“Elections Don’t Have Consequences”: In His Warped Mind, Jim DeMint Is Essentially Declaring A Mistrial
Remember the 2012 elections? The one in which Republicans ran on a platform of repealing the Affordable Care Act, and then lost?
If you’re Heritage Foundation President Jim DeMint, helping lead the anti-healthcare crusade, the apparent answer is no.
DeMint thinks the election results don’t accurately reflect national sentiment and therefore can’t be used to argue against his desire to move the party to the right. True conservatism never got a hearing — particularly not in regard to Obamacare, which was, after all, modeled after a Massachusetts law signed by Romney. “Because of Romney and Romneycare, we did not litigate the Obamacare issue,” he says. Essentially, DeMint is declaring a mistrial.
So while John McCain and I — there’s a pairing I didn’t expect to write about — agree that elections have consequences, we nevertheless have Jim DeMint sticking up for the “these elections don’t really count” contingent.
And they don’t count, he argues, because that darned Republican presidential candidate just didn’t push the health care issue. Sure, if you have the memory of a fruit fly, you might not recall Romney promising in every speech for a year and a half to repeal the health care law, the ads promising to destroy the law on Romney’s first day in office, or the central role the anti-Obamacare message played in the Republican pitch in 2012.
But for the rest of us, it’s getting increasingly difficult not to just laugh out loud when Jim DeMint starts talking.
In fact, the closer one looks at this, the more hilarious DeMint appears.
I suspect he’d prefer that we forget, but in 2007, DeMint, then a U.S. senator, endorsed Mitt Romney’s presidential candidacy, citing — you guessed it — Romney’s successful health care reform law in Massachusetts.
And yet, at this point, DeMint no longer remembers his affinity for Romney, his support for Romney’s health care plan, or Romney’s platform from last year’s campaign.
This guy’s the head of a once-relevant think tank?
On a related note, Molly Ball has a great new piece in The Atlantic on Heritage’s dwindling credibility under DeMint’s leadership.
[T]here is more at stake in Heritage’s transformation from august policy shop to political hit squad than the reputation of a D.C. think tank or even the careers of a few squishy GOP politicians. It is the intellectual project of the conservative movement itself. Without Heritage, the GOP’s intellectual backbone is severely weakened, and the party’s chance to retake its place as a substantive voice in American policy is in jeopardy.
As the right embraces a post-policy role in American politics, Republicans can thank DeMint for helping lead the way.
By: Steve Benen, The Maddow Blog, September 26, 2013
“Republican Health Care Panic”: Willing To Risk Economic And Fiscal Crisis To Deny Essential Health Care And Financial Security To Millions
Leading Republicans appear to be nerving themselves up for another round of attempted fiscal blackmail. With the end of the fiscal year looming, they aren’t offering the kinds of compromises that might produce a deal and avoid a government shutdown; instead, they’re drafting extremist legislation — bills that would, for example, cut clean-water grants by 83 percent — that has no chance of becoming law. Furthermore, they’re threatening, once again, to block any rise in the debt ceiling, a move that would damage the U.S. economy and possibly provoke a world financial crisis.
Yet even as Republican politicians seem ready to go on the offensive, there’s a palpable sense of anxiety, even despair, among conservative pundits and analysts. Better-informed people on the right seem, finally, to be facing up to a horrible truth: Health care reform, President Obama’s signature policy achievement, is probably going to work.
And the good news about Obamacare is, I’d argue, what’s driving the Republican Party’s intensified extremism. Successful health reform wouldn’t just be a victory for a president conservatives loathe, it would be an object demonstration of the falseness of right-wing ideology. So Republicans are being driven into a last, desperate effort to head this thing off at the pass.
Some background: Although you’d never know it from all the fulminations, with prominent Republicans routinely comparing Obamacare to slavery, the Affordable Care Act is based on three simple ideas. First, all Americans should have access to affordable insurance, even if they have pre-existing medical problems. Second, people should be induced or required to buy insurance even if they’re currently healthy, so that the risk pool remains reasonably favorable. Third, to prevent the insurance “mandate” from being too onerous, there should be subsidies to hold premiums down as a share of income.
Is such a system workable? For a while, Republicans convinced themselves that it was doomed to failure, and that they could profit politically from the inevitable “train wreck.” But a system along exactly these lines has been operating in Massachusetts since 2006, where it was introduced by a Republican governor. What was his name? Mitt Somethingorother? And no trains have been wrecked so far.
The question is whether the Massachusetts success story can be replicated in other states, especially big states like California and New York with large numbers of uninsured residents. The answer to this question depends, in the first place, on whether insurance companies are willing to offer coverage at reasonable rates. And the answer, so far, is a clear “yes.” In California, insurers came in with bids running significantly below expectations; in New York, it appears that premiums will be cut roughly in half.
So is this a case of something for nothing, in which nobody loses? No. In states like California, which have allowed discrimination based on health status, a small number of young, healthy, affluent residents will see their premiums go up. In New York, people who don’t think they need insurance and are too rich to receive subsidies — probably an even smaller group — will feel put upon by being obliged to buy policies. Mainly, though, those insurance subsidies will cost money, and that money will, to an important extent, be raised through higher taxes on the 1 percent: tax increases that have, by the way, already taken effect.
Over all, then, health reform will help millions of Americans who were previously either too sick or too poor to get the coverage they needed, and also offer a great deal of reassurance to millions more who currently have insurance but fear losing it; it will provide these benefits at the expense of a much smaller number of other Americans, mostly the very well off. It is, if you like, a plan to comfort the afflicted while (slightly) afflicting the comfortable.
And the prospect that such a plan might succeed is anathema to a party whose whole philosophy is built around doing just the opposite, of taking from the “takers” and giving to the “job creators,” known to the rest of us as the “rich.” Hence the brinkmanship.
So will Republicans actually take us to the brink? If they do, it will be crucial to understand why they would do such a thing, when their own leaders have admitted that confrontations over the budget inflict substantial harm on the economy. It won’t be because they fear the budget deficit, which is coming down fast. Nor will it be because they sincerely believe that spending cuts produce prosperity.
No, Republicans may be willing to risk economic and financial crisis solely in order to deny essential health care and financial security to millions of their fellow Americans. Let’s hear it for their noble cause!
By: Paul Krugman, Op-Ed Columnist, The New York Times, July 25, 2013
“Political Skullduggery”: Indiana Fudges Truth On Health Exchange Rates To Make Obamacare Look Bad
Sometimes, the political urge simply overwhelms anything resembling common sense and appropriate behavior.
Witness the latest example of political skullduggery playing out in the great State of Indiana where GOP Governor Mike Pence has found it necessary to take extreme liberties with the reporting of the state’s healthcare exchange data—all to justify his anti-Obamacare political positioning.
Anyone paying attention to data projecting what a health insurance policy will likely cost on the newly formed individual policy insurance exchanges could hardly miss the headlines late last week announcing that premiums for health insurance policies stood to rise to an average monthly price of $570—a 72 percent increase over current rates in Indiana.
Of course, if this data is correct, it would be quite a blow to Indiana residents at the hand of the dreaded Obamacare.
At first glance—the only glance the Indiana officials intend for you to see—this is certainly disturbing news. Even those willing to accept the projections and claims made by the President during last week’s health care address—where he referred to the ‘good news’ in California, Oregon, Washington and, particularly, New York—would have to come to the understanding that there may, indeed, be states where the law is going to badly hurt consumers.
Fortunately, there are those whose job it is to dig below the surface of that ‘first glance’ to discover the truth of any situation—and, in this situation, we learn that Indiana has sought to play cute in its efforts to present a grim picture of the healthcare reform law, even when the data reveals otherwise.
You see, while the states that have already released their projections have based their price expectations on what insurance company filings suggest will be the cost of a ‘Silver’ plan (the second least expensive option to be offered on the exchanges), Indiana decided to publish their projections based on a calculation that took all the levels of plans to be offered—ranging from the less expensive Bronze and Silver plan to the most expensive Gold and Platinum plans—and averaged them all together to come up with their projected rates.
As Sy Mukherjee points out, “That’s like saying the average cost of a car in an Indiana dealership is $100,000 because it sells $20,000 Fords, $60,000 BMWs, and $220,000 Lamborghinis — technically true, but highly misleading.”
Exactly.
What possible benefit can there be to taking an average of costs ranging from most expensive to least expensive when we know full well that the overwhelming majority of those living in Indiana—and, for that matter, everywhere else—will purchase the policies in the lower cost ranges?
How do we know this?
We know this because we have the evidence of buying patterns provided by the State of Massachusetts, a state that has been utilizing this system for quite some time now.
As Sarah Kliff at the Washington Post reports—
“In Massachusetts, 8 percent of enrollees bought a gold plan. Eighty-four percent chose bronze or silver. At least one carrier in Indiana seems to agree with this distribution. In state rate filings, Physicians Health Plan of Indiana estimates that 45 percent of its enrollees will pick bronze and 38 percent take up silver. It is expected that the average mix of Individual Market will be more toward less rich benefit plans and credit should be given for the associated reduction in induced utilization,” the company wrote in its filing. In other words, the average plan cost isn’t a great estimation of what the average person will pay.”
Ms. Kliff also did a little digging to discover that the actual prices for Bronze and Silver plans in Indiana are going to be far below the $512 a month estimate provided by the state’s government.
“Anthem’s rate filing includes projections for health insurance costs in their bronze plans. A 47-year-old male who does not smoke would be charged, on average, $307 per month. Sample plans from another plan, MDWise, predict a 47-year-old man will be charged $294 and $391 for a bronze and silver plan, respectively.”
While you may find the actual rates of the policies to be made available on the Indiana individual exchange to be good news or bad— depending on what you currently pay for health coverage—one would at least hope that the state would want to put out an honest analysis.
“The Fire In Mitt’s Belly”: New Book Reports That Romney Didn’t Want To Run For President In 2012
On an episode of The Office from a few years ago, the desperately insecure character of Andy Bernard (played by Ed Helms) hits upon a strategy to ingratiate himself with people, called “personality mirroring.” He begins not only repeating what people say to him, but adopting the precise manner and mood of whoever he’s talking to. This is pretty much how Mitt Romney went about running for president. A man deeply unsuited to the gladhanding required of a politician made himself into one, through a titanic act of will. And just like when Andy Bernard did it, it was incredibly awkward and off-putting. As the old saying has it, sincerity is the most important thing—if you can fake that, you’ve got it made. Trouble was, Mitt just couldn’t, hard though he might have tried.
And it turns out, Mitt didn’t even want to run for president a second time. Veteran reporter Dan Balz is coming out with a book about the 2012 campaign, and he learned of the internal Romney family deliberations. They took a vote, and ten out of twelve Romneys, including Mitt himself, said he shouldn’t run. Here’s an excerpt:
Mitt Romney had other reasons to think that not running might be the wiser choice. Winning as a moderate from Massachusetts who happened to be Mormon was always going to be difficult. “A lot of the thinking on the part of my brothers and dad was, ‘I’m not sure I can win a primary given those dynamics.'” Tagg Romney said. The prospective candidate also knew the sheer physical and family toll another campaign would take. “He’s a private person and, push comes to shove, he wants to spend time with his family and enjoy his time with them,” his son said. “Even up until the day before he made the announcement, he was looking for excuses to get out of it. If there had been someone who he thought would have made a better president than he, he would gladly have stepped aside.”
I guess the gentle voice of America, whispering to him on the wind that it needed his square jaw and concern for the ruling class, was enough to change Mitt’s mind. But I wonder what he thinks now? We all tend to absolve ourselves of guilt in situations like this, and I’m guessing Mitt now believes there’s nothing he could have done to win. What with Obama showering government goodies on a population of greedy takers, some strategic tinkering wouldn’t have made a difference. But if thinks that now, that would mean that he was wrong when he decided that he couldn’t leave the Republican nomination to the collection of clowns he ended up beating. It’s something of a conundrum. Perhaps late at night, when everyone else is asleep, he rides his car elevator up and down, up and down, replaying the whole campaign in his head.
By: Paul Waldman, Contributing Editor, The American Prospect, July 2, 2013
“How Safe Are Pharmaceutical Supply Chains?”: An Organizational Mindset Is Necessary, Even If Costly In The Short-Term
GlaxoSmithKline announced this week that it is recalling some of its asthma drug Ventolin. The reason: its contract manufacturer said that the syrup bottles might have been contaminated with glass particles.
Last fall, in what 60 Minutes described as “the worst pharmaceutical disaster in decades,” 48 people died in a meningitis outbreak that was traced back to contaminated production in a compounding pharmacy in Massachusetts. The New York Times reported that the U.S. is suffering from a shortage of injectable drugs caused by quality failures at large manufacturers such as Hospira.
As a result of these and other stories, the quality of our medicines, or more precisely the failure in quality, has gained widespread attention.
Many believe the solution is to increase business investment in capital equipment. Hospira announced last year that it would spend hundreds of millions of dollars on a new state-of-the-art plant and quality and operations specialists. David Gaugh, vice president for the Generic Pharmaceutical Association, said that the perception that injectable drugs are produced in run-down facilities was “absolutely not true” and compared them to well-maintained vintage cars. This focus on technology might appear reasonable; but it is not sufficient.
The only way to guarantee that no defective drugs are ever produced is to never produce any drugs. None of us wants a world without medicine, and thus, we must live with some risk of quality failures in our drug supply chains. Because testing pharmaceuticals for every theoretically-possible contaminant or process deviation is prohibitively expensive if not impossible, drug quality must be built into the product through well-designed production processes, the use of quality ingredients and the consistent adherence to quality control procedures.
Aware of this, regulators long ago established “Good Manufacturing Practices,” known as GMPs, in the pharmaceutical industry. Operating in full compliance with these legally-required GMPs greatly reduces the risk of contaminated or misformulated product reaching the market. It seems that many of the plants highlighted in recent reports were not adhering to GMPs.
To address the problem, it is necessary that executives develop a quality-oriented mindset across the entire supply chain. For example, are employees empowered and encouraged to report deviations from GMPs, even if doing so is costly in the short term? Are deviations investigated and corrective actions put in place, even if doing so requires failing to meet promised delivery dates? Absent such an organizational mindset, quality failures will occur even with the best technology.
This soft side of quality management does not come easily. It often takes years of time to embed in a company, and even a longer time to regenerate if the culture has been undermined. Our research (with co-authors) has found that is difficult for companies to prevent a “decay” in GMP adherence even in their own factories.
When production is outsourced, ensuring adherence is more challenging. Recognizing this, the Food and Drug Administration is currently seeking comment on a “Guidance for Industry” document on quality agreements in contract manufacturing. The document focuses on clarifying responsibilities. Most companies engage in some form of certification, facility audits and product inspections with their contract manufacturers. While clear responsibilities and such actions can help to ensure quality at contractors, they do not guarantee consistent day-to-day adherence to good manufacturing practices.
Using FDA inspection data, we (and co-authors) have studied quality risk in the pharmaceutical industry. In one set of studies, we found that plants in a location with a different primary language than the firm’s headquarters operate with less GMP compliance than those with no language difference. Regarding outsourcing, we did not find an overall difference in quality risk between company-owned plants and contract manufacturer plants.
However, we did find a higher quality risk for small contract manufacturers and those subject to less regulation. Given this, we were not altogether surprised that these lightly regulated, small compounding companies like NECC were found to operate with high quality risk.
Taken together, our research provides empirical evidence that drug manufacturers are hard-pressed to consistently maintain high quality operations even in their own domestic facilities. This challenge is magnified when production is performed in offshore and outsourced plants. Our study and related studies reinforce the recent call to increase FDA regulatory scrutiny of compounders; this is clearly necessary and will help prevent future tragedies such as the recent meningitis outbreak.
However, regulatory and technical solutions alone are not adequate—an organizational mindset of compliance with GMPs is necessary throughout a drug’s supply chain, even if developing and maintaining this mindset is costly in the short-term.
By: John Gray, Aleda Roth & Brian Tomlin, U. S. News and World Report, June 21, 2013
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