Republicans Plan To Impose Huge Tax Increase On Middle Class In Opposing Obamacare Fix

Republicans are increasingly seeing King v. Burwell as a way to do what they couldn’t accomplish in over fifty votes–repeal the Affordable Care Act. While it defies logic, the Supreme Court could conceivably rule that the Affordable Care Act only provides subsidies for plans purchased on state exchanges but not on the federal exchange.

A majority of people want Congress to pass a simple legislative fix should this occur, guaranteeing a continuation of the subsidies for those who purchase plans over the federal exchange. The health care and insurance industries also support such a fix.

This does not mean that the Republican Party will take the rational path. The Wall Street Journal reports:

Congressional Republicans say they won’t move to preserve consumers’ health insurance tax credits if the Supreme Court strikes them down, raising the stakes in the latest legal challenge to the Affordable Care Act…

Leaders in the GOP-controlled House and Senate see the court challenge as their best hope for tearing apart a law they have long opposed. If the court strikes down the subsidies, Democrats are expected to clamor for lawmakers to pass a measure correcting the language in the law to revive them. Congressional Republicans say there is no possibility they would allow that.

“No, no, no, no,” said Sen. Dan Coats (R., Indiana). “Even Democrats have acknowledged that this needs fixing.”

That position would force lawmakers to confront people in as many as 37 states where the federal government is currently running some or all of the exchange where consumers buy plans and tap the tax credits. There are 6.1 million people in those states who have the credits for 2015, according to federal data released this week. The average tax credit this year is $4,330, the Congressional Budget Office said this week.

Eleven of the states where the federal government has a hand in running the insurance exchange – including seven with Republican governors – signed onto a brief submitted late Wednesday asking the Supreme Court to uphold their tax credits. The brief said the loss of the credits “would deprive millions of low-and moderate-income Americans of billions of dollars in federal premium assistance essential to buy health insurance, thereby disrupting state insurance markets throughout the United States.”

The brief was filed by a group of mostly Democratic attorneys general. The lone Republican, North Dakota’s Wayne Stenehjem, declined to comment…

Nobody in the Senate Republican caucus has said the party should tweak the law so it can continue as it is, particularly since such a move would preserve the unpopular requirement for people to buy coverage or pay a fine, said Don Stewart, a spokesman for Senate Majority Leader Mitch McConnell of Kentucky.

Republicans are also increasingly preparing to use the budget procedural tactic known as reconciliation to repeal large parts of the law and potentially enact alternative provisions after the court ruling, whatever the outcome. The reconciliation process allows party leaders to pass changes with a simple majority, rather than the 60 votes most bills need to clear procedural hurdles in the Senate.

A loss of the subsidies would amount to a tax increase on the middle class. Republicans tend to concentrate on lowering taxes for the wealthy, at the expense of the middle class, and therefore see no problem in this. They mistakenly believe this will not affect their more affluent supporters, who do not qualify for the subsidies. What they fail to realize is that reducing the number of people in the risk pool will result in higher premiums for everyone.

Republicans are again talking about proposing their own plan, but they have repeatedly failed at doing so. The last time the Republicans did propose a plan it was remarkably similar to Obamacare, except then it was proposed as the conservative alternative to Hillarycare.

Any Republican plan which avoids harming millions of people will not only have to provide a mechanism for assisting those who cannot afford insurance coverage. Any plan must also ensure that insurance companies could not return to denying coverage to those who have medical problems. Republicans will find that this is not so simple, and will require the type of compromises seen in the Affordable Care Act.

CMS Agrees To Demands From Physicians & Congress To Modify Rules For Electronic Medical Records

I recently discussed the problems with the government regulations for conversion to electronic medical records. The majority of doctors have been unable to comply with the regulations which were scheduled to begin this January (already postponed from last October) for reasons beyond our control. A bill with bipartisan sponsors was introduced in Congress to postpone the current requirements further until October, 2015. While this would be helpful, further changes are also needed in the requirements.

CMS has responded to the complaints, sending out an email to physicians today stating that the rules will be reevaluated this spring. This includes considering changing the requirement from a 365 day reporting period for 2015 to a 90 day reporting period, which would essentially postpone the requirements until October. The email also stated they would be “Modifying other aspects of the programs to match long-term goals, reduce complexity, and lessen providers’ reporting burden.” Modifications have already been made in the past to the regulations to reduce their complexity, but further modifications remain necessary.

While no official changes were announced at this time, it seems inconceivable that they will not go long with recommendations to postpone when the changes are due until October now that they have announced plans to consider this. It will also be necessary to make other revisions to the rules, which also now is under consideration. Complicating matters further, in addition to these requirements for electronic medical records, conversion to ICD-10 diagnoses codes (which has also been postponed several times) is also now scheduled to occur in October.

CMS has also announced plans to reconsider the regulations on their blog.

Kaiser Health Tracking Poll Shows Most Support Fix For Subsidies Under Affordable Care Act

While you can never be certain as to what the Supreme Court would do, I’ve always felt that it is most likely that they would ultimately find that King v. Burwell is a frivolous case. (In other words, the most conservative justices might accept it, but John Roberts will cast the deciding vote against it if needed). This case is the latest Republican attempt to overturn the Affordable Care Act in the courts because of some language in the law, contradicting other portions, which could be taken to mean that subsidies are only available to those who obtain coverage through state exchanges, and not the federal exchange.

As I’ve pointed out in the past, it would politically be bad for Republicans if the court ruled against the Obama administration in this case. If the Supreme Court does accept the absurd argument that subsidies should only be available under the law for policies purchased on state exchanges, the simplest solution would be for Congress to revise a few words in the law to fix the problem. It is rather common for Congress to pass laws after major legislation to fix minor problems, except in this case Republicans in Congress are more interested in repeated, futile efforts to repeal ObamaCare as opposed to making such fixes–with yet another repeal vote now planned.

The Kaiser Health Tracking Poll for January finds that relatively few people are now aware of King v. Burwell, but most people do think that Congress should fix the problem. Among total voters, passing a law to fix this is supported 64 percent to 27 percent. There is similar support among independents, greater support among Democrats, and even a substantial number of Republicans (40 percent) would support such a fix:

King v Burell

If this is not fixed by Congress passing such a law, the second solution would be for states to start their own exchanges. A majority would also support this in affected states. Even Republicans support this, although at lower levels than Democrats and independents:

King v Burell2

I suspect that Republican leaders would much prefer to see the Supreme Court not put them in a position to have to take such action, either in Congress or at a state level. Failure to take such action would make displease the majority of voters, while taking such action would displease their base, who might take revenge in primaries where they dominate.

Update: Hospitals and insurance companies also lose if the subsidies are not continued, and are therefore also defending the subsidies before the Supreme Court.

CBO Shows ObamaCare Costing Less Than Projected–Ignore Conservative Attempts To Distort The Data

There was more good news from the Congressional Budget Office today regarding the Affordable Care Act. The latest’s estimates significantly reduce the costs of expanding medical care under the law:

 The Congressional Budget Office on Monday significantly lowered its estimate of the cost of providing health insurance coverage to millions of Americans under the Affordable Care Act.

Douglas W. Elmendorf, the director of the budget office, said the changes resulted from many factors, including a general “slowdown in the growth of health care costs” and lower projections of insurance premiums that are subsidized by the federal government.

In March 2010, when President Obama signed the health care law, the Congressional Budget Office estimated that the expansion of coverage would cost the federal government $710 billion in the fiscal years 2015 through 2019, Mr. Elmendorf said.

“The newest projections indicate that those provisions will cost $571 billion over that same period, a reduction of 20 percent,” he said. The Affordable Care Act not only subsidized the purchase of private insurance, but also authorized a major expansion of Medicaid, the federal-state program for low-income people.

As usual, conservatives are cherry picking and distorting the numbers to portray this as a negative. Among other distortions of the facts, they fail to take into account the fact that having a substantial portion of the country be uninsured results in higher costs for both government programs, as well as costs which are passed on to those who do pay for insurance. The bottom line is that, even before these more favorable numbers, the CBO found that the Affordable Care Act results in a reduction in the deficit. Strange that conservatives who place such a high priority on reducing the deficit (which was run up by Republicans during the Bush years) oppose a program which will help reduce the deficit.

Of course if conservatives are unhappy with the cost of the Affordable Care Act, they should keep in mind the fact that costs are much higher due than they otherwise might be due to providing coverage through private insurance companies rather than through a single-payer system modeled on Medicare. Somehow I doubt many conservatives would go for the far more cost effective single-payer model.

Conservatives are also attacking the law because, while reducing the number of uninsured by 27 million people, there will still be 31 million uninsured in 2025. However, when looking at who will remain uninsured, I wonder which group conservatives are complaining about. Of this 31 million, 30 percent are illegal aliens and conservatives would sure protest if health care coverage were extended to them. Another 1o percent are ineligible for coverage because of living in states which did not expand Medicaid–a decision which conservatives support. The remainder are people who will qualify for coverage but choose not to purchase it.

The number of uninsured might fall as more red states go along with the expanded Medicaid program. It was just announced that Indiana is the latest to offer the expanded Medicaid program.

Conservative Argues That It Is Not A Bad Thing If People Die Due To Repealing Obamacare

If the Affordable Care Act were to be repealed, as most Republicans are calling for, we would see millions of Americans lose their insurance. We would return to past problems, including people being denied insurance when they have medical problems, people once again being forced to declare bankruptcy due to medical costs, and we would see many more deaths than we will otherwise see.  Michael R. Strain of the American Enterprise Institute has an op-ed in The Washington Post under the headline, End Obamacare, and people could die. That’s okay.

Note again that the author is from the American Enterprise Institute and this is published in The Washington Post. This is not just some isolated blogger or conservative shouting out their personal opinion.

Strain’s logic is that “We make such trade-offs all the time.” For example, “Consider, for example, speed limits. By allowing people to drive their cars at speeds at which collisions result in death, our government has decided that the socially optimal number of traffic fatalities is not zero.”

He has other such examples, but they do not apply to the type of trade-off he is advocating. There are good reasons for having a society in which people can drive, and it is an unavoidable fact that this will lead to a certain number of traffic fatalities. The types of trade offs he discussed are not analogous to taking away health care coverage.

While there are reasons for having a society in which people can drive, despite traffic fatalities,  there is no good reason for either having people uninsured or for a system in which insurance companies are allowed to profit by denying coverage to those who become sick.

Strain argues that, “In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals.” This falsely assumes that health care coverage is something which we cannot afford to provide. However every other industrialized nation on the planet, existing in the same “world of scarce resources,” is able to provide health care coverage to its citizens. The Affordable Care Act is a valuable step in the right direction, but it is an incremental step which still falls short of what is provided in the rest of the industrialized world.

There is no good reason why the United States cannot provide the same level of health care coverage as is seen in the rest of the industrialized world. One reason why we have been unable to do this is the unnecessary middleman–private insurance companies making huge profits while making health care more expensive than elsewhere. Perhaps the answer is that in a world of scarce resources, a system of private insurance is an unacceptable price to pay, and we should be thinking in terms of conversion to a far more cost-effective single payer system.

SciFi Weekend: Agents of SHIELD; The 100; Supergirl; Person of Interest; The End of Parenthood and Parks and Recreation & The Decline of NBC; 12 Monkeys; Netflix Marvel Series; The Americans; Sleepy Hollow; The End of The Marvel Universe; The Humor Of Sarah Palin; Mellisa Raunch Sex Scene

Agents of Shield Coulson Skye

Agents of SHIELD has come a long way from the first season. While they always hinted there was something special about Skye, they didn’t have the payoff on this plotline until the midseason finale with her conversion to an Inhuman. This might have major ramifications for her relationship with Coulson:

Executive producer Jeph Loeb says that the current Inhumans plotline has always been the plan for “Agents of SHIELD.” Like they always knew that Grant Ward was going to be HYDRA in Season 1, the seeds of Skye being something other were planned in the pilot.

“Once we started down that road hopefully you were coming along for the adventure, and now that you’ve come along for the adventure one of the things that’s so amazing about what’s happening on that show is so now we know she has gone through a transformation,” he says. “How is everyone going to react to that? And in the same kind of way you’re asking as an audience member, one of the things that I think is really valuable and one of the things that I think Jed [Whedon] and Maurissa [Tancharoen] and Jeff Bell and the writing staff really do have a great feeling for is they are audience members. The writers room sits around and tries to come up with, ‘What is it that you think we’re going to do and how can we then turn that on its ear in a way that makes it feel like it’s fun and valuable?'”

Blood says “SHIELD” has often gone in a different ways from what he expected. He says the latest script he read “just turned another corner,” and that audiences will “be surprised of a lot of stuff that’s coming up.” Because the SHIELD team doesn’t know about the term “Inhumans” like audiences do, Blood says “it’s going to be something that is unraveled.” He has yet to find out where the storyline is going.

The obvious turn would be that Coulson helps Skye — someone Gregg says is the “the person he cares about most” — through her transformation into an Inhuman. But what if he views her as a threat instead of an ally because of her new powers?

“His no. 1 job is to be responsible for SHIELD, which he views as being responsible for the safety of billions of people from things they don’t know about. That’s what SHIELD is. No matter how much he loves Skye — and it’s as much as you can love somebody — it’s the closest thing to a daughter he has. That’s a sacred trust,” Gregg says. “I hope he doesn’t get put in that situation [where she is a threat] because it would mess him up.”

He teases there will be trouble within SHIELD in the aftermath of Trip’s death and Skye’s transformation. “I don’t think the whole team is going to be unified behind what just went on, and it’s hard to blame them. He’s got a couple of people that he’s come to really trust,” Gregg says. “One of my favorite things about this season is that everybody comes up to me on the street really worried about Fitz and these new characters we introduced this year. Coulson also has these new people … he doesn’t have the same type of history with those people. It’s going to be hard to hold the baby brand new, on the run SHIELD together in the wake of what just happened.”

There’s also the question of Bobbi’s secret, which Blood says is as big a mystery in the second half of Season 2 as who the man with no eyes is. “I honestly think people are going to freak when they see some of the stuff we’ve been filming recently,” he says.

The 100
The 100 returned last week and the events of the fall finale continued to have a major impact on the characters. While I originally did not watch this show, thinking it was another CW show putting attractive young people in a sci-fi scenario which has been done before, I found that this was far better done than I anticipated.

Yes, it does have its attractive young cast members, led by Eliza Taylor as Clarke Griffin, who does an excellent job in the role. (Having binged on the first one and one-half seasons over a weekend, I did notice that Eliza Taylor does show less cleavage in the second season, which must have been a conscious decision by the producers considering that the characters couldn’t just run out to clothing stores in this post-apocalyptic world to change their wardrobe). There are also the CW love triangles, but they do not distract from the stories. Both the characterization and plot lines have been strong, even when going where other shows have gone before. Bustle and The Mary Sue both have posts on why you should watch the show.

Supergirl-TV-Show-Actress-Melissa-Benoist

CBS has chosen Melissa Benoist to play the lead role on Supergirl. Previous reports on the show have described it as more of a CBS procedural with Supergirl as a feminist investigating crimes, but with cross overs possible with the CW shows Arrow and The Flash.

CBS is showing success with another mixture between procedural and genre with Person of Interest. The show started out as a procedural show with a science fiction gimmick to propel it, and has evolved to what might be seen in the future as “a modern sci-fi epic that is considered a must-see show along the lines of Firefly or Battlestar Galactica…”

Many blogs and podcasts, along with this thread on Reddit, have looked at the question of how someone could get caught up with the show without watching all the old episodes. The purely procedural episodes of the first two seasons are mostly unnecessary to appreciate the more recent episodes since the show evolved into a more significant science fiction series, but it is hard to say exactly what can be skipped and must be watched as often early episodes would have a few minute segment towards the end to slowly develop the mythology in addition to the number of the week story.

There have been some posts, such as here and here, which might help in listing some of the more essential episodes. It would really be helpful if some of the other mythology segments which are only small parts of other episodes could be accumulated in a video.

Parks and Recreation

Time looked at the politics of Parks and Recreation, which is concluding its run on NBC.

But there’s a big idea in Parks’ small-scale vision. In the frame of today’s politics, it might be a liberal notion, but it’s one that for much of the 20th century was centrist, and even championed by Republicans like park lover Teddy Roosevelt: that we need government to do things the private sector can’t or won’t, like preserving public spaces.

Shockingly, Parks has dared to suggest that while some civil servants might be bumbling–sorry, Jerry!–they can also be well-intentioned and competent. (This too wasn’t considered a liberal notion before the era when Ronald Reagan joked that “the nine most terrifying words in the English language are ‘I’m from the government and I’m here to help.’”) Leslie is comically tenacious–Poehler plays her as a cheerfully overprepared super-wonk–but she’s good at what she does and is driven by a fierce love for her hometown as well as its famous waffles…

Leslie can’t do it alone, though: she’s assisted by a network of co-workers and friends (played by a comedy-powerhouse cast, many of whom–like Chris Pratt, Aubrey Plaza and Aziz Ansari–have deservingly become stars). Even her former supervisor Ron Swanson (Nick Offerman) admires Leslie’s commitment, even though he’s so libertarian, he once illustrated the evils of taxation to a fourth grader by eating 40% of her lunch. Parks argues not only that we need our neighbors’ help but that helping makes us better ourselves; it’s in the small-town, populist tradition of Friday Night Lights and It’s a Wonderful Life.

Parenthood Series Finale

When I recently posted my list of top television shows of the year, I noted how little representation the major broadcast networks had on the list. Perhaps the biggest decline is being seen at NBC. They will soon be without two of their highest quality returning shows. Besides trying to run through Parks and Recreation as quickly as possible,  Parenthood concludes this week, apparently with Lorelei Gilmore marrying Ray Romano. If it ends with Zeke dying, I’m imaging angry mobs storming Rockefeller Center. After these are gone they will still have some shows worth watching, most notably Hannibal, which I’m amazed a network is broadcasting, but the lineup of quality shows will sure be thin. Their announcements of upcoming shows is being greeted with far more snark than interest.

In the past NBC would often be the home of some of the highest quality drama shows on television, such as The West WingFriday Night Lights, I’ll Fly Away, and St. Elsewhere. They probably had better ratings success with some, but not all of their sitcoms, which included shows such as Cheers, Frasier, Friends, Community, 30 Rock, and Will and Grace. Going further back, it was also the home of some classic genre shows such as the original Star Trek and The Man From UNCLE. (We won’t talk about some of their more recent attempts at genre such as Revolution, The Cape and Heroes after the first season.)

So, what happened to NBC? I suspect that that it is a victim of otherwise good changes in television. Writers and producers for many high quality shows are now going to cable and streaming networks, where they can develop an audience without the need for netw0rk-level ratings. (In the case of Community, it is moving directly from NBC following cancellation by NBC, with the first two episodes to be streamed by Yahoo! on March 17.) It will be a challenge for NBC to attract this type of quality show in the future, and it is questionable as to whether they even care considering that lower quality shows will probably deliver higher ratings.

Increasingly cable or smaller networks owned by the major networks are offering higher quality shows than the major networks. FX and FXX are offering some of the best shows on basic cable. CBS has Showtime and CW, with The CW Network  turning into one of the strongest networks, especially for genre, as it attracts a totally different audience than CBS. NBC/Universal have even lagged behind other cable networks which have produced better science fiction than its Syfy Network.

12Monkeys_gallery_102Recap_04

Syfy is finally trying to compete with hard science fiction. 12 Monkeys remains promising after the second episode, which aired Friday and was available for streaming last week. With Leland Goines dead, his daughter Jennifer becomes a major character. Her character in an insane asylum serves as an alternate version of the Brad Pitt character in the movie. As discussed previously, the television show can cover far more ground with changes such as having the ability to change time and with the Army of the 12 Monkeys playing a more significant role.

I saw a posted link here which supposedly allows streaming of the third episode for cable subscribers in the United States but it would not allow viewing through either my Charter or Xfinity account. I’m posting the link in case it works for other cable systems, or if it becomes active later. The first two episodes are available for streaming there.

the_defenders_poster___marvel_netflix_series_by_tchallacbm-d78ic4v

Netflix has released a brief synopsis for their upcoming Marvel shows. While previous reports suggested that we might have to wait a year between shows, it looks like the Jessica Jones show (staring Krysten Ritter) will be out sometime later this year.

Daredevil
“Marvel’s Daredevil” is a live action series that follows the journey of attorney Matt Murdock, who in a tragic accident was blinded as a boy but imbued with extraordinary senses. Murdock sets up practice in his old neighborhood of Hell’s Kitchen, New York where he now fights against injustice as a respected lawyer by day and masked vigilante at night. Coming April 10

A.K.A. Jessica Jones
Working as a private investigator in New York’s Hell’s Kitchen, a troubled ex-superhero’s past comes back to haunt her in the live-action series, “Marvel’s A.K.A. Jessica Jones.” Coming 2015

Iron Fist
“Marvel’s Iron Fist” follows superhero and martial arts master Danny Rand in the upcoming live-action series. Coming soon

Luke Cage
In this Marvel live-action series, a street-fighting ex-con battles crime in New York’s Hell’s Kitchen as the superhero Luke Cage. Coming soon

The Defenders
“Marvel’s The Defenders” brings together Daredevil, Jessica Jones, Iron Fist and Luke Cage in an epic superhero team-up in New York City. Coming soon

The Americans returns this week. Unreality Primetime has a couple spoilers on upcoming episodes. The season three trailer is above.

Can Henry be redeemed? The cast of Sleepy Hollow answer questions such as this in videos available here.

The Marvel universe ends as we know it in the comics this spring.

Who needs Tina Fey to mock Sarah Palin? Her own words are ridiculous enough. Check out the reaction to her latest speech from Twitter.

bronze

Melissa Raunch of The Big Bang Theory has received a lot of attention at Sundance for her raunchy sex scene in The Bronze.

“The Bronze” kicked off the 2015 edition of the Sundance Film Festival on a foul-mouthed note Thursday, sticking a dagger through the concept of hometown heroes and providing one of the raunchiest sex sequences in movie history.

The scene in question, one that involves pole vaults, cartwheels and pirouettes, was a constant source of amusement during a question and answer period immediately following the film’s premiere at the Eccles Theater.

“Right after this there’s going to be an audition for the sex scene in the sequel,” joked director Bryan Buckley.

Melissa Rauch, the star of the film and its cowriter along with husband Winston Rauch, said, “As for the sex scene, you write what you know.”

Her husband added that it gave the couple a chance to “show you what we do in our bedroom.”

A Bigger Computer Fiasco For The Obama Administration Than Healthcare.gov

The fiasco with the initial opening of the exchanges at healthcare.gov has become a well-known IT glitch from the Obama administration, but that might not turn out to be their biggest mistake regarding computers and health care. As it primarily involves physicians and hospitals, as opposed to the general public, far fewer people are aware with the ongoing problems regarding implementation of Meaningful Use Stage 2 requirements for electronic medical records.

The original stimulus package after Barack Obama took office included a program to provide funds to medical practices to be used for conversion to electronic medical records. In order to qualify for the incentive payments, physicians and hospitals have to follow a set of Meaningful Use requirements which have increased requirements for each stage. Initially there would be incentive payments (which turned out to be far less than the costs of conversion to electronic medical records), and subsequently there are penalties for failing to comply. The first stage was successful in terms of getting large numbers of doctors to adopt electronic medical records, but it is more questionable as to whether this is really resulting in the desired cost savings.

Stage 2 was initially required by October 2014. This would have greatly increased the use of electronic medical records, possibly resulting in more medical cost savings, but the requirements were unrealistic. The law originally required that physicians comply with the requirements of Stage 2 for a 90 day period in 2014, which essentially meant that we could wait until October 1 to implement them. When it was apparent that most physicians could not comply with this, the government postponed this until January 2015.

It was quickly apparent that this was no solution, partially as the new requirements required a full twelve months of compliance with the Stage 2 rules. By requiring compliance by this January, this only gave an additional three months. The same problems which prevented compliance with the rules by October 2014 are still present this January.

The biggest obstacle is that the rules require communication between systems which do not exist in the present software. Before making such requirements, the government should have set up a secure system for communication between computer systems rather than hoping that each individual vendor would offer a solution. Another problem is that the requirements include factors which are outside of a medical office’s control. For example, a medical office could set up a patient portal as required in order for patients to assess medical information. However, there are requirements not only to establish this, but for five percent of patients to utilize it. Many physicians, such as those with primarily elderly patients are especially concerned that not enough will even be interested in using such computerized tools. Fortunately this requirement was at least reduced from ten percent in the original regulations to five percent.

Compliance with the rules is further complicated by it being all or nothing. A medical office might follow 90 percent of the rules but will get zero incentive money and pay the full penalties for non-compliance. There are some exclusions and some flexibility in some areas, but this still creates far too great a burden on physician practices.

When the government first changed the rules last fall delaying the requirements for Stage 2 until January, some members of Congress did realize that this was not long enough to have any impact. There was a bipartisan bill introduced to reduce the requirements for a 90 day period in 2015, essentially giving physicians until October instead of January. This was not introduced until shortly before Congress went on recess prior to the election, and died before the end of the last session. Earlier this month Renee Ellmers (R-N.C.) and Ron Kind (D- Wis.) introduced The Flexibility in Health IT Reporting (Flex-IT) Act of 2015 to restore the 90 day requirement. The bill also has the support of organizations including the American Academy of Family Physicians, American Hospital Association, American Medical Association, College of Healthcare Information Management Executives and Medical Group Management Association.

Even this only postpones the problem and we don’t know if the technology will be any better this fall than it is now. A recent survey of physicians found that 55 percent do not plan to attest to Stage 2, despite the financial penalties.

This failure in the implementation of computerized medical records could be a far worse fiasco than the initial roll out of the exchanges under the Affordable Care Act. The manner in which the Obama administration quickly fixed that problem turned out to be a tremendous success, and this problem is also fixable. A real fix will take more than just postponing requirements.

The government must rethink the logic behind the requirements. Most industries have computerized on their own without being forced to by the government. Some government assistance in conversion to electronic medical records would be helpful, such as establishing standards for communication between systems. Physicians must also be given flexibility to determine for ourselves which aspects of computerization are really of value for caring for our patients and which are not, rather than being forced to follow a long set of rules and only receive credit for 100 percent compliance, or being dependent on factors beyond our control.

Doomsday Clock Moves Two Minutes Closer To Midnight

The Doomsday Clock from The Bulletin of Atomic Scientists was more commonly seen during the Cold War but CNN reports that they have moved the clock to three minutes to midnight,  two minutes closer than its previous setting. This was the first move since 2012, precipitated by both nuclear arsenals and the risk to humanity from climate change:

“Today, unchecked climate change and a nuclear arms race resulting from modernization of huge arsenals pose extraordinary and undeniable threats to the continued existence of humanity. And world leaders have failed to act with the speed or on the scale required to protect citizens from potential catastrophe,” said Kennette Benedict, executive director of the Bulletin of the Atomic Scientists, in a news release. “These failures of leadership endanger every person on Earth.”

The Bulletin’s Science and Security Board looks at global issues on a regular basis and decides whether to move the minute hand of the clock, with particular stress on the status of nuclear arms and reaction to climate issues.

In recent years, the clock has moved the wrong direction for humanity. After standing at 17 minutes to midnight in 1991 — the furthest it’s ever been from the end of the world — it’s gotten closer each time it’s been changed since, with the exception of 2010, when it was pushed back by one minute to 11:54 p.m.

This is the closest the Doomsday Clock has been to midnight since 1984.

They point out that the science is clear on these problems:

The science is clear: Insufficient action to slash worldwide emissions of greenhouse gases can produce global climatic catastrophe. Even a so-called “limited” nuclear weapons exchange will produce massive casualties and severe effects on the global environment … We implore the political leaders of the world to take coordinated, quick action to drastically reduce global emissions of heat-trapping gases, especially carbon dioxide, and shrink nuclear weapons arsenals.

The following steps are recommended:

·        Take actions that would cap greenhouse gas emissions at levels sufficient to keep average global temperature from rising more than 2 degrees Celsius above preindustrial levels.

·        Dramatically reduce proposed spending on nuclear weapons modernization programs.

·        Re-energize the disarmament process, with a focus on results.

·        Deal now with the nuclear waste problem.

Senate Republicans Agree Climate Change Is Real But Continue To Deny Cause

Climate-vote

With Republicans controlling the Senate, Democrats are largely limited to symbolic votes. Democrats wanted to attach an amendment to the Keystone XL Pipeline bill which would get Republicans on record with regards to climate change. There was little difficulty in passing an amendment agreeing that climate change is real, and not a hoax. Only one Republican, Roger Wicker of Mississippi, voted no. The catch is that, while they agreed that the climate is changing (a fact which some conservatives do deny), they do not accept the view of 97 percent of climate scientists that human action is the cause.

Senator Brian Schatz introduced a stronger amendment: “To express the sense of the Senate that climate change is real; and human activity significantly contributes to climate change.” Under the rules of the Senate, this amendment failed with a 50-49 majority. Most Republicans voted against it, but there were a handful of exceptions–full list here.

I’m not sure what all this proved, but next could we have a vote to determine which Republicans don’t believe in evolution, or that the earth is not flat?

Will The State Of The Union Address Matter After This Week?

Obama SOTU

I certainly liked Obama’s State of the Union Address while listening to it. In a room dominated by Republicans, Obama was once again the adult in the room–the sensible one interested in governing and not bogged down in extremist ideology. His economic numbers provided real evidence of success, despite Republican obstructionism, and Obama was right in addressing the need to extend the benefits of economic recovery to more in the middle class.

The question is whether the speech, and Obama’s aggressiveness on policy matters, will make a difference matters beyond this week. David Corn summed up some of my concerns:

Barack Obama is very good at getting elected president (two for two!) and pretty darn good at policy (Obamacare; the stimulus; the auto industry rescue; Wall Street reform; ending Don’t Ask, Don’t Tell; Cuba; immigration reform executive action; dumping DOMA; middle-class tax cuts; new EPA limits on emissions that cause climate change; banning torture; downsizing the wars in Iraq and Afghanistan, and killing Osama bin Laden). But there’s one key piece of the job description where he’s fallen short: shaping the ongoing political narrative of the nation.

The president is the country’s storyteller in chief. And despite his inspiring powers of oratory (see Campaign 2008) and his savvy understanding of the importance of values in political salesmanship (see Campaign 2012), Obama, as his aides concede, has not effectively sold the nation on his own accomplishments, and, simultaneously, he has failed to establish an overarching public plot line that explains the gridlock in Washington as the result of GOP obstructionists blocking him on important issues where public opinion is in his favor. With his State of the Union speech Tuesday night, Obama had one last chance to take a swing at forging this narrative. Though he did adopt a muscular stance in presenting a forceful and vigorous vision—going on offense in the fourth quarter of his presidency, as his advisers have put it—the president let the Republicans off easy.

Throughout his presidency, as the GOP has consistently sought to block him, Obama has responded inconsistently. He often has pleaded for reason and looked to craft a deal—frequently (and justifiably) to prevent a hit to the economy. (This was the adult-in-the-room strategy.) At times, he has praised House Speaker John Boehner, while pointing to Boehner’s tea party wing as the cause of the partisan paralysis. And then he has occasionally—but not too often—flashed anger and slammed Republicans for being irresponsible and reckless (the debt ceiling scuffle, the assorted government shutdown showdowns). He has not presented a steady and stark tale in which he stars as the fighter for the middle- and lower-income Americans who are stymied repeatedly by always-say-no Republicans aligned with plutocrats, the gun lobby, corporate polluters, and other foes of progress. Consequently, he has often borne blame for the sluggish economy and the mess in Washington, with the Democratic Party paying the price for the dips in his approval rating.

For this to have meaning, Obama must stick to pushing his views, and the Democratic Party must be there behind him. The reaction of the Democratic Party has been even more inconsistent than Obama’s. Here’s what I thought during the speech:

Of course the general election is an entirely different ballgame than the midterms, and Democrats who thought there was benefit in running as Republican-lite in a midterm election where the big contests were in the red states might act more boldly. Or maybe not.

On the other hand, maybe we should just be happy that Obama had a good speech, the positive results from his policies are real, and that the speech was well accepted. Beyond that, I’m not sure that a State of the Union address ever really matters all that much.