“For GOP, ‘Obamacare’ Is Inherently Bad, Even When It’s Good”: Focusing On Guns And Mental Health Means Talking About The ACA
In the wake of every mass-shooting – events that occur with heartbreaking regularity in the United States, but no other industrialized democracy – political rhetoric tends to follow a predictable trajectory. Democratic officials, in general, raise the prospect of new policies to curtail gun violence.
And Republican officials, in general, decry such efforts as anti-freedom, preferring to focus on practically anything else. For some on the right, mass shootings serve as an excuse to renew conversations about violent entertainment (though plenty of other countries enjoy similar cultural fare without violent consequences). For others, gun massacres are reason to start merging religion and public schools (as if the Second Amendment is inviolate, but the First Amendment is malleable).
But in recent months, a focus on mental health – which must have tested well with focus groups – has become one of the GOP’s principal talking points. Senate Majority Whip John Cornyn (R-Texas), the day of the mass-shooting in Oregon last week, urged President Obama to back Cornyn’s bill “to address mental health factor in mass violence incidents.”
In the Washington Post over the weekend, University of Chicago professor Harold Pollack described some provisions of Cornyn’s proposal as “helpful and constructive,” but highlighted a missing piece of the puzzle.
Cornyn’s proposal does not address the most glaring issue in American mental health policy: the Affordable Care Act’s Medicaid expansion. Medicaid expansion was always the public health cornerstone of ACA. It remains the single most important measure to expand access to mental health and addiction treatment, serving severely vulnerable populations such as the homeless, addressing the complicated medical and psychiatric difficulties of many young men cycling through our jails and prisons.
I suspect that for many Republicans, the idea of “Obamacare” playing a meaningful role in preventing mass-shootings must sound ridiculous. After all, “Obamacare” is inherently bad, even when it’s good, and all of its provisions must be rejected because, well, just because.
But Pollack is entirely correct, and if GOP officials are going to ignore gun-safety measures to focus on mental health, they should probably grow up and reconcile their mental-health rhetoric with their mindless, knee-jerk hostility towards Medicaid expansion through the ACA.
Indeed, Pollack’s Washington Post piece added:
In 2013, the National Alliance on Mental Illness (NAMI) released a report endorsing Medicaid expansion. The report argued that “States that decline to expand Medicaid will miss as good an opportunity as they may ever have to address this shameful void in access to mental health treatment.” Addressing the connection between mental illness and violence, NAMI concluded:
“In the aftermath of Newtown, many politicians and policy makers have promised to take steps to fix America’s broken mental health system. Expanding Medicaid in all states would represent a significant step towards keeping those promises.”
My suspicion, based on years of conservative apoplexy about expanding Americans’ access to affordable health security, is that when Republicans talk about mental health as a substitute for a debate about gun policy, they’re creating a smoke screen. Many of these partisans aren’t serious about expanding mental-health services, so much as they’re pushing a talking point to circumvent an even less pleasant conversation about the frequency of gun deaths in the United States.
They can, however, prove these suspicions wrong fairly easily. Pollack concluded, “If any other politician suggests that mental health rather than gun policy is central to reducing mass homicides, ask where they stand on Medicaid expansion. Their answer will be clarifying.”
Let’s start with Senator Cornyn, who fought tooth and nail to block Medicaid expansion in Texas, despite the fact that Texas has the highest uninsured rate in the entire country. Any chance he’ll consider a new, more constructive posture on the issue as part of his renewed interest on the issue of mental health?
By: Steve Benen, The Maddow Blog, October 5, 2015
“Obamacare After Obama”: The Next President Should Be Grateful To Have A Universal Health Care Program On Which To Build
The morning of the recent Republican debate, the U.S. Census Bureau reported that the number of uninsured Americans in 2014 had dropped by about 9 million from the year before. This was thanks, of course, to the Affordable Care Act.
So it did cross one’s mind that at least one of the Republican presidential candidates might lend a kind word to Obamacare. After all, some of the largest gains in health coverage were among moderate-income families, a group including much of the Republican base.
A futile hope. Not even Govs. John Kasich of Ohio and Chris Christie of New Jersey — who, to their credit, had accepted the law’s expansion of Medicaid coverage in their states — offered a shred of praise. Instead we heard vows to basically blow it up, the main difference being the number of dynamite sticks to use.
Grudging appreciation for Obamacare has also extended to significant parts of the Democratic base. In the 2012 election, many Democratic candidates actually avoided discussing it. You see, a flood of anti-Obamacare propaganda — which Democrats had neglected to counter — caused support for the program to swoon in the polls.The new Census Bureau numbers show that African-Americans and Latinos have enjoyed an especially sharp rise in health coverage under Obamacare. And that makes it painful to contemplate these groups’ dismal turnout in the 2014 midterm elections.
Back then, the newly won guaranteed health coverage was under grave threat. Republicans had tried to repeal Obamacare dozens of times. Had a case before the U.S. Supreme Court gone badly, the program could well have been destroyed.
You’d think that low-income Americans would have marched to the polls waving Obamacare flags. Problem was their so-called advocates had moved on to immigration and income inequality and saw the elections as an occasion to blame Democrats for what they held was inadequate progress. They forgot there was something precious to defend — and that Obamacare was a huge advance against said inequality.
Nowadays, Hillary Clinton not only is waving the flag but has hired a brass brand to march behind it. We await the details of her proposals for improving the program. Same goes for Joe Biden, should he choose to run.
Sen. Bernie Sanders, the Vermont independent seeking the Democratic nomination, gives Obamacare two cheers but not enough credit. In a recent CNN interview, he said he wants a “Medicare-for-all single-payer health care system.”
Expanding Medicare to everyone happens to be a super idea. But we must note that Medicare is not single payer. It is a multi-payer program combining government and private coverage. As such, Medicare is more like the top-ranked French and German health care systems than it is the good, but not-as-good, Canadian single-payer program.
Because Medicare has strong public support, Medicare for all can be imagined. It would be a very hard political sell, however. Recall that Democrats couldn’t even get the “public option” past Congress. That was to be a government-run health plan to compete on the new insurance exchanges with the private ones.
Sanders’ own Vermont tried but failed to put together a modified single-payer health plan. If Vermont can’t do single payer…
Suffice it to say, it would take a master politician to get a greatly expanded Medicare passed in this country. A master politician Sanders is not. But may his vision live on.
Happily, Obamacare now seems safe. Its imperfections well-documented, it remains a work in progress. But whoever is the next president should be grateful to have a universal health care program on which to build.
By: Froma Harrop, The National Memo, September 22, 2015
“The Equivalent Of Thinking The Iraq War Would Be A Cakewalk”: Why The GOP Presidential Candidates Can’t Reform Health Care
In the last few days, Scott Walker and Marco Rubio released health care plans, and other Republican candidates are sure to follow soon. Most will probably be pretty similar, even if some are more fully fleshed out than others.
But they’ll all share one feature, the thing that tells you that they aren’t even remotely serious about this issue: they will take as their starting point that the entire Affordable Care Act should be repealed.
I say that that shows they aren’t serious not because I think the ACA has done a great deal of good, though I do think that. I say it because it shows that they’re completely unwilling to grapple with both the health care system as it exists today, and how incredibly disruptive the wholesale changes they’re proposing would be. Walker’s plan even says, “unlike the disruption caused by ObamaCare, my plan would allow for a smooth, easy transition into a better health care system.” This is the health care equivalent of thinking the Iraq War would be a cakewalk.
The reality is that repealing the ACA now that it has been implemented would mean a complete and utter transformation of American health care. Republicans have often lamented that the law was so terribly long and included many different rules and regulations — yet now they act as though the law amounts to just a couple of rules here and there that can therefore be tossed out without too much trouble. But they were right the first time: the law is indeed complex, and has brought hundreds of changes big and small to American health care, not just in how people get insurance but in how Medicare and Medicaid work, how doctors and hospitals are paid, and in all sorts of other areas.
The ACA established health care exchanges. It brought millions of people into Medicaid, it closed the Medicare prescription drug “doughnut hole.” It gave subsidies to small businesses. It funded pilot projects to explore new means of providing and paying for care, it imposed new regulations on insurance companies. It created new wellness and preventive care programs, it provided new funding for community health centers. It did all that, and much more. You can argue that each one of these was a good or a bad idea, but you can’t pretend that unwinding them all would be anything resembling a “smooth, easy transition.”
We know why every Republican health care plan has to start with repealing the ACA: politics. Republicans have spent the last five years telling their constituents that they’re going to repeal it any day now, and they’ve held over 50 repeal votes in Congress. They’ve refused to admit that a word of it has any merit, even as they try to incorporate some of its more popular reforms (like protections for people with pre-existing conditions) into their own plans. So they’ve backed themselves into a corner where whatever any Republican offers has to start with repeal.
Which is why all their plans, the ones that have been released and the ones yet to come, are absurdly unrealistic. They pretend that it will be no problem to completely transform the American health care system — and there will be no losers in such a transformation, only winners — which shows that they have no intention of actually doing so. In fact, I’d go so far as to say that if a Republican gets elected next November, he’ll be relieved when his health care plan dies in Congress.
Let’s contrast that with how Democrats acted in 2008, when there was a vigorous debate in the presidential primary over health care. The three leading candidates, Barack Obama, Hillary Clinton, and John Edwards, all had very similar plans, similar because they reflected the Democratic consensus on health care reform that had evolved in the decade and a half since Bill Clinton’s reform effort failed. One major disagreement was over whether there had to be an individual mandate — Clinton’s plan had one, and Obama’s didn’t — but when he took office, Obama accepted that the mandate was necessary to make the entire plan work. It wasn’t a fantasy plan that just pandered to liberal hopes, it was something that could actually pass and be implemented.
Whenever liberals told Obama that a single-payer health plan would be far superior to what he was proposing, he would respond that if we were starting from scratch, that would probably be true. But, he’d say, we aren’t starting from scratch, so the ACA has to accommodate itself to the health care system that already exists. The result was a gigantic kludge, new complexity layered on top of an already complex system in an attempt to solve its varied shortcomings. Like all kludges, it seemed like the realistic option given the situation we confronted, but it left us with something that was far from perfect.
A Republican who actually wanted to pass real health care reform would have to approach the problem the same way: by saying that for better or worse, the Affordable Care Act has already affected the system in profound ways, so any realistic plan has to understand what those changes are, and find the most efficient way to keep the ones that are working and change the ones that aren’t. That doesn’t mean that repeal is impossible, just that it would be a spectacular upheaval, one that I promise you Republicans have no genuine appetite for. Remember all the screaming and shouting they did over the people on the individual market whose previous plans didn’t qualify under the new regulations, and who had to shop for new plans? Multiply that by ten or twenty times, because that’s how many people would likely lose their existing coverage if you repealed the ACA in one fell swoop.
And that would be only the beginning. So when any Republican candidate says he or she has a plan to reform health care, take a close look. If it starts with repealing the ACA — and it will — then you’ll know it isn’t serious and it’s never going to happen.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The PlumLine, The Washington Post, August 20, 2015
“Struggling To Justify A Heresy”: Are Republicans Falling Out Of Love With Ronald Reagan?
The first big Republican presidential primary debate defied expectations in any number of ways. But one of the most surprising things may have been that only five of the 10 candidates invoked the memory of that most sainted Republican, that giant among dwarves, that demigod among mortals, America’s greatest president and a man who walked the Earth without sin. I speak, of course, of Ronald Reagan.
How on Earth did the other five candidates forget to speak his name and clothe themselves in his holy memory?
In the “undercard” debate that took place hours before the main event, the ratio was a bit better — four of the seven candidates invoked Reagan. But the trend still held. Could it be that the power of invoking Reagan is beginning to fade — even if only a bit?
Consider that, with the exception of Donald Trump, the Republican candidates who mentioned Reagan in the prime-time debate — Ted Cruz, Rand Paul, Mike Huckabee, and John Kasich — are all stuck in single digits, as are all the candidates from the undercard. Furthermore, many of the mentions came when a candidate was struggling to justify a heresy, as if to say, “Please don’t be too angry with me about this, because Reagan did it too.”
Defending his switch from pro-choice to pro-life, Trump said, “Ronald Reagan evolved on many issues.” Paul, explaining why he’s not the hawk other Republicans are, said, “I’m a Reagan conservative. Reagan did negotiate with the Soviets.” And Kasich explained his support of the Affordable Care Act’s expansion of Medicaid by saying, “President Reagan expanded Medicaid three or four times.” Only Cruz offered a good old-fashioned song of praise, when he said with a stirring voice and passion in his eyes, “It is worth emphasizing that Iran released our hostages in 1981 the day Ronald Reagan was sworn into office.” (I won’t bother going over the history of that event, except to say that it didn’t happen because the Iranians were so terrified of Reagan’s steely resolve.)
In a group of people who worship Reagan, maybe there’s little to be gained by reiterating your love for him; it would be like a cardinal saying he ought to be pope because he is in fact a Catholic. Or maybe it’s that a full quarter-century after Reagan left office, even Republicans have a somewhat more realistic view of his presidency than they used to.
I’d like to think that if the importance of Reagan as a totem is fading, it has at least something to do with liberals like me, even if that seems a little far-fetched. We have spent a lot of time not only mocking Republicans for their worship of Reagan, but also pointing out that he was a far more complicated president than they claim. His record even includes a number of decisions that today look downright liberal. He did indeed negotiate with the Soviets (to the dismay of many Republican hard-liners at the time), he raised taxes repeatedly, the deficit ballooned on his watch, and instead of setting out to destroy government entitlements, he partnered with liberals to save Social Security in 1983 (more details can be found here).
That isn’t to say that Reagan wasn’t a strong conservative, because he was. But he was president in another era, when being a Republican meant something rather different than it does today.
Up until the last few years, you could be a Republican in good standing while still being pragmatic. But today’s Republican Party isn’t just more conservative on policy, it has become doctrinaire in a way it didn’t used to be. Compromise itself — regardless of the context or the content — is now held by all right-thinking Republicans to be inherently evil. Far too much is made of Reagan’s alleged friendship with Democratic House Speaker Tip O’Neill, but it’s true that Reagan could be friendly with his political opponents. Today, every Republican has to express a deep and intense loathing for Barack Obama and Hillary Clinton if they hope to win their party’s favor. The Tea Party essentially took over the GOP after Obama’s election, forcing everyone in the party to prove again and again that their hearts are pure and they’d rather lose everything than willingly give an inch on anything. Entire organizations now exist to police elected Republicans for signs of heresy, and punish those who fail to measure up.
So maybe that’s why you now hear Reagan invoked mostly defensively. The one who does it knows that he has transgressed, and hopes that the aura of Saint Ronnie will cleanse him of his sins and bring him before the primary electorate clean and unsullied. But it doesn’t seem to work — Republicans are vigilant for even the faintest whiff of impurity, and no amount of Reagan-invocation will distract them once they’ve caught the scent. If that’s true, we might hear his name spoken less and less often as time goes on.
By: Paul Waldman, Senior Writer, The American Prospect; Contributor, The Week, August 10, 2015
“The First Republican Debate”: The Trump Show, The Kasich Dissent And Everybody Else
I saw three shows tonight during Fox News’ Republican debate: The Trump Show, The Kasich Dissent, and Everybody Else. Among those in that last category, Jeb Bush had a good night, New Jersey Gov. Chris Christie had his moments, and Sen. Marco Rubio (R-Fla.) won more friends.
Although he occasionally disappeared from view, Donald Trump was the central figure, particularly during the first hour. I can’t do any better on Trump than MSNBC’s Kasie Hunt, who tweeted: “Everyone was asking, which Trump would show up? There is only one, and he showed up to play.”
Yes, he did. From the very first moment of the debate, when he refused to rule out a third party run, to his defense of what we’ll call boorish comments about women to his reprise of his position on immigration, it was the same Trump who has risen to the top of the GOP polls.
There are moments that could hurt him. Certainly some Republicans will resent his refusal to pledge his support for the party’s nominee (unless, of course, it is he). In answering Fox News’s Megyn Kelly on women’s issues and his past comments on women, Trump’s in-your-face reply — “I’ve been very nice to you although I could probably not be based on the way you have treated me” – no doubt went badly with some viewers, particularly women.
But Trump has been entirely immune from the usual laws of politics, so it’s possible that his supporters will just keep cheering his violation of all the political conventions and his insistence on being himself. Fox itself and conservative talk radio hosts, with their power to influence Republicans, could influence how the faithful view these and other choice Donald moments.
Ohio Gov. John Kasich, playing on his home turf in Cleveland, stood out as decidedly different from all his foes. He was “compassionate conservatism” come back to life. A Republican who not only accepted the Medicaid expansion under Obamacare but actually fought for it, Kasich didn’t back away. Instead, he offered a passionate and spirited defense of the program and a description of the good it does. Praising Medicaid is something that’s just not done at GOP events.
Medicaid money, he said, allowed the state to treat the mentally ill in prisons and those addicted to drugs. “The working poor, instead of having them come into the emergency rooms where it costs more where they’re sicker and we end up paying, we brought a program in here to make sure that people could get on their feet,” he said. “And you know what, everybody has a right to their God-given purpose.”
Kasich also gave an empathetic answer when asked about gay marriage and proposed that Republicans reach out to racial minorities and others who have not felt much welcomed by the party lately.
This may not play with significant parts of the GOP primary electorate, but on Thursday night, Kasich established himself as a unique and important voice.
Among the rest, judgments are necessarily subjective, but I thought Jeb Bush, who was threatening to turn into a gaffe machine, was forceful and clear. He did what others on the stage shied away from doing, criticizing Trump’s divisiveness. Trump did not hit him back, a kind of victory for Bush. The former Florida governor showed real passion in sticking by his support for Common Core education standards.
Chris Christie has not loomed large in the post-debate analysis I have seen so far, but he made his presence felt which, given his low standing in the polls, was essential to his soldiering on. The toughest interchange of the night came not, as many expected, with Trump, but between Christie and Sen. Rand Paul (R-Ky.) over government meta-data collection.
Rubio was fluent and smooth. If there is a sub-contest going on among Rubio, Wisconsin Gov. Scott Walker and Sen. Ted Cruz (R-Tex.), Rubio was Thursday’s winner. Cruz’s unabashed right-wing oppositionism may yet work for him if Trump collapses. For now, Trump is taking up space Cruz needs to occupy.
The day’s other winner, in an earlier debate involving the candidates who didn’t make the main stage, was Carly Fiorina. Her over-the-top attacks on Hillary Clinton play very well among Republicans, and she seemed informed and in control.
The underlying premises of the debate were so deeply conservative that I doubt any Democrats who watched were tempted to jump ship, and I am not sure how many middle-of-the-road voters were drawn the Republicans’ way, except by Kasich and possibly by Rubio. The debate was held on the 50th Anniversary of the Voting Rights Act. This never came up. I wasn’t surprised. But I was disappointed.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, August 7, 2015
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