Cries Over Lois Lerner’s Lost Email Look Like Just Another Conservative Conspiracy Theory

Conservatives 1) love to act like the victim and 2) have been desperately trying to make it appear that there have been scandals which they can attribute to the Obama administration. As the Obama administration has been remarkably free of scandals, they have had to invent several. The IRS scandal first appeared to be something to be concerned about, until we realized that while Republicans like Darrell Issa were only looking at conservative groups which had problems with the IRS, it turned out that both conservative and progressive groups received extra scrutiny. This hardly comes as a surprise in light of the ambiguous tax regulations which deny tax breaks for political organizations when engaged in political activity.

Conservative conspiracy theorists typically work by using limited information to suggest something is not right, when the full facts often contradict this. There is no way I, or anyone else, can say for certain what happened to Lois Lerner’s lost emails, but once the full facts are reviewed, rather than the distorted reporting on many conservative sites, it looks far less likely that anything improper occurred. I’ve seen some claims that the email couldn’t really be lost because they are all backed up, but this just simply is not the case. The New York Times reports:

The I.R.S. initially provided 11,000 of her emails that it deemed directly related to the applications for tax exemption filed by political groups. Under pressure from Republican leaders, Mr. Koskinen later agreed to provide all of Ms. Lerner’s emails but said that doing so might take years. Since then, the I.R.S. has provided roughly 32,000 more emails directly from Ms. Lerner’s account.

After the agency discovered that its initial search of Ms. Lerner’s emails was incomplete because of the computer crash, it recovered 24,000 of the missing messages from email accounts on the other end of Ms. Lerner’s correspondence, the I.R.S. said.

Although Mr. Koskinen had indicated in congressional testimony that I.R.S. emails were stored on servers in the agency’s archives and could be recovered, the agency said Friday that was not the case.

The I.R.S. said that because of financial and computing constraints, some emails had been stored only on individuals’ computers and not on servers, and that “backup tapes” from 2011 “no longer exist because they have been recycled.”

Don’t trust the left-leaning New York Times? The right-leaning Politico reports the same practices with respect to email:

The IRS explains in the letter that it has not always backed up all employee emails due to the cost the agency would incur for allowing 90,000 employees to store their information on the IRS’s internal system.

Currently, IRS employees have the capacity to store about 6,000 emails in their active Outlook email boxes, which are saved on the IRS centralized network. But the letter and background document sent to the Hill Friday said they could only store about 1,800 emails in their active folders prior to July 2011.

When their inboxes were full, IRS employees had to make room by either deleting emails or archiving them on their personal computers. Archived data were not stored by the IRS but by the individual.

Such archived emails on Lerner’s computer were what were lost when her computer crashed.

“Any of Ms. Lerner’s email that was only stored on that computer’s hard drive would have been lost when the hard drive crashed and could not be recovered,” the letter reads.

Overall, more than 250 IRS employees have spent more than 120,000 hours digging up documents and emails for congressional investigators, spending $10 million.

I’m sure there are many conservatives who still won’t believe that email can be lost until they hear it on Fox or from Rush. In that case, how about what may have been as many as 22 million lost emails under Bush during the controversy over the improper dismissal of U.S.  attorneys for political reasons. There is a key difference here. While the Republican claims in the IRS case have been debunked, there was a real scandal and impropriety in the Bush White House which led directly to Karl Rove and Alberto Gonzales. In addition, the Bush administration broke the law by using outside accounts to avoid detection and circumvent laws regarding maintaining email in the Executive Branch.

If there was a conspiracy to hide emails,it doesn’t make sense that it would be email from before 2012 which is missing. Steve Benen put it into perspective:

For Republicans and their allies, this sounds like a convenient way to deny investigators access to Lerner’s emails. But note, the IRS has already produced 67,000 emails to and from Lerner, from 2009 to 2013, and were able to piece together 24,000 Lerner emails from the missing period based those who’d been cc’d in various messages. This is hardly evidence of a cover-up.
For that matter, note that Republicans and conspiracy theorists are principally interested in Lerner’s messages from 2012 – the election year. The computer crash affected emails from before 2012. If the IRS intended to hide potentially damaging materials from investigators, and it was willing to use a made-up technical problem to obscure the truth, chances are the agency would have scrapped Lerner’s emails from the relevant period, not emails from before the relevant period.
When all the facts are considered, Lois Lerner no longer looks like a modern day Rose Mary Woods. It all looks like just another weak attempt by conservatives to portray themselves as victims, and one more unfounded conservative conspiracy theory.
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Republican Extremism And The Weakness Of Republican Leadership

The victory of David Brat over Eric Cantor was momentarily a cause for celebration, but the long term results might not be so favorable. Norm Ornstein warns that this will lead to further radicalization of the Republican Party:

First, it is clear that this moves the Republican Party even further to the right, in approach, attitude and rhetoric. Even if the overwhelming majority of incumbents, including establishment ones, have won renomination, even if broader Republican public opinion is more establishment conservative than Tea Party radical, all it takes is an example or two of the opposite to get all politicians jumping at their shadows and muttering to themselves, “That could happen to me.”

…American political parties always face a tension between their establishment and ideological wings. On the Republican side, going back more than a hundred years to the Teddy Roosevelt era, that was a struggle between moderate progressives and conservatives.

Now it is different. There are no moderates or progressives in today’s GOP; the fight is between hard-line conservatives who believe in smaller government and radical nihilists who want to blow up the whole thing, who have as much disdain for Republican traditional conservatives as they do for liberals.

In our 2012 book, “It’s Even Worse Than It Looks,” Tom Mann and I described the Republican Party as an “insurgent outlier.” That is even more true today. The energy and driving force in the party, in its House membership, media dominance, caucus and primary electorates and financial backers, is not its conservative wing but its radical side.

Ornstein is probably right that this will pull the Republicans even further to the right, but how far right can they go before even safe Republican districts are at risk? Will Republicans in these districts support any lunatic with an R after his name, or is there a limit? At the moment it appears that Brat should win, but the narrative would certainly change if the victory by such an extremists were to cause the Republicans to lose a safe Republican district.

Yesterday I noted Brat’s views on slashing spending on Medicare, Social Security, and education.  His plan to replace Obmamacare is just as absurd: “We need to also scrap employer-based health insurance, and give those incentives to individuals to carry their own portable health insurance. If we did that, the issue of pre-existing conditions largely goes away.” This makes absolutely no sense as the individual market has been dominated by insurance plans which have been the most abusive at denying coverage to the sick.

Brat’s campaign manager, Zachery Werrell, scrubbed his Facebook page after the victory but Yahoo News took screen shots while the page was still available:

From comparing George Zimmerman’s shooting of unarmed black teenager Trayvon Martin to abortion to calling for the abolition of the Food and Drug Administration and encouraging the adoption of the silver monetary standard, Zachary Werrell – one of just two paid staffers for the upstart campaign of Randolph-Macon College economics professor David Brat – sought in 2012 and 2013 to build a public profile as a socially conservative libertarian voice…

“Can someone who was outraged that George Zimmerman was found not guilty of ‘SOMETHING ANYTHING’ and who is simultaneously pro-choice explain the logical dissonance there? Ie. Why its not ok to kill someone who is banging your head into concrete but its ok to kill someone for simply existing who, through your conscious actions, you brought into the world?” Werrell had written in an Oct. 24, 2013, posting.

The month before, the campaign manager for the likely next congressman for Virginia’s 7th District – since no Democrat has represented that district since 1971 – questioned whether existing state lines were defensible. “Should sections of States be allowed to secede from a State if they feel they are un/underrepresented in the State Government?” Werrell asked. “I say yes. I derive that opinion from our first foundational document – the Declaration of Independence. What say you?”

On Oct. 25, 2013, he called for an end to the regulation of prescription drugs, citing a story from the Ludwig von Mises Institute. “Abolish the FDA!” he wrote.

On Oct. 29 of that year, it was a piece by Fred Reed from Lew Rockwell’s website on the wussification of boys that set him off. “There is a war on boys!” Werrell wrote. “Rough housing, playing soldier, etc, are all punished or medicated away. And we wonder why there is gender inequality in the classroom and in college/attendance/graduation rates.”

The Reed piece called for the end of women teachers in coed or boys’ schools. “It is time to get women out of the schooling of boys,” wrote Fred Reed. “It is way past time. Women in our feminized classrooms are consigning generations of our sons to years of misery and diminished futures.” The piece further argued that “women should not be allowed within fifty feet of a school where boys are taught” and that “Women are totalitarian. Men are happy to let boys be boys and girls be girls. Women want all children to be girls.”

Brat is far more likely than Cantor to make a major gaffe. It will be interesting to see his take on the views of his campaign manager.

If we can fantasize about a Democratic upset in this Congressional district, we might also fantasize about another upset in the general election. Peter Beinart looked at the weakness of the Republican leadership:

Cantor’s boss, John Boehner is, according to Nancy Pelosi, “the weakest speaker in history.” Less than 50 percent of Republicans approve of his performance. Over the last two years, he has repeatedly retreated in the face of opposition from rank-and-file conservatives who treat him with barely disguised disdain. Until the defeat of Cantor, his most likely heir apparent, it was widely assumed that he would soon either step—or be pushed—aside soon.

In the Senate, Minority Leader Mitch McConnell only avoided Cantor’s fate by attaching himself to his Kentucky colleague Rand Paul, whose upstart Senate candidacy McConnell had opposed. Like Boehner, McConnell is treated with striking disrespect in his own caucus.

David Frum wonders whether the Republican leadership will ever fight back:

At some point, Republican leaders must recognize that they have a fight on their hands whether they like it or not. If they refuse to join that fight, they will be devoured anyway. If they surrender, they condemn the whole conservative project in America to the destructive leadership of fanatics (and the cynics who make their living by duping fanatics).

I never thought there was much of a chance of Grimes to beat Mitch McConnell despite being close in the polls but today Political Wire reported that “A new Magellan Strategies (R) poll in Kentucky finds Allison Lundergran Grimes (D) leading Sen. Mitch McConnell (R) by three points in the U.S. Senate race, 49% to 46%.” Perhaps a major reason that Cantor was defeated is general bipartisan disgust with the Republican leadership, and if so this just might extend to knocking out McConnell.

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David Brat’s Views On Economics And Religion

brat_cantor

The surprising defeat of Eric Cantor last night appears to be largely due to the personal faults on Cantor’s part along with possible preference for the more extremist views of David Brat, despite Cantor’s dishonest ads calling him a liberal college professor. It does not appear that cross over Democratic voters had a meaningful impact on the results. Cantor’s problems appear more cultural than strict ideology as pointed out at The New York Times.

David Wasserman, a House political analyst at the nonpartisan Cook Political Report, said another, more local factor has to be acknowledged: Mr. Cantor, who dreamed of becoming the first Jewish speaker of the House, was culturally out of step with a redrawn district that was more rural, more gun-oriented and more conservative.

“Part of this plays into his religion,” Mr. Wasserman said. “You can’t ignore the elephant in the room.”

The New York Times does go overboard in calling Cantor’s loss a bad omen for moderates. While Brat is more extreme in opposing immigration reform and raising the debt ceiling to meet our financial obligations, Cantor is hardly a moderate. As Steve Benen pointed out, “He has a 95% lifetime rating from the American Conservative Union, for goodness’ sake.”

Brat has been called a follower of Ayn Rand, and his victory could be seen as a loss for crony capitalism. Whenever I hear that a Republican is a follower of Ayn Rand I wonder if they are aware of or acknowledge Rand’s atheism and strong hostility towards religion. Brat’s economic writings have shown a view of religion which Ayn Rand would never accept. The Wall Street Journal writes:

In the paper, titled “Is Growth Exogenous? Taking Bernanke Seriously (But How Can a Fed Guy Forget the Institutions)”, Mr. Brat waded into a debate among economists over the determinants of long-term growth with this conclusion: Mr. Bernanke’s work on economic growth overlooked the role that religious institutions–particularly Protestant ones–play in driving a country’s growth rates.

In his argument against Mr. Bernanke, Mr. Brat draws on previous research titled “Economic Growth and Institutions: The Rise and Fall of the Protestant Ethic?” a 2004 paper in which he wrote that Protestantism “provides an efficient set of property rights and encourages a modern set of economic incentives” so “one might anticipate positive economic performance.”

“Give me a country in 1600 that had a Protestant led contest for religious and political power and I will show you a country that is rich today,” he wrote.

On the other hand, another article in The Wall Street Journal suggests he does not accept the agenda of the religious right:

Can Christians force others to follow their ethical teachings on social issues? Note that consistency is lacking on all sides of this issue. The political Right likes to champion individual rights and individual liberty, but it has also worked to enforce morality in relation to abortion, gambling, and homosexuality. The Left likes to think of itself as the bulwark of progressive liberal individualism, and yet it seeks to progressively coerce others to fund every social program under the sun via majority rule. Houston, we have a problem. Coercion is on the rise. What is the root word for liberalism? (Answer: Liberty)

It is of course a straw man argument to claim that the left seeks to fund every social program under the sun. Unless he means the cost of established and highly successful programs such as Medicare and Social Security, the spending advocated by most liberals on social programs is far less than Republicans have coerced others to pay, such as on the Iraq War. Bush’s policies, including both his spending and tax cuts for the wealthy have had far more impact on the deficit that liberal social programs. Despite his acceptance of these rather naive right wing talking points, it is encouraging that Brat has opposed the Republican use of government to enforce the social views of the religious right. It remains to be seen if he will buck the Republicans on such issues when voting in Congress.

Update: Mother Jones takes a look at Brat’s libertarian views, including slashing spending on Medicare,  Social Security, and education. What happens when you cut funding on education? A lack of understanding of science, leading to people falling for denial of climate change.

Update II: There has been considerable speculation that Brat won due to Cantor’s views on immigration. It is not clear that this was the reason for Brat’s victory. A survey from Public Policy Polling showed that there was not widespread opposition to Cantor’s views on immigration in his district but it is possible that those turning out in a Republican primary held stronger anti-immigration views than the general population. Both blogs on the left (such as Mother Jones) and right (such as Hot Air) have questioned if immigration was the reason Cantor lost.

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Medicaid Coverage Varies From One Side Of Town To Another In Some Border Cities

As Annie Lowrey described, which side of town one lives on can determine whether a poor person receives Medicaid benefits if the town is on a border between a state which participates in the expanded Medicaid program and one which does not. The Affordable Care Act provides for expanding Medicaid benefits with the federal government paying most of the cost, but many Republican-controlled states have chosen not to participate in the program:

Arkansas accepted the Medicaid expansion in the Affordable Care Act. Texas did not.

That makes Texarkana perhaps the starkest example of how President Obama’s health care law is altering the economic geography of the country. The poor living in the Arkansas half of town won access to a government benefit worth thousands of dollars annually, yet nothing changed for those on the Texas side of the state line.

After the Supreme Court decided in 2012 that states could not be compelled to expand Medicaid to cover more of their low-income residents, many politicians voiced fears that the poor in states that opted out of the expansion might flood into states that opted in.

Thus far, 26 states and the District of Columbia have chosen to extend Medicaid, encouraged by the promise that the federal government will shoulder 90 percent of the cost indefinitely. The others — including Texas — have so far declined.

But none of the low-income Texarkana residents interviewed realized that moving to the other side of town might mean a Medicaid card. In fact, health researchers and those who work with the poor expect very few Americans to move between states to take advantage of the law.

“It’s impossible to understand what it is to move when you have nothing,” said Jennifer Laurent, the executive director of Randy Sams’ Outreach Shelter, where Ms. Marks is staying until she puts together enough savings from her two low-wage jobs to find her own place. “To risk everything — losing your bed, your sense of community — for an uncertain benefit? There’s no way you want to risk that.”

Research on other expansions of government benefits has borne that out: A study in the journal Health Affairs looked at the “welfare magnet hypothesis” and found no evidence that it exists…

The disparities among states have left about eight million low-income adults ineligible for Medicaid and have widened the difference in what federal safety-net benefits are available to similar families in different states. There are a number of border communities where one state is expanding Medicaid and the other is not: West Memphis, Ark., and Memphis; Chicago and Gary, Ind.; Washington’s Maryland suburbs and those in Northern Virginia; and Spokane, Wash., and Coeur d’Alene, Idaho.

There is currently a battle in Virginia over whether to accept the program. In order to prevent this, the Republicans are attempting to flip the state Senate by offering a Democratic member what might be an illegal bribe to step down.

The expanded Medicaid program is both providing many people with needed health are coverage, and is also improving profits for hospitals which no longer have to provided reimbursed care.

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Koch Brothers Donate $25 Million To The United Negro College Fund

David Koch

I think it was a smart move by the Koch Brothers to give a $25 million grant to the United Negro College Fund. If their goal is to improve their public reputation in response to the campaign by the Democratic Party to vilify them, such a move is likely to be far more effective than Charles Koch’s whiny and misleading op-ed in The Wall Street Journal. Maybe they hope that this will help counter some of the harm done by their financing of the Tea Party which, while containing a variety of views, far too often looks like the KKK without the white sheets. The willingness and ability of the Koch Brothers to receive this form of favorable publicity also gives an example of why it is foolish for the Democrats to spend so much effort in their campaign against the Koch Brothers personally as opposed to actually learning how to promote a coherent message.

There are many reasons to vote for the Democrats over the Republicans with the Republicans adopting an extremist agenda, acting to undermine the foundations of our Democratic system, and failing to engage in any rational thought as they pursue policies in contradiction of economics, science, and the very principles of individual liberty which this nation was founded upon. There are so many issues for the Democrats to concentrate on, yet Harry Reid wants to concentrate on a pair of brothers who most people have never heard about. Sure attacking the Koch Brothers might be good for fund raising emails, but this is no substitute for coming up with a real message.

The fact of the matter is that the Koch Brothers are not the worst enemy faced by the Democrats and supporters of liberty (true liberty, not the plutocracy and religious authoritarianism promoted by the right wing under this label). There is certainly quite a bit of hypocrisy  in the economic views of the Koch Brothers, who made their fortune taking advantage of government programs while selectively arguing for economic libertarianism as a means to escape regulation. However in some ways the Koch Brothers are preferable to the standard Republican line, from opposing the Iraq War to being more libertarian on social issues. David Koch also has a long history of philanthropy. They could even be a force for moderation of some of the extreme views of the Republican Party.

Of course this is not meant to excuse all their behavior, including suspected illegal activity and funding of efforts to deny climate change (which on at least one occasion has blown up in their faces). The most reprehensible has been the funding of dishonest advertisements against the Affordable Care Act.  Everyone is entitled to their opinion, but when they spread false information which contributes to mistrust of a law which has resulted in improvements in the lives of millions, they risk doing serious harm to those who remain uninsured based upon misinformation. The Affordable Care Act is also a good thing for the economy, helping to reduce the deficit, reduce unemployment, and enable people to leave jobs they remain in for insurance coverage to work for or form small businesses of their own. Those who truly support freedom, as opposed to giving it lip service as the right wing does, would prefer a system which gives more choice to individuals rather than leaving them at the mercy of an insurance industry which has existed without serious competition in most markets, and which found it to be more profitable to find ways to deny providing care. Support of Obamacare is the only rational position for those who support the rights of the individual over the rights of abusive monopolies. Unfortunately such a choice is beyond the thought process of those on the right who have been brainwashed to see our tradition of self-government as the source of tyranny.

I would find it far easier to ignore the Koch Brothers if they would cease spending their money on these dishonest ads and ideally use their influence to truly promote freedom. Regardless, we could show appreciation for contributions such as this and perhaps it is time for Harry Reed to find a new bogey man–or preferably to do a better job of actually promoting ideas.

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Ohio Bill Prohibits Insurance Coverage Of Both Abortion And Forms of Contraception

Republicans have become increasingly successful in restricting insurance coverage of abortion in many of the states where they control the state government, and a bill in Ohio could extend this to restricting access to contraception:

Ohio might make it illegal for insurance to cover abortions, even in cases of rape, incest and when pregnancy threatens a mother’s life.

The first hearing for House Bill 351 was held yesterday.

The only exception allowed in the bill, which would affect all insurance policies that cover Ohioans, is in cases of ectopic, or tubal, pregnancies.

The bill also would ban insurance coverage for public employees as well as those on Medicaid for birth control that prevents the implantation of a fertilized egg, such as intrauterine devices, known as IUDs.

During testimony, Rep. John Becker, a suburban Cincinnati Republican who sponsored the bill, acknowledged that the wording can be interpreted to include birth-control pills, which he said wasn’t his intention. An amendment could be introduced to clarify that point, he said.

When it came to IUDs, which are plastic devices implanted into a woman, Becker said they should be included in the ban because they prevent the implantation of a fertilized egg, meaning they can be considered an abortion.

Unlike a similar law passed by Michigan Republicans last December, the bill in Ohio would not only ban insurance coverage of abortion in standard insurance policies but also prohibit the purchase a separate insurance rider for abortion coverage. The requirement forcing Michigan women to purchase an extra rider if they desire coverage for abortions has been derided as a requirement to pay extra for “rape insurance.” The rider to cover abortions in Michigan must be purchased prior to pregnancy and women are not able to buy the rider after getting pregnant even by rape or incest

According to the National Women’s Law Center, restrictions on abortion coverage are becoming increasingly common:

Twenty-five states (Alabama, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Utah, Virginia, and Wisconsin) have laws prohibiting insurance coverage of abortion in state exchanges.  Ten of those states – Idaho, Indiana, Kansas, Kentucky, Michigan, Missouri, Nebraska, North Dakota, Oklahoma, and Utah  – go even further and reach all plans in the state, banning insurance coverage of abortion in plans outside the exchange as well.

Think Progress had this information regarding the ramifications of this Ohio bill:

The unintended pregnancy rate for women living below the poverty level is more than five times as high than the rate for the women in the highest income level, largely because they struggle to access affordable birth control. Since long-lasting forms of birth control like the IUD remain effective for years without the need to take a daily pill or a monthly shot, public health experts recommend them for women who struggle with avoiding pregnancy. But IUDs are expensive, and can cost as much as $1,000 upfront. A large 2012 study focusing on low-income women in St. Louis found that when cost barriers to IUDs are removed, more women choose them and fewer women end up needing abortions.

Social conservatives’ crusade against abortion, which often hinges on redefining some forms of contraception as “abortion-inducing drugs,” has ensured that IUDs are continually caught in the crossfires. This is the same type of birth control that Hobby Lobby, the crafts company that sued the Obama administration over the health law’s contraceptive coverage requirement, doesn’t want to offer to its employees.

Of course, aside from the implications for birth control access, HB 351 would also impose a significant financial burden on the women who need abortion services. The bill does not include any exceptions for women who became pregnant from rape or who are faced with a pregnancy that threatens their life, which means even the Ohioans who find themselves in those desperate circumstances would be forced to pay for the entire cost of the procedure out of pocket. An in-clinic abortion during the first trimester can cost anywhere from $300 and $950. Later procedures, which are typically necessary when women discover serious health issues with their pregnancies or their fetuses, can be thousands of dollars.

This comes from the part which claims to be the party of small government.

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Doctors No Longer Strong Republicans

JAMA Internal Medicine has some data which I would have predicted–doctors are less likely to support Republicans now than in the past. The data is based upon campaign contributions and therefore has no data regarding reasons for the change. This data would not include contributions under $200 and it is not known if those making smaller donations differ from the larger, reportable contributions.

The study found that since 1996 contributions to Republicans by physicians have decreased, dropping to under 50 percent leading up to the 2008 election. Many of the results suggest that doctors are contributing based upon factors comparable to the general population. This includes a significant gender gap with 57 percent of men and 31 percent of women contributing to Republicans over the entire study period. Leading up to the 2012 election, 52.3 percent of male physicians contributed to Republicans and 23.6 percent of female physicians contributed to Republicans.

I am apparently an exception to the trend that male physicians and physicians in solo or small practices are more likely to contribute to Republicans. Another trend mirrors the general population with those earning more being more likely to contribute to Republicans.

Overall the trend against support for Republicans is similar to the overall trend for more highly educated people to be less likely to support Republicans. The education in science might make many physicians more likely to reject Republicans in recent years as scientists have tended to oppose Republicans. Many people trained in science would have a difficult time supporting a party in which many believe in creationism, and most reject the view of 97 percent of climate scientists on global warming.

The study is unable to determine whether medically related issues have any bearing on the results. Democrats have been far more supportive of health care in recent years, but I also find that many of my colleagues get their news from Fox and have the same misconceptions about the Affordable Care Act and other issues as Republicans in general have. On the other hand, many physicians, along with many physician organizations, have been highly supportive of Obamacare after having seen the serious problems in health care delivery in this country. Republican policies would also be terrible for the future of Medicare, but I’m not sure how widespread this realization is among physicians.

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Medicaid Expansion Leading To Increased Care For Poor And Increased Revenue For Hospitals

After Medicaid was expanded in Oregon prior to the passage of the Affordable Care Act there was an increase in Emergency Room visits from people using their new coverage. This was not surprising and the challenge was to get those with the new coverage both established with primary care physicians and to get the Medicaid patients in the habit of seeing a primary care physician as opposed to over-utilizing Emergency Rooms. This raised questions as to whether we would see a similar initial increase in Medicaid utilization of Emergency Rooms with the expansion of Medicaid coverage under the Affordable Care Act. So far there are optimistic reports regarding the effects of Medicaid expansion.

A recent survey conducted by the American College of Emergency Physicians found that 37 percent of ER physicians reported that patient volume had increased slightly, 9 percent reported that it had increased greatly, and 27 percent reported that the number of ER visits had remained the same.  Only 3 percent reported an increase in patients with private insurance  while 35 percent reported an increase in patients with Medicaid. This could be an indicator that those with Medicaid were having more difficulty than those with new private insurance in finding private primary care physicians. This might also be partially due to patients receiving Medicaid being poorer and sicker and in greater need of emergency services.

Kaiser Health News reported on more promising news for those receiving Medicaid. They found that safety-net hospitals were seeing more paying patients due to more poor patients receiving Medicaid, and these hospitals were therefore bringing in more money.

One of the biggest beneficiaries of the health law’s expansion of coverage to more than 13 million people this year has been the nation’s safety-net hospitals, which treat a disproportionate share of poor and uninsured people and therefore face billions of dollars in unpaid bills.

Such facilities had expected to see a drop in uninsured patients seeking treatment, but the change has been faster and deeper than most anticipated— at least in the 25 states that expanded Medicaid in January, according to interviews with safety-net hospital officials across the country.

“This is really phenomenal,” said Ellen Kugler, executive director of the National Association of Urban Hospitals, based in Sterling, Va., which represents inner-city safety net institutions. “It shows the Affordable Care Act is clearly working in these locations.”

Safety net hospitals, most of which are government-owned or nonprofit, have typically struggled financially because their urban locations mean they treat more uninsured patients who show up in emergency rooms and cannot be turned away.

An Urban Institute study published in the May edition of Health Affairs estimated the costs of uncompensated care to hospitals were as high as $45 billion in 2013. Government programs helped defray 65 percent of those costs, the study estimated.  That left providers billions of dollars in the hole.

They also found that more were receiving care from primary care physicians as opposed to from Emergency Rooms:

Hospital officials say the biggest impact of the change is on patients themselves. Rather than having to rely on emergency rooms, newly insured patients can see primary care doctors and get diagnostic tests and prescription drugs, among other services.

Some safety-net hospitals say they started to see their numbers of uninsured patients dropping almost immediately after the Medicaid expansion took effect in January.

“We have seen a steady decline in our uninsured visits,” said Roxane Townsend, CEO of UAMS. “We did not anticipate this big a drop this quickly.”

About 80 percent of the system’s new Medicaid patients had previously been seen by the hospital as uninsured patients, she said. Their enrollment in coverage means the hospital is paid more for their care and is able to direct them to outpatient services and preventive care.

She said that UAMS has also seen a drop in ER visits by uninsured patients — from 6,000 visits in first three months of 2013 to about 4,000 visits in first three months of this year, calling the decline “significant.”

While some emergency physicians have offered anecdotal reports of increased use of the ER since January, there is no documentation of the health law’s impact yet. Studies examining ER use in Massachusetts following that state’s expansion of coverage showed an initial surge followed by a decline in those numbers over several years.

Denver Health officials said the increase in insured patients since January — most of whom are enrolled in Medicaid – appears to be boosting the number of people seeking care at its primary care clinics, rather than through the emergency room.

Patient visits to Denver Health primary care offices are up 14 percent this year, while ER visits are down 2 percent. Patient visits for mental health and substance abuse services are also up nearly 50 percent.

“Patients are seeking care at better and more cost-effective and more appropriate settings,” said Peg Burnette, chief financial officer at Denver Health.

This trend was not limited to safety-net hospitals. For-profit hospitals are also benefiting from increased coverage:

Although safety-net hospitals may be experiencing the biggest impact from the expansion of coverage, the improvements are not limited to them.

Investor-owned hospital companies HCA, Tenet Healthcare Corp., Community Health Systems (some of which own safety-net hospitals) say they saw their rates of uninsured patients drop by as much as a third in the first quarter of 2014 in hospitals located in Medicaid-expansion states.  HCA said its hospitals in states that chose not to participate in the health law’s expansion of the program saw rates of uninsured patients rise by 6 percent.

LifePoint Hospitals, a Brentwood, Tenn.-based company that owns 60 hospitals nationwide, said the Medicaid expansion led to an average 26 percent reduction in uninsured patients at its facilities.

“It’s been a big financial help,” said Chief Financial Officer Leif Murphy, noting the reduction will help offset the health law’s Medicare funding cuts.

Converting patients from no cash to some cash “is a good thing,” said Sheryl Skolnick, a hospital analyst with CRT Capital Group in Stamford, Conn.

The exception to this trend is in states where Republicans have blocked Medicaid expansion. This is especially foolish as the federal government pays most of the cost, with states, along with hospitals, benefiting from the decrease in uninsured. Salon reported over the weekend on efforts in Georgia, also being seen in other Republican states, to make it more difficult to expand Medicaid in the future by requiring that the decision be made by the state legislature as opposed to by the governor. The conservatives Republicans don’t want to gamble on a Democrat, or even a rational Republican, becoming governor in the future and deciding to accept the federal funds to expand Medicaid.

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Obama Responds To Myth That Both Parties Are Responsible For Current Gridlock

Obama Green Lantern

There has been a lot of back and forth on line recently regarding whether Obama deserves blame for the gridlock in Washington. Ezra Klein explained the fallacies once again in the Green Lantern view of the presidency as a character with near infinite powers.  Ron Fournier continues to play the false equivalency game in trying to blame both the left and right, ignoring the considerable differences between the two and the unprecedented levels of obstructionism since Obama was elected.  He seems to think that being a typical politician and promising more than he can deliver is somehow equivalent to the Republicans deciding to oppose anything proposed by Obama from day one.

Jason Linkins suggested a more realistic view of Obama. If he isn’t Green Lantern, he might be more like Agent Coulson: “team-assembler, favorable environment provider, manager of discrete tasks and outsized personalities, quick to adapt to changing circumstances, eminently mortal, and yet (spoiler alert) at times resurrectable.” Last year Linkins wondered if Fournier could read when he made the same mistakes.

I was happy to see Obama directly respond to this at a fund raiser:

“You’ll hear if you watch the nightly news or you read the newspapers that, well, there’s gridlock, Congress is broken, approval ratings for Congress are terrible.  And there’s a tendency to say, a plague on both your houses.  But the truth of the matter is that the problem in Congress is very specific.  We have a group of folks in the Republican Party who have taken over who are so ideologically rigid, who are so committed to an economic theory that says if folks at the top do very well then everybody else is somehow going to do well; who deny the science of climate change; who don’t think making investments in early childhood education makes sense; who have repeatedly blocked raising a minimum wage so if you work full-time in this country you’re not living in poverty; who scoff at the notion that we might have a problem with women not getting paid for doing the same work that men are doing.

“They, so far, at least, have refused to budge on bipartisan legislation to fix our immigration system, despite the fact that every economist who’s looked at it says it’s going to improve our economy, cut our deficits, help spawn entrepreneurship, and alleviate great pain from millions of families all across the country.

“So the problem…is not that the Democrats are overly ideological — because the truth of the matter is, is that the Democrats in Congress have consistently been willing to compromise and reach out to the other side.  There are no radical proposals coming out from the left.  When we talk about climate change, we talk about how do we incentivize through the market greater investment in clean energy.  When we talk about immigration reform there’s no wild-eyed romanticism.  We say we’re going to be tough on the borders, but let’s also make sure that the system works to allow families to stay together…

“When we talk about taxes we don’t say we’re going to have rates in the 70 percent or 90 percent when it comes to income like existed here 50, 60 years ago.  We say let’s just make sure that those of us who have been incredibly blessed by this country are giving back to kids so that they’re getting a good start in life, so that they get early childhood education…Health care — we didn’t suddenly impose some wild, crazy system.  All we said was let’s make sure everybody has insurance. And this made the other side go nuts — the simple idea that in the wealthiest nation on Earth, nobody should go bankrupt because somebody in their family gets sick, working within a private system.

“So when you hear a false equivalence that somehow, well, Congress is just broken, it’s not true.  What’s broken right now is a Republican Party that repeatedly says no to proven, time-tested strategies to grow the economy, create more jobs, ensure fairness, open up opportunity to all people.”

Ron Fournier has been one of the more prominent journalists attacking Obama from the center with arguments based upon drawing a false equivalency. This has led to some criticism of centrists, but not all centrists have fallen for this idea that both sides are mirror images of each other. Centrists Thomas E. Mann and Norman J. Ornstein made it clear that Republicans are the problem in 2012:

We have been studying Washington politics and Congress for more than 40 years, and never have we seen them this dysfunctional. In our past writings, we have criticized both parties when we believed it was warranted. Today, however, we have no choice but to acknowledge that the core of the problem lies with the Republican Party.

The GOP has become an insurgent outlier in American politics. It is ideologically extreme; scornful of compromise; unmoved by conventional understanding of facts, evidence and science; and dismissive of the legitimacy of its political opposition.

When one party moves this far from the mainstream, it makes it nearly impossible for the political system to deal constructively with the country’s challenges.

“Both sides do it” or “There is plenty of blame to go around” are the traditional refuges for an American news media intent on proving its lack of bias, while political scientists prefer generality and neutrality when discussing partisan polarization. Many self-styled bipartisan groups, in their search for common ground, propose solutions that move both sides to the center, a strategy that is simply untenable when one side is so far out of reach.

It is clear that the center of gravity in the Republican Party has shifted sharply to the right. Its once-legendary moderate and center-right legislators in the House and the Senate — think Bob Michel, Mickey Edwards, John Danforth, Chuck Hagel — are virtually extinct.

The post-McGovern Democratic Party, by contrast, while losing the bulk of its conservative Dixiecrat contingent in the decades after the civil rights revolution, has retained a more diverse base. Since the Clinton presidency, it has hewed to the center-left on issues from welfare reform to fiscal policy. While the Democrats may have moved from their 40-yard line to their 25, the Republicans have gone from their 40 to somewhere behind their goal post…

Today, thanks to the GOP, compromise has gone out the window in Washington. In the first two years of the Obama administration, nearly every presidential initiative met with vehement, rancorous and unanimous Republican opposition in the House and the Senate, followed by efforts to delegitimize the results and repeal the policies. The filibuster, once relegated to a handful of major national issues in a given Congress, became a routine weapon of obstruction, applied even to widely supported bills or presidential nominations. And Republicans in the Senate have abused the confirmation process to block any and every nominee to posts such as the head of the Consumer Financial Protection Bureau, solely to keep laws that were legitimately enacted from being implemented.

In the third and now fourth years of the Obama presidency, divided government has produced something closer to complete gridlock than we have ever seen in our time in Washington, with partisan divides even leading last year to America’s first credit downgrade

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Liberals Were Wrong About The VA, But Conservatives Remain Wrong About Health Care Coverage

James Taranto of The Wall Street Journal, today demonstrating what they say about a broken watch, is right on one point. His column carries the subheading of “Not long ago, the left raved about the VA.”  While this is widely true about the left, there was at least one exception (myself). A few years back, many on the left were exclaiming about the quality of the VA system based upon quality evaluations. Evaluations of quality in health care currently has many limitations, and was downright primitive a few years back.  I pointed out several times, such as here, that the indications being looked at were not a valid means of determining quality health care.

Now we are learning that there is an even more serious problem beyond the fallacy of accepting computerized data as truly indicating quality health care. If the allegations we are now hearing are true, there is also the danger that information entered into computer systems might not even be accurate.

Suddenly, with the recent revelations about the VA, the line from the left has changed to (more accurately) saying that The Veterans Affairs Scandal Was Decades in the Making.

Of course this doesn’t mean that that the right is correct in their interpretation of this scandal. Many are using this to attack the idea behind the Affordable Care Act. We are comparing two entirely different ideas here. The VA is a rare case of government actually providing health care while the ACA involves using private insurance (or in some cases Medicaid) to pay for private medical care. The ACA became necessary in order to provide necessary regulations to curb the abuses of the insurance industry, along with providing support for those who could not afford health care coverage.

If government has problems in providing health care, as with the VA system, the problems in the private insurance industry have been far worse. In the past most areas had one or a very small number of insurance plans dominating a market. Thanks to the Affordable Care Act, we are having more insurance companies planning to enter many markets, which should lower prices. In the past, private insurance companies found it to be more profitable to deny coverage to many people with medical problems, including finding ways to terminate coverage should a policy holder develop a serious (and expensive) medical problem. Here is a report of just one example of an insurance company targeting women with breast cancer for recission of policies.

Obamacare provides needed reforms to encourage more market competition and eliminate this type of abuse from the insurance industry. It is an example of where government action is necessary and beneficial. We also have an example in providing coverage for medical care where government does a better job than the market. People on Medicare have a choice of the government program, which pays private physicians to provide medical care, or Medicare Advantage plans in which private companies handle the payment instead of the government. It costs from 13 to 19 percent less to over the same Medicare population under the government plan than with private insurance plans. The added money going to the private Medicare Advantage plans primarily goes towards increased profits for the insurance companies. Medicare might also be a better, and more cost effective, model to care for Veterans as opposed to the government attempting to maintain a parallel health system.

The lesson of the VA might be to question having the government actually provide health care, although Republicans certainly share the blame here considering their long history of opposing funding which Democrats have backed for the VA. Regardless of whether this is true, this has no bearing as to the benefits of the Affordable Care Act along with government programs such as Medicare which handle health care payments as opposed to directly providing health care.

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