“A Vile And Wicked Plot”: How Barack Obama Trapped The GOP On Health Care
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy.
By now you’re well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as “guaranteed issue”), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use of markets. When Mitt Romney installed it in Massachusetts, it worked quite well and everybody was pleased. But then Barack Obama came along and embraced it, so all good and true conservatives had to conclude that it was not only a terrible idea in practical terms but a vile and wicked plot to rob Americans of their freedom.
And that has left Republicans in a difficult spot. They would very much like to have market-based health care ideas they could rally around, if nothing else than to demonstrate to the public that they sincerely want to fix what’s wrong in America’s health care system. But the theft of the guaranteed issue-plus-mandate-plus-subsidies framework has left them with nothing but unappetizing scraps off the health care table, none of which will do much of anything to address problems like the large number of uninsured Americans.
There’s a ritual people like me have taken to of late. Republicans announce that they’re about to release a health care plan. Then we say sarcastically, “Gee, let me guess. It involves 1) tort reform; 2) letting people buy insurance across state lines; 3) incentives for more use of health savings accounts, and 4) high-risk pools for people with pre-existing conditions” (here’s a recent example). And we’re always right, because those are the Big Four conservative health care ideas, and nobody can come up with anything different.
Here’s the thing about these ideas: neither any of them individually, nor all of them collectively, would even begin to tackle the things that ail the American health care system, the things the Affordable Care Act was meant to address. Tort reform—which means making it difficult or impossible for patients to sue for malpractice—won’t bring down costs like conservatives think it will. We know this because a number of states have enacted the kind of tort reform Republicans advocate for the whole nation, and it had no impact on spending. Realistic assessments of the effect of tort reform on medical spending conclude that if there’s any impact at all, it would be tiny (I discussed this issue at length here).
Letting people buy insurance across state lines would be fine if it was accompanied by national standards for policies; you’ve surely forgotten it by now, but the more liberal House version of the ACA created a national insurance exchange instead of 50 state exchanges, in which you could have bought insurance from anywhere. But a well-regulated system isn’t what conservatives want; they propose to remove the ACA’s regulations and then initiate a race to the bottom, where the least-regulated state would offer cheap insurance to lure customers who wouldn’t realize the limits of what they had bought until they got sick (here’s an explanation of just how bad an idea this is).
As for health savings accounts, we already have them. They’re a great deal for people who are healthy, but not so much when you actually need care. And high-risk pools are a terrible solution as anything other than a temporary stopgap—they put all the sick people in the same pool, meaning covering them is extremely expensive. That’s no help to the tens of millions of Americans with pre-existing conditions.
Which brings us to Louisiana governor Bobby Jindal, who is almost certainly running for president in 2016. There aren’t a lot of Republicans who have a good understanding of health care policy, but Bobby Jindal is one of the ones who do. Back in 1996, at the tender age of 24, he was appointed the head of the Louisiana Department of Health; George W. Bush later made him an assistant secretary of health and human services. So he’s well familiar with this issue, and surely has a reasonably good understanding of which policies are likely to have a large impact and which are likely to make no difference at all.
But Jindal is hamstrung, like all Republicans, by the fact that they can’t advocate anything Barack Obama has ever supported. So when he released a health care plan yesterday, it was a predictable mixture of small-bore proposals (Wellness incentives! Eliminate fraud!), and the Big Four conservative ideas. For good measure, he threw in a version of Paul Ryan’s plan to turn Medicare from an insurance program into a voucher program, where the government would give seniors a certain amount of money and then they’d seek private insurance, with the invisible hand of the market bringing prices down, all previous evidence to the contrary notwithstanding.
In fairness to Jindal, he has tweaked a few things from the standard conservative playbook. He would require insurance companies, once they’ve sold you insurance, to continue your plan even if you get sick—but doesn’t say how he’d protect the tens of millions of Americans with pre-existing conditions who would have trouble getting covered in the first place, other than state high-risk pools. And there are a few smaller features of his proposal that make sense. For instance, he’d change the tax treatment of health insurance so everyone could get the same favorable treatment that people with employer-provided insurance get. That would increase the fairness of the system, even if Jindal’s assertions that it would magically cut the ranks of the uninsured by 9 million and dramatically slow health care spending are absurd on their face.
But if we repealed the ACA and instituted all of Jindal’s proposed reforms, we’d still have all the problems we had before the ACA was passed. And I suspect that if you gave him a truth serum, he’d admit that none of what he proposes would have much of a salutary effect. But that’s where conservatives are. Barack Obama stole the one market-based idea they had that might actually bring us to something close to universal coverage. They have no idea where to go from there, and that’s how it’s going to be for the foreseeable future. They’ll feel the need to keep saying, “We have a plan too!” And when everyone says, “OK, tell us what it is,” it will be the same old thing, and no one will take them seriously.
By: Paul Waldman, Contributing Editor, The American Prospect, April 3, 2014
“It’s A Whole Different Issue”: John Boehner, Willfull Ignorance Or Willful Lying?
The day after this week’s mass shooting at Fort Hood, Army Secretary John McHugh said the gunman lived off post and was therefore not required to register his weapon with the military.
McHugh told senators yesterday, “We try to do everything we can to encourage soldiers to register their personal weapons, even when they live off post. We are not legally able to compel them to register weapons when they reside off post.”
Soon after, during House Speaker John Boehner’s (R-Ohio) press conference, a reporter noted McHugh’s comments and asked the House leader whether this is an issue Congress should address. Boehner replied:
“Well, there’s no question that those with mental health issues should be prevented from owning weapons or being able to purchase weapons. In the so-called ‘doc fix’ that passed here, there was funding for a pilot project dealing with mental health issues and weapons from both the Senate side and the House side. There are two programs that are being funded in there. The bill went to the president yesterday. This issue we need to continue to look at to find a way to keep weapons out of the hands of people who should not have them.”
The “doc fix” bill related to Medicare reimbursement rates for physicians, but it’s always a pretty big bill with plenty of unrelated provisions. This year, there was quite a bit of controversy surrounding how the bill passed – House GOP leaders played a fast one on their own members and conservatives were right to be annoyed – but I never heard a word about funding for a pilot project dealing with mental health issues and firearms.
And that’s surprising. Usually, any federal measure related in any way to gun ownership is the subject of considerable scrutiny. But there was the House Speaker yesterday, assuring the public in the wake of another mass shooting that lawmakers just acted on a policy related to gun violence and mental health.
It’s enough to make one wonder: does the provision Boehner referenced actually exist?
Roll Call reports this morning that according to the lawmaker who wrote the measure, no, it doesn’t.
Speaker John A. Boehner Thursday morning said that Congress had recently passed a provision to address whether people with mental health issues have access to weapons, but the measure’s Republican author said his bill actually does nothing of the sort.
Rep. Tim Murphy, R-Pa., told CQ-Roll Call that despite Boehner’s assertion, his measure to incentivize outpatient treatment for mental health issues has nothing to do with keeping guns out of the hands of the severely mentally ill.
“Not our bill, no. It’s a whole different issue,” Murphy told Roll Call. “I think he confused that. When he said that it dealt with it, I think he confused that.”
I checked the text of the legislation itself and it includes no references to gun, weapons, or firearms.
Murphy went on to say, “What this provision that I had in there allows in states is an outpatient treatment for patients who have a risk of past incarceration or past multiple hospitalizations where they were a safety risk, to work to say, ‘We need to get you back in treatment, get your life back together.’ That does not necessarily preclude or affect anything about a person’s ability to own a gun, unless they also have a history of being put in against their will.”
When Boehner says Congress just approved a project “dealing with mental health issues and weapons,” he appears to be wrong.
By: Steve Benen, The Maddow Blog, April 3, 2014
“Showing Its True Colors”: The GOP’s Case For Scrapping Democracy
When I wrote a recent column describing the GOP’s new voting laws as a “war on democracy,” I expected a sharp response from the Right. What I thought I’d hear were variations on the following: “No, Republicans aren’t at war with democracy. We’re just trying to fight voter fraud and make sure elections are held fairly and uniformly within states. And that’s a goal that enhances democracy.”
Not only is this how the issue is usually discussed by Republican politicians; it’s also the way nearly every political dispute in the United States over the past century has been framed — as a clash between different camps over which one can claim the mantle of “democracy” for itself. People will routinely assert that some other group, party, or position is anti-democratic in its aims and ideals. But no group, party, or position comes right out and explicitly denounces democracy in its own name.
At least until recently.
Allow me to quote a representative email written in response to my column: “I just read your piece on the GOP changes to voting laws. It’s complete garbage! Americans who have no skin in the game should not be voting! The way things have evolved in the last 200 years is nothing short of disgusting! People who don’t offer anything tangible to the country are given as much say as people who pay 400k in taxes per year? Ridiculous! How did we regress so far?”
An anti-democratic outlier? Five years ago, I would have thought so. But now I’m not so sure.
This was the week, of course, when the Supreme Court’s five-member conservative majority knocked down limits on aggregate contributions to federal political campaigns, opening the door for the rich to exercise even more influence on the political system than they already do. It was also the week when Rep. Paul Ryan unveiled his latest budget proposal, which would gut food stamps and other aid to the poor. And as I wrote about the other day, this is a political season that has seen the Republican Party working to make it harder for poor people and members of minority groups to vote.
Then there was venture capitalist Tom Perkins suggesting a couple of months ago that only taxpayers should be permitted to vote — and that those who pay more in taxes should be given more votes to cast in elections. And that came less than two years after Mitt Romney was caught kissing up to wealthy GOP donors by denigrating the “moochers” who make up 47 percent of the country’s population.
Ladies and gentlemen, that many data points make a pattern. We seem to be living in an era in which the Republican Party is turning against democracy in an increasingly explicit and undeniable way.
Within the context of the nation’s recent political history, this is a shocking prospect. We’re used to a constant evolution in the direction of ever-more democracy. At the time of the country’s founding, the franchise was limited to white male property owners. Then the property qualification was eliminated. Then the vote was extended (de jure) to black men. Then to women. Then to all blacks (de facto), with most of the remaining obstacles to the exercise of voting rights by minorities and the poor removed by the mid-1960s.
What growing numbers of Republicans appear to want is a reversal of this trend — a reform of the political system to exclude large numbers of Americans from having a say in politics while augmenting and enhancing the electoral power of the rich.
This might be unprecedented in American history, but it’s certainly not unthinkable. Despite our fondness for describing ourselves as a democracy, the American system is already far from being wholly democratic. A pure democracy would pick leaders by lot, indiscriminately assigning citizens to political office for fixed terms according to chance. This year your Aunt Bess might be president. Next year it could be a 19-year-old mechanic from Omaha. And so on, haphazardly hopscotching through the population at random.
The institution of elections introduces an element of hierarchy into the system, since it presumes that some people are more capable than others of exercising political rule and that voters can recognize this quality when they see it.
What the GOP appears to be inching toward is a rejection of the democratic presumption that all American citizens should have a say in making that determination. Interestingly, the anti-democratic argument doesn’t seem to be arising directly or primarily from a concern about the quality of the people’s political choices — a perennial and nontrivial objection to democratic forms of government going all the way back to Plato.
Instead, Republicans and their wealthy donor base appear, above all else, to be up in arms about the lack of deference shown to the rich, with the implication being that those at the top of the economic pyramid deserve greater public honors (and power) than they currently enjoy. (That certainly seems to be the subtext of this rather self-pitying Wall Street Journal op-ed by billionaire industrialist Charles Koch.)
Aristotle would have recognized this line of argument instantly. It is the classic case for political rule of the few. Aristotle would also have been unsurprised to learn that those making this claim use their wealth as evidence of personal virtue or excellence that entitles them to honor and deference.
What the ancient philosopher could not have anticipated is the role that free-market ideology would play in convincing nonwealthy members of the Republican Party that the self-enriching activity of entrepreneurs (“job creators”) self-evidently demonstrates their public-spiritedness and worthiness to wield political power without challenge.
Politicians of both parties are fond of saying that whatever election looms before us is the most important in recent memory. But if Republicans continue to stand against democracy itself, the hype, for once, will be true — and for a long time to come.
By: Damon Linker, The Week, April 4, 2014
“The Moment Of Truth”: The GOP Must Admit It Was Wrong On Obamacare
Is there any accountability in American politics for being completely wrong? Is there any cost to those who say things that turn out not to be true and then, when their fabrications or false predictions are exposed, calmly move on to concocting new claims as if they had never made the old ones?
The fact that the Affordable Care Act (ACA) hit its original goal this week of signing up more than 7 million people through its insurance exchanges ought to be a moment of truth — literally as well as figuratively. It ought to give everyone, particularly members of the news media, pause over how reckless the opponents of change have been in making instant judgments and outlandish charges.
When the health-care Web site went haywire last fall, conservatives were absolutely certain this technological failure meant that the entire reform effort was doomed. If you doubt this, try a Google search keyed to that period relating the word “doomed” to the health-care law.
It should be said that the general public was much wiser. A CNN poll in November that Post blogger Greg Sargent highlighted at the time found a majority (54 percent to 45 percent) saying that the problems facing the law “will eventually be solved.” Political moderates took this view by 55 percent to 43 percent, independents by 50 percent to 48 percent. Only Republicans — by a whopping 72 percent to 27 percent — and conservatives (by 66 percent to 33 percent) thought the law could never be fixed.
Their representatives in Washington, moderate conservatives as well as the tea party’s loyalists, followed the base’s lead. In mid-November, for example, Sen. Rob Portman (R-Ohio) told Fox News flatly that the law is “destined to fail,” “fundamentally flawed” and “not ready for prime time.” House Speaker John Boehner predicted dire outcomes before the Web site fiasco. He repeatedly insisted, as he did in July, that “even the Obama administration knows the ‘train wreck’ will only get worse.”
This attitude affected more neutral observers. Forbes magazine posted a piece on Nov. 22 under the headline: “What to do if and when Obamacare collapses.” The op-ed modestly acknowledged that “it’s too soon to write an epitaph for Obamacare,” but then barged forward, since “its crises are piling up so fast that one has to begin looking ahead.”
At this point, the etiquette of commentary typically requires a “to be sure” paragraph, as in: To be sure, the law could still face other problems, blah, blah, blah. But such paragraphs are timid and often insincere hedges. After all, every successful program, even well-established ones such as Medicare, Social Security and food stamps, confronts ongoing challenges.
So let’s say it out loud: The ACA is doing exactly what its supporters said it would do. It is getting health insurance to millions who didn’t have it before. (The Los Angeles Times pegged the number at 9.5 million at the beginning of the week.) And it’s working especially well in places such as Kentucky, where state officials threw themselves fully and competently behind the cause of signing up the uninsured. Those who want to repeal the law will have to admit that they are willing to deprive these people, or some large percentage of them, of insurance.
Too many conservatives would prefer not to say upfront what they really believe: They don’t want the federal government to spend the significant sums of money needed to get everyone covered. Admitting this can sound cruel, so they insist that their objections are to the ACA’s alleged unworkability, or to “a Washington takeover of the health system” (which makes you wonder what they think of Medicare, a far more centralized program). Or they peddle isolated horror stories that the fact-checkers usually discover are untrue or misleading.
Thus the moment of truth, about the facts and about our purposes.
From now on, will there be more healthy skepticism about conservative claims against the ACA? Given how many times the law’s enemies have said the sky was falling when it wasn’t, will there be tougher interrogation of their next round of apocalyptic predictions? Will their so-called alternatives be analyzed closely to see how many now-insured people would actually lose coverage under the “replacement” plans?
Perhaps more importantly, will we finally be honest about the real argument here: Do we or do we not want to put in the effort and money it takes to guarantee all Americans health insurance? If we do — and we should — let’s get on with doing it the best way we can.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post, April 2, 2014
“In Dire Demographic Straits”: The GOP’s New Voting Laws Are Nothing Less Than A War On Democracy
Can someone please explain to me why the New York Times’ top story from this past Sunday hasn’t provoked nationwide outrage?
Allow me to provide a handy summary: Having spent the last several years trumping up unsubstantiated charges of voter fraud in order to justify new laws and regulations making it more burdensome to vote in poor and minority (read: Democratic-leaning) districts around the country, the Republican Party has now changed tactics. In the name of enforcing the “uniformity” of voting rules, Republican governors and legislatures in a number of swing states have begun to increase the obstacles to voting still further. Some states are requiring that would-be voters show birth certificates or passports (which many poor people don’t possess), while others are curtailing the days, times, and places available to vote (which is particularly onerous for poor people who have little workplace flexibility and often lack transportation).
Let’s leave aside the spectacle of Republicans, usually our most fulsome champions of local control, suddenly banging on about the need for statewide uniformity in voting rules.
What’s far more noteworthy (and frankly pathetic) about these moves is that they’re a tacit acknowledgement by the Republican Party that it’s in dire demographic straits — and that one of the key pillars of its ideology over the last half-century is crumbling right before our eyes.
Ever since Richard Nixon claimed to speak for the “silent American majority,” the GOP has identified itself with the real America, the true America, the America of morals and faith and common sense, as opposed to the ersatz America of secular liberalism made up of judges, professors, journalists, and other elites who control the commanding heights of culture from decadent enclaves in New York and Hollywood. These elites have a pernicious influence and do a lot of damage, Republicans have maintained, but they’re vastly outnumbered by the real Americans who find their natural home in the GOP.
This ideology of righteous majoritarianism received intellectual validation from the first generation of neoconservatives, who wrote during the 1970s about the emergence of a “new class” of liberal professionals whose moral outlook differed from that of the rest of the country. Then, the ideology contributed to the rhetorical populism of the Reagan Revolution. Later, in a purer, high-octane form, it fueled the rise of right-wing talk radio, Fox News, and the rest of a conservative media infrastructure that exists to continually feed the flames of partisan fury through a potent mixture of flattery, demonization, and identity politics. “YOU are the real and righteous Americans,” these outlets tell their loyal listeners and viewers day after day, year after year, “and THEY are illegitimate, immoral imposters who have usurped political power.”
The story was always an exaggeration, but it once had a certain plausibility. Reagan won re-election in 1984 with 58.8 percent of the vote. Millions of his supporters were lifelong New Deal and Great Society liberals who jumped parties to become the fabled “Reagan Democrats.” It seemed for a time like the silent American majority had finally found its voice.
But then the numbers started heading south. George H.W. Bush succeeded Reagan with a softer 53.4 percent of the vote, and then went on to lose his bid for re-election in 1992. His son notoriously made it to the White House in 2000 despite losing the popular vote; four years later he won a majority — though, with only 50.7 percent of the vote, just barely. And it’s been downhill ever since.
The grassroots of the GOP and its media cheerleaders like to attribute the party’s losses in 2008 (McCain, 45.7 percent) and 2012 (Romney, 47.2 percent) to the party’s foolish decision to go with presidential candidates who were compromised conservatives. If only they’d chosen real Republicans!
But this is a self-serving fantasy. As John Judis and Ruy Teixeira have been arguing for years, with each election cycle providing confirmation of their thesis, the Republican Party faces a possibly intractable demographic problem — with its core voters (older white men) becoming an ever-smaller proportion of the electorate. This means that in the country’s only national election contest (the presidential vote), the popular margin is likely to swing increasingly in the direction of the Democratic Party. Unless, of course, Republicans can keep Democrats from voting.
But what about the GOP’s success at holding on to the House of Representatives in recent years? That, too, is a product of anti-democratic manipulation. The Democrats actually received more overall votes in House races in 2012 but failed to win control of the chamber because the GOP has used state-level redistricting to cram ever-greater numbers of Democrats into smaller numbers of districts, effectively decreasing their political power relative to their raw numbers.
Charming, isn’t it?
But also pitiable. Having built an ideology around the conviction that it speaks axiomatically for the real American majority, the Republican Party has become incapable of coping with evidence to the contrary — and willing to do just about anything, including subverting democracy, to maintain that fiction.
Republicans should be ashamed of themselves — and the rest of us should be disgusted.
By: Damon Linker, The Week, April 1, 2014
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