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“Clouded By Misperceptions”: Five Myths About The Health-Care Law

The Supreme Court will hear three days of arguments starting Monday on whether President Obama’s Affordable Care Act is constitutional. Twenty-six states have filed challenges to the health-care reform law. The main issue, on which the lower courts have split, is whether Congress had the power to pass this law under the Constitution’s commerce clause. The answers to that and other questions are clouded by misperceptions about the law itself. Let’s debunk them.

1. The “individual mandate” forces everyone to buy health insurance.

The law states that, beginning in 2014, individuals must ensure that they and their dependents are covered by health insurance. Taxpayers who do not meet this requirement will have to pay a penalty that the law calls a “shared responsibility payment.” It begins at $95 for the first year and never exceeds 21/2 percent of anyone’s annual taxable income.

A large majority of Americans, of course, have health insurance through their employers, Medicare or Medicaid and are already in compliance with this requirement. Given the relatively modest payment required of those who choose not to maintain insurance, no one is being forced to buy a product they don’t want.

The challengers argue that the mandate is a binding requirement that makes anyone who goes without insurance a lawbreaker. The government has determined, however, that those who pay the penalty, like those who are exempt from the penalty, are not lawbreakers. As a practical matter, the so-called mandate is just a relatively modest financial incentive to have health insurance.

2. Only the individual mandate is at stake in the Supreme Court case.

The mandate is not a stand-alone provision that can be invalidated without affecting the rest of the law. In fact, it is merely an ancillary measure that makes two more-fundamental provisions of the law workable: “guaranteed issue” and “community rating.”

A significant problem with our nation’s health-care system has been that insurance companies can reject applicants who have had health problems, including minor ones. The guaranteed issue provision prevents companies from turning down applicants because of their medical conditions or history. The community rating measure bars insurers from charging higher premiums to those who have had illnesses or accidents.

Experience in the states has shown that if people can’t be turned down for health insurance, there must be an incentive for them to sign up for it before they have an accident or illness. The individual mandate was enacted to ensure that the central, nondiscrimination provisions can work as they were intended — to provide everyone access to affordable health care, regardless of their medical history or current conditions.

If the court were to strike down the mandate, the law’s popular provisions on preexisting conditions would fall as well.

3. If the court upholds the health-care law, it means Congress has the power to require Americans to purchase any product.

The health-care case is a test of Congress’s power under the Constitution to regulate commerce among the states. One way to defend the law is simply to say that a requirement to purchase insurance or any other product sold in interstate commerce is obviously a regulation of that commerce. President Ronald Reagan’s solicitor general, Charles Fried, and conservative judge Laurence Silberman have adopted this view.

The Obama administration is not relying upon such a sweeping argument, however, and its more limited claim would not justify any law that required Americans to buy products such as cars or broccoli.

The mandate does not force people into commerce who would otherwise remain outside it. Instead, it regulates the consumption of health care, an activity in which virtually everyone will engage. Right now, people who go without insurance often shift the costs of their health care to other patients and taxpayers. That situation is different from what happens with any other type of purchase.

Would the government’s defense of the mandate also support a law requiring Americans to buy broccoli or a car? The answer is a simple and emphatic no.

4. The law is socialist.

Actually, the opposite is true. The principal reason the Affordable Care Act has been called unprecedented is that it declines to follow the New Deal approach of having a monolithic government agency be the single provider of a good or service. Instead, the law adopts a new approach, one conservatives have long supported, of using providers in the private market to deal with social and economic problems.

In defending his “Massachusetts mandate” as a conservative model for national health-care legislation, former governor Mitt Romney editorialized in 2009 that by imposing tax penalties on people who choose to remain uninsured, an individual mandate “encourages ‘free riders’ to take responsibilities for themselves rather than pass their medical costs on to others.” And, as Romney noted, conservatives have never been inclined to favor freeloaders.

5. The law is an extraordinary intrusion into liberty.

Liberty is always said to be fatally eroded, it seems, when great advances in social legislation take place. The lawyers who urged the Supreme Court to strike down the Social Security Act of 1935 argued that if Congress could provide a retirement system for everyone 65 and older, it would have the power to set the retirement age at 30 and force the very young to support everyone else.

It was said that if Congress had the authority to create a minimum wage of $5 an hour, it would also be a regulation of commerce to set the minimum at $5,000 an hour. In 1964, critics argued that if Congress could tell restaurant owners not to discriminate on the basis of race, it could tell them what color tablecloths to use. None of these things happened.

Nothing in the health-care law tells doctors what they must say to patients or how those patients are to be treated. It only requires people to either have insurance coverage or pay a modest tax penalty.

Nearly 75 years ago, a Supreme Court dominated by appointees of conservative presidents rejected the challenge to the constitutionality of the Social Security Act. The words of Justice Benjamin Cardozo’s 1937 opinion are relevant today:

“Whether wisdom or unwisdom resides in [the statute in question] it is not for us to say. The answer to such inquiries must come from Congress, not the courts.”


By: Walter Dellinger, The Washington Post, March 23, 2012

March 25, 2012 Posted by | Affordable Care Act, Constitution | , , , , , , , | Leave a comment

“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

March 13, 2012 Posted by | Affordable Care Act, Election 2012 | , , , , , , | 2 Comments

Mitt Romney: The Anti-Jobs Candidate

My friend Peter Daou had an item the other day, noting the potency of the Republican presidential frontrunner’s message: “Romney is a threat because he can focus on a dead simple message: ‘I’m a successful businessman, I’ll create jobs and fix the economy.’”

That’s exactly right. Mitt Romney, at least this latest version of him, has an entire campaign rationale that fits comfortably into a tweet. Better yet, it’s a message that voters are eager to hear.

Ed Kilgore had a related piece on this the other day, summarizing the argument that Romney and his backers are likely to push aggressively: “Romney has an extensive corporate background, looks the part of a CEO, and without question, he would prefer an issues environment focused on anything other than health care reform or the cultural issues on which he’s never inspired trust among conservatives.”

Romney doesn’t want to talk about health care or the fact that he was a pro-choice moderate who supported gay rights and gun control. Indeed, he would just as soon hope people forget he was even a governor. This is Businessman Mitt, running as a less ridiculous version of Herman Cain.

Kilgore’s argument is that this message is simple and straightforward, but it probably won’t help him in a competitive Republican primary. That’s compelling, but my take is a little different: I think Romney’s biggest problem is that the message brings to the fore his key weaknesses — Romney’s record on jobs is atrocious.

Stephen Colbert devoted a terrific segment to this the other day, highlighting Romney’s “real claim to business fame,” which is “founding a private equity company called BainCapital.” The embed won’t fit the column length of the redesigned website, but here’s heart of Colbert’s take:

“You see, Romney made a Mittload of cash using what’s known as a leveraged buyout. He’d buy a company with ‘money borrowed against their assets, groomed them to be sold off and in the interim collect huge management fees.’ Once Mitt had control of the company, he’d cut frivolous spending like jobs, workers, employees, and jobs. Just like America’s sweetheart, Gordon Gecko. […]

“Because Mitt Romney knows just how to trim the fat. He rescued businesses like Dade Behring, Stage Stories, American Pad and Paper, and GS Industries, then his company sold them for a profit of $578 million after which all of those firms declared bankruptcy. Which sounds bad, but don’t worry, almost no one worked there anymore.

“Besides, a businessman can’t be weighed down with a bleeding heart, as one former Bain employee put it, ‘It was very clinical…. Like a doctor. When the patient is dead, you just move on to the next patient.’ See? Mitt Romney is like a doctor! [On screen: Dr. Kevorkian]”

And this is the part of Romney’s record he’s most proud of. Romney slashed American jobs as if his career depended on it — and it did.

Complicating matters, during Romney’s only service in public office, his state’s record on job creation was “one of the worst in the country.” Adding insult to injury, “By the end of his four years in office, Massachusetts had squeezed out a net gain in payroll jobs of just 1 percent, compared with job growth of 5.3 percent for the nation as a whole.”

How bad is Romney’s record? During his tenure, Massachusetts ranked 47th out of 50 states in jobs growth.

Yes, Romney has a simple message: “I’m a successful businessman, I’ll create jobs and fix the economy.” It also comes with an equally simple response: “Mitt Romney is the anti-jobs candidate.”


By: Steve Benen, Contributing Writer, Washington Monthly-Political Animal, June 12, 2011

June 12, 2011 Posted by | Bankruptcy, Businesses, Conservatives, Corporations, Economy, Elections, GOP, Ideologues, Ideology, Jobs, Mitt Romney, Politics, Republicans | , , , , , , , , , | Leave a comment

Mitt Romney’s Flawed View Of Freedom

The bales of hay were stacked strategically in the hope that they’d make it into the television screen. The sturdy white barn nearby provided an image worthy of a Christmas card, the symbol of a solid, calm, industrious and confident country. The slogan behind the candidate, “Believe in America,” did not invite debate.

Whatever the punditocracy may have made of Mitt Romney’s formal announcement of his presidential candidacy last week, we could all give the guy credit for trying to reassure us that not everything in politics has changed.

In an age of media flying circuses where you never know who is running for president and who is just trying to boost book sales and speaking fees, Romney did it the old-fashioned way. He really, really wants to be president, and he offered pretty pictures to encourage us to watch him saying so. It was the venerable liturgy of our civil religion.

Unfortunately for Romney, he barely got his moment in the sun because dark clouds rolled in. Sarah Palin and Rudy Giuliani showed up in New Hampshire on the former Massachusetts governor’s magical day, underscoring why Romney is plagued by the word “putative,” which almost always appears before “front-runner.”

But Romney’s travails are about more than the man himself. They speak to the
condition of a party that won’t let him embrace his actual record and constantly
requires him — and all other Republicans — to say outlandish things.

Romney’s greatest political achievement, the Massachusetts health-care law, was a genuinely masterful piece of politics and policy. The New Yorker’s Ryan Lizza recently wrote a superb article about how Romney got the plan passed. The campaign should be
reproducing the article in bulk. Instead, Romney’s lieutenants will pray that Republican primary voters never read the story. Working with those horrid Democrats to pass any sort of forward-looking government program is now forbidden.

When Romney spoke at Doug and Stella Scamman’s Bittersweet Farm, he was guarded in talking about his health plan, saying he “hammered out a solution that took a bad situation and made it better. Not perfect, but it was a state solution to our state’s
problem.” The crowd gave him modest cheers when he got to the part about health
care being a state problem.

But he received what was, by my reckoning, his loudest response when he pledged “a complete repeal of Obamacare.” That’s where the GOP heart is, and Palin and Giuliani both got into most of the Romney announcement stories by bashing him on health care. When you’re forced to tiptoe around your accomplishments, it’s no wonder you get accused of shifting your shape.

Yet it was Romney himself who exposed contemporary conservatism’s core flaw.
“Did you know,” he asked, “that government — federal, state and local — under
President Obama, has grown to consume almost 40 percent of our economy? We’re
only inches away from ceasing to be a free economy.”

Actually, the federal government of which Obama is in charge “consumes” about a quarter of the economy — and this after a severe recession, when government’s share
naturally goes up.

But even granting Romney his addition of spending by all levels of government, the notion that we are “inches away from ceasing to be a free economy” is worse than absurd. It suggests that the only way we measure whether an economy and a country are “free” is by toting up how much government spends.

Are we less “free” because we spend money on public schools and student loans, Medicare and Medicaid, police and firefighters, roads and transit, national defense and environmental protection? Would we be “freer” if government spent zero percent of the economy and just stopped doing things?

Romney, presumably, doesn’t think this, but the logic of what he said points
in exactly that direction. We thus confront in 2012 nothing short of a fundamental argument over what the word “freedom” means. If freedom, as the conservatives seem to insist, comes down primarily to the quantity of government spending, then a country such as Sweden, where government spends quite a lot, would be less “free” than a right-wing dictatorship that had no welfare state and no public schools — but also didn’t allow its people to speak, pray, write or organize as they wish.

Many of us “believe in America” because we believe its history shows that our
sacred liberties are compatible with a rather substantial government that invests in efforts to expand the freedom from want, the freedom from fear, the freedom from unfair treatment and the freedom to improve ourselves. That, as the politicians like to say, is what this campaign is all about.


By: E. J. Dionne, Opinion Writer, The Washington Post, June 6, 2011

June 10, 2011 Posted by | Affordable Care Act, Conservatives, Democracy, Democrats, Economy, Elections, Freedom, GOP, Government, Health Care Costs, Ideologues, Ideology, Liberty, Media, Medicaid, Medicare, Mitt Romney, Politics, Republicans, Voters | , , , , , | Leave a comment

Mitt! Mitt! Mitt!: It’s A Bad Sign When One Of Your Errors Is Your Book Title

This was the week we’ve been waiting for! Decades into the future, you will be able to tell your grandchildren where you were when Mitt Romney announced that he had formed a presidential exploratory committee.

Who knew he needed to explore? He said he was running on his Christmas card, for Lord’s sake.

My job today is to give you a run-through of every book Mitt Romney has ever written. Fortunately, there are only two: “Turnaround,” which is about his stint as the leader of the troubled 2002 Salt Lake City Olympic Games, and “No Apology,” his campaign tome, which used to be subtitled “The Case for American Greatness” but is now “Believe in America.”

Perhaps three. When the new paperback edition of “No Apology” came out in February, early readers noted that not only had Romney added a new subtitle but also a new preface, ranting about the founders-hating big spenders who are now running the country. And, most notably, he had also changed some critical chunks of the original to make the text more Tea Party-friendly.

For instance, paperback Romney has now noticed that the Massachusetts health insurance law that he championed as governor does have some flaws, all of which are because of anti-freedom provisions that the Democrats in the State Legislature put in. Also, the stimulus was way, way worse than he originally thought.

We all know that Mitt has a habit of, um, mutating to the political winds. So even in its earlier incarnation, the book had a decidedly uneven tone. “Despite my affiliation with the Republican Party, I don’t think of myself as highly partisan,” Moderate Mitt wrote toward the end. This comes after 300 pages of unrelenting attacks on Barack Obama and every member of his party since Andrew Jackson. He blames Bill Clinton for everything from cutting military spending to presiding over an administration during which “birth to teenage mothers rose to their highest level in decades.” I’m sure this week’s Romney does not regard that as a partisan statement even though teenage birth rates actually fell spectacularly during that exact period.

The book is heavy into policy and rather sparse on personal history, except for the parts that relate to his dad being a successful businessman and Mitt himself being an entrepreneurial hero along the deal-making, business-closing, job-slashing private equity line. Romney’s earlier book, “Turnaround,” had some great stories about his Mormon ancestors, including a great-grandmother who single-handedly drove her children to Mexico in a covered wagon during the Indian wars. “At one point along the way, she came across freshly slaughtered U.S. Cavalry horses. She paused only long enough to pry the shoes from the wasted horses, re-shod her own wagon horses, and journey on,” he wrote. Truly, “No Apology” could use a whole lot more of Hannah Romney and a whole lot less about the causes of the decline of the Ottoman Empire.

Also, there is not a single mention in “No Apology” of the fact that Romney once drove to Canada with the family Irish setter strapped to the roof of the car. I regard this as a critical oversight, although perhaps it was Seamus that Romney was thinking of when he chose his title.

But, according to the book, “No Apology” refers to Romney’s objections to President Obama’s alleged habit of going around the world, asking other countries to forgive America for its faults. This Obama apologizing tour is an article of Tea Party faith, but one that PolitiFact analyzed a while back and found it to be false. (“Yes, there is criticism in some of his speeches, but it’s typically leavened by praise for the United States and its ideals.”)

Anybody can make a mistake, but it’s a bad sign when one of your errors is your title.

Of all the awful books by presidential candidates I have read this year, “No Apology” was the hardest to get through. To be fair, Romney does write a lot about the issues, but in a way that makes you feel as if you’re trapped at a school assembly where a long-winded donor is telling you what life is all about. (“If I may return to my engine analogy from earlier in this chapter: Our economy is powered by two pistons …”)

“Turnaround” is a much easier book to read, even though it requires a pretty keen interest in how the Salt Lake City Olympics planners saved the day after Mitt took over in 1999. I was particularly fascinated by Romney’s insistent contention that he is a fun guy. (“I love jokes, and I love laughing.”) There is not much evidence of actual humor, although Romney says that when he visited the Clinton White House, he prankishly protested being given a visitor’s badge that had a red A on it, saying, “I’m not the one that cheated on my wife.”

Maybe you had to be there.

By: Gail Collins, Op-Ed Columnist, The New York Times, April 15, 2011

April 16, 2011 Posted by | Birthers, Conservatives, Democrats, Elections, Exploratory Presidential Committees, Freedom, GOP, Governors, Independents, Jobs, Mitt Romney, Politics, Teaparty, Voters | , , , , , , , | Leave a comment


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