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Health Care

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The Wisdom of the Elders.

“Does this rollout failure discredit the core goals of a liberal project, including that of a mixed economy, a regulatory state, and social insurance? Conservatives in particular think this website has broad implications for liberalism as a philosophical and political project. I think it does, but for the exact opposite reasons: it highlights the problems inherent in the move to a neoliberal form of a governance and social insurance, while demonstrating the superiorities in the older, New Deal form of liberalism.”

Assessing the failure of the healthcare.gov rollout, Mike Konczal makes the case for returning to the old ways. “[T]he Category B grouping, which we associate with the New Deal and the Great Society…creates a universal floor so that individuals don’t experience basic welfare goods as commodities to buy and sell themselves…My man Franklin Delano Roosevelt may not have known about JavaScript and agile programming, but he knew a few things about the public provisioning of social insurance, and he realized the second category, while conceptually more work for the government, can eliminate a lot of unnecessary administrative problems.”

Of course, Social Security had rollout problems too. And progressives at the time definitely lamented the concessions that were made as Social Security evolved from bill to law, including the exclusion of agricultural and domestic laborers [re: African-Americans] from the law. (Frances Perkins: “The whole thing has been chiseled down to a conservative pattern.”)

That being said, I think it’s important to keep this in mind every time the right starts complaining about byzantine complexities in the Affordable Care Act: We could’ve avoided many of these issues if this change-bringing administration hadn’t immediately ruled out the obvious progressive solution to the health care problem — a single-payer system of Medicare-for-all, like most other advanced industrialized nations enjoy, perhaps phased in with an immediate voluntary buy-in and a gradual lowering of the coverage age.

Instead, we adopted the Republicans’ proposal, the marketplace/exchanges plan originally conceived by the Heritage Foundation and enacted by Mitt Romney, without even including a public option to keep the insurers honest. And what’d we get for this ginormous unforced concession to the right? Nothing. Republicans still didn’t support the health care law in 2010, and they’ve screamed holy hell that it’s tyrannical government socialism for the past three-odd years — even though it was their plan to begin with.

Now, they’re deliberately sabotaging implementation of the ACA and trying to pin every misstep, including this rather sad website #fail, as a failure of the liberal project. As Konczal aptly points out, what’s failing here is the NEO-liberal project — the desire to embrace public-private, technocratic conservative ideas of a generation ago (see also: cap & trade), in the hopes that today’s conservatives will somehow be intellectually honest enough to support them too. That is a sucker’s bet every time.

One other important takeaway from this article: “[I]f all the problems are driven by means-testing, state-level decisions and privatization of social insurance, the fact that the core conservative plan for social insurance is focused like a laser beam on means-testing, block-granting and privatization is a rather large problem. As Ezra Klein notes, ‘Paul Ryan’s health-care plan — and his Medicare plan — would also require the government to run online insurance marketplaces.'”

In other words, here again conservatives are decrying exactly what they ostensibly espouse. Perhaps a better way forward on fundamental pieces of legislation, instead of playing Lucy and the football with the Republicans, is to try to enact our own ideas from now on.

Update: In Foreign Affairs, Kimberly Morgan makes much the same argument: “The real source of Obamacare’s current problems lies in the law’s complexity. A straightforward way to assure coverage would have been to extend an existing, well-worn program to more people…In the United States, [due to] political antipathy to government programs…policymakers regularly rig up complex public-private, and often federal-state, arrangements that are opaque to the public, difficult to administer, and inefficient in their operation.”

Nihilists, Dude.

“‘It’s imperative to act now, Cruz warns, before the full benefits of Obamacare kick in and Americans get “hooked on the sugar, hooked on the subsidies.’ His plan: Yoke the defunding of Obamacare to the must-pass budget bill the House will take up in September. The endgame? To force a government shutdown so painful and protracted that Barack Obama would have no choice but to surrender the crown jewel of his presidency. ‘As scary as a shutdown fight is,’ Cruz insists, ‘if we don’t stand and defund Obamacare now, we never will.'”

Another dispatch from the madhouse: In a fine piece of reporting, Rolling Stone‘s Tim Dickinson delves inside the Republican suicide machine. “Having backed the GOP into a shutdown fight that congressional leaders never wanted, the insurgents are winning, and establishment leaders are running scared. America is now careening toward a catastrophic voluntary default on our debt because no one in the Republican Party with the authority to put on the brakes has the guts to apply them, for fear of being toppled from power.”

An important point Dickinson makes here that cannot be emphasized enough: We didn’t just stumble into this crisis: Taking the government and the debt ceiling hostage was the strategy all long, and the right-wing insurgents have been planning for this for months. “They’d drawn a dangerous lesson from the previous battle: Brinksmanship works…In February, the House temporarily suspended the debt ceiling — intending to give the president’s poll numbers three months to come back to earth.”

Hey, speaking of polling numbers coming back to Earth

In any case, see also the NYT on this: “To many Americans, the shutdown came out of nowhere. But interviews with a wide array of conservatives show that the confrontation that precipitated the crisis was the outgrowth of a long-running effort to undo the law, the Affordable Care Act, since its passage in 2010 — waged by a galaxy of conservative groups with more money, organized tactics and interconnections than is commonly known.”

So we’re not in this hostage crisis by accident. The GOP even changed the House rules so they could maximize this confrontation. Republicans saw Obama fold in December 2010 on the Bush tax cuts and in August 2011 on the last debt ceiling hike. They think they can make him fold again here, and on every subsequent debt ceiling hike, and sadly, history is on their side on this. As Ted Cruz put it a few months ago: “If you have an impasse, you know — one side or the other has to blink. How do we win this fight? Don’t blink.”

Another small digression: If, like Ralph Nader this morning, you’re wondering why the right-wing of the GOP always seems to pull these sorts of stunts off while the left-wing of the Dems are usually completely marginalized, two quick answers: 1) The lefties don’t have billionaires backing their plays, and 2) we’re the People’s Front of Judea. They’re the right, they’re inherently better at the goose-stepping.

That being said, this whole episode also illustrates why it’s useless for Democrats to try to meet these fools halfway on policy: Republicans have now spent almost three years voting constantly to end the Affordable Care Act. To break a health care law originally penned by the Heritage Foundation and enacted by Mitt Romney, they have shut down the government and sent us to the brink of an economic default. So, how, exactly, would things be different if we had just passed Medicare for all, and/or a public option? They were going to lose their shit regardless, just like they did on Social Security, on Medicare, and any other progressive issue you can think of. There’s no point in trying to placate people who aren’t bargaining in good faith.

Anyway, as it happens, and as Andrew Sullivan recently pointed out, we’ve seen a minority party in America rejected at the polls try to take the entire nation hostage before. Here’s Abe Lincoln in 1861:

“What is our present condition? We have just carried an election on principles fairly stated to the people. Now we are told in advance, the government shall be broken up, unless we surrender to those we have beaten, before we take the offices. In this they are either attempting to play upon us, or they are in dead earnest. Either way, if we surrender, it is the end of us, and of the government. They will repeat the experiment upon us ad libitum. A year will not pass, till we shall have to take Cuba as a condition upon which they will stay in the Union.”

So too here: This time the scalp the GOP wants is the Affordable Care Act, or the Ryan budget, or social insurance cuts, or Malia Obama. “‘The girl. Bring us the girl,’ said Congressman Steve King (R-IA)..’The bill may pass, but the firstborn shall be ours.'” It’ll be something else the next time and the time after that.

That’s why John Judis is calling this “one of the worst crises in American history“, and why Jon Chait wrote that “Allowing Republicans to default on the debt now is better than trading something that allows them to threaten it later.” Because if Obama buckles this time — and, let’s remember, we already gave the GOP their sequester-funding-levels — the Republicans will just keep taking the American government and economy hostage to get whatever they want. And quicker than you can say he-said, she-said, the rest of the lazy Beltway media will come to treat this sort of hostage-taking as politics as usual. It has to end here, or it never will.

Adjuncting Gets Even Worse.

“Allison G. Armentrout, an adjunct instructor at Stark State College, doesn’t get paid by the hour. She earns $4,600 to teach two English composition courses…On a recent week, she spent three hours preparing for her lectures, close to six hours in the classroom, and 16 more grading assignments for a grand total of about 25 hours. So she can breathe a sigh of relief because she won’t lose her job: She came in under the college’s new 29-hour-a-week wire designed to keep her ineligible for health-care coverage under the Patient Protection and Affordable Care Act.”

Leave this academic factory, you’ll find me in the matinee: Compounding life in the Nine Circles of Adjunct Hell, more and more college and universities are trying to game the system so they don’t have to pay for adjuncts’ health care coverage. Because if you’re going to exploit your desperate, over-educated workforce like it’s a Gilded Age factory floor, why not go all the way?

“What is happening — and I’m finding this even with just two classes—because of the grading load, I’ve been put in a position twice this semester where I’ve just had to lie about the number of hours I actually worked. I don’t want to have to make a choice between having a job or not.”

The Doctors Get Paid.

“This is basically never mentioned in the US health care policy debate but the reason why foreign prices are lower is not mysterious — they have laws forcing the prices down. The fact that we allow such high prices is why health care in America is hard to afford. The high prices make private health care extraordinarily expensive to patients and employers, and the same high prices make it difficult for the government to cover everything through public sector insurance. Canada, where the prices are lower, manages to have a more robust welfare state without higher taxes for precisely this reason.”

As Matt Yglesias points out, one of the many reasons health care is so expensive in the United States: doctors are paid way too much. See also: 21 graphs that show America’s health-care prices are ludicrous. And after that: The Serpent on the Staff.

Along with pretty much always being on the wrong side of reform, the American Medical Association has contributed heavily to this problem. First, by working to artificially limit the supply of doctors for decades, and thus helping to ensure the doctors we do have are burdened with crushing amounts of debt. Second, by pushing for a cap on Medicare-supported residencies in 1997, further decreasing the US supply of doctors — They’ve since reversed course on that. And third, by continually skewing Medicare payment models and reimbursement rates. Don’t expect this issue to be resolved anytime soon.

Better Living through Virology.

“[Above] is a look at the past morbidity (how many people became sick) of what were once very common infectious diseases, and the current morbidity in the U.S. There’s no smallpox and no polio, almost no measles, dramatically less chickenpox (also known as varicella) and H. influenza (that’s not flu, but a bacteria that can cause deadly meningitis.” How Vaccines Have Changed Our World in One Graphic.

Braaaaaiiiiiiiiiins.

“‘Every dollar we invested to map the human genome returned $140 to our economy — every dollar,’ he said. ‘Today our scientists are mapping the human brain to unlock the answers to Alzheimer’s. They’re developing drugs to regenerate damaged organs, devising new materials to make batteries 10 times more powerful. Now is not the time to gut these job-creating investments in science and innovation.'”

President Obama makes the case for federal investment in the Brain Activity Map Project. (You heard it here first, tinfoil hat people. The tyranny of the Kenyan socialist will not stop at your precious bodily fluids — He’s going to read your brainwaves too!) Seriously, though, investing in basic scientific research like this is, er, a no-brainer. It creates jobs while advancing the frontiers of human knowledge in all kinds of unanticipated ways. We’d be stupid not to support this — which means, of course, the jury’s still out on whether we will.

Update: “BAM is an acronym you’ll probably be hearing a lot in the weeks and months to come — so let’s talk about what the BAM project is, what it isn’t, and why it’s raising both interest and eyebrows throughout the scientific community.” Io9 has more.

Rolling the Clocks Back.

[T]his new method changes everything. To start with, it uses normal adult blood cells from the patient, so there’s not need to keep umbilical cords in storage. It also doesn’t use any virus reprogramming, so it’s completely safe. It’s also very efficient: researchers successfully transformed about 50 to 60 percent of adult blood cells into embryonic stem cells that can then be turn into any type of cell—a heart muscle cell, a bone cell, a nerve cell, anything.

By way of Dangerous Meta, researchers figure out a way to manufacture embryonic stem cells without an embryo, thus clearing the path for future research in that direction unhampered by abortion politics. “The discovery could be the key to cure the incurable – from heart attacks to severed spinal cord to cancer—and open the door, some day, to eternal youth.

Akin is the New Normal.


So, Todd Akin. I must say, it’s heartening to see some of the Taliban-like tendencies of today’s GOP finally drawing condemnation in the culture at large. But the thing is, what Rep. Akin said is very much within the mainstream of his party. This was not a one-off event: They actually believe this tripe, and they’re constantly voting like The Handmaid’s Tale was meant to be aspirational.

In their very first month back in power, Paul Ryan, Akin and the gang — 225 Members, in fact — were trying to define rape down — “House Speaker John Boehner (R-Ohio) has dubbed [it] a top priority in the new Congress.” — and that bill passed the House(!)

Yes, today’s Democrats have their own serious problems — our leaders prostrate themselves before the phantom deficit gods, look the other way on Wall Street malfeasance, and have been actively terrible on the civil liberties front, and our policy playbook (individual mandate, cap-and-trade) has too often been cribbed from the Republicans of the ’90s. But it’s a difference in kind, not in degree. Akin is not an aberration in the GOP — He’s the new normal. Not that anyone who comes around here still does this sort of thing, but if you vote Republican, have no illusions about what you are doing: Ayn Rand and Akinism is basically what you’re voting for. Seriously, these guys are cray-cray.

(By the way, the great facehugger pic above is from From Talking to Doctors — worth checking out.)

Deregulating Rape.

With this legislation, which was introduced last week by Rep. Chris Smith (R-N.J.), Republicans propose that the rape exemption be limited to ‘forcible rape.’ This would rule out federal assistance for abortions in many rape cases, including instances of statutory rape, many of which are non-forcible. For example: If a 13-year-old girl is impregnated by a 24-year-old adult, she would no longer qualify to have Medicaid pay for an abortion.

On the principle that, as per MLK, “in the end, we will remember not the words of our enemies, but the silence of our friends,” I post more often here these days about issues I have with our own, ostensibly-lefty party. But, as Dangerous Meta reminds me: Just in case anyone forgot how crazy the Republicans are these days, the GOP Congress has, for pro-life purposes, actually fashioned a bill that defines rape down. “House Speaker John Boehner (R-Ohio) has dubbed [it] a top priority in the new Congress.” There are no words.

Anatomy of a Tantrum.


This is the public option debate all over again. So I pass a signature piece of legislation where we finally get health care for all Americans, something that Democrats had been fighting for, for a hundred years – but because there was a provision in there that they didn’t get…somehow that was a sign of weakness and compromise.

“Now, if that’s the standard by which we are measuring success or core principles, then let’s face it, we will never get anything done. People will have the satisfaction of having a purist position, and no victories for the American people. And we will be able to feel good about ourselves, and sanctimonious about how pure our intensions are and how tough we are…That can’t be the measure of how we think about our public service. That can’t be the measure of what it means to be a Democrat.

As I’m sure most of y’all know by now, the president decided to indulge in some cathartic lefty-bashing at his tax cut deal press conference earlier in the week. [Transcript.] At this point, the fact that Obama feels this way about progressives is not at all a surprise, and I feel like I’ve already responded to his appalling penchant for this sorta thing at length. So, here’re just a few numbered points about this latest sad window into Obama’s “pragmatic” mindset:

1) Alex Pareene at Salon cut right to the heart of the fallacy on display here: “[Obama] continues to imagine that his liberal critics are upset with the idea that compromises need to be made in order to accomplish progressive policy goals. Some of them are that stupid. But lots of them are actually critics of the White House’s legislative strategy, and their apparent willingness to preemptively compromise before the negotiations have already begun.Yep.

2) See also Paul Krugman: “Leave aside the merits for a moment: what possible purpose does this kind of lashing out serve? Will activists be shamed into recovering their previous enthusiasm? Will Republicans stop their vicious attacks because Obama is lashing out to his left? It was pure self-indulgence; even if he feels aggrieved, he has to judge his words by their usefulness, not by his desire to vent…[W]hat we really don’t need right now is a president who blames everyone but himself, and seems more concerned with self-justification than with sustaining the alliances he needs.

3) As I noted on Twitter, the president’s argument here is inherently contradictory. He began his presser by saying he had to make a bad deal because the Right, however wrongheaded, held stubbornly to their convictions. Then he verbally abuses the Left for…holding stubbornly to their convictions. Uh, it seemed to work pretty well for the GOP.

4) Speaking of Twitter, the Twitterverse response to the presidential presser is well worth perusing for gallows humor and hard truths. Take for example, “Obama: This is like the public option fight all over again where I caved and opposed the thing that reduced the deficit.

5) As many have pointed out now, the president is also wrong on his New Deal history. In the presser, he claimed Social Security was only for widows and orphans. Wrong. He’s thinking of the civil war pension system, circa 1862. I know that law degrees are considered the be-all, end-all of our civilization these days, but an ostensibly progressive president not understanding the origins of Social Security is sort of a big effing deal. (And he didn’t just misspeak — He’s said it before.)

6) As historian Thomas Ferguson noted several weeks ago, this is not the first time the president has badly screwed up the history of the New Deal in a way that was ultimately self-serving. (As an aside: Given they they chose to structure a major policy speech around a fake Lincoln quote, his communications staff isn’t much better.)

7) As Dan Froomkin pointed out, Obama’s argument about the public option is also contradictory. He argues that Social Security and Medicare started out small, than belittles the public option because it “would have affected maybe a couple of million people,” i.e. it would’ve started out small.

8) Obama also no longer seems to understand how the public option was supposed to work. Here’s Froomkin: “What the president conspicuously disregarded was that the central point of the public option was that its existence would exert enormous competitive pressure on the private insurance system. The goal was not to serve a particularly large number of people directly — that would only happen if the private offerings were terribly inadequate. The goal was to keep the private sector honest. So no matter how many people it enrolled, ‘the provision,’ as Obama put it “would have affected” tens of millions.” In other words, the public option was designed to be a yardstick. So, even in terms of recent history, there are some serious revisions going on.

9) Politico’s catty analysis of the president’s relationship with Chuck Schumer offered more insights on Obama’s thinking today: “Obama himself warned Schumer that the millionaire strategy could sink the stock market. When a vote on the millionaire plan came up short last Saturday, the administration gloated.” The vagaries of the stock market? Is that really what we’re basing our tax policies on these days? (Also, I don’t think Chuck Schumer, of all people, needs to be informed of when and how Wall Street will balk. I think he has his finger pretty solidly on that pulse.)

10) A day after the president’s remarks, Larry Summers solemnly informed us that not passing the millionaire tax cut would lead to a double-dip recession. This is basically the economic equivalent of the terror, terror, terror, 9/11, 9/11, 9/11 argument. And, as David Dayen and Jon Walker both pointed out: If the economy is resting on that sort of knife’s edge, why’s the White House just reduce purchasing power by announcing a federal worker’s pay freeze? Something does not compute.

11) Obama at the presser again: “Look at what I promised during the campaign. There’s not a single thing that I’ve said that I would do that I have not either done or tried to do. And if I haven’t gotten it done yet, I’m still trying to do it.” Um…do we really want to go there? Because I’m sure this would be news to Maher Arar. In any case, as a friend pointed out, this isn’t kindergarten — You don’t get a gold star just for “trying.”

Anyways, so, yeah, Obama doesn’t like “the professional left” very much. And, at this point, it’s safe to say the feeling is mutual. As for myself…well, these days I just feel like a sucker.

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