Washington Post Editorial Board Spreading Fictions About Bernie Sanders

Washington Post Logo

The Washington Post has carried op-eds both in support of Bernie Sanders and in opposition to him. I looked at a couple of them yesterday. The  Post followed this up with an editorial full of right wing attacks on Sanders which were out of touch with reality. Bernie Sanders has responded:

At a breakfast with reporters here Thursday that was hosted by Bloomberg Politics, Sanders fired back — again and again and again.

“That’s not a new argument. We’ve been hearing that months and months, and that’s in a sense what this campaign is about,” Sanders said in response to a request for his reaction to the editorial. “People are telling us, whether it’s the Washington Post editorial board or anybody else, our ideas are too ambitious — can’t happen. Too bold — really? Well, here’s something which is really bold. In the last 30 years, there has been a massive transfer of wealth from the middle class and working families of this country. The middle class has become poorer and trillions of dollars have been transferred to the top one-tenth of 1 percent.”

“That’s pretty radical, isn’t it?” Sanders said. “Where was The Washington Post to express concern that the middle class was shrinking?”

…When he was asked about foreign policy, Sanders detoured: “Getting back to The Washington Post — check out where all the geniuses on the editorial page were with regard to the invasion of Iraq.” (They supported it.)

At another point: “I know The Washington Post may think I’m radical, but I’m not.”

More on Sanders’ response at Common Dreams.

Just as The Washington Post was wrong on the facts when they supported the Iraq war and in ignoring the economic meltdown, they totally botched the health care issue:

He admits that he would have to raise taxes on the middle class in order to pay for his universal, Medicare-for-all health-care plan, and he promises massive savings on health-care costs that would translate into generous benefits for ordinary people, putting them well ahead, on net. But he does not adequately explain where those massive savings would come from. Getting rid of corporate advertising and overhead would only yield so much. Savings would also have to come from slashing payments to doctors and hospitals and denying benefits that people want.

He would be a braver truth-teller if he explained how he would go about rationing health care like European countries do. His program would be more grounded in reality if he addressed the fact of chronic slow growth in Europe and explained how he would update the 20th-century model of social democracy to accomplish its goals more efficiently. Instead, he promises large benefits and few drawbacks.

Medicare for All is not a program which Sanders has pulled out of the air. Supporters of health care reform have discussed this for years. It is not difficult to see where the savings would come from. To begin with, Medicare is much more efficient in the use of health care dollars than the private insurance industry. This isn’t just about getting rid of corporate advertising and some overhead costs. This is about eliminating the vast amount of money spent on the health insurance industry and the huge profits they make. This is all money which would be better spent on health care for Americans.

Rationing? These days all health care payers have restrictions on what they will pay for. We already have rationing, and often it is the private payers which are more restrictive than the government Medicare program.

Some of the savings will come from the fact that Medicare often pays less than private insurance. Despite this, there is good reason why many of us doctors support the plan. The secret is that we believe we will come out ahead financially with Medicare for All. Here’s why–

Back in the old days, a medical practice would typically have one biller. Now things are much more complicated. Many practices need to pay additional people to handle the billing because of the complexity of handling different rules from each payer–and the billers are very likely the highest paid non-medical employee in any medical practice you step foot in. It gets even worse. We also have to have employees to handle getting prior authorizations from different payers for tests, procedures, and prescriptions, again dealing with multiple sets of rules. On top of all this, a growing amount of payment to physicians comes from incentive payments which come from not only practicing medicine as required, but having somebody enter all the data into the insurance company computer systems. Again, each payer has their own set of rules, often requiring more than one employee to handle them. Plus it is a headache to try to keep track of all the rules from each payer.

Just compare this to the overhead of a medical practice in Canada, which has a single payer plan similar to Medicare for All.

Plus if we have Medicare for All, we will no longer have to worry about bad debts from uninsured patients, and receiving payments significantly lower than from Medicare on patients with Medicaid. It is a win financially for many physicians, as well as for most Americans who will no longer have the large insurance premiums and out of pocket expenses they now face.

The Washington Post also questions whether Sanders  can pass his agenda. Whether or not he can is a fallacious reason not to support him. Sanders’ supporters see what Sanders speaks about as being a description of his long-term goals, not a set of promises to be completed his first hundred days in office. With our current grid lock in Washington, no candidate will be able to quickly get their goals through Congress, but I see Sanders has having a far better chance of bringing in members of Congress who will support him than Clinton. If Clinton is the nominee, my bet is that many people will split their ticket, wanting members of the other party to keep an eye on a president they know is untrustworthy.

Plus the important thing in voting for a president is over matters more directly under the control of the president. Sanders is far less likely to get us involved in unnecessary wars than Clinton or the Republican candidates. Sanders is more likely to reform the surveillance state and back away from the drug war. A Sanders Justice Department will treat those who violate the law on Wall Street far different than I would expect a Clinton Justice Department to respond.

It is The Washington Post, not Bernie Sanders, which is spreading fictions.

Ben Carson Doesn’t Know Any More About Health Care Policy Than He Knows About The Constitution Or Foreign Policy

Ben Carson Health Plan

You might know Ben Carson as the ignorant theocratic who does not understand the Constitution of the United States or understand separation of church and state. Or you might know him as the Republican who had been challenging Donald Trump for leadership in the GOP race until it became apparent that he didn’t know a thing about foreign policy. Today we were introduced to a new Ben Carson–a doctor who doesn’t have any idea how to formulate a health care plan.

Carson tried to distract from his ignorance about other matters by introducing his health care plan (copy here). There are far more pictures than detailed policy in the pdf. There is a lot of talk about hating Obamacare and of providing a market solution–two lines which Republicans love but which don’t hold up too well if you think about them. The whole reason for Obamacare was that the market was not able to handle providing health care coverage. We wound up with perverse profit motives which led insurance companies to try to profit by denying care and eliminating coverage from those who were sicker.

Carson’s plan relies on “health empowerment accounts,” which are essentially another name for health savings accounts–which people can already purchase with high deductible plans under Obamacare (which is exactly what I have done). Except if you get rid of Obamacare, you also get rid of the preventative care covered without out of pocket expenses, the subsidies to help people afford it, coverage for young adults on their parents’ plans, and the guarantee that nobody can be denied coverage.

The biggest folly in Carson’s plan is to gradually increase the eligibility age for Medicare from 65 to 70. We should be doing the reverse–gradually lowering the eligibility age. (Or better yet, go with Bernie Sanders’ plan and offer Medicare for All right now). Our traditional private health care insurance has generally worked for the young (unless they got really sick and became as expensive to care for as the elderly). The problem has been with covering people as they get into their 40’s and 50’s and start developing more medical problems which private insurance companies would rather not deal with.

Medicare handles the chronically ill much better. Originally this problem might have been dealt with under the Affordable Care Act with either a public option modeled on Medicare or a buy in for Medicare. For the benefit of those who have forgotten the details surrounding the fight to enact the Affordable Care Act, the two most conservative Senators voting with the Democrats, Joe Lieberman and Ben Nelson, would only vote for Obamacare if these ideas were dropped, and there were no votes to spare with the Republicans one hundred percent united in voting against it.

Carson’s idea to increase the eligibility age of Medicare to 70 is awful, although that might not be the worst part of the plan. Carson also wants to replace the government Medicare plan with private insurance companies. Everyone would get a fixed contribution from the government towards purchasing a plan. Presumably if the fixed contribution is not enough to purchase an adequate plan they would be on their own (with their health empowerment plan, if there is enough there), but to conservatives that’s freedom. Medicare patient’s already have the option of a private plan instead of the government plan. We have found that it costs fourteen percent more to care for patients under the private plans than under the government plans–so much for greater efficiency in the private sector.

Brain surgery, along with rocket science, was once considered among the most difficult of intellectual pursuits. Now that America has become familiar with neurosurgeon Ben Carson, we will have to reconsider that idea.

Nation’s Largest Organization of Nurses Joins Liberal Writers In Protesting Hillary Clinton’s Attacks On Bernie Sanders

National Nurses Union Medicare For All

Hillary Clinton’s sharp move towards the right has many liberals questioning how much further right she will move in the general election, and if elected president. Her recent attacks on Bernie Sanders for his advocacy of a single payer health plan, which as I have noted she once supported, has resulted in considerable criticism from the left and a major nurses organization.

Jonathan Cohn, Senior National Correspondent at The Huffington Post asked, Why is she talking like a Republican? He also pointed out, “This is why Hillary Clinton makes so many progressives queasy.” Jim Newell at Slate wrote, Hillary Is Already Triangulating Against Liberals: Her new attack on Bernie Sanders’ single-payer health care plan shows her indifference to progressive voters. He pointed out that “she is a Clinton, and this is what they do.”

National Nurses United, which previously endorsed Bernie Sanders for president, has issued a press release to respond to Clinton’s attacks on Sanders over his support for a single payer plan:

National Nurses United, the largest U.S. organization of nurses, condemned the Hillary Clinton campaign today for its attack on Sen. Bernie Sanders’ proposal for healthcare for all, including its slanted use of data on the economics of Medicare for all.

“Any politician that refuses to finance guaranteed health care has abandoned my patients, and I will never abandon my patients. That’s why we support improved Medicare for all, and that’s why I support Bernie Sanders,” said NNU Co-President Jean Ross, RN.

“While the Affordable Care Act corrected some of the worst injustices in our insurance, profit-based healthcare system, the work of healthcare reform is far from done,” said Ross. “Today, 33 million Americans remain uninsured. Tens of millions more remain underinsured, facing bankruptcy due to unpayable medical bills or the choice of getting the care they need or paying for food or housing for their families.”

“The only fix for our broken system once and for all is the prescription Bernie Sanders has so eloquently presented – joining the rest of the world by expanding and updating Medicare to cover everyone,” Ross said.

NNU also criticized Clinton for citing a rightwing report first published in the Wall Street Journal on the inflated cost of $15 trillion to implement a Medicare for all system. The Journal report claimed as its source research by University of Massachusetts Amherst economics professor Gerald Friedman.

But Friedman himself has criticized the Journal report, noting in a Huffington Post column that the “economic benefits from Senator Sanders’ proposal would create dynamic gains by freeing American businesses to compete without the burden of an inefficient and wasteful health insurance system.”

Those include a “productivity boost coming from a more efficient health care system and a healthier population, [that] would raise economic output and provide billions of dollars in additional tax revenues to offset some of the additional federal spending,” said Friedman.

Friedman estimates nearly $10 trillion in savings while still reducing national health care spending by over $5 trillion. “With these net savings, the additional $14.7 trillion in federal spending brings savings to the private sector (and state and local governments) of over $19.7 trillion,” Friedman wrote.

Clinton is “ignoring the enormous savings that would come by assuring people could get proper care where and when they need it,” Ross added.

For example, a report out just last week noted $6.4 billion in lost wages and productivity in low income communities through premature deaths due to colon cancer, according to researchers at the Centers for Disease Control and Prevention.

“Dismissing the yearning of millions of Americans for a more humane healthcare system not based on ability to pay, and relying on a disputed data is disgraceful,” said Ross. “It’s a reminder again why nurses across the U.S. have been rallying and campaigning for a candidate who will never stop fighting for guaranteed healthcare for all.”

I further discussed Clinton’s fallacious attacks on Sanders here.

By attacking Sanders from the right on health care and economic policy, along with reminding the left how hawkish she is in her recent speech at the Council on Foreign Relations, Clinton risks seeing progressive voters refuse to vote for her.

Conor Lynch at Salon warns that Hillary Clinton is playing a dangerous game: How her anti-Bernie talking points could cost her — and America — big time. He began, “Hillary Clinton is starting to remind progressives why the name Clinton brings up such a mixed bag of emotions, and why it’s so hard to believe Clinton’s pivot to the left this campaign season.”He concluded:

But Clinton is making it harder for progressives to support her. With a history of hawkish foreign policy and Wall Street backing, she truly is the lesser to two evils. (A neoliberal is better than a fascist, after all [referring to Donald Trump]) But many on the left tend to vote with their conscience, and going after single-payer healthcare and hurling dishonest attacks on Sanders will only alienate progressives further.

Her problem is also not likely to be limited to progressive voters. When Clinton campaigns as a Republican-lite, many potential Democratic voters are not going to see very much reason to turn out to vote, risking the same fate for Democrats as they suffered in 2014.

Clinton Attacks Sanders On Progressive Agenda Including Single Payer Health Care

BernieSanders-Healthcare2

Hillary Clinton distorted the meaning of single payer health plans in the second Democratic debate and is continuing to attack Sanders’ progressive agenda on the campaign trail. Politico reports, “Three days after the fairly cordial second Democratic debate, Clinton’s campaign is mounting an attack against Sen. Bernie Sanders for proposals to raise taxes on the middle class that were part of the national single-payer health care bills he introduced in Congress.”

As Jonathan Cohn, Senior National Correspondent at The Huffington Post asks, Why is she talking like a Republican? He also points out, “This is why Hillary Clinton makes so many progressives queasy.”

Sanders’ campaign responded:

“On Medicare for all, the middle class would be far better off because it would save taxpayers money,” Sanders spokesman Michael Briggs said in response to Clinton’s latest line of attack. “More people would get better care at less cost. Didn’t she used to be for that? We wouldn’t throw money away on costly premiums for profit-making private insurance companies. Pharmaceutical companies would no longer be able to rip off Americans with the most expensive prescription drugs in the world. Didn’t she used to be for that?”

“Secretary Clinton has singled out Senator Gillibrand and praised her [family leave] legislation which, it turns out, Secretary Clinton now refuses to support because of the way it’s paid for,” Briggs added, noting it requires a small tax hike on the middle class. “No wonder people have their doubts about her.”

His campaign web site has further information:

What’s the Truth About the Clinton Campaign False Attacks?

The truth is that a single-payer plan will save American families money and provide universal health care.

Under the legislation offered by Sen. Sanders in 2013, families with taxable income under $250,000 a year (individuals under $200,000) would pay a tax of 2.2 percent of taxable income.

That means a family with a taxable income of $100,000 a year would pay $2,200 a year – but would be relieved of paying any private health insurance premiums and any copayments or deductibles.

A family making $50,000 would pay $1,100 a year.

The page also notes that, “The Clinton campaign received more contributions from the pharmaceutical industry than any other – Republican or Democrat – through the first six months of the campaign.”

Clinton’s attack sounds like a  repetition of attacks on Sanders in The Wall Street Journal in September. Physicians For A National Health Program responded:

In a front-page Wall Street Journal article a few days ago, the projection was made that a single-payer national health insurance program (NHI), as part of the presidential campaign of Senator Bernie Sanders (I-VT), would cost $15 trillion over ten years. Accurate though that figure is, this under-researched article conveys disingenuous misinformation to a broad readership that might be inclined to dismiss such a program as too expensive to even consider.

This article is irresponsible in what it doesn’t say— what the savings would be of reining in our current wasteful, overly bureaucratic profit-driven medical industrial complex, and the benefits that NHI would bring to our entire population compared to what we have now or have ever had.

Thanks to a landmark study in 2013 by Gerald Friedman, Professor and Chairman of the Department of Economics at the University of Massachusetts, we have a solid financial analysis of the costs and benefits of a single-payer national health plan. With NHI, $592 billion would be saved annually by cutting the administrative waste of some 1,300 private health insurers ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). These savings would be enough to cover all of the 44 million uninsured (at the time of his study) and upgrade benefits for all other Americans, even including dental and long-term care. A single-payer public financing system would be established, similar to traditional (not privatized) Medicare, coupled with a private delivery system. Instead of having to pay the increasing costs of private health insurance, so often with unaffordable deductibles and other cost-sharing, patients would present their NHI cards at the point of service without cost-sharing or other out-of-pocket costs. Care would be based on medical need, not ability to pay…

There is far more on this in the full post. Common Dreams adds:

Sanders’ embrace of a single-payer system—also widely backed by the American public—earned him the endorsement of the National Nurses United (NNU), the nation’s largest organization of nurses. NNU Executive Director RoseAnn DeMoro said in August that his ” issues align with nurses from top to bottom,” including his “insist[ance] that healthcare for everyone is a right not a privilege.”

Clinton Flip Flop

There is added irony in that this is yet another flip-flop from Hillary Clinton. She has flip-flopped on some selective economic issues to try to attract progressive support, and she has flip-flopped on gun control.  As I recently posted, some of her statements on gun legislation were  like the views from Sanders which she attacks. At other times she has taken a more conservative viewpoint.  As Martin O’Malley pointed out during the second debate, she has held at least three views, portraying herself  “as Annie Oakley and saying we don’t need those regulations.” Clinton has also supported a single payer plan in the past. This is from Clinton in 1994, both supporting single payer and showing no objection to a general tax to fund it (emphasis mine):

..I believe, and I may be to totally off base on this, but I believe that by the year 2000 we will have a single payer system. I don’t think it’s — I don’t even think it’s a close call politically.

I think the momentum for a single payer system will sweep the country. And regardless of the referendum outcome in California, it will be such a huge popular issue in the sense of populist issue that even if it’s not successful the first time, it will eventually be. So for those who think that building on the existing public-private system with an employer mandate is radical, I think they are extremely short-sighted, but that is their choice.

There are many ways to compromise health care reform, and I don’t think that the President could have been clearer in every public statement he has made that he has one bottom line. It is universal coverage by a date certain. And he has basically told the Congress, you know, you’ve got different ways of getting there. Come to us, and let’s look at it. There are only three ways to get to universal coverage. You know, a lot of people stand up and applaud universal coverage, and they sit down, and you say, “Well, how are you going to get there?”, and they don’t want to confront that there are only three ways.

You either have a general tax — the single payer approach that replaces existing private investment — or you have an employer mandate, or you have an individual mandate. And there isn’t any other way to get to universal coverage. The market cannot deliver universal coverage in the foreseeable future, and any compromise that people try to suggest that would permit the market  to have a few years to try to deliver universal coverage without a mandate that would take effect to actually finish the job will guarantee a single payer heath care system.

Or maybe we are just dealing with ignorance of the topic as opposed to flip-flopping.  Physicians For A National Health Program pointed out her confusion on Medicare for All as a model for single payer plans displayed in an interview in The New York Times in 2008:

Q: Last question. You talked earlier in the interview about how your plan maintains the private insurance system. But in October, at the forum of the Kaiser Family Foundation, you were asked whether your plan to make government insurance, a Medicare-type plan, available to all was a backdoor route to a single payer system, and you said, “What are we afraid of? Let’s see where the competition leads us.” So is it okay with you if the market ultimately dictates that the U.S. system sort of morphs into a single-payer system? And if so, doesn’t that arm the Republicans with exactly what you were talking about, this claim that it’s socialized medicine?

MRS. CLINTON: No, because I think what we would be offering would be a Medicare-like system, which is something people are familiar with, and you know whether we would call it Medicare 2.0 or whatever we would call it. And we’d see whether people want that or not. And where it morphs to, I think this whole system will morph. I mean, look at where Medicare started and where it is today. In large measure, some of the problems we have are because of the way it evolved. But I think from my perspective, having this Medicare-like alternative really does answer the desires of people. And there’s a significant minority who want quote a single-payer system. It at least gives them the feeling it’s not for profit, they’re not paying somebody a billion dollars for raising their premiums 200 percent and all the rest of the problems that we face with the for-profit system. You get the costs of overhead and administration down as much as possible. I believe in choice. Let Americans choose and what better way to determine that than letting the market have some competition and you know see where it does lead to.

Q: And if the choice is a single-payer system, that’s fine by you?

MRS. CLINTON: You know, I think that would be highly unlikely. I think that, you know, there’s too many bells and whistles that Americans want that would not be available in kind of a bare-bones Medicare-like system but I think it’s important to have that competition.

Comment:

By Don McCanne, MD

Competition between a bare-bones Medicare-like plan versus private bells-and-whistles insurance? What kind of framing is that!?

In her proposal, is she really advocating for a public Medicare-like option that provides only bare-bones coverage? That’s certainly not the model that single payer advocates propose.

Is she suggesting that the private insurance industry will be able to provide us with an insurance product that includes all of the bells and whistles at a premium that is affordable? If such a plan were to be offered it would have a very small market limited to only the wealthiest of us. Insurers typically shun small markets.

On this issue, at least, it looks like Clinton has been moving to the right over the years.

I could understand a politician not pursuing a single payer plan because of the political obstacles in getting it passed. It is a totally different thing when Hillary Clinton repeats right wing talking points to attack Sanders for desiring a single payer plan, especially when she once had a far more liberal view on the subject.

Update: Nation’s Largest Organization of Nurses Joins Liberal Writers In Protesting Hillary Clinton’s Attacks On Bernie Sanders

Donald Trump Continues To Threaten To Run As Third Party Candidate

DONALD-TRUMP

Last week I pointed out that Donald Trump was refusing to rule out running as a third party candidate. Several days later The Hill  received the same response in another interview:

Donald Trump says the chances that he will launch a third-party White House run will “absolutely” increase if the Republican National Committee is unfair to him during the 2016 primary season.

“The RNC has not been supportive. They were always supportive when I was a contributor. I was their fair-haired boy,” the business mogul told The Hill in a 40-minute interview from his Manhattan office at Trump Tower on Wednesday. “The RNC has been, I think, very foolish.”

Pressed on whether he would run as a third-party candidate if he fails to clinch the GOP nomination, Trump said that “so many people want me to, if I don’t win.”

“I’ll have to see how I’m being treated by the Republicans,” Trump said. “Absolutely, if they’re not fair, that would be a factor.”

Typically primary candidates remain in the race until they drop out of money. Donald Trump differs as he will not run out of money, not being dependent upon contributions from others. He has the ability to remain in the race as long as he desires–including after the conventions are over if he should feel that the RNC has been unfair to him.

While polls continue to show Trump with a lead (which might not last much longer after his comments on John McCain) for the Republican nomination, he is also among the weakest Republican candidates in head to head match ups against Hillary Clinton. A Washington Post/ABC News poll gives a clue as to what it would mean if Trump were to run as a third party candidate:

The survey shows that in a hypothetical three-way race, Clinton is at 46 percent, Bush is at 30 percent and Trump is at 20 percent among registered voters.

Trump takes more support away from Bush than Clinton in such a contest. In a head-to-head matchup, Clinton tops Bush by 50 percent to 44 percent among registered voters.

The current polls suggest that the Republicans will lose if they nominate Trump, or if someone else wins and Trump decides to run as a third party candidate. These numbers can change quite a bit by next November, but in this poll the vast majority of the votes taken by Trump come at the expense of the Republican candidate, and I would expect that pattern to continue. Possibly the magnitude of Trump’s vote will decrease by then, but this suggests there is an excellent chance that he could take at least five to ten points from the GOP candidate, which would probably tip the balance towards the Democrats should the race become closer (as other polls suggest it might be).

The same pattern is likely to also hold should Sanders or someone else manage to beat Clinton for the Democratic nomination, or someone other than Bush be the Republican candidate. It is certainly premature to assume Bush will be the Republican nominee. If he is, the Democratic candidate might not need any help from Trump in winning if Bush keeps taking about phasing out Medicare.

Single Payer Coming?

It looks like we might be heading in the direction of a single payer health care system, but note in the way we wanted. Aetna is seeking to buy Humana. While this would not actually be single payer, it would further decrease competition in the insurance industry. There is also speculation that UnitedHealth is interested in purchasing Cigna and Aetna. Instead of a single=payer system modeled on Medicare, we could wind up with a more monopolistic system, which should please Republicans. These purchases would be subject to anti-trust review.

Aetna purchasing Humana would also give Aetna a much larger share in the Medicare Advantage market. So much for George Bush’s plan to supposedly increase competition and choice for Medicare patients. The plan has was more designed as a reward to the insurance industry for all the contributions they have made to the Republicans.

In related news, The New York Times repeated misleading information on health care rates which I previously discussed. Only plans desiring rates over ten percent are required to submit their requests. Insurance companies have multiple plans, and are only seeking increases on some plans, leaving less expensive choices for those who take advantage of the exchange to compare plans. Plus the requests for larger rate increases will not necessarily be granted.

However, should private insurance rates still be too high, single payer remains the most cost-effective means of providing health care coverage. This could turn into a major issue in Bernie Sanders’ favor.

Americans Generally Satisfied With Healthcare Costs But Those On Medicare Are Happier Than Those With Private Insurance

A Friday afternoon news dump is not always bad news. Gallup released a poll under this headline on Friday: As ACA Takes Effect, Majority OK With Personal Health Costs. Gallup reported, “Nearly six in 10 Americans (57%) say they are satisfied with the total cost they pay for healthcare, on par with other readings over the last five years. So far, there is little indication that the Affordable Care Act (ACA), also known as ‘Obamacare,’ has affected the way Americans view their healthcare costs, either positively or negatively.”

Gallup Insurance Satisfaction

Note that the graph above shows very little change over time, with the current numbers very close to when Obama took office. Satisfaction did increase slightly in 2014, presumably because of more people having coverage thanks to the Affordable Care Act.

Satisfaction increased by age, essentially correlating with reaching age 65 and having Medicare. The assumption that those who are older are more satisfied because they have Medicare is verified when the results are broken down by type of insurance. Satisfaction with costs  is at 74 percent among those with Medicare or Medicaid, compared to 58 percent with those on private insurance. Note that another recent study did show that overall satisfaction was much closer than this poll on satisfaction with costs. Out of pocket payments for those on Medicare are typically significantly lower than those covered by private insurance, except for those with the most generous employer-paid plans.

Gallup Insurance Satisfaction by Age

Other findings were that people were generally satisfied with the quality of health care but less satisfied with healthcare coverage as a whole in the United States compared to other countries. Gallup concluded:

U.S. adults holding health insurance via a private insurance plan are about as likely to rate their coverage positively (77%) as Americans holding either Medicare or Medicaid (75%), suggesting both groups are about equally happy with their plans. But, as noted earlier, Medicare and Medicaid holders are far more satisfied with the cost of their plan.

As Gallup has found in the past, Americans are far less effusive with their praise for healthcare coverage in the U.S. as a whole. This year is not an exception: Fewer than four in 10 Americans now rate healthcare coverage in the U.S. as excellent or good.

Before passing the ACA, the large majority of Americans who had health insurance were broadly satisfied with their medical care and coverage and their healthcare costs. Thus, a major test of the ACA will be whether it succeeds in expanding affordable healthcare to the previously uninsured while doing “no harm” to the large majority of Americans who are already highly satisfied with their healthcare coverage. So far, the verdict is positive. Gallup finds no decrease in insured Americans’ satisfaction with their healthcare services and their costs. At the same time, the uninsured are as negative as ever, but their numbers have dwindled. Gallup’s annual November updates of these trends will monitor whether this positive outcome persists as implementation of the ACA progresses.

Republicans have backed high deductible plans as a way to restrain health care costs for quite a long time. Now that they got what they want with plans sold on the exchanges (like plans previously sold in the individual market) generally having high deductibles, they have been using this as a line to attack Obamacare. If this is the main objection, rather than cowering in the face of attacks on the ACA, Democrats might be better off taking advantage of this as a reason to push for the type of single payer plan that most liberals supported before Obama compromised and promoted what was previously a Republican health care plan.

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.

Two Successes For Obamacare In Reducing Health Care Costs

Two stories today show further areas where the Affordable Care Act was successful, with both helping to reduce health care costs. While conservatives claim that Obamacare is a government takeover of health care, it actually expands market choices. In the past it was very common for one insurance company to dominate an area, contributing to high prices. Selling health policies through exchanges, and expanding the market of those having coverage, is leading to more insurance companies which plan to sell insurance. From Kaiser Health News:

The number of health insurance companies offering plans in the marketplaces this fall will increase by 25 percent, giving consumers more choices for coverage, Health and Human Services Secretary Sylvia Burwell announced Tuesday.

When the marketplace enrollment reopens in November, 77 new insurers will be offering coverage in the 44 states for which HHS had data, which includes the 36 states that use the federal marketplace and eight states that run their own, the department reported.

The number of competitors on the marketplaces is considered important because it signifies the vitality of the exchange and can mean increased competition and lower prices for consumers. It also means that insurers see the health law’s online marketplaces or exchanges, as a good business opportunity, senior HHS officials said…

Burwell sought to cast the increase as one of a number of recent announcements suggesting that the 2010 health law has been successful in improving health care options for Americans.  She pointed to figures announced last week that 7.3 million people who signed up for the exchanges and paid their premiums, findings that HHS released Monday that 8 million people enrolled in Medicaid or the Children’s Health Insurance Program since the beginning of open enrollment last year, and a 26 percent reduction of uninsured adults.

“I think we need a bit of a course correction in this country when it comes to how we talk about these issues — and it starts with collectively turning down the volume a bit,” she said. “Surely, we’d all agree that the back-and-forth hasn’t been particularly helpful to anyone — least of all the hardworking families who we all want to help.”

She also said that backers of the law “haven’t done a very good job of explaining why middle-class families who already had insurance are better off.” Families are paying less for coverage, Burwell said, and they benefit from knowing they “no longer have to worry about losing their homes or having their hard-earned savings wiped-out by an accident, or unexpected diagnosis.”

The New York Times showed how Accountable Care Organizations which were organized under the Affordable Care Act can save money:

IT may have been the most influential magazine article of the past decade. In June of 2009, the doctor and writer Atul Gawande published a piece in The New Yorker called “The Cost Conundrum,” which examined why the small border city of McAllen, Tex., was the most expensive place for health care in the United States.

The article became mandatory reading in the White House. President Obama convened an Oval Office meeting to discuss its key finding that the high cost of health care in the country was directly tied to a system that rewarded the overuse of care. The president also brought up the article at a meeting with Democratic senators, emphasizing that McAllen represented the problem that needed to be fixed.

Five years later, the situation has changed. Where McAllen once illustrated the problem of American health care, the city is now showing us how the problem can be solved, largely because of the Affordable Care Act that Mr. Obama signed into law in 2010…

One of its provisions created the Medicare Shared Savings Program, which rewards doctors for keeping their patients healthy. Participation in the program requires primary care doctors to create networks, called accountable care organizations, or A.C.O.s, to better coordinate patient care. These networks are reimbursed for delivering high-quality care below a baseline of historical Medicare costs.

In 2012, doctors in McAllen formed the Rio Grande Valley Accountable Care Organization Health Providers, and signed up for this experiment. The early results are in, and they are stunning: From April 2012 to the end of 2013, the Rio Grande Valley A.C.O. saved more than $20 million from its Medicare baseline.

This is just two more ways in which the real world successes for Obamacare show a totally different picture than the right wing media has been portraying.

What’s The Matter With Thomas Frank?

Obama Green Lantern

Thomas Frank has fallen for the Green Lantern view of the presidency, thinking that the president has the power to do anything he wishes. His criticism of Obama:

Why did he do nothing, or next to nothing, about the crazy high price of a college education, the Great Good Thing that he has said, time and again, determines our personal as well as national success? Why didn’t he propose a proper healthcare program instead of the confusing jumble we got? Why not a proper stimulus package? Why didn’t he break up the banks? Or the agribusiness giants, for that matter?

Well, duh, his museum will answer: he couldn’t do any of those things because of the crazy right-wingers running wild in the land. He couldn’t reason with them—their brains don’t work like ours! He couldn’t defeat them at the polls—they’d gerrymandered so many states that they couldn’t be dislodged! What can a high-minded man of principle do when confronted with such a vast span of bigotry and close-mindedness? The answer toward which the Obama museum will steer the visitor is: Nothing.

In point of fact, there were plenty of things Obama’s Democrats could have done that might have put the right out of business once and for all—for example, by responding more aggressively to the Great Recession or by pounding relentlessly on the theme of middle-class economic distress. Acknowledging this possibility, however, has always been difficult for consensus-minded Democrats, and I suspect that in the official recounting of the Obama era, this troublesome possibility will disappear entirely. Instead, the terrifying Right-Wing Other will be cast in bronze at twice life-size, and made the excuse for the Administration’s every last failure of nerve, imagination and foresight. Demonizing the right will also allow the Obama legacy team to present his two electoral victories as ends in themselves, since they kept the White House out of the monster’s grasp—heroic triumphs that were truly worthy of the Nobel Peace Prize. (Which will be dusted off and prominently displayed.)

But bipartisanship as an ideal must also be kept sacred, of course. And so, after visitors to the Obama Library have passed through the Gallery of Drones and the Big Data Command Center, they will be ushered into a maze-like exhibit designed to represent the president’s long, lonely, and ultimately fruitless search for consensus. The Labyrinth of the Grand Bargain, it might be called, and it will teach how the president bravely put the fundamental achievements of his party—Social Security and Medicare—on the bargaining table in exchange for higher taxes and a smaller deficit. This will be described not as a sellout of liberal principle but as a sacred quest for the Holy Grail of Washington: a bipartisan coming-together on “entitlement reform,” which every responsible D.C. professional knows to be the correct way forward.

Frank both ignores the real obstacles which Obama faced and is not very accurate in describing Obama’s record. He forgets that the there was a very good reason that Obama never had a chance to reason with the Republicans–they decided right off the bat that they would oppose anything Obama supported for political reasons. Frank might check out the work of  centrists Norman Ornstein and Thomas Mann on how Republicans are responsible for the current gridlock along with  this Frontline documentary:

On the night of Barack Obama’s inauguration, a group of top GOP luminaries quietly gathered in a Washington steakhouse to lick their wounds and ultimately create the outline of a plan for how to deal with the incoming administration.

“The room was filled. It was a who’s who of ranking members who had at one point been committee chairmen, or in the majority, who now wondered out loud whether they were in the permanent minority,” Frank Luntz, who organized the event, told FRONTLINE.

Among them were Senate power brokers Jim DeMint, Jon Kyl and Tom Coburn, and conservative congressmen Eric Cantor, Kevin McCarthy and Paul Ryan.

After three hours of strategizing, they decided they needed to fight Obama on everything. The new president had no idea what the Republicans were planning.

There were clear institutional limits on Obama in a system where forty Senators could block the majority on anything. The Democrats had sixty votes for a very brief time due to the delays in swearing in Al Franken and later Ted Kennedy’s death.  Even when Obama technically had sixty Senators voting with the Democrats, this included Joe Lieberman and Ben Nelson who would never go for the type of leftist agenda Frank favored.

Obama chose to use his limited political political capital to concentrate on health care reform, passing a comprehensive health reform package after previous presidents from Harry Truman to Bill Clinton were unsuccessful. Ted Kennedy once expressed regret at working with Richard Nixon and instead insisting upon a single-payer system at the time. Similarly Hillary Clinton convinced Bill to threaten to veto anything other than her plan, rejecting a Republican proposal which was very similar to the Affordable Care Act. It would be far better to accept what can be passed and then work to improve it over time.

Sure the Affordable Care Act is a confusing jumble, but that is because it built upon our current system. It would have been better if the system was even more complex and perhaps confusing, including either the public option or Medicare buy-in. Neither could pass because both Lieberman and Nelson opposed them. Obama certainly could have never received sixty votes for a single-payer plan, breaking up the banks, or a bigger stimulus.

Beyond Congress, Obama was limited by conservative media bias on economic matters. Obviously Fox was out there spreading lies and attacking anything Obama wanted to do, but the problems weren’t limited to Fox and its viewers. Most of the media is owned by the wealthy, and much of the news, especially on television, is reported by wealthy television stars. They might not share the Republican views on social issues or their opposition to science and reason (leading to the conservative view of  a liberal media) but many of them are quite conservative on economic issues. They were biased towards tax cuts and cutting spending. Media reports on the economy typically stressed the size of the deficit and included the assumption that a reduction in government spending was necessary. Few pointed out the degree to which Republican spending and tax cuts in the Bush years contributed far more to the deficit than Obama’s stimulus spending. The atmosphere was hardly conducive to pushing an even bigger stimulus, regardless of how much more this would have helped the economy recover. He also ignores the degree to which Obama’s stimulus did help bring about economic recovery.

Just as Frank ignores the benefits of Obama’s policies, including the Affordable Care Act and the stimulus, he exaggerates what Obama did not do. No, Obama did not destroy Social Security and Medicare. It is the other party which has been seeking to do that. Offering  Chained CPI in exchange for a grand bargain on the deficit might never have been a good idea, but we can’t blame Obama for making a bad deal when such a deal was never made and we don’t know what he would have held out for before making such an agreement.

Obama’s record has much in it to displease the far left. It is doubtful that any other president would have achieved more than he actually did.