Tag: ACA

Ed Kilgore has some thoughts on Democratic leadership and the need for term-limits (and specifically for Nancy Pelosi):

Ever since Democrats fell short of their 2016 goal of taking back control of the U.S. House, there’s been talk about […] leadership change in the House Democratic Caucus. And after Democrats failed to win any of the four GOP House seats where special elections were held this year, there was renewed talk about Nancy Pelosi stepping down as House Democratic Leader. The negative buzz became particularly loud after the party’s biggest special-election hope, Georgia’s Jon Ossoff, suffered a disappointing loss, in the wake of Republicans running many millions of dollars of ads linking the candidate to Pelosi.

[…]

[Pelosi] is a much bigger target for Republicans than Paul Ryan or Mitch McConnell appears to be for Democrats. Part of the problem may simply be that she happens to represent a jurisdiction with rich negative symbolism (dating back at least to the attacks on “San Francisco Democrats” in 1984 after the Donkey Party held its convention in the City by the Bay) for the conservatives who are mostly the target for anti-Pelosi ads. You cannot quite imagine Democrats running ads mocking Paul Ryan’s Wisconsin or Mitch McConnell’s Kentucky in this manner.

Emphasis added by me because Kilgore completely discounts the most important information in his several paragraphs. The demonization of Pelosi has nothing to do with her having been in the arena for too long, being a woman, coming from San Francisco, or anything else. Those are all useful pegs for the GOP to build their messaging on and around, but they aren’t themselves decisive or even all that interesting. Anyone serving as minority leader will immediately come under sustained and focused attack from the right wing and their stenographers in much of the media. It’s Cokie’s Law: if information, factual or otherwise, is “out there” then it must be discussed uncritically. Thus the media happily carries the GOP messaging machine’s water on Pelosi and anybody else in the cross-hairs that day. There’s just no getting around it, and The Democrat not only doesn’t have anything like this, they aren’t even on the same planet with the scale and coordination of this operation. Unless and until they create a sustained messaging attack on McConnell and Ryan, those two can continue right on doing what they’re doing. Just to focus on McConnell, he’s likely the most destructive force in government today, but most people would be hard pressed to name him, much less know what he’s been up to and why it is dismantling the way our government has, until recently, functioned.
That’s simply not the case for Pelosi, and that has nothing to do with the fact that she’s from San Francisco and everything to do with a sustained, targeted, and years long messaging attack that salts the Earth and leaves useful framing tools for any GOP hopeful to pick up and use, readymade. Democrats try to build the machine from scratch with every individual election, every cycle. How’s that working out for them?

Lastly, if you like the ACA, thank Nancy Pelosi. Period. That doesn’t mean she gets a pass to serve in party leadership forever, but she did that lift more or less with her own political momentum and within the context of the sustained, entirely negative noise machine and well after perceptions about her in the media were set in stone. Think on that as you try to show her the door.

The Center for American Progress helpfully worked through a few common preexisting conditions among, oh, all of them that will be newly surcharged should the AHCA pass. I think my favorite is completed pregnanct with no or minor complications; that’ll be an additional $17,060 atop your existing fees. Makes perfect sense to me.

The GOP’s health care plan is and always has been: sick individuals should endure bankruptcy for themselves and their families and then, when the money’s gone, kindly go die in the streets. If you don’t have the money to go bankrupt keeping yourself alive in the first place, then don’t get sick (because people who live a good life just don’t get sick) or just go die in the streets. Period.

And, of course, who is not subject to these exciting new ideas? That’d be Congress. I’ve said it before and will say it again: Congress and their dependents should be automatically enrolled the lowest coverage health care allowable by law with no recourse to outside insurance and no Congressional Clinic with 24/7 full service walk-in care for ~$500/year either. Such a law could be about two sentences long (which seems to be the limit for the GOP’s attention) and would greatly clarify these debates.

I was struck last night by a comment that I heard made by Speaker Ryan, where he called this [Affordable Care Act] repeal bill ‘an act of mercy.’ With all due respect to our speaker, he and I must have read different Scripture…The one I read calls on us to feed the hungry, to clothe the naked, to shelter the homeless, and to comfort the sick. It reminds us that we are judged not by how we treat the powerful, but by how we care for the least among us. There is no mercy in a system that makes health care a luxury. There is no mercy in a country that turns their back on those most in need of protection: the elderly, the poor, the sick, and the suffering. There is no mercy in a cold shoulder to the mentally ill. This is not an act of mercy. It is an act of malice.

Joe Kennedy III (D. MA) doing it the right way

So why do Republicans hate Obamacare so much? It’s not because they have better ideas; as we’ve seen over the past few weeks, they’re coming up empty-handed on the “replace” part of “repeal and replace.” It’s not, I’m sorry to say, because they are deeply committed to Americans’ right to buy the insurance policy of their choice.

No, mainly they hate Obamacare for two reasons: It demonstrates that the government can make people’s lives better, and it’s paid for in large part with taxes on the wealthy. Their overriding goal is to make those taxes go away. And if getting those taxes cut means that quite a few people end up dying, remember: freedom!

Paul Krugman, writing in the Times of New York. I’d only quibble with the “over the past few weeks, they’re coming up empty handed” part. The GOP has had YEARS to come up with a plan. They haven’t. In fact, they haven’t even produced so much as a meaningful tweak, much less full replacment. Their plan is that anyone who can’t pay or exhausts their tax sheltered Health Savings Account should kindly go die in the streets. Period. Just how big should that HSA get? I guess that depends on how sick you plan on being or the level to which you are prepared to shop around during your heart attack.

Rock Bottom

In other settings the media normalization of the coming shit storm might be charming or even amusing.

First, we have the “that will never get 60 votes in the Senate” crowd. People, there will be no filibuster when the new Congress convenes in 2017; the only possible hope for a retained filibuster is that Mitch McConnell cynically enjoys power more than actually governing and wants a safety hatch of “someone to blame” (namely: Democrat minority in the Senate) for the outcomes of GOP policy decisions.

Similarly, we have the “what might they do” thought pieces. People, we know what they’ll do. They have an incurious leader that has repeatedly expressed his complete lack of interest in the policy details of even his own policy proposals. Assuming Ryan remains Speaker, we know what he’ll do. He’s been talking about it for years in explicit, legislative terms.
One notable example, “Medicare,” as a name for a program will still exist, but it will be converted to a fixed payment with which program recipients can attempt to go buy insurance on the open market. From Day One of the program, said payment will be insufficient to actually, you know, buy coverage on the market, but you can rest easy in the knowledge that the payment will never increase. But: Medicare is still there, folks! Nothing to see here, and I fully expect it to be reported in exactly those terms, because it’s been reported in exactly those terms every time he’s talked about it. Again, this is not a secret. It’s right there in the Plan for America.

Ryan’s broader proposed budgets actually contains no non-military discretionary spending at all, so the fact that Medicare will at least remain in name only is going to be characterized as a big liberal victory, I guess.

As far as Obamacare (or, really, the ACA): also toast. All the media assurances about “but the GOP will have to do the hard work of coming up with a replacement before repealing coverage” for the ~20M folks that were uninsured pre-ACA: Again, super-funny in other circumstances, media elite. The GOP has had the better part of a decade to suggest a replacement for the ACA and has offered nothing. If anything, they will drop in a high risk pool plan with capped lifetime benefit limits. The more likely outcome is the ACA is replaced with nothing. Is it any wonder that drug company stocks spiked on news of the election?

What a Democratic party should do: there’s no stopping most of it (see: filibuster, lack of), but the better long range strategy is to induce the healthcare death spiral. The community rating and associated benefits of the ACA are extremely popular. With heavy heart the Democrats should offer to gut the unpopular parts of the ACA, namely the mandate and the “Obamacare” portion, which actually subsidizes coverage for people unable to afford it on their own. We need to face the fact that the poors are in for quite the kicking over the next four years, no matter what, and but also work to keep the massively popular parts of ACA in force. The GOP, ever attracted to bad policy like cats to catnip, will be unable to resist, because: hey, popular! And so the Democrats shall have ushered in single payer health care, courtesy of the poison pill; briefly, the community rating forces coverage but eliminating the mandate allows people to buy healthcare only when they really need it, thus slowly burning the medical insurance establishment to the ground. Once there is no functional insurance infrastructure, the only remaining option is single payer. Good thing we still have that Medicare name sitting around and largely going unused.

Mostly, The Democrat needs to be planning based on gaining some seats in 2018, but then creating a wave election in 2020. You’re not going to be in control of any lever of govenment until at least 2018. Plan accordingly. Make small changes around the edges that, longer term, create a death-spiral situations to which your policy provides a positive (and ultimately the only) answer. They’re going to destroy most of the ACA no matter what, you can at least work to keep the popular parts that also happen to inexorably drag our healthcare system towards single payer.

There is zero doubt that this sort of approach creates real pain and suffering in the short term. But we’re going to get that pain and suffering no matter what. May as well make it worth something.

41% of Americans were not aware of the [Supreme Court’s ACA] decision and/or its major finding. That includes 18% of the public who asserted that the decision had not yet been made.

Kaiser Family Foundation polling data (PDF link).
On the bright side, 56% of Americans that, uh, actually knew something had transpired in this area prefer that lawmakers “move on to other national issues” rather than “continue to block the law from being implemented.“ So there’s that…
Source: Washington Post

Romney won’t have 60 votes in the Senate. But if he has 51, he can use the budget reconciliation process, which is filibuster-proof, to get rid of the law’s spending.

Ezra Klein reflects on President Romney’s potential chances and methods should he try repealing the ACA.
I’m not sure when, if ever, the DC Commentariat will get this through their heads: the next time the GOP holds the Presidency and a non-supermajority in the Senate, the filibuster will be eliminated approximately 30 seconds into the new Congress. Period, the end, carve it in stone.
Reconciliation won’t even be an issue with ACA repeal. It will be a simple majority vote, no filibusters allowed because there aren’t any allowed for any reason. Same with the functional elimination of Medicare, Social Security, and all the other Glibertarian wonders that await us under the Ryan budget plan when and if Romney wins. There’s simply no other way to get their preferred policies through, and the next time they have control of these levers of power they will get their policies through, no matter what it takes. Eliminating the filibuster will be among the more minor procedural changes and will be lost in the shuffle that heralds the end of the New Deal and basically all of the legislative 20th century.
Those are the stakes. Just when, exactly, will anyone in DC realize it? Sometime six to eight years after it all transpires, apparently. I’m assuming David Brooks already has an editorial in the can praising the end of filibusters. For Democrats, anyway.

Roberts Prevents Single Payer

Matt Yglesias makes a strong case re: the likely philosophical underpinnings of Roberts’ joining the more liberal members of the court to uphold the mandate. Namely that, in the absence of mandate, the Democrats would begin campaigning for Medicare for All. And they’d get it. Maybe not today, maybe not tomorrow, but almost certainly within a millennium or two, and then for a long time.

But! I don’t think nearly that long of a game is needed, though. Presuming Roberts was never going to gut the whole bill, knocking out just the mandate within the political system as currently figured does nothing so well as guarantee the end of the private insurance system we all know and love within 5 or 10 years. This is because, without a mandate, healthy individuals would have powerful incentive not to buy insurance until they are sick. Since the ACA already prevents insurers from refusing coverage for any reason, you’d simply buy insurance on the day you started needing it. That is, to say the least, an unsustainable business model. Some even called for a “poison pill” in the original law designed to create this situation such that even a GOP government would be forced into extending Medicare to all the moment even their constituents could no longer afford insurance premiums.

Roberts knew all of this. He knew he likely couldn’t simply gut the law without adversely affecting the public’s opinion of the Supreme Court in general and the Roberts court in particular, knew he furthermore couldn’t simply kill the mandate without also killing private insurance (gridlock essentially ensured this outcome), and decided the least of these was simply keeping the mandate and letting Congress sort it out. Which, as it happens, was exactly the right decision by any reading of the Constitution and precedent that my not-a-lawyer eyes can detect. Huzzah for democracy.

Roberts Prevents Single Payer