s did Social Security cover most working-age Americans.
As Alexis de Tocqueville recognized as early as the 1830s, what distinguishes America is our pragmatism, resilience, and optimism. We invent, experiment, and fix what has to be fixed.
Of course there will be problems implementing the Affordable Care Act. But if we’re determined to create a system that’s cheaper and more effective at keeping Americans healthy than the one we have now – and, in truth, we have no choice – we have every chance of succeeding.
By: Robert Reich, The Robert Reich Blog, December 27, 2013
“Getting Secret Money Out Of Campaigns”: It’s In The Public Interest To Disallow Sleazy Secret Money In Campaigns
The Internal Revenue Service spent years averting its eyes while clever campaign operatives abused the tax code for political purposes. Advocacy groups, mostly on the right, wanted to run attack ads while concealing the source of their money, and they came up with a brilliant way to do it: claim to be “social welfare” groups, which are allowed to hide donors.
Federal statutes say these groups can only engage in social welfare activity, but the tax agency decided political activity was fine as long as it wasn’t the primary purpose of the group. That helped create the torrent of secret money that poisoned the last few federal elections. The I.R.S. never explained, though, what kinds of activities are considered political, or why these groups, also known as 501(c)(4)’s, should be allowed to participate in campaigns at all.
On Thursday, long after the abuse became too rampant to ignore, the I.R.S. took the first tentative steps at reining in the problems it helped create. It proposed a definition of “candidate-related political activity,” an important starting point in determining what tax-exempt groups are really allowed to do. But it will have to do much more than that if it wants to be taken seriously as a regulator on this battlefield.
According to a press release from the Treasury Department, the agency said the new definition of political activity would include ads or other communications that clearly advocate for a candidate or party, or ads that mention a candidate within 60 days of a general election (30 days for primaries). That’s a good start for a definition, though 60 days is far too narrow a window — many of these attack ads air a full year or more before voting begins.
Once political activity is defined and separated from social welfare activity, 501(c)(4)’s will no longer be able to claim, as Karl Rove and others have, that “issue ads” mentioning candidates are for social welfare purposes. (These are the kinds of ads that say, “Dog-kicking is terrible. Call Senator Jones and tell her to stop doing it.”)
But a definition alone won’t do any good unless the I.R.S. tells these groups how much political activity is permitted. The ideal answer would be: zero. Social welfare groups have no business meddling in politics. Any group with a political interest has its own place in the tax code — they can be a 527 political organization. Those groups, which include political parties and official campaign organizations, also get tax exemptions, but there is one crucial difference: they have to disclose their donors, and 501(c)(4)’s don’t.
Conservatives immediately claimed that the I.R.S. was trying to take away their free-speech rights, which is laughable. Absolutely nothing is stopping advocacy from running ads, and the Supreme Court, in the Citizens United case, even granted corporations the right to make unlimited donations to independent groups that produce political ads. But there is no right to keep these donations a secret.
The Treasury announcement, tantalizingly, said the I.R.S. would consider comments from the public on how much political activity should be permitted for a social welfare group, suggesting that decision was farther down the road. It’s in the agency’s interest to end the confusion surrounding 501(c)(4)’s, which has led to charges that it has been arbitrary in its audits. But it’s in the public interest to do even more, and disallow sleazy secret money in campaigns.
By: David Firestone, Editors Blog, The New York Times, November 27, 2013
“Republican America”: Voter Suppression Is The New GOP Strategy
Better bring some identification — and not just any identification, official though it may be — if you plan to vote in Republican-controlled states. However, if you contribute tens of millions of dollars to sway an election on Republicans’ behalf, the party will fight to keep your identity a secret.
Consider, for instance, what happened to some attempting to participate in this month’s elections in Texas. The New York Times reported that “Judge Sandra Watts was stopped while trying to vote because the name on her photo ID, the same one she had used for voter registration and identification of 52 years, did not exactly match her name in the official voter rolls.” Both Democratic state Sen. Wendy Davis and Republican Attorney General Greg Abbott — the front-runners in next year’s gubernatorial contest — encountered the same obstacle. As did Jim Wright, the 90-year-old former speaker of the U.S. House. Wright, who represented his Fort Worth district in Congress for 34 years, told the local paper that he had voted in every election since 1944 and that he had realized shortly before Election Day that his identification — a driver’s license that expired in 2010 and a university faculty ID — would not suffice under the state’s 2011 voter ID law. Indeed, officials required Wright to produce a certified copy of his birth certificate to procure a personal identification card that would allow him to vote.
Fortunately, no issues of cosmic importance appeared on this year’s Texas ballots. Next year, however, congressional seats and control of the statehouse will be up for grabs, and voter turnout probably will be much higher. The purpose of these and other vote-deterring measures, adopted in Texas and a slew of other GOP-controlled states, is to make sure turnout is not too much higher by reducing voter participation, particularly among the young (student IDs often don’t suffice), the poor (no driver’s license? Sorry.) and racial minorities. That is, groups that tend to vote Democratic.
Voter suppression has become the linchpin of Republican strategy. After Mitt Romney’s defeat in 2012, the GOP was briefly abuzz with talk of expanding the party’s appeal to young and Latino voters. Instead, the party doubled down on its opposition to immigration reform and its support for cultural conservatism — positions tantamount to electoral suicide unless the youth and minority vote can be suppressed.
Republicans have justified this crackdown as a way to keep non- citizens from infiltrating the electorate, not that there’s evidence such a thing is happening. But if a non-citizen wants to contribute millions of dollars to one of those “social welfare organizations” that spends gobs of money on an election campaign, Republicans fight to shield his or her identity. Recently released tax documents showed that one such organization — Crossroads GPS, the group headed by Karl Rove that spent $189 million in last year’s elections opposing President Obama and Senate Democrats — received 53 contributions of $1 million or more. The three largest were for $22.5 million, $18 million and $10 million.
Who did they come from? Because Crossroads GPS is classified as a 501(c)4 “social welfare” group, which is not legally required to list its donors, we’ll never know. Could such contributions come from a non-citizen? With donors’ identities shielded by law, there is no way of knowing.
Some states require donors to such campaign groups in state and local elections to be identified. But other states don’t, which allows for the kind of interstate shell games that wealthy right-wing donors played during the 2012 election. In one instance, an anonymous $11 million contribution to a California campaign opposing a ballot measure that raised taxes on the rich and supporting a measure to curtail unions’ political activities was tracked by state election officials to a 501(c)4 organization in Arizona that had gotten its funding from another such group in Virginia. The investigation revealed that a California GOP consultant had raised money for the ballot measure campaigns by promising his donors the anonymity that this shell game provided.
A pre-election tally by the Sunlight Foundation of “dark money” contributions to federal races as of Nov. 1, 2012, showed nearly $175 million going to GOP candidates and roughly $35 million to Democrats. A bill backed by Senate Democrats that would have required such groups to report the identity of donors who give more than $10,000 for electoral campaigns was killed last year by GOP opposition to a cloture motion, even though it was backed by a majority of senators.
So: If you want to vote in the Republicans’ America, remember to bring your birth certificate. But if you want to buy an election and stay under wraps, your secret is safe with them.
By: Harold Meyerson, Opinion Writer, The Washington Post, November 21, 2013
“Happiness Today, Bankruptcy Tomorrow”: Why Letting Everyone Keep Their Health-Care Plan Is A Terrible Idea
The current furor over President Obama’s broken “keep your plan” promise confusingly melds together two very different claims. The first is a simple question of accuracy and honesty: Obama made a promise about his legislation, the promise has not come true, and a certain level of abuse is deserved. (Karl Rove huffs, “This is a serious breach of trust with the American people.” And you know that Karl Rove takes breaches of presidential trust with the utmost seriousness.)
The justifiable scrutiny of Obama’s veracity has melded seamlessly into a second and very different claim: That Obama’s broken promise is not merely a violation of trust, a fair enough charge, but an act of unfairness to those who have lost their plans.
The health-care debate has suddenly come to focus almost obsessively on the alleged victims of Obamacare, who have lost their cheap individual insurance. Here’s Matthew Fleischer mourning the loss of his bare-bones plan in the Los Angeles Times; here’s David Frum doing the same for the Daily Beast. Mary Landrieu, a vulnerable red-state Democrat, is introducing legislation to ensure that nobody can lose their individual health-care plan.
The idea underlying this notion, while facially appealing, is in fact misguided and morally perverse. No decent health-care reform can keep in place every currently existing private plan.
The New York Times has a helpful graphic displaying the structure of the insurance market:
The left and top-right squares show the four fifths of Americans who get coverage through the government. Those on the left who get covered through their employer get tax-subsidized insurance, and those in the top right get insured by the government directly. Obamacare leaves that structure in place (though it has a series of mechanisms designed to hold down their cost inflation).
The main coverage provisions affect the people in the bottom right quadrant. Most of that quadrant lacks any insurance at all, which points to the dysfunctionality of buying individual insurance before Obamacare. Some of them — 5 percent of the population — have a health-insurance plan. Health-care reforms have always thought of the people within that segment as being essentially the same group of people. Those are mainly healthy, non-poor people who have been skimmed out of the insurance pool, leaving behind those too poor, or too likely to need medical care.
Obamacare is designed to pool the bottom-right quadrant into risk pools, somewhat like the people on the left and the upper right. The poorest of the uninsured are eligible for Medicaid, though a Republican Supreme Court and Republican state governments collectively decided to leave them uninsured. The rest have coverage through the new health exchanges. By design, those exchanges prevent insurers from skimming out the healthy and excluding the sick. Some of the 5 percenters will get less expensive health care, mainly because they qualify for tax credits. Others think they will have to pay higher costs but, upon inspection, will be getting cheaper coverage on the exchanges.
But some other portion — an as-yet-undefined fraction of the 5 percent — will actually be paying higher insurance premiums in the exchanges, and their complaints are echoing across the land. Should we feel concerned for their plight? No, we should not, for three reasons.
First, a great many of the people who are happy with their individual health-insurance plan are happy only because they are unaware of its actual value. This sounds patronizing, but it also happens to be demonstrably true. Even highly educated consumers within this market were frequently snookered by insurance plans that turned out to leave them exposed to surprise costs — they incur a sudden high medical cost and discover their plan does not actually cover them. The fine print is a game of wits between insurer and customer that the insurer always wins. A large share of the people telling us now they’re happy with their individual insurance simply haven’t been exposed to a negative surprise. The handful of reporters who closely followed the individual-insurance market before last week are all watching the eulogies for the lost individual plans and having their brains explode.
Second, it is true that some people actually are getting decent individual health insurance, and have to pay more under Obamacare. Before, insurers could charge them a rate based on their individual likelihood of needing medical care, and some people are lucky enough to present a very low actuarial health risk. Now those people will have to pay a rate averaging in the cost of others who are less medically fortunate.
Have those healthy 5 percenters who do have decent insurance “lost” under Obamacare? In the very immediate sense, yes. That is what Obamacare advocate Jon Gruber is getting at when he concedes that 3 percent of Americans will be worse off under the new law. They’ll be paying higher rates in 2014 than they would have.
Yet this takes an oddly narrow view of their self-interest. You may pose a low actuarial risk today, but you cannot be certain your luck will continue for the rest of your life (or until you qualify for Medicare). Even people living the healthiest lifestyles suffer illnesses and accidents, or marry people who have a uterus. Those who are paying a higher rate are getting something for their money: a guarantee that some future misfortune won’t lock them out of the market. You might call such a guarantee “insurance.”
So some of the 5 percenters are wrong, some of them are short-sighted, but they have identified a basic moral principle: Why is it fair to steal from them, the healthy, and give to others, who are sick? If they have truly mastered the fine print of the individual insurance market and want to gamble on remaining a good actuarial risk forever, should they be permitted to keep their winnings? Having drilled down through the practical arguments, here we get to the final reason, the moral bedrock of the issue.
Their objection has an intuitive, libertarian appeal that obscures the fact that the vast majority of insured Americans already submit to this form of redistribution. Indeed, they’re submitting to a much more stringent form of this redistribution. The exchanges are allowed to charge older people up to three times the premium they charge the young. But in the employer system, they’re not allowed to charge older people any higher rate at all. The shift from healthy to sick in the employer insurance pool is massive. Adrianna McIntyre, a 24-year-old wonk prodigy, notes that her employer-based coverage charges her more than three times the rate she could get in the new exchanges.
People accept this transfer from the healthy to the sick because it is the only way to make medical care affordable to the sick. This is a simple mathematical truism. If your medical care costs more than you can afford to pay, the difference must be borne by those whose medical care costs less than they can afford to pay. There are any number of ways to handle this transfer. One is taxes, and Obamacare does use taxes to make insurance more affordable for many of its recipients. There are other potential methods — conservatives like to tout high-risk pools, at least in the abstract — but none escape the basic math.
The healthy 5 percenters do recognize that Obamacare carries out this transfer. Fleischer complains he is “being taken advantage of.” Frum, writing in the same spirit, complains that he must pay $200 more now that insurers can no longer reward him for his excellent health:
That $200 a month differential seems to be the cost of community rating: I had to answer a bunch of questions about my health before qualifying for my prior plan; the new plan will be issued, no questions asked. Presumably somewhere there is a D.C. resident who smokes or who has some pre-existing condition who will receive a corresponding $200 a month windfall.
The complainers are right. But they won’t quite face up to the full implications of their complaint. If you believe the healthy are entitled to keep the financial benefits of their good health, then you must also believe the sick must be denied medical care. Should that principle be the foundation of our health-care system?
By: Jonathan Chait, New York Magazine, November 1, 2013
“Purposely Stripped Of Context”: When Obamacare Polls Are Accurate Without Being True
As Republicans form a circular firing squad, nervous Democrats continue to believe that this is a depressing time when the future of Obamacare is on the line.
There is some reason for worry: the Koch brothers are spending millions trying to get young people to “opt out” of seeking health insurance at the state level, which could wreck the risk pool essential for the program’s success.
But young people, who as a group support President Obama, aren’t likely to buy Koch lies. And Hollywood progressives are about to unveil a strange-bedfellows alliance with insurance companies that will spend tens of millions of dollars telling Americans the truth — that they are better off with Obamacare being fully implemented.
Meanwhile, the chances of the Affordable Care Act being defunded in Washington are between zero and none, as many Republicans are now acknowledging. Senator Ted Cruz (R-TX) doesn’t have the votes for his strategy of threatening a government shutdown over Obamacare, and everyone but Cruz knows it. Karl Rove wrote an impassioned plea to Republicans not to use this “ill-conceived tactic.” Some analysts believe a government shutdown, which would almost certainly be blamed on the GOP, could even give Democrats an outside shot at winning back the House in 2014.
So why the jitters on the left? At least part of the explanation lies in polls on Obamacare that have been misunderstood or stripped of context. Over and over, Americans have been told that the public doesn’t support the president’s signature achievement. This is true in only the most literal sense of the word. It turns out that the idea behind the new law — universal coverage — is backed by a strong majority.
To get a sense of how the media are misreporting the story, consider a September 15 NBC News/Wall Street Journal poll. As David Weigel has noted in Slate, this is one of the most reliable polls around. It found public widespread ignorance about the law, which will be implemented beginning October 1, and a high level of skepticism about Obamacare’s ability to improve people’s lives The poll reported that 30 percent of respondents thought it would have a negative impact on their families and only 12 percent were convinced it would be positive. More than half felt — accurately — that it would have no impact on their families.
But those weren’t the results that made headlines. It was the overall figure — 43 percent support Obamacare and 54 percent oppose it — that received wide coverage, just as similar poll numbers have in the past.
This is a classic example of something being accurate without being true.
As New York Times columnist Charles Blow has noted, a new CNN/ORC Poll shows that while 35 percent of the public (the conservative base) oppose Obamacare because it’s too liberal, 16 percent oppose it because it isn’t liberal enough.
In other words, 59 percent of the American public either supports Obamacare or wants it to go further.
This casts an entirely new light on the health care debate and further isolates the obstructionists. They are now exposed as radicals who believe in extortion rather than elections — a fringe group of what John McCain in another context called “wacko birds.”
More evidence to bolster that point comes from a CNBC poll that shows the public opposed to cutting off funding for Obamacare by 44 to 38 percent. If it meant a government shutdown, nearly 60 percent oppose defunding. Surely if a majority opposed the idea of Obamacare, a similar majority would oppose the funding of it.
Liberals are justifiably upset about the way public opinion has been misreported on this issue, and most of the blame rests with reporters who don’t probe the internals of polls deeply enough.
But progressives have a role to play in changing the way the polling looks.
Longtime supporters of a single-payer system (I am among them) need to stop telling pollsters that they don’t like Obamacare, even if its provisions seem inadequate to them. Otherwise they will continue to be lumped in with Tea Party types and depicted as standing against a landmark achievement that liberals have been seeking since universal coverage first appeared in Theodore Roosevelt’s Progressive Party (Bull Moose) Platform of 1912.
By: Jonathan Alter, The National Memo, September 23, 2013
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