“The South’s New Lost Cause”: A Mason-Dixon Line Of Health Care Dispair
Before he was immortalized for saving the union, freeing the slaves and giving the best political speech in American history, Abraham Lincoln was just an unpopular new president handed a colossal crisis. Elected with 39.7 percent of the vote, Lincoln told a big lie in his inaugural address of 1861.
“I have no purpose, directly or indirectly, to interfere with the institution of slavery in the states where it exists,” he said, reaching out to the breakaway South. “I believe I have no lawful right to do so, and I have no inclination to do so.”
He was saying to a Confederacy that would enshrine owning another human being in its new constitution: If you like the slaves you’ve got now, you can keep them. It was a lie in the sense that Lincoln made a promise, changed by circumstances, that he broke less than two years later — and probably never meant to keep.
The comparisons of President Obama to Lincoln fade with every day of the shrinking modern presidency. As for the broken-promise scale: Lincoln said an entire section of the country could continue to enslave more than one in three of its people. Obama wrongly assured about five million people that they could keep their bare-bones health plans if they liked them (later amended when it turned out not to be true).
As inapt as those comparisons are, what is distressingly similar today is how the South is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States.
And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
But in the states that have embraced a program that reaches out to low-wage workers, almost 500,000 people have signed up for health care in less than two months time. This is good for business, good for state taxpayers (because the federal government is subsidizing the expansion) and can do much to lessen the collateral damages of poverty, from crime to poor diets. In Kentucky, which has bravely tried to buck the retrograde tide, Medicaid expansion is projected to create 17,000 jobs. In Washington, the state predicts 10,000 new jobs and savings of $300 million in the first 18 months of expansion.
Beyond Medicaid, the states that have diligently tried to make the private health care exchanges work are putting their regions on a path that will make them far more livable, easing the burden of crippling, uninsured medical bills — the leading cause of personal bankruptcy.
And those states aren’t going to turn back the clock and revert to the bad old days, no matter how Republicans try to kill health care reform in the wake of the federal rollout. Many are refusing to accept Obama’s “fix” of allowing people to keep sketchy health care policies. If they follow the pattern of Massachusetts — where a mere 123 people enrolled in the first month of Romneycare, after which it gradually took off — the progressive states could end up with more than 95 percent of their residents insured.
What we could see, 10 years from now, is a Mason-Dixon line of health care. One side (with exceptions for conservative Midwest and mountain states) would be the insured North, a place where health care coverage was affordable and available to most people. On the other side would be the uninsured South, where health care for the poor would amount to treating charity cases in hospital emergency rooms.
Texas, where one in four people have no health care and Gov. Rick Perry proudly resists extending the Medicaid helping hand to the working poor, would be the leading backwater in this Dixie of Despair. In the 11 states of the old Confederacy, only Arkansas and Tennessee are now open to Medicaid expansion.
The South, already the poorest region in the country, with all the attendant problems, would acquire another distinction — a place where, if you were sick and earned just enough money that you didn’t qualify for traditional Medicare, you might face the current system’s version of a death panel.
The only good news is that a handful of political leaders down South have grasped the utter stupidity of refusing to help their own people, or even giving the state exchanges a chance. In this month’s recent special election for a congressional seat in a solidly Republican Louisiana district, a pragmatic businessman, Vance McAllister, beat a Tea Party candidate with the full Obama derangement syndrome. The winner said Obamacare was the law of the land and might as well be applied in Louisiana, the nation’s third poorest state. (It didn’t hurt that he had the backing of a “Duck Dynasty” star.)
But most of the South is defiant — their own Lost Cause for the 21st century.
By: Timothy Egan, Op-Ed Contributor, The New York Times, November 21, 2013
“Ignoring The Elephant In The Room”: No, President Obama’s Policies Are Not Holding Back The Economy
Wall Street Journal columnist Daniel Henninger had fun this week arguing that President Obama’s problems implementing health reform pale next to his problems getting the economy back to health. The attack on Obama’s economic stewardship, however, looks just like the standard conservative attack on health reform: it’s light on sound arguments and ignores the elephant in the room — Republican obstructionism.
First, health care. As the president says, it’s on him that the rollout of HealthCare.gov and the health insurance marketplaces — where individuals can purchase health insurance to avoid the fine for not having it — has been, to put it kindly, rocky. But Republicans have provided no clear alternative to expand access to good quality, affordable health care, and they have made the rollout more difficult.
Many Republican governors and state legislatures have left implementation of their health insurance marketplaces (also known as exchanges) to the federal government rather than do it themselves — hardly the usual position of a party that believes in devolving as much power as possible to the states. And, at the moment, 25 states are not moving forward to implement the Medicaid expansions — which are a very good deal for them — leaving a significant coverage gap among low-income adults and complicating the determination of eligibility for coverage on the exchanges.
Finally, Republican proposals to “fix” the problem would undermine, not improve, health reform. The president’s proposal, while not perfect, is the best on the table.
Like problems with the health care rollout, the problems in the economy are plain to see. Henninger plays fair when he notes that the president did not cause the Great Recession, which is the source of the problems with which we’re still grappling. But, he’s wrong to say it’s the president who “has the economy on lockdown.”
First, he ignores what many economists and policymakers see as the main problem we still face – inadequate demand for goods and services. Second, he cavalierly dismisses the benefits of economic stimulus in such an economy. Third, he insists the main thing holding back the recovery is excessive business regulation. With that mindset, he naturally doesn’t acknowledge the drag on economic activity and job creation from the premature austerity that Congress has imposed on the economy since Republicans regained control of the House in the 2010 mid-term elections and the barriers that Republicans have put in the way of a budget plan that could boost the recovery in the short run while still putting deficits and debt on a sustainable longer-run trajectory.
Just a reminder to all who, like Henninger, parrot the shibboleth that stimulus did not work: the Congressional Budget Office finds that gross domestic product has been higher each year since 2009 than it would have been without the 2009 American Recovery and Reinvestment Act and unemployment has been lower (see chart).
CBO includes a broad range of estimates about the recovery act’s impact to encompass the views of economists who continue to doubt the mounting evidence that stimulus is highly effective under the economic conditions prevailing in recent years. But, that evidence suggests that act’s impact is quite likely much nearer the high than the low estimate.
Here’s what the International Monetary Fund says about that research, the expansionary effects of fiscal policy (tax cuts and increases in government spending) and the “old Keynesian mulitplier” that Henninger mocks: “While debate continues, the evidence seems stronger than before the crisis that fiscal policy can, under today’s special circumstances, have powerful effects on the economy in the short run [and] that fiscal multipliers are larger.”
The powerful effects of fiscal policy in today’s special circumstances work both ways. The economic forecasting firm Macroeconomic Advisers estimates that the economic uncertainty and policy choices to raise taxes and cut spending that we’ve made since 2010 have cost the economy up to a percentage point per year of slower economic growth and up to 2 million jobs.
It’s Republicans whose policy preferences have pulled policy toward greater near-term fiscal austerity through spending cuts; Democratic plans look more like bipartisan proposals for less spending restraint in the short term and more deficit reduction that’s balanced between revenues and spending down the road when the economy is stronger.
It’s Republicans who have the U.S. economy on lockdown.
By: Chad Stone, Chief Economist, Center on Budget and Policy Priorities, U. S. News and World Report, November 22, 2013
“The Party Of Zilch”: The GOP Is Out To Destroy The Country
Yes, the headline is rather hyperbolic. It’s as over-the-top as some of President Obama’s most unhinged critics, who believe he is running the nation without care or concern for the Constitution. But when you look at the actions of the Republican Party, particularly its members in Congress, my headline seems appropriate.
Three different pieces highlighted how the GOP is grinding just about every sector of the federal government to a halt. And it is doing it through a cynical combination of obstruction, saying no and failing to have viable alternative proposals worthy of national debate. Whatever political gains Republicans achieve in the short-term come at the long-term expense of the country. That’s simply unacceptable.
Even though the Affordable Care Act (a.k.a. Obamacare) is much more than a Web site, the disastrous roll out of Healthcare.gov has done a number on the president’s standing with the American people. According to the latest Post-ABC News poll, Obama’s overall approval rating sits at 42 percent. His 55 percent disapproval rating is the highest of his presidency. This would be the perfect time for the opposition to step forward with those alternative proposals. But the GOP is “The Party of Zilch,” as Ron Fournier so accurately described.
Rather than be the party of solutions in a gridlocked capital, appealing to a leadership-starved public, the GOP is the party of obstruction, ensuring that its putrid approval ratings nose dive apace with Obama’s.
The country needs sensible immigration reform that brings 11 million or so undocumented residents out of the shadows. No, says the GOP
The country needs to tame a massive debt that will be 100 percent of the gross domestic product by 2038 unless Congress raises revenue and trims entitlements. No, says the GOP.
The country needs fair debate and compromise around existential issues such as climate change, income inequality, and a deteriorating 20th century infrastructure. No, says the GOP.
“Other than hard partisans on the left and right, the majority of the public—moderate, fix-it Americans who simply want a sensible government—now have nowhere to turn, because the GOP is the party of nothing,” Fournier correctly concludes.
The New York Times editorial board delivered its own party-of-zilch disquisition using opposition to the ACA as the jumping off point.
What is the Republican alternative to this government program, flawed as it is right now? There is none. Party members simply want to repeal the health law and let insurers go back to canceling policies at the first sign of a shadow on an X-ray. They have no immigration policy of their own. They have no plan that will stimulate job growth. They are in favor only of shutdowns and sequesters and repeals, giving the public no reason to believe they have a governing vision or even a legislative agenda.
That congressional Republicans have no “governing vision or even a legislative agenda” was proven in a Politico story on Sunday. The headline said it all: “House GOP 2014 agenda starts with blank slate.”
Last Thursday, a group of House Republicans filed into Majority Leader Eric Cantor’s Capitol office suite and received a blank piece of paper labeled “Agenda 2014.”
The blank slate just about sums up where Republicans find themselves after a year marked by the first government shutdown in 17 years, futile efforts to repeal Obamacare and the inability to pass spending bills at the levels set by Republican leaders.
As bad as that is, what a Republican aide said is worse. “What we have done so far this year clearly hasn’t worked,” the GOP aide involved in the planning sessions told the Politico reporters. “Cantor wants to take us in a new direction, which is good. The problem is we don’t know where we are headed, and we don’t know what we can sell to our members.” This no way to run an enterprise as large and as important as the United States.
The judicial branch is crippled as qualified nominees go unconfirmed due to “unfair hurdles in the Senate.” As a result, the U.S. Court of Appeals for the District of Columbia, the nation’s second-highest court, has three vacancies on the 11-seat court that handles cases involving federal regulations and national security. Half of the legislative branch is in thrall to a band of right-wing zealots unmoved by facts as much as they are motivated by hatred of the president. As a result, the threat of government shutdowns and default is constant. Inaction on pressing issues is now routine. And the executive branch finds its agenda held hostage by an opposition that schemed against it since before its inauguration in 2009, even though said agenda was approved by the American people — twice.
That the Obama administration has been able to get as much done as it has speaks to the president’s determination to move this nation forward. Yet it’s not enough. Ours is a government that requires two functioning parties that produce good public policy through the necessary friction of governing. Neither party is perfect nor has all the ideas or the answers. But no good comes from a party that gives up completely on governing.
At the end of its editorial, the Times noted, “Democrats may be stumbling right now, but at least they are trying.” Would that Republicans did the same. It is long past time they did.
By: Jonathan Caphart, The Washington Post, November 20, 2013
“Feigning Outrage”: The GOP’s Health Reform Playbook
The last thing Republicans want right now is to repeal the Affordable Care Act.
They may claim it is destroying the country, but they need it, and desperately, to rebuild their party. They even have a detailed playbook to exploit it, outlining how and when to stage attacks against Democrats who support it in order to inflict maximum damage in the months before the 2014 midterm elections.
As Jonathan Weisman and Sheryl Gay Stolberg reported in this morning’s Times, House Republicans have been organizing their strategy behind closed doors for the last month. They began by capitalizing on the gifts given them by the White House in the form of the malfunctioning health care website and President Obama’s false promise that no one need lose an insurance policy. Then they moved on to claims that personal data is insecure on the insurance exchanges.
Next, according to the playbook, will come criticism of premium price hikes, and breast-beating about changes to Medicare Advantage plans, as well as the possibility that people will lose their doctors under some policies.
Republicans will also hold hearings, and come armed with anecdotes from outraged citizens who suddenly find their new health insurance options aren’t perfect.
Reform has given new life to a party that was in the depths after the shutdown debacle just last month.
This deep concern about Americans’ access to quality insurance is entirely new and utterly insincere, of course. Nearly one in 10 people on Medicare — 4 million people — are dissatisfied with that program, according to surveys, but you don’t hear their complaints broadcast at hearings or at Republican news conferences. In 2010, long before the health reform law took effect, 20 percent of people on employer-based insurance expressed dissatisfaction with their plans, as did a third of people on the individual market. They complained about high deductibles and constrained networks of doctors and hospitals, just as many of them will under the new system. And they complained about cancelled policies.
Republicans never cared about those concerns before the Affordable Care Act came around, and they don’t really care now, even though they’re doing a great job of feigning outrage. They’re simply using these grievances, magnified by anecdotal media coverage, to batter Democrats who are still standing up for the president’s program.
Some of those Democrats are fighting back. They’re pointing out, as the White House did yesterday, that the growth in health care costs is slowing significantly. They’re trying to highlight people who are saving money on their new policies, or who can buy insurance even if they are sick. And they will try to broadcast the voices of the previously uninsured, who have never appeared in a Republican diatribe and never will.
But the most attention, as always, will be paid to the shrillest critics. Just remember, as their attacks pick up in volume in the months to come, that they were prepared long in advance, as cheap as canned laughter.
By: David Firestone, Editors Blog, The New York Times, November 21, 2013
“A Right Wing Non-Plan”: Ted Cruz Reveals He’s A Thin-Skinned Wuss, Hypocrite And Policy Lightweight
Sen. Ted Cruz pretends to be a tough guy, but mostly he spends his time trashing Democrats in front of adoring right-wing crowds and conservative journalists. On Wednesday he sat down with CNN’s Chris Cuomo – you didn’t expect him to go to MSNBC, did you? – and showed himself to be incredibly thin-skinned when pressed just a little on how he would replace the Affordable Care Act he wants to repeal. It was an interesting window on Cruz’s temperament as well as his cynical, threadbare “policy” agenda.
Cuomo asked Cruz how he would replace the law he inveighs against, and as usual, Cruz dodged the question and kept on inveighing instead. Cuomo followed up. “You don’t think that you have a responsibility as a U.S. senator to do better than that, in terms of offering a solution for what to do next?” he asked.
And Cruz shot back: “Well, I appreciate your trying to lecture me in the morning.”
Cuomo didn’t leave it there.
“No, no, no, not at all, Senator. I’m worried, same as you, anybody who looks at the situation has worries.”
So Cruz tried to turn the tables. “If you’re worried, did you speak out for the 5 million people who have lost their health insurance?”
Cuomo had an answer: “Absolutely — we’ve been covering it doggedly. The problem is, I don’t have the power to fix it. You do. That’s what a U.S. senator does, is you sponsor law. You know this. It’s not a lecture, it’s a concern; I’m asking, what are you going to do about it?”
Apparently Cruz isn’t used to being grilled. Cuomo got him to share what passes for an answer from conservatives these days: “Let people purchase health insurance across state lines.”
Wow. That’s what Princeton and Harvard Law degrees get you: a warmed-over right wing non-plan that’s been around forever. As Ezra Klein reported back in 2010, the Congressional Budget Office looked at it in 2005 and found it didn’t reduce the number of uninsured and would only save the federal government $12 billion over the next eight years. (By contrast, the CBO says the ACA will reduce the deficit by $41 billion in 2013 alone.)
The CBO also found that allowing people to buy insurance plans across state lines would “make insurance more expensive for the sick and cheaper for the healthy, and lead to more healthy people with insurance and fewer sick people with insurance.” Other than that, it’s a terrific idea.
Of course, insurers like Cruz’s non-plan because it would mean a boon for the states that provide the least regulation and thus encourage the “cheapest” but least protective insurance policies. Rather than insuring states’ rights and competition, which conservatives pretend to like, it would, in effect, create a national insurance-regulation standard, as states then raced to the bottom to compete. Of course, a state’s “rights” usually diminish, for conservatives, whenever that state decides to give its citizens more power and its corporations less.
So in just one morning, Ted Cruz was revealed as a wuss, a hypocrite and a policy lightweight. The last one doesn’t matter on the right, but the first two won’t wear well in a presidential race. Kudos to Cuomo for not accepting Tea Party platitudes as a substitute for governing proposals.
By: Joan Walsh, Editor at Large, Salon, November 20, 2013
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