Why do Republican leaders oppose fixing the Affordable Care Act?

Way back on December 3, 1993, early in the Clinton Administration, conservative political strategist William Kristol distributed a memo urging the GOP to go all out to block health insurance reform because it would likely prove so popular as to be, in his words, “a serious political threat to the Republican Party.”

Its passage in the short run will do nothing to hurt (and everything to help) Democratic electoral prospects in 1996. But the long-term political effects of a successful Clinton health care bill will be even worse—much worse. It will relegitimize middle-class dependence for “security” on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government.

Fifteen years later, Obama’s election provoked the same alarm. In a November 21, 2008, article for U.S. News, James Pethokoukis of the American Enterprise Institute declared that healthcare reform could “kill conservatism.” He reported that even before the election a “scary serious” GOP strategist had said to him, “Let me tell you something, if Democrats take the White House and pass a big-government healthcare plan, that’s it. Game over.”

Indeed, just a week earlier Michael Cannon of the Cato Institute had published an article whose title summed up the fear succinctly: “Blocking Obama’s Health Plan Is Key to GOP’s Survival.”

In a November 1 interview the following year, Senator Orrin Hatch (R-Utah) warned the pro-Republican Cybercast News Service that if healthcare reform proved successful, “you’re going to have a very rough time having a two-party system in this country, because almost everybody’s going to say, ‘All we ever were, all we ever are, all we ever hope to be depends on the Democratic Party.’”

I don’t mean to suggest that rank-and-file Republicans think this cynically, and to be sure, a lot of Republicans seem to believe in all sincerity that the ACA is harmful, despite the fact that the ACA is actually based on conservative proposals, despite the surveys that show substantial Republican support for almost all ACA provisions taken individually, despite the hard evidence that the ACA has been a lot more beneficial than harmful, and despite the now-obvious nonexistence of the supposed “death panels” and other silly horrors promised by the nuttier opponents.

But clearly, some influential Republican leaders have been worrying that the better the Affordable Care Act works the more it hurts them politically. This explains why improvements are being fought tooth and nail.



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An elegant and tasteful cat maze

A Minnesota man has created a series of catwalks and hiding places for his four cats, and the result is impressively well designed and downright elegant, enhancing the look of the house. The catwalks run along the walls near the ceiling like a sort of elaborate crown molding with a vaguely nautical look.

The architect and builder of the cat maze, homeowner Greg Krueger, has been diagnosed with Asberger’s syndrome, a mild form of autism, and he credits it for giving him the concentration to work on his hobby.



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Update on the Affordable Care Act (“Obamacare”)

Yesterday’s edition of Healthcare Triage looks at the Affordable Care Act, aka “Obamacare,” one year after its less-than-spectacular launch:


Link: http://youtu.be/v-LzLGjNi18

The speaker is Aaron Carroll MD, a pediatrician who also blogs and vlogs about healthcare. You can read his blog (with contributions from other folks) here: http://theincidentaleconomist.com.

To summarize what Dr Carroll has to say, the dire prediction about the ACA haven’t come true, and most people are better off. However, there are some problems he doesn’t touch on:

The law offers income tax credits to working people with income between one and four times the poverty level so that a policy in the “silver” category will cost no more than 9.5 percent of their income (in fact, no more than 2 percent for those making just above the poverty level). In addition, those with income between one and 2.5 times the poverty level can get help with their out-of-pocket spending. Those making below the poverty level are supposed to be covered by Medicaid, whose coverage was expanded by the ACA.

However, the Supreme Court made up a brand new law based on a “states rights” provision not actually found in the Constitution (seriously, the opinion makes no specific reference to any section of the Constitution or the Amendments) saying that states can unilaterally choose to follow the old Medicaid rules rather than current law, and a number of state governments, for purely partisan reasons, opted to do so. (I say “partisan reasons” because there is no economic justification for it. Accepting the expansion saves them money both immediately and in the long run.)

Consequently people making below the poverty line and living in the wrong state are out of luck.

People making over four times the poverty level face a less serious problem but one that still ought to be fixed. Just below that amount (around $46,000 for a single taxpayer with no dependents) their Silver-plan premiums are capped at 9.5 percent of income and they get a tax credit worth an average of more than $3000 per year, or covering over 40% of the premium. But if their income is just a tiny bit higher, they get no tax credit. It should phase out rather than cutting off abruptly.

In addition, while most states have seen very modest increases in health insurance costs for individuals buying insurance through the exchanges — markedly less than in previous years, in fact — insurers in a few states have announced significant increases. Thanks to the aforementioned tax credits, however, the majority of people will see little if any rise in the amount they pay. Interestingly, though, the “grandfathered” non-ACA-compliant policies that people can still renew for next year are increasing nearly 20%. That at least shows that it’s not the ACA that’s making the rates here go up.

The ACA has been more successful than not, but it isn’t perfect and ought to be improved in a few areas. Unfortunately too many Republicans in Congress are determined to block any improvements because they want to see the law fail. I’ll have more to say tomorrow about the reasons for this, but in the meantime see these articles from New York Magazine, Business Insider, and WBUR radio in Boston.



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John Oliver on improving Supreme Court coverage

John Oliver and his associates at HBO’s Last Week Tonight have come up with a brilliant way to make coverage of the Supreme Court more watchable:


Link: http://youtu.be/fJ9prhPV2PI

The raw footage to let you make your own Supreme Court videos can be found here: http://youtu.be/tug71xZL7yc and official audio recordings from Supreme Court oral arguments are here: http://www.supremecourt.gov/oral_arguments/argument_audio.aspx. If you post any videos based on this, they ask that you “Tag them with #RealAnimalsFakePaws so we can find them.”

(I just did a search for #RealAnimalsFakePaws on YouTube and got nearly 2000 hits.)

See the first YouTube link above for more more information.



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Congress is mostly ignoring the antibiotic crisis

Diana Zuckerman has an important blog post on the member’s website of the American Association for the Advancement of Science.

As she points out, Congress has taken some action — and is considering more — to promote the development of new antibiotics (mainly by passing bills the pharmaceutical industry wants) but is doing little to discourage the misuse and overuse of existing antibiotics, which increasingly leads to antibiotic-resistant “super-bugs.” I hate to sound cynical, but one reason for that is that the industry benefits financially from that overuse.

So what do we need to do? See Zuckerman’s blog post for her take, but it agrees with things I’ve read in other credible sources. Here’s my own list (keeping in mind that I’m not a medical professional):

1. Convince patients to finish a full course of whatever antibiotic they’re prescribed. Too many of us stop as soon as we feel OK again, which can be well before the offending bacteria have been wiped out.

2. Convince other countries to put better controls on antibiotic use. In some countries there’s no prescription required, which obviously promotes overuse.

3. Convince doctors not to overprescribe antibiotics. They’re useless against viral infections and often not needed for mild bacterial ones.

4. Convince doctors to use older antibiotics unless there’s a real need for a new one. (This also saves patients money.)

5. Stop the routine use of antibiotics in livestock feed, where they’re employed to promoted rapid growth rather than to fight disease.

(A couple of these points are not on Zuckerman’s list but my guess is she’d agree with them.)



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Sanity on Ebola from Fox News

Shepard Smith on Fox News spends just a few minutes explaining why it makes no sense for people in the United States to panic over their tiny risk of contracting Ebola:


Link: http://youtu.be/Z2KBfynW09I

As Smith says in the clip above, not one person in the U.S. general population has contracted Ebola. In contrast, more than 50,000 Americans die every year from a far more readily transmitted viral illness. Amazingly enough fewer than half of us bother to get vaccinated against it even though for almost everyone with insurance of us the vaccine is free and available in most drug stores. The disease in question is influenza. Wherever you live, go and get your flu shot or jab or whatever you call it where you are.

Back to Ebola: None of this is to suggest that Ebola isn’t a serious disease; it is, and it’s devastating a number of poor countries in western Africa. You can help by donating to Doctors Without Borders / Médecins Sans Frontières at this link: http://www.msf.org/. These people do good work, often at risk to their own lives, and they deserve our help.



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Jesse Stone news (slightly stale)

My single most popular entry on this blog was a review of the Jesse Stone series of TV movies starring Tom Selleck. I’ve had dozens of comments on it, almost all from people wanting to see more of them.

By accident I just ran across something on Jay Bobbin’s Zap2It blog from May 8 of this year suggesting that Selleck is still interested in doing more of the films. The problem is that CBS, which previously broadcast them, doesn’t want any more, and while there’s a possibility of continuing them on a cable channel, he’s not sure they would budget enough to make it possible to achieve good production values.

Unfortunately this is the way things have stood for some time now.



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XKCD on U.S. legal and public acceptance of mixed-race and same-sex marriage

The XKCD web comic offers not just comic strips but often some quite interesting and informative graphics. Here’s yet another example:

Marriage

The associated title text (what you see if you hover your mouse pointer over the image) reads, “People often say that same-sex marriage now is like interracial marriage in the 60s. But in terms of public opinion, same-sex marriage now is like interracial marriage in the 90s, when it had already been legal nationwide for 30 years.”

As the graph indicates, only about a quarter of Americans surveyed were in favor of mixed-race marriage at the time the Supreme Court legalized it in 1967 in the wonderfully named decision Loving v Virginia.

It’s interesting to compare legalization against popular support. It is probably safe to say that throughout our history, fewer Americans have supported same-sex marriage than lived in states where it was legal. (A few states never outlawed it.) But with same-sex marriage it’s the opposite: A higher fraction of Americans support same-sex marriage than live in states that permit it.

I saw that last point made here at the website explainxkcd.com, where you can find some interesting additional data.



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John Oliver on civil asset forfeiture

A caution before you watch this: If you have some good reason not to get seriously angry right now — perhaps high blood pressure or you need to get to bed soon — don’t watch this, because it will very likely bring you close to explosion. It’s amazing that this happens in the United States, but it does, and the consequences can be even worse than Oliver’s report suggests. (More on that below the video, plus an objection to one thing Oliver brings up.)


Link: http://youtu.be/3kEpZWGgJks

I don’t have a reference to this handy since I read about it years ago, but I’m pretty sure I have the gist of the facts correct. A law enforcement agency — a sheriff’s department in California if I recall correctly — received a tip from a paid informant that a farmer was growing marijuana on his land. The cops staged on overnight raid on the farm and farmhouse, during which the farmer was shot and killed.

(Why the raid in the middle of the night? Were they afraid the farmer would otherwise flush his entire crop down a toilet?)

No trace of marijuana was found. I guess the paid informant didn’t have a legitimate tip to sell and he needed some money, so he made one up.

The incident was investigated by a department from another county, which determined the perpetrators of the raid had been motivated by the money they expected to get from seizing the farm and selling it. In fact, one of the people brought along on the raid was a real estate appraiser.

And people say government can’t be efficient.

I also recall a report on 60 Minutes or some similar television news magazine program (again this was years ago) in which they interviewed a prosecutor with a long history of seizing vehicles in which drugs had been found. Then her son was arrested driving her car with drugs in his possession, but her car was not seized. They asked the prosecutor if this didn’t this strike her as unfair. She said she didn’t think so.

I do have a complaint about Oliver’s report: He makes fun of the seizure of shark fins. In fact, there are some things that are in themselves pretty clear evidence of a crime, and shark fins certainly fall into that category. Do a search for it if you’re unclear why.



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