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“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

April 5, 2014 Posted by | Affordable Care Act, GOP, Health Reform | , , , , , , | 1 Comment

“Reality Is Starting To Set In”: Is The “Mend It” Period Of The Affordable Care Act’s Evolution Beginning?

All of a sudden, people in Washington seem to want to fix the Affordable Care Act. And regardless of their motivations, that should be—well, maybe “celebrated” is too strong a word, but we can see it as a necessary and positive development. Is it possible that the arguments about whether the ACA was a good idea or should have been passed in the first place are actually going to fade away, and we can get down to the businesses of strengthening the parts of it that are working and fixing the parts that aren’t? It might be so.

Sure, cretinous congressional candidates will continue to display their seriousness by pumping paper copies of the law with bullets, probably for years to come. But with this year’s open enrollment period coming to an end in a few days, a particular reality is starting to set in, namely that, however you feel about the law, millions of Americans have now gotten health insurance because of it. Repealing it would mean taking that insurance away. So let’s look at what people whose political fortunes are dependent on some measure of anti-ACA grandstanding are doing.

First, a group of centrist Democrats, mostly from conservative states, offered a plan to make some changes to the ACA, some of which are more meaningful and reasonable than others. Yes, they’re doing it because they want to give themselves some political cover. But that’s OK. Meanwhile, some Republicans are, for the umpteenth time, crafting a package of things they claim will “replace” the ACA. Of course it’s the same few things they’ve always advocated—make it impossible for people to sue for medical malpractice (AKA “tort reform”), let people buy insurance across state lines, encourage health savings accounts. Nobody who has thought about health care for five minutes thinks those “reforms” would do anything to address real health care challenges, but more importantly, they wouldn’t prevent the massive upheaval that would occur if you repealed the ACA. And that’s a reality that will become increasingly clear: the disruption of taking away the ACA now would be even greater than the disruption the law brought about in the first place.

So if Republicans took over the Senate, there would be a brief period of kabuki, in which they would attempt to pass their reform package, then President Obama would say, “This is a joke” and veto if it passed. Then they’d have to decide if they actually wanted to address their specific complaints about the ACA. And yes, we have to start from the assumption that everything conservatives say about the Affordable Care Act is offered in bad faith (sorry, conservatives, but you’ve earned it). That doesn’t mean, however, that they can’t prove that assumption wrong at some later date.

Democrats should respond by welcoming a more particular debate about the ACA, starting from the presumption that it’s law now and millions of people are dependent on it, so the question is what needs adjustment. Republicans can no longer just shout “This law sucks, because freedom!” It’s too late for that.

And some context is in order. Before the law was even passed, many of its advocates were careful to note that no matter how much care went into its design, adjustments were going to be required as it was implemented. That’s how things always go with complicated laws: conditions change, certain features don’t work the way they were supposed to, and unforeseen challenges emerge. Revising existing legislation is a substantial part of lawmaking, and always has been. For instance, when Social Security was created in 1935, it was written to exclude agricultural and domestic workers, which included most blacks in the South (there’s some debate about whether this was actually done in order to secure the support of Southern segregationists). That didn’t change until the 1950s. Survivor benefits for spouses and children were also added later. Cost of living adjustments were added later. In other words, the most successful and popular social program in American history required a lot of changes and alterations as it evolved, and no one ever expected that the ACA would be any different.

There are going to be changes to the ACA in the coming years, just as there should be. The trick now will be making sure the right changes are made.

 

By: Paul Waldman, Contributing Editor, The American Prospect, March 28, 2014

March 29, 2014 Posted by | Affordable Care Act, Obamacare, Republicans | , , , , , , | Leave a comment

“Revisionist History”: Chris Christie Shows Why The GOP Is Hopeless On Health Care Reform

With the rollout of the health care exchanges created by Obamacare hitting some bumps, to put it mildly, and President Obama’s approval rating falling to new lows, it seems like now would be the perfect time for Republicans to take control of the health care issue. Yet they haven’t.

Why? To figure that out, look no further than the GOP’s darling of the moment, New Jersey Gov. Chris Christie.

Fresh off a re-election rout, plenty of conservatives are pointing to Christie as the hope for a new, modern and revitalized GOP. And at the Wall Street Journal’s CEO Council 2013 yesterday, Christie knew his cue, saying, “Obamacare is a failure, it’s always been a failure and it will not succeed. It just won’t.”

But when asked what he would replace it with, Christie first demurred, saying he didn’t have enough time to flesh out a solution, but then added:

Obamacare is wrong, it’s a failure, it’s the most extraordinary overreach of government power in the history of our country. And it’s being run by people who have never run anything. So why are we surprised it’s failing?

What do we need to replace it? We need a robust debate among both sides. Unlike last time, where the president jammed this down everybody’s throat and got not one Republican vote because he was unwilling to make any compromise, including tort reform, for god’s sake. Well, then this time we need a robust conversation between both sides where everybody brings skin to the table and everybody compromises. And if we do that we can craft a solution.

This is just red meat, not a constructive discussion of the nation’s health care problems. And it’s emblematic of the mainstream GOP’s fact-free approach to health care reform and the problems it’s having landing punches against Obamacare.

For starters, it’s simply incorrect that the Obamacare exchanges are “being run by people who have never run anything.” Secretary of Health and Human Services Kathleen Sebelius, after all, ran a state (she was the governor of Kansas, not exactly a socialist utopia), which I imagine Christie counts as executive experience. And President Obama, like it or not, has been at the helm of the world’s largest economy and military since 2009.

But far more importantly, Christie’s only solution to the health care conundrum is more “debate.” He seems to believe that health care reform would have gone just fine if mean old Obama hadn’t “jammed this down everybody’s throat” without making any compromises. That’s revisionist history, to say the least.

Back here in reality, Senate Finance Committee Chairman Max Baucus, D-Mont., spent months fruitlessly trying to get Republicans to sign onto a health care bill, which was also endlessly debated in committee, in each chamber of Congress and on the airwaves. There are a slew of provisions in the law that come from various proposals Republicans have put forth over the years, including some lifted from their Obamacare alternative, but they earned Obama not one Republican vote.

Obama also ditched the public option – a government run plan in the health care exchange – as a concession, for which he got nothing in return except accusations that he was engineering a “government takeover” of health care.  Oh, and Christie’s magical tort reform, the GOP silver bullet? Obama has offered it to Republicans multiple times, and in response, they did nothing. (Tort reform, in the end, would result in scant savings anyway.)

This is not to deny that Obamacare has its problems, but simply to highlight that the GOP had the opportunity to be constructive during the health care debate, and instead chose across-the-board opposition and obstruction as an explicit political strategy to bring about Obama’s “Waterloo.”

Now, years later and with Obamacare faltering, the best the GOP’s newest star can muster is to tell the same old tales in the same old way. Complicating the matter is the fact that the few ideas conservatives do have for health care reform would result in many of the same things which Republicans are now criticizing. Reforms favored by the GOP would cause people to lose their insurance plans, even if they like them. And they would cut Medicare. Gasp!

Christie either knows this and can’t say it, because he would then be vilified by the conservative base, or he is just another Republican who doesn’t understand the tradeoffs involved in reforming America’s inefficient, wasteful and oftentimes completely backward health care system. And his refusal to even try to formulate a coherent health care alternative shows why, even after 40-something repeal votes and a disastrous rollout of the exchanges, Obamacare is still very much the law of the land.

 

By: Pat Garofalo, U. S. News and World Report, November 19, 2013

November 24, 2013 Posted by | Affordable Care Act, Health Reform | , , , , , , , | Leave a comment

“The Elderly And The Infirm”: Scott Walker’s Latest Victims Are The Most Vulnerable

When Governor Scott Walker faces Wisconsin voters in 2014, he’ll be running on a record of confronting public worker unions, turning down Medicaid expansion that would have covered 181,000 Wisconsinites and creating far fewer than the 250,000 new jobs he promised.

And if that isn’t enough, he can run on the Wisconsin Omnibus Tort Reform Act of 2011.

One of the first bills Walker signed into law, these reforms were taken almost entirely from the Koch-funded legislative warehouse of the Billionaire Rights Movement, the American Legislative Exchange Council (ALEC).

The legislation prevents state health investigation records from being admitted as evidence in any civil or criminal cases against long-term care providers, including nursing homes and hospices.

Sarah Karon of the Wisconsin Center for Investigative Journalism looked into the impact of the reform and found that the families of patients who often cannot testify on their own behalf are powerless to redress abuse and neglect.

In one case, Joshua Wahl — a paraplegic patient with spina bifida and brain damage — had a bedsore left to fester for months before he was finally hospitalized, according to a state investigator.

“It scares me for those who put their trust in a facility,” said Karen Nichols-Palmerton, Wahl’s mother. “It scares me to think of things that could be brushed aside. I don’t rest so easy anymore.”

Nichols-Palmerton is suing the facility, but the investigator’s report will not be heard in court, thanks to the Wisconsin Omnibus Tort Reform Act of 2011.

Why did Walker and Wisconsin’s Republicans decide records documenting such abuse shouldn’t be admissible in court?

It isn’t good for business.

“Each of these (proposals) is aimed at one thing — jobs,” said Brian Hagedorn, Walker’s chief legal counsel, during a hearing for the bill. “These changes send a symbolic and substantive message that Wisconsin is open for business.”

State investigators’ reports are published online. But a Department of Justice spokeswoman told Karon that the law makes it difficult to prosecute abuse and neglect cases at early stages, when severe injuries or death can be prevented.

Nursing homes that accept Medicaid or Medicare must be investigated every 15 months. Non-federally certified facilities are investigated by the states every two years. Wisconsin has cut its staff of nursing home surveyors by more than 30 percent, even as complaints about such facilities have risen by more than 100 percent since the year 2000.

Walker’s record of opening Wisconsin “for business” and turning away from its grand tradition of progressivism hasn’t had such a great effect on job creation. And the cost, especially for those forced to rely on long-term care, is falling squarely on the most vulnerable.

 

By: Jason Sattler, The National Memo, February 22, 2013

February 25, 2013 Posted by | Scott Walker | , , , , , , , , | Leave a comment

Texas-Style Tort Reform: Rick Perry’s Texas Health Care Hoax

In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reformwould go a long way toward curing what ails the U.S. health care system.

Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected.

Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.

“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide,” Perry wrote in a newspaper commentary in 2009. “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”

Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.

But if Perry had his way, all the states would do as Texas did in 2003 when lawmakers enacted legislation, which he championed, limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The legislation capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. A few months after he signed the bill into law, the state’s voters narrowly passed a constitutional amendment, also endorsed by Perry, which had the same effect. Proponents of the amendment wanted to be sure the new law would be constitutional.

Texas, he wrote in that 2009 commentary “stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.”

As a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, according to Perry, the number of doctors applying to practice medicine in the state “skyrocketed.”

He says that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing there for the first time.

Tort Reform Backfires in Texas

That certainly sounds impressive — so long as you look at that number in isolation. But when you look at how Texas stacks up with the rest of the country in terms of physician growth in direct patient care, tort reform appears to have given Texas no leg up in competition with others states for doctors. In fact, according to statistics compiled by the American Medical Association and other physician organizations, Texas has actually lost ground when it comes to the number of doctors practicing in the state since tort reform was enacted. Big time.

In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states. In fact, only nine states fared worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not as badly. Back then, 11 states fared worse than the Lone Star state.

Even more revealing, the number of doctors in patient care increased 13.2 percent nationwide from 2000 to 2008. It increased only 12.8 percent in Texas. The rate of growth was actually greater in 41 other states and in Washington, D.C. than it was in the Lone Star state.

It is true that malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit from that drop — except, that is, Texans who are doctors.

The Dallas Morning News published a chart earlier this year showing that the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. The paper reported drops of similar percentages for doctors in family practice and general surgery.

Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is the “defensive medicine” doctors practice, such as over-treating and prescribing more medications and diagnostic tests than necessary, out of fear of being sued. Well, if Texans believed their own health insurance rates would go down once tort reform made defensive medicine less prevalent, they have by now been disabused of that notion. The chances of a Texas family saving a few bucks on premiums would actually be greater if they moved to another state.

In 2010, the average premium for family coverage in Texas was $14,526. That’s $655 higher than the U.S. average. Those numbers seem to indicate that doctors have not passed on their own insurance savings to their patients and that they are not practicing medicine any less defensively than before tort reform was enacted.

Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived in another state. The Dallas Morning News, citing statistics from the Agency for Healthcare Research and Quality and other sources, reported that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively). And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was much lower: $3,721.

Another statistic Perry is not likely to mention when he talks about the benefits of tort reform is the number of Texans who are uninsured. The U.S. Census Bureau reports that Texas continues to be the state with the highest percentage of its residents without coverage, a whopping 25 percent last year, compared to about 16 percent nationwide. It was dead last in 2003 and it is dead last now.

All this should leave us wondering what “thing or two” states have come up with to solve the problems that affect their citizens. Considering the dismal state of health care in Texas, perhaps Perry had Massachusetts in mind.

 

By: Wendell Potter, Center for Media and Democracy, September 1, 2011

September 1, 2011 Posted by | Conservatives, Consumers, Elections, Freedom, GOP, Government, Governors, Health Care, Health Care Costs, Ideologues, Ideology, Lawmakers, Middle Class, Politics, Public, Public Health, Republicans, Right Wing, State Legislatures, States, Teaparty, Uninsured, Voters | , , , , , , , , , , , , , , , , , | 1 Comment

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