By: Paul Kane and Rosalind S. Helderman, The Washington Post, March 10, 2012: Contribution by Ed O’Keefe
“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
“Sowing Confusion”: Is There Any Limit To Mitt Romney’s Dishonesty?
The other day, David Bernstein argued that there’s been an “important tipping point” where many national media figures have come to understand that “in the Romney campaign, they are dealing with something unlike the normal spin and hyperbole.” Bernstein suggested they are realizing Romney has crossed into groundbreaking levels of dishonesty.
I wish I were as optimistic. I’d argue that much of the national media is still treating Romney’s nonstop distortions, dissembling, and outright lying as par for the course, as business as usual.
Here’s a test case: The debate over Medicare — and Romney’s embrace of the Paul Ryan plan — is about to dominate the conversation. Romney is moving to get ahead of the story by accusing Obama of being the one who would “end Medicare as we know it.” Here’s the Romney campaign’s statement this morning:
“There are two proposals on the table for addressing the nation’s entitlement crisis. Mitt Romney — along with a bipartisan group of leaders — has offered a solution that would introduce competition and choice into Medicare, control costs, and strengthen the program for future generations. President Obama has cut $500 billion from Medicare to fund Obamacare and created an unaccountable board with rationing power — all while America’s debt is spiraling out of control and we continue to run trillion-dollar deficits.
“If President Obama’s plan is to end Medicare as we know it, he should say so. If he has another plan, he should have the courage to put it forward.”
The claim that Romney supports a solution favored by a “bipartisan group of leaders” is a reference to the plan authored by Ryan and Dem Senator Ron Wyden. The idea that this represents “bipartisan” suppport is laughable. But this type of claim is made on both sides, so put it aside.
More interesting is the assertion that Obama has “cut $500 billion from Medicare” and created an “unaccountable board with rationing power” even as the deficit is “spiraling out of control.” That’s a reference to Obamacare’s efforts to curb spending with $500 billion in savings that are actually wrung from health care providers, not Medicare beneficiaries. That “unaccountable board,” meanwhile, is a reference to the Independent Payment Advisory Board, which is designed to make recommendations for reducing Medicare costs, and explicitly cannot recommend rationing.
Get the trick here? The Romney campaign is accusing Obama of slashing Medicare, and hence “ending Medicare as we know it,” while simultaneously accusing him of failing to curb entitlement spending in ways that pose grave danger to the nation’s finances. This, even as Romney has endorsed a plan that would quasi-voucherize Medicare and end the program as we know it.
This is all about muddying the waters in advance of a debate that could cut badly against Romney. The GOP primary forced him to embrace Ryancare; Dems are going to hammer him over it. So the Romney camp is trying to get out front by blurring lines and sowing confusion over who actually is defending traditional Medicare and who would end the program’s fundamental mission as we know it. The question is whether this, too, will be treated as just part of the game.
By: Greg Sargent, The Washington Post, The Plum Line, March 12, 2012
“Changing Climate”: Santorum Says Mitt Romney “Doesn’t Tell The Truth” On Health Care…And Other Things
Ahead of two suddenly pivotal primaries in Alabama and Republican presidential candidate, former Pennsylvania senator Rick Santorum, speaks in Cape Giradeau, Mo., on Saturday. (Eric Gay – Associated Press) Mississippi on Tuesday, Republican presidential candidate Rick Santorum on Sunday stepped up his criticism of Mitt Romney, arguing that his primary rival has not told the truth when it comes to his record on health care.
In an interview on NBC’s “Meet the Press,” Santorum told host David Gregory that Romney has sought to mislead voters when it comes to his position on health-care reform as governor of Massachusetts.
“Governor Romney in the state of Massachusetts mandated every person in Massachusetts have to buy health care,” Santorum said. “He doesn’t tell the truth about that either. He said, ‘Oh, it’s only the 8 percent that didn’t have insurance.’ That is simply not true.”
Andrea Saul, a spokeswoman for the Romney campaign, said it was Santorum who was misrepresenting Romney’s position on health care.
“Rick Santorum has a habit of making distortions, exaggerations and falsehoods about Mitt Romney’s record,” Saul said. “Governor Romney has never advocated for a federal individual mandate. He believes in the Tenth Amendment and, as a result, has always said that states should be free to come up with their own health care reforms.”
Santorum charged that on both health care and on climate change, Romney “continues to go out there and tries to misrepresent what he did in Massachusetts because it’s not popular.”
“He was for climate change,”Santorum said. “Man-made global warming. He put caps on CO2. And now that it’s not popular, now that the climate changed, guess who changed along with it? Governor Romney.”
Republican presidential candidate Mitt Romney gestures while speaking to workers and supporters at Thompson Tractor in Birmingham, Ala., on Friday. (Marvin Gentry – Reuters) A Romney spokeswoman did not immediately respond to a request for comment on the interview. Romney has repeatedly defended his health care record by arguing that he supported reform in Massachusetts but does not back it at the federal level.
The ramped-up offensive by Santorum against Romney comes as some supporters of the former senator are urging former House speaker Newt Gingrich (R-Ga.) to drop out and allow Santorum to run a one-on-one race against Romney.
And as the four-way GOP primary slog continues, Santorum himself on Sunday again declined to call on Gingrich to step aside.
“Well, you know, that’s not my job,” Santorum told Gregory when asked whether he’d urge Gingrich to get out of the race. “I’m not going to tell people to get in and out of this race. I didn’t ask Speaker Gingrich to get in. I’m not going to ask him to get out.”
He noted that he hopes a two-man race will take place “sooner rather than later, but we’ll wait and see what the speaker decides.”
By: Felicia Sonmez, The Washington Post, March 11, 2012
“Abandon Ship”: While Waiting For Dust To Settle, GOP Leaders Sharpen Case For Their Own Re-Election
Watching with growing unease as the GOP presidential nomination fight promises to stretch into the spring, Republican leaders on Capitol Hill are making moves to protect their own reelection prospects in the fall.
The aim is to fashion a political and legislative agenda to sharpen the party’s case against President Obama and Democrats, and make a coherent argument for why the Democratic-controlled Senate, and not the GOP-led House, is to blame for the congressional gridlock that has disheartened the public. A side benefit is that the legislative strategy might shift public attention away from some of the social issues that have recently dominated their party’s presidential contest.
While most congressional leaders continue to believe that former Massachusetts governor Mitt Romney will be the nominee, they worry about how long it will take to secure the nomination and the political costs of a drawn-out battle.
“Every day that goes by [without a nominee] is a day that plays to President Obama’s advantage,” said Sen. John McCain (R-Ariz.), who has endorsed Romney and was the party’s 2008 standard-bearer.
While GOP leaders are eager for a nominee to emerge so they can begin a coordinated campaign against the Democrats, they are increasingly convinced that they must move ahead with an agenda of their own.
Last week, House Speaker John A. Boehner (R-Ohio) said that regardless of who the nominee is and when he assumes the role, the core of the GOP argument against the president will be the same.
“Listen, one thing is clear here,” Boehner said Thursday. “ . . . This year’s election is going to be a referendum on the president’s economic policies. . . . The American people are concerned about our economy and concerned about jobs, and that’s going to continue to be my focus.”
And Senate Minority Leader Mitch McConnell (R-Ky.) has sketched out what a joint agenda should look like. “ ‘Obamacare’ should be the number one issue in the campaign,” McConnell told the Weekly Standard. “I think it’s the gift that keeps on giving.” The other top issues, as McConnell sees them, should be the deficit and national debt.
Bread-and-butter topics
One main concern going forward, key Hill Republicans say, is to avoid falling into more social-issue debates, which have hurt the broader party image and could affect down-ballot races for the House and Senate.
“To the extent that the focus in this cycle is on the economy, it’s better for Republicans. I think that’s probably where the stronger case for Republican change can be made,” said Rep. Patrick Meehan (R-Pa.), who managed presidential hopeful Rick Santorum’s 1994 campaign for the Senate but remains neutral in the presidential race. “I think we’re stronger when we’re talking about economics.”
The result is a congressional party determined to show action on bread-and-butter issues that can serve as the core of a unified economic agenda.
“We’ve got plenty of things to worry about here in the House. We’ve got a transportation bill, we’ve got Iran, we’ve got debt and deficit,” said Rep. Allen B. West (R-Fla.). “ Whatever happens with the presidential race will happen with the presidential race. People sent me up here to focus on being a good congressional representative, not worrying about being a cheerleader in a food fight.”
House Republicans will move legislation later this month to repeal a key portion of Obama’s health-care law, days ahead of the Supreme Court’s oral arguments on the legislation. Next week, Rep. Paul Ryan (R-Wis.) is expected to unveil a budget proposal that will slash federal spending and stick closely to last year’s controversial proposal to alter Medicare with private options. Both of these efforts could flow seamlessly into whatever coordinated effort emerges once there is a nominee.
But, while it is widely acknowledged that tax reform will be a key point of argument in the fall campaign, Rep. Dave Camp (R-Mich.), chairman of the tax-writing Ways and Means Committee, said last week that he will not wait to for a presidential nominee decide how to move ahead on the issue.
“I’m going to continue to do that regardless of when we get a nominee,” Camp said. “I’ve got an agenda that I’ve been working on for a year and a half, and I’m going to keep doing that.”
House Republicans had hoped to be able to take some of the presidential nominee’s proposals and offer them on the chamber floor, while Senate Republicans might use their rights to offer them as amendments. If the nomination fight lasts deep into the spring, there will be little to no time for such stage battles in Congress.
Hedging on health care
One area of legislative indecision has already emerged. While the House GOP is moving ahead with its health-care debate, Senate Republicans have not decided whether to push for another vote repealing the health-care law. Action in the Senate could shine a spotlight on what Republicans believe will be a key issue of the fall campaign, but another vote could also give embattled swing-state Democrats the chance to vote for repeal, bolstering their independent credentials.
There is deep division between House and Senate Republicans about the consequences of a long primary season. Some, like McCain, thinks it hurts Republicans. Others, including McCain’s close friend Sen. Lindsey O. Graham (R-S.C.), say the lengthy process has made Romney a better candidate, who will benefit from having had to fight for the nomination.
GOP leaders had anticipated that Romney would wrap up the nomination by Super Tuesday, and they would then begin the routine cooperation in which the presidential candidate defines a daily message that members of Congress amplify. For the immediate future, they will have to wait on that.
Gingrich’s top ally in Congress, Rep. Joe Barton (R-Tex.), is trying to build support by arguing that his candidate can energize the base and give down-ballot candidates something to rally around. Barton says that when he first ran, in 1984 on the same ticket as Ronald Reagan and Phil Gramm, he linked his candidacy to the popular president and the Senate candidate from Texas.
“Everything I did was Reagan, Gramm, Barton. They didn’t know me. But they knew them,” he said.
Contraception debate
And lawmakers acknowledge that the GOP message got derailed in February, when the issue of contraceptive coverage in the health-care law consumed the presidential campaign. As the discussion focused on whether the federal government could compel institutions connected to the Catholic Church to cover contraception costs in insurance programs, Republicans thought they were on high ground, and Sen. Roy Blunt (R-Mo.) introduced an amendment to allow exemptions.
Then when Santorum publicly declared his opposition to the use of contraceptives, the tables began to turn. The House Oversight and Government Reform Committee held a hearing on contraception, in which no women testified; the optics of that miscalculation were amplified by the politics of the presidential primary debate with adverse consequences for the GOP on the Hill.
Blunt, a key Romney backer, said that the other candidates in the race must decide how much longer they want to deprive Romney of the chance of assuming the mantle of the nominee. “They have to decide on their own that they’re no longer serving a positive purpose,” Blunt said.
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