“Why They Are Dead, Horribly Wrong”: What Democrats Whine About When They Whine About ObamaCare
Democrats have reacted to crushing losses in November’s midterm elections in the usual manner: with a circular firing squad. And one of the targets has been the signature policy of the Obama administration, the Affordable Care Act.
Sen. Chuck Schumer of New York took the lead earlier this month, arguing that it was a mistake for Democrats to pass comprehensive health care reform. Retiring Sen. Tom Harkin (Iowa) has come to the same conclusion for different reasons.
While it’s not surprising that this argument has intensified after the midterm bloodbath, it isn’t a new one. Massachusetts congressman Barney Frank was saying the same things in 2012, and former White House Chief of Staff Rahm Emmanuel urged Obama to abandon health care reform in 2010, after the election of Scott Brown to the Senate cost Democrats their brief filibuster-proof majority.
But whether made now or at the time, whether from the left, right, or center, whether driven by policy or pragmatism, all of these arguments have one thing in common: they’re dead wrong. Horribly wrong. Wrong about the ACA, wrong about what was possible in 2010, and wrong about American political history in general.
Before analyzing each variation of the claim that Democrats were wrong to pass the ACA, it’s important to start with this: the ACA has been a remarkable policy success. It has substantially reduced the number of Americans without health insurance, and in so doing has alleviated a great deal of needless suffering, anxiety, and financial stress. It has slowed the growth in health care costs. And its medley of wonky reforms has improved health outcomes.
Furthermore, had it been allowed to work as intended, rather than having its Medicaid expansion ineptly re-written by the Supreme Court and obstructed by Republican statehouses, the scope of the achievement would be even greater.
The ACA doesn’t represent optimal health care policy by any means — to find a better one you need only throw a dart at a map of Western Europe. But it’s a success that Democrats should be very proud of, one that can stand alongside the great achievements of the New Deal and the Great Society.
Arguments that Democrats should not have done health care face a very, very high burden of proof. And they don’t even come close.
Democrats should have focused on something else.
This is a recurring theme in the anti-ACA arguments being made by Democrats. Schumer says Democrats should have focused on the “middle class” rather than health care reform, while Frank argued that the Democrats should have emphasized financial reform instead.
The main problem with these arguments is that no alternative course of action would be remotely worth trading for the ACA. As Paul Krugman points out, “focusing” on the economy in and of itself has no value, and Schumer can’t point to any concrete policy that would have passed had the Democrats not pursued comprehensive health care reform. There was not going to be a second major round of stimulus no matter what. The Obama administration didn’t do nearly enough for underwater homeowners, but this failure was independent of the ACA.
The only alternative policy course that could have arguably been preferable to the ACA would have been legislation addressing climate change. But given the Senate’s heavy tilt towards conservative fossil-fuel states, cap-and-trade legislation was always going to be stillborn. The idea that two Democratic senators from North Dakota, two Democratic senators from Montana, Mary “I’m going to my political grave defending the Keystone pipeline” Landrieu, and other relatively conservative Democrats were all going to vote for major climate change legislation is fantastical. In addition, much of what cap-and-trade would have accomplished can be addressed through regulatory action, which is not the case with health care.
Democrats should have waited for a pony.
Harkin’s argument is somewhat different — and is superficially more appealing — than Schumer’s. Instead of arguing that health care reform was a misguided priority, Harkin argues that the ACA wasn’t good enough. “We should have either done it the correct way or not done anything at all,” he asserts. Democrats should have tried for “single-payer right from the get go or at least put a public option [which] would have simplified a lot.”
This is like saying that Democrats should have gotten “two weeks at the penthouse suite at the Ritz-Carlton in San Francisco…or at least a night at the Motel 6 in Tulsa.” It misleadingly conflates two very different policies with two different political possibilities. Single-payer would certainly have been a better policy than the ACA, but it would be hard to get 20 votes for it in the Senate, let alone 60. (It’s worth noting that Sen. Bernie Sanders’ 2009 single-payer bill had a grand total of zero co-sponsors.)
The question of the public option is more complicated. There are variants of the public option — most obviously a universally available Medicare buy-in — that would have been major reforms, representing a pathway to single-payer. But that is precisely why a robust public option was as DOA in Congress as single-payer itself. The public option in the House bill — which would not have been universally available or cheaper than private alternatives — was small potatoes that would not have made the ACA simpler, more popular, or significantly more progressive. And even so, there almost certainly weren’t the votes in the Senate to pass even the neutered version of the public option.
Should the Democrats have just given up then, as Harkin suggests?
No. Let’s put this in historical perspective. Harry Truman tried and failed to pass comprehensive health care reform. Lyndon Johnson, in extraordinarily favorable circumstances, failed to pass comprehensive health care reform. Ted Kennedy’s efforts under the Nixon administration failed. Bill Clinton’s efforts failed. The idea that Democrats will nationalize the health insurance industry the next chance they get is just the purest wishful thinking. And the idea that millions of people should be denied health insurance for such a long-odds gamble is not merely wrong but immoral.
Democrats would have avoided big losses in the midterms.
At the core of these arguments is the fact that the ACA is unpopular, which presumably played a major role in the Democratic Party losing big in the 2010 and 2014 midterms. This argument might be the least convincing of all.
Let’s set aside the fact that Democrats held on to the Senate in 2010 and 2012, despite the ACA’s unpopularity, as well as the presidency. The argument, at its core, is deeply problematic. It presumes that Democrats should maintain power as an end in itself. But it’s not an end in itself — the point of being elected is to do things that benefit your constituents. What’s the point of political capital if you don’t spend it?
Again, it’s worth putting things in historical perspective. The problem with waiting for the perfect, risk-free time to pass major reform legislation is that there’s never a perfect time. There have been three major periods of progressive reform legislation in Congress between the Civil War and 2008. (The fact that there have been only three should give pause to those who think that Obama, Reid, and Nancy Pelosi are worthless sellouts because they failed to completely transform the American political economy in Obama’s first two years.) In 1966, Great Society Democrats lost 47 seats in the House and three in the Senate, a preview of the crack-up of the Democratic coalition that would (with a detour created by Watergate) lead to the election of Ronald Reagan in 1980. In 1938, New Deal Democrats lost 72 seats in the House and seven in the Senate, and this tally doesn’t account for the failure of FDR’s efforts to defeat anti-New Deal Democrats in the primaries. In 1874, the Reconstruction-era Republicans lost 93 (out of 293) seats in the House and a net of seven seats in the Senate, effectively ending Reconstruction.
Does this mean that Lyndon Johnson shouldn’t have signed the Civil Rights Act? That FDR should have waited until he didn’t need Southern segregationists to pass New Deal legislation? That Republicans should have nominated Andrew Johnson rather than Ulysses S. Grant in 1868? Of course not.
The perfect response to these kind of arguments was made by Pelosi: “We come here to do a job, not keep a job. There are more than 14 million reasons why that’s wrong.” This is exactly right. The window for progressive reform in the United States is always narrow and treacherous — you get the best you can get when you have the chance. The unpopularity of the greatest progressive achievement passed by Congress in nearly five decades is unfortunate, but misguided Monday-morning quarterbacking isn’t the right response.
By: Scott Lemieux, Professor of Political Science at the College of Saint Rose in Albany, N.Y.; The Week, December 11, 2014
“Democrats Against Reform”: Democrats Should Be Celebrating The Fact That They Did The Right Thing
It’s easy to understand why Republicans wish health reform had never happened, and are now hoping that the Supreme Court will abandon its principles and undermine the law. But it’s more puzzling — and disturbing — when Democrats like Charles Schumer, senator from New York, declare that the Obama administration’s signature achievement was a mistake.
In a minute I’ll take on Mr. Schumer’s recent remarks. But first, an update on Obamacare — not the politics, but the actual policy, which continues to rack up remarkable (and largely unreported) successes.
Earlier this week, the independent Urban Institute released new estimates of the number of Americans without health insurance, and the positive results of Obamacare’s first year are striking. Remember all those claims that more people would lose coverage than would gain it? Well, the institute finds a sharp drop in the number of uninsured adults, with more than 10 million people gaining coverage since last year. This is in line with what multiple other estimates show. The primary goal of health reform, to give Americans access to the health care they need, is very much on track.
And while some of the policies offered under Obamacare don’t offer as much protection as we might like, a huge majority of the newly insured are pleased with their coverage, according to a recent Gallup poll.
What about costs? There were many predictions of soaring premiums. But health reform’s efforts to create meaningful competition among insurers are working better than almost anyone (myself included) expected. Premiums for 2014 came in well below expectations, and independent estimates show a very modest increase — 4 percent or less — for average premiums in 2015.
In short, if you think of Obamacare as a policy intended to improve American lives, it’s going really well. Yet it has not, of course, been a political winner for Democrats. Which brings us to Mr. Schumer.
The Schumer critique — he certainly isn’t the first to say these things, but he is the most prominent Democrat to say them — calls health reform a mistake because it only benefits a minority of Americans, and that’s not enough to win elections. What President Obama should have done, claims Mr. Schumer, was focus on improving the economy as a whole.
This is deeply wrongheaded in at least three ways.
First, while it’s true that most Americans have insurance through Medicare, Medicaid, and employment-based coverage, that doesn’t mean that only the current uninsured benefit from a program that guarantees affordable care. Maybe you have good coverage now, but what happens if you’re fired, or your employer goes bust, or it cancels its insurance program? What if you want to change jobs for whatever reason, but can’t find a new job that comes with insurance?
The point is that the pre-Obamacare system put many Americans at the constant risk of going without insurance, many more than the number of uninsured at any given time, and limited freedom of employment for millions more. So health reform helps a much larger share of the population than those currently uninsured — and those beneficiaries have relatives and friends. This is not a policy targeted on a small minority.
Second, whenever someone says that Mr. Obama should have focused on the economy, my question is, what do you mean by that? Should he have tried for a bigger stimulus? I’d say yes, but that fight took place in the very first months of his administration, before the push for health reform got underway. After that, and especially after 2010, scorched-earth Republican opposition killed just about every economic policy he proposed. Do you think this would have been different without health reform? Seriously?
Look, economic management is about substance, not theater. Having the president walk around muttering “I’m focused on the economy” wouldn’t have accomplished anything. And I’ve never seen any plausible explanation of how abandoning health reform would have made any difference at all to the political possibilities for economic policy.
Finally, we need to ask, what is the purpose of winning elections? The answer, I hope, is to do good — not simply to set yourself up to win the next election. In 2009-10, Democrats had their first chance in a generation to do what we should have done three generations ago, and ensure adequate health care for all of our citizens. It would have been incredibly cynical not to have seized that opportunity, and Democrats should be celebrating the fact that they did the right thing.
And one related observation: If more Democrats had been willing to defend the best thing they’ve done in decades, rather than run away from their own achievement and implicitly concede that the smears against health reform were right, the politics of the issue might look very different today.
By: Paul Krugman, Op-Ed Columnist, The New York Times, December 4, 2014
“When Government Succeeds”: Surrounded By Examples Of Government Success, Which Republicans Don’t Want You To Notice
The great American Ebola freakout of 2014 seems to be over. The disease is still ravaging Africa, and as with any epidemic, there’s always a risk of a renewed outbreak. But there haven’t been any new U.S. cases for a while, and popular anxiety is fading fast.
Before we move on, however, let’s try to learn something from the panic.
When the freakout was at its peak, Ebola wasn’t just a disease — it was a political metaphor. It was, specifically, held up by America’s right wing as a symbol of government failure. The usual suspects claimed that the Obama administration was falling down on the job, but more than that, they insisted that conventional policy was incapable of dealing with the situation. Leading Republicans suggested ignoring everything we know about disease control and resorting to extreme measures like travel bans, while mocking claims that health officials knew what they were doing.
Guess what: Those officials actually did know what they were doing. The real lesson of the Ebola story is that sometimes public policy is succeeding even while partisans are screaming about failure. And it’s not the only recent story along those lines.
Here’s another: Remember Solyndra? It was a renewable-energy firm that borrowed money using Department of Energy guarantees, then went bust, costing the Treasury $528 million. And conservatives have pounded on that loss relentlessly, turning it into a symbol of what they claim is rampant crony capitalism and a huge waste of taxpayer money.
Defenders of the energy program tried in vain to point out that anyone who makes a lot of investments, whether it’s the government or a private venture capitalist, is going to see some of those investments go bad. For example, Warren Buffett is an investing legend, with good reason — but even he has had his share of lemons, like the $873 million loss he announced earlier this year on his investment in a Texas energy company. Yes, that’s half again as big as the federal loss on Solyndra.
The question is not whether the Department of Energy has made some bad loans — if it hasn’t, it’s not taking enough risks. It’s whether it has a pattern of bad loans. And the answer, it turns out, is no. Last week the department revealed that the program that included Solyndra is, in fact, on track to return profits of $5 billion or more.
Then there’s health reform. As usual, much of the national dialogue over the Affordable Care Act is being dominated by fake scandals drummed up by the enemies of reform. But if you look at the actual results so far, they’re remarkably good. The number of Americans without health insurance has dropped sharply, with around 10 million of the previously uninsured now covered; the program’s costs remain below expectations, with average premium rises for next year well below historical rates of increase; and a new Gallup survey finds that the newly insured are very satisfied with their coverage. By any normal standards, this is a dramatic example of policy success, verging on policy triumph.
One last item: Remember all the mockery of Obama administration assertions that budget deficits, which soared during the financial crisis, would come down as the economy recovered? Surely the exploding costs of Obamacare, combined with a stimulus program that would become a perpetual boondoggle, would lead to vast amounts of red ink, right? Well, no — the deficit has indeed come down rapidly, and as a share of G.D.P. it’s back down to pre-crisis levels.
The moral of these stories is not that the government is always right and always succeeds. Of course there are bad decisions and bad programs. But modern American political discourse is dominated by cheap cynicism about public policy, a free-floating contempt for any and all efforts to improve our lives. And this cheap cynicism is completely unjustified. It’s true that government-hating politicians can sometimes turn their predictions of failure into self-fulfilling prophecies, but when leaders want to make government work, they can.
And let’s be clear: The government policies we’re talking about here are hugely important. We need serious public health policy, not fear-mongering, to contain infectious disease. We need government action to promote renewable energy and fight climate change. Government programs are the only realistic answer for tens of millions of Americans who would otherwise be denied essential health care.
Conservatives want you to believe that while the goals of public programs on health, energy and more may be laudable, experience shows that such programs are doomed to failure. Don’t believe them. Yes, sometimes government officials, being human, get things wrong. But we’re actually surrounded by examples of government success, which they don’t want you to notice.
By: Paul Krugman, Op-Ed Columnist, The New York Times, November 16, 2014
“A Cardinal Reality Facing The Justices”: The Supreme Court Is Now A Death Panel
Back in March 2011, when the biggest threats facing Obamacare were the Supreme Court and the 2012 elections, I argued that the demise of the Affordable Care Act would put people’s lives in immediate danger.
At the time, the law had relatively few beneficiaries—people under 26 covered by their parents’ health plans, a small population of people with pre-existing medical conditions. But some of them had already used their new coverage to finance the kinds of life-saving treatments that would leave them in need of chronic care for the rest of their lives. Take away the health law, and most of these organ transplant recipients and other patients would have become unable to afford their medications, and some of them would die.
Since then, millions of people have gained coverage under the law, and that group of chronic care patients has grown much larger. But despite the fact that the Court upheld the law, and President Obama won reelection, the ACA isn’t out of danger.
On Friday, the Supreme Court agreed to hear a case that will determine whether the federal government can continue to subsidize private ACA coverage in states that didn’t set up their own insurance exchanges.
That case is King v. Burwell, but the issue at stake has come to be defined by a comparable case called Halbig v. Burwell.
The Fourth Circuit Court of Appeals ruled against the challengers in King, but the Supreme Court agreed to grant cert to those challengers anyhow, despite the absence of a Circuit Court split. If the five conservative Supreme Court justices are so inclined, they can void ACA subsidies for millions of beneficiaries, and cripple the insurance markets in about three dozen states.
Some of those beneficiaries will be the kinds of transplant recipients and other patients I wrote about three and a half years ago. Except today there are many more of them. Several of these patients explained the risk to their lives in an amicus brief, urging a different circuit court to reject the challenge to the subsidies, and thus to the viability of the insurance markets their lives depend on.
“Without insurance, Jennifer [Causor’s] treatments would be completely unaffordable. Her transplant cost nearly $280,000. She takes three anti-rejection drugs, one of which has a sticker price of $2,400 per month…. Should she become uninsured, Jennifer would face bankruptcy and even death.”
You can read the whole brief below. Conservatives are brimming with excitement over the Court’s decision to hear the challenge. Should the five conservatives rule that the text of the law doesn’t provide for federal subsidies in states that didn’t set up their own exchanges, they’ll place the onus on Congress or state governments to address the consequences for constituents who lose their benefits. The contested text could be fixed with a comically simple technical corrections bill, which Democrats would happily support. If Republicans were to sit on their hands, or use the ensuing chaos as leverage to extract unrelated concessions, it will cost people their lives. That is a cardinal reality facing justices, and the people soliciting their conservative activism.
There’s an ironic post-script to this article. The Supreme Court is likely to resolve this case with a 5-4 decision, one way or another. Either a single conservative will side with the Court’s four liberals as in 2012, and leave the law unscathed, or the five conservatives will align to void the subsidies.
Under the circumstances, supporters of the law might be nervous about the potential loss of a liberal justice. Ruth Bader Ginsburg’s health and advanced age make many liberals very uneasy, especially now that Obama’s ability to fill Supreme Court vacancies has come into doubt. But for the purposes of King, this issue is immaterial.
If Ginsburg’s seat were to become vacant, then the fate of the law would remain in the hands of a conservative swing justice. A 4-4 split effectively upholds the lower court’s ruling—and since the Fourth Circuit upheld the subsidies, the subsidies would stand. If the Fourth Circuit had ruled the other way, her health would be much more material.
When I mentioned this admittedly morbid but nevertheless important curiosity on Twitter, a large number of dimwitted (or in some cases persistently dishonest) conservatives flooded my mentions column in outrage. Most of them missed the meaning altogether, and accused me of wishing death upon a conservative Supreme Court justice. But even the ones who didn’t managed to contain their enthusiasm over the possibility of millions of people losing insurance for a moment, to reprimand me for being so cavalier about people’s lives.
By: Brian Beutler, The New Republic, November 7, 2014
“Obamacare Is Here To Stay”: Kentucky Is Emblematic Of The States That Have Received Substantial Assists From Obamacare
You’ve heard of Obamacare, right?
It’s that disastrous, costly and intrusive policy that President Obama and his fellow Democrats rammed down the throats of Congress back in 2010 — a failed plan that conservative Republicans have pledged to “repeal and replace.” According to its critics, it is un-American; it destroys the health care system; it burdens businesses; it hollows out Medicare. Right?
Ah, wrong. Despite what you may have heard and despite the caprice of electoral campaigns, the changes wrought by the Affordable Care Act are here to stay. That’s because it accomplishes much of what it set out to do — and its beneficiaries mostly like it.
Don’t expect Republicans to try to turn back the clock. Oh, some of them will continue to bash Obamacare and to blame it for any negative effects on the country’s dysfunctional health care “system” — including rising costs. And some will even go so far as to continue to insist that it ought to be repealed.
Take Senate Minority Leader Mitch McConnell, who expects to lead the upper chamber if Republicans claim a majority. In a debate last month with his Democratic rival, Alison Grimes, McConnell suggested that he would repeal the Affordable Care Act but leave in place Kentucky’s popular state exchange program.
“… The best interest of the country would be achieved by pulling out Obamacare, root and branch,” he said. “Now, with regard to Kynect, it’s a state exchange. They can continue it if they’d like to.”
McConnell’s pronouncement was a tour de force of dissembling, a virtuoso performance of fabrications and disinformation. The Washington Post’s fact checker awarded him three Pinocchios.
That’s because the state’s health care exchange, Kynect, is a part of Obamacare, made possible by the 2010 law. If Obamacare is ripped out “root and branch,” the state exchanges could not continue to exist. (The GOP has continually pledged to find a mechanism to replace Obamacare, but its warring factions have failed to agree on any plan that would leave state exchanges in place.)
Here’s the rub: Kynect is very popular with Kentucky’s residents, many of whom are enjoying health insurance for the first time in their lives. They have been primed by Republican politicians to hate the president and any policy he endorses — including his signature health care plan — but they don’t want to give up Obamacare’s benefits.
Kentucky is emblematic of the states that have received substantial assists from Obamacare. It is largely rural and is among the poorest states. It has also long ranked near the bottom in several health indicators, including obesity and smoking rates and cancer deaths. Obamacare has been a boon for its residents, cutting the rate of uninsured in half.
According to The New York Times, people who live in rural areas are among the biggest winners from the Affordable Care Act. Other groups who have reaped substantial benefits are blacks, Latinos, women and younger Americans between 18 and 34.
Here’s another reason that Obamacare is here to stay: Its expansion of Medicaid is a boon to the states that have taken advantage of it. After the Supreme Court ruled that Medicaid expansion was optional, most Republican governors vowed to resist it — even though the federal government will pay 100 percent of the cost for the first three years and 90 percent thereafter.
But some of those GOP governors are now having second thoughts as rural hospitals are forced to close down for lack of funds and poor people are sidelined by preventable illnesses. Several GOP governors have already expanded Medicaid — which provides health insurance for the poor — and others are considering doing so.
Last month, Ohio’s Republican governor, John Kasich, advised his GOP colleagues to stop fighting the Medicaid expansion. The opposition, he said, “was really either political or ideological. I don’t think that holds water against real flesh and blood, and real improvements in people’s lives.”
Some Republicans have trouble admitting that on the campaign trail, but they all know it’s true.
By: Cynthia Tucker, The National Memo, November 1, 2014
Share This Blog
Unknown Feed- An error has occurred; the feed is probably down. Try again later.
mykeystrokes.com 