“First Do No Harm”: It’s Time To Rethink The Oath Of Office For People We Vote To Represent Us
First do no harm. That’s a tenet of medical ethics that future doctors worldwide are taught in medical school.
If only the people we elect to represent us were required to take such an oath when they’re sworn into office.
Because they aren’t, folks in Florida are facing having to pay far more for health insurance over the next two years than necessary. And health insurance executives will be laughing all the way to the bank.
Florida state lawmakers, in their ongoing efforts to block the implementation of Obamacare in the Sunshine State, recently passed a law that will allow health insurance companies to gouge Floridians more than any corporate boss dreamed was possible.
And if that weren’t bad enough, insurers will actually be required by law to mislead their Florida customers about why they’re hiking their premiums.
Republicans, who control the governor’s office as well as both houses of the Florida legislature, were confident the U.S. Supreme Court would declare the Affordable Care Act unconstitutional. Not only did they vote to prohibit the state from spending money to implement a law they just knew would be overturned by the high court, they refused to accept money from the federal government that would have enabled the state’s department of insurance to do a better job of regulating health insurers and enforcing new consumer protections in the law.
When the Supreme Court shocked Obamacare opponents last year by upholding the law, Florida lawmakers were in a pickle.
Their response? They passed a bill that prohibits the state’s Office of Insurance Regulation from protecting consumers from unreasonable rate increases for two years.
I learned about what is essentially a “first do as much harm as possible” bill in a letter the nine Democrats in the Florida congressional delegation sent to U.S. Secretary of Health and Human Services Kathleen Sebelius earlier this month pleading with her to step in to protect Floridians by taking an active role in regulating rate increases in the state.
The lawmakers said intervention by HHS was urgently needed because of a law signed in May by Gov. Rick Scott that specifically prohibits Insurance Commissioner Kevin McCarty from doing his job of reviewing rate increases and rejecting those he and his staff determine are unjustifiably high.
Until the passage of SB 1842, McCarty had the power to do that. Florida state lawmakers who voted for the bill, including a few Democrats who seemed to think HHS has more authority than it does, took the position that since the federal government was requiring insurance companies to be more consumer friendly, the federal government should assume the responsibility of enforcing the new consumer protections in Obamacare. The problem is that Congress gave the federal government no such additional powers. As a consequence, HHS really can’t take over what is still a state responsibility. And since Florida turned down the federal money that McCarty would have used to do his job, Floridians appear to be out of luck.
Last month, McCarty’s office said insurance premiums for individuals in Florida would be significantly higher than they are now. In their letter to Sebelius, the state’s congressional Democrats wrote that those increases are “not a coincidence, but rather the product of a cynical and intentional effort by Gov. Scott and the Florida legislature to undermine the Affordable Care Act and make health insurance premiums on the Florida Health Insurance Marketplace more expensive by refusing to allow the insurance commissioner to negotiate lower rates with companies or refuse rates that are too high.”
As PolitiFact noted in a recent analysis of the charges made by the Democrats in their letter (which PolitiFact ruled are true), the states that have authority to approve or disapprove rates were “able to extract significant reductions.” PolitiFact cited a Palm Beach Post story which noted that Maryland’s insurance department had used its regulatory powers “to push rates for next year’s premiums down by as much as a third.”
As Florida CHAIN, a state advocacy group, pointed out when Scott signed SB 1842, the law not only blocks McCarty’s office from protecting consumers, a provision in the law actually requires insurers to send deceptive and misleading notices about rate increases to consumers — and to blame Obamacare for them.
“The only ’public education’ of any sort authorized by the Legislature related to the ACA (Affordable Care Act) is a requirement … that insurers send extremely biased and incomplete notices this fall about the ACA and its effect on policyholders’ rates,” Florida CHAIN said in a statement.
“The sole purpose of the requirement is to create ‘sticker shock’ that can be blamed on the ACA. There will be no mention of the many uncertainties or any other relevant factors, such as past rate increases or how actual rates will be reduced for many by the availability of premium tax credits (to low and middle income earners.)”
So not only will many Floridians be harmed by SB 1842, they will, by law, be misled about who caused the harm.
Maybe it’s time to rethink the oath of office for people we vote to represent us.
By: Wendell Potter, The Center for Public Integrity, August 19, 2013
“Ideology Meets Idiocy”: The GOP’s Obamacare Youth Hoax
It’s rare for a political party to trumpet a position that unintentionally reveals its myopia, incoherence and expediency. Yet such is the trifecta with the Republican campaign to call attention to Obamacare’s young “victims.”
Republicans are obsessed with the supposed injustice being done to some healthy young people who will effectively subsidize their sicker elders when Obamacare’s individual mandate takes effect.
The crusaders are nothing if not convinced of the righteousness of their cause. “The whole scheme is enlisting young adults to overpay, so other people can have subsidies,” Dean Clancy, a vice president at FreedomWorks, told my Post colleague Sarah Kliff. “That unfairness reminded us of the military draft.”
Conservatives are therefore urging young Americans to resist. “I’m burning my Obamacare draft card,” runs one theatrical riff from a group called Young Americans for Liberty, “because I’m too busy paying student loans to pay for somebody else’s health insurance.” Republican policy advisors have urged the party to make such child abuse a big part of their anti-Obamacare message.
Sounds like a sexy argument, except for one thing. Republicans seem to have forgotten where most people aged 19 to 34 get health coverage: from their employer. And at virtually every company, young people pay the same premiums as employees who are much older than they are and who get more expensively sick than they do. In other words, the evil cross-subsidy Obamacare’s foes are storming the barricades to roll back already exists, at vastly larger scale, in corporate America.
These youngsters are already in chains! They’ve been put there by the private sector! And, inexplicably, young employees have entered this servitude of their own volition. (To extend the GOP’s draft analogy, it turns out there’s a voluntary army of health care masochists from sea to shining sea.)
How could injustice on this scale escape the GOP’s searing moral scrutiny?
After all, the president is only hoping that about 2.7 million young people will purchase coverage in the new exchanges. But 20 million Americans between the ages of 19 and 34 get coverage from their employer right now, according to an analysis by the Kaiser Family Foundation.
If you’re keeping score, that makes employer-based health care’s cross-subsidy about eight times more evil than Obamacare’s.
How does it work? Compare a typical, strapping young employee of 28 to her broken- down 58-year-old colleague. These two employees have very different annual health expenses. Yet under the nefarious plot known as “group health insurance,” they basically pay the same premiums. It turns out every big company in America is essentially a socialized health care republic, in which the young subsidize the old, and the healthy subsidize the sick — all of whom pay the same premiums for the same plans.
Similar dynamics explain why, in the federal health-care plan, spry 42-year-olds like Marco Rubio and Ted Cruz subsidize 79-year-old geezers like Chuck Grassley and Orrin Hatch.
Maybe that’s why Cruz always seems so angry.
Of course, most people in civilized nations know and accept that this is how insurance works. But Republicans nowadays aren’t like most people in civilized nations. They think Obamacare is a form of injustice akin to slavery. Which makes employer-provided health care slavery on steroids. Where’s the outrage? If conservatives were consistent and principled, they would devote far more time and effort to liberating 20 million young Americans from the socialism baked into employer-based insurance and look past the Obamacare exchanges as a puny sideshow.
But, alas, conservatives are not consistent and principled, save for their consistent determination to hurt the president politically.
It would be better if all those smart GOP thinkers devoted their talent and energy to the question of how they would expand coverage to the 50 million uninsured — but to raise that question is to enter the policy cul de sac in all its delicious irony.
Because the answer to that question is RomneyObamacare, the only sound way (as Republicans rightly taught us) that a country can move toward universal coverage using private health plans. The GOP could offer a tweaked version with slightly fewer regulations. Or structure it to offer universal catastrophic coverage to save money. But if Republicans were serious, they’d offer the same basic reform architecture.
So Republicans choose not to be serious. And it shows.
In the end, the GOP’s Obamacare youth hoax shows how silly a party can look when a political focus on one corner of a policy leads it to latch on to “insights” that utterly miss the big picture. It’s a reminder, if we needed another, of how close the connection can be between ideology and idiocy.
By: Matt Miller, Opinion Writer, The Washington Post, August 21, 2013
“Petulant Little Children”: Why The Republican Obamacare “No Strategy At All” Strategy Fell Apart
After President Obama signed the Affordable Care Act, conservative writer David Frum, who had been a speechwriter for George W. Bush, chided his compatriots for the strategy they had employed in opposing it. Had they worked with Obama on a compromise, he argued, the result could have been a more conservative version of the law; by simply opposing it in its entirety, they wound up with nothing once the law passed. For raising this criticism, Frum was declared a traitor and banished from the conservative movement; these days his (still conservative) ideas get a better hearing on the left than the right.
And what has been the Republican strategy on health-care reform since the ACA’s passage? Well, first they tried to kill it through the courts. That didn’t work, though they won for Republican governors the right to refuse the Medicaid dollars that would enable them to offer insurance to their states’ poor (congrats on that), though many of them are coming around to accept the money. In the one house of Congress they control, they’ve held dozens of symbolic repeal votes, so many that it’s become a national joke. They’re now threatening to shut down the government (very bad) or default on America’s debts (even worse) unless Obama agrees to shut the law down, a plan even many within their own party realize is insane. So they’ve ended up looking like petulant children who don’t know when they’ve lost, not to mention viciously cruel ideologues who would literally rather see people go without health insurance than allow them to get it through a system tainted in any way by contact with a law with Barack Obama’s signature on it.
So once again, they’re not getting what they want substantively, and they’re losing politically as well. Even Newt Gingrich—Newt Gingrich!—is criticizing them for not bothering to come up with the “replace” part of “repeal and replace.” Why didn’t they? It’s partly because, as I’ve argued before, the whole topic of health-care reform is something they just don’t care about. But Ed Kilgore adds an important insight: their stance of opposition to every single component of what is a pretty conservative reform plan not only left them defending the status quo, but has pushed them step by step so far to the right that they’ve now reached a point where they’ve almost rejected the very idea of insurance. They’re attacking Obamacare on the grounds that healthy people will have to buy insurance, but might not use it as much as sick people, even going so far as to encourage young people to stay uninsured. But that’s how insurance works! Is it a “bad deal” for many healthy young people? Absolutely, just like car insurance is a bad deal for people who never get into an accident, and homeowner’s insurance is a bad deal for people whose houses never burn down. You don’t have to be a health-care wonk to hear them saying these things and say, “Geez, these people are nuts.”
The real problem is that, as usually happens in a complex political world, the Republican “strategy” to oppose Obamacare was no strategy at all. It was a bunch of ad-hoc decisions, based on a mixture of reason, ill-informed judgment and emotion, made by people not necessarily working together, over an extended period of time. And now it’s falling apart.
By: Paul Waldman, Contributing Editor, The American Prospect, August 20, 2013
“Kill The Law, Kill The Patient”: The Most Insane Conservative Anti-Obamacare Gambit Ever
In a last-ditch effort to stop Obamacare, Tea Party groups are trying to sabotage the healthcare law in a way that could leave young people without coverage and increase insurance premiums for everyone else. It assumes that the end of “repealing Obamacare” justifies the means of potentially years of worse health.
The gambit, as explained by Sarah Kliff of the Washington Post, is to convince young people to eschew the Affordable Care Act’s health insurance exchanges and the subsidies they offer in order to destabilize the insurance risk pools. And now the leader of the effort is talking to Salon about the idea.
First, some background. The “plan,” such as it is, works like this: Young people tend to be healthier and thus cheaper to insure, so they essentially subsidize the cost of older and sick people. If enough young people don’t sign up, and the pool is mostly older and sick people, costs will skyrocket. A price “death spiral” is health policy experts’ biggest fear with the law, but it’s exactly what the conservative groups want to artificially induce, thus dooming the law.
To that end, conservatives are trying to rally young people to skip the healthcare exchange and pay the fine for violating the individual mandate to have health insurance. They’re making their case with GIFs, Op-Eds and a campaign to burn Obamacare draft cards (which don’t actually exist, but can be downloaded from FreedomWorks’ website for later incineration). Americans for Prosperity is even considering setting up kiosks at Universal Fighting Championship matches and college football games to tell people not to enroll.
But, if this gambit is successful, wouldn’t that lead to millions of young people living without health insurance, and older and sick people paying higher health insurance premiums? And since Obama will never repeal his signature law, we’re talking about at least three years of intentionally inflicted misery, all for a shot at repealing Obamacare sometime in the future and replacing it with something that doesn’t even exist yet. What about the human toll?
We asked Dean Clancy, the vice president of FreedomWorks who is spearheading the effort. “Yes, we would like to hasten the collapse of the exchanges, but the purpose is not to drive up anybody’s insurance. The purpose is to get this law defunded or delayed so we can get to a patient-centered system,” Clancy said in a telephone conversation Thursday evening. “Without young people, Obamacare can’t work.”
Regardless of intention, wouldn’t it have the effect of driving up premiums? “I would not say it will drive up premiums for older Americans, I would say it will allow premiums to rise,” he said. “It would allow premiums to rise faster than they otherwise would if everybody bought the overpriced coverage, including the younger, healthier people.”
And what about young people who currently lack insurance – 90 percent of whom will qualify for subsidies in the Obamacare exchanges — what should they do? “You can get coverage outside the exchanges,” Clancy said, pointing to catastrophic care plans, healthcare savings accounts, or even Medicaid.
Even without the subsidies, which are only available through the exchanges, Clancy said, it would still be cheaper for young people to pay the fine and go their own way. “We encourage people to go for a health savings account with a high deductible policy, and to pay cash for repeat medical expenses. It’s a great way to save money and helps the system be more efficient,” he said. Plus, there’s always free-riding: “And they have to take you when you get sick, that’ll be in the law now.”
What if you get in a car accident or something and don’t have time to sign up for insurance? A pause as he consulted with the communications director, who was also on the call. “In that case, you may incur some costs,” Clancy acknowledged. “You may have to deal with, as people do today who don’t have funds available, paying it back in installments, or uncompensated care, or you can sign up for Medicaid.” In other words, you’re on your own. Most uninsured people can’t afford medical bills.
“Just to be clear, we’re telling people: ‘Do what you think is best for you,’” he added. “But understand that if Obamacare continues, you’re going to have to pay more and more to get less and less.”
For Judy Feder, a prominent health policy expert at Georgetown who supports the health reform law, this approach is “crazy.” “It’s not even killing the patient to save the patient — it would stick with killing the patient. They just want to kill the law, which doesn’t save anybody,” she said.
It’s hard to overstate how nihilistic this plan is. If the scheme succeeds — which it will not, since more than enough young people are saying they’ll purchase insurance through the exchange — not only would some people lack good health coverage they’d otherwise be entitled to, but costs would be higher on everyone else. “It is as outrageous as you say it is,” Feder confirmed.
This is basically the “Cloward–Piven strategy” Glenn Beck always rants about, but 1) applied to healthcare instead of the economy, and 2) real.
By: Alex Seitz-Wald, Salon, August 2, 2013
“The Character Of The Caucus”: Thanks To Republican Intrasigence, It’s All About 2016 Now
It wasn’t the House Republicans’ refusal to take up the president’s jobs plan before the last election. Or their reckless games with the debt ceiling when Paul Ryan’s budget called for trillions in fresh debt itself. Or House intransigence when it comes to the Senate’s bipartisan immigration fix. Or even its recent call to nix high, common school standards.
Not that these steps weren’t awful. But somehow they could be put down to “normal” petty politics. The “out” party never wants the jobs picture to improve before an election. The debt ceiling is one of a handful of “forcing devices” that pols of all stripes seize on in a town where nothing really has to happen. One can argue that immigration reform isn’t as urgent as, say, jobs. And stoking phony fears of a federal school takeover is the oldest slander in the book (never mind that these “common core” standards were adopted by states voluntarily, and that the world’s top-performing school systems all have something like them).
No, what finally made me lose it was House Republicans’ warped obsession with Obamacare. This fixation showcases so many noxious traits simultaneously that it reveals the ultimate character of the caucus.
At bottom, Obamacare is a moral assertion that it is wrong when a wealthy nation has 50 million people without health insurance, when medical bills are a leading cause of bankruptcy for families and when millions of luckless souls are unable to get coverage because they have preexisting conditions. The House GOP today says these are not real problems.
Obamacare addressed these problems with precisely the mechanism that conservative thinkers and Republican policymakers favored (subsidies to buy insurance from competing private carriers with a requirement that everyone be in the insurance pool). Yet the House GOP effectively has said: Even if you adopt the approach our party favors for a problem we used to say was real — a problem that our presidential nominee addressed successfully in his state — we still can’t be with you. We have to damn you as un-American. We have to deceive the public about your aims and methods. We have to do everything in our power to stop you from using our preferred approach to bring a measure of security to the middle class.
It’s the most perverse, irredeemable bait-and-switch since Lucy pulled the football away from Charlie Brown. Even Lucy didn’t do it 39 times.
I’ve long been a critic of the House GOP. But something in their poisonous Obamacare stance has made me snap. It’s one thing to think you can’t do business with these people. It’s another to realize these people aren’t operating in the same moral and economic universe.
So here we are. The only question for those seeking American renewal is what will break this gridlock. The only certain answer is that the president’s speech Wednesday will not. Obama is calling for an economy built from the “middle out” (hats off to progressive activists Nick Hanauer and Eric Liu, who pushed this smart messaging so relentlessly for two years that it’s become the official Democratic creed).
By: Matt Miller, Opinion Writer, The Washington Post, July 24, 2013
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