Republicans Had To Hide Support For Fix To Affordable Care Act To Limit Attacks From The Right

The “doc fix”  has become a strange legislative tradition as Congress regularly votes to stop the automatic  cuts in physician payment called for under the flawed Sustainable Growth Rate formula. As I discussed in March, this time there were a couple of new twists which were known, but in addition it turns out that another item hidden in the bill reveals a lot about the Republican Party.

First I’ll recap what we had already known. The “doc fix” proposed to block the cuts which would have taken effect in April was for one year and included multiple other measures, including a delay in implementing change to ICD-10 diagnosis codes until at least October 2015. Physician groups actually opposed this bill because a permanent fix was also under consideration and it was feared that passing yet another temporary fix would lead to abandonment of the permanent fix (which does now appear dead).

The “doc fix” regularly passes with bipartisan support because Congress is not going to risk the backlash which would be created if many Medicare patients could no longer find physicians willing to accept them. This time the House passed the “doc fix” on a voice vote, which allows individual members to avoid being held accountable for the vote.

Over the weekend we learned why House Republicans wanted to pass this on a voice vote. Another item in the bill made some changes in the Affordable Care Act which was desired by small business and which Democrats were willing to make:

At the prodding of business organizations, House Republicans quietly secured a recent change in President Barack Obama’s health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it.

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

“Maybe you say it helps (Obamacare), but it really helps the small businessman,” said Rep. Phil Roe, R-Tenn., one of several physician-lawmakers among Republicans and an advocate of repeal.

No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans’ request, into legislation preventing a cut in payments to doctors who treat Medicare patients.

It is unclear how many members of the House rank and file knew of it because the legislation was passed by a highly unusual voice vote without debate.

This shows how dysfunctional Congress has become. Normally both parties would see it as a victory for the system that they passed a measure to make requested changes in the Affordable Care Act. However, Republicans felt compelled to hide this vote because it contradicts their public policy of only supporting repeal (having voted for repeal over fifty times). Since this became public, the Republicans have faced criticism from the right, probably making it even harder for them to vote on improvements in the Affordable Care Act in the future.

The fix which passed allows small businesses to offer policies with higher deductibles. This allows for lower premiums, and the higher deductibles are often handled separately with Medical Savings Accounts. There are also added protections in new insurance policies under the Affordable Care Act such as annual limits on out of pocket expenses and the elimination of annual and lifetime caps on coverage which help offset the problems created by higher deductibles.

If Republicans should attack the Affordable Care Act based upon including high deductible plans, keep in mind that this is exactly the type of plan which Republicans frequently advocate, and that the Republicans voted to increase the allowable deductible levels in response to requests from small business.  Democrats had no objection to the change as the limit on deductions was originally placed in the bill because it was supported by Republican Senator Olympia Snowe. In response to this addition, Snowe voted for the Affordable Care Act when in the Senate Finance Committee but ultimately voted against the bill on the Senate floor, along with every other Republican Senator.

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Democrats Need A Message

One reason that the Republicans get people to turn out to vote in off year elections, often to vote against their economic self-interest, is that they have a message. The message might be based upon dishonest claims and incorrect views as to how the economy and government work, but it is a message. In contrast, many Democratic voters feel less interested in turning out to vote, especially in off year elections. To some degree the Democrats have difficulty in defining a message as they are a big tent party which wins elections by appealing to a wide variety of voters, ranging from center-right to left wing. Issues which appeal to some Democratic voters might turn off others.

The Washington Post describes how Senate Democrats are struggling to define a message:

Senate Democrats’ latest effort in that regard is a 10-point plan for legislation they intend to bring to the floor over the spring and summer.

The issues are familiar ones for Democrats, and poll well among Americans generally.

Yet they are top priorities to narrower slices of the Democrats’ constituency — particularly those who showed up to vote for President Obama in 2012, but who do not have a history or voting in off-year contests.

The first items up for Senate debate will be increasing the minimum wage, from $7.25 an hour to $10.10 an hour, and a bill to assure paycheck equity between male and female workers.

Democratic pollster Celinda Lake said that those are measures that would have their greatest impact on young people, unmarried women, Latinos and African-Americans — all of whom can be difficult to turn out in years when there is no presidential election.

“This doesn’t replace a broader economic message. In the long run, we have to do that. But in the short run, this is very helpful,” said Lake, who has warned that the Democrats face a large turnout disadvantage in a year when Republican voters appear to be more motivated.

GOP pollster Neil Newhouse said the Senate Democrats’ targeted strategy echoes that of Obama’s 2012 reelection campaign, where he emphasized a number of “niche group” issues such as the Dream Act, mandatory contraception coverage under the Affordable Care Act, student loan expansion and support for same-sex marriage.

Why haven’t Democrats been pushing for legalization of same-sex marriage more strongly in the past? As Michigan and other states saw recent legal victories for marriage equality I thought that, although this is an issue far more associated with Democrats than Republicans, the victories are in the courts and not the result of actions by the Democratic Party.

Perhaps Democratic leaders did not want to be associated with bringing about marriage equality out of a fear of losing socially conservative Democratic voters. Maybe, but I also wonder how many socially liberal people who lean Democratic don’t bother to get out to vote because of not seeing a real commitment from Democratic leaders for liberal causes.

Republicans have learned that people tend to take on the other views of the party they associate with when there is a consistent message. They get social conservatives to back their economic policies by joining these as a common conservative philosophy. If the Democrats were to put out a more consistent message, perhaps those who vote for Democrats for other reasons would also “evolve,” as Barack Obama has, on issues such as same-sex marriage.

Democrats should frame this as a consistent platform of keeping government out of the private lives of individuals, along with support for reproductive rights and ideally an end to marijuana prohibition (or at least a stronger defense of medical marijuana). It is amazing that Democrats have allowed Republicans to take an advantage on issues which should be seen as reasons to vote Democratic, from size of government as it relates to private lives to support for Medicare.

Democrats also think too small on economic matters. Rather than just concentrating on issues such as increasing the minimum wage, Democrats need an economic message showing how Democratic ideas strengthen and grow the economy while Republican economic policies lead to economic stagnation and a concentration of wealth in a small minority. Income inequality is an important issue, but only when placed in an overall economic message of expanding the economy and how extreme income inequality destroys the middle class. An economic message seen as merely dislike for the rich (or the Koch brothers) will never sell.

Of course making a coherent economic message which will not only mobilize their own voters but bring in new voters will take time and cannot be done in only one election year. The Republicans have been working for years at indoctrinating the country in their type of Voodoo Economics. It will also take several years to get out the message on how the economy actually works, but the Democrats might as well start now.

Health care remains one of the strongest reasons to vote for Democrats. Even those who have a negative view of the Affordable Care Act based upon Republican misinformation still prefer to improve it over either repeal or turning to any Republican alternative. As I have written before, Democrats need to go on the offensive on health care reform, not run away from the issue. Joe Conason has the same message again, with numbers now out showing that enrollment through the exchanges has exceeded the projected number of six million:

Success for Obamacare might boost the turnout projections that Republicans have tried so hard to suppress and that Democrats have so far proved unable to resuscitate.

Dominant forces in the Republican Party — including the tea party and its billionaire financiers — have staked everything on the commonplace assumption that Obamacare will drag down Democrats across the country.

Indeed, they make almost no other argument. Bolstering that cynical bet is the Democratic hesitation to mount a powerful counteroffensive on health care, with the impulse to push the minimum wage, unemployment benefits, and other vital issues that still feel safer.

But as Clinton warns, they will find no shelter from this storm. They cannot hide from their own history; and the more they pretend to do so, the more they risk contempt. For decades, Democrats have insisted that all Americans must have health coverage — a momentous and admirable goal advanced by the Affordable Care Act.

With the numbers now on their side, they should lift their heads, raise their voices, and lean into the midterm debate. They have no better choice.

Cross Posted at The Moderate Voice

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Bill Calls For Adding ICD-10 Delay To Latest “Doc Fix”

I recently pointed out that the Republicans killed a recent attempt to repeal the Sustainable Growth Rate formula by attaching a measure to end the individual mandate in the Affordable Care Act. With failing to repeal the Sustainable Growth Rate it becomes necessary for Congress to pass yet another temporary “doc fix” to prevent Medicare reimbursement from automatically falling so low that doctors will not be able to afford to see Medicare patients.

Medical Economics reports that a proposal to delay the transition from ICD-9 to ICD-10 diagnoses codes from October 2013 to October 2014. The transition was originally passed under the Bush administration, so ignore the Republican claims which are out there which blame Obamacare for the change. While there are benefits to the newer system which is used by the rest of the world, the change would be very expensive for medical practices. Changes such as this also take up a lot of physician time, reducing the number of patients which can be seen each day.

Such decreases in productivity would come at a poor time in 2013 when millions of new people will receive health insurance due to the Affordable Care Act and will need to find physicians who are accepting new patients. In addition, the second phase of requirements for electronic medical records (EMR’s) also kicks in for many physicians this October and having two sets of major changes will further reduce physician productivity, making it more difficult to accept new patients. Personally I had to greatly restrict accepting new patients for several months after the first phase of requirements went into effect, and anticipate again having to limit accepting new patients this fall if both the new EMR requirements and change to ICD-10 take effect simultaneously.

The AMA and many other physician groups have been lobbying for a further delay in ICD-10 implementation, which has already been delayed in the past. Medical Economics reports:

The ICD-10 transition has been a major point of concern for physicians due to its scope and cost to implement. In recent months the American Medical Association (AMA) ramped up opposition to the ICD-10 transition, and petitioned CMS for a delay to the implementation of ICD-10.

According to the AMA, small practices can expect staggering costs ranging from $56,639 to $226,105 to implement the new code set. According to a February survey by the Medical Management Group Association, 79% of physicians report that they haven’t begun ICD-10 implementation, or were only “somewhat ready.”

Molly Cooke, MD, FACP, president of the American College of Physicians, said the college favors the delay. “The college has expressed concern at every opportunity about the implementation of ICD-10. I’m not sure the healthcare system loses a lot if we delay implementation for another year, and it certainly would give our members a bit of a breather.”Earlier this month, the Republican-led House passed a bill to repeal SGR and replace it with a formula that would calculate payments based on quality metrics. But the bill received widespread opposition from Democrats because it was paid for by a five-year delay in the individual mandate in the Affordable Care Act (ACA).

Cross posted at The Moderate Voice

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Don’t Panic Because Nate Silver Predicts Republicans Will Take Senate

I was traveling yesterday and when I finally got on line saw a lot of panic over Nate Silver predicting that the Republicans were favored to take control of the Senate. I don’t find this terribly significant.

We already knew that there was a real possibility that the Republicans could take control of the Senate and Silver’s prediction does not provide any new information. Silver making the prediction does not mean it is any more likely to occur than it was last week. He was way off in predicting a 61 percent chance the Republicans would take control of the Senate in 2012. I hope he is wrong again.

As I noted recently, Nate Silver’s predictions in the 2012 presidential election were similar to those from other sources (ignoring the Republicans who made predictions contrary to polling results). His predictions for the Senate in 2012 were also comparable to predictions being made by others at that point. His prediction for the Senate in 2014 is comparable to predictions already made by others.

There is real reason to fear that the Republicans will take control of the Senate is year, but the news of Nate Silver predicting this does not alter what we knew before he made this prediction and does not mean that it is any more likely to occur.

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Republican House Plays Politics, Screwing Both Doctors And Medicare Patients

After several years a deal had been reached to permanently repeal the flawed Sustainable Growth Formula but the House Republicans chose to play politics with it. The House Republicans showed a disregard for both physicians and  Medicare beneficiaries. They attached the fix to a five year delay on the individual mandate, knowing that this would be dead in the Senate.

The Sustainable Growth Formula was initially devised to give doctors increased Medicare reimbursement if medical costs go down and decrease reimbursement if costs rise. The formula was quickly found to be flawed. Individual physicians cannot control the overall trajectory of Medicare expenses regardless of the financial rewards or penalties. The formula failed to take into account overall increases in costs we have experienced over the past decade as a result of an aging population and new medical technology. As a result, the formula would reduce Medicare payments to physicians to a level below what doctors could afford to see Medicare patients for. Reimbursement from Tricare, which covers military families, is also tied to Medicare reimbursement. Congress has realized that the cuts were not tolerable and has repeatedly voted for a “doc fix” to circumvent the automatic cuts called for under the Sustainable Growth Formula.

The persistence of this problem over the past decade has eroded confidence in the federal government and the Medicare program, leading some physicians to stop accepting Medicare patients. Even Congress finally realized that something had to be done and an agreement was reached in principle between the federal government and physician organizations for a new payment structure to replace the Sustainable Growth Formula. The House had the opportunity to pass this as a clean bill today, but instead played politics by attaching it to a delay to the individual mandate.

It is getting difficult to keep count but I believe this is now the fifty-first vote to either repeal or greatly interfere with the implementation of the Affordable Care Act.

The individual mandate is a necessary component of the Affordable Care Act as currently structured. If insurance companies are required to provide coverage to everyone applying, they need protection against the problem of people not buying insurance until they become ill. In order for the system to function, insurance companies need the premiums from healthy people coming into the system every year to cover the expenses of those who are ill.

There are potentially other ways to solve the free rider problem but it is not possible to simply eliminate the individual mandate without implementing alternative measures to provide strong incentives for people to purchase insurance coverage while still healthy. While I had preferred using other measures instead of the mandate when health care reform was being considered, unlike the House Republicans I recognize when an issue has been settled and see no sense in continuing to fight the same battle. The Affordable Care Act is established law which has been upheld by the Supreme Court. Congress should be concentrating on making some necessary fixes (as any law of this complexity would require) to smooth its implementation as opposed to trying to sabotage it.

Twelve Democrats voted with the Republicans out of political fears. The Affordable Care Act is turning into a major success, providing millions with health insurance coverage and ending the ability of insurance companies to abuse the system by finding ways to sell policies and then avoid paying out. In addition,  Obamacare frees people from the “insurance trap” which forced people who otherwise do not need to work to continue working for insurance coverage, along with other overall benefits to the economy. The Congressional Budget Office Report, frequently distorted by Republicans, showed that the Affordable Care Act will reduce unemployment, help decrease the deficit, and allow more people to leave large corporations to start small businesses, further stimulating the economy.

Despite all of these benefits, Democrats remain on the defensive politically. While granted the Republicans have a strong propaganda machine delivering their misinformation, and a media willing to repeat Republican lies as if they are equally valid as statements of fact, Democrats should be able to do a better job of gaining support when the facts are so firmly on their side. The same is true of health care issues in general, as Republicans have managed to put Democrats on the defensive over bogus claims of Medicare cuts while the Republicans seek to turn Medicare into a voucher system which would destroy the program as we know it.

Democrats need to follow the advice of Paul BegalaStop being so damn defensive about the law and show people it’s worth fighting for, already.

Begala thinks Dems can address it with a simple flipping of the script. Dems now debating how to talk about Obamacare seem to be leading defensively with their willingness to fix the law. Instead, Begala says, they should lead with an attack on Republicans that is framed as a medical rights issue – before pivoting to fixing the law — and then wrap it all up in a larger message about how Republicans have no answers to people’s health care or economic problems.

“We should open by saying, ‘my opponent wants to repeal your rights,’” Begala said. “He wants to take away your right to be protected against discrimination because you have a preexisting condition. He wants to take away your right to be protected against discrimination for being older or being a woman. He wants to take away the closing of the Medicare donut hole for seniors.”

“That’s point one,” he continued. “Then you say, ‘look, I’m open to working with everybody to fix the law. But I’ll never let them go back to the days where insurance companies could send letters saying your coverage has been canceled because you have a preexisting condition.’”

And then from there to an economic message: “Repeal is their whole agenda. They have no ideas for giving you a pay raise. No ideas for raising the minimum wage. No ideas about how to create jobs. No ideas about how to get your kid into pre-K. Their entire agenda as a party is repeal — to take away rights that you have won. I’m not going to let them do that.”

All Democrats should have also stood up for both physicians and Medicare patients today and demanded a clean vote on the repeal of the Sustainable Growth Formula as opposed to tying it to yet another attempt to thwart Obamacare. If Democrats did something as silly as vote over fifty times to repeal the same thing while otherwise failing to legislate, imagine how the right wing noise machine would be mocking them.

Cross Posted at The Moderate Voice

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Why Do Republicans Hate Veterans?

Senate Republicans have blocked a Democratic proposal to increase veteran’s benefits. The Hill reports:

Senate Republicans stopped Democrats from advancing a bill that would have expanded healthcare and education programs for veterans.

In a 56-41 vote Thursday, the motion to waive a budget point of order against the bill failed, as Democrats fell short of the 60 votes needed to overcome the Republican roadblock.

GOP Sens. Dean Heller (Nev.) and Jerry Moran (Kan.) voted with Democrats.

Senate Majority Leader Harry Reid (D-Nev.) refused to allow a GOP substitute amendment to get an up-or-down vote because it included Iran sanctions, which he said were unrelated to veterans’ issues.

“I hope all the veterans groups have witnessed all the contortions the Republicans have done to defeat this bill,” Reid said Thursday. “Shame on Republicans for bringing base politics into a bill to help veterans.”

Why do I have a sense of deja vu in reading this story? Maybe because it has become quite common for Republicans to pretend to support the vets while opposing benefits backed by Democrats. A quick Google search for Republicans oppose veterans benefits brought up plenty of hits from previous examples.

Veterans–one of many groups who vote against their self-interest when they vote for Republicans.

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Republican Health Care Proposal Would Remove Employer Coverage From One Million And Increase Deficit

The Affordable Care Act is a great idea in principal, increasing the number of people with coverage and eliminating the abuses from insurance companies which had destroyed the individual market. So far it has been working out well as policy beyond the initial IT glitches. Republicans have repeatedly brought up horror stories, but each time they have turned out to be false when the details were examined (see here and here). Considering the complexity of the law it is certainly possible that some of the details might be improved upon. It also would not be surprising if the Affordable Care Act had aspects which might need changes considering the manner in which it was passed after the Democrats lost sixty votes in the Senate (in these days in which sixty votes are needed to pass anything of consequence over a Republican filibuster). Rather than passing the House bill, which I thought was better, or going to a Conference Committee to work out the differences between the two bills, it became necessary for the House to pass the Senate bill without any changes.

Republicans have been complaining a lot, but have not been very successful in suggesting improvements. Their overall health care proposals, on the rare times they bring one up, would increase out of pocket expenses for most Americans while increasing the number of uninsured. Republicans are now promoting a bill with some adjustments to the Affordable Care Act. Their plan is to change the definition of a full time employee from thirty to forty hours per week in order to reduce the impact of the requirement for companies with over fifty full time employees to provide insurance or pay a penalty.

The Congressional Budget Office came out with their analysis of this bill today (pdf here).  The result would be to 1) reduce the number of people receiving coverage thorough employers by one million people, 2) increase the number of people obtaining coverage through Medicaid, CHIP, or the exchanges by between 500,000 and one million, and 3) decrease the number of insured  by up to 500,000. As a consequence of the costs from these changes, the deficit would be increased by $25. 4 billion between 2015 and 2019. The deficit would be increased by $73. 7 billion between 2015 and 2024.

The irony here is that after the Republicans have made a lot of noise about policy cancellations (ignoring the fact that most of those who had policies canceled wound up receiving better coverage at a lower cost) it has repeatedly been their plans which would lead to more people losing insurance coverage. Another irony is the name of this Republican plan: The Save American Workers Act. How are they saving workers by reducing the number who receive health care coverage?

Cross posted at The Moderate Voice

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The Battle For Control Of Congress 2014

While the media is increasingly talking about the 2016 presidential election, we have a major election coming up for control of Congress later this year. At present it appears that it is unlikely for the Democrats to take control of the House, and they are now fighting to retain control of the Senate. Predictions that the Republicans will hold the House and possibly take the Senate are based upon historical trends and which Senate seats are up for reelection this year. Of course it is possible to see a break from past trends.

Among the trends causing people to predict this to be a good year for Republicans: minorities and young voters don’t vote as often in off-year elections, a president’s party generally does poorly in the sixth year of the president’s term, a president’s party does poorly when the president has low approval ratings, and a president’s party does poorly when the economy is having difficulties.

On top of this, the Democrats are defending Senate seats in several red states this year, giving the Republicans a chance to pick up some seats. Fortunately the situation is reversed in 2016 with more blue-state Republicans up for reelection. Based upon these fundamentals in a presidential election which is likely to already be more favorable to the party, a Democrat winning the White House should also see a pick up of several Senate seats.

The Republican Party has been working in other ways to pick up votes. They have made voter suppression a major part of their electoral strategy, along with continuing the Southern Strategy based upon racism and now xenophobia. On the other hand, their history of racism may backfire with the increase in minority voters, possibly turning some southern states blue in the near future. We saw this first in Virginia and to a lesser degree in North Carolina. In the future this could extend to Georgia, Texas, and additional states.

Republicans have an advantage in keeping control of the House as so many House districts are gerrymandered to protect the incumbent. In addition, Democrats tend to be more concentrated in urban areas, meaning that even if more people vote for Democrats than Republicans, the Republicans will win more seats by small margins while Democrats will win a smaller number with bigger majorities. More people voted for Democrats than Republicans in Congressional races in 2012 but the Republicans retained control of the House. It would probably take at least  a seven percent margin of victory for Democrats to take control of the House. Republican representation in the Senate is also exaggerated compared to their level of support due to lesser populated Republican states having the same number of Senators as more populated Democratic states.

There are some things which could throw off the fundamentals this year, but we cannot count on voters suddenly no longer being fooled by the GOP line. At present the Republicans receive far too many votes from low-information white voters. Over time the number of younger voters who receive their fake news from Jon Stewart will overtake the older voters who receive their fake news from Fox.

While Obama’s approval rating is low, Congress has an even lower approval rating. Typically in such situations people like their own Congressman even if they disapprove of Congress. This year polls show that many people also think their own Congressman should be thrown out. Based upon this, I wouldn’t be surprised if more incumbents than usual get upset, but that might not necessarily help the Democrats over Republicans. In addition, more people see the Republicans as being more responsible for gridlock, in contrast to a common false media narrative of treating each party as being equally responsible. Maybe they will surprise the pundits and throw the Republicans out.

Another factor influencing whether predictions based upon the fundamentals must occur is that any competent Democratic strategist is aware of every point here, and the party is doing far more than they did in 2010 to try to change this. They are working to increase turnout among Democratic voters this year. They  have a technological edge both in regards to get out the vote efforts and fund raising. It even appears that the same problems which are placing Republicans at a disadvantage with younger voters is also impacting their ability to recruit young tech savvy political operatives. Besides using their technological advantages over Republicans in getting out the vote efforts, they can  motivate Democratic voters with fear of the consequences of the Republicans taking control of the Senate. Tea Party extremism has led to an end to talk of a grand bargain. Democratic compromises on entitlement programs might have discouraged some voters on the left from turning out for Democrats.

I think Democrats will do better if they can successfully explain the advantages of their policies as opposed to Republican policies. Democratic economic policies turned around the economic collapse caused by Republican economic policies, even if the Republicans have managed to slow recovery with their obstructionist moves, decided upon from the start of Obama’s term. The deficit rolled up by George Bush has dropped considerably since Obama took office. The CBO  projects a deficit of $514 billion in 2014, representing three percent of the Gross Domestic Product. This is near the average level for the past forty years, and a vast improvement from 2009 when the deficit was at 10.1 percent of GDP.

Despite early IT problems, which the Obama administration does deserve criticism for, the Affordable Care Act has turned into a tremendous success on a policy level, both in terms of health care reform and its benefits for the economy. Both the Medicare Advantage plans under George Bush and the original Medicare program had early implementation problems which took a couple of years to solve. Of course Republicans will continue to spread unsubstantiated scare stories and it is possible Obama might never received the credit he deserves. Health care premiums will be remain high on the individual market as they were high before Obamacare. Insurance companies will continue to use restricted panels of physicians and hospitals as they did before Obamacare, leaving room for Republicans to blame the Affordable Care Act for problems unrelated to the law.

Other factors could come into play. The Tea Party might oust electable Republicans and replace them with extremist candidates which the Democrats can more easily beat. While doubtful, the Tea Party might force Congressional Republicans into a situation analogous to the government shut-down before the election which reduces public support for Republicans. While it is doubtful it will really alter that many votes, even the changes in the late night comedians could help the Democrats over the Republicans.

The easy prediction is now that the Republicans will keep control of the House and control of the Senate is up for grabs. Depending upon whether the factors discussed above alter the usual fundamentals, we still might wind up seeing the pundits talking about all the reasons they knew we would have a different outcome after the results are known.

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House Votes To Increase Debt Ceiling

The House passed a clean bill increasing the debt ceiling today, showing that the Democrats have learned their lesson to refuse to negotiate with terrorists. The bill extending the debt ceiling until March 2015 passed by a margin of House voted 221-201, with the support of only 28 Republicans.

Initially Republicans had hoped to tie their vote to some concessions, such as elimination of the risk corridors form the Affordable Care Act. Their argument for this fell apart when the Congressional Budget Office reported that the risk corridors will wind up saving the government eight billion dollars. It would hardly make sense to tie a measure to the vote on the debt ceiling which would lead to an increase in the deficit.

Democrats have learned that if they give into Republican demands, they will insist upon further concessions with each vote on the budget or debt ceiling, further harming the economy. The full Republican caucus would never vote for something as basic as paying our bills (a concept that previous Republican presidents such as Ronald Reagan had no problem with). The only way that the bill would pass would be if John Boehner allowed a vote of the entire House, leading to passage primarily with Democratic votes.

By allowing the bill to go to a vote of the entire House, Speaker Boehner showed that he understood how damaging it would be to the country and/or the Republican Party to once again play chicken with defaulting on the debt. The vote also showed how few sane Republicans there are, with 199 voting against, however I suspect that some of them understood the damage which would result from defaulting but voted against the increase to appease their constituents. One danger of gerrymandering Congressional districts to keep incumbents safe is that even sane Republican Congressmen would find it safer to vote as extremists out of fear of a Tea Party challenge.

While Boehner allowed the bill to come before a vote of the entire House, there is no guarantee that he will do so on future bills, especially when the consequences are less dire. Shutting down the government in October led to a drop in Republican support in the polls, showing that to some degree public pressure can influence the Republicans, but Boehner will be under other pressures from the right to limit his ability to repeatedly bring measures before the full House. Greg Sargent believes that the era of Republican debt limit extortion is dead while Talking Points Memo cautions that the Tea Party Ain’t Over yet.

Imagine if we lived in a country where we had majority rule and a minority party was unable to repeatedly impose its will upon the rest of the country. While a certain degree of roadblocks on government are needed to prevent the “tyranny of the majority,” our current system is being abused, leading to a tyranny of the minority.

Cross posted at The Moderate Voice

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The Past Week In Conservative Stupidity

Over a year ago Bobby Jindal warned that Republicans “must stop being the stupid party.” They have not been doing particularly well at following his advice. To extrapolate this to the conservative movement, this week provided two more examples of what can only be labeled as stupidity dominating conservative conversation–the intentional misinterpretation of the Congressional Budget Office report on the Affordable Care Act and reaction to Olympic coverage from Russia.

This is not to say that all conservatives believe these things or are stupid. However, the prevalence of stupidity does seem to have increased tremendously in the conservative movement and Republican Party in recent years. Even ignoring the easy targets such as Sarah Palin and Michele Bachmann, the caliber of conservative discourse generally seen today is far different from what came from past conservatives such as William F. Buckely, Jr., who also fought to keep the Birchers and other predecessors of today’s Tea Party out of the GOP. Barry Goldwater might have many views which liberals find objectionable, but he also warned about what would happen if the religious right took control of the Republican Party. Even Ronald Reagan was not so foolish as to oppose any tax increase or to prevent increases in the debt ceiling to allow the Unites States to honor its debts.

It is understandable that some conservatives might have been misled by the initial headlines on the report from the non-partisan Congressional Budget Office. Many journalists, overly influenced by conservative arguments and lacking adequate understanding of health care policy, initially were inaccurate in their coverage. Once the report was more fully evaluated, it was clear that the CBO report actually showed that there is no evidence of an increase in unemployment due to the Affordable Care Act as Republicans had been predicting would occur.  Instead the portions of the report on employment showed that Obamacare was projected to be successful in one of its goals--saving people from the “insurance trap.”

Until the Affordable Care Act came into effect many people continued in jobs they did not want because they would be unable to obtain health insurance if they left their current job. Under the Affordable Care Act, health insurance is no longer tied to employment. Now people are free to retire at an earlier age if they desire, instead of waiting until age 65 when they qualify for Medicare. They are also free to leave large corporations to work for small businesses, or perhaps even start a business of their own. The Robert Wood Johnson Foundation wrote about projections for an increase in entrepreneurship and self-employment last May. The CBO report confirms that they were correct. This can help boost the economy.

While an initial mistake regarding this might have been unintentional, there has subsequently been many corrections. Glenn Kessler of The Washington Post,  corrected errors in reporting in writing, “No, CBO did not say Obamacare will kill 2 million jobs”.  Kessler concluded with saying, “we award Three Pinocchios to anyone who deliberately gets this wrong.” Factcheck.org also corrected the misconceptions.

As some people leave jobs they no longer want or need, their jobs can open up for others. In testimony before the House Budget Committee, CBO Director Douglas Elmendorf confirmed that the CBO report suggests the Affordable Care Act will reduce unemployment. Even Paul Ryan corrected fellow Republicans on this point. Besides reducing unemployment, the CBO report showed that, while Republicans had been demanding an end to the risk corridors in order to agree to an increase in the debt limit, the risk corridors actually wind up saving the government eight billion dollars. The CBO projects a deficit of $514 billion in 2014, representing three percent of the Gross Domestic Product. This is down from 2009 when deficit was at 10.1 percent of GDP, and more in line with the average size of the deficit compared to GDP over the past forty years.

Conservatives are rarely willing to give up on their criticism of the Affordable Care Act even when contradicted by the facts. They continue to repeat fallacious arguments about death panels or their false claim that Obamacare constitutes a government takeover of health care. Finding that those who received cancellation notices from insurance companies generally received better coverage at a lower price under the Affordable Care Act did not end their claims of people supposedly losing their insurance under Obamacare.

Conservatives remain unwilling to give up the argument about people leaving their jobs, spinning it to suggest that the Affordable Care Act encourages people to be lazy parasites on society instead of working, ignoring the actual types of people this is likely to affect. Conservatives have been presenting “horror stories” of people allegedly harmed by the Affordable Care Act which typically turn out to be untrue once the details are examined. Finally we are seeing newspaper reports emphasizing the positive aspect of freeing people from the “insurance trap.”

While conservative columnists such as Ross Douthat fear that Obamacare will lead to a “strong work disincentive while looking at a population of childless, able-bodied, mostly working-class adults,” these are not the type of people I am seeing as benefiting by freedom from the “insurance trap.” If the health care debate is turning into one of anecdotal cases, I’m thinking of an affluent friend who, because of health history, cannot obtain insurance on the individual market so his wife has been working full time in a job purely for the health insurance, even though they have no need for the income beyond the benefits. I have a patient who was left without insurance when her husband retired in his early sixties and then struggled to pay her medical bills. As of January she finally has comprehensive coverage she can afford. These are the types of people who are benefiting from the supposed disincentive to work under Obamacare.

In theory there is a risk that “able-bodied, mostly working-class adults” might have less incentive to work, but I hardly think that providing affordable health care is enough to do this on a widespread level. Far more able-bodied adults are not working because jobs are not available. Besides making more jobs available, the Affordable Care Act can help relieve this problem in another way. In addition to freeing people to retire in their early sixties or leave jobs held solely for the insurance, people will be able to start small businesses without losing health insurance. In Republican-speak, this should also be beneficial to the economy due to making more “job creators.” The Robert Wood Johnson Foundation wrote about projections for an increase in entrepreneurship and self-employment last May. The CBO report confirms that they were correct, and to a greater degree than previously projected.

Conservatives were wrong about this argument, and now appear stupid, and dishonest, when they continue to repeat the same mistakes. I spent more space on this first example than intended, but in retrospect this is an important point which deserves repeated explanations as long as conservatives are claiming that this positive aspect of the Affordable Care Act is somehow undesirable.

The second example is bizarre outrage from the right wing over the video below which comes from NBC’s coverage of the Olympic games:

Their objection is to this line: “The empire that ascended to affirm a colossal footprint; the revolution that birthed one of modern history’s pivotal experiments.”

This is being spun by right wing bloggers as praise for Communism, including by FoxMarco Rubio, along with other conservatives commenting, does not appear to understand what pivotal means. The word refers to points which are critical or vitally important. The Russian Revolution was a pivotal point in their history, along with the history of the world. Similarly, Hitler’s rise to power was a pivotal moment. Both 9/11 and Katrina were pivotal moments during the Bush years.  The computer problems during the first month of the exchanges has unfortunately become a pivotal moment for the Obama administration. The word pivotal says nothing about whether the events were good or bad.

This was one line in a video narrated by Peter Dinklage as introduction to NBC’s sports coverage of the Olympics. If this was a political documentary we would expect information on the horrors of communism. This is unnecessary, and probably out of place, in sports coverage, especially if they desire to be polite and avoid criticism of the host country over a political system which has been overthrown (even if the current regime is repeating many of the same mistakes as under Communism).

I suspect this is outrage is partially motivated by the desire of conservatives to falsely paint liberals as socialists or Communists, such as with the absurd claims that a moderate such as Barack Obama is a socialist. To the conservative mind, the mainstream media represents liberals, especially when they fail to differentiate the evening commentary shows on MSNBC from the rest of NBC. There are rare examples, such as the absurd argument I noted a couple of weeks ago at Salon to nationalize the news media, but putting aside such outliers, there no meaningful interest in Marxist-style socialism or Communism on the left. In contrast, I would think that today’s Republicans would love modern Russia. Between its homophobia and substitution of a plutocracy for a working market economy, Russia has become an example of the end-result of the Republican platform.

Cross posted at The Moderate Voice

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