Bruce Bartlett Argues That Obama Is A Republican

Obama is a Republican

There’s nothing really new here, but it will be interesting to see conservative response to Bruce Bartlett’s article in The American Conservative entitled, Obama Is A Republican. The article is a rehash of how Obama’s record is actually quite conservative, clashing with the conservative myth that he is a socialist. He started with mentioning other Republicans who supported Obama’s election, and next discussed foreign policy:

One of Obama’s first decisions after the election was to keep national-security policy essentially on automatic pilot from the Bush administration. He signaled this by announcing on November 25, 2008, that he planned to keep Robert M. Gates on as secretary of defense. Arguably, Gates had more to do with determining Republican policy on foreign and defense policy between the two Bush presidents than any other individual, serving successively as deputy national security adviser in the White House, director of Central Intelligence, and secretary of defense.

Another early indication of Obama’s hawkishness was naming his rival for the Democratic nomination, Sen. Hillary Clinton, as secretary of state. During the campaign, Clinton ran well to his right on foreign policy, so much so that she earned the grudging endorsement of prominent neoconservatives such as Bill Kristol and David Brooks.

After further discission of foreign policy, he went on to discuss economic policy and the deficit. The most important point is how the deficit has fallen under Obama and how fiscally conservative Obama has been:

With the economy collapsing, the first major issue confronting Obama in 2009 was some sort of economic stimulus. Christina Romer, chair of the Council of Economic Advisers, whose academic work at the University of California, Berkeley, frequently focused on the Great Depression, estimated that the stimulus needed to be in the range of $1.8 trillion, according to Noam Scheiber’s book The Escape Artists.

The American Recovery and Reinvestment Act was enacted in February 2009 with a gross cost of $816 billion. Although this legislation was passed without a single Republican vote, it is foolish to assume that the election of McCain would have resulted in savings of $816 billion. There is no doubt that he would have put forward a stimulus plan of roughly the same order of magnitude, but tilted more toward Republican priorities.

A Republican stimulus would undoubtedly have had more tax cuts and less spending, even though every serious study has shown that tax cuts are the least effective method of economic stimulus in a recession. Even so, tax cuts made up 35 percent of the budgetary cost of the stimulus bill—$291 billion—despite an estimate from Obama’s Council of Economic Advisers that tax cuts barely raised the gross domestic product $1 for every $1 of tax cut. By contrast, $1 of government purchases raised GDP $1.55 for every $1 spent. Obama also extended the Bush tax cuts for two years in 2010.

It’s worth remembering as well that Bush did not exactly bequeath Obama a good fiscal hand. Fiscal year 2009 began on October 1, 2008, and one third of it was baked in the cake the day Obama took the oath of office. On January 7, 2009, the Congressional Budget Office projected significant deficits without considering any Obama initiatives. It estimated a deficit of $1.186 trillion for 2009 with no change in policy. The Office of Management and Budget estimated in November of that year that Bush-era policies, such as Medicare Part D, were responsible for more than half of projected deficits over the next decade.

Republicans give no credit to Obama for the significant deficit reduction that has occurred on his watch—just as they ignore the fact that Bush inherited an projected budget surplus of $5.6 trillion over the following decade, which he turned into an actual deficit of $6.1 trillion, according to a CBO study—but the improvement is real.

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Republicans would have us believe that their tight-fisted approach to spending is what brought down the deficit. But in fact, Obama has been very conservative, fiscally, since day one, to the consternation of his own party. According to reporting by the Washington Post and New York Times, Obama actually endorsed much deeper cuts in spending and the deficit than did the Republicans during the 2011 budget negotiations, but Republicans walked away.

Obama’s economic conservatism extends to monetary policy as well. His Federal Reserve appointments have all been moderate to conservative, well within the economic mainstream. He even reappointed Republican Ben Bernanke as chairman in 2009. Many liberals have faulted Obama for not appointing board members willing to be more aggressive in using monetary policy to stimulate the economy and reduce unemployment.

Obama’s other economic appointments, such as Larry Summers at the National Economic Council and Tim Geithner at Treasury, were also moderate to conservative. Summers served on the Council of Economic Advisers staff in Reagan’s White House. Geithner joined the Treasury during the Reagan administration and served throughout the George H.W. Bush administration.

There is certainly nothing new. Forbes pointed out a couple of years ago how Obama has been the most fiscally conservative president since Eisenhower.It is worth repeating considering how many people have been fooled by the Republican line that Obama and other Democrats, as opposed to the Republicans, are responsible for the size of the deficit.

Bartlett next discussed how Obamacare is based upon old Republican policies proposed by the Heritage Foundation and later Mitt Romney. He discussed at length how the individual mandate was originally an idea which was strongly promoted by Republicans. While Bartlett concentrated on Romney, many other Republicans shared this view.

Bartlett than had briefer discussions of several other issues–drugs, national-security leaks, race, gay marriage, and corporate profits. His argument for Obama being a Republican is weaker on social issues. While Obama took “two long years to speak out on the subject and only after being pressured to do so,” there remains a big difference between Obama keeping quiet on the issue and Republicans who actively promoted bans on same-sex marriage and Obama.

Bartlett concluded with:

I think Cornell West nailed it when he recently charged that Obama has never been a real progressive in the first place. “He posed as a progressive and turned out to be counterfeit,” West said. “We ended up with a Wall Street presidency, a drone presidency, a national security presidency.”

I don’t expect any conservatives to recognize the truth of Obama’s fundamental conservatism for at least a couple of decades—perhaps only after a real progressive presidency. In any case, today they are too invested in painting him as the devil incarnate in order to frighten grassroots Republicans into voting to keep Obama from confiscating all their guns, throwing them into FEMA re-education camps, and other nonsense that is believed by many Republicans. But just as they eventually came to appreciate Bill Clinton’s core conservatism, Republicans will someday see that Obama was no less conservative.

There is considerable truth to what Bartlett wrote, especially if social issues are ignored. However to be less progressive than Cornell West desires is not sufficient to prove someone is a Republican. Anyone who saw Obama as a candidate of the far left, as opposed to being more centrist, just wasn’t paying attention to what he was saying. Of course there is room for disappointment in some of these areas from the left, especially on drug policy and aspects of his foreign policy.

If Obama is said to be governing like a Republican, the key point which would need to be stressed is he is governing as a moderate Republican from the past–something which no longer exists. Obama certainly would not fit in with the Republican Party of today, which has moved to the extreme right. Bartlett is viewing Republicans from the perspective of his days as an adviser to Ronald Reagan and George W. Bush. The reality is that today neither Reagan nor Bush would be sufficiently conservative to survive in the Republican Party. Therefore, while it is ludicrous to consider Obama to be a socialist, or even from the far left, those who share the extreme views of current Republicans are correct in not seeing Obama as one of their own.

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Beware Of Those Politicians Who Spread Fear–We Have No Reason To Fear Ebola As Long As We Respond Sensibly

A mood of fear is engulfing the country which might very well affect the midterm elections. Hopefully people will react rationally and reject the Republicans who promote unwarranted fears, play politics, and advocate for counterproductive responses such as travel bans. Unfortunately but this is not the probable response.

As I discussed last week, even citing a report on Fox, we have no need to fear Ebola as long as proper precautions are taken.

There is no need to panic, or initiate measures which would be counterproductive such as a travel ban at this time. There is no meaningful problem with Ebola in this country and the biology of the virus makes it unlikely we will have a problem in the future. The nature of Ebola makes it a serious problem in countries without a Public Health infrastructure, but not in countries like the United States.

To date we have had exactly one patient with Ebola come into the country beyond medical personnel transported back here. Despite some serious mistakes being made, he did not infect a single person in the general population. The spread was limited to two nurses who cared for him at the most infectious stage, but before this stage the viral load is very low and Ebola is not likely to spread. This is also why, despite people who did come into contact with him having traveled, not a single other person has contracted Ebola.

Ebola is a serious problem in countries without sufficient infrastructure to deal with it, and if we are ever to be at serious risk it would be due to more widespread infection outside of the United States first. Our major focus must be on eradicating Ebola in West Africa, and anything which hinders this will make this more difficult and be counterproductive.

We also must closely track those who have been exposed, and a travel ban would also make this far more difficult. One of the major reasons for Ebola spreading in West Africa is an atmosphere which causes people who have been exposed to hide this until they are very sick and courageous. We must avoid an atmosphere such as this in the United States if we are going to prevent spread here.

We see in Nigeria that Ebola can be beaten, with the country now being free of the disease. Among the measures cited for eradicating Ebola are avoiding fear and keeping the borders open:

Nigeria has not closed its borders to travelers from Guinea, Sierra Leone and Liberia, saying the move would be counterproductive. “Closing borders tends to reinforce panic and the notion of helplessness,” Shuaib said. “When you close the legal points of entry, then you potentially drive people to use illegal passages, thus compounding the problem.” Shuaib said that if public health strategies are implemented, outbreaks can be controlled, and that closing borders would only stifle commercial activities in the countries whose economies are already struggling due to Ebola.

Similarly, Republicans are playing on exaggerated fears of terrorism and unfounded claims that the Affordable Care Act will cause increases in premiums when insurance companies are actually reporting plans for lower premium increases than were the norm prior to Obamacare.

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SciFi Weekend: Doctor Who; Dr. Cotton’s Bizarre Ideas, Boardwalk Empire & The Knick; DC and Marvel Movie Plans; Twin Peaks; The IT Crowd & Other British Adaptations

DoctorWho Flatline

Flatline managed to provide an episode of Doctor Who which successfully combined elements of both horror and humor. While not a totally original idea, it was something not seen on Doctor Who before, and realistically few television shows manage to come up with ideas which have not been influenced by other works. Think of it as if the residents of Flatland by Edwin Abbott Abbott were to invade earth, with a touch of The Adams Family thrown in.

Besides the idea of two dimensional beings invading, there was the added component of the TARDIS shrinking when the “structural integrity is compromised.” This did contradict The Name of the Doctor which showed such leaking to cause the TARDIS to swell in size, not shrink. The shrinking of the TARDIS, with the Doctor trapped inside, did enable Clara to take a leading role in this episode. This whole situation was quite difficult for the Doctor: “I mean this is just embarrassing. I’m from the race that built the TARDIS. Dimensions are kind of our thing.”

The Doctor did win out in the end. Ultimately the aliens from the two dimensional world were defeated by their inability to distinguish a two dimensional picture of a door from a real three dimensional door.

With the Doctor separated from the action for most of the episode, Clara took on the role of the Doctor, including taking on a companion, Rigsy, and calling herself the Doctor:

Rigsy: “What are you the doctor of?”
The Doctor: “Of lies.”
Clara: “Well, I’m usually quite vague about that. I think I just picked the title because it makes me sound important.”
The Doctor: “Why, ‘Doctor Oswald,’ you are hilarious.”

Clara did show Rigsy the inside of the shrunken TARDIS leading to the classic comment, “It’s bigger on the inside.” This set up the Doctor’s response:  “I don’t think that statement has ever been more true.”

Doctor Who Flatline1

Clara also showed that she can act like the Doctor, from using the Sonic Screwdriver to using his tactics:

Clara: “I just hope I can keep them all alive.”
The Doctor: “Ha. Welcome to my world. So, what’s next, ‘Doctor Clara’?”
Clara: “Lie to them.”
The Doctor: “What?”
Clara: “‘Lie to them.’ Give them hope. Tell them they’re all going to be fine. Isn’t that what you would do?”
The Doctor: “In a manner of speaking. It is true that people with hope tend to run faster, whereas people who think they’re doomed …”
Clara: “Dawdle. End up dead.”
The Doctor: “So, that’s what I sound like?”

Ultimately, when Clara asked if she did a good job, the Doctor did respond, “You were an exceptional Doctor, Clara. Goodness had nothing to do with it.” We still have the question from the start of the season as to whether the Doctor is a good man, and whether they are doing good.

The most amusing gag of all in the episode was seeing the Doctor’s full sized hand emerge from the tiny TARDIS to walk it away from an oncoming train.  The episode was very light on Danny Pink, but we did have another amusing scene with Clara talking on the phone with Danny, hiding the fact that she was in danger. The previews do show him taking an active part next week, but it still remains unclear whether we will ultimately see a return to two teachers from Coal Hill School being companions aboard the TARDIS as was teased last summer.

The ending scene with Missy took a different turn from her previous scenes, with Missy saying, “Clara, my Clara. I chose well.” It has already been suggested that it was Missy who gave Clara the Doctor’s phone number back in The Bells of Saint John, but we still have no idea as to what Missy’s overall plan is. Also uncertain is whether this has any connection to Clara’s role in The Name of the Doctor to become fragmented in time and have a role in each of the Doctor’s regenerations.

The writers this season do seem to be writing as if some of the past events have not taken place, almost starting fresh with Clara and the Peter Capaldi Doctor. Even going back to the season premiere in Deep Breath, the Clara who saw each regeneration in The Name of the Doctor should not have been as surprised by seeing the changes in the Doctor after his regeneration. Perhaps the events of The Time of the Doctor, with the Doctor gaining additional regenerations and not dying on Trenzalore, also mean there was never a giant TARDIS tomb for the Doctor and Clara never was fragmented in time. The Missy story line might wind up providing a completely different version of Clara’s life.

The Doctor Who Extra for Flatline is above.

While both the Doctor and now Clara having claimed to be a doctor without formal qualifications, there are some actual doctors who have done considerable harm despite having true medical degrees. One example, Dr. Henry Cotton, has appeared on cable television shows in the past week both on The Knick (at the start of his career and Boardwalk Empire (near the end). He was a real person. Henry Cotton believed that psychiatric problems were based upon infections and his treatment often began with pulling the teeth of psychiatric patients. If this did not provide a cure, then he would proceed to remove other organs which he believed were the cause of the infection. Needless to say, in an age before antibiotics, such unnecessary surgery could have catastrophic results. At one point during his career Cotton even had a nervous breakdown. He responded by pulling his own teeth, then proclaimed himself to be cured and returned to work.

Knowing the factual basis behind Dr. Cotton’s life leaves me concerned about Gillian Darmody’s fate after she told Dr. Cotton that she felt she was cured. We already saw another woman at the asylum undergo surgery, and Cotton would not be likely to accept Gillian’s assessment that she is cured without surgically removing what he believes to be the site of her infection. Being the final season,  Boardwalk Empire does have the ability to show tragic endings for its characters. This included the deaths of two long time characters last week. While Boardwalk Empire is ending, The Knick just ended its first season and has done an excellent job of showing what medical care was like back in 1900 and the development of new ideas such as transfusions.

News came in last week that a cable series which debut last summer, Manhattan, was renewed. While I have not seen the series, I feel comfortable in recommending this show about the development of the atomic bomb based upon several favorable reviews. (Although I have not seen Manhattan yet, do I get any points for reading Joseph Kanon’s novel, Los Alamos, several years ago?)

Still no news on whether Continuum will be renewed.

Episode 101

I would also recommend another new cable series which I did see the premiere of last weekend, The Affair. The main story involves an affair from the viewpoint of both parties, each telling their version for half the episode. We have narrators who are unreliable at least due to the faults in human memory. There might be additional reason for intentional deceit as we found that the stories are being told as part of a possible criminal investigation years afterwards, similar to in the first season of True Detective. It also reminds me of William Landay’s novel, Saving Jacob, in which there are glimpses of future questioning but we don’t know who the accused is or the crime until the end of the novel.

The creator of The Affair, Sarah Treem, discussed the dual narratives in an interview at The Hollywood Reporter:

With Noah and Alison remembering different accounts of the same stories, the series explores the notion of objective truth. Do you think there’s such a thing?

I think there is such a thing as objective truth. There are events that actually happen. As individuals our understanding of what happens is often quite limited. Sometimes the only way to get at objective truth is to have multiple people tell their own version of the same event. It is the job then of the interrogator, the therapist, the audience member, whomever, to basically try to find the commonality between the accounts in order to figure out what actually happened. That’s basically what we’re trying to do with this show. We’re not saying there’s no such thing as truth — there absolutely is — but we don’t think that one person is usually the arbiter of the truth. We think that it comes forward in conversation. There’s this quote, I think it’s from Hegel, but it’s the idea that all understanding is dialectic, meaning that nothing gets understood unless it’s as a result of a conversation. That’s how I think of the two sides of this show, that it’s a conversation from which the audience gains an understanding.

Will we see the perspectives of other characters besides Alison and Noah?

Not this season but maybe in subsequent seasons, if we get them.

We see a lot of overlapping stories that vary slightly depending on who’s telling them. What’s it like to have to regularly write two versions of the same event?

It’s a really fun exercise for a writer. It’s just about putting yourself in another character’s perspective, seeing the scene through the other character’s eyes. For the scene at the end of the pilot [where Alison and Cole have sex on their car], I was interested in writing a scene that looked like an attack on one side, and then coming back into it knowing more about what was actually happening to where all of the sudden the scene plays as a very different negotiation. Writers are trained at this because you’re always approaching the story through somebody’s eyes so it’s just a great, enjoyable exercise to go back and think, “Well, I wrote it this way the first time and now let me jump into a different character’s body and a different character’s mind and let me try it again and just see what happens.”

super-movies

Both Warner (DC) and the various studies which own the rights to Marvel characters have recently released news on their upcoming movie plans. Comics Alliance has more information and has put together the above infographic.

Here is an ambitious list from Warner Brothers:

  • “Batman v Superman: Dawn of Justice,” directed by Zack Snyder (2016)
  • “Suicide Squad,” directed by David Ayer (2016)
  • “Wonder Woman,” starring Gal Gadot (2017)
  • “Justice League Part One,” directed by Zack Snyder, with Ben Affleck, Henry Cavill and Amy Adams reprising their roles (2017)
  • “The Flash,” starring Ezra Miller (2018)
  • “Aquaman,” starring Jason Momoa (2018)
  • “Shazam” (2019)
  • “Justice League Part Two,” directed by Zack Snyder (2019)
  • “Cyborg,” starring Ray Fisher (2020)
  • “Green Lantern” (2020)

Batman v Superman: Dawn of Justice producer Charles Roven recently gave an interview with more information on the movie, including the origin story for Wonder Woman which is being used.

Unlike Marvel, DC is keeping their movie and television universes separate. While Gotham will probably need to be kept in a separate world of its own, Green Arrow, The Flash, and next Supergirl are forming their own television universe. Many fans are angry that Stephen Amell and Grant Guston won’t be appearing as Green Arrow and The Flash in the  Justice League movie. While fans would probably prefer such continuity, it does make it easier to wrote both the television shows and the movies if there is not a need for consistency. We saw how Agents of SHIELD was harmed by a need to postpone mention of HYDRA taking over SHIELD until after Captain America: The Winter Soldier was released.

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Marvel fans are getting more excited by what appears to be planned. While Robert Downey, Jr. has not agreed to do another stand alone Iron Man movie, he may be appearing in Captain America 3, which reportedly involves the two being on opposing sides over the Superhero Registration Act. This could also be the end of Chris Evans as Steve Roberts. of There have also been rumors of Marvel making a deal with Sony, which owns the cinematic rights to Spider-Man, to allow him to appear, which sounds plausible as Spider-Man had a role in this storyline in the comics. Several other Marvel characters are also rumored to be appearing.

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Meanwhile Emma Stone, when not playing the role of Gwen Stacy in Spider-Man, will be playing Sally Bowles on Broadway in Caberet.

With Twin Peaks coming back we have twenty-five years to catch up on. Mark Frost is writing a book to fill in this gap. I am looking forward to see what they do with the series and which characters return. I do hope that Audrey Horne returns and has a daughter who can tie a knot in a cherry stem with her tongue.

The IT Crowd

NBC has commissioned Bill Lawrence (Scrubs) to do a remake of the fantastic British sit-com, The IT Crowd. I have mixed feelings about such attempts to remake UK shows here. NBC’s first attempt at a remake, with cast including Joel McHale, was reportedly a total flop and never aired. NBC also failed in adapting Coupling, another excellent British sit-com written by Steven Moffat.

Fox has  had their own problems in attempting to remake British shows, both with Gracepoint (a remake of Broadchurch) and Us and Them (a remake of Gavin and Stacey).

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Republicans Attack Ebola Czar While Blocking Surgeon General Nomination

On the surface, Republicans have been all over the place regarding the idea of a government official to coordinate handling of Ebola. For example, there’s John McCain. Back in 2009 he attacked Obama over having too many czars:

Then McCain demanded an Ebola czar:

“From spending time here in Arizona, my constituents are not comforted,” Senator John McCain (R-AZ) told State of the Union host Candy Crowley Sunday morning. “There has to be more reassurance given to them. I would say that we don’t know exactly who’s in charge. There has to be some kind of czar.”

So Obama appointed an Ebola czar. Ezra Klein explained why Ron Klain is an excellent choice:

Today, the White House will announce that Klain is being named “Ebola czar.” It’s a good choice because it shows a healthy respect for how hard the bureaucratic job of coordinating the Ebola response really is.

The Ebola response involves various arms of the Department of Health and Human Services (particularly, though not solely, the Centers for Disease Control and Prevention), the Pentagon, the State Department, the National Security Council, the World Bank, the World Health Organization, President Obama’s office, private stakeholders, and many, many more.

The “czar” position requires someone who knows how these different agencies and institutions work, who’s got the stature to corral their efforts, who knows who to call when something unusual is needed, who can keep the policy straight…

Actual government experience is badly underrated in Washington. Politicians run for office promising that they know how to run businesses, not Senate offices. “Bureaucrat” is often lobbed as an insult. But in processes like this one, government experience really matters. Nominating Klain suggests the White House is thinking about this correctly: as an effort that requires the coordination of already ample resources, where the danger is that the federal government will be too slow in sharing information across agencies and getting the resources where they need to go.

John McCain’s reaction to the appointment of an Ebola czar was to again attack Obama for doing what he recommended:

“Frankly, I don’t think Mr. Klain fits the bill, as a partisan Democrat, certainly not in any effort to address this issue in a bipartisan fashion,” McCain said Friday evening on Fox News.

“He has no experience or knowledge or background in medicine,” he added.

McCain is hardly the only Republican with irrational attacks. For example, Steven Taylor has looked at even more irrational attacks from Mike Huckabee. The only common thread to Republican response appears to be a knee jerk opposition to whatever Obama does.

The duties of an Ebola czar are exactly the bureaucratic skills which Klain has, not being a medial expert. Of course there is a position in government which should have a background in medicine, and work closely with the Ebola czar. That would be the Surgeon General–a nomination which Republicans have blocked as Obama’s nominee has shown concern for gun violence.  Now Democrats are demanding that the Senate vote for approval of the Surgeon General nominee:

More than two dozen House Democrats are calling on the Senate to swiftly approve Vivek Murthy’s nomination to serve as surgeon general to help combat the spread of the deadly Ebola virus in the U.S.

Murthy’s nomination got sidelined after Republicans and vulnerable Senate Democrats voiced reservations about the Harvard Medical School physician’s outspoken views on gun violence and public health. But the House Democrats, in a letter set to be released next week, argue that the Obama administration needs a top official in place to help with the Ebola response.

“The American public would benefit from having a Surgeon General to disseminate information that is desperately needed,” the Democrats wrote. “The Surgeon General can also work to amplify the Center for Disease Control’s actions, reassure the American people, and combat misinformation here at home.”

We have around 30,000 deaths due to guns a year in this country, but Republicans would rather ignore this problem, while playing politics and creating hysteria with a disease which so far has resulted in exactly one death in this country.

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Avoiding Panic Regarding Ebola

With some conservatives playing politics with Ebola, it is good to see that Shepard Smith at Fox is being more responsible. See the video above where he explains why there is no reason to panic. Hopefully this will calm down the conservatives who are being incited to panic and see this as reason to vote against Democrats by other conservative voices.

As Shepard Smith explains, there is no outbreak of Ebola in the United States. We had an isolated case of one person with Ebola returning to the United States. Unfortunately, two nurses who cared for him when critically ill contracted the virus. Some mistakes were made. Hopefully what was learned in this case will help reduce the risk of this happening in the future, both in terms of handling patients with Ebola and in monitoring those who care for them. One key point is that Ebola is highly contagious when someone is this critically ill, but it is not contagious before symptoms appear.

Unfortunately far too many people in this country learned epidemiology from The Walking Dead. Some conservatives who otherwise deny evolution are now claiming Ebola could mutate to become an airborne menace–and this is far from the most absurd thing being claimed.

There is no need to panic and initiate bad policy such as a travel ban, which is primarily supported by Republicans.  A travel ban is unlikely to be effective and could have several adverse effects. It could make it harder to treat Ebola at its source. Further spread in West Africa would increase the risk of worldwide spread. Adverse effects on commerce in Africa could make it harder for local governments to deal with the problems. People who came from the region would be harder to track as this would give them motivation to come to the United States by less direct routes and deny possible exposure at borders. Even during the SARS outbreak a decade ago, with a disease which actually is airborne, travel bans were found to be unnecessary and ineffective.

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California Study Debunks Claims That Medicaid Expansion Will Increase ER Utilization Long Term And Excessively Increase Costs

Opponents of the Affordable Care Act and Medicaid expansion have often twisted the results of a study in Oregon showing an increase in Emergency Room utilization after their expansion of Medicaid. Subsequent studies have debunked claims that Medicaid patients are abusing Emergency Rooms and studies of the Medicaid expansion in Ohio showed that better management of the Medicaid patients can lead to better control of chronic disease while limiting Emergency Room use. A new analysis from the UCLA Center for Health Policy Research released Wednesday also specifically debunks claims made based upon the Oregon study, showing that the increase in Medicaid utilization is short-lived. From Kaiser Health News:

While the Medicaid expansion may lead to a dramatic rise in emergency room use and hospitalizations for previously uninsured people, that increase is largely temporary and should not lead to a dramatic impact on state budgets, according to an analysis from the UCLA Center for Health Policy Research released Wednesday.

Researchers reviewed two years of claims data from nearly 200,000 Californians, including a group  who had enrolled in public programs well in advance of the expansion of Medi-Cal,the state’s version of Medicaid, in January. These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults who were not eligible for Medi-Cal at that point but would be when the health law’s expansion went into effect earlier this year. The researchers  divided the group into four categories, based on the researchers’ assessment of each group’s pent-up demand for health care.

In July 2011, after being enrolled in California’s Low Income Health Program, the so-called “bridge to reform,” the group with the highest pent-up demand had a rate of costly emergency room visits triple — or more — that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained “relatively constant,” according to the analysis.

“We were hoping that this would be the case,” said lead author Jerry Kominski, director of the UCLA Center for Health Policy Research, “because we think that that’s what access to care does for low-income individuals … that there’s an additional increase in demand for services and that that demand, or utilization, drops off pretty rapidly.”

Rates of hospitalization for the “highest pent-up demand” group also started high and dropped by almost 80 percent over the two-year period. Curiously, if ER and hospitalization rates were dropping, it’s reasonable that outpatient visits might rise. But that wasn’t the case; the rate of outpatient visits was largely unchanged during the two-year period.

Kominski said that one of the fears of the Medicaid expansion was the potential high cost of low-income patients. He argued that this analysis should ease those fears: “What our findings say to the country is (that) concerns about Medicaid expansion being financially unsustainable into the future are unfounded.” Under the Affordable Care Act, the federal government provides 100 percent of the cost of the newly eligible under the Medicaid expansion, but in 2017 that contribution will phase down until it reaches 90 percent in 2020.

As was the case in Ohio, a key factor in keeping costs down was better coordination of patient care:

One factor in helping drive down the higher rates of use, Kominski said, is better efforts at coordination for Medi-Cal beneficiaries. For example, virtually all Medi-Cal beneficiaries are now enrolled into a Medi-Cal managed care plan. “To the extent that other states don’t have adequate coordinated care mechanisms in place for their Medicaid populations, then the kinds of drop off that we observed in California may not occur there,” Kominski said.

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Media Lets Republicans Get Away With Absurd Statements On Obamacare & Other Issues

Republicans have been successful at “playing the refs” with false claims of liberal bias, helping them get away with spreading their misinformation. Liberal blogs and magazines, have commented a lot on Mitch McConnell’s absurd statement in support of the popular and successful Kynect exchange site while attacking Obamacare, which makes Kynect possible. Fact checkers have debunked this claim months ago. However the mainstream media is paying little attention to this–considerably less than the far less significant refusal of Alison Lundergan Grimes to say who she voted for.

Brian Buetler thinks that the media is largely giving McConnell a pass on this due to failing to understand this, and not really liking to discuss policy. He explained, as so many have in the past, why McConnell is both wrong and dishonest:

During the debate, McConnell said he’d be “fine” with it if Kentucky decided to hold on to Kynect if and when Republicans repeal Obamacare. The subtext of Holmes’s tweet is that Kynect would simply become a hub for the kinds of plans that existed in Kentucky before Obamacare. After all, it’s true there was an insurance market (a non-group market) before there was Obamacare. It could follow that McConnell’s proposition is perfectly reasonable.

But there were also websites before there was Kynect. One of those websites is a Kynect-like exchange called ehealthinsurance.com. Yet somehow, before Obamacare and Kynect came along, it wasn’t processing half a million Kentuckyians a year. The uninsurance rate in Kentucky was extremely high and showed no signs of falling on its own.

That’s because prior to Obamacare, the non-group market was dysfunctional. It excluded and priced out the sick and poor. It offered decent plans to young people who posed minimal health risks, but also sold junk policies that left people who believed they were doing the responsible thing exposed to medical bankruptcy.

It took Obamacare (and, thus, Kynect) to transform that market into something that proved inviting to half of Kentucky’s uninsured population almost overnight. Take away Obamacare, and Kynect might still exist as a website. But it’d be about as useful to Kentuckians as ehealthinsurance was prior to last year. Not totally useless, perhaps, but dramatically diminished and completely superfluous.

You need to know all this if, as a political reporter, you’re going to dismiss the McConnell camp’s spin and call him out as clearly as you (presumably) called out Grimes. Likewise, when McConnell implies that Kentucky could simply replicate the ACA’s private insurance expansion and its Medicaid expansion, you need to know that Kentucky probably couldn’tand certainly wouldn’tever do it on its own. McConnell is suggesting that Kentuckians replace a valuable, paid-for federal benefit with one that would impose steep new burdens on the people of the state alone, knowing it’ll never happen.

Once you grasp it all, then it becomes obvious why McConnell’s contradiction is theoretically so dangerous. He isn’t just painting a shiny gloss on a controversial position. He’s exploiting the public’s confusion over it, playing voters for fools by peddling absurdities. Something that can come to define a campaign just as easily as Grimes’ political cowardice might ultimately come to define hers.

This isn’t the only dishonest statement to come from Republicans in recent debates. Tom Cotton, Republican Senate candidate in Arkansas, made an absurd claim that people with pre-existing conditions were better off before the Affordable Care Act. I happened to listen to the debate in Virginia on C-Span, hearing Ed Gillespie make multiple false claims, such as repeating the Republican lie that Medicare is being cut to pay for Obamacare.

Part of the problem is that many in the media sees their job as “objectively” reporting what each side says, regardless of whether one side is saying far more absurd things. The conventional wisdom this year is that Republicans are doing better because there have not been statements such as Todd Akin talking about “legitimate rape,” but in reality Republicans continue to say many totally off the wall things which are being ignored by the media. Paul Waldman discussed absurd statements which Republicans are getting away with this election cycle and concluded:

…in the last few years, there’s a baseline of crazy from the right that the press has simply come to expect and accept, so the latest conspiracy theorizing or far-out idea from a candidate no longer strikes them as exceptional. Sure, there are exceptions: For instance, Republicans Sharron Angle and Christine O’Donnell both saw their candidacies derailed by their crazy or outsized statements. But their utterances were truly, deeply bizarre or comical, so they broke through.

But during this cycle, Republican crazy just hasn’t broken through at all. It’s almost as if the national press has just come to accept as normal the degree to which the GOP has moved dramatically to the right. At this point so many prominent Republicans have said insane things that after a while they go by with barely a notice. This is an era when a prominent Republican governor who wants to be president can muse about the possibility that his state might secede from the union, when the most popular radio host in the country suggests that liberals like Barack Obama want Ebola to come to America to punish us for slavery, and when the President of the United States had to show his birth certificate to prove that he isn’t a foreigner.

So ideological extremism and insane conspiracy theories from the right have been normalized. Which means that when another Republican candidate says something deranged, as long as it doesn’t offend a key swing constituency, reporters don’t think it’s disqualifying. And so it isn’t.

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The Highly Successful Presidency Of Barack Obama

Paul Krugman has been defending Barack Obama much more recently, such as in a recent article in Rolling Stone and on ABC’s This Week. Krugman’s views on Obama have evolved over the years. I think that early on he was critical of Obama based upon disagreements on policy matters. Two things have altered how he discusses Obama. First there are all the off the wall attacks on Obama from both the right and many mainstream commentators. Secondly, he is doing a better job of separating differences of opinion with a more centrist president from outright condemnation where he disagrees. This includes both recognition of Obama’s actual accomplishments and realization that wherever he disagrees with Obama, the Republicans would be far, far worse.

In Rolling Stone, Krugman looked at the various types of attacks on Obama:

All Obama-bashing can be divided into three types. One, a constant of his time in office, is the onslaught from the right, which has never stopped portraying him as an Islamic atheist Marxist Kenyan. Nothing has changed on that front, and nothing will.

There’s a different story on the left, where you now find a significant number of critics decrying Obama as, to quote Cornel West, someone who ”posed as a progressive and turned out to be counterfeit.” They’re outraged that Wall Street hasn’t been punished, that income inequality remains so high, that ”neoliberal” economic policies are still in place. All of this seems to rest on the belief that if only Obama had put his eloquence behind a radical economic agenda, he could somehow have gotten that agenda past all the political barriers that have con- strained even his much more modest efforts. It’s hard to take such claims seriously.

Finally, there’s the constant belittling of Obama from mainstream pundits and talking heads. Turn on cable news (although I wouldn’t advise it) and you’ll hear endless talk about a rudderless, stalled administration, maybe even about a failed presidency. Such talk is often buttressed by polls showing that Obama does, indeed, have an approval rating that is very low by historical standards.

But this bashing is misguided even in its own terms – and in any case, it’s focused on the wrong thing.

There’s a different story on the left, where you now find a significant number of critics decrying Obama as, to quote Cornel West, someone who ”posed as a progressive and turned out to be counterfeit.” They’re outraged that Wall Street hasn’t been punished, that income inequality remains so high, that ”neoliberal” economic policies are still in place. All of this seems to rest on the belief that if only Obama had put his eloquence behind a radical economic agenda, he could somehow have gotten that agenda past all the political barriers that have con- strained even his much more modest efforts. It’s hard to take such claims seriously.

Finally, there’s the constant belittling of Obama from mainstream pundits and talking heads. Turn on cable news (although I wouldn’t advise it) and you’ll hear endless talk about a rudderless, stalled administration, maybe even about a failed presidency. Such talk is often buttressed by polls showing that Obama does, indeed, have an approval rating that is very low by historical standards.

But this bashing is misguided even in its own terms – and in any case, it’s focused on the wrong thing.

Yes, Obama has a low approval rating compared with earlier presidents. But there are a number of reasons to believe that presidential approval doesn’t mean the same thing that it used to: There is much more party-sorting (in which Republicans never, ever have a good word for a Democratic president, and vice versa), the public is negative on politicians in general, and so on. Obviously the midterm election hasn’t happened yet, but in a year when Republicans have a huge structural advantage – Democrats are defending a disproportionate number of Senate seats in deep-red states – most analyses suggest that control of the Senate is in doubt, with Democrats doing considerably better than they were supposed to. This isn’t what you’d expect to see if a failing president were dragging his party down.

More important, however, polls – or even elections – are not the measure of a president. High office shouldn’t be about putting points on the electoral scoreboard, it should be about changing the country for the better. Has Obama done that? Do his achievements look likely to endure? The answer to both questions is yes.

From there, Krugman looked at Obama’s achievements on health care, financial reform, the economy, the environment, national security, and social change. As Obama has so many favorable accomplishments, I would suggest seeing the original article rather than trying to list them all here. He then concluded:

Am I damning with faint praise? Not at all. This is what a successful presidency looks like. No president gets to do everything his supporters expected him to. FDR left behind a reformed nation, but one in which the wealthy retained a lot of power and privilege. On the other side, for all his anti-government rhetoric, Reagan left the core institutions of the New Deal and the Great Society in place. I don’t care about the fact that Obama hasn’t lived up to the golden dreams of 2008, and I care even less about his approval rating. I do care that he has, when all is said and done, achieved a lot. That is, as Joe Biden didn’t quite say, a big deal.

Andrew Sullivan cited Krugman’s article and added:

Just a year ago, I had a conversation with a friend as the healthcare website was crashing. All that mattered, we agreed, was if, this time next year, the healthcare reform is working and the economy is doing better. Well, both those things have happened – Obamacare is actually a big success so far; the growth and unemployment rates are the envy of much of the Western world – and yet we are now told that he’s a failure. WTF? The architects of the Iraq War – like, yes, Clinton and McCain – somehow believe they have a better grasp of foreign affairs in the twenty-first century than he does. And the party that bankrupted this country in eight short years now has the gall to ignore the fastest reduction in the deficit ever, and a slow-down in healthcare costs that may well be the most important fiscal achievement of a generation.

Add to this two massive social shifts that Obama has coaxed, helped or gotten out the way: marriage equality and the legalization of cannabis. These are not minor cultural shifts. They are sane reforms, change we can absolutely believe in and have accomplished on his watch. Jihadist terrorism? It has murdered an infinitesimal number of Americans in the past six years, compared with almost any other threat. Yes, Americans are still capable of PTSD-driven panic and hysteria over it, and Obama has failed to counter that more aggressively, but to be where we are in 2014 is something few expected after 9/11.

The idea that he has “lost Iraq” is preposterous. We “lost” Iraq the minute we unseated the Sunnis, disbanded the Baathist army and unleashed the dogs of sectarian warfare.

The only sane response to continuing unrest there is to cut our losses, act as an off-shore balancing power, and protect ourselves. And one reason we have this capability is that Obama managed to pivot nimbly last fall to ensure the destruction of Assad’s WMDs. The Panettas and McCains and usual suspects still seem to believe that it would have been better to have bombed Assad, let him keep his WMDs, and … what exactly? Can you imagine ISIS with its hands on those weapons in a failed state with a deposed leader? Think Libya today with poison gas. Who prevented this? Obama. And he is still pilloried for it.

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Ebola Spreads To Nurse and Is Affecting Chocolate Supplies (Updated)

It has been a day for bad news related to Ebola. The more serious concern is the apparent transmission of Ebola to a nurse caring for the patient in Texas despite wearing protective gear. It is of concern that these precautions did not prevent the spread to this individual (although it now is reported to have been due to a breach in protocol), but it is at least encouraging that surveillance efforts were successful and the person was quickly identified and precautions taken against further spread.

John McCain, a member of the party which has been protesting the number of czars in the Obama administration, has now called for an Ebola Czar. Perhaps as a first step, the Republicans should reconsider their actions in blocking the appointment of Obama’s nominee as Surgeon General.

On top of this is the news that Ebola could affect supplies of chocolate:

Ebola is threatening much of the world’s chocolate supply.

Ivory Coast, the world’s largest producer of cacao, the raw ingredient in M&M’s, Butterfingers and Snickers Bars, has shut down its borders with Liberia and Guinea, putting a major crimp on the workforce needed to pick the beans that end up in chocolate bars and other treats just as the harvest season begins. The West African nation of about 20 million — also known as Côte D’Ivoire — has yet to experience a single case of Ebola, but the outbreak already could raise prices…

The market is worried, too. Prices on cocoa futures jumped from their normal trading range of $2,000 to $2,700 per ton, to as high as $3,400 in September over concerns about the spread of Ebola to Côte D’Ivoire, noted Jack Scoville, an analyst and vice president at the Chicago-based Price Futures Group. Since then, prices have yo-yoed down to $3,030 and then back to $3,155 in the past couple of weeks.

While not yet time to panic, are we now in danger of seeing riots at the supermarkets and hoarding of chocolate?

(Original post updated with further information on the case in Texas and John McCain’s call for an Ebola Czar.)

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Republican Tactics Of Fear And Voter Suppression

Republicans, lacking a real agenda or any solutions to problems, are basing their campaign this year on a combination of fear and voter suppression. They are even trying to politicize Ebola with threats that it will cross our borders (along with people of other colors) and even mutate to become airborne to attack us. (Does their belief that Ebola will change into an airborne infection suggest a new found belief in evolution for some?) First Read writes:

…these advertisements we’re seeing (here, here, and here) go well beyond faith in institutions or government competence. They’re about fear. And frankly, they come when there’s no evidence of ISIS coming across the border and when (remarkably) there’s still been just one confirmed case of Ebola in the United States. Now we understand why Republicans are picking up this theme — they want to nationalize the election, and they have every incentive to. (The more they get voters going into the voting booth upset at Washington, the more likely they are to get Republicans defeating Democratic incumbents in Senate races.) But some of these candidates are walking a fine line; there is a Chicken Little aspect here regarding Ebola and it can border on the irresponsible.

The New York Times reports:

Playing off feelings of anxiety is a powerful strategy for motivating the Republican base. And few issues have proven as potent when linked together as border security and the fear of terrorism. Representative Duncan Hunter, Republican of California, said this week on Fox News that border agents had told him they apprehended 10 Islamic State fighters in Texas. The Department of Homeland Security said his statement was “categorically false.”

Fear has always been a centerpiece of Republican strategy. They scare poorly educated white males into fearing that minorities and women will take their money. They scare Republican voters into believing that Democrats will take away their guns and their bibles. More recently they have been concentrating on fear of Obamacare, even if every single one of their predictions of dire consequences has failed to come about.

Republicans rely upon fear to get their supporters to turn out to vote, and resort to voter suppression to try to keep Democrats from voting. As the GAO reported, Republican-supported voter ID laws aimed at voter suppression result in fewer minorities and young people voting. Fortunately the Supreme Court has thrown out voter ID laws in Wisconsin and Texas, but they have also allowed a law to stand in North Carolina.

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