Archive for July, 2013

Chariots of Fire

Wednesday, July 24th, 2013

And when the servant of the man of God was risen early, and gone forth, behold, an host compassed the city both with horses and chariots.  And his servant said unto him, Alas, my master! how shall we do?  II Kings 6:15

Elisha was in a tough spot.  God, through Elisha, was helping the King of Israel elude the more powerful Syrian army.  When the King of Syria discovered Israel’s secret weapon, he sent a bunch of his best chariot soldiers (the military killing machines of the day) to capture Elisha.  They surrounded him at Dothan.

Republicans have adopted a similar strategy with Obamacare and so far have been just as frustrated as the King of Syria.

President Obama used the majority that he earned in his first election to get this legislation passed.

He lost that legislative majority in part because of Republican opposition and popular backlash to the law.

The law did survive legal challenges that ultimately went to the Supreme Court.

It also survived a second national election where Obama’s opponent, Mitt Romney pledged to repeal the legislation.  Paul Ryan was recently quoted saying that Obamcare was a key component in their defeat.

“This was our challenge that Mitt Romney and I had in this last election,” Ryan said in a speech at the annual Faith and Freedom Coalition conference in Washington, DC. “We had to argue against the promise and the rhetoric of President Obama. The great soaring rhetoric, all of the empty promises.”

It may have also been the unseemly spectacle of Romney arguing against a program that he had promoted while Governor of Massachusetts.  Or it could have been the failure of Republicans to offer a credible alternative, but we’ve already discussed the 2012 election in more than enough detail.

Now Republicans are attempting to defund any part of the bill that they can get their hands on, while beating the drum as loudly as they can that the implementation is going to be a disaster.  This is right in the wheelhouse for Republicans, since Big Lie politics has been their strategy pretty much since this President first ran for office.  The result is that some people are scared, though there is little proof yet that they have anything to be afraid of.

When you look at this from a historical perspective, the same things happened to every major new government social program over the last century, Social Security, Medicare, and Medicaid.

In 1966 the Johnson government had to mount a door to door campaign to sign up seniors for a free medical insurance program designed to help them with what for many was their single largest expense.

“What will happen then, on that summer day when the federally insured system of paying hospital bills becomes reality?” Nona Brown, a New York Times reporter, wondered in a story published April 23, 1966. “Will there be lines of old folks at hospital doors, with no rooms to put them in, too few doctors and nurses and technicians to care for them?”

Medicare wasn’t a slam dunk either.  JFK was the first to propose it and he failed.  The AMA opposed it.  Two months before LBJ signed the bill the AMA ran ads across the country denouncing the program as “the beginning of socialized medicine”.   Some experts said that the government would fail to enroll enough seniors to make the plan work.  They worried that the $3.00 monthly premium would be too expensive, particularly for those poor seniors who needed it most.  They also said that there wouldn’t be enough physicians to treat all of these newly insured people.  Segregation was also a problem in the south were hospitals refused to provide service for elderly African Americans.  Medicare patients had access to only 1% of the available hospital beds in Mobile Alabama because they potentially could be used by African Americans.  Within weeks of the start of the program, however, all 65 hospitals were accepting patients.

There are also parallels to Medicare Part D rolled out eight years ago. In the spring of 2005, Medicare Part D was less popular that Obamacare is now in part because even fewer Americans understood how IT worked than understand how Obamacare works.  Just before the start of enrollment, in October 2006, “only one in five seniors expected to enroll in Part D.” The rest either hadn’t made up their mind, or thought they already had similar coverage.

Medicare Part D rollout compared with Obamacare

Medicare Part D rollout compared with Obamacare

Seniors, it turned out, were not exactly great at predicting their behaviors: 53 percent of Medicare beneficiaries ended up enrolling in the new benefit. The CBO was off by a bit too, with the average drug plan costing $29 per month rather than $35.

The Medicare Part D rollout had plenty of problems and still hasn’t reached all of the seniors originally targeted.  It has also been criticized as a give-away to Big Pharma.  But in a recent survey, 90% of the participants in the plan said they were satisfied.

“The temporary issues were just that, temporary,” said Mark McClellan, who led Medicare during the rollout. “The memories didn’t last that long. In the end, it comes down to how good the insurance coverage is.”

So what are the clues that we’ve been seeing so far for Obamacare?

Premium bids on the health exchanges, for example, are coming in slightly lower than the Congressional Budget Office projections. Call centers are starting up right now, but it’s still hard to predict what call volume they will receive in the coming months.

Medicare Part D started marketing a year ahead of the program.  Obamacare is planning a big push this fall closer to when the new plans will actually be available.

What they have determined is that they have to get 7M people signing up through the exchanges, 2.7M of whom need to be in the 18-35 set.  Fortunately this is in the wheelhouse of the Obama administration because this was the same targeted group that helped elect Obama in 2012, and the administration has kept all of the microtargeting data that proved so effective in that campaign.

Here’s an example of what they have learned.

The Obama administration believes it has four ways to pull people — both young and old — into the market. There are the subsidies. There’s the individual mandate. There’s the hoped-for ease and transparency of the new marketplaces. And then there’s the fact that people want health insurance.

The rest of the good news for Obamacare is that young people are the largest uninsured group at 18M.  8M will qualify for free insurance.  9M will qualify for subsidized insurance.  Now the prospect of getting 2.7M young people to sign up doesn’t seem nearly so daunting.  The urban institute projects that 96% of 21 to 27 year olds will qualify for some subsidy.  Combine that with the individual mandate penalties for those who can afford insurance and you get the results seen in Massachusetts, where the number of uninsured young adults dropped into the low single digits.

That’s not to say that Republican opposition won’t still impact the rollout, but that opposition is going to be increasing desperate as the facts on the ground prove Republican claims to be, yet again, lies.

A good example is the recent revelation in Indiana. Republican Governor Mike Pence has made opposition to Obamacare a major part of his platform in hopes, perhaps, of making a run at national office.  Funny thing happened on the way to the primaries, however.

Pence’s administration gleefully announced that under Obamacare Indiana premiums were going to rise to an average of $572 a month.  That’s a 72% increase over where they are now.  That seemed to fly in the face of announcements from states like California, Oregon, Washington, and New York where Democratic governors announced projected savings.

Turns out that those same savings exist in Indiana too with the most popular plans coming in under $300, but Indiana officials masked that savings by assuming that at least 30% of the people in that state would purchase the most expensive options.  The national guideline is more like 8%.  In Midwestern states like Indiana that number is even lower.

The recalcitrant Michigan Senate also finally voted today to extend Medicaid to the poor and accept the Federal government subsidies.  If the tea party zealots that comprise the majority in the Michigan Senate ultimately wilted under the reality that this deal is just too good to pass up, the same thing will happen in all of the other states opposing Medicaid expansion.  Accepting the deal makes too much economic sense.  Those states who oppose it for political reasons will discover, just as they did in Michigan, that they have put their business community at a cost disadvantage.  Even fanatical conservatives understand where their support comes from, and if they persist in their opposition, the business community will make sure someone more favorable to expanded Medicaid coverage takes their place.

Obamacare will succeed because, just like the 2012 election, he has the numbers.  The numbers of people who will see improvement in their healthcare coverage WILDLY outnumber the people who may either see their rates go up or their coverage change because of actions of their employer.  The CBO has already said that 90% of those who currently have coverage through their employer will not see any change.  And each person, whose access to healthcare improves as a result of this plan, will oppose any future effort to take that coverage away.

And he answered, Fear not: for they that be with us are more than they that be with them.

And Elisha prayed, and said, Lord, I pray thee, open his eyes, that he may see.  And the Lord opened the eyes of the young man; and he saw: and, behold, the mountain was full of horses and chariots of fire round about Elisha.  II Kings 6:16-17

 

The Original Tea Party Patriots

Saturday, July 13th, 2013

The Declaration of Independence and the Constitution continue to be controversial, as they were intended to be.

Nathan Philbreck has written a wonderful new book called Bunker Hill chronicling the role that Boston played in the revolution that led to the creation of these documents.  The Boston of his telling was not too far removed from the ungovernable tribal areas of Afghanistan that we hear about today.  As a result, founding fathers like Franklin, Jefferson, Washington, and even Adams were way more concerned about the Boston rabble than they were the British.  They feared that after beating the British, Bostonians would keep right on going and defeat the rest of the colonies in short order, establishing themselves as the rulers of the new America.

The one saving grace was that the inhabitants of this feisty bare-knuckled blue collar town of 15,000 also believed in this new idea of democracy.  That’s the soil in which the seeds of this great country were sown.  While they still believed in settling their differences with their fists, they longed for a government where laws protected the rights of the individual from the might of the powerful.

Today’s Tea Party could learn something from the history of the group whose name they have taken.

What has grown from those Boston seeds is a government of checks and balances that is now severely challenged by special interest money and partisan politics.

Let’s go down some of the list examples of those challenges.

Obamacare – No single recent political issue is more divisive.  The reality, however, is that Obamacare did pass by a majority vote of both the House and Senate, was upheld by the Supreme Court, and is now the law of land.  Republicans ran a Presidential candidate in the last national election who promised to repeal Obamacare if elected.  He lost convincingly.  Rather than accept the obvious and work to make the law better, Republicans continue to fight a trench war against its implementation.

The Republican budget proposed this year included a repeal of Obamacare, even though there was no hope of getting that past the Democratic majority in the Senate or the White House.  That budget did, however, still include the same taxes that Republicans labeled as “job killing” in the last election.

Michigan is another example.  The Republican Governor supports the federal expansion of Medicaid contained in the bill.  He says it is a good deal for the state and for businesses.  He is supported by the business community.   The Medicaid expansion bill passed the house but stalled in the Senate.  It has stalled because the Republican majority leader refused to bring the bill up for a vote before the Senate adjourned.  It was because he didn’t have enough votes to defeat it.  Instead Michigan is at risk for loss of billions of dollars of federal aid and significant added business cost because a Conservative MINORITY opposes the whole concept of subsidized care for the poor.

Abortion – The single most divisive political issue of our time.  Abortion up to 28 weeks has been legal for decades since the Supreme Court Roe V. Wade case in 1973.  This ruling continues to be upheld in the courts.  It continues to survive in national elections, 2012 being the last example.  Rather than seek some common ground where both pro-life and pro-choice forces could focus efforts on the prevention of unwanted pregnancies; those opposed to abortion continue to use the same trench war tactics against access to abortion.  It has become a valuable fund raising issue for both conservatives and liberals.  States with conservative majorities are passing laws to make abortion more difficult, expensive, and time consuming.  Just like the Michigan Senate, the goal is to “run the clock out” for some of the women seeking these services.  These laws will eventually make their way to the Supreme Court and will likely be struck down.  In the meantime, though abortion is a constitutional right, ability to exercise this right depends on the state you live in.

Immigration – The courts have ruled that all residents (legal and illegal) are protected by our laws and have a right to things like a free public education.  In striking down the Arizona laws, the court said that immigration status in and of itself is not probable cause for a police stop.  In the wake of a sound drubbing in the 2012 election, Senate Republicans and Democrats came up with a compromise immigration bill that offers those who are currently in this country illegally a path to citizenship.  That bill will likely pass the House if an up down vote is taken today.  House Majority Leader Boenher, however, is unwilling to bring it to a vote because a majority of Republicans in the house oppose it.  This after the CBO projected that the Senate Immigration bill would reduce the deficit by $135B over the next decade and reduces illegal immigration by 50%.

Surveillance – The US began a massive data gathering activity to monitor all internet communications as well as phone conversations during the Bush administration.  The Obama administration continued this surveillance with full Congressional and judicial overview.  This clearly runs counter to the privacy protections of the constitution, but it is a practice that a majority of our elected representatives have approved as part of a larger effort to detect terrorist plots.  What is interesting here is to see the role that politics is playing.  In 2006 when the illegal Bush Administration NSA surveillance schemes came to light, Pew Research found that 75% of Republicans supported the plan and 61% of Democrats opposed it.  Now in 2013, the opinions have flipped.  47% of Republicans oppose the NSA program.  64% of Democrats support it.  So clearly this has WAY more to do with who is in the White House than the legality or constitutionality of the program.

Marriage Equality – This was a wedge issue created by Republicans to energize social conservatives.  It culminated in Bill Clinton signing a Defense of Marriage act in 1996.  He signed it because it had passed both houses of Congress with veto proof majorities.  Every national election cycle since has seen local conservative groups in at least one state propose a state-wide issue to define marriage even though at a federal level the issue had already been decided.  The Mormon Church and it’s members contributed more than $20M of the $39M ultimately raised by the supporters of Prop 8.  45% of the out of state money supporting this California ballot measure came from Utah.

The bottom line is that all of these measures are unconstitutional and will ultimately all be repealed or struck down because they violate the basic constitutional rights of same sex couples.

Summary

The Constitution doesn’t care about politics.  It only cares about rights.  The Supreme Court interprets those rights based on the body of law to date as well the needs of TODAY’S citizens.  That’s why slavery was abolished and women can now vote, even though the original document allowed slavery and prohibited women from voting.

Citizens also have an opportunity to amend the constitution, but the last time that happened was in 1971 when the voting age was lowered to 18 (not counting the 27th amendment which took 203 years to ratify).  So the reality is that most of the time these days the Supreme Court decides how the constitution applied to the laws that Congress passes.

Some conservative groups have attempted to revise history regarding the intent of our founding fathers and at least one Supreme Court justice reflects this “strict constructionist” view of how the constitution should be interpreted.  Fortunately the court continues to steer a path between the extremes represented in the voting electorate.  That makes extremists from both sides of the political spectrum unhappy.

That’s because the courts and our founding documents are mitigating the impact of the more extremist policies coming from our deeply divided electorate.

Like it or not, that is one of enduring qualities of a country where right can trump might.  Those Bostonian patriots would be proud of how well this system that they created continues to function.