Frequent commenter Andy drew my attention to this WP article on the roots of the shutdown. It touched on a number of topics near and dear to my heart. For example:
Today, there is almost no overlap between the voting behavior of the most conservative Democrats in the House and the most liberal Republicans. That’s in part because there are few moderate-to-conservative Democrats and Âmoderate-to-liberal Republicans left in the chamber.
It also is a reflection of the fact that members from districts that are more evenly balanced ideologically now vote the way their colleagues from highly ideological districts vote. In other words, there is a big difference in the way Republicans and Democrats represent relatively neutral districts.
Today the Congress is more polarized than it has ever been. More polarized than during Reconstruction.
And here:
The absence of a center in today’s politics significantly complicates coalition building. “How do you build a coalition from the center out when there’s no one in the middle?†Abramowitz asked. “Reaching across the aisle means reaching pretty far.â€
I think there’s a possibility on which more reflection is due: that today’s federal government shutdown was “baked in” when the Pelosi-Reid Congress enacted the PPACA. Major social programs have historically been enacted with bipartisan support. The metaphor frequently used is that the parties join hands and jump. That is extremely difficult in today’s highly polarized climate.
But it’s not impossible. Wyden-Bennett had bipartisan support. It wasn’t rejected by Republicans; it was dismissed by the Democratic leadership. Why? I think it’s because the “Healthy Americans Act” didn’t satisfy enough of the items on their checklist and they felt they deserved a victory and they wanted to continue to be able to run on the issue. They didn’t want to “join hands” with the Republicans to construct a plan with bipartisan support.
Pointing to the adoption in the PPACA of an approach that was first proposed more than a decade previously is begging the question. Today’s Republican Party is on the “all politics all the time” path that New Gingrich put them on. It’s not that Republican Party. The approach selected doesn’t suggest they were looking for Republican support; it just points out how the conversation has changed over the years. And the notion that Democrats were trying to gain bipartisan support by courting Olympia Snowe is even more outlandish. As voted Olympia Snowe so voted Olympia Snowe. She was the last holdout of a cadre of Northeastern Republican moderates. For good or ille she had practically no influence in today’s Republican Party.
The idea that Republicans were ever going to join in a health care overhaul is utter nonsense. Has a GOP president ever made any serious effort in that direction? No. Has a Republican Congress? No. Have they run on reforming health care? No. Did they attack Mitt Romney in the primaries for his own Massachusetts efforts? Yes.
Once again, you do not get the politics here. It’s not about health care reform, it’s not about policy. On the politics of this you’re like a toddler who wanders into a whorehouse and thinks he’s seeing pretty ladies trying on dresses. What’s happening right now has nothing to do with the benefits or downsides of health care policy. Nothing.
By the way, whatever happened to Bob Bennett of Wyden-Bennett fame? Primaried by the Tea Party and currently employed at a think tank. And that’s in not-entirely-insane Colorado.
Do you have proof of that other than assertion? Wyden-Bennett had Republican sponsors in 2009.
“Do you have proof of that other than assertion? Wyden-Bennett had Republican sponsors in 2009.”
And who got primaried for supporting it? Note that Wyden is still in office. As Salam noted at link, support for Wyden-Bennett was mostly gone by 2009. It had some support in 2008, but after the election and folks took office, working across the aisle was not allowed on major reforms like health care. Every Senator in office for the GOP in 2009 was pretty darn safe from losing an election to a Democrat, but not safe in a primary.
http://www.nationalreview.com/agenda/39391/second-look-wyden-bennett/reihan-salam
I think the real point to be made here is your point about the polarization. Politicians mostly worry about primaries in their own party. You need to be far left enough or far right enough to win a primary. Then, if you are in a safe district you just keep up the extremist nonsense. If you are in a non-safe district you try to move back to the middle. (If you were a witch, that becomes impossible and you then lose a state that you should have won.)
“Do you have proof of that other than assertion? ”
The fact that the GOP has never pursued health care reform except in response to Democratic proposals should be sufficient. As I noted above, they had effectively bailed on Wyden-Bennett by the time it could have been put forth as a serious plan. It should be noted that Wyden-Bennett had strong support among the health care economists on the left. At that time, economists on the right were mostly avoiding the issue or just writing criticisms of proposed plans. Heaven knows I used to send enough emails and complaints to prominent economists on the right like Goodman and Roy who were writing on the topic to try to get others involved.
Steve
Slightly OT, but I had forgotten that Medicare Part D was even less popular than the ACA prior to inception, and that it also had major implementation issues.
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/21/part-d-was-less-popular-than-obamacare-when-it-launched/
Steve
Reihan Salam’s recollection is wrong. As late as August 2009 it had substantial Republican support. Which is more than can be said about the PPACA.
steve, I honestly think you should revisit what was actually happening in the Congress in 2009. The House Republicans were irrelevant and there were no Young Turks among the Democrats to oppose the leadership which got pretty much what it wanted. The Senate Democratic leadership could either go for a little bipartisan support or hoss-trade for lock-step Democratic support there. Harry Reid elected to do the latter.
Wyden-Bennett wasn’t a non-starter due to Republican opposition. It didn’t have any support among the Democratic Congressional leadership.
I looked in vain for some insights into the reasons for the polarization in that article. I found none. Well, none except for this:
What exactly is meant by “losing our country”? I recall after the first Obama election, seeing some Republicans on TV, and one woman
was in tears saying, “I want my country back”. (I believe she, in fact, went on to found the group True the Vote.) One has to ask,
to whom do these folks think they’re losing the country? And what are the emotional contours of the supposed loss?
I don’t think that in the first instance it’s simply a matter of feeling loss because the party that believes in strong government won the election(s). I think the anti-government sentiment is in some sense an artifact of much more deeply held and unarticulated feelings. After all, just talking about the Tea Party, for instance, a major component of that movement are folks over the age of 65 on Social Security and Medicare.
So I think a simple assertion of antigovernmentism as an explanation misses the mark. It’s not government per se that is objected to, but
government being in the hands of certain people that is objected to.
Now, by certain people, I don’t mean a certain black person. Although I do think that there is an element of racism involved, the racism, to the
extent it exists, is itself an artifact of those unarticulated feelings I mentioned above. There are black politicians who are well-received in the political community we are discussing. Race as a determinant of political antipathy is what we might call a “second-level” determinant. (Not in all cases, of course, but in most cases.)
I think what we are seeing is, broadly, the reaction of a mainly rural, aging, and not highly educated population observing wealth, influence, and power flowing (with, they believe, — rightly, it must be said –unstoppable momentum) to an urban, educated, and young population whose culture is unfathonable to them. They view the contemporary American landscape and the see the marks of success and acceptance, of worth, in our culture are overwhelmingly colored by urbanism. Just look at the TV shows and commercials for confirmation. (And consider the depth of disparagement and contempt in the expression “Fly-over country”.) The country they believe they are losing is the country they believe once accorded them respect and honor.
What we’re seeing now, I believe, is an attempt at revenge, arising out of that most dangerous of emotions, Ressentiment — a seething rage at the supposed author or authors of your devaluation. It should fill you with foreboding.
I’m in substantial agreement with that statement.
It’s interesting to read previously posted comments trying to pin the tail on the donkey of blame onto the republicans.
However, even if a republican administration had come up with health care reform, checking a reform-effort-box for Steve’s sake, it most certainly would have contained: tort reform (anathema to dems); competitive accessibility to HC insurance across state lines; HSA plans; and the creation of special insurance pools in which all HC companies would have to financially contribute to, as a HC safety net for all those with special economic/medical needs. And, such proposals would have most probably been met with resistance and thumbs-down, scorned as not doing enough. After all, it’s a well-worn given that anything free-market based is usually not enough to please the ideology of social progressives, while anything involving big government machinations and control is worthwhile and acceptable.
This political trait was illustrated by the dems reception of medicare proposals sketched out by Paul Ryan. The voucher idea was soundly derided — even though it was an option not a mandate, and seniors already getting medicare were not effected, only younger generations. But, this all got lost in the hoot and hollers of dems screaming that republicans were trying to push granny off the cliff. It was ridiculous, deleterious to even seriously engaging in medicare reform discussions. However, their distortions were a successful strategy, derailing further talks about medicare reform. Ditto, when GWB attempted to introduce SS reforms aimed at younger generations being allowed to set up their own investment accounts. Even though he held an open hand out to dems, saying he would work with Congress to “find the most effective combination of reforms,” the dems refused to cooperate, and the idea died.
As for the PPACA now being cranked into place, there has never been a large public appetite for HC mandates. This has been obvious with earlier failed D and R attempts, as well as when it was contrived by today’s Senate and eventually passed with not a single R vote behind it. Democrats are now lecturing everyone on how historically there has never been such bad behavior displayed as has been done by the R’s in this CR debate. However, I want to remind them that there has never been a big entitlement program antagonistically glued together, from beginning to end, such as the PPACA — virtually passed by only one party’s consent, and then punitively forced onto an unwilling public Consequently, IMO, this HC “lemon’, marinating in divisiveness for three plus years, will continue to be embroiled in conflict for a very long time to come.
It’s unfortunate too, because a better plan could have been conceived and passed with bipartisan approval. But, the Obama Administration wanted it’s legacy moment, ASAP, no matter how much it hurt the people, placing personal ambition above principles.
Dave- It had 10 R supporters in 2007. It had 4 nominal sponsors in 2009. There 8 D sponsors in 2007 and 9 in 2009. I am counting Lieberman as an independent. Importantly, every major conservative/libertarian think tank, publication and policy writer had come out against it by 2009, especially Heritage, Cato and National Review. You can maybe make the case that the Ds were really fake supporters of Wyden, but I think it is pretty clear that it applied even more so to the Rs. It was bipartisanship for the sake of bipartisanship with no chance they would actually vote for it. (I could be persuaded that both Wyden and Bennett were sincere.)
Steve
@ jan
“and the creation of special insurance pools in which all HC companies would have to financially contribute to, as a HC safety net for all those with special economic/medical needs”
Followed by:
“it’s a well-worn given that anything free-market based is usually not enough to please the ideology of social progressives, while anything involving big government machinations and control is worthwhile and acceptable.”
Cognitive dissonance, thy name is jan.
Sam
For your information, free market solutions produce the most reliable safety nets — well- capitalized with a healthy revenue baseline to support a strong, enduring safety net for those who need it. Big government fails to do this, and hence their safety net becomes a short-lived mirage.
I would recommend that everyone get rid of their televisions.
Hey Sam, I was going to comment but you probably would conclude my observation would be either racist or uneducated despite my engineering degree coupled with MBA from an East Coast School frequently listed in the top ten…..and If I hit the jackpot, possibly both.
jan- In order. The Rs controlled both houses and POTUS and never offered up tort reform. I meet with our Republican Congressman every year along with a few other docs. He told us their is no support fo rit in Congress. When we met with Santorum, he told us there was no support for it in the Senate.
Competition across states? Insurance companies can sell across state liens now if they want, they just need to comply with the rules of that state. The GOP has a problem here as they advocate for state’s rights, but if they want to let insurance companies sell the same product everywhere they need to use the federal govt to override state laws. Not happening anytime soon.
The problem with Ryan’s plan was the funding levels. It was set to grow too slowly and basically used magic to accomplish it, a not uncommon tactic (see magic asterisk). The GOP was not honest about the depth of its cuts. Need I also remind you that it was Romney who ran on Obama cutting too much from Medicare in the last election? We dont get health care reform from the GOP and we also have them poisoning the well on reforming Medicare, which is what we really need.
You really should read long time conservative health care policy/economist on Obamacare. It provides the framework for everything the GOP claims it wants to do.
http://thehealthcareblog.com/blog/2013/10/06/how-i-learned-to-stop-worrying-and-love-obamacare/
Steve
Dave:
On any other topic I think you’d see what is right in front of your face. But you are so deeply involved in, and knowledgeable about, the policy aspects of health care that you miss the fact that not 1% of the American population can articulate any of the actual details of Obamacare. The American people are not you. They are not anything like you. They don’t start with reason, they start with emotion and then, after the fact, they invent rationales to justify their position.
You’re also acting emotionally, though. You’re trying to squeeze the wild and unpredictable world of humans into the Dave Schuler paradigm of sweet reason. It doesn’t work.
Go to the map of the hardcore rejectionists. http://www.newyorker.com/online/blogs/comment/2013/09/meadows-boehner-defund-obamacare-suicide-caucus-geography.html What do you see? The little red dots are overwhelmingly in the Confederacy, the border states and the rust belt. Do you really, honestly believe the people in those districts object to Obamacare because they think the cost containment measures are insufficient?
100% of districts in the suicide caucus are Republican. 100% are not urban. I don’t have time to do the research but I’ll bet you a dollar the districts in question have a markedly lower number of major colleges or universities. I’ll bet you a second dollar that they are on average poorer. I’ll bet you they are net recipents of federal taxes. Do you really believe that poor, less-educated white people are sitting around Crapheel, Alabama parsing the arcane details of policy and from that concluding in a rational fashion that they’d rather shut down the government and default on the national debt?
Is that really what you think is going on? Or is that just what would put this whole thing into your comfort zone?
No compromise was ever going to be possible. Not with this GOP. The GOP you and I grew up with? Sure. This GOP? No.
Steve,
The Wonkblog piece states:
That’s immediately followed by a graph with the poll data which shows Part D’s “unfavorable” was 34% compared to the ACA’s 40%, and the “don’t know/neutral/neither” was 45% for Part D and 24% for the ACA. I think it’s a stretch to conclude from that poll data that the ACA was “less popular.”
As for health reform generally and Wyden-Bennett in particular I’m not surprised the plan went nowhere. The Democrats were, quite obviously, pushing toward single payer or at least a public option. On the other side, the GoP, in a weaker position politically, was not going to embrace a moderate plan as starting position against that Democratic strength.
Michael talks about the politics and he’s partly right – there’s no incentive for either party to actually embrace a moderate plan like Wyden-Bennett because the political fear is that the party which embraces a moderate plan will be forced to compromise from that middle point toward the opposition. No one begins a negotiation advocating for the solution that might satisfy most parties.
So, the incentives promote starting from position at your own end of the field and work toward some kind of compromise – at least that’s the theory. Unfortunately, that theory is difficult with today’s polarized electorate and culture where there are fewer people in the middle and more true believers tugging at the ends of the string.
It’s easy to see how this plays out with the PPACA. After the 2008 election the Democrats controlled the House, Senate and Executive which didn’t exactly incentivize the Democrats toward compromise, despite the rhetoric. At the end of the day, they were in the dominant position politically and thus why should they seriously accomodate the GoP if they can get what they want passed without the GoP? The Democrats were eventually forced into a compromise, but it was due to moderate Democrat who rejected the public option among other things. The GoP didn’t enter the picture much on any of that – it was primarily an inter-party struggle between the liberal and moderate wings of the Democratic party. That said, the rhetoric wasn’t completely false since the GoP had no interest in enabling a process in which their political relevance was small. So, IMO, neither side had much interest in an actual bipartisan bill.
Steve also talks about members of the GoP being primaried. That’s true for some and is a real threat. But one shouldn’t ignore what happened to the Democrats with the PPACA. Sen. Pelosi, pretty clearly, sacrificed her majority to get it passed. Primary challenges aren’t the only consequences for politicians.
In closing, here is Pat Lang’s analysis, which I agree with:
Ultimately, we are a divided country and that is reflected in our politics.
Sam:
Beautifully put.
We differ on the centrality of racism, but you and I are in substantial agreement, I think. This is fear. And as I’ve said on many occasions, it is a justified fear. The world really is changing. These people really are dinosaurs the day after the comet hit. They could theoretically adapt, but if you’re still living in a rural area in 2013 adaptation is probably not your strong suit.
The changes have come very quickly by historical standards. In my lifetime black people gained the right to vote in the south. In my lifetime they gained the right to attend white schools. In my lifetime women have taken on a more equal role, contraception and abortion both became mundane facts of life, secularism has become accepted, gays have gone from pariahs to legal equality. The drug culture, the rock and roll culture, the youth culture, multiculturalism, the internet, cell phones, all in my (not that long) lifetime. And all these things threaten the very essence of an old, white, Baptist in rural Arkansas.
They are scared. The culture has moved on. Even the Pope is abandoning them, let alone their own children. It has nothing to do with health care per se, it is simply panic. We should have sympathy for them, and I do, but their world is not coming back and it’s adapt or die time.
Andy:
But we did compromise. We never even put forward a single payer plan. The compromises we made were with conservative Dems like Senator Ben Nelson, who represented a state that should have been (and now is) Republican. An all-white, rural, poorer state. We needed his vote, so instead of single payer we went with Romneycare in the mistaken belief that opting for a Republican plan would appease Republicans.
But of course we were wrong. Republicans unanimously opposed Romneycare once it was rechristened Obamacare. Even Romney opposed it. Which all by itself puts the lie to the notion that compromise was possible.
Andy- 14% higher in favorables and 6% higher in unfavorables comes out 8% ahead in my book, especially since we know that some of that unfavorable is because it is perceived as not going far enough. YMMV.
On Wyden-Bennett, I think it is important to remember that the punditry on the right had mostly removed their support for it. OTOH, those on the left continued to support it with many of the leading writers actively campaigning for it. Hence, I dont think there was any real support from it on the right. You had Graham and Alexander with their names on as sponsors, but they always like to maintain the image of being bipartisan w/o making any real commitments. Since the think tanks had panned it, they were not going to actually vote for it. The Ds are a little harder to figure out. Since their pundits liked it, I am guessing that some of them would have actually voted for it.
Obama, I thin I can still find the quotes, acknowledged that it was probably a better plan on its merits. However, he didnt think it was politically viable. Too big of a change. He preferred incremental change, which is why he started with Romneycare and modified it. The critique that Obama is some radical has always been odd. If anything he is overly cautious.
Steve
Andy- 14% higher in favorables and 6% higher in unfavorables comes out 8% ahead in my book, especially since we know that some of that unfavorable is because it is perceived as not going far enough. YMMV.
On Wyden-Bennett, I think it is important to remember that the punditry on the right had mostly removed their support for it. OTOH, those on the left continued to support it with many of the leading writers actively campaigning for it. Hence, I dont think there was any real support from it on the right. You had Graham and Alexander with their names on as sponsors, but they always like to maintain the image of being bipartisan w/o making any real commitments. Since the think tanks had panned it, they were not going to actually vote for it. The Ds are a little harder to figure out. Since their pundits liked it, I am guessing that some of them would have actually voted for it.
Obama, I thin I can still find the quotes, acknowledged that it was probably a better plan on its merits. However, he didnt think it was politically viable. Too big of a change. He preferred incremental change, which is why he started with Romneycare and modified it. The critique that Obama is some radical has always been odd. If anything he is overly cautious.
Steve
Ah, yes. Anyone who disagrees with government run health care is a country bumpkin. Probably still has an outhouse. Liberal mindset in a nutshell.
It really shouldn’t be controversial to agree that portability and the free rider problem need addressing, but by something other than a wholesale takeover of the health care system, especially in light of the experience with other government services, the, ahem, roaring start it is having, and the cost control driven restrictions to access experienced in other countries.
Harry Read did the cause no service by admittedly pitting the child cancer institute against his own chosen constituents. That is how it will really work.
You really are a poor reader.
“We dont get health care reform from the GOP and we also have them poisoning the well on reforming Medicare, which is what we really need. “
I assumed you might address the current problems with the PPACA and it’s less-than-admirable roll-out, by comparing it to the lack of GOP action to even push a HC reform measure during a republican administration.
First, the GOP, even when they had congressional control, their margins were slim and transient — nothing like the numbers Obama had in his first two years, where there was absolute, irrefutable control on all fronts in government. The sheer numbers, comprising the democratic majority, in both the House and Senate consequently gave Obama the best presidential shot at pushing any legislation through, including a HC reform bill. There were simply no major obstacles, except if one wanted to take into consideration the enormous public and republican opposition this measure always provoked. Obama, of course, just plowed through that, using the power he had to do want he wanted. Some would describe this is as dictatorial, and others, like you, deserving accolades for getting some form of HC legislation finally enacted.
Now you are calling for patience to wait out programming flaws the government had over 3 years to fine tune! IMO, that just dovetails into the incompetence this administration has demonstrated on all levels — both domestically and especially in foreign affairs.
As for the R’s ‘poisoning the well’ of medicare reform, that is your opinion. Ryan’s plan was a rudimentary framework, that had yet to undergo scrutiny of Congress etc., as did the PPACA. And, the dishonesty in medicare figures, during the last election, were disseminated on both sides. In fact, Obama’s cuts to medicare, aren’t even being enacted during this implementation period, making the plan all the more worthy of skepticism as to it’s ultimate workability. Add into the mix of changes Obama made to the PPACA — the lack of subsidy verification (another programming deficiency), and the delay of the big business mandate, deleting billions from the original funding expectations — and what you have is a fiscal disaster in the making, being coddled and covered-up.
What Sam and Michael describe as fear can also be seen as overreach of the progessive agenda. And that fits with what Dave, describes, IMO.
I see Wyden Bennet more as Dave does. But let’s not kid ourselves- the reason it failed also has to do with the moneyed interests deciding (or being cajoled, or bribed) to support the plan of the Democratic leadership. It’s irrelevant that the Dems who supported a bipartisan plan didn’t face primary challenges, if the real reason that there weren’t more of them is that they would have lost their bankrolling from the healthcare industry.
jan- 1) AFAICT, there are no major problems with the ACA yet. There are problems with the rollout of the sign up process, just like we had with Medicare Part D, which as has been pointed out, is now popular. Frankly, I find it kind of bizarre to make pronouncements after just a few days.
2) It didnt really have 3 years. It had to go through the Supreme Court. No one was sure if it would pass. There was no cooperation from many states during this period (or later for that matter).
3) The Ds did not have an unassailable majority. They had 58 Senators until Kennedy died. They also had to convince Lieberman and Saunders. The bigger problem was getting the senators from swing states to agree. In the past, the most conservative D would be close to the most liberal R. That just isnt the case now.
4) There was no massive objection to it until it passed and the Rs went into propaganda mode. Actually, there has never been “massive” opposition. It has always been less than 50%, IIRC, and its unfavorables usually outweigh favorables by a few percentage points. Some of that is from Ds who think it was not liberal enough and wanted single payer. All of the parts of the ACA except for the mandate poll positive.
5) I can provide many, many quotes from the Romney campaign criticizing Obama for cutting Medicare.
Steve
Steve:
As I wrote in comments at OTB and as I implied in my post above, I’m kind of sympathetic with the rollout issues with healthcare.gov. IMO any pronouncement is grossly premature.
However, I’m comfortable with some conjectures. If the problem is architectural rather than due to loads or due to bugs, they have a real problem on their hands. More than that, if the number of actual enrollees by the first of the year is measured in the thousands rather than the millions, they have a real problem on their hands.
Finally, if the enrollees run heavily to those who are already sick rather than those who are young and healthy, they’ve got a real problem on their hands.
Time will tell.
Dave- I suspect a lot of the problem comes from sticking with the October 1 rollout date. If you read through the Part D story, it got delayed over and over. Of course, you didnt have an opposition party claiming that it was unconstitutional to do so back then.
Steve
@steve, Illinois has veto-proof Democratic legislature and Democratic governor, and it didn’t sign onto the exchanges until around May of this year. I believe it had to do with the state’s Medicaid problems and its budget. There were numerous Democrats, including the director of the relevant department, who took the position that the state needed to fix its current Medicaid program before increasing the burden. I’m not sure I’m clear of the specific dynamic, but culling the Medicaid rolls before the ACA was fully operational was less harmful to the state’s budget vis a vis federal funding. I’m sure other states have serious Medicaid problems as well.
CStanley:
Would those be the same “moneyed interests” that primaried Senator Bennett as too moderate and tossed him out on his ear?
“I find it kind of bizarre to make pronouncements after just a few days.”
Steve,
I made no pronouncement, except to posit the PPACA as a: “…..fiscal disaster in the making, being coddled and covered-up.” IMO, I do think that this HC legislation will be a disaster, in how it was manufactured, marketed and now implemented. I also think that cherry-picking who is subject to requirements of the mandate (individuals) and who is exempted (Congress and big business) is disgraceful, especially in lieu of all the ‘fairness’ rhetoric that normally goes on in the democratic regime. However, be that as it may, the ACA is law, and I guess we are stuck with it.
Yes, the ACA did go through the Constitutional gauntlet, but I don’t think that excused the government from designing programs in the interim that would sufficiently function as a good operating system when it was set to open. And, why not embrace postponement for everyone if the software was so untrustworthy to handle either the traffic or the downloads? As for it’s constitutional standing, that was only because it was interpreted by Roberts as a ‘tax’ rather than as a fee — the former being something Obama refuted when he marketed this mess to the people. And, BTW, aren’t tax bills suppose to originate in the House? Why was this bill created in the Senate? There are so many misnomers, glitches, selective applications of the law, and yet you continue to overlook all these ill fitting qualities and wonder why there are those who dislike it so much.
I did not use the word unassailable in describing the dem majorities under Obama. What he did have was a decidedly bigger, irrefutable margin than is usually enjoyed in Congress by one party, especially GWB’s congress. And this larger-than-normal majority was definitely used to Obama’s advantage to achieve his lopsided victory.
“There was no massive objection to it until it passed and the Rs went into propaganda mode”
I guess it’s all depends how you define ‘massive objection.’ And, it’s disingenuous to call the R’s objections to Obamacare as going into propaganda mode. Republicans and their base, pure and simple, did not agree with nor wanted this bill to pass. The real lasting by-product, though, of the PPACA’s passage, was energizing a subset movement — the tea party. This was a group of people who equally criticized Bush’s Medicare Part D. Obama’s PPACA ultimately became the last straw, causing them to organize, becoming a force to be reckoned with in the 2010 midterms. There is a time line of evolving public outrage, and it tracks through both Bush and Obama administrations. .
“All of the parts of the ACA except for the mandate poll positive.”
The mandates are the core dysfunction of the bill. Mandates were something Obama even campaigned against Hillary Clinton, in the ’08 primaries. But, like so many of Obama’s words and directions, he reversed himself and promoted mandates.
Also, prior to the inception of this bill 85% of the people were satisfied with their HC coverage. You would think that some kind of moderate HC bill could have been enjoined, redressing the errors and omissions of the 15%, while leaving the other 85% happily alone. However, that was not the case, and now everyone is forced into unknown HC territory, and the social progressives are rejoicing.
At least we have a principled leader at the till –
http://www.zerohedge.com/news/2013-10-07/debt-ceiling-humor-i-therefore-intend-oppose-effort-increase-americas-debt-limit
Jan:
From OTB:
Please update your Fox News talking points.
Source?
@Michael-
I’m sure if we followed the money we’d see interest groups of all sorts lined up to support or refuse support for these legislative options. My point is that that’s where the real tipping point occurs now because once our politicians are bought and sold, propaganda can convince the public of anything. I’ve seen our politics this way for years but never more so than when I witnessed the debacle of the PPACA being dragged across the finish line.
It’s like Rube Goldberg designed a machine that picks up dog excrement, and in the process it spills most of the feces before it gets to the sack. And half of the country now believes that we have to have this machine, because a) there is no better alternative shit picker-upper available and b) the half of the country that doesn’t want this shit picker-upper are deranged. The half of the country that believes that the non-working contraption is in the vital interest of the nation the also chooses to conveniently ignore that the reason Mr. Goldberg had to design this machine, and the reason all of its intricate steps fail to accomplish the goal for which it was intended, was not related to the people who opposed the building of the machine to begin with.
CS:
We already had a Rube Goldberg machine. It didn’t cover working people who clogged emergency rooms costing thousands for kid’s ear infections that could have been a 100 dollar office visit. It meant if you got sick and couldn’t work you lost your job which meant also losing your health insurance. It meant insurance companies throwing you out the window when you got sick. It was a clusterfuck of astounding proportions.
What we have now is a somewhat more decent clusterfuck. The reason we don’t have better is that Republican voters are terrified that black people will get something.
By the way, Obamacare? Going to save me thousands of dollars.
I went back today to reacquaint myself with the politics of Medicare Part D today. Turns it reconfirmed my cynicism at partisanship in general and partisan arguments WRT the PPACA in particular. This, from 2010, gets to the gist of my cynicism about what Michael calls the politics of health care reform. There are many other parallels between the politics of the PPACA and Part D, including criticism of implementation – on that it’s almost as if the GoP critics are working of the Democratic script from eight years ago.
In short, the roles changed, but the song remains the same. This is a big reason why I fully subscribe to the “both sides do it” worldview, which is a view that inevitably drives partisans from both sides bonkers. Mainstream partisanship seems to value team loyalty above just about everything. So to me the difference between the two is a matter of zealotry and on that the GoP is way out in front.
Michael,
I had little time to respond to your post, but here are a few links that were quickly found:
1) Regarding the congressional exemptions — it’s more like Congress and their staff have been exempted from losing their health care subsidies. From the WSJ:
The Hypocrisy Of Congress’s Gold-Plated Health Care
Basically, congress complained about the possibility of the ACA delivering a governmental “brain drain,” without granting special exemptions for HC subsidies, stemming Obamacare fears or jitters of increasing their out-of-pocket insurance costs. Therefore…
It goes to show that all politicians have hypocritical sides to them — republican and democrat alike.
More of the same from Forbes:
Congressmen Rejoice Government To Subsidize Their Health Insurance Through Obamacare Exchanges
2) Here is a Politifact piece fact-checking the percentage of people liking their healthcare, previous to Obamacare. George Will says that 95 percent of people with health insurance are satisfied with it. The percentage of people already having healthcare was 85%
Politifact rated Will’s statement as true..
Andy,
The difference between Medicare Part D, created by Bush, and the PPACA, concocted under Obama, is that republicans seem to be much more diversified and honest in their opinions. Many, Many republicans and fiscal conservatives railed against Bush’s hand in this expansion of medicare. Whereas, democrats seem to passively support, with a herd mentality, their party line, rarely saying a peep about a “clusterfuck” law, like the PPACA, when it is conceived under a Democratic administration.
The same behavior is displayed on the debt ceiling, where Obama derided Bush for raising it, calling him the usual derogatory names dems do to republicans, including pointing out his lack of leadership. And, now he is saying just the opposite, calling Boehner and company all the usual derogatory names for not wanting to raise it, while denying their claims of his lack of leadership! And, the dems just submissively go along with this conflicted rhetoric, and continue to demagogue their republican nemesis.
Somehow the role of the oppositional party to actively demonstrate opposition to rules, regulations, laws, practices they see as unwise or fiscally harmful is completely dismissed by democrats, when they are in power. And, the same is true, but, IMO, not as inflammatorily expressed, when it’s the GOP in power and the dems braying at the wall opposing something.
I think that the case that emergency room visits are a consequence of lack of insurance (which you’re implying above) or that the reforms that have been made will alleviate the present situation is a pretty tough one to make.
Roughly 20% of present emergency room visits are by the uninsured. Of the total number of uninsured about a quarter don’t qualify for insurance under the PPACA. Of those who do qualify some proportion still won’t get insurance and some will go to the emergency in any event.
Here in Chicago, if you need care now the odds are pretty good that your physician will tell you to go to the emergency room. The real problem is a lack of slack capacity and the PPACA doesn’t do anything about that.
I’ve been to emergency room sin Evanston, IL, Chapel Hill, NC, and Marin County. (Various things, all requiring emergent care, none life-threatening.)
In every single case I have sat in waiting rooms behind poor people there for stuff exactly on the level of ear infections. You get whole families more or less camping out as they have to swap adults in and out to manage work and other kids. The waits are appreciably longer because they are there for b.s. that should have gone to a pediatrician.
In no case have I ever had any problem getting a GP or pediatrician. It never happens.
As for coverage, I guarantee you 90% of these working poor people would have been covered by expanded Medicaid, which is part of Obamacare.
Jan:
So 85% of people who already have employer-provided coverage are happy. This is good news since Obamacare will have no impact on them. They can keep their coverage. They were never the problem.
The problem was the people who were not covered, the free riders, the working poor who are not obviously included in Will’s number. Right? And now they are being covered under Obamacare and expanded Medicaid — except in states run by Republicans where they have a different plan known as, “Fuck you if you get sick.”
Of the 15% who are already covered and not happy, many are probably unhappy because their insurers won’t actually pay their bills, or are dumping them off the rolls.
Have you checked CoveredCA? Because I did, and I’ll be saving thousands of dollars.
Yes, anecdotes constitute unassailable truth while statistics are meaningless.
Much of the ER traffic is oftentimes composed of illegals. I remember when my husband split his lower leg open by a saw dropping on it, a woman, speaking little English, ahead of me at the reception desk, was there because of her small child’s sore throat. And, then there was my guy sitting in a chair with his fat and muscle hanging out of his leg…..
Michael,
My millennial son is having his catastrophic policy going up, as of the next renewal date in ’14. He refuses to pay the increase. I don’t know if he has tried the exchanges yet. However, he bluntly said he could not afford a higher premium, and would not pay the fine. He is very OWS in how he views the world.
I have not tried the CoveredCA site, myself But, if for nothing more than curiosity’s sake, will do so. Regarding your conviction about people being able to keep insurance and doctors they have been happy with, I think that is a premature assumption. It has no factual basis, other than hope that changes will not adversely effect people — much of it due to your own anecdotal experience touting preliminary savings through California’s exchanges.
One has to remember, though, that these past 4 years were designed to stream all the ‘free,’ feel-good HC goodies people like, creating a gains with no pain atmosphere hooking people, at the get go, onto the merits of the ACA . It’s like leaving donut crumbs on the way to the implementation phase (some are calling it a ‘heroin drip’), which is where we are now. After October 1, some of the unwanted, and perhaps surprising financial implications of this law will slowly reveal themselves and come into play. But, it won’t even be until after 2014 that the full impact of the PPACA will be realized, as Obama has shrewdly delayed or waived big business mandates, medicare defunding, subsidy verification, 2000 special, hand-picked groups/allies, sign-up requirements for small business, reinstated HC subsidies for Congress and their staff/aides — relieving everyone except nameless ordinary individuals from being caught up in mandatory compliance of the law. This Obama-chosen group can continue to enjoy HC bliss, until, curiously, after the ’14 midterms. Coincidence? I don’t think so. It appears to be nothing more than a disingenuous plan complimented by a brilliant government strategy, to install yet another entitlement program in place for forever.
Jan:
From those crazy socialists at The American Conservative:
Even real conservatives know the Tea Party people are crazy.
@Dave Schuler
I suspect there are differences depending upon one’s location.
If I am not mistaken, Chicago has one or two large public hospitals that serve mostly poor folks, and these hospitals have set up clinics to take care of the people going to the ER for ear infections.
The people who do not qualify for any assistance will be charged, and non-payment will be treated as any other non-payment – collection agency & ruined credit score.
A lot of people assume the world is similar to their experiences.
Dave:
Yes, statistics are totally reliable.
Statistically I never had skin cancer. It was the easy-going kind, I had it removed, explained to the doctor that I would self-pay and that I didn’t want insurance knowing. To which the doctor replied, “What cancer?” Anecdotally I totally had it. Statistically no.
Statistically I also don’t smoke cigars. Oh, and my maternal grandfather did not die at age 54. My daughter is statistically suffering from ADD while anecdotally she’s behind in school and Ritalin helps. My son statistically also has ADD, which anecdotally may have something to do with the fact that he hates homework and is in a school where about half the other students also have ADD (It’s an epidemic!) requiring all of them to use Adderall in a creepy kind of arms race.
Also statistically my wife suffers from depression requiring Prozac. Despite anecdotally using Prozac to take the edge off an entirely different issue: OCD.
So, four people, at least 6 bits of statistical health-related b.s.. Surely no one else does things like that. Certainly not poor people at the emergency room, or doctors who either accommodate patients or know the answers their bosses want to hear and parse the two.
Statistically I did not sit shivering from high fever for four hours in the Marin County hospital while surrounded by poor families and their kids who were suffering from the kind of crap any pediatrician could have dealt with. And yet, anecdotally I have these memories of having done so. Weird.
You really don’t see the distinction between the point I’m making and the point that you’re making? You’re saying that statistics aren’t completely predictive of every individual case. I agree with that.
But you’re overreaching to say that statistics are irrelevant in looking at aggregate behavior.
Just to add my own anecdotes, I have very good insurance (Military Tricare thanks to my wife) where we pay almost nothing in deductibles and copays. I’d say out of all my health care visits, about 1/2 were ER visits. The reason is that urgent care facilities are rare and it’s even rarer for one to be open when you need it. My wife went to the ER probably 5-6 times during her second pregnancy for this reason. New parents will probably spend a lot of time in the ER as well (it wasn’t really until my third kid that I was experienced enough to know when an ER visit was actually warranted). Then there are the borderline issues where you have to decide whether it’s worth it to wait for an appointment the next day (assuming you can get a next-day appointment).
All that (and more) has nothing at all to do with insurance and everything to do with access to health care when and where you need it. For most people, the ER is the only game in town when regular appointments aren’t available.
Now, the PPACA doesn’t address this at all. So I think we’re likely to see increased ER use because demand for healthcare is likely to rise while the supply stays relatively flat.