“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
“There’s Something There”: GOP ‘Confronting A New Reality’ On Healthcare
The Obama administration won’t have an official announcement on December’s health care enrollment numbers for a few more weeks, but chances are good that we’ll see a spike in the number of newly enrollment Americans. At the end of November, the Affordable Care Act had helped bring coverage to about 1.2 million people; by the end of this month, that total will include millions more.
And with each new enrollment, it slowly dawns on congressional Republicans that the larger calculus has changed in fundamental ways. Jonathan Weisman reported overnight that GOP policymakers are “confronting a new reality.”
The enrollment figures may be well short of what the Obama administration had hoped for. But the fact that a significant number of Americans are now benefiting from the program is resulting in a subtle shift among Republicans.
“It’s no longer just a piece of paper that you can repeal and it goes away,” said Senator Ron Johnson, Republican of Wisconsin and a Tea Party favorite. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”
And that underscores a central fact of American politics since Franklin D. Roosevelt signed the Social Security Act during the Depression: Once a benefit has been bestowed, it is nearly impossible to take it away.
Quite right. The Republican repeal crusade, whether the party wants to admit it or not, is over. Sure, Boehner & Co. can schedule a few dozen more repeal votes to help Tea Partiers feel warm and fuzzy, but even that’s less likely in light of the millions of consumers who’ve signed up for coverage – in an election year, candidates don’t generally thrive running on a platform that says, “Vote for me so I can take health care benefits away from your family.”
Indeed, GOP officials are desperate to talk about the “cancellation notices” a small sliver of the population received, but it gets a little tricky for these same Republicans to draw up plans to cancel millions more health care plans on purpose.
As we discussed a few weeks ago, the fight over health care is no longer an abstraction over hypothetical benefits. There’s a profound difference between “Republicans are voting to deny you a benefit you don’t yet enjoy” and “Republicans are voting to take away your health insurance and replace it with nothing.” The former struck GOP officials as plausible; the latter is politically suicidal.
So, as of this minute, what’s the Republican position on health care? No one, including GOP policymakers themselves, has any idea. For years, it was a straightforward push to repeal the entirety of the law, regardless of the consequences or human suffering. Now, some still want to pretend repeal is possible, others want to tinker around the edges with “reforms.” Some believe it’s time for Republicans to craft a policy alternative of their own to present to voters, others believe incessant complaining should be enough to give the GOP a boost on Election Day.
“The hardest problem for us is what to do next,” Sen. Lindsey Graham (R-S.C.) told Weisman.
Ya don’t say.
By: Steve Benen, The Maddow Blog, December 27, 2013
“Fast And Loose With The Facts”: Lying About Obamacare Continues As Campaign Season Begins
You may want to sit down before reading this: Republicans aren’t being totally truthful about the Affordable Care Act (ACA). As the 2014 midterm elections approach, conservative groups are beginning to hit the airwaves with spots targeting vulnerable Democrats and their support for the health law — and the ads are playing fast and loose with the facts.
Americans for Prosperity, the tax-exempt conservative action group created by brothers Charles and David Koch, took out two ads against vulnerable Democrats: Rick Nolan of Minnesota’s 8th District and Ann Kuster of New Hampshire’s 2nd District. Both focus on the health-care law, and they are important to dissect because they are the first trickles of what is sure to be a torrent of anti-ACA advertising.
The ad against Nolan features a middle-aged Minnesota resident named Randy Westby, who [http://youtu.be/-VVwc60M8zg]says he lost his health care plan because it no longer qualified for purchase in the exchanges. “I’ve had three heart attacks in the last six years. Health care is something that’s essential, and my life depends on it,” he continues.
The ad leans heavily on Politifact’s “Lie of the Year” designation for President Obama’s “if you like your plan, you can keep it” claim, and gives the strong impression that sick people are much worse off under Obamacare.
But was Westby able to find another plan? Four million to five million people probably had their plan canceled because of updated coverage requirements, but the administration believes fewer than 500,000 of those people are still looking for another plan. The ad doesn’t tell us if Westby is one of those people.
Nor does it note that he can’t be disqualified from any of the plans on the exchanges because of his preexisting condition — and three heart attacks in six years is one heck of a preexisting condition. Are the plans available to him cheaper than what he had before? How much better is the coverage? We don’t know, although given Westby’s medical history and apparent age, it seems he is exactly the type of person most likely to benefit from how the new individual market is structured.
The New Hampshire ad is more general and features an actress, but it relies on the same central and shaky claim that “millions of people” are losing coverage. Both ads hit the Democrats in question for voting to keep the ACA in place. (Aside from firing up the conservative grass roots, there was a good political reason for all those repeal votes in the House: to get vulnerable Democrats on the record, again and again.)
A focus on horror stories like these is the likely new Republican approach to Obamacare, as the New York Times outlines today. “It’s no longer just a piece of paper that you can repeal and it goes away,” Sen. Ron Johnson (R-Wis.) told the times. “There’s something there. We have to recognize that reality. We have to deal with the people that are currently covered under Obamacare.”
But Westby may well be one of these people. And he may be getting better coverage. These will be the battle lines for the upcoming year: Republicans are gearing up to tell the horror stories, and Democrats will have to respond with stories of their own — the eight million to 10 million people who will be getting coverage under Obamacare by the end of March.
By: George Zornick, The Plum Line, The Washington Post, December 27, 2013
“Yes, A Birthright To Health Care”: America Joins The Developed World, Thanks To Obamacare
I’m sitting here very early Christmas Eve morning staring at a chart from the Organization for Economic Cooperation and Development. You know the OECD—they’re the people who keep all those annoying stats about how the United States is 17th in this and 32nd in that, the kind that alas aren’t very surprising anymore except that they do make us shake our heads and wonder how we managed to come in behind even Belarus.
This chart is on an Excel spreadsheet, so I can’t provide a link, but it shows access to “health insurance coverage for a core set of services, 2009.” It then lists the 34 OECD member states, showing percentages of citizens with “total public coverage” and with “primary private health coverage.”
In 19 countries, 100 percent of the population is covered via public insurance. In 11 more, more than 95 percent are covered the same way. So all but four countries basically provide universal or near-universal public coverage. In Turkey, Mexico, and Chile, between 70 and 80 percent are covered—also publicly. In the United States, that number is 26.4 percent. That’s the seniors, the veterans, and the very poor who get direct public health care. We then add 54.9 percent who get private coverage. No other country even bothers with private coverage at all, except Germany a little bit (10.8 percent). Our two numbers add up to 81.3 percent, ranking us 31st out of the 34. The rest of the advanced world, in other words, with not all that much fuss and contention, has come around to the idea that health coverage is a right.
As I think back over 2013, in my sunnier moments, I try to think of it as the year that future historians will point to as the time when the United States finally and grudgingly started joining this world consensus. Sometime in the 2030s, after Medicare for all has passed and we’re finally and sensibly paying taxes for preventive cradle-to-grave care, people will note—with pride!—that the long process started with Obamacare (yes, conservatives: I’m admitting gleefully that the elephant’s nose is under the door, so spare yourselves the trouble of thinking you’re clever by tweeting it!).
There were of course other important stories in the year now ending. For my number two, I’d choose Iran and Syria; that’s certainly one to watch heading into next year. Barack Obama mishandled Syria with all that talk of red lines that ended up being unenforced, badly letting down the small-d democrats in the region who count on the United States to countervail Iran. On the other hand, those chemical weapons actually are being destroyed, evidently. On the other other hand, the slaughter continues, and we will do nothing. Even a deal with Iran on nuclear technology, certainly a thing to be celebrated in one respect, will also allow Iran to show the region (that is, Saudi Arabia, its main competitor for regional domination) that it’s in the big leagues now too. As is typical in that part of the world, no diplomatic development is all good or all bad.
But this has been the year of Obamacare first and foremost. And next year pretty much will be, too. I’m glad the website was fixed, and glad for the apparent surge in the enrollment numbers. But it’s still the case for the change to take root and really succeed, Democrats from Obama on down have to defend this policy on principled terms, not just practical ones.
That is—right now, Democrats and progressive groups are mostly trying to get people to sign up for coverage by scaring them into thinking they might break their leg. But there are two problems with this approach. One, most people don’t break their leg. I’ve been on this planet 53 years and I’ve never broken a bone.
Two, it’s not completely honest as a selling point. Yes, liberals are concerned that people who face injury have coverage. But that’s not the main reason liberals support health care reform. We support it because we think health care coverage should be a right, and this is a big step down that road, or the best step we could make under current reality. Like any right, it comes with responsibility, so that’s why you have to buy it. But it’s a right. It’s not an extravagance or something you earn by having a better-than-Walmart-level job. You “earn” it by doing something a lot simpler than that—you earn it by being born.
This is one of those occasions where I wish desperately that Democratic politicians would just say what they believe without worrying how it’s going to be played in Politico or what those fat-mouth propagandists on the right are going to say about it. Obamacare isn’t just about getting people to fear illness or injury. It’s about changing people’s minds about what health coverage fundamentally is. And they’re not going to change any minds unless they’re willing to say that.
Hey, I’ve kept flipping through those OECD spread sheets and I’ve found some things we’re number one in. Male obesity—70.3 percent in 2011! Female obesity, too—56.1 percent! Infant mortality rate of 6.1 per 1,000 live births! Okay, we trail Mexico and Turkey there, but still. Income inequality—well, thank God for Turkey, Mexico, and Chile. Whoever let them in was really thinking ahead, so at least we’d look OK compared to someplace.
Something like reducing obesity can be best done through preventive care that kicks in well before a person has a BMI in the 40s. Obamacare already has started the process of changing this. More than 5 million Medicare recipients are getting free preventive treatments across a range of categories (PDF). That’s health care as a right. Democrats need to be unapologetic in talking like that.
By: Michael Tomasky, The Daily Beast, December 26, 2013
“Private Isn’t Always Better Than Public”: UPS Delivers Christmas A Day Late
It’s the day after Christmas, which means, for many holiday revelers, that their Christmas packages are just arriving today. Or maybe tomorrow.
United Parcel Service, the Georgia-based company that is the go-to package delivery option for millions of Americans, fell short – far short – of meeting holiday expectations this year. Apparently overwhelmed by the delivery demands of the season, UPS failed to get packages to customers in time to put them under the holiday tree.
The number of undelivered packages was not revealed by the company, but social media exploded with complaints from people who said they had ordered online specifically because they were guaranteed pre-Christmas delivery. In a statement, the company said:
UPS understands the importance of your holiday shipments. UPS is experiencing heavy holiday volume and making every effort to get packages to their destination.
It’s not an acceptable explanation, just as it wasn’t a good explanation when the Obama administration said its health care website wasn’t working right because it was overwhelmed with traffic the first day people could go online to sign up for insurance. It is – or should be – someone’s job to figure out that when one is in a big-demand season, there needs to be enough staff to handle it. No one put it better than Saturday Night Live: It’s like 1-800-FLOWERS being taken by surprise by Valentine’s Day.
But there’s another issue here, and that is the public/private bias. Why is Amazon using UPS instead of the U.S. Postal Service? I ordered two books and a CD from Amazon 10 days before Christmas, and my package arrived (thankfully) late afternoon on Christmas Eve. The packages I sent through the U.S. Post Office arrived exactly as promise: When I got two-day Priority delivery, it got there in two days. And (“free” shipping aside), the U.S. postal service is cheaper than the private alternatives.
There seems to be a persistent idea that a private entity is always better or more efficient than a public one. You have people who spent many tens of thousands of dollars to attend some private college which offers no better education than many of the public institutions out there. But the graduates behave as though they’ve gotten some superior level of instruction, just because they didn’t have to go to school with the socio-economic riff-raff. There is, of course, a difference between state universities and pricey private colleges, of course. You can’t buy your way into a public school.
My mail arrives every day it’s supposed to – on time, and delivered by a cheerful and dedicated public servant, a mail carrier who managed to get mail to my building during Hurricane Irene, Superstorm Sandy and all kinds of bad weather. It’s a shame UPS didn’t get packages to people on time. Next year, two changes could fix the problem: the private company could hire enough staff to handle and deliver packages. Or consumers could just use the reliable U.S. Postal Service.
By: Susan Milligan, U. S. News and World Report, December 26, 2013
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