“It’s My New Heart”: Dick Cheney, An Even Bigger Monster Than You Thought
You’ve probably heard that Dick Cheney agrees with Bill Clinton about letting people who are losing private insurance keep their old plans, as President Obama repeatedly seemed to promise they could. That’s not surprising: Cheney is a troll who maligns the president whenever he can, and piling on with Clinton is a special kind of fun. Yes, it’s outrageous that a man who has enjoyed many millions of dollars of taxpayer-funded medical care doesn’t give a damn about the uninsured in our society, but that’s Dick Cheney.
Still, I was a little startled to hear the former vice president express total indifference to questions about his heart donor in a revealing interview with Larry King (it airs Thursday night; here’s a clip). It’s a window into his utter entitlement and self-absorption, and he comes off as an even bigger monster than I’d thought. Most people would at least feign interest in the donor; Cheney can’t manage it.
When King asks if he knows the identity of the person whose heart keeps him alive, Cheney, who is promoting a book about his transplant experience, says no, and adds, “it hadn’t been a priority for me.” Then he goes on:
When I came out from under the anesthetic after the transplant, I was euphoric. I’d had–I’d been given the gift of additional lives, additional years of life. For the family of the donor, they’d just been [through] some terrible tragedy, they’d lost a family member. Can’t tell why, obviously, when you don’t know the details, but the way I think of it from a psychological standpoint is that it’s my new heart, not someone else’s old heart. And I always thank the donor, generically thank donors for the gift that I’ve been given, but I don’t spend time wondering who had it, what they’d done, what kind of person.
“It’s my new heart, not someone else’s old heart.” Consider the complete self-centeredness of that statement, and the utter lack of empathy. I shouldn’t be surprised at that — war criminals and torture-promoters aren’t known for their empathy — but I was. Cheney’s so absorbed in his great good luck that he can’t help sharing: “My cardiologist told me at one point, ‘You know, Dick, the transplant is a spiritual experience, not just for the patient, but also for the team.’” What a generous guy, sharing that “spiritual experience” with his cardiology team! So: Cheney is happy to have a new heart, but doesn’t bother to “spend time wondering who had it, what they’d done, what kind of person.”
And his statement that it wasn’t a “priority” to learn about his heart donor revealingly echoes his explanation for getting five deferments from the Vietnam War: The notorious war hawk famously told the Washington Post: “I had other priorities in the ’60s than military service.” Now he has other priorities than learning about his heart donor.
It’s certainly not compulsory to find out about the person who died so that you could live – who gave what Cheney called “the gift of life itself.” There may be valid psychological reasons not to. I don’t judge that decision. But I can’t get over the coldness required to express complete indifference to knowing about that person, and their family’s suffering.
Or could it be compassion? For a lot of people, the tragedy of a family member dying would be compounded, not lessened, by learning that their heart went to Cheney. Nah, there’s neither compassion nor self-awareness in the way Cheney talks about receiving “the gift of life,” from American taxpayers or from his mystery heart donor.
By: Joan Walsh, Editor at Large, Salon, November 14, 2013
“What A Shocker”: Obamacare Is Working Best In States That Aren’t Trying To Sabotage It
The disappointing Affordable Care Act (ACA) numbers the Department of Health and Human Services (HHS) released on Wednesday revealed that the law is working best in the states that are — shockingly — implementing the law as it was designed.
Of the 106,185 people who have completed an application for health insurance, nearly 75 percent came from 14 states and the District of Columbia that both set up their own exchanges and expanded Medicaid.
Unsurprisingly, California and New York combined for the bulk of the enrollments, 51,769. But the most promising news from the Golden State wasn’t even included in this report.
Peter Lee, the executive director of Covered California, reported Wednesday that as of Tuesday, 60,000 Californians had signed up for insurance. Signups have increased to a rate of almost 2,500 enrollees per day in November. At that pace, the state could be expected to enroll 402,500 people by March 31 but Lee says that he expects to hit a goal of 500,000 to 700,000 people by then, which means he expects the pace to pick up by at least 640 people a day to over 3,000 enrollees.
Lee’s optimism is linked to more than the enrollment numbers. It seems California’s consumers are happy with the state’s website.
“Overall, nearly 70 percent of consumers who completed the survey found the application process easy to complete, and 88 percent of customers visiting CoveredCA.com found the information needed to choose a health plan that was right for them,” Covered California reported in a statement released Wednesday, giving Republicans another reason to hope that California isn’t a bellwether for the rest of the nation.
Red Kentucky is the only state in the union that voted for Mitt Romney and set up its own exchange, thanks in large part to Democratic governor Steve Beshear. The state’s site signed up a total of 32,485 Kentuckians, with 5,586 enrolling in private plans, in its first month of operation. This reduces the state’s uninsured population —estimated at 640,000 — by just over 5 percent.
Of course, it’s not hard for the states to look impressive next to the federal number that is anemically low. And not all the states that set up their own exchanges have succeeded. Oregon’s marketplace is so flawed, they didn’t even have numbers to report for October.
Implementing health care reform was never supposed to be easy.
“It’s like fixing an airplane while it’s in flight, if there is something terribly wrong with the plane,” said Timothy Jost, a health law professor at Washington & Lee University and an expert on the ACA.
And that’s without the unprecedented campaign of sabotage the right has waged. But the obstruction that has threatened the law most has been the combination of a mostly unforced error — Healthcare.gov’s disastrous launch — and Republican states refusing to launch their own exchanges. While the right is thrilled they’ve assisted in this catastrophe, it was the ancillary result of another sabotage strategy that was either masterminded or enthusiastically encouraged by Michael Cannon.
Who?
“Cannon is a health care policy expert at the libertarian Cato Institute,” reports The New Republic‘s Alec MacGillis. “He is also an avowed opponent of the Affordable Care Act, and has for several years now been embarked on a legal crusade that, while a ways from triumphing, may have inadvertently played an outsized role in suppressing the number of states setting up their own exchanges, thereby greatly confounding the law’s implementation.”
Cannon believes he has found a loophole in the law that could end up undoing it in any state that didn’t set up an exchange. With that in mind, he helped successfully convince every state with a Republican governor to reject their right to build their own site.
By opting out, states made the success of the president’s signature legislative accomplishment dependent on one single portal that needed to reach its tentacles into three dozen complex insurance markets at one time.
That — it turns out — is a lot more complicated than the administration expected it to be.
The best state numbers show that the ACA can be implemented with participation rates that are in at least in the same ballpark as Massachusetts’ Romneycare or Medicare Part D.
And there were some other numbers in the HHS report that bode well for reform.
HHS reports that 26,876,527 different users accessed the site and 3,158,436 calls were made to its center. A total of 1,477,853 applications processed to the point of where eligibility could be determined. This shows that the demand for what the marketplace is offering definitely exists.
Clearly and undeniably, the fate of the law now depends most on one thing.
“The October report is clearly disappointing,” Timothy Jost wrote in his blog. ”But the really important reports will be the December report, which will tell us how many will be enrolled for coverage that begins in January, and the March report, which will tell us how many will be enrolled for 2014. If healthcare.gov is up and running by December, there is every reason to believe those reports will be much more promising.”
By: Jason Sattler, The National Memo, November 14, 2013
“Obamacare’s Critical Moment”: It’s Time For Nervous Democrats To Have A Gut Check
At times like this, with the Obama administration weathering yet another controversy regarding the stumbling beginnings of the Affordable Care Act, it’s useful to remind ourselves that this too shall pass. I’ve been plenty critical of how Healthcare.gov has been handled (see here, or here, or here), but eventually it will get fixed, at least to the point at which it works well enough. Likewise, the fears now being experienced by people with individual insurance policies will, by and large, turn out to be unfounded. There will be some who have to pay more than they’ve been paying, but in almost all cases they’ll be getting more too.
But there’s no doubt that this is an escalating problem for the administration. The person who got sold a cheap insurance policy on the individual market because the insurer was confident that either a) they probably wouldn’t get sick any time soon, or b) the policy was so stingy (whether the customer knew it or not) that the insurer wouldn’t have to pay anything even if they did, has now become the victim whom all agree must be made whole. We’re all talking endlessly about Obama’s “If you like your current plan, you can keep it” pledge, but the fact is that if you have one of these junk insurance plans, you only like it if you haven’t had to use it. But no matter—the people on these plans (and not, say, people who are finally getting Medicaid, because they’re poor so who cares) are now the only people that matter. Congress is obsessed with them, the news media is obsessed with them, and Something Must Be Done.
The administration is clearly spooked, and so are Democrats. But everyone needs to take a breath and ask themselves whether what they do in the next couple of weeks is something they’ll be able to live with in a year or five years or twenty years.
No one should be under the illusion that the Republican proposals to “fix” the problem of people on the individual market who want to keep their current plan—one of which could be voted on today in the House—are anything other than an effort to cripple the ACA. Not only would they allow insurers to continue selling junk policies, they would also allow the insurers to deny people coverage because of pre-existing conditions. In other words, the Republicans propose to restore the abysmal status quo ante that led to passage of the ACA in the first place. They’d also have the likely effect of jacking up premiums in the exchange marketplace by allowing the insurers to cherry-pick healthy young people for the now still-legal junk policies, leaving older and sicker people to migrate to the exchanges, where premiums will almost surely skyrocket a year from now once the damage becomes clear. As Igor Volsky puts it, “On the eve of implementing hard fought reforms, lawmakers are essentially considering re-segregating the health care market: healthy uninsured individuals without an offer of employer-sponsored coverage, Medicare or Medicaid will be lured away into subprime policies that include few consumer protections (and probably won’t be there for them should they fall ill); sicker people will find themselves in exchanges that resemble high-risk insurance pools, paying ever-more for coverage.” Any Democrat who votes for something like that should be ashamed of themselves.
There’s a Democratic proposal from Mary Landrieu that’s almost as bad. Meanwhile, House Democrats are threatening the White House that they’ll sign on with the Republican plan if the White House doesn’t come up with some other solution that will allow them to cover their asses. But there may be no way to let people who have junk insurance keep it without undermining the law as a whole. As Ezra Klein says, “Solving a political problem now at the case of worsening a policy problem 10 months from now isn’t a good trade.” And that’s putting it way too mildly. They could easily try to solve a political problem now and give themselves a much worse political problem ten months from now by making it impossible for the law to succeed. If that happens, the fact that they signed on to the measure that all but destroyed the law isn’t going to save them with the voters. Obamacare’s fate is every Democrat’s fate, whether they like it or not.
You can say that Obama made his bed by repeating that “If you like your insurance, you can keep it,” and now he has to sleep in it. I’d have two responses to that. First, plans that were in effect when the ACA passed in 2010 fall under a grandfather clause, so strictly speaking, if you liked the plan you had when the law was passed and you still have it, you can keep it, even if it doesn’t meet the new requirements. But since the individual market is volatile (people move in and out of it frequently) and only plans that haven’t been altered since then fall under the grandfather clause, that’s a small number of people.
But much more importantly, we shouldn’t make a terrible policy choice just because it’s the one that we think would line up most precisely with a rhetorical pledge Barack Obama made three years ago. Yes, he should have said, “If you like your plan you can keep it, so long as it’s a plan that gives real coverage and doesn’t leave you vulnerable to bankruptcy if you get sick or have an accident.” But he didn’t. And today, we should make the policy choice that does the most good for the most people.
It would be nice if you could make an enormous policy change without leaving a single American worse off. But that was never possible. There are millions who are going to benefit from the ACA—people who had no insurance who will now be able to get it for free or for a modest cost, people with pre-existing conditions who couldn’t get coverage but now can, and yes, people who thought they were covered but weren’t and now will be, even if they have to pay a little more. Screwing huge numbers of them over for the sake of a small number of people who have been sold a bill of goods by their insurance company and want to keep their junk plans would be unconscionable.
As Josh Marshall says, it’s time for nervous Democrats to have a gut check. Republicans are positively slobbering at the opportunity they think they have to destroy the ACA. After all that’s happened—after a generation of waiting for health reform, after all the effort it took to pass it, after the Supreme Court case and the election and everything else—are there Democrats who want to find themselves telling their grandchildren, “Well, I helped the Republicans subvert the ACA and deprive millions of Americans of health security, because I was afraid somebody might run an ad against me in my next election”?
My confidence that your average member of Congress in either party fully understands the policy implications of what they might be voting for hovers somewhere near zero. But they need to get up to speed, and then find their moral centers. This is among the most critical moments in the already long and tortured history of this law. They’d better not screw it up.
By: Paul Waldman, Contributing Editor, The American Prospect, November 14, 2013
“Medicaid Matters”: Where Is The Outrage Over GOP Governors Cutting Off Lower-Income Americans From Access To Medicaid
E.J. Dionne Jr. raises an argument in his column this morning that’s been getting short shrift by too much of the political world lately: Medicaid expansion matters, and far too many state Republican policymakers are blocking it for no reason.
“President Obama apologized last week after all the criticisms of what’s happening in the individual insurance market,” Dionne explained. “But where is the outrage over governors and legislators flatly cutting off so many lower-income Americans from access to Medicaid? The Urban Institute estimates that 6 million to 7 million people will be deprived of coverage in states that are refusing to accept the expansion.”
The recent disruption in the health care marketplace certainly matters, and the Obama administration has a lot of work to do to put things right. But if we’re going to talk about policymakers who need to apologize and show some semblance of regret, can we at least start to have a conversation about those keeping millions of struggling Americans from having access to coverage, largely out of partisan spite?
Jonathan Cohn published a good piece on this earlier:
Today it’s a few hundred thousand people. By next year, it will be at least a few million. Their health insurance status is changing dramatically: What they have in 2014 and beyond will look nothing like what they had in 2013 and before. For many of these people, the difference will be hundreds or even thousands of dollars a year. In a few cases, it may be the difference between life and death.
You probably think I’m talking about the people getting cancellation notices about their private insurance policies. I’m not. I’m talking about the people getting Medicaid. Both stories are consequences of the Affordable Care Act. But one is getting way, way more attention than the other.
There’s been an obvious preoccupation – on Capitol Hill, with Beltway media, etc. – with website dysfunction and cancelation notices, while Medicaid expansion, which arguably affects a larger group of people, has been routinely overlooked.
Maybe it’s because Washington is “wired” for Republicans and it’s the right’s complaints that have been driving the recent conversation. Perhaps it’s the result of Medicaid beneficiaries lacking the kind of political capital that keeps their plight on the political world’s front-burner. Maybe it’s a matter of timeliness, with implementation disruption seeming “new” in ways Medicaid is not. Perhaps it’s a combination of things.
Regardless, by my standards, this is a genuine scandal. The administration’s missteps are real, but they’re not deliberate. “Red” states rejecting Medicaid expansion because of some misguided contempt for “Obamacare” are leaving struggling families behind on purpose. The callousness is outrageous.
Cohn concluded, “”Should the president have been more candid about the impact his plan would have on people buying their own coverage? Yes. Should we pay attention to those people, particularly when they must now pay more for equivalent coverage? Definitely. Should this put extra pressure on the administration and some states to fix their websites? You bet. But that’s not the only Obamacare news right now. The law is making life better for a great many people – and would help even more if only Republican lawmakers would relent.”
By: Steve Benen, The Maddow Blog, November 11, 2013
“Separating Myth From Reality On Obamacare”: The Greatest Good For The Greatest Number, More People Are Better Off In The End
My heart sank when I got an email late last month from my friend Robert, who has been battling multiple sclerosis for the past decade. He wrote to tell me that he was among the many Americans who in recent weeks received letters from their insurance companies saying that their policies won’t be available next year.
Insurance companies are sending those letters primarily because the policies they will no longer offer don’t provide enough coverage — or have deductibles that are too high — to comply with the Affordable Care Act. In many cases, however, the policyholders getting those letters are simply victims of a business practice insurers have engaged in for years: discontinuing policies because they’re no longer sufficiently profitable.
Robert understandably was worried. Like most of us, he’d been seeing the news stories about people who had received similar letters and seemed to be resigned to having to pay more in premiums next year for comparable or even less coverage, thanks to Obamacare.
Considering his very serious and costly preexisting condition — his medications alone cost more than $5,000 a month — Robert was nervous as he started looking for a replacement policy. How much more would he have to pay to stay insured?
A couple of weeks went by. I assumed Robert, like many others, was still waiting for the Obama administration to fix Healthcare.gov so he could shop online for coverage. It turns out Robert wasn’t willing to just wait. He decided to call an insurance agent and talk to a real live human being about his options for next year.
He could barely believe what he heard: he could get better coverage than the policy being discontinued — and pay less — thanks to Obamacare.
“The overall cost of the plans I’m considering is cheaper than the plan I am currently paying for,” he wrote me this week. “My total cost for coverage now, including premiums and out of pocket costs, is about $9,800. Two of the plans I’m seriously considering for next year have total costs of $8,400. I’m shocked, but in a good way.”
So not only did Robert not experience the sticker shock he had been expecting, he will save $1,400 next year on health insurance.
The plan he is leaning toward — a top-of-the line “platinum” plan — will have a higher monthly premium, but he will still save on average about $117 a month because of the way his out-of-pocket costs will be calculated.
Robert is among many who are losing their current coverage but in the end will be better off. In fact, considering that many folks buying coverage on the individual market have at least one pre-existing condition — which insurers can no longer take into consideration when pricing their policies — it’s likely that more people will get more for their insurance buck next year than less.
In addition, most of the people who buy coverage through the new insurance marketplaces (as Robert will when the balky Healthcare.gov website is working more smoothly) will be eligible for tax credits and subsidies from the federal government that will lower their monthly and overall costs even more.
Robert knows that you can’t determine how much you’ll spend on coverage during a given year just by multiplying the monthly premium by 12. If you don’t take into consideration out-of-pocket costs and just pick the policy with the cheapest premium, you could wind up paying more overall than if you picked a plan with a slightly higher monthly premium.
Robert also will be able to spread the cost of his coverage more evenly over the year. Under his current plan, he had to have at least $5,000 in the bank at the beginning of every year when his policy renewed to cover the cost of his medications for just one month. Under the new plans he is considering for next year, his monthly out-of-pocket costs will range from $80 to $120 a month.
“It will be easier to manage paying for my drugs spread out over a period of 12 months instead of in one lump sum at the beginning of the year,” Robert told me.
Robert said the insurance agent told him his case is not unique, that a lot of the people she talks to who have been frightened by the media coverage are pleasantly surprised to learn that they will get better coverage for less money next year. Once the Healthcare.gov website is fixed, more people who have received letters from their insurance companies will get a similar pleasant surprise.
By: Wendell Potter, The Center for Public Integrity, November 12, 2013
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