New CBO Report Shows Medicaid Expansion Is A Better Deal For The States Than Previously Predicted

The trend continues. We have seen predictions regarding costs and benefits of the Affordable Care Act and then receive further data which shows that Obamacare is working even better than expected. The latest news comes from a new Congressional Budget Office report on Medicaid expansion.

Congressional Budget Office (CBO) estimates released last week show that health reform’s Medicaid expansion, which many opponents wrongly claim will cripple state budgets, is an even better deal for states than previously thought.[1]  CBO has sharply lowered its estimates of the costs to states of adopting the Medicaid expansion.

  • CBO now estimates that the federal government will, on average, pick up more than 95 percent of the total cost of the Medicaid expansion and other health reform-related costs in Medicaid and the Children’s Health Insurance Program (CHIP) over the next ten years (2015-2024).
  • States will spend only 1.6 percent more on Medicaid and CHIP due to health reform than they would have spent without health reform (see Figure 1).  That’s about one-third less than CBO projected in February.[2]  And the 1.6 percent figure is before counting the state savings that the Medicaid expansion will produce in state expenditures for services such as mental health and substance abuse treatment provided to the uninsured.

The federal government pays 100 percent of the cost of Medicaid expansion for the first three years with this gradually dropping to 90 percent in 2020. Republican governors opposing Medicaid expansion have claimed that ultimately paying 90 percent will strain their budgets while supporters argue that using this money to care for the uninsured will help the economies in these states and save money in other areas by having the currently uninsured receive coverage.

Republicans have also argued that one result of offering the expanded Medicaid program is that people eligible for the original program but who have not applied will apply for Medicaid as a result of the publicity surrounding the expanded Medicaid program. This would cost the states more as the federal government will continue to match funds for those who qualify for the original Medicaid program at current levels which average 57 percent. This tells a lot about how these Republicans think, seeing it as beneficial for the poor to not receive benefits they qualify for. The CBO has decreased its estimates as to cost to the states as fewer people who qualified for Medicaid but remain unenrolled are now enrolling than projected.

Despite the significant benefits from the expanded Medicaid programs, some Republican states remain determined to block the program. Bills have recently passed in Georgia and Kansas to make sure that they do not wind up with a Democrat getting elected governor and deciding to accept the federal funds to expand Medicaid. This changes the law so that approval would be needed by the state legislature and a governor could not expand Medicaid without their vote.

Rape in Game of Thrones

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For two weeks in a row there has been considerable talk about a scene from Game of Thrones. Due to the questions raised by this scene and all the discussion it has stimulated, I have decided to post on this today rather than waiting until the weekend for the usual weekly review of genre television. Major spoilers ahead for those who are behind in watching.

The scene between Cersei and Jaime Lannister by Joffrey’s dead body was disturbing and raised questions on multiple levels. While some disagree, I clearly saw it as rape, but with all the violence on this show didn’t necessarily find this aspect any more disturbing than many other events on the show. We’ve already seen everything from mass murder at a wedding to chopping off a prisoner’s penis to send to his family. While I don’t mean to minimize it, I also don’t find Jaime raping Cersei to be any worse than Jaime pushing Bran Stark out a window. The denial that the scene was rape is perhaps more disturbing than the portrayal of a rape on a show where violence is commonplace.

I did question why they portrayed Jaime as a rapist here, considering that they seem to have been presenting Jaime in a better light lately, unless they thought that Jaime was coming off too good lately and they wanted to alter this (an idea denied by the director of the show in an interview cited bel0w). Naturally the time and place was questionable. I also wondered why the first sex scene we have seen between Jaime and his sister was presented as rape considering that they have been shown to have consensual sex in the past. The question as to why it was portrayed as rape became even bigger once it became known that the scene was different n the book.

Show runner David Benioff  essentially described the scene as rape with Jaime forcing himself upon Cersei, who was resisting:

It becomes a really kind of horrifying scene, because you see, obviously, Joffrey’s body right there, and you see that Cersei is resisting this. She’s saying no, and he’s forcing himself on her. So it was a really uncomfortable scene, and a tricky scene to shoot.

George R.R. Martin has provided some background, explaining the difference between the situation here and in the book, where the sex was consensual:

I think the “butterfly effect” that I have spoken of so often was at work here. In the novels, Jaime is not present at Joffrey’s death, and indeed, Cersei has been fearful that he is dead himself, that she has lost both the son and the father/ lover/ brother. And then suddenly Jaime is there before her. Maimed and changed, but Jaime nonetheless. Though the time and place is wildly inappropriate and Cersei is fearful of discovery, she is as hungry for him as he is for her.

The whole dynamic is different in the show, where Jaime has been back for weeks at the least, maybe longer, and he and Cersei have been in each other’s company on numerous occasions, often quarreling. The setting is the same, but neither character is in the same place as in the books, which may be why Dan & David played the sept out differently. But that’s just my surmise; we never discussed this scene, to the best of my recollection.

Also, I was writing the scene from Jaime’s POV, so the reader is inside his head, hearing his thoughts. On the TV show, the camera is necessarily external. You don’t know what anyone is thinking or feeling, just what they are saying and doing.

If the show had retained some of Cersei’s dialogue from the books, it might have left a somewhat different impression — but that dialogue was very much shaped by the circumstances of the books, delivered by a woman who is seeing her lover again for the first time after a long while apart during which she feared he was dead. I am not sure it would have worked with the new timeline.

That’s really all I can say on this issue. The scene was always intended to be disturbing… but I do regret if it has disturbed people for the wrong reasons.

I considered the scene a rape scene while viewing considering how Cersei resisted with Jaime ignoring her but  Alex Graves, who directed the show, said it became consensual by the end an interview with HotFix:

Well, it becomes consensual by the end, because anything for them ultimately results in a turn-on, especially a power struggle. Nobody really wanted to talk about what was going on between the two characters, so we had a rehearsal that was a blocking rehearsal. And it was very much about the earlier part with Charles (Dance) and the gentle verbal kidnapping of Cersei’s last living son. Nikolaj came in and we just went through one physical progression and digression of what they went through, but also how to do it with only one hand, because it was Nikolaj. By the time you do that and you walk through it, the actors feel comfortable going home to think about it. The only other thing I did was that ordinarily, you rehearse the night before, and I wanted to rehearse that scene four days before, so that we could think about everything. And it worked out really well. That’s one of my favorite scenes I’ve ever done.

The description as “consensual by the end” raises obvious objections when considering the position of rape victims. Vulture asked Graves about this, along with the motivations behind such a scene with Jaime:

One of my colleagues suggested that the tweak, making Jaime the kind of person who might force himself on Cersei, might have happened to remind viewers that he’s not a morally upright guy, pouring out his heart to Brienne notwithstanding. Was that part of the decision to your knowledge?
No. It’s a very, very complicated scene. The thing about it is that Jaime has come home and is trying to convince himself that things are the same: that he and Cersei are a unit, they’re in love, they have sex, everything comes out of that bond. And he’s desperate to reinvigorate that and it has not been working. That’s part of what’s behind him, that lie he’s telling himself, that seasons two and three didn’t happen. So it’s a last act of stupid clinging to what’s been home for him, because it will never be the same. It’s also setting up something that happens in the finale. For Cersei, she is so blindsided and in the middle of the audacious murder of Joffrey at his own wedding, she’s standing there pondering all this with her other son, her sweet son. And her father comes in and basically says, “There is no way you’re going to have control over this kid” and takes him away. So she’s just empty. She’s decimated. What I said is what we just talked about. It’s just fleshing it out.

You say it “becomes consensual by the end.” I rewatched the scene this morning, and it ends with Cersei saying, “It’s not right, it’s not right,” and Jaime on top of her saying, “I don’t care. I don’t care.” It leaves some room for debate. Were you involved with cutting the scene? Was there a longer version of the scene that might have read more like they were both consenting?
It’s my cut of the scene. The consensual part of it was that she wraps her legs around him, and she’s holding on to the table, clearly not to escape but to get some grounding in what’s going on. And also, the other thing that I think is clear before they hit the ground is she starts to make out with him. The big things to us that were so important, and that hopefully were not missed, is that before he rips her undergarment, she’s way into kissing him back. She’s kissing him aplenty.

Despite how disturbing the scene might have been, there was also a behind the scenes humorous aspect to filming the scene:

Right, and part of what she’s resisting is that this is all happening next to Joffrey’s body.
It’s bizarre, and I highlighted that in how I shot it. A funny behind-the-scenes joke was every time we shot a take, and Lena and Nikolaj drop beneath the table, Jack Gleason would sit up and look down to try and see what was going on.

He really did that?
Yeah, he did! It was hilarious. He would take the rocks off of his eyes and lean over to take a look. He was so funny.

While it remains debatable as to whether changing the scene from the book was a good idea, at least George R.R. Martin did provide an explanation for why this might have been handled different on the television version. Perhaps this decision will make more sense when we see where the relationship between Cersei and Jaime goes from here, and if it also differs from the novels.

Posted in Television. Tags: . 1 Comment »

Increased Health Care Spending Just Might Be Buying Higher Quality Care

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Jonathan Cohn has looked at what appears to be a recent increase in health care spending (national health expenditures in the above graph) after a period of decline. Most likely this is due to a variety of reasons, and I don’t find it surprising that a period of decreased spending would be followed by increased spending. This is partially a sign of an improving economy as people are less likely to put off spending on medical problems when they have more money available. The increase in people covered by insurance this year due to the Affordable Care Act should lead to a further increase in spending, but this spending is desirable

Cohn looked at a variety of possible causes but didn’t hit on the key point that increases in medical spending might not necessarily be a bad thing until late in the article:

It’s not always the case that spending more on health care is a bad thing. New or more treatments might alleviate suffering, reduce disability, or extend life—all of which have value. Providing insurance to more people, so that they are more secure financially, also has value. The reason to worry about high health care spending is that the extra money America spends doesn’t actually seem to buy America better health care. But, over the long run, the real goal of health care reforms should be a combination of restraining costs and improving quality.

Traditionally it has been true that we could not see benefits from increased spending compared to other countries, but there are factors in health care which could currently be causing increased spending compared to previous spending in the United States as well as increased quality. There has been a push for Medical Homes, increased payment for primary care services, and for increased attempts at payment of doctors based upon performance as opposed to fee for service alone. If doctors are given incentives to screen more for elevated cholesterol and do more to treat diabetic patients this would lead to increased spending, with this spending being beneficial.

Contrary to the argument that we were not seeing quality for our past spending, The New England Journal of Medicine reports this week that complications among diabetic patients have decreased between 1990 and 2010. The Annals of Internal Medicine also reports that between 1999 and 2010 the number diabetics has increased, with a decrease in the number who have the disease but are undiagnosed, and that treatment has improved. Both having more diabetic patients and providing treatment which results in better control is going to cost more money. It is too soon to have any data to see if there is a correlation between increased spending over the past year and quality of care, but I do wonder to what degree the trends I noted in the above paragraph are contributing to higher costs and how this might correspond with further improvements in the quality of care.

Cosmos For Creationists II

Cosmos contains facts which some on the anti-science religious right object to, such as discussion of evolution and creation of the universe in the big bang. Last month I posted a video in which an episode of Cosmos was edited for creationists. Funny or Die made their version of an episode made for creationists–video above.

SciFi Weekend: Orphan Black; Hannibal; Arrow; Agents of SHIELD; The Americans; Fargo; Continnum; Game of Thrones; The Newsroom; Hugo Nominees

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Orphan Black returned for a second season following several days of receiving a considerable amount of publicity for being such a high quality show, even if few knew about it when it aired last season. Nature Under Constraint and Vexed picked up right where the show left off last season, but BBC America did run a show last week which might help new viewers catch up, and has been rerunning the entire first season. It is definitely worth watching the full season before starting the second season.

The initial moments, while not as dramatic as the first moments of the first season, when Sarah saw someone who looks just like herself jump in front of a train, did have a similar feel. Sarah was on the run, and initially could not contact anyone else. Subsequently Sarah did reunite with Felix and then with some of her clones. Tatiana Massany has been widely praised for her work as multiple female lead characters in roles far more challenging than those faced by Patty Duke.This includes the following characters mentioned here: Sarah, Beth, Allison, Cosima, Helena, and Rachel.

Last season Sarah did frequently pretend to be Beth, taking her place after her suicide, and briefly impersonated Allison last season. Beyond this they did not take advantage of the fact that Sarah and her clones are even more alike than identical cousins. I liked that Sarah did use this to her advantage twice this week, both with using Alison as a decoy and impersonating the lesbian scientist Cosima, even fooling Delphine when she kissed her. They were also less concerned about hiding their existence, but it hardly matters that Ramone saw someone identical to Allison.

Orphan Black Sarah as Cosima

The episode made excellent use out of the supporting characters. Felix’s performance, and clothing, were most notable, but other characters were also important. I’m glad that Art is now in on what is going on and expect to see him help Sarah more in the future. Paul is at least partially under the control of Dyad, but does seem to want to help Sarah. Delphine seemed to have sided with Cosima, then betrayed her by doing the one thing Cosima told her not to do-give a sample of her blood to Dr. Aldous Leekie. Even Leekie’s motivations are not entirely clear, and in the end I can see him acting to protect the clones.

Besides the clones on one side and Leekie and the Dyad Institute on the other, it looks like other people, another branch of  the anti-clone religious extremists of Proleatheans, will have a major role in the second season. It appears that they have Kira and possibly Mrs. S, and the biggest surprise of the episode was that the presumed-dead Helena is still alive. A lesser surprise, but still unexpected, was how little interest Rachel seemed to have in Kira, except as bait to capture Sarah.

The location of the show remains purposely ambiguous. The show films in Toronto but unlike Continuum doesn’t actually state its Canadian location. They have not tried especially hard to hide this, with Canadian money and license plates visible in some scenes. The federal agency brought in to investigate was intentionally not named, while mention of a Supreme Court decision on genetic material suggests an American background. The show is written to seem like any city, including one surrounded by suburbia with big box stores (where an employee had guns and other items to sell out of his trunk) and a community theater, which fortunately is not putting on a new production of Cats.

Hannibal s02e08

On the surface Su-zakana was like a first season episode of Hannibal, with Jack, Will, and Hannibal working together to solve the  murder of the week. The three even started out the episode having dinner together, except with the Chesapeake Ripper supposedly out of commission, Hannibal served fish instead of red meat. I could even imagine yet another fish in the episode–Richard Fish of Ally McBeal saying “bygones.” When speaking around others, Hannibal explained overlooking Will’s attempts at killing him as being because of Will believing that Hannibal was a killer. This included telling Alana that Will was acting to protect her.

Under the surface, both Will and Hannibal knew that Hannibal really is the killer, and they were more honest when alone. Hannibal might have revealed his own code in saying, “Doing bad things to bad people makes you feel good.” If this is his motivation for killing, he is far less consistent in sticking to his code than Dexter Morgan was to sticking with his.

The murder of the week story was also a bizzaro recreation of the Will/Hannibal dynamic. Peter Bernardorne was a crazier version of Will who was  manipulated by Chris Diamantopoulos, playing a weaker version of Hannibal. We also saw that Will remains damaged, even if not as much as Peter, by Hannibal’s manipulations. Will even considered killing Chris as a substitute for Hannibal, until Hannibal warned him that it wouldn’t feel the same.

The episode also introduced Margot and Mason Verger, who should become more significant in future episodes.

The Man Under the Hood

On Arrow, Laurel has learned more about The Man Under The Hood but took the news far better than expected, deciding against letting Oliver know she knows his secret. That should be the subject for a future episode. The writers have often had difficulty in deciding what to do with her character, and in this episode she appeared far stronger than before. The producers had also been undecided as to whether to ultimately make Isabelle an ally or villain, deciding in last week’s episode that she would be a villain working with Slade. She appeared to be dead, but we learned that Mirakuru is as effective as alien blood on Agents of SHIELD at bringing people back from the dead. While we are not certain as to all the effects of the alien blood, we do know on Arrow that Mirakuru both gives superpowers and makes people go crazy. I wonder if Slade will regret creating an army of crazy super-villains who might be more difficult to control than herding cats.

We did learn that there is a cure to Mirakuru, which might turn out to be the way that the new army is ultimately defeated, and perhaps be used to keep Roy from going insane. The back story makes more sense in giving Slade additional motivation beyond the death of Shado to want to destroy Oliver. Back on the island, Oliver had chosen to kill rather than cure Slade. The episode also introduced characters from the upcoming Flash spin-off.

Collider spoke with producer/writer Andrew Kreisberg about Oliver’s relationship with Laurel and the ramifications of the Queens’ financial problems now that Isabelle has taken control of Queen Industries:

Where are Oliver and Laurel at now, romantically?

KREISBERG:  It’s Oliver and Laurel.  It’s Lois and Clark.  They can break up, get together, sleep together, break up, get married, get divorced, and she can forget him.  The best part about the success of the show is that it’s always our desire to speed through story.  The fans appreciate that.  We just blow through things.  We’re not like, “Well, we’ll do that in Season 4.”  No, we’ll just do that now.  On the other hand, success has enabled us to slow play some things.  We’ve really adopted this mantra of, “We’ll give people what they need, even if that’s not what they want.”  Having Oliver and Laurel get together in Season 1 is what people needed then.  But then, they needed them to go on a break, so Oliver could have his storyline with Sara for this season.  That’s what felt right to us.  Oliver has women in his life.  He has Laurel.  He has Felicity.  Helena is doing a 10 to 20 stretch.  But Laurel will always be one of the closest people to him, whether that’s romantic or not.  That’s why it’s so powerful to us that, in his darkest hour, Laurel is the one who pulls him out of it.  There has been a subset of fans who have questioned our sanity and our talent, for making some of the decisions we’ve made, over the course of last year and this year, but somebody is always going to be upset.  A lot of the things we have done have been leading up to what we’re doing in the finale, and then moving that forward to Season 3.

How long-running are the ramifications of the Queens’ financial problems?

KREISBERG:  We’re gonna make it a thing.  That plays out in the last five episodes.  We’re gonna start Season 3 with Oliver in very different circumstances than he’s been before.  Obviously, him being in different circumstances changes the circumstances of his paid bodyguard and paid assistant, since he can no longer pay them.  For Season 3, you’ll see that some of our familiar standing sets from Season 1 and 2, that you’ve come to know and love as being Arrow, are gonna be retired for reasons that will become apparent, as you see these last episodes.  We have already seen designs for some of the new sets for Season 3, which are amazing.  We want the show to feel like it’s constantly evolving, changing and growing.  If this year is the sequel, then next year is Arrow 3.  As different as 2 is from 1, in 3, they got Ewoks.

BRETT DALTON, BILL PAXTON

Providence continues the story of Agents of SHIELD after the infiltration by Hydra destroyed the organization, at least as we knew it. The have a secret base, Coulson learned that Director Fury is alive, and they are determined to remain Agents of SHIELD rather than Agents of Nothing. Last week there was a lot of speculation as to whether Ward had been brainwashed like the Winter Soldier or was faking allegiance to Garrett.  Anything is possible in this series, but the exchanges between Ward and Garrett suggest that Ward was recruited as a teenager and really has been working with Garrett from the start, with many of his actions designed to obtain trust from Coulson and his team. It appears that the only way that this could not be real would be if false memories were implanted into Ward, or if Ward spying on Garrett was intentionally withheld from Coulson. Such explanations would seem extremely contrived, and I hope that they just keep Ward the villain. Besides he is more interesting that way, although his feelings for Skye might complicate matters, especially as Ward’s allegiance so far seems more personal with Garrett as opposed to Hydra as an organization.

Besides the direct continuity in the recent episodes to Captain America: The Winter Soldier, there is further continuity with the Marvel universe with the Hulk’s old enemy, Colonel Talbot. Next episode Amy Acker visits as Coulson’s cellist girlfriend.

The Americans - Episode 2.08 - New Car - Promotional Photos (3)_FULL

The Americans maintained its usual quality with New Car. Once again Elizabeth and Philip had to deal with questions as to who to kill, or allow to be killed, and hand child rearing problems. Unfortunately for Lucia, it turns out that Larrick was far more important to the Russian plans than she was.  Plus Elizabeth really hates Ronald Reagan. The big surprise of the episode was to see Vasili alive along with Anton in the Soviet Union.

Fargo was off to an excellent start. It does remind me a little of Breaking Bad with over the top events portrayed as plausible in an area where I would not want to live. You would have to combine both Martin Freeman’s Lester Nygaard and Billy Bob Thornton’s Lorne Malvo to have a Walter White. While the premiere episode had a few murders, it looks like the series will be more about the consequences of the actions than a traditional detective series to uncover the identity of the murders.

I continue to avoid writing too much about Continnum as I’m a few weeks ahead of the American schedule by downloading from Showcase and I want to avoid any spoilers. The third episode, Minute To Win It, aired in the United States this week. The sequence taking place in the future revealed Kiera as being less blood thirsty than her superiors, but perfectly willing to ignore what they do. This week it was the future police shooting someone unnecessarily. Next week look forward to seeing Kiera’s take on a shooting which really has occurred in our history.

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Major Spoiler if you have not seen last week’s Game of Thrones: I make a point of not posting predictions about Game of Thrones as many people know far more than I do about the series if they have read the books. I would have never predicted that Joffrey would be killed off until late in the series. This should create a lot of interesting situations, ranging from speculation as to the murderer, effects on various characters, and a new fight for power. Natalie Dormer discussed the impact on Margaery in this interview. George R.R. Martin discussed the death here.

There is a little more news on the script being worked on for a Farscape movie which will follow the son of John and Aeryn.

Laura Pepon is only returning for four episodes of the second season of Orange Is The New Black but will return full time assuming there is a third season.

Aaron Sorkin only plans to write six episodes for the probable third and probable final season of The Newsroom. As he writes every episode of the series, I imagine it is better that he limit this to what he can handle if this leads to better scripts. HBO has not let the cast out of their contracts in case Sorkin decides to do more according to an interview with Olivia Munn.

The Hugo Award Nominees for 2014 are out. Doctor Who dominates the nominations for Dramatic Presentation (short form) with two episodes of the show, Adventures in Space and Time, a documentary about the origin of the television show, and The Five(ish) Doctors about the former Doctors who did not make it into the 50th Anniversary episode. An episode of Game of Thrones and Orphan Black complete the nominations in that category.

BEST DRAMATIC PRESENTATION (LONG FORM)

  • Frozen Screenplay by Jennifer Lee; Directed by Chris Buck & Jennifer Lee (Walt Disney Studios)
  • Gravity Written by Alfonso Cuarón & Jonás Cuarón; Directed by Alfonso Cuarón (Esperanto Filmoj; Heyday Films; Warner Bros.)
  • The Hunger Games: Catching Fire Screenplay by Simon Beaufoy & Michael Arndt; Directed by Francis Lawrence (Color Force; Lionsgate)
  • Iron Man 3 Screenplay by Drew Pearce & Shane Black; Directed by Shane Black (Marvel Studios; DMG Entertainment; Paramount Pictures)
  • Pacific Rim Screenplay by Travis Beacham & Guillermo del Toro; Directed by Guillermo del Toro (Legendary Pictures, Warner Bros., Disney Double Dare You)

BEST DRAMATIC PRESENTATION (SHORT FORM)

  • An Adventure in Space and Time Written by Mark Gatiss; Directed by Terry McDonough (BBC Television)
  • Doctor Who: “The Day of the Doctor” Written by Steven Moffat, Directed by Nick Hurran (BBC)
  • Doctor Who: “The Name of the Doctor” Written by Steven Moffat, Directed by Saul Metzstein (BBC)
  • The Five(ish) Doctors Reboot Written & Directed by Peter Davison (BBC Television)
  • Game of Thrones: “The Rains of Castamere” Written by David Benioff & D.B. Weiss; Directed by David Nutter (HBO Entertainment)
  • Orphan Black: “Variations under Domestication” Written by Will Pascoe; Directed by John Fawcett (Temple Street Productions; Space/BBC America)

Republicans Will Soon Regret Being The Party Of Repealing Obamacare

The Affordable Care Act has exceeded expectations where ever we have measurements, such as in people signing up, despite the Congressional Budget Office reducing their prediction after the computer problems in October. The Republican horror stories have been debunked whenever the facts have been examined. There are no death panels, and the Republican predictions of doctors refusing to see Obamacare patients or long waits have turned out to be false. Health insurance companies desire to increase participation in the exchanges, and premium increases are projected to be far less than Republicans have predicted. However, despite the success, the debate over Obamacare is unlikely to end soon. Far too many Republicans suffer from Obamacare Derangement Syndrome.

This includes a degree of short term memory loss. The individual mandate, selling insurance through exchanges, and high deductible plans to discourage spending are all conservative ideas which most Republicans supported up until the Affordable Care Act was nearing passage in Congress. This year Republicans will continue the attacks on Obamacare because of the intensity of opposition among Republican voters. Elections, especially off-year elections, have become far more about motivating the base to get out to vote as opposed to convincing undecided people to vote for your party. Repeating the same lies about the Affordable Care Act will motivate their voters to get out to vote. If Democrats, who at times are almost as inept at campaigning as Republicans are at governing (and predicting the effects of Obamacare), continue to cower in fear over their own accomplishments, there will be little to motivate as many Democrats to get out and vote.

However the realities will change over time, as First Read explained:

It’s easy to explain why the GOP doesn’t want to move on. Health care is the issue that fires up the base; it unites a party that’s divided on other issues; and the law remains mostly unpopular in most public-opinion polls. Obama even recognized this when he talked about possible bipartisan fixes to the health-care law during his news conference yesterday. “My suspicion is that probably will not happen until after November, because it seems as if this is the primary agenda item in the Republican political platform.”

That’s a short-term winner but a long-term problem

That political platform looks like a short-term winner in the upcoming midterm elections, with the GOP having an excellent opportunity of winning back the Senate. But it raises other long-term challenges. What do you do with the eight million Americans who now have insurance on the exchanges, and with the 24 million Americans who are projected to be on the exchanges by 2017 (the next time there’s the possibility of a GOP president)? What about the millions more who have insurance via expanded Medicaid or via their parents’ insurance? And how do you advocate repeal and replace when you don’t have a detailed legislative alternative (that’s scored by the Congressional Budget Office)? Come 2015 and 2016, Republican presidential candidates could very well find themselves in an unsustainable position — having to campaign on a repeal message in the primaries (because that’s what GOP voters want), but then having to face a general electorate that’s more hostile to the idea (because repeal doesn’t poll well outside the GOP).

Americans will not want to repeal Obamacare when they consider what this means. We cannot take away health insurance from millions, and place many more at risk of losing coverage should they become sick. In the near future, to argue to repeal Obamacare will sound as absurd as arguing to repeal Medicare. Of course those who think that Republicans have really moved beyond wanting to repeal Medicare haven’t paid enough attention to the Ryan budget which Republicans have repeatedly voted to support.

Edward Snowden Explains That His Goal Was To Expose Putin For Lying About Mass Surveillance, Not To Whitewash Him

Yesterday Edward Snowden called into a question and answer show held by Vladamir Putin and asked him about mass surveillance in Russia. The video is above. Putin’s response:

“Mr. Snowden, you are a former agent,” the president replied. “I used to work for an intelligence service. Let’s speak professionally.”

“Our intelligence efforts are strictly regulated by our law,” Mr. Putin said. “You have to get a court’s permission first.” He noted that terrorists use electronic communications and that Russia had to respond to that threat.

“Of course we do this,” Mr. Putin said. “But we don’t use this on such a massive scale and I hope that we won’t.”

“But what is most important,” Mr. Putin concluded, “is that the special services, thank God, are under a strict control of the government and the society, and their activities are regulated by law.”

Most likely as a reflection of views they already had about him, some people have since criticized Snowden for giving Putin the opportunity to lie in this manner, as if the only way Putin could lie on Russian television is by responding to a question from Edward Snowden. Think Progress has pointed out some of the ways in which Putin was lying:

Numerous reports lay doubt to Putin’s claims that the collection of information is much more narrowly tailored in Russia. In fall 2012, Russia put into place a system it claimed was to protect children from viewing pornography. The method it decided to enact that goal, however, was one not only puts into place a list of banned websites that could surpress political speech, but also has the ability to track the flow of information across Russian networks. “Logistically, this will require Russia’s [internet service providers] to maintain detailed records of user traffic and would allow the Russian government a potential backdoor into the private lives of Russia’s internet users,” ThinkProgress explained at the time of the network’s launch.

Last October, Reuters also reported that the Russian government was requiring internet service providers to “store all traffic temporarily and make it available to the top domestic intelligence agency.” Under the order drafted in the Communications Ministry, the FSB — the successor to the KGB — would have access for 12 hours to all stored data, “including phone numbers, IP addresses, account names, social network activity and e-mail addresses.” That order is due to take effect this July.

And just this year, Russian officials admit while defending hotels in Sochi built for the Winter Olympics that they were equipped with surveillance equipment that was closely watched. The entire proceedings in the Russian resort town were subject to a massive dragnet of surveillance as a system was put into place to monitor all communications that flowed in and out. This was done using the SORM system that Russia utilizes to listen in to phone conversations and read email threads, which according to Privacy International, “gathers information from all communication media, and offers long-term storage (three years), providing access to all user data.” SORM is deployed year-round and controlled by the FSB.

Former U.S. Ambassador to Russia Michael McFaul said he has been on the receiving end of the Russian surveillance program. As a government official, he was a prime target, he told NBC just prior to stepping down earlier this year, but Americans writ large are also subject to having their information spied upon, given Moscow’s espionage abilities. “As we remind all Americans that come to this country,” McFaul said, “the Russian government has tremendous capabilities, and legal by their law, of intercepting phone calls, emails, etc.”

In a post at The Guardian entitled Vladimir Putin must be called to account on surveillance just like Obama, Snowden explained that “I questioned the Russian president live on TV to get his answer on the record, not to whitewash him.”

On Thursday, I questioned Russia’s involvement in mass surveillance on live television. I asked Russia’s president, Vladimir Putin, a question that cannot credibly be answered in the negative by any leader who runs a modern, intrusive surveillance program: “Does [your country] intercept, analyse or store millions of individuals’ communications?”

I went on to challenge whether, even if such a mass surveillance program were effective and technically legal, it could ever be morally justified.

The question was intended to mirror the now infamous exchange in US Senate intelligence committee hearings between senator Ron Wyden and the director of national intelligence, James Clapper, about whether the NSA collected records on millions of Americans, and to invite either an important concession or a clear evasion. (See a side-by-side comparison of Wyden’s question and mine here.)

Clapper’s lie – to the Senate and to the public – was a major motivating force behind my decision to go public, and a historic example of the importance of official accountability.

In his response, Putin denied the first part of the question and dodged on the latter. There are serious inconsistencies in his denial – and we’ll get to them soon – but it was not the president’s suspiciously narrow answer that was criticised by many pundits. It was that I had chosen to ask a question at all.

I was surprised that people who witnessed me risk my life to expose the surveillance practices of my own country could not believe that I might also criticise the surveillance policies of Russia, a country to which I have sworn no allegiance, without ulterior motive. I regret that my question could be misinterpreted, and that it enabled many to ignore the substance of the question – and Putin’s evasive response – in order to speculate, wildly and incorrectly, about my motives for asking it.

The investigative journalist Andrei Soldatov, perhaps the single most prominent critic of Russia’s surveillance apparatus (and someone who has repeatedly criticised me in the past year), described my question as “extremely important for Russia”. According to the Daily Beast, Soldatov said it could lift a de facto ban on public conversations about state eavesdropping.

Others have pointed out that Putin’s response appears to be the strongest denial of involvement in mass surveillance ever given by a Russian leader – a denial that is, generously speaking, likely to be revisited by journalists.

In fact, Putin’s response was remarkably similar to Barack Obama’s initial, sweeping denials of the scope of the NSA’s domestic surveillance programs, before that position was later shown to be both untrue and indefensible.

So why all the criticism? I expected that some would object to my participation in an annual forum that is largely comprised of softball questions to a leader unaccustomed to being challenged. But to me, the rare opportunity to lift a taboo on discussion of state surveillance before an audience that primarily views state media outweighed that risk. Moreover, I hoped that Putin’s answer – whatever it was – would provide opportunities for serious journalists and civil society to push the discussion further.

When this event comes around next year, I hope we’ll see more questions on surveillance programs and other controversial policies. But we don’t have to wait until then. For example, journalists might ask for clarification as to how millions of individuals’ communications are not being intercepted, analysed or stored, when, at least on a technical level, the systems that are in place must do precisely that in order to function. They might ask whether the social media companies reporting that they have received bulk collection requests from the Russian government are telling the truth.

I blew the whistle on the NSA’s surveillance practices not because I believed that the United States was uniquely at fault, but because I believe that mass surveillance of innocents – the construction of enormous, state-run surveillance time machines that can turn back the clock on the most intimate details of our lives – is a threat to all people, everywhere, no matter who runs them.

Last year, I risked family, life, and freedom to help initiate a global debate that even Obama himself conceded “will make our nation stronger”. I am no more willing to trade my principles for privilege today than I was then.

I understand the concerns of critics, but there is a more obvious explanation for my question than a secret desire to defend the kind of policies I sacrificed a comfortable life to challenge: if we are to test the truth of officials’ claims, we must first give them an opportunity to make those claims.

This comes a few days after The Guardian and the Washington Post received a Pulitzer Prize for Public Service for their reporting on the NSA surveillance based upon documents leaked by Edward Snowden.

Success Of Obamacare Might Translate Into Political Success

The number of people signing up for private insurance coverage under the Affordable Care Act has now reached eight million. While primarily symbolic, it does represent a victory after initial projections of seven million were reduced to six million due to the problems when the exchanges opened. We know that if they failed to meet these projections, Republicans would be making a big deal of them. In addition, late enrollees included a high percentage of young people.

Good news means more positive head lines, such as National Journal writing that Obamacare is on a Winning Streak. The political climate is changing, with some Democrats now being more willing to run on its success.  I think it is essential that they do this to reduce the risk of the loss of a large number of seats this November. The evidence shows that Obamacare is a success but if Democrats don’t defend it, voters will only hear Republican attacks. Hiding from Obamacare will only make Democrats look weaker, and will not protect them from voters who vote against Democrats based upon Republican misinformation.

Ezra Klein writes that the right suffers from Obamacare Derangement Syndrome, being unable to admit that it is working:

Republicans used to talk about Bush Derangement Syndrome. Washington Post columnist Charles Krauthammer defined it as “the acute onset of paranoia in otherwise normal people in reaction to the policies, the presidency — nay — the very existence of George W. Bush.” Republicans like Krauthammer understood that BDS helped the Bush administration in two ways: it fired up their supporters and it distracted liberals from more modest, but effective, critiques.

Today, the right struggles with Obamacare Derangement Syndrome: the acute inability to see Obamacare as anything but a catastrophic failure that the American people will soon reject. For those suffering from ODS, all bad Obamacare news is good news, and all good Obamacare news is spin. In this world, delays of minor provisions in the law prove that the entire structure is collapsing, while surges of millions of people enrolling in insurance don’t prove anything at all…

But it’s coming at a moment when Obamacare’s successes are getting tougher and tougher to deny. The law signed up more than 7.5 million people in the exchanges, more than 3.5 million people in Medicaid, and it led millions more to get health care through their employers or directly through insurers. Premiums are lower than the Congressional Budget Office predicted when the law passed, and insurers are already thinking about how to compete for applicants in 2015. The White House has a much better story to tell than anyone — including me — thought possible in December.

For Republican pundits it might not matter that Obamacare is a success. Republicans show more intensity in their views, and very little concern for the truth. Campaigning against Obamacare might still motivate Republicans to get out and vote.

Andrew Sullivan might be a bit overly optimistic about the political effects of the success of Obamacare, but I hope he is right:

There’s simply no denying that the law has been rescued by an impressive post-fiasco operation that did to ACA-opponents what the Obama campaign did to the Clintons in 2008 and to Romney in 2012. Obama out-muscled the nay-sayers on the ground. I have a feeling that this has yet to fully sink in with the public, and when it does, the politics of this might change. (Since the law was pummeled at the get-go as something beyond the skills of the federal government to implement, its subsequent successful implementation would seem to me to do a lot to reverse the damage.) There are some signs that this is happening. A new Reuters/Ipsos poll finds the following:

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

That’s mainly because of renewed confidence and support from previously demoralized Democrats. But it’s also a reflection, it seems to me, of the political vulnerability of Republicans who have failed to present a viable alternative to the law, and indeed seem set, in the eyes of most voters, merely to repeal ACA provisions that are individually popular. And this bad position is very likely to endure because of the intensity of the loathing for Obama/Obamacare among the Medicare recipients in the GOP base. It seems to me that right now, the GOP cannot offer an alternative that keeps the more popular parts of Obamacare without the air fast leaking out of their mid-term election balloon. And so by the fall, the political dynamics of this may shift some more in Obama’s direction. By 2016, that could be even more dramatic. One party – the GOP – will be offering unnerving change back to the status quo ante, and the other will be proposing incremental reform of the ACA. The only thing more likely to propel Hillary Clinton’s candidacy would be a Republican House and Senate next January.

It’s that long game thing again, isn’t it? Like the civil rights revolution of the Obama years, it seemed a close-to-impossible effort to start with, and then was gradually, skillfully ground out. It also seems true to me that the non-event of the ACA for many, many people will likely undermine some of the hysteria on the right. The ACA-opponents may be in danger of seeming to cry wolf over something that isn’t that big a deal. Yes, they may have premium hikes to tout as evidence of the alleged disaster. And every single piece of bad news on the healthcare front will be attributed to the ACA, fairly or not. But the public will still want to know how premiums can go down without people with pre-existing conditions being kicked out of the system, or without kids being kicked off their parents’ plan, and so on. I think, in other words, that the GOP’s position made a lot of short-term political sense in 2010 and even 2012. But it’s a much tougher sell in 2014, let alone 2016. Once again, they have substituted tactics for strategy. Every time they have done that with Obama, they have failed.

Sullivan described how he has benefited from the Affordable Care Act and concluded, “Yes, I am just one tiny, and rare example. But for me, at least, Obamacare has over-delivered and over-performed. If my experience is replicated more widely, then I suspect the polling and politics will shift yet again.”

Cross posted at The Moderate Voice

Possible Class M Planet Discovered

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A  possible Class M planet, which may be suitable for humanoid life, has been discovered 500 light-years away:

It is a bit bigger and somewhat colder, but a planet circling a star 500 light-years away is otherwise the closest match of our home world discovered so far, astronomers announced on Thursday.

The planet, known as Kepler 186f, named after NASA’s Kepler planet-finding mission, which detected it, has a diameter of 8,700 miles, 10 percent wider than Earth, and its orbit lies within the “Goldilocks zone” of its star, Kepler 186 — not too hot, not too cold, where temperatures could allow for liquid water to flow at the surface, making it potentially hospitable for life.

“Kepler 186f is the first validated, Earth-size planet in the habitable zone of another star,” Elisa V. Quintana of the SETI Institute and NASA’s Ames Research Center in Mountain View, Calif., said at a news conference on Thursday. “It has the right size and is at the right distance to have properties similar to our home planet.”

Dr. Quintana is the lead author of a scientific paper describing the findings in this week’s issue of the journal Science. Kepler 186f is the latest planet to be sifted out of the voluminous data collected by Kepler, which kept watch over 150,000 stars, looking for slight drops in brightness when a planet passed in front.

There is no word from Star Fleet as to whether there are plans to initiate First Contact with the planet. Most likely this is because we are unable to determine whether there is life on the planet and we have not yet developed warp technology which would enable us to travel 500 light years, not to mention that Star Fleet is a fictitious organization which will not be founded until the 2130′s. While similar to earth, we also do not actually know the composition of the atmosphere and therefore cannot be certain if it really is a Class M planet.

Insurance Companies Plan To Increase Policies Offered On Exchanges Following 2014 Success, And Other Health Care News

The first year of enrollment for insurance under the exchanges is largely for first getting our feet wet, with more people projected to sign up in the future. It certainly exposed problems in the computer system and allowed for them to be fixed (although further testing before October was clearly needed). Insurance companies got to see whether this was a profitable market they would want to enter. In the past one or two insurance companies dominated in most areas on the individual market. One of the benefits of selling coverage through the exchanges was the hope that multiple companies would now begin to offer coverage.

Even conservatives who oppose the Affordable Care Act should agree with the benefits of having more companies offer insurance, including the likelihood of competition leading to lower prices. Actually exchanges, along with mandates, were originally supported by Republicans until they opposed the plan when supported by Barack Obama.

So far we are receiving good news following the initial IT problems. The Affordable Care Act now looks like a good policy which just got off to a rocky start. Enrollment is estimated at 7.5 million, exceeding predictions made even before they were adjusted downward with the early computer problems, with more healthy young people signing up at the last minute. Politico reports that insurance companies are happy with what they are seeing and want to get in:

Health insurers got their first taste of Obamacare this year. And they want seconds.

Insurers saw disaster in the fall when Obamacare’s rollout flopped and HealthCare.gov was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year.

At least two major national insurers intend to expand their offerings, although a handful of big players like Aetna, Humana and Cigna, are keeping their cards close for now. None of the big-name insurers have signaled plans to shrink their presence or bail altogether after the first rocky year. And a slew of smaller health plans are already making moves to join more states or get into the Obamacare business for the first time.

“[W]e see 2014 as just the beginning for exchanges,” said Tyler Mason, a spokesman for UnitedHealth Group, one of the nations’ largest insurers. “As the economics, sustainability and dynamics of exchanges continue to become clearer, we believe exchanges have the potential to be a growth market with much to offer UnitedHealthcare and other insurers and consumers.”

Nurturing this growth and health plan participation will be one of the first tasks of Sylvia Mathews Burwell, assuming she is confirmed to succeed Kathleen Sebelius as secretary of Health and Human Services.

The article reviewed plans by many of the larger insurance companies and also noted that several smaller companies now want to start selling insurance. Being able to offer their plans on the same computer site as the larger companies will allow small companies to compete for sales more easily than in the past, further increasing choice for consumers.

It is not only insurance companies which see the Affordable Care Act as succeeding. The latest Reuters/Ipsos poll shows the number of people who prefer Democrats over Republicans on health care has increased:

Americans increasingly think Democrats have a better plan for healthcare than Republicans, according to a Reuters/Ipsos poll conducted after the White House announced that more people than expected had signed up for the “Obamacare” health plan.

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

Not surprisingly, Gallup has found a greater decrease in the uninsured in states which have embraced the Affordable Care Act, such as by setting up their own exchanges and taking advantage of the expanded Medicaid program.

Having Gallup survey the number of uninsured is of value as the Census Bureau is changing how it is surveying the uninsured, with Gallup providing a second set of numbers for comparison. Many Republicans see a conspiracy to make Obamacare look good. Actually this looks like a change to get more accurate results, which might actually show a greater number of uninsured. The changes also started with 2013 so we will still be able to compare the year prior to the exchanges to subsequent years. Sarah Kliff explained further at Vox.

Cross posted at The Moderate Voice