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Public Opinion Redux October 12, 2010

Posted by Dwight Furrow in Dwight Furrow's Posts, politics.
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The most recent Bloomberg Poll has some interesting results on the fate of health care reform.

Here is the relevant question:

Turning to the health care law passed earlier this year, what is your opinion of the bill — should it be repealed or not?

It should be repealed: 47%
It should not be repealed: 42%
Not sure: 11%

It looks like this ought to be discouraging for proponents of reform. Until voters are polled on what’s in the health care law.

A 54% majority don’t want to bring back the lifetime caps on expenditures. A 75% majority do not want to repeal protections for pre-existing conditions. 60% want to preserve the insurance exchanges for the unemployed. 67% want to keep the elements of the law that allow kids up to age 26 to remain on their parents’ policies. 73% want to fill the Medicare donut hole.

Republicans seem to think that their calls to repeal the Affordable Care Act will be popular. Good luck with that.

But it would be nice if the public had a clue about what was in the bill.

Of course, if you get your news from the mainstream media you are likely to be confused about basic facts.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

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What the Health Care Plan Does Immediately March 24, 2010

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There has been (and still is) a lot of nonsense said about the recently passed health care bill. So it is worth clearing up misconceptions. Nancy-Ann Perle summarizes the immediate benefits:

  • This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
  • This year, health care plans will allow young people to remain on their parents’ insurance policy up until their 26th birthday.
  • This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
  • This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
  • In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
  • This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
  • This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
  • Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don’t meet those thresholds will be required to provide rebates to their policyholders.
  • Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.
  • This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
  • This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
  • This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
  • This year, this bill starts to close the Medicare Part D ‘donut hole’ by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the ‘donut hole.’

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

Victory (I Hope) March 21, 2010

Posted by Dwight Furrow in Dwight Furrow's Posts, politics.
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Assuming, as expected, that the Senate plays ball, we will have Health Care Insurance Reform.

This is indeed an important victory and an historic moment. And it is testimony to Obama’s political skills and the policy chops of Senate and House Democrats.

Although the process has been exhausting and frustrating and the deal-making ugly, the result is impressive. Ezra Klein provides an excellent summary of the accomplishment:

This was a hard bill to write. Pairing the largest coverage increase since the Great Society with the most aggressive cost-control effort isn’t easy. And since the cost controls are complicated, while the coverage increase is straightforward, many people don’t believe that the Democrats have done it. But to a degree unmatched in recent legislative history, they have.

Furthermore, the bill reduces the federal budget deficit.

All of this was accomplished in the face of lies about “death panels” and “government takeovers”, deep cynicism, outright threats, an utterly polarized electorate, and powerful interest groups who could easily have scuttled the effort. Ezra Klein again:

This year, the Obama administration succeeded at neutralizing every single industry. Pharma supports the bill. Insurers are incoherent on it, but there’s not a ferocious and united campaign to kill the proposal. The American Medical Association has endorsed the Senate bill. The hospitals have endorsed the bill. Labor has endorsed the bill. The business community is split, with larger employers holding their fire.

The legislation isn’t perfect—far from it. And one could argue that Democrats should have pushed for a better bill, ditched the attempts at bi-partisanship that failed to garner a single Republican vote, and resisted the influence of the insurance companies who will likely come out winners from all of this.

But truth be told, there was not a lot of room for maneuver. The compromises were probably necessary given the political climate.

The unsung hero here is Nancy Pelosi who mastered the end game and guided this legislation through a House Democratic caucus with sharp ideological differences in an election  year.

But with all the celebration, a note of caution is in order. As Robert Reich wrote recently:

Nothing that’s legislated is perfect and in my view the good that will come from passing health care legislation outweighs the bad, but be warned: the pending House bill (that will go to the Senate for a “reconcilation” vote) does not repeal the antitrust exemption for health insurers, nor does it contain a public insurance option. It thereby will allow health insurers to continue to consolidate into even larger entities, gain as much market power as they can, and charge ever higher prices. Yet Americans will be required to buy health insurance from them. Assuming the bill becomes law, this dissonance spells trouble. It will have to be addressed before 2014, when the bill takes effect.

The real work starts now. This is complex legislation that must be implemented correctly if it is to have the desired effects on health care coverage and cost reductions. And much of the bill does not take effect until 2014—that is a lot of time for mischief-makers to derail the effectiveness of this much needed reform.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

Embarrassed January 20, 2010

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One day after Republicans win back one Senate seat, Democrats as usual are acting like the spineless, pathetic losers they been for most of the past 30 years.

They now claim that their signature issue, health care reform, can no longer pass Congress.

I am embarrassed to be a Democrat, not because we lost an election but because, in the aftermath, they are proving they lack the courage of their convictions.

Look. When Obama was inaugurated there were 58 Democrats in the Senate and 257 Democrats in the House. Once Scott Brown is sworn in there will be 59 Senate Democrats and 256 Democrats in the House. We are better off now than we were throughout most of Obama’s first year.

This Congress has already passed the stimulus package, regulations on credit card and tobacco companies, the Lilly Ledbetter Fair Pay Act, and SCHIP with fewer Democrats than they have now.

Pass the damn Senate version of the bill, fix the flaws in the budget reconciliation process (which cannot be filibustered by the Republicans) and move on.

As Howard Dean said on the Rachel Maddow show:

This is like Washington was when I got there five years ago. You know, the Democrats really weren’t sure they were Democrats. If you want to win, you actually can’t sort of move to the middle and become a Republican. You’ve got to stand up and stand for the things that you got elected on and that the Democratic Party believes in and we haven’t seen that in the healthcare bill and I think that’s part of the problem.

Try to show some leadership for once.

Just pathetic.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

After Health Care Reform, Reform Democracy December 20, 2009

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It ain’t over till it’s over, but unless Joe Leiberman decides to move the goal posts again, it looks like the Democrats have enough votes to approve health care legislation.

The compromises necessary to win the votes of a few conservative Democrats have opened a yawning chasm within the Democratic Party between those who hail the plan as a giant leap forward for progressive ideals and those who are bitterly disappointed about what could have been.

 Paul Krugman on balance approves:

But let’s all take a deep breath, and consider just how much good this bill would do, if passed — and how much better it would be than anything that seemed possible just a few years ago. With all its flaws, the Senate health bill would be the biggest expansion of the social safety net since Medicare, greatly improving the lives of millions. Getting this bill would be much, much better than watching health care reform fail.

At its core, the bill would do two things. First, it would prohibit discrimination by insurance companies on the basis of medical condition or history: Americans could no longer be denied health insurance because of a pre-existing condition, or have their insurance canceled when they get sick. Second, the bill would provide substantial financial aid to those who don’t get insurance through their employers, as well as tax breaks for small employers that do provide insurance.

All of this would be paid for in large part with the first serious effort ever to rein in rising health care costs.

The result would be a huge increase in the availability and affordability of health insurance, with more than 30 million Americans gaining coverage, and premiums for lower-income and lower-middle-income Americans falling dramatically. That’s an immense change from where we were just a few years ago: remember, not long ago the Bush administration and its allies in Congress successfully blocked even a modest expansion of health care for children.

The bill establishes a fundamental principle that liberals have been advocating for decades—that all citizens have a right to health care, regardless of pre-existing conditions or the ability to pay.

This is a rare opportunity—I don’t see how a genuine progressive could vote against such a bill.

But having said that, there is a sense in which the bill offers no real reform and progressives are right to be upset about our inability to replace a fundamentally broken system. The structure of the private, employer based insurance system is still in place. And the lobbying power of the insurance companies made sure of it—they stand to profit handsomely from 30 million new customers.

But such is the nature of political change in our system.

When Medicaid was passed it was unavailable to many low-income adults; the original Medicare bill didn’t cover people with disabilities, the original social security program excluded agricultural workers, government employees, railroad employees, etc. and offered no cost of living adjustments.

In order to achieve any significant social change, liberals must constantly battle to improve programs—but the programs first have to be written into law before they can be expanded.

Matt Yglesias thinks the bill is promising:

And the crucial question going forward is whether it will be possible to further improve this legislation.”

I think it’s very possible, but only if the people who are disappointed by the shortcomings of this bill take appropriate action. First and foremost, that means working as hard as possible to produce as good an outcome as possible in the 2010 midterm elections. […]

[Y]ou accept compromises and then keep on working to build more political power. You do it by contacting members. You do it by urging friends and colleagues to contact members. You do it by donating to and volunteering for good candidates. You do it by turning out and voting for the better candidate in the race even when that candidate is disappointing. You do it by urging viable candidates to mount risky primary challenges against incumbents who don’t reflect the real possibilities of their constituency. You do it by staying engaged, and working hard.

I think this is an excellent bill, all things considered, but whether you agree with that or not the most important thing is what does the progressive community do going forward to enact even better bills in the future.

I agree; progressive voices calling for a defeat of the bill are delusional.

The issue that ought to have progressives riled up is not the bill itself but the process by which the bill was created, which reveals the utter corruption at the heart of our political system. The wholesale bribery which we call “democracy” was on view. The insurance companies made out like bandits with millions of customers who are now mandated to purchase insurance and no competition or price controls that would limit insurance company exploitation. Most of the bill was negotiated in secret with lobbyists and their pawns in Congress calling the shots, supported by the always supine media who praised the so-called “centrists” as genuine pragmatists rather than corporate whores.

What seems to be in tatters is Obama’s promise to change the culture of Washington. Of course, it is not obvious how that culture can be changed (without a wholesale change in the make-up of the Supreme Court which has persistently enabled the Washington cleptocracy with its rulings on commercial speech). Change requires legislation and, with a Republican Party in full-dress, nihilist regalia, Obama had little choice but to play ball with corporate shills like Lieberman and Ben Nelson.

So going forward, while we try to mend the defects in the health insurance system, we should devote more attention to finding some way of mending defects in our democracy—apparently elections aren’t sufficient.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

Moral Bankruptcy December 14, 2009

Posted by Dwight Furrow in Dwight Furrow's Posts, Ethics, politics.
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The question of whether we will have progressive health care reform or a new subsidy for the insurance companies comes down to whether the odious Joe Leiberman (Independent, CT) can be cajoled into supporting a public option or something very similar to it.

Yesterday, Leiberman seemed to pull the plug on that possibility, saying that he now opposes the Medicare expansion that he has supported in the past. The health care reform debacle illustrates once more the near impossibility of getting a liberal bill through the Senate.

But part of the reason goes beyond mere politics. As Matt Yglesias writes:

Can’t liberals be just as stiff-necked as Lieberman? Sure, they could. But liberals members do have an incentive to compromise—the tens of thousands of people who die every year for lack of health insurance. The leverage that Lieberman and other “centrists” have obtained on this issue (and on climate change) stems from a demonstrated willingness to embrace sociopathic indifference to the human cost of their actions.

The moral bankruptcy of so-called “centrism” becomes more apparent everyday but few seem to notice.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

A Muted Celebration and More Work to Do November 9, 2009

Posted by Dwight Furrow in Dwight Furrow's Posts, politics.
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On Saturday night, for the first time in history, the House of Representatives passed legislation to provide near universal health insurance. There is still a lot of work to do before the bill becomes law and it will be a struggle getting it through the Senate. But nevertheless, Saturday’s accomplishment is noteworthy. Many Presidents and many congresses have tried to reform the health insurance system; only this President and this congress have gotten close to success.

So there is cause for some celebration.

President Obama issued the following statement:

“Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people.

“The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality affordable options for those who don’t; and bring down the cost of health care for families, businesses, and the government while strengthening the financial health of Medicare. And it is legislation that is fully paid for and will reduce our long-term federal deficit.

“Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year.”

Senate Majority Leader Harry Reid (D-Nev.) has to figure out how to generate 60 votes (in our current oligarchy, a majority isn’t sufficient) without a single defection from the Democrats. So the deal is not done. But it is close.

But now for the bad news. The downside of the House vote was that Democrats had to assent to the abhorrent Stupak amendment which prevents insurance companies participating in the health care exchanges from covering abortion services. Ann Friedman is right:

On some level, I don’t care about the nitty-gritty details of this amendment. This isn’t just about how the money is allocated or what workarounds exist. This has me so incredibly infuriated because it further segregates abortion as something different, off the menu of regular health care. It is a huge backward step in the battle to convey — not just politically, but to women in their everyday lives — that reproductive health care is normal and necessary, and must be there if (or, more accurately, when) you need it.

This also sets apart women’s rights from the Democratic/progressive/whatever agenda. As something expendable. But fundamental rights for women are not peripheral. They are core. And not just because of so-called “progressive” values. In a political sense, too: Seeing as how the Democratic party relies on women voters to win elections, you would think they would have come around to this no-brainer by now.

A significant number of congresspersons (Democrats and Republicans, mostly men) were willing to vote health care reform down if it didn’t include abortion restrictions. Thousands of people die every year because of lack of health insurance. Somehow that doesn’t matter. For the religious right, forcing everyone to conform to their “doctrine” is more important than saving lives. This is what they mean by a “culture of life”.

There is some chance that this amendment can be removed from the legislation before it becomes law.

Something to keep an eye on.

 

x-posted at Reviving the Left

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com

Slippery Slopes and the Health Care Debate August 27, 2009

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Most of the objections to the various Democratic plans for health care reform that have received media attention are quite frankly lies. Claims that the government is planning to take over health care, that it will cost the taxpayer $1 trillion per year, that undocumented immigrants will get free care, that bureaucrats instead of doctors will decide treatment options, and that “death panels” will pull the plug on grandma are cynical attempts to scare misinformed voters into opposing any health care reform.

None of the plans under consideration propose any of this.

But there are versions of these arguments that are not merely paranoid rants. For instance, one could argue that a government-run insurance plan will have incentives to save money by providing sub-standard care or will set payment rates too low to encourage medical innovation. Or the government might prevent people who can afford it from buying better private insurance plans that would make up for what the government plan doesn’t cover.

It might be the case that a government-run insurance plan would be so efficient that it would drive private insurance companies from the market.

Or one could argue that panels of medical experts charged with deciding what treatments are most effective will have some sort of systematic bias that would prevent legitimate procedures from being performed.

The government could decide to give free medical care to undocumented immigrants or to place severe constraints on end-of-life care.

All these outcomes are conceivable. But these are all slippery-slope arguments. They have the form if we do X, then Y will inevitably follow, and Y is really bad. But slippery-slope arguments are notoriously, well, slippery.

The problem is that if you are going to claim that if we do X then Y will follow, you have to provide some plausible mechanism by which X will lead to Y. It is not sufficient to say that if we do X, Y could happen. Of course it “could”; but if this kind of argument is to be persuasive we need to know why “Y” is a plausible outcome.

If a government-run health insurance plan is sub-standard, why would people opt for it in lieu of their private insurance? Why would the government give free health care to illegals or cut-off end-of-life-care? And why would the government prevent people from buying better health insurance if the government plans are minimal?

Furthermore, even if a plausible mechanism for “Y” is discovered, opponents would still have to show that “Y” has negative outcomes that would outweigh the positive outcomes of health care reform.

But this kind of reasoning about how to create a plan with appropriate incentives and the right benefits is lacking in much of the health care debate. I’m sure there are conservative economists who can supply plausible slippery slope arguments. But instead all we get are lunatic rants or vague, unsupported allusions to government incompetence.

book-section-book-cover2 Dwight Furrow is author of

Reviving the Left: The Need to Restore Liberal Values in America

For political commentary by Dwight Furrow visit: www.revivingliberalism.com