Good Morning Sky Dancers!
I’m not sure how many of you watched the late night drama on the floor of the US Senate last night on the so-called “skinny repeal” but it was the first thing that’s ended well for some time. This was old time Senate Drama and not the kind cooked up by Kremlin Caligula and Scary Moochie. for reality TV viewers.
Senator John McCain–long time cancer survivor and usually full of empty words–stood up and did the right thing. He stood with Murkowski and Collins and voted a resounding “no”. He did so in a way that will undoubtedly make him the target of the Orange of Wrath. As my youngest used to say, it was Amazeballs.
Ed O’Keefe of WAPO provides the narrative.
It was the most dramatic night in the United States Senate in recent history. Just ask the senators who witnessed it.
A seven-year quest to undo the Affordable Care Act collapsed — at least for now — as Sen. John McCain (R-Ariz.) kept his colleagues and the press corps in suspense over a little more than two hours late Thursday into early Friday.
Not since September 2008, when the House of Representatives rejected the Troubled Asset Relief Program — causing the Dow Jones industrial average to plunge nearly 800 points in a single afternoon — had such an unexpected vote caused such a striking twist.
The bold move by the nation’s most famous senator stunned his colleagues and possibly put the Senate on the verge of protracted bipartisan talks that McCain is unlikely to witness as he begins treatment for an aggressive form of brain cancer.
“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict party-line basis without a single Republican vote,” he said in a statement explaining his vote. “We should not make the mistakes of the past.”
“From the beginning, I have believed that Obamacare should be repealed and replaced with a solution that increases competition, lowers costs, and improves care for the American people. The so-called ‘skinny repeal’ amendment the Senate voted on today would not accomplish those goals. While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens. The Speaker’s statement that the House would be ‘willing’ to go to conference does not ease my concern that this shell of a bill could be taken up and passed at any time.
“I’ve stated time and time again that one of the major failures of Obamacare was that it was rammed through Congress by Democrats on a strict-party line basis without a single Republican vote. We should not make the mistakes of the past that has led to Obamacare’s collapse, including in my home state of Arizona where premiums are skyrocketing and health care providers are fleeing the marketplace. We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”
Paul Krugman tries to make sense of the Republican Cruelty on display during this debacle. The passage of any of these Republican Repeal Bills would have been the definition of winning at any cost. I cannot even believe Louisiana Senator Bill Cassidy–a medical doctor–would throw millions of people into suffering and early death. That’s a cost only an army of demons could love.
More than 40 percent of the Senate bill’s tax cuts would go to people with annual incomes over $1 million — but even these lucky few would see their after-tax income rise only by a barely noticeable 2 percent.
So it’s vast suffering — including, according to the best estimates, around 200,000 preventable deaths — imposed on many of our fellow citizens in order to give a handful of wealthy people what amounts to some extra pocket change. And the public hates the idea: Polling shows overwhelming popular opposition, even though many voters don’t realize just how cruel the bill really is. For example, only a minority of voters are aware of the plan to make savage cuts to Medicaid.
In fact, my guess is that the bill has low approval even among those who would get a significant tax cut. Warren Buffett has denounced the Senate bill as the “Relief for the Rich Act,” and he’s surely not the only billionaire who feels that way.
Which brings me back to my question: Why would anyone want to do this?
I won’t pretend to have a full answer, but I think there are two big drivers — actually, two big lies — behind Republican cruelty on health care and beyond.
First, the evils of the G.O.P. plan are the flip side of the virtues of Obamacare. Because Republicans spent almost the entire Obama administration railing against the imaginary horrors of the Affordable Care Act — death panels! — repealing Obamacare was bound to be their first priority.
Once the prospect of repeal became real, however, Republicans had to face the fact that Obamacare, far from being the failure they portrayed, has done what it was supposed to do: It used higher taxes on the rich to pay for a vast expansion of health coverage. Correspondingly, trying to reverse the A.C.A. means taking away health care from people who desperately need it in order to cut taxes on the rich.
So one way to understand this ugly health plan is that Republicans, through their political opportunism and dishonesty, boxed themselves into a position that makes them seem cruel and immoral — because they are.
The clerk read the Arizona senator’s surname in the microphone of the tense Senate chamber. The two words were met with silence — McCain had stepped out of the room minutes before.
But moments later, he reappeared. By then, the alphabetical roll call had reached Sen. Gary Peters of Michigan. McCain walked over to the front of the chamber, raising his right arm. He held it up in the air until he had the attention of the clerk.
“No,” he said, with a swift thumbs-down.
It was a “no” that could barely be heard on C-SPAN, and a thumbs-down that viewers would not have been able to easily make out. But the moment was crystal clear for the dozens of reporters watching from the gallery above, who let out a collective gasp and made a stampede exit for the wooden double doors behind them to report the news.
In hindsight, it seems clear: McCain had made up his mind to vote “no” well before he walked into that chamber.
There were hints in his body language, the demeanor of the colleagues who approached him and the way the senator navigated the room. As he huddled with members in a series of hushed conversations while Thursday night turned into Friday morning, there were words that could almost be heard from above and even discerned through lip-reading. The clues were all there.
In other words, those 50 people helped McCain be the political winner. Here are seven people in particular who he can thank for his victory lap this morning.
Sen. Susan Collins (R-Maine). It’s sort of amazing that Collins hasn’t gotten more attention for her role in opposing the health-care bill this week. She was one of two Republican senators who opposed the motion-to-proceed, the procedural vote that allowed the climactic vote on Friday morning to happen at all. She was one of the three votes against the Republican bill.
She also made headlines for bashing President Trump after a hearing when a live microphone caught her conversation with a colleague. The administration’s handling of the budget was just “incredibly irresponsible,” and she was “worried” about what might happen. She delivered bad headlines for Trump on three different days — yet somehow has escaped his Twitter wrath.
Sen. Lisa Murkowski (R-Alaska). Murkowski did not escape that wrath.
She also didn’t escape a phone call from the secretary of the interior in which projects important to her state were tacitly threatened. (That’s according to her colleague from Alaska, who received a similar call. She told reporters on Thursday that she preferred not to use the word “threat.”)
Murkowski’s opposition was driven, among other things, by a desire to protect funding for Planned Parenthood, a commitment she made publicly in the state earlier this year. When McCain’s “no” became known on the floor of the Senate as voting loomed, Murkowski was swarmed by her colleagues, hoping to cajole her into flipping. As on the motion-to-proceed, which she also opposed, Murkowski didn’t budge.
I admit to running the gamut of emotions from anxiety, fear, and depression over the thought of losing my access to health care again. I’ve been on Louisiana’s Medicaid Expansion now for a year. I’m getting preventative care again. It’s something that I will likely need for three more years until I can get on Medicare given it will be there for me as it has been for all other over 65 Americans.
I hugged the soundly sleeping cat on my chest and startled her when I yelped and sprung up from bed to dance. I have a reprieve from unnecessary suffering. My long-gone cancer still haunts my life.
A viral video overnight Thursday night showed protesters outside the Capitol break out into massive cheers the moment they learned the Senate GOP’s ObamaCare repeal bill would fail.
The video, shared by Splinter News reporter Emma Roller, captured protesters chanting “yes we did” after news the repeal bill failed.
So, I’m just going to enjoy #FridayFeeling and hope that the usual ugly Friday night Trump news Dumps can be held at bay for awhile.
What’s on your reading and blogging list today?
Good Afternoon Sky Dancers!
I don’t know about you, but I can barely keep up with the breaking news this week. I feel like I’m caught in a whirlpool of unbelievable events and emotions. I’m going to be like BB yesterday and just try to list them. I’m not sure I have to time to truly analyze or elucidate anything. Maybe the chaos is working in their favor on that account. At least news reporters are assigned desks and topics. Some of them must be very busy. Here are the three top stories: T-Russia, T-RumpCare, and T-Rump Syndicate shenanigans.
First, up is that notorious Foreign Agent, obsequious Trump neighbor, and former Campaign Director Paul Manafort has volunteered to testify to Congressional Intelligence Committees. Congressional Clown Car Chauffeur Devon Nunes announced it today. It will likely be a closed session.
Manafort has also offered to be interviewed by the Senate Intelligence Committee, according to a Senate source.
Both Intelligence committees are investigating Russian interference in the US election.
The White House this week rushed to distance itself from Manafort after the revelation that he signed a multimillion-dollar contract with a Russian oligarch in 2006 to help advance Russian President Vladimir Putin’s interests around the world.
The story fueled the growing controversy over the Trump team’s ties to Russia, which was rekindled Monday when FBI Director James Comey publicly confirmed the bureau is investigating whether Trump associates coordinated with Moscow during the 2016 presidential race.
Nunes also said Friday he has asked Comey and National Security Agency (NSA) Director Michael Rogers to brief the House Intelligence Committee in a closed session.
Nunes cautioned that he does not expect to receive documentation from the NSA regarding his claims that Trump campaign associates were possibly monitored by the intelligence community on Friday.
Nunes said he expects to have more information from the NSA by “early next week.”
But he categorically denied that his decision to make public the information on the issue that he does have was coordinated by the White House.
Nunes continues to be underfire for what appears to be collusion with the White House to cover up the Russian Involvement with the Trump Campaign which is so obvious now that a grade school kid would call “shenanigans!!”
So you can read more about this unfolding story at CNN too as well as the recent announcement that Republicans are using closed meeting formats which is not making Democrats happy. Nunes is really in over his head on all of this.
The House Intelligence Committee chairman and the panel’s top Democrat publicly disagreed Friday over the handling of their investigation into Russian meddling into the US election, coming after the announcement that President Donald Trump’s campaign chairman agreed to testify before the committee.“Yesterday, the counsel for Paul Manafort contacted the committee yesterday to offer the committee the opportunity to interview his client,” committee chairman Devin Nunes announced during a news conference. “We thank Mr. Manafort for volunteering and encourage others with knowledge of these issues to voluntarily interview with the committee.”
Nunes also announced that the committee is bringing in FBI Director James Comey and National Security Agency Director Mike Rogers for a second briefing, this time behind closed doors so that they can provide more information. The committee is also delaying its March 28 hearing, a decision infuriating Democrats on the committee.
“Chairman just cancelled open Intelligence Committee hearing with (former Director of National Intelligence James) Clapper, (former CIA Director John) Brennan and (former deputy Attorney General Sally) Yates in attempt to choke off public info,” Rep. Adam Schiff, the top Democrat on the committee tweeted moment before going to speak to the press Friday morning.
Schiff refused to say whether he thought Nunes should step down from his position, telling reporters, “What’s really involved here is the cancellation of this open hearing and the rest is designed to distract.”
You can view the Nunes presser at that link also.
GOP leaders have done the WHIP count on Trumpcare and it appears that they do not have the votes they need to pass it. This may be a very big test of both Paul Ryan and Kremlin Caligula’s ability to whip a vote.
House GOP leaders aren’t confident they have enough votes to pass their embattled health-care bill, according to a senior congressional aide, and are already considering what to do if the measure is blocked before a do-or-die vote hours away.
House Speaker Paul Ryan went to the White House Friday to brief President Donald Trump ahead of the vote. Vice President Mike Pence canceled a trip to Arkansas to be in Washington for the vote, a White House official said.
The Trump administration is doubling down on its demand that House Republican leaders hold a vote Friday on their embattled health-care bill without any changes. White House Press Secretary Sean Spicer said the vote will proceed as scheduled Friday afternoon.
“It’s not a question of negotiating any more, it’s understanding the greater good,” Spicer said at a news conference. “This is it.” The president, he added, has “made it clear this is our moment.”
But an influential GOP member said he’s not sure they have the votes.
“I’m not sure we’ve landed it,” Mark Walker of North Carolina, chairman of the conservative Republican Study Committee of House members, said Friday morning. “I’m hopeful that we can get there today but at this point I don’t know how many we’re short.”
Tensions among House Republicans were high, said Chris Collins of New York, the first House member to endorse Trump last year.
“There’s some divisiveness within our conference now that’s not healthy,” Collins said. “I’ve never seen this before. People are just refusing to talk to each other. They’re storming past each other. This is not good.”
House Speaker Paul D. Ryan, facing a revolt among conservative and moderate Republicans, rushed to the White House Friday afternoon to inform President Trump he did not have the votes to pass legislation to repeal the Affordable Care Act and to decide whether to pull the bill from consideration.
The president and the speaker faced the humiliating prospect of a major defeat on legislation promised for seven years, since the landmark health legislation was signed into law. President Trump had demanded a vote regardless, which has been scheduled for Friday afternoon. But House leaders were leaning against such a public loss.
The House opened debate Friday on what would have been one of the most consequential pieces of legislation in years, a bill that would have rolled back a major, established social welfare program, a feat that is almost unheard of.
Meanwhile, more Trump ethics violations are on the horizon: “After Promising Not To Talk Business With Father, Eric Trump Says He’ll Give Him Financial Reports”.
Eric Trump sits behind a desk on the 25th floor of Trump Tower in New York City, dressed in a slightly less formal version of his father’s go-to power uniform—blue suit, white buttoned-down shirt, no tie. There are reminders of Donald Trump everywhere in this office, including the TV in the corner that beams out wall-to-wall news about the president any time his son turns it on. Amidst it all, Eric Trump, who now manages the Trump Organization with his brother Don Jr., wants to emphasize that the Trump business is separate from the Trump presidency.
“There is kind of a clear separation of church and state that we maintain, and I am deadly serious about that exercise,” he says, echoing previous statements from his father. “I do not talk about the government with him, and he does not talk about the business with us. That’s kind of a steadfast pact we made, and it’s something that we honor.”
But less than two minutes later, he concedes that he will continue to update his father on the business while he is in the presidency. “Yeah, on the bottom line, profitability reports and stuff like that, but you know, that’s about it.” How often will those reports be, every quarter? “Depending, yeah, depending.” Could be more, could be less? “Yeah, probably quarterly.” One thing is clear: “My father and I are very close,” Eric Trump says. “I talk to him a lot. We’re pretty inseparable.”
So, this is what it’s like to live in a Banana Republic.
What’s on your reading and blogging list today?
Good Afternoon! Happy Martin Luther King Day!!
I’ve been spending the morning getting back up to speed on Health Care Economics which is something I never enjoy but never seem to be unable to avoid. The facts on the ground never change much. What we know about single payer and third party payer systems remains pretty much the same. The only thing that seems to change is the hostility in this country on the subject. I keep having to dredge up the same information over and over with the new twists.
Well, here I go again …
There are three articles that BB sent me this morning that sum up the situation nicely. I’m going to start with those and then finish up by reviewing the mini-case of the failed single payer case in the state of Vermont. I’m not doing this because I don’t think single payer health insurance is a good deal ceteris paribus. It obviously works in other countries. As the Republicans remind us daily, we are not other countries. Theoretically, it provides superior risk sharing and economies of scale on cost. So, my theoretical economist side loves it. My living in America with everything that’s already standing and Republicans who thwart everything at every turn except tax cuts for the wealthy and wars side has a different train of thought.
Yes, it’s time to heal those suffering badly from Berns. I’m going to be in good company because the public wonks are with me on both accounts. We yearn for a simpler, cheaper, more efficient way of paying and getting health care. But, we know the difference between brainstorming and an actionable policy. I’m cursed with a heart longing for idealism but a brain that reins the damn thing in. Bernie Sanders plan really isn’t a plan. It’s a lofty goal.
Here’s Ezra Klein writing for VOX stating ‘Bernie Sanders’s single-payer plan isn’t a plan at all: Sanders’s long-awaited health care plan is, by turns, vague and unrealistic.‘ You should read these links fully if you can manage the time.
Sanders calls his plan Medicare-for-All. But it actually has nothing to do with Medicare. He’s not simply expanding Medicare coverage to the broader population — he makes that clear when he says his plan means “no more copays, no more deductibles”; Medicare includes copays and deductibles. The list of what Sanders’s plan would cover far exceeds what Medicare offers, suggesting, more or less, that pretty much everything will be covered, under all circumstances.
Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
Sanders goes on to say that his plan means “no more fighting with insurance companies when they fail to pay for charges.”
To be generous, it’s possible that Sanders is just being cynical in his wording, and what he means is that, under his plan, individuals have to fight with the government rather than private insurers when their claims are denied.
But the implication to most people, I think, is that claim denials will be a thing of the past — a statement that belies the fights patients have every day with public insurers like Medicare and Medicaid, to say nothing of the fights that go on in the Canadian, German, or British health-care systems.
What makes that so irresponsible is that it stands in flagrant contradiction to the way single-payer plans actually work — and the way Sanders’s plan will have to work if its numbers are going to add up.
Behind Sanders’s calculations, both for how much his plan will cost and how much Americans will benefit, lurk extremely optimistic promises about how much money single-payer will save. And those promises can only come true if the government starts saying no quite a lot — in ways that will make people very, very angry.
“They assumed $10 trillion in health-care savings over ten years,” says Larry Levitt, vice president at the Kaiser Family Foundation. “That’s tremendously aggressive cost containment, even after you take the administrative savings into account.”
The real way single-payer systems save money isn’t through cutting administrative costs. It’s through cutting reimbursements to doctors, hospitals, drug companies, and device companies. And Sanders’s gestures towards this truth in his plan, saying that “the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively.”
But to get those savings, the government needs to be willing to say no when doctors, hospitals, drug companies, and device companies refuse to meet their prices, and that means the government needs to be willing to say no to people who want those treatments. If the government can’t do that — if Sanders is going to stick to the spirit of “no more fighting with insurance companies when they fail to pay for charges” — then it won’t be able to control costs.
Put it this way: for all the talk about being honest and upfront, even Sanders ended up delivering mostly smoke and mirrors — or as Ezra Klein says, puppies and rainbows. Despite imposing large middle-class taxes, his “gesture toward a future plan”, as Ezra puts it, relies on the assumption of huge cost savings. If you like, it involves a huge magic asterisk.
Now, it’s true that single-payer systems in other advanced countries are much cheaper than our health care system. And some of that could be replicated via lower administrative costs and the generally lower prices Medicare pays. But to get costs down to, say, Canadian levels, we’d need to do what they do: say no to patients, telling them that they can’t always have the treatment they want.
Saying no has two cost-saving effects: it saves money directly, and it also greatly enhances the government’s bargaining power, because it can say, for example, to drug producers that if they charge too much they won’t be in the formulary.
But it’s not something most Americans want to hear about; foreign single-payer systems are actually more like Medicaid than they are like Medicare.
And Sanders isn’t coming clean on that — he’s promising Medicaid-like costs while also promising no rationing. The reason, of course, is that being realistic either about the costs or about what the system would really be like would make it a political loser. But that’s the point: single-payer just isn’t a political possibility starting from here. It’s just a distraction from the real issues.
The deal is this. We have entire systems, institutions, and agents that have been functioning under multiple plans for quite some time. This includes Medicaid, Medicare, SCHIP, the VA, and a myriad of private health insurance plans. You just don’t wave a magic wand and expect that all to unwind costlessly and seamlessly. You also don’t expect all those folks to be thrilled about it either or to seamlessly transfer their efforts and resources to a new system. It takes big money and time to do that. We’re not operating from scratch here.
That also doesn’t take into account politics. Yes. POLITICS. Remember when we first got the ACA and how the majority of Dems and Republicans voted for a single payer plan when the Dems controlled Congress? Remember how the ACA should work if SCOTUS hadn’t let so many states opt out of the system? Yes, Virginia, there is no Santa Claus.
Dear Bernie Sanders-supporting Friends: Sanders is nice enough. He’s got some good ideas. But, no, I do not think he’s got what it takes to be President. He operates out there in gadfly paradise. Or, as Michel Cohen writes it: ‘Bernie Sanders doesn’t get how politics works’.
Now for my deeper impression of the debate: even with his rising poll numbers in Iowa and New Hampshire, I find it increasingly difficult to take Sanders seriously as a presidential candidate.
Maybe it’s the fact that he’s 74, would be the oldest man to ever become president, and yet couldn’t be bothered to release his medical records until a Clinton surrogate attacked him for it.
Maybe it’s that Sanders finds a way to answer virtually every question by turning it back to another predictable and one-dimensional attack on Wall Street and big money.
Maybe it’s that he gets away with proposing unrealistic policy ideas that have little chance of being passed even by Democrats in Congress, let alone Republicans, and then gets praised for being authentic. Sunday night Sanders finally released his single-payer health care plan, which is all of eight pages and provides little detail on how he’ll implement a complete restructuring of the US health care system. That’s at least an improvement over his plan for breaking up the banks, which is four pages and just as short on detail.
Maybe it’s that every time he answers a question on foreign policy and national security, it’s blindingly apparent that not only does he not understand foreign policy and national security, he simply doesn’t care to know more. I mean, only Bernie Sanders could answer a question about instability Middle East by pivoting to an attack on wealthy nations like Saudi Arabia, which he repeatedly says has to play a greater role in the civil war in Syria, as if no one on his staff could bother to tell him that Saudi Arabia is already playing an important role in the civil war in Syria.
It’s all that and something else — Sanders really does have a singularly naive and simple-minded understanding of American politics. He genuinely seems to believe — and I know this because he repeatedly yelled it at me during the debate — that money is the root of all evil in politics and that if you get the big money out, great things will happen. Sanders said that “a handful of billionaires . . . control economic and political life of this country.” He argued that Republicans and Democrats don’t “hate each other.” He called that a “mythology.” Instead, he said, the “real issue is that Congress is owned by big money and refuses to do what the American people want them to do.”
I’m sorry, but that is a maddeningly simplistic — and wrong — explanation of how American politics works.
Take single-payer health care, which Sanders claims has been difficult to enact because of a corrupt campaign finance system that allows the “pharmaceutical industry” and private insurance companies to spend millions in “campaign contributions and lobbying.”
On the one hand, Sanders is right — those are powerful interests. But so are doctors and hospitals, who’d pay a huge price if single payer became law; so are Republicans, who fought tooth and nail to defeat Obamacare and would do the same for a single-payer plan; so are Democrats, who couldn’t even support a public option for Obamacare and are unlikely to support single payer; so are Americans, who may not be inclined to support another restructuring of the health care system — a few years after the last one. It’s not just about money; it’s also about a political system constructed and reinforced to block the kind of massive reform Sanders is advocating. Money is important, but it’s not even close to the whole story.
How someone who’s been in Washington as long as Sanders can believe that all that stands between doing “what the American people want [Congress] to do” is something as simple as reforming campaign finance is stunning. Sanders, who brags the NRA gives him a D- rating, is the same politician who supported legislation giving gun manufacturers immunity from civil lawsuits and voted against the Brady Bill. Why? Perhaps it is because Sanders comes from a state that has few gun control laws and lots of gun owners. Yes red-state senators who oppose gun control receive contributions from the NRA. They also have constituents who oppose gun control measures and vote on the issue — like Bernie Sanders. It’s as if in Sanders’ mind, parochialism, ideology, or politics plays no role . . . in politics.
So, yes, we have the ACA (Obamacare) which is a “kludge” to borrow a turn of phrase from Krugman. If we could start from scratch then single payer health insurance would be infinitely cheaper and better. But, that’s not the way it is.
Krugman admits that Obamacare is far from perfect, an awkward, imperfect solution that does not work for everyone. But he thinks it would be a mistake for Democrats to expend political capital refighting the battle that gave them their biggest victory in decades. Here’s how he lays out his case:
If we could start from scratch, many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone. But single-payer wasn’t a politically feasible goal in America, for three big reasons that aren’t going away.
First, like it or not, incumbent players have a lot of power. Private insurers played a major part in killing health reform in the early 1990s, so this time around reformers went for a system that preserved their role and gave them plenty of new business.
Second, single-payer would require a lot of additional tax revenue — and we would be talking about taxes on the middle class, not just the wealthy. It’s true that higher taxes would be offset by a sharp reduction or even elimination of private insurance premiums, but it would be difficult to make that case to the broad public, especially given the chorus of misinformation you know would dominate the airwaves.
Finally, and I suspect most important, switching to single-payer would impose a lot of disruption on tens of millions of families who currently have good coverage through their employers. You might say that they would end up just as well off, and it might well be true for most people — although not those with especially good policies. But getting voters to believe that would be a very steep climb.
Bottom line for Krugman is that single-payer ain’t gonna happen. Like it or not, the fact that Obamacare did not disrupt the millions of Americans who get health insurance through their employers gives it a leg up. Then there is the fact that taxes would have to be raised on the middle class to pay for it, as even Sanders acknowledges. And even though the middle class would not doubt save even more on their health insurance premiums, Krugman comes down on the side that higher taxes on them would not fly politically.
I’d like to add something to all of this. It’s frequently nice to have test cases for policy change. Massachusetts was the test case for ChaffeeCare/DoleCare/RomneyCare/ObamaCare. It wasn’t perfect but it worked.
According to a new analysis, health care reform in Massachusetts, popularly known as “Romneycare,” didn’t cause hospital use or costs to increase, even as it drove down the number of people without health insurance.
Implemented by the state in 2006, and signed by then-Gov. Mitt Romney, the reform is looked at as a model for the Affordable Care Act, also known as “Obamacare,” the sweeping and controversial health care law that Republican lawmakers in the House tried to repeal for the 37th time Thursday.
Amresh Hanchate, an economist with the Veterans Affairs Boston Healthcare System and lead author of the study, which he presented Thursday at an American Heart Association conference, says that the results of the study were surprising.
When it was implemented, about 8.4 percent of Massachusetts citizens were uninsured; by 2010, just 3 percent were uninsured. Uninsured rates fell most among minorities: In 2006, 15 percent of African-Americans were uninsured, in 2010, that rate was at 3.4 percent. Uninsured rates for Hispanics in the state fell from 20 percent to 9.2 percent during the same period.
Similarly encouraging news is found on the ACA even though it was seriously hampered by the SCOTUS ruling that allowed many states to opt out of the medicaid expansion and hosting local exchanges. We have one state that tried to have single payer. It failed. The state was Vermont. Sanders was asked about it during the debate. He dodged the question by referring it to the state’s governor. Well, there’s a lot of information out there on it. I’ll start with NEJM.
On December 17, 2014, Vermont Governor Peter Shumlin publicly ended his administration’s 4-year initiative to develop, enact, and implement a single-payer health care system in his state. The effort would have established a government-financed system, called Green Mountain Care, to provide universal coverage, replacing most private health insurance in Vermont. For Americans who prefer more ambitious health care reform than that offered by the Affordable Care Act (ACA), Shumlin’s announcement was a major disappointment. Was his decision based on economic or political considerations? Will it damage the viability of a single-payer approach in other states or at the federal level?
Shumlin’s exploration of a single-payer health care system, which included three assessments by different expert groups, was among the most exhaustive ever conducted in the United States. A 2011 study led by Harvard health economist William Hsiao provided optimistic projections: immediate systemwide savings of 8 to 12% and an additional 12 to 14% over time, or more than $2 billion over 10 years, and requirements for new payroll taxes of 9.4% for employers and new income taxes of 3.1% for individuals to replace health insurance premiums (see table) Financial Estimates from Three Projections for a Vermont Single-Payer Health Plan.).
Two years later, a study by the University of Massachusetts Medical School and Wakely Consulting projected savings of just 1.5% over 3 years.2 Finally, a 2014 study by Shumlin’s staff and consultants predicted 1.6% savings over 5 years and foresaw required new taxes of 11.5% for employers and up to 9.5% for individuals. The governor cited these last projections in withdrawing his plan: “I have learned that the limitations of state-based financing, the limitations of federal law, the limitations of our tax capacity, and the sensitivity of our economy make that unwise and untenable at this time . . . . The risk of economic shock is too high,” Shumlin concluded.
Two factors explain most of the decline in the plan’s financial prospects. First, the anticipated federal revenues from Medicaid and the ACA declined dramatically. Second, Shumlin’s policy choices significantly increased the total projected cost of Green Mountain Care: raising the actuarial value of coverage — the expected portion of medical costs covered by a plan rather than by out-of-pocket spending — from 87% to 94%, providing coverage to nonresidents working in Vermont, and eliminating current state taxes on medical providers. Still, even Shumlin’s projections indicated that the plan would reduce Vermont’s overall health spending and lower costs for the 90% of Vermont families with household incomes under $150,000. Despite differing projections, all three studies showed that single payer was economically feasible.
In reality, the Vermont plan was abandoned because of legitimate political considerations. Shumlin was first elected governor in 2010 promising a single-payer system. But in the 2014 election, his Republican opponent campaigned against single payer. Shumlin won the popular vote by a single-percentage-point margin, 46% to 45%, which sent the election to the Democratic-controlled House of Representatives; though the House reelected him easily in January, a clear public mandate for his health care agenda was nowhere in evidence.
Here’s some slightly less academic explanations. This one comes from the Boston Globe.
Vermont took Obamacare a step further. In 2011, Shumlin proudly signed a bill to establish a publicly financed, single-payer system. The law required Shumlin to submit a detailed financial plan by 2013.
Shumlin missed the deadline, raising fears among supporters and critics alike that single-payer health care would cost much more than anticipated. Those fears were realized on Dec. 17, when Shumlin, two years late and just a month from narrowly winning reelection, released the financial analysis.
The numbers were stunning. To implement single-payer, the analysis showed, it would cost $4.3 billion in 2017, with Vermont taxpayers picking up $2.6 billion and the federal government covering the rest. To put the figures into perspective, Vermont’s entire fiscal 2015 budget, including both state and federal funds, is about $4.9 billion.
Shumlin’s office estimated the state would need to impose new personal income taxes of up to 9.5 percent, on top of current rates that range from 3.55 to 8.95 percent. Businesses would be hit with an 11.5 percent payroll tax, on top of 7.65 percent payroll taxes employer pay for Social Security and Medicare.
And even those tax increases might not have been enough. The governor’s office estimated the Green Mountain Care program would run deficits of $82 million by 2020 and $146 million in 2021. Shumlin said he feared the tax increases would harm businesses and the economy.
Okay, this is VERMONT, folks. Now, try doing that in Louisiana and Kansas or try getting their elected officials in the District to buy off on it.
So, a lot of children just really like believing in Santa Claus and it doesn’t take much to get them to continue their buy-in. Then there was Doctor Daughter who figured out it was her Dad and me at an extremely tender age after careful empirical study then asked me if that was the case. Of course, I said yes rather than try to lead her on like my parents did me for the sake of my sister. I just told her to go along if other kids believed and their parents hadn’t told them the truth yet. She did so like a little Nixonian co-conspirator.
I will not lie to you. Ceteris paribus. I prefer Single Payer Health Insurance. Ceteris paribus. Bernie Sanders has some really nice ideas.
I have never been one of those theoretical researchers. All of my stuff is empirical. I live in the land of empirical evidence. Yes, folks socialized medicine works just fine in the UK and is fairly cheap and folks get turned away for stuff that would probably piss the average American off. Yes, single payer health or a government option works great in Switzerland and other places. But, this is a country where it appears that our options will be Hillary Clinton or Donald Trump.
Spare me the Santa Claus mythos or the Senator Gadfly mythos.
Sorry this is so long, but as you can see, I had a lot to say and prove. I vote we try to improve on the ACA and for Hillary. Just sayin’.
Mea culpas go to any one whose work I over quoted. I love fair use but I also loved what you wrote. I quoted and cited you. Just sayin’.
What’s on your reading and blogging list today?
Most of the news today is about the looming shutdown of the Federal Government. Our government is truly dysfunctional. The states have gerrymandered us into a Congress that doesn’t care about the country at all. They just take care of their base and their personal pork. We’ve also got a krewe of congress critterz that’s about as dumb as they come. Why are some of them gleeful over the idea of a shutdown? What do they think they have to gain and why would they hurt so many people?
Why have House Republicans pursued their effort to defund, and now to delay, Obamacare so relentlessly, even though they have almost zero chance of success in the face of a rapidly-approaching deadline for shutting down the government? And why have they done so when many in their party have warned that a shutdown would be suicidal for the GOP?
I talked with one of the most vocal of the defund/delay advocates, Minnesota Rep. Michele Bachmann, on Friday night, as she waited to hear what path the House Republican leadership would take. It’s safe to say her views reflected those of many of her conservative colleagues, and her reasoning was this: One, Obamacare as a policy is so far-reaching, so consequential, and so damaging that members of Congress should do everything they can — everything — to stop it before it fully goes into effect. Two, lesser measures to fight Obamacare — repealing the medical device tax or making Congress purchase coverage through the exchanges without special subsidies — are just not big enough to address the problem. And three, there have been government shutdowns in the past over far less urgent reasons that did not result in doom for Republicans.
“There is a very large group of us who believe that this is it, this isn’t just another year, this isn’t just another CR fight,” Bachmann told me. “This is historic, and it’s a historic shift that’s about to happen, and if we’re going to fight, we need to fight now.”
“This isn’t just another bill,” Bachmann continued. “This isn’t load limits on turnip trucks that we’re talking about. This is consequential. And I think the reason why you’ve come to this flash point is that this is an extremely consequential bill that will impact every American, and that’s why you have such passionate opinions. And we’re not giving up and we’re not caving in that easily.”
For Bachmann and many of her colleagues, the enormity of the issue serves to highlight the problem with less extensive anti-Obamacare measures. “The Vitter Amendment isn’t going to help real people,” Bachmann told me. “It’s going to be a political move, but it’s not going to help real people. Obamacare will continue to destroy the economy. Now, repealing the medical device tax does help the economy. Here in the Beltway, we get the medical device tax issue. And in my state of Minnesota, we get the medical device tax issue. That’s our industry. And I’m all for [repealing] it, but for most Americans, that is not something that they see that they want to get.”
It’s really strange to see the apoplexy shown by Republicans when they call the American Heritage’s Dole/Chaffey Care alternative to Hillarycare some kind of socialist plot. What happens under the law if implementation is slowed down even one year? Many states, businesses, insurance companies and health care providers have already started their transition.
So what does this “compromise” actually look like? For a party that has centered their platform around reducing spending and the deficit, it’s surprisingly bad economics.
First of all, repealing the medical device tax would actually add $30 billion to the deficit. That provision, which imposes a 2.3 percent tax on medical devices, is one of the funding sources for Obamacare’s coverage expansions. Proponents say that the tax will be balanced out by the influx of new Americans entering the insurance market. But getting rid of it now without finding another way to finance health reform would simply increase health reform’s price tag.
Furthermore, delaying Obamacare’s individual mandate — a central tenet of the health law that requires everyone to purchase insurance — would have catastrophic effects. The Congressional Budget Office (CBO) projects it would end up forcing Americans to pay higher premiums for their health coverage. Healthier people would be discouraged from buying insurance, resulting in an older and sicker pool of people in the individual market and encouraging insurers to submit higher rates. The delay would ultimately hike premiums by an estimated 15 to 20 percent.
And according to the CBO, a one-year delay would leave about 11 million Americans uninsured, ultimately reducing the expected coverage gains under the health reform law by nearly 85 percent. As those uninsured Americans end up seeking care in hospitals, the cost of providing that uncompensated care will offset any costs that are achieved by delaying Obamacare’s coverage expansion. Ultimately, delaying the mandate doesn’t actually save the government any money.
As Wonkblog reports, delaying the individual mandate would have a “ripple effect” throughout the health insurance industry. That sector has been preparing for impending changes under Obamacare, and a last-minute decision to delay the law would be a huge drain on the companies that have already spent millions of dollars on advertising and outreach campaigns. “It’s just too late,” Joe Antos, a health policy researcher at the American Enterprise Institute,told Wonkblog. “Everybody who is involved, insurance companies and hospitals and any other big entity, they’re ready to go. They really can’t make any changes.”
When the Affordable Care Act was winding its way through the court system last summer, a conservative federal judge made the point that suddenly striking down health reform would create “economic chaos.” And at this point, as many of Obamacare’s consumer protections have already taken effect, the individual mandate is inextricably linked to making the health reform law work in practice. A new paper from the Urban Institute notes that delaying the individual mandate would “seriously disrupt overall implementation” of health reform.
The federal government swerved toward a shutdown on Saturday when House Republicans demanded to hold a vote to delay Obamacare by one year instead of cooperating with the Senate to pass a “clean” spending bill. It’s now practically assured that parts of the government will go dark on Tuesday for the first time in 17 years.
From a Republican point of view, there are three possible happy endings to the looming catastrophe.
Happy Ending #1: The president blinks. He’s blinked before after all—notably when he agreed to sequestration in 2011—and who knows? He might blink again.
Problem with Happy Ending #1: This time, though, “blinking” means blowing up the president’s most important legacy: his health-care plan. That’s more than a blink. He might as well hand in his resignation after that.
Happy Ending #2: The country blames the Democrats for the shutdown. After all, the GOP is only asking for the president to negotiate. It’s the president who refuses to yield.
Problem with Happy Ending #2: Republicans actually shut down the government in 1995. They took the country to the brink of debt default in 2011. Their caucus is reacting to this shutdown with enthusiasm, not regret. It’s going to be hard to sell the claim that it’s the Democrats who brought about this latest outcome when Republicans come out of caucus looking so happy about it.
Happy Ending #3: Even if the president does not blink, and even if Democrats don’t get blamed, perhaps Republican activists will be so motivated and mobilized by the shutdown that their excitement will loft the party to big wins in the 2014 races.
Problem with Happy Ending #3: Because Happy Endings 1 and 2 look so unlikely, the shutdown is likely to end in a Republican retreat. Party activists will be demotivated—and may waste their energy recriminating against their own leadership rather than organizing to fight Democrats.
Typical of the privileged, entitled spoiled brats that they collectively are, the House Republicans threw everything but the kitchen sink into their government funding bill. The bill, which purportedly was to stave off a government shutdown, was instead a big, fat sloppy kiss to all of the special interests that want to curtail average Americans’ lives while enriching the top one percent even further.
Telling, perhaps, that they were unable to do it without drinking heavily enough to be noticeable from the gallery. Putzes.
The “funding” bill included a clause that for the puritanical and/or science ignorant Republicans, may be the king of unintended consequences: delaying funding for contraceptive care under ACA:
The House voted 231-192 on a bill that would delay much of the 2010 health care overhaul for a year. It would also repeal a tax on medical devices that helps finance the health care law. The measure would allow employers and insurers to opt out of providing health care services that they find morally or religiously objectionable. The addition reignites the debate over a portion of the health care reform law that requires most insurers to cover women’s preventative health care, including contraception.
It’s enough to make me want to nut punch a Republican member of Congress. Need I remind them once again that in addition to preventing unwanted pregnancies, contraceptives are used therapeutically as well for a host of women’s health issues? Those “family-friendly” idiots will not be satisfied until Americans see an increase of abortions (oh, wait…), an increase in people applying for federal assistance due to the forced births (oh, wait…) or a bunch of motherless children,
However, the Exchanges set up by the Affordable Healthcare Act are being set up. It’s interesting that the Republican plan to shut down the Government isn’t really shutting down Obamacare.
Many pieces of the health care law, the Affordable Care Act, aren’t tied to the annual spending bills. Much of the health law is mandatory spending — a kind of fiscal autopilot that’s not part of the annual appropriations battle that has Congress tied in knots. The mandatory components of the health law include the subsidies to help people buy private health plans as well as the expansion of Medicaid in many states. Both of those functions will be handled through the new health insurance markets or exchanges.
Because those programs are mandatory, the Department of Health and Human Services has a lot of leeway to say whether Obamacare activities can continue — and HHS officials have made clear they’re going to use it.
On Friday, the HHS quietly posted its shutdown contingency plan. The bottom line is clear: Obamacare would continue, including the health exchanges and their coordination with Medicaid. It also said Medicare coverage “will continue largely without disruption.” True, lots of HHS workers would be furloughed — but those who would be told to stay home are concentrated in agencies that are not driving the launch of the health law.
HHS says its plan is consistent with legal advice that allows activities that “do not rely on annual appropriations, and activities that involve the safety of human life and protection of property” to keep running even if much of the government shuts down. And that means the staff that carry out mandatory programs like those in the health law can keep working — even if their positions are funded through the annual spending bills
I’ll let you know how the process is going to work down here in one of the states that’s fighting the law every way it can. I was told Friday that the adjunct health care plan that I’ve had for the past few years doesn’t meet the minimum standards for the Act and won’t be offered. I am going to head to the exchange next week and find out what my options are going to be. I’m glad to be out of my subpar health insurance plan, but wondering if the federal exchange is going to have many choices here in a state with a hostile governor.
So, I know this was a little oriented to the one topic of the day, but I thought we needed to spend some time on it. Feel free to share your thoughts on this or any other links on any other subjects that made your reading and blogging list today!!!
So, I am not exactly going to use the term “irrational exuberance” quite in the context that it was originally uttered by Alan Greenspan in 1996. Maybe irrational mania or hate-driven zealotry or crazy-go-nuts gullibility are better terms. Whatever the case, the so-called “Tea Party” ginned up by the histrionics of folks like Ted Cruz , the low information and thought ability of Sarah Palin, and the whacko ideology of the neoconfederate Pauls believes that taking down “Obamacare” and our government is the be all and end all of their existence. There’s some articles today looking at their efforts. Why are they doing everything from crowing townhall meetings and running strange ads? There’s an interview there with one of the exhuberati that’s pretty damned strange.
Another objection that’s been raised is that this would only lead to a government shutdown or default, and Republicans would get blamed for that. Are you advocating that outcome?
The outcome we would like to see is that the American people don’t have to pay for Obamacare, however that comes to pass. It’s like driving from L.A. to San Francisco — there’s a million different ways to get there. We believe this approach is the last, best opportunity to prevent the American taxpayer from having to shell out the money and support Obamacare.
Think for a second. You’re a taxpayer, an ordinary American working woman. You’ve got to pay for a health-care system that Congress is exempt from. You have to participate in a health-care system that big business, political cronies, congressmen and their staffs do not have to participate in. That doesn’t sound like a democratic republic to me. That’s what’s got the grassroots upset. We are not serfs. We are citizens.
The House has had, what, 40 votes to repeal Obamacare, and what has that done? Besides given members of Congress a bloody shirt that they can wave on the stump back home and say, “I’m against Obamacare”? This effort to ensure right now that Americans don’t have to pay for Obamacare is the best way to go about it. It’s not just bloody-shirt-waving for the voters, it’s an actual, working thing.
For some reason, the right wing always seems to think they get to pick and choose what their tax dollars go for even though their representatives and our representatives do that for us as clearly outlined. They seem to think that they don’t have to pay for birth control or abortion services or whatever it is that drives them to hysteria while I have to pay for their wars, their Isreal at all costs policies, their police state, their gay conversion therapies, and their screeds and lies that basically outline state ownership of women.
The deal is that the anti-Obamacare movement will fail if it does not succeed now. Folks like Ted Cruz basically know this.
Cruz’s suggestion that conservatives can still win the defund fight is getting attention, but the really important quote here is Cruz’s concession that conservatives have not won “the argument” in a long time. Here’s why: Cruz almost certainly knows full well that this is the last chance to win the broader argument over Obamacare. Once the law’s benefits kick in, it will probably no longer be winnable.
Obamacare opponents cite polls showing Obamacare’s unpopularity to justify continued efforts to repeal and/or sabotage the law, whether through a government shutdown or through more prosaic methods. But, as even some Republicans are now acknowledging, the Republican position on health care is untenable as long as they fail to offer a meaningful alternative that would accomplish Obamacare’s core goals — expanding coverage to many millions of uninsured and protecting consumers and those with preexisting conditions from insurance industry abuse.
This is the argument conservatives are losing: As unpopular as Obamacare is, there is simply no evidence that this dissatisfaction translates into public support for repealing the law entirely and simply letting the “magic of the marketplace” ensure that everyone is covered. And a number of writers — Jonathan Bernstein, Aaron Carrol, Ezra Klein,Jonathan Cohn, and Paul Krugman — have already explained well why Republicans can’t offer an alternative to Obamacare that accomplishes what the law accomplishes, and why there’s simply no meaningful Republican alternative to embracing Obamacare’s general approach or essentially doing nothing.
For several years now, Republicans have been able to paper over this problem by making the political argument only a referendum on the lurid, nightmarish vision of Obamacare they have painted (with some success) for voters. But as even Cruz seems to recognize, the actual contours of the argument we’re having will only become clearer as Obamacare’s concrete benefits kick in — very likely rendering that argument unwinnable. That leaves Republicans in the position of hoping the law is a disaster and doing all they can to bring that about. But that posture only further underscores what makes the GOP position untenable in the first place. Cruz is absolutely right: time is running out.
Undoubtedly, the law will begin to morph into something else should the political and governance process in Washington work again. The absolute hysteria on the right caused by the law is nearly as bad as the attempts by the right to circumvent civil rights, gay rights or reproductive rights. The weird difference is this law has some component that is likely to benefit nearly every one. It isn’t aimed at relieving oppression of any one group. It’s aimed at solving a nationwide problem created by our very dysfunctional healthcare system that mostly became dysfunctional because of the system of paying for health care.
From the day the Affordable Care Act was enacted, every Republican in Congress and most Republicans in state and local governments have done everything imaginable to interfere with its implementation, and have systematically opposed the kind of legislative “fixes” that are normal for any major new law, while loudly cheering for its failure. Now we are told that executive measures to make the law work mean that it’s not the law of the land. So what exactly happened when the president signed this legislation on March 23, 2010? Does the legitimacy of a law depend on acceptance of it by its opponents? Think about the implications of that theory, and recall that not so very long ago Republicans tried to drive a president from office on grounds that his efforts to hide sexual impropriety threatened the very Rule of Law.
That last sentence deserves a second look because there are calls to impeach Obama over “ObamaCare”. This is another clear indication that the Tea Party and Republicans–n general–are rarely about the Constitution. What is their generally accepted definition of “high crimes and misdemeanors”? Even Republican congress critters don’t seem to understand our Constitution.
Kerry Bentivolio is a Republican member of The House of Representatives from the great state of Michigan. He’s also clearly deranged. Bentivolio is the latest TEApublican to throw his voice in support of impeaching President Barack Obama. Speaking at a town hall meeting in his home district, the congressman told a constituent that essentially he doesn’t like President Obama, would love to impeach him, but he just doesn’t have any of the pesky evidence you need to actually convict a sitting president on impeachment charges.
“You know, if I could write that bill and submit it, it would be a dream come true,” Bentivolio told the constituents. “I feel your pain, I know, I stood twelve feet away from the guy and listened to him. I couldn’t stand being there, but because he is president I have to respect the office. That’s my job, as a congressman, I respect the office.” A dream come true, congressman? There used to be a time in this country where impeachment was considered such a drastic undertaking that even a president’s political foes took no glee in doing it.
All of this just isn’t rational under any logical paradigm. So, that just brings me back to the the conclusion that this is mostly about anger, hatred, and racism at a very visceral level. This is also what probably ties what should just be a basic economic policy issue to basic civil rights issues and it’s also what makes the Tea Party a mostly white movement tinged with strong elements of neoconfederates, christofascists, and gun toting preppers. These folks seem to like their social security and medicare and scream loudly when these programs are threatened. They only seem to hate it when folks outside of their ‘own’ might get access to something that they’re convinced doesn’t benefit them even when it likely does. That’s just plain crazy talking.