Yet Barletta did land one of the Republicans’ few punches when he pressed Johnson over the fact that undocumented migrants granted permits to stay in and work in the country would not qualify for benefits under the Affordable Care Act.A better response would be, "If in your analysis of the legislation that's even a remote possibility, passing a bill to prevent that problem would provide a quick and easy resolution in favor of the American worker."
He said that put them at an advantage over US citizens, who he referred to as “American workers”.
“You don’t think an employer will think, ‘Do I keep an American worker and provide health insurance or pay a $3,000 fine, or do I get rid of the American and hire an undocumented worker?’” Barletta asked.
“I don’t think I see it that way,” Johnson said. “You don’t think any American workers would see it that way?” Barletta continued.
“I don’t think I see it that way,” Johnson replied. “No, sir.”
Political discussion and ranting, premised upon the fact that even a stopped clock is right twice a day.
Tuesday, December 02, 2014
A Republican Punch That Shouldn't Have Landed
Friday, November 21, 2014
Before Charles Lane Accuses Others of Hypocrisy, Perhaps He Should Look Up the Definition
Still, accusations of hypocrisy abound. Certainly there are times that they are warranted, but often they're the hallmark of a lazy columnist. Falling into that latter category, Charles Lane is waving his finger at "liberals".
Building the Keystone XL pipeline, to speed the flow of crude from Canada’s oil sands to refineries in Texas, would be “game over for the climate,” says NASA-scientist-turned-climate-activist James E. Hansen. Heeding Hansen’s words, environmentalists have sworn to stop the project, which requires U.S. government approval.Perhaps we should note, up front, that not all environmentalists are liberals, and not all liberals are environmentalists.
Yet large, bipartisan majorities of the House and Senate support Keystone XL, as does 60 percent of the American public, according to the latest USA Today poll.And... that has absolutely nothing to do with whether the project is environmentally wise.
Today, it is still on hold, because Tuesday night 41 Senate Democrats voted against ending debate on a bill to green-light Keystone XL, thus thwarting what might have been a disastrous exercise of democracy.Perhaps it escaped Lane's notice, but that is not the first-ever use of a filibuster in the Senate. As Lane himself noted in a prior screed,
Republican opposition to Obamacare may be hypocritical, irrational and opportunistic — especially GOP opposition to the exchanges, which the party previously favored in various forms. And, yes, the modern filibuster takes counter-majoritarianism to an extreme even the Framers probably didn’t contemplate.The fact that Senators who are part of an institution that has created and upheld the filibuster actually employ a filibuster is in no way hypocritical. Even if we assume (in defiance of the facts) that each and every one of those Senators would vote for straight majority rule in the Senate, it would not be hypocritical of them to employ the actual rules of the Senate when voting on legislation.
But the Constitution lets the Senate write its own rules.
In short, the filibuster may have just saved the planet, at least for now.Here, through his link, Lane suggests that Markos Moulitsas is a hypocrite for opposing the filibuster and... he doesn't offer a link, but perhaps Moulitsas praised the Senate vote somewhere? As with Warren Buffett and his taxes, even if Moulitsas is overjoyed that the pipeline bill was filibustered, it's not hypocritical for him to advocate changing the Senate's rules while nonetheless encouraging Senators to use those rules to advance policy positions he favors. The concept isn't even slightly difficult to grasp -- it is possible to believe that something is bad on the whole such that it should be eliminated, even when recognizing that it has potential value under certain circumstances.
Or so it must be believed by Keystone XL’s opponents — even though they include some of the same people who decried the filibuster, not unreasonably, as an obstructionist, anti-majoritarian evil when Republicans employed it against President Obama’s health-care reform, cap-and-trade and other progressive legislation.
When I saw the film, Shattered Glass, I had some sympathy for the Charles Lane played by Peter Sarsgaard, a well-meaning guy who got duped by one of his employees. But the Charles Lane who writes for the Washington Post seems to have a different problem -- he seems to be lazy and indifferent to the facts, the sort of approach to journalism that can allow somebody like Stephen Glass to get away with feeding him the most absurd fabrications as long as they don't conflict with his preconceptions. When you click through the link to the actual statement by Markos Moulitsas, Lane's exemplar of a hypocrite, you hear this:
There's a huge movement, and I think it's going to happen, to change the filibuster rules from requiring sixty votes to requiring forty "no" votes. Right now if you want to filibuster you don't even have to show up, you know, the onus is on the "pro" side to round up the sixty votes. So when you turn it to forty votes you gotta have those forty people there, and if one of them has to go to the bathroom, boom, you call cloture, and that's that.Moulitsas was not calling for the elimination of the filibuster -- he was calling for the perpetuation of the filibuster, but with a change in how you vote for cloture. Given that Lane knows that forty-one Democrats voted to filibuster, and he should know that Moulitsas favors a filibuster rule that would sustain a filibuster based on those forty-one votes, his insinuation of hypocrisy has no basis in reality. It's instead an example of Lane getting his facts wrong. And with that example having been dredged up from September 10, 2010, either Lane couldn't find an actual example of a statement from a liberal that would support his thesis, or he got lazy.
Majority rule is not the only progressive principle some progressives seem ready to sacrifice on the anti-Keystone altar.First, are we talking about "liberals", are we talking about "progressives", or does Lane view the term as interchangeable? Either way, I am not aware of any consensus among either group that we should eliminate representative democracy in favor of direct democracy.
If we're simply talking about Senate rules, to put it mildly, there is no consensus among liberals or progressives that the filibuster should be abandoned. Some believe that it should be eliminated, but others (as with Lane's exemplar progressive, Markos Moulitsas) favor continuing the filibuster but changing the rules to make it less of a tool for obstruction, and still others would leave well enough alone. Meanwhile, it was not so many years ago that Republicans on the floor of the Senate made frequent calls for a "straight up or down vote" when confronted with the filibuster. Some of that opposition may have been opportunistic, but the fact is that the recognition that the filibuster is anti-democratic and could benefit from reform is not something that is unique to the political left.
Remember the corrupting influence of money on politics? Billionaire Tom Steyer has spent millions on TV ads backing environmentalist Democrats and trashing the pipeline itself, thus purchasing outsize influence in the White House and the Democratic Party.Although this should go without saying, campaign finance reform has traditionally been a bipartisan issue, once championed by none other than John McCain. As should also go without saying, proponents of campaign finance reform have not proposed that no money be spent on political advertising. But beyond that, we're back to Warren Buffett and his taxes. You can believe that wealthy individuals and corporations gain an outsized voice in politics and government through their direct and indirect contributions, while nonetheless believing that you should take full advantage of the existing laws to advance your causes. There is no hypocrisy in advocating for a change in the law while operating under the existing laws, and it would be extraordinarily foolish to refuse adequate funding for your political goals out of principle when the likely consequence would be that your opponent would win. Heck, Steyer even spoon-fed that reality to those who are a bit slow on the uptake, and Lane quotes the explanation:
“On issues as critical as climate change, we will take action and work within the system that we’ve got until we can change it,” Steyer pragmatically told Forbes magazine.How can Lane read that statement yet fail to understand that it's not an example of hypocrisy?
Next up, infrastructure,
Most of the time, liberals tout the job-creating potential of critical infrastructure projects, based on the indirect “multiplier effect” that even short-term construction can have on economic growth.Perhaps lane doesn't realize that with his opening qualifier, he hobbled his argument before it left the starting gate. There is a vast difference between supporting infrastructure projects most of the time, and supporting them all of the time. We should note, also, that many conservative voters recognize the need for and benefit of infrastructure projects -- but that doesn't mean that either side has to embrace every infrastructure project, that they cannot prioritize certain types of project over others, or that they cannot object to an infrastructure project that they deem wasteful or harmful.
For Keystone XL, though, different rules apply.Apparently, to lane, "different rules" means roughly the same thing as "the same rules".
We are instructed, by Daniel Weiss of the Center for American Progress, among others, that the $8 billion project will create “only” 3,900 “direct” one-year construction jobs and a mere 50 permanent ones. Forget the 42,000 jobs that a State Department analysis said would be “supported” by the project.Here, rather than pointing to the actual State Department report, Lane links to a post from the Washington Post's Wonkblog. That blog post indicates that "About 3,900 of [the] jobs would be temporary construction jobs", and that once built, "the pipeline would support 50 jobs". In other words, Lane is complaining not that the one person he mentions got the facts wrong, but that he should have provided additional facts.
When you go to the written statement of Daniel Weiss, you find that his reference to the number of jobs that would be created by the Keystone XL pipeline was specifically addressing the number of permanent jobs that would be created. While Lane can certainly argue that a greater discussion of temporary jobs would make the statement more complete, surely he can understand that temporary jobs are not of great significance to an assertion about permanent jobs. After all, if he cannot make that distinction, he is guilty of the same offense he attributes to Weiss -- Lane does not mention that either that the 42,000 indirect jobs would be temporary, continuing only during the construction of the pipeline.
Lane is also engaged in a sleight of hand. The people -- liberal and conservative -- who favor infrastructure projects have done so in no small basis upon the position that although a typical infrastructure project is relatively short-term, we need to invest in our nation's decaying infrastructure and that the short-term boost in employment can help stimulate the economy. As previously stated, this was never an endorsement of any infrastructure project. In fact, the proposed focus has typically been on public infrastructure.
But as Lane knows, those commenting on the very small number of permanent jobs that will result from pipeline construction are addressing a different issue. They were attempting to rebut exaggerated claims by pipeline proponents about the number of jobs the pipeline would generate, and to point out the indisputable fact that the pipeline will create an inconsequential number of long-term jobs. There is absolutely no reason to believe that the people making these observations about Keystone XL would not say exactly the same thing about other major infrastructure projects.
Construction unions understand that employment in their field is inherently temporary in the sense that it ends when the building is built. They strongly favor Keystone XL. Yet this reliably Democratic middle-class constituency is also being thrown under the anti-Keystone bus.Wow... crocodile tears for union worker.
It's even slightly surprising that unions whose members would benefit from construction jobs favor construction projects. I would not be surprised if there was significant union support to build "the bridge to nowhere". The question of whether a particular faction supports a project does not answer the question of whether the project is wise or appropriate. Further, given that only a few short paragraphs ago Lane was grousing that progressives have forgotten their principle of "majority rule", Lane wants to have it both ways. If it's hypocritical and an affront to progressive principles to not abide by the judgment of the minority, how can it be simultaneously an affront to progressive principles to not allow a vocal minority to impose its will on the majority? Does Lane not find it obvious that it's one or the other?
The least attractive violation of progressive values by Keystone XL opponents’ was their attempt to recast this joint project of Canada and the United States in xenophobic terms.Oh, this should be good....
One Steyer-financed ad warned that China is “counting on the U.S. to approve TransCanada’s pipeline to ship oil through America’s heartland and out to foreign countries like theirs.”So... based on one ad that virtually nobody in the nation has seen, Lane has concluded that progressives have embraced xenophobia.... (Has Lane ever noticed the Republican Party's treatment of issues like immigration?)
The only basis for this claim was that state-owned Chinese companies have a modest investment in Canada’s oil sands. The Post’s Fact Checker, Glenn Kessler, awarded the ad four Pinocchios, noting that “it relies on speculation, not facts, to make insinuations and assertions not justified by the reality.”That's it, then? One ad, financed by one individual, seen by virtually no one? It's difficult to imagine how Lane could build a stronger case.
Speaking of the planet, perhaps the only person on it who still hasn’t made up his mind about Keystone XL is President Obama, though his dithering has recently given way to expressions depressingly reminiscent of those in the Steyer ad.In reality, President Obama has expressed that he is waiting for private lawsuits over the pipeline's proposed path to be resolved, and for the State Department to complete its analysis of how the pipeline will affect the environment, before taking a position on the pipeline. It's easy to understand why some might want the President to take a firm position, pro- or con-, before all of the facts are in. It's also easy to see why the President would instead choose to remain neutral pending either the outcome of litigation and studies that might prevent the pipeline's construction, or the presentment by Congress of legislation for his signature. Lane chooses the pejorative, "dither", but there is no reason to believe that the President is being even slightly indecisive on the question, as opposed to playing a careful political game on a hot button issue.
And yes, obviously, his suggestion that the President is xenophobic is absurd.
“Understand what this project is,” he said at a news conference in Burma last week. “It is providing the ability of Canada to pump their oil, send it through our land down to the Gulf [Coast], where it will be sold everywhere else.” Their oil. Our land.Does Lane disagree that the oil belongs to Canada? Does he disagree that a pipeline that will run across the United States is accurately described by the President as crossing "our land"? If Lane actually believes that the President's statement reflects xenophobia or anti-Canadian agitation, he should seek psychiatric help.
Yet his own State Department’s exhaustive review of the project found that re-exports of the oil, either as crude or in refined form, were unlikely.This time around, Lane links to the actual State Department report. However, he is not being honest about the report's conclusion:
It is likely that increasing amounts of WCSB crudes will reach Gulf Coast refiners whether or not the proposed Project goes forward (products from this processing will be used in both domestic markets and for export). As a result, future refined product export trends are also unlikely to be significantly impacted by the proposed Project.The report does not suggest that export won't occur. It suggests instead that enough Western Canadian Sedimentary Basin (WCSB) crude will reach the Gulf, with or without the pipeline, that net exports are unlikely to be affected.
Lane's second link is to a Reuter's analysis of the President's statement, which it declares to "ring[] only half true".
"Some of it will stay in Gulf, some of it will leave," said Sarah Emerson, president of Energy Security Analysis, Inc. in Boston. "I don't think anyone would have built if they thought the oil was just going to stay in the Gulf Coast, that is like bringing coal to Newcastle."It would be fair to accuse the President of overstatement. However, once again Lane is guilty of the very offense he attributes to others -- he is misrepresenting the State Department's report and is implying, in defiance of the facts and his own sources, that export is unlikely to occur.
Hypocrisy and rhetorical flimflam are standard in politics, and liberals are not the only guilty parties in the Keystone XL battle.At this point, Lane has identified zero examples of hypocrisy. Not a one. It's not even clear that he understands the meaning of the word. As for "rhetorical flimflam", it's a colorful way of describing something that is inherent to politics. To observe, even with colorful language, that politicians are guilty of practicing politics seems somehow banal.
Keystone XL proponents have undoubtedly tapped corporate coffers to fund their share of exaggerations about the project’s benefits.Lane speaks of this as if it's an assumption, not a fact. It's a fact.
And of course climate change is real and must be addressed.Which doesn't mean that Lane isn't going to insist that the President state a firm opinion, or insult him for declining to do so, while we await the environmental impact report.
But in this case progressives are not only being intellectually dishonest and traducing their values, they’re doing so pointlessly: This end doesn’t justify these means.Really, other than waving his hands a lot, all Lane has documented is that one wealthy person produced one TV ad, approved by nobody but himself and seen by virtually no one, that has an element of xenophobia; and that the President has implied that more of the WCSB crude will be exported than is likely to be the case. And in producing that tepid indictment of "liberals", he has misstated the facts, misrepresented the positions of people he has held up as hypocrites, and misunderstood the basic issues under debate.
Far from being “game over” for the planet, Keystone XL would not boost greenhouse gas emissions significantly, according to State Department experts. With or without Keystone XL, Canada’s oil sands will still be turned into crude oil and shipped, often by rail, to markets in the United States and elsewhere. The environmental movement’s energies — not to mention Steyer’s millions — would be far better spent elsewhere.Lane's implication is that the crude is going to be extracted, shipped and used, so environmentalists may as well shut down and go home. Sometimes, even a fight for a losing cause can bring about results that benefit the losing side -- a better educated, more aware public, the exercise of greater caution when proposing and planning future projects with significant potential environmental impact, and the like. Also, while Lane writes off the possibility, perhaps those environmentalists don't intend to call it quits if the pipeline is not constructed. But, frankly, it's not his place to tell environmentalists how to expend their energies or to tell Steyer how to spend his own money.
In their tendentious effort to deny these realities, progressives risk violating yet another cherished principle that, in their view, distinguishes them from the right: that of letting facts and science, not ideology, determine policy.And here Lane is back to his earlier trick of conflating the terms "environmentalist" and "progressive" -- as if there are no conservative environmentalists nor any progressives who don't oppose the pipeline. And in relation to letting the facts and science dictate policy, what was it that Lane said only a few sentences ago?
And of course climate change is real and must be addressed.So which is it -- is this a situation in which climate change is real and must be addressed, or a situation in which that science is already known and weighs in favor of the pipeline? If Lane's theory is that the oil will be extracted and used, rendering the existence of the pipeline irrelevant to the debate, he's missing the actual goal of the environmentalists opposed to this project -- they don't want that oil to be extracted or used at all. That's not because they are ignorant of science and climate change, or because they are refusing to consider the science when forming their positions on WCSB crude -- quite the opposite. Given that Lane is now endorsing making decisions based on science, it also seems odd that he wants the President to get ahead of the environmental impact analysis for the Keystone XL pipeline. It's almost as if Lane is privileging ideology over science.
Campaigning for a symbolic victory over the fossil-fuel industry, they may end up with a pyrrhic one — if any.It goes without saying that the environmentalists could lose their fight against the pipeline. But it also goes without saying, even with due respect to Lane's accusations of imagined hypocrisy, if the environmentalists who oppose the pipeline prevail they will not view their victory as pyrrhic. More likely, they will be energized for their next battle.
Do you know what would have made Lane's column better? If, rather than launching a poorly reasoned screed about "liberals", "progressives" and "environmentalists", that did little more than reveal his sloppy, lazy fact-checking, he had tried to lay out the case for why the pipeline is a good idea. He might have tried to explain how the pipeline compares to other possible infrastructure projects in terms of need, job creation and long-term benefit. He could have attempted to address environmental concerns, rather than brushing them off. Too much to ask?
Sunday, September 02, 2012
What if Barack Obama had been a Republican?
Graceful in defeat, my colleague Mitt Romney volunteered to serve as my healthcare czar, donating his entire salary to charity. Together we fought back against socialized medicine, built on his fine work in Massachusetts, and brought to the nation a market-based health insurance policy that will protect your right to keep the insurance and doctor you have right now, while helping millions of Americans get affordable health insurance from private insurance companies. And we did so with incredible bipartisan support, winning over most Democrats to our conservative, market-based model of reform.
We brought reforms to Medicare that will save billions by cutting waste and removing market-distorting subsidies, and will leave the quality of care unaffected.
We saved the American auto industry from collapse, and helped usher in efficiencies previously prevented by unions and lobbyists, creating a context in which our auto manufacturers are once again profitable and producing cutting-edge vehicles.
Due to the depth of the recession we bit the bullet and passed a bipartisan stimulus bill, but we quickly returned to restraint. That one-time stimulus helped get us through the worst of the recession, and we have since seen our trust in the markets rewarded with steady job growth and continuing recovery, and the markets have been slowly doing their job.
We have kept America safe for another four years. We have prevented Iran from gaining nuclear weapons. We have toppled a tyrant in Lebanon. We got Bin Laden! We ended the war in Iraq, and are preparing Afghanistan to stand on its own.
We implemented reforms that will prevent another financial industry collapse and protect consumers from the irresponsible lending practices that helped contribute to the housing bubble. George W. Bush put his reputation on the line when he decided that bailing out the banks was the best way to save our economy, but he was right. We saved the banks with minimal government intervention. And thanks to our reforms, achieved with broad bipartisan support, never again will we have to bail out banks with taxpayer money.
We have made our party inclusive and have worked hard to make sure that everybody in this country is treated equally. We have implemented sensible immigration reforms by executive order, and Senator Rubio has taken the lead in getting the Democrats to join us in long-overdue immigration reform in my next term. We are the Party of Lincoln, and are proud to be the Party of Lincoln. We have put to rest the false notion that our party is anti-gay, anti-immigrant, anti-women, anti-civil rights. We are the party of America!
I continue to believe that money can be a corrupting influence in political campaigns and Vice President McCain continues to work with Congress to try to fashion new campaign finance transparency laws that will restore the common sense of the McCain-Feingold Bill, so the poeple can clearly see when special interests are trying to buy votes and influence elections.
Private industry is the engine that drives America, and subsidies interfere with competition and innovation. Our nation will save hundreds of millions of dollars through the elimination of Medicare's subsidies to private insurance companies, and through the elimination of subsidies to banks that provide student loans. We have a lot more work to do, but our trust in free markets and competition will prevail over the culture of the handout.
With the help of rising star Paul Ryan we came within inches of a "grand bargain" on the deficit that would have preserved Medicare and Social Security for generations to come. We will continue to work, to build on the atmosphere of bipartisanship my administration has restored to Congress, to complete that process, to cut the flab from government and keep our nation strong, while maintaining tax rates that are fair for everyone.
Saturday, July 07, 2012
Right-Wing Bullying of Justice Roberts
Now, however, if the Chief Justice rules to uphold the ACA after all these nonlegal pleas and threats, he will always be suspected by both supporters and opponents of the ACA of having changed his vote in response to this political pressure. As with Justice Owen Roberts’ vote, the supporters of the law will cheer and the opponents will complain, but both groups will have reason to believe that Chief Justice Robert’s decision reflected political considerations rather than his considered legal judgment in a close case. And, because Supreme Court deliberations are secret, he cannot defend himself by revealing that he did not in fact change his vote after conference.Secret, that is, if we ignore the leaking from somewhere in the ranks of the dissenters, meant to embarrass Justice Roberts.
I've already suggested the first question raised by Barnett's brand of character assassination: None of this matters unless you believe Roberts is the sort of person who will bend to political pressure. If he will not, the story is over before it began - before the political right, through the pens of people like Kathleen Parker and Jennifer Rubin, implied that any vote except reversal would forever tar Roberts' reputation. If he is, then it's a distinction without a difference - whatever his vote, whether or not he had a change of heart somewhere along the way, people on the right perceived Roberts as being pliant to political pressure, their ultimate disappointment being that for some reason he bent the wrong way.
But more than that, when Barnett speculates about pressure on Roberts from "President Obama, Senator Leahy, and pundits like Jeff Rosen", exactly what form does he imagine that "pressure" could take? Exactly why is it that he believes Roberts would care what President Obama thought of an issue, let alone respond to "pressure" from the President? Of all the nonsensical right-wing conspiracy theories we've endured over the past few decades, the idea that the President has the power to cow the life tenured Chief Justice of the Supreme Court is right up there with the best of 'em.
It's even harder to imagine what Senator Leahy might have done that would cause Roberts to feel any amount of pressure. (Massage his shoulders?) Jeffrey Rosen? Does Barnett imagine that Rosen teaches at Hogwarts instead of George Washington University and somehow got his hands on the Elder wand? Rosen himself addresses the absurdity of the argument:
The idea that I was trying to “intimidate” or “bend” the Chief Justice came as a surprise to me. The justices have already voted in the health care case and are hardly influenced, in any event, by legal punditry. On the contrary, I suggested that this is a moment of truth for Chief Justice Roberts because I’ve been a staunch supporter of the vision of bipartisanship that he articulated when he became Chief Justice, and have continued to defend him during the past six years when others have denounced him for failing to live up to the standards he set for himself.Yeah, but what do facts have to do with an otherwise good conspiracy theory?
So far we seem to be dealing with the following:
Somebody leaked to the right-wing media that Roberts might vote to uphold the ACA.
A number of right-wing political columnists, largely of the hack variety, started to write editorials claiming that Roberts was coming under pressure from the political left, and how atrocious that was.
No evidence was ever produced of any form of actual pressure on Roberts from the political left, let alone of why he would have been receptive or responsive to any such pressure.
Roberts ultimately voted to uphold the ACA.
Many on the political right has since engaged in a relentless attack on Roberts.
So far, I see no reason to believe that Roberts cares about all of the right-wing furor, or the implication that he can expect this type of personal attack every time he rules the "wrong way". After all, he has never shown even the slightest concern about opprobrium from the political left resulting from any of his past decisions. Do those on the political right who are still pushing this line of attack believe otherwise? Are the attacks a form of prolonged venting of misdirected anger? Of disappointment that he's a mindful as opposed to mindless partisan? Are they hoping to make Roberts or other justices more responsive to their pressure in the future?
Really, why do these attacks keep on coming?
Wednesday, July 04, 2012
Taxes, Penalties and Whether or Not to Buy Health Insurance
First, the label we hang on the mandate does not change either its amount or the triggering mechanism. Yes, I appreciate that due to the way our brains are structured we humans are subject to irrationality and misperception, and thus may actually react to the notion of a "tax" and "mandate" differently. But the relative costs and benefits are not difficult to understand, no matter what the mandate is called. Gerson appears to believe that people think like this:
"You have a choice, you know, between buying insurance and paying the penalty required by the mandate. If the penalty is a lot lower, you may be better off paying the penalty."I personally believe that under the facts and circumstances, people who don't want to pay for insurance will largely figure out the costs and benefits, and the few who can't figure it out won't be as hung up on labels as Gerson believes - if somebody explains it to them, they'll "get it".
"But it's a mandate, so... no, I don't understand. I have to go buy insurance."
"It's a tax."
"Whoah... A tax... So I can, like, do a cost-benefit analysis?"
But more than that, the issue is irrelevant for the same reason another "spaghetti argument" fantasy - "Now that it's a 'tax' the mandate can be repealed through reconciliation" - is a fantasy. The mandate goes hand-in-hand with the ACA's changes to community rating and ban on consideration of preexisting conditions. The Republican Party is not going to be instructing people to choose a small tax over buying insurance, because the insurance industry won't stand for it.
More than that, if insurance companies decide that the mandate as implemented is insufficient to get enough people to sign up for insurance, I expect the Republicans to work very hard to increase its bite - a task made a bit more difficult by Roberts' label and Republican anti-tax and anti-mandate demagoguery, sure, but they'll find a way.
Republicans can talk about repealing the mandate and the community rating/preexisting condition language but, as much as it might work in the abstract, due to insurance industry pressure the Party will not urge the public to treat the mandate as a mere option and to go without insurance. And as you cannot repeal the community rating/preexisting condition language through reconciliation, the mandate will not be zeroed out.
(The same also extends to various Republican proposals to block funding for the implementation of parts of the ACA. Such arguments make a mockery of past Republican demagoguery about the need for certainty in the marketplace - they would be creating an uncertain, unstable environment. But for that very reason, you can expect that the insurance industry will put the kibosh on Republican machinations that could or will increase its administrative expenses or diminish its profits.
Saturday, May 19, 2012
The Wright Way and the Wrong Way
A lot of the commentary on Romney's effort to shut down that proposed campaign argues that Romney wants to keep the election focused on the economy, or sees potential in alienating moderate voters who may well be offended by race-baiting ads. And perhaps both of those theories are correct. But I see little evidence in Romney's own statements that he wants to limit the debate to the economy - the focus on the economy seems instead to come from his inability to gain traction on any of the other issues he's raised, such as the confabulated "apology tour", the missile treaty with Russia, his incorrect prognostications on the auto industry bailout, and the like.
On the other hand, one thing Romney does not have working in his favor is his religion. Despite his making a strong effort to minimize the differences between Mormonism and Christianity, evangelical voters continue to have a problem with him. It's difficult to distinguish to what degree their problem arises from his having, in the past, been sympathetic to gay rights, taken strong pro-choice positions, and having otherwise endorsed positions at odds with those held by religious social conservatives, as opposed to his faith, but it is fair to say that it was discomfort with Romney that buoyed Rick Santorum's campaign despite his obvious weaknesses as a candidate.
Romney has wrapped up the nomination process, and the polls thus predictably show that evangelical voters are lining up behind him. (Who else are they going to vote for?) Let's just say, this would be an awkward time for Romney to effectively make it "fair game" to attack a candidate based upon what he may have heard in Church. Given the nature of the Mormon priesthood and Romney's personal family history, there is little doubt that he has been exposed to religious teaching and preaching that many Americans would find alien and that, strictly speaking, evangelical voters would regard as dooming the believer to hell.
Tuesday, February 28, 2012
Sugar, Food and the Nanny State
When Ronda Storms, a Republican state senator in Florida, is accused of nanny-state-ism for her efforts on behalf of a sane diet, it’s worth noting. When she introduced a bill to prevent people in Florida from spending food stamps on unhealthy items like candy, chips and soda, she broke ranks: few of her party have taken on Big Food....First, most products include sugar. How do you create a meaningful regulation? Sugar is okay as long as the food isn't "too sweet" by some arbitrary measure? Raisins are okay, but not chocolate-covered raisins - even if the chocolate is less sweet than the raisins? No "craisins" or other dried fruits that have sugar added? What about sugar substitutes, some of which may be no more healthy than sugar and some of which may pose other health consequences? Also, if we're trying to ban "unhealthy foods", aren't we opening the door to a non-fallacious slippery slope argument: what about foods that are too fatty? What about foods that contain tropical oils? Salt? Nitrates?
To some, dictating what recipients of benefits through the Supplemental Nutrition Assistance Program can eat seems unfair. But when the program began in 1939 it aimed both to feed the unemployed and to aid farm recovery. Participants received $1.50 in stamps for every cash dollar spent, 50 cents of which was designated for purchase of agricultural surplus. That’s already a directive on spending, but perhaps more important is that nearly three-quarters of a century ago almost the only thing you could buy — with or without regulation — was real food. Since then Big Food has moved our diet in the wrong direction, and now we have a surplus of empty calories.
The argument for limiting the use of food stamps to actual food is consistent with established policy. They’re already disallowed for tobacco, alcohol,vitamins, pet foods, household supplies and (with some exceptions) food meant to be eaten on premises. Payments have been based on the cost of a “nutritionally adequate diet.”
The author cites a study that is particularly critical of fructose:
The authors specifically target “any sweetener containing the molecule fructose (which makes sugar sweet) that is added to food in processing” as the key problem in our current diet, and correlate the rise in consumption of sugar with a rise in disease, listing the many ways in which sugar’s effects on the body are similar to those of alcohol.The authors also distinguish naturally occurring fructose from the addition of processed fructose to food products - a distinction that appears t be supported by science but again complicates the issue of regulation. You can't buy product X because it's sweetened with high fructose corn syrup, but you can buy product Y because it's sweetened with white grape juice?
Also, isn't it a bit simplistic to say that fructose "makes sugar sweet" when we also sweeten with glucose (high fructose corn syrup is about 55% fructose and about 42% glucose) or sucrose (in which the fructose is bound to glucose at a molecular level, rather than being free)? If the problem is an excess of fructose, and fructose is markedly worse for the health than other sugars, why not work on reducing the food industry's reliance on high fructose corn syrup instead of targeting sugars that are, well, less unhealthy?
Fundamentally, though, I think the idea of trying to regulate poor people in this fashion is ill-considered. It's fairly described as nanny-statism becuase tht's exactly what it is. If I had my druthers, although an initial lump sum would be included on a newly issued card, we would charge EBT cards by an equal increment each day (so nobody could completely run out of food money for more than a day) but otherwise let individual recipients decide how to use that money. I don't see much point to creating a context in which some recipients trade their EBT card for a cash payment of half of its value, or buy groceries that they intend to trade for what they really want. Let people make mistakes, let people learn from those mistakes. (I would extend this to other aid for which the recipient doesn't want bills to be vendored - if you want a cash allotment to pay your heating bill and you choose to spend it on something else, you should face the consequences of that choice and can subsequently either manage the money properly, have the bill vendored, or again deal with the consequences of a possible shutoff when you don't pay your bill).
I find it interesting that the author makes no argument that sugar poses a special or unique risk to the poor, or that the poor eat a disproportionate number of desserts or candy bars as compared to other groups. Just that poor people don't need sweet foods and we should feel free to try to regulate the poor into eating healthier diets. We also overestimate the effects of the interference - money is fungible, after all, and if you provide two sources of cash aid, one with strings and one without, you don't stop somebody from purchasing cigarettes or alcohol even as you pat yourself on the back for not letting them buy it with their EBT money. There are better ways to approach this issue, and ways that should be far more effective than trying to impede the poor from buying sweetened foods. I know the poor are easy targets, easily vilified, easily treated as some form of the "undeserving other", but you would think that present times would teach us that we "responsible folk" aren't necessarily as far removed from being on food assistance as we would like to believe.
Monday, January 02, 2012
Child Tax Credit Proposals Won't Fix Families (And Aren't Meant To)
Where mating and marrying are concerned, both our policies and our institutions are increasingly out of date: they’re built for a world in which two-parent, single-breadwinner families were a near-universal norm, and they don’t take enough account of the mass entrance of women into the work force, or the mounting economic pressures on the American family.Not just "more babies", but more babies in non-traditional family arrangements? No, this one's not going to resonate with other conservatives. Douthat implies that a tax credit might allow parents of young children to spend more time at home during this "time when sustained parental attention can make the biggest difference to health, intelligence and life outcomes", but it is difficult to believe that a tax credit is going to be so large as to have a material impact on parents' career choices.
Douthat mentions that an alternative to a tax credit would be extended, paid parental leave, but complains that some governments that offer such leave offer a lower level of benefit to a parent "who is already at home full time", and that Europe supposedly has rigid rules that make it difficult to get part-time work "which is the kind of work that mothers, especially, tend to want". The first point objection could easily be addressed by not taking prior earnings into consideration. It would seem a bit odd to many Americans that people who chose not to work would be in effect given a stipend or salary if they chose to also have babies, but if the problem is overcoming popular resistance to giving a parental leave benefit to parents who have no employment history, Douthat should try to make a case for why such payments would in fact represent good public policy rather than ducking the issue.
The second objection is silly. Leaving aside for the moment the fact that many people in Europe do work part-time, there's a huge difference between wishing and having. The fact that many mothers would prefer part-time work tells us nothing about the relevant statistic - how many mothers actually work part-time. Douthat has made pretty clear that his tax credit, based upon the family unit, would not change if one parent worked only part-time or stayed home full-time, but it's difficult to believe that the tax credit will be so generous as to overcome a middle class family's need for two full-time incomes.
Douthat refers to a proposal that the tax credit be worth $4,000 which, when combined with other "reforms", would allow "a married couple with two children, earning $70,000 a year", to "enjoy a tax cut of more than $7,000 per year". But if mom goes half-time, their income drops by $17,500 or so, resulting in a net loss approaching $900 per month - not something that they're apt to be able to afford.
Douthat makes no reference to the rest of that proposal, perhaps out of recognition of its incoherence. The authors' thesis is, in essence, that with Social Security and Medicare to support them in their old age, people aren't making enough babies:
Our nation's long-term economic prospects are threatened by a declining fertility rate that, if it remains constant, will only barely manage to replace our current population. And even as Social Security and Medicare depend on large numbers of future workers, they have created an enormous fiscal bias against procreation, undermining an important motive for raising children: to safeguard against poverty in old age.So the solution is to slash business taxes, estate taxes, capital gains taxes, taxes on unearned income, and... all of those things that have nothing to do with procreation, but to also offer the aforementioned tax credit for having babies. The author, unlike Douthat, see the tax credits as "enhanc[ing a] family's work incentives", not an opportunity to work less. The author assures his readers that the tax credit won't give a significant benefit to the working poor ("once a household has no more income or payroll tax to offset, having more children gets the family nothing") or those who aren't working ("If one has no labor income, one simply does not receive the credit"). And it won't encourage middle class workers to have more babies: "Anyone who has children knows that $4,000 per year is only a fraction of the actual cost of raising them." That is to say, the "tax credit" side of this proposal seems like a fig leaf, meant to cover up the fact that this is a run-of-the-mill Republican proposal to slash taxes on the rich - although they attempt to imply otherwise ("the tax proposal outlined here would increase the share of annual taxes paid by the highest earners") they are definitely talking about earners - wealthy people who derive their massive incomes through unearned income will receive massive tax cuts.
So who pays more? Primarily high-income workers, but also upper-middle-class taxpayers who do not have children in the home (either because they have decided not to raise children at all, or because their children have already turned 18).That is to say, people who act responsibly by not having children they cannot afford or by attempting to establish themselves in a career before having children, and people who have decent incomes but apparently not yet enough in the way of income or assets that the Republican Party cares about their votes. No surprise here, even after (or perhaps because of) Bush's massive tax cuts for the rich, they're already the population hit hardest by federal taxes. But nobody feels sorry for them, so oddly enough they're easy marks.
If Douthat recognizes that the child tax credit was the best idea (or perhaps the only thing approaching a good idea) in that tax proposal, I'll give him credit. And it's easy to see why he looks past the superficial self-contradiction of its authors ("We need more babies, not that this proposal will result in people having more babies") to argue that we need to make it easier for families to procreate. But the idea that this tax credit, or a burgeoning population, will cause parents to be able to be supported by their children in their old age rather than being supported by Social Security and Medicare is no more based in fact or logic than tacking the standard bill of Republican tax cuts on to a proposal supposedly meant to help working parents.
Wednesday, September 14, 2011
Capitalism... Bad?
In "yet another 'kids these days'" editorial, Brooks complains that "kids these days" don't have a strong sense of moral virtue:
Rejecting blind deference to authority, many of the young people have gone off to the other extreme: “I would do what I thought made me happy or how I felt. I have no other way of knowing what to do but how I internally feel.”...Smith and company found an atmosphere of extreme moral individualism — of relativism and nonjudgmentalism. Again, this doesn’t mean that America’s young people are immoral. Far from it. But, Smith and company emphasize, they have not been given the resources — by schools, institutions and families — to cultivate their moral intuitions, to think more broadly about moral obligations, to check behaviors that may be degrading. In this way, the study says more about adult America than youthful America.
Smith and company are stunned, for example, that the interviewees were so completely untroubled by rabid consumerism.The effective Republican reaction to Carter's "malaise" speech was to kick of an orgy of consumerism that propelled the U.S. economy from the Reagan era through the Great Recession. Dick Cheney: "Conservation may be a sign of personal virtue but it is not a sufficient basis for a sound, comprehensive energy policy"; "Deficits don't matter". George W. Bush on reaction to 9/11: "I ask your continued participation and confidence in the American economy". Keep shopping, don't conserve, don't worry about deficits, don't worry about the future. Some of that "morality" got internalized by the kids who grew up under the Bush/Cheney brand of Republicanism? Go figure.
When Brooks claims, "now more people are led to assume that the free-floating individual is the essential moral unit" or "Morality was once revealed, inherited and shared, but now it’s thought of as something that emerges in the privacy of your own heart", is he talking about today's young people or the 1960's? His observations seem remarkably... generic.
There are a few obvious problems with Brooks' reasoning:
- Complaining that kids these days are somehow different from kids in the past only works if you present a point of comparison. "In 2008 kids were surveyed and they thought X" is a commentary on what kids thought in 2008, not how the thinking of young people has changed over time. The authors quoted by Brooks complain "that sturdy virtues are being diluted into shallow values", leading Brooks to opine, "
Many of these shortcomings will sort themselves out as these youngsters
get married, have kids, enter a profession or fit into more clearly
defined social roles." So maybe even Brooks recognizes that nothing is different.
- The zeitgeist reflected by the kids, which does seem to echo the moral philosophy of the Bush/Cheney years, is not necessarily worse than the more structured, institutionalized moralities that Brooks seems to favor.
- When a "kids these days" author complains about "an atmosphere of extreme moral individualism — of relativism and nonjudgmentalism." it usually actually means, "The kids aren't bothered by stuff that bothers me," and possibly also, "They're bothered by things that don't bother me."
Saturday, July 23, 2011
John Boehner is an Incompetent Speaker of the House
I'll grant, perhaps the Republican party is now so packed with fools that nobody is up to the task.
Friday, July 15, 2011
The Republican Balanced Budget Amendment - Another Exercise in Vapidity
A small dose of honesty would be nice: Congress controls the budget. If Congress wants to balance the budget, all it needs to do is pass a balanced budget. It managed to do that a few times under President Clinton, so it's not like we're dreaming the impossible dream here. The Republican Party shouldn't need to amend the Constitution to give itself sufficient inspiration to do its job.
But truly, this "balanced budget amendment" is made to be broken. It contains intentional loopholes that every Congress can and will drive a truck through. To the extent that it works, it guarantees the type of budgetary gridlock that has paralyzed California's legislature for years. But it won't work, and it will become a matter of routine for Congress to pass resolutions putting it off to the following year or impose disaster on the nation.
Section 1. Total outlays for any fiscal year shall not exceed total receipts for that fiscal year, unless two-thirds of the duly chosen and sworn Members of each House of Congress shall provide by law for a specific excess of outlays over receipts by a roll call vote.So Congress must balance the budget unless it votes not to balance the budget. We're adding a supermajority requirement to the status quo.
``Section 2. Total outlays for any fiscal year shall not exceed 18 percent of the gross domestic product of the United States for the calendar year ending before the beginning of such fiscal year, unless two- thirds of the duly chosen and sworn Members of each House of Congress shall provide by law for a specific amount in excess of such 18 percent by a roll call vote.There is no basis for imposing an arbitrary cap on spending, and it should go without saying that such a cap could paralyze the nation in a time of crisis, such as a recession (like the present one) in which the GDP drops and huge, immediate spending cuts are required, resulting in a downward economic spiral. Or Congress votes to exempt itself from the cap and finds itself locked into the pattern of having to continue to exempt itself, year after year, because the insanity of the cuts required by the cap spirals upward with each passing year. It also encourages Congress to play budgeting games. Rather than including an expenditure in the current year's budget, commit to pay for it next year - make it the problem of the next Congress. And once again, if Republicans want to commit to only voting for budgets for which total outlays do not exceed 18 percent for the fiscal year, they may do exactly that.
``Section 3. Prior to each fiscal year, the President shall transmit to the Congress a proposed budget for the United States Government for that fiscal year in which--Why? Congress, the body charged with passing the budget, is so incompetent that it cannot propose a budget within these parameters? No, really, this is about Kabuki theater and the avoidance of responsibility. The Republicans want to be able to blame the President for unpopular cuts. "We only did what was in his budget.
``(1) total outlays do not exceed total receipts; and
``(2) total outlays do not exceed 18 percent of the gross domestic product of the United States for the calendar year ending before the beginning of such fiscal year.
If they cannot reasonably meet this requirement, Presidents, not being stupid, will take one of the many obvious paths around this requirement. One way would be to submit two budgets to Congress, one that complies with this requirement and the other that it the actual spending proposal.Another might be to simply include a line, "If Congress finds that this proposal exceeds the limits set forth in 'Section 3' of the balanced budget amendment, Congress shall determine the percentage by which this budget proposal exceeds the limits and reduce all items by that percentage." Another would simply be to propose a budget based upon unrealistic revenue projections.
Section 4. Any bill that imposes a new tax or increases the statutory rate of any tax or the aggregate amount of revenue may pass only by a two-thirds majority of the duly chosen and sworn Members of each House of Congress by a roll call vote. For the purpose of determining any increase in revenue under this section, there shall be excluded any increase resulting from the lowering of the statutory rate of any tax.Because this approach works so well in California?
Seriously, Republicans have proved themselves capable of blocking tax increases, the closing of even absurd tax loopholes, or even the scheduled expiration of tax cuts, while in the minority. I will grant that this type of provision gives the likes of Grover Norquist wet dreams, but why is it actually necessary, let alone desirable, if you're concerned less with your trust fund and more with the welfare of the nation?
Section 5. The limit on the debt of the United States shall not be increased, unless three-fifths of the duly chosen and sworn Members of each House of Congress shall provide for such an increase by a roll call vote.So we'll have additional rounds of the childish Kabuki theater we're presently "enjoying", but with a supermajority requirement such that a minority of Congress can hold the nation hostage, potentially destroy the nation's credit rating, and potentially trigger a national or global recession or depression. By refusing to authorize the government to borrow money to cover the financial obligations Congress has already authorized? Brilliant. Here's an idea: If Congress doesn't want the money spent, it should refrain from including the expenditure in the budget.
This type of provision makes you wonder if the Republicans want to be taken seriously. There is no constitutional requirement that there even be a debt ceiling. It's entirely a legislative creation. Congress could render this language a nullity simply by repealing the law setting a debt ceiling.
``Section 6. The Congress may waive the provisions of sections 1, 2, 3, and 5 of this article for any fiscal year in which a declaration of war against a nation-state is in effect and in which a majority of the duly chosen and sworn Members of each House of Congress shall provide for a specific excess by a roll call vote.This gives the President cause to seek a declaration of war against a nation state, or to continue to declare that hostilities remain open in relation to a previous declaration of war. This could pretty much guarantee that the U.S. is always in a declared war against a nation state. We might have declared wars in Iraq and Afghanistan. Heck - had this requirement been in the Constitution back when Reagan was running up the deficit, we might still be in a declared state of war against Grenada. What brilliant foreign policy the Republicans would create by giving Presidents even more incentive to take military action against foreign nations, and drag out those wars and occupations rather than bringing them to the fastest possible resolution.
Note that the one thing a war would not do is allow for a tax increase based upon a majority vote of Congress. It's better, after all, to risk sending ill-equipped, ill-supported troops into battle than to risk that a majority of Congress might raise taxes in order to properly fund the war effort.
Section 7. The Congress may waive the provisions of sections 1, 2, 3, and 5 of this article in any fiscal year in which the United States is engaged in a military conflict that causes an imminent and serious military threat to national security and is so declared by three-fifths of the duly chosen and sworn Members of each House of Congress by a roll call vote. Such suspension must identify and be limited to the specific excess of outlays for that fiscal year made necessary by the identified military conflict.So if a President declares something along the lines of a Global War on Terror, we can expect Congress to authorize hundreds of billions of dollars in new debt without concern for if or when it might be repaid. And we raise the serious risk that a minority of the members of a new Congress might decline to continue war spending authorized by a prior Congress, or might demand ridiculous concessions if we want to avoid walking away from a military commitment or leaving troops in the field without adequate support. Small chance, you say? Some wars should be defunded? Even accepting that, this language creates an unnecessary potential national security risk.
Note also the lack of consideration for other contingencies. Massive natural disasters? Huge regional power grid failures? Another financial industry collapse? A recession that could turn into a depression? Domestic emergencies, it seems, are of little import - which I guess is consistent with the Republican Party's actions and the Bush Administration's record - but aren't they supposed to occasionally pretend that they care about responsibly governing this country?
Section 8. No court of the United States or of any State shall order any increase in revenue to enforce this article.To enforce which provision? This seems gratuitous, but appears to have been thrown in to satisfy certain right-wing think tanks who criticized prior balanced budget amendments for leaving open the possibility of enforcement through the courts.
I suspect that at the heart of this provision is a recognition by the Republicans that, should this pass, at times they'll want to fake it and run up a deficit based on revenue projections they know to be false, or they fear that a recession will turn their projected balanced budget into a deficit-generating budget, and that somebody might try to go to the courts to compel that the budget actually be balanced. Nobody, but nobody, is going to tell a Republican Congress how to do its job, particularly when it is failing in that job.
``Section 9. Total receipts shall include all receipts of the United States Government except those derived from borrowing. Total outlays shall include all outlays of the United States Government except those for repayment of debt principal.This language, of course, targets the Social Security trust fund. The Republicans are proposing to steal it, fair and square.
``Section 10. The Congress shall have power to enforce and implement this article by appropriate legislation, which may rely on estimates of outlays, receipts, and gross domestic product.Well, duh?
Section 11. This article shall take effect beginning with the fifth fiscal year beginning after its ratification.Typical legislative cowardice. "We don't want this to hurt us in the coming election... or the one after that. We don't want this to harm our next presidential candidate. But after five years many of us will be retired and rewarded with cushy sinecures."
I don't believe that the Republicans actually want this nonsense to become part of the Constitution, with the caveat that a significant faction of the Republican caucus is willing to take any number of reckless and stupid risks they know could harm the country if they believe their actions could also harm the Democrats. If they muck up the country and the Constitution in the process, so be it - this is about money and power. The balanced budget proposal is a ploy for the next election, so they can claim to have been seriously trying to force themselves to act responsibly, but that those darn Democrats keep making them run up the deficit.
I'll repeat myself: If the Republicans truly want to balance the budget, all they need to do is pass a balanced budget.
Tuesday, May 10, 2011
Did You Check the Toilet Tank
One of those signs [that the country is becoming less vital and industrious] comes to us from the labor market. As my colleague David Leonhardt pointed out recently, in 1954, about 96 percent of American men between the ages of 25 and 54 worked. Today that number is around 80 percent. One-fifth of all men in their prime working ages are not getting up and going to work.It's fair to ask a question that perhaps did not occur to Brooks: How many of of the jobs that disappeared between 1954 and 2011 are the sort that represent the best of American opportunity? And how many of them were mundane jobs that have been replaced by robotics and automation, or have been shifted to overseas manufacturing facilities?
Brooks also notes that the number of people on disability is rising.
Ten years ago, 5 million Americans collected a federal disability benefit. Now 8.2 million do. That costs taxpayers $115 billion a year, or about $1,500 per household.The rise in disability claims is a genuine problem - but it's hardly a surprise that disability claims go up when the job market tanks and millions of workers find themselves unable to find a job even after a year or more of searching.
Brooks really offers nothing in the way of ideas to resolve the problem. His suggestions:
"[E]xpanding community colleges and online learning" - Where's the evidence that retraining older workers through community colleges and "online learning" results in significant numbers of marginalized workers returning to the work force - and when it does work, is it not fair to note that the typical retrained worker takes a significant pay cut and perhaps never recovers his former level of income?
"[C]hanging the corporate tax code and labor market rules to stimulate investment" - What changes does Brooks propose (other than, of course, the implicit "cut corporate taxes and kill unions") that would increase job prospects for marginalized workers? Where's the evidence that corporate tax cuts will increase jobs? (Having successfully reduced its tax rate to 0%, is GE producing exponential numbers of jobs?) If Brooks is suggesting going after unions... you know, so that older, higher paid, "unproductive" workers can be the first to be laid off in an economic downturn... wouldn't that in fact worsen the problem, pushing more marginal workers into chronic unemployment and depressing wages? (You can argue that marginal and bad workers shouldn't be protected from being laid off by virtue of seniority, but that's a question apart from what Brooks is suggesting>)
[A]dopting German-style labor market practices like apprenticeship programs, wage subsidies and programs that extend benefits to the unemployed for six months as they start small businesses." - With the money for these programs coming from where? And who would be charged with designing and implementing these programs, or trying to prognosticate the areas in which new workers should be trained or subsidized?
Health care spending, which mostly provides comfort to those beyond working years, is expanding. Attempts to take money from health care to open it up for other uses are being crushed.I think it is fair to note that health care dollars don't simply go up in smoke - if you pull billions of dollars out of the health care system you will cause clinics and hospitals to close and will see medical workers laid off. But for goodness sake, Brooks is complaining that there are too many disabled workers while simultaneously suggesting that part of the solution is to reduce the amount of health care available to those workers, as well as to those who might become disabled?
Brooks is, lamentably, dishonest in his characterization of the health care debate:
There are basically two ways to cut back on the government health care spending. From the top, a body of experts can be empowered to make rationing decisions. This is the approach favored by President Obama and in use in many countries around the world. Alternatively, at the bottom, costs can be shifted to beneficiaries with premium supports to help them handle the burden. Different versions of this approach are embodied in the Dutch system, the prescription drug benefit and Representative Paul Ryan’s budget.It's not demagoguery to observe that Ryan's plan eliminates Medicare and replaces it with a voucher program that, even if offered under the same name, bears no resemblance to the current system. By way of example, Brooks might consider what would happen if Paul Krugman started ghost writing his columns - but that they continued to be published under the byline of "David Brooks". Sure, the quality would increase, but they would not actually be David Brooks columns. Or consider the cry, "The King is dead, long live the King" - the new king is not the old king. This isn't complicated stuff.
We’ll probably need a mixture of these approaches to figure out what works. Instead, Republicans decry the technocratic rationing model as “death panels.” Democrats have gone into demagogic overdrive calling premium support ideas “privatization” or “the end of Medicare.”
Let’s be clear about the effect of this mendacity: We’re locking in the nation’s wealth into the Medicare program and closing off any possibility that we might do something significant to reinvigorate the missing fifth.Pots and kettles. Yes, David, let's be honest. Right now, we could take a look at the models of health care offered throughout the developed world, pick one that produces similar or better outcomes in most cases, and implement that system in this nation - and we would see immediate, massive cost savings. We have the greatest market participation of any developed nation, and we have by far the most expensive health care system in the world - but we're not seeing a good return on that additional investment. Where can I find a David Brooks column acknowledging that fact, that undeniable truth, rather than the suggestion that the only choices we have are rationing and imposing significantly higher costs on consumers?
Brooks also seems to be confusing the cart with the horse. Demagoguery about the unaffordability of providing the general public with quality health care doesn't have quite the same salience when the economy is booming, and at least from where I'm sitting it seems that health insurance coverage has already moved significantly in the direction Brooks desires - significantly higher consumer costs, deductibles and copays - as compared to what was available during the various economic booms between the 1950's and the present. And seriously, Brooks is holding up the deficit-financed "Medicare Part D" prescription benefit as good Republican policy in action? How about that....
Thursday, January 27, 2011
"High Deductible, Low Benefit" Plans May Worsen Healthcare Costs
right now insurance companies act as a gatekeeper. If their analysis shows that a particular procedure is unnecessary, or that a more cost-effective procedure will suffice, they'll refuse to pay for the more expensive or "unnecessary" test or procedure. Sure, the denials can be frustrating, even maddening, but they do hold down health care costs.There's also the associated issue of health savings accounts - you're supposed to be able to pay for the coverage for which you're uninsured out of your savings. Let's say you're a young, healthy person but crash your motorcycle, fall on your leg the wrong way while sliding home in a softball game, or simply have your feet go out from under you on an icy driveway. You suffer a fractured ankle that requires an open reduction and fixation. Let's say the bills come in at $10,000 and you're responsible for the first $4,000. What are the odds that you have sufficient health savings to pay your share of the cost? Now what if it's a cancer diagnosis and we're talking a six figure medical bill?
Consumers don't have the information, resources, or sophistication to make a similar evaluation of a doctor's recommendation. They may not even have a chance to reflect on whether they should agree to an expensive procedure at an emergency room, let alone inquire and evaluate alternatives, assuming they're even in a state of mind to do so.
It's a bit annoying that the right-wing acts as an echo chamber to this type of proposal, rather than taking a serious look at the problems of the proposal and how they might be corrected. I recognize that if we're talking Newt Gingrich, the problems become features - he seems to want people (other than himself) to go without adequate health coverage. But there are people covering these issues from a Republican standpoint who are approaching the issue in good faith, and it would be nice if they would spend some time thinking about this type of claim instead of mindlessly repeating it.
Ross Douthat recently wrote,
...Obamacare entrenches the very model of health care financingthat drove costs sky-high to begin with — a model in which every insurance plan has to be comprehensive, every significant payment is made by a third party, and consumers have no idea what their treatments actually cost.Presumably Douthat is talking about the health insurance exchanges, which are intended to offer coverage comparable in its scope to that which might be obtained through an employer-sponsored plan. If you're under thirty or if you will otherwise be exempt from the requirement to purchase coverage because the premium exceeds 8% of your income, even if you're buying through an exchange you will be able to purchase a Gingrich-style catastrophic coverage plan. No matter what your age or income you remain eligible to purchase such a plan, just not necessarily through an exchange.
* * *
To address the first problem, Republicans should work to deregulate the new health care exchanges, so that high-deductible, catastrophic coverage can be purchased as easily as comprehensive plans.
The idea that insurance purchased through an exchange will leave consumers unaware of the actual cost of their care? It's nonsense, and there's really no excuse for a New York Times columnist to distort basic facts. The exchanges will allow people to purchase comprehensive insurance at the "Bronze," "Silver," "Gold" and "Platinum" levels, respectively offering benefits equivalent to 60%, 70%, 80% and 90% of the full actuarial value of plan benefits. In other words, people will be able to purchase plans that include significant copayments and coinsurance, and will pay a substantial premium if they wish to reduce their out-of-pocket costs.
My concerns have focused on these plans as an ineffectual cost-shift - it seems reasonable to expect that they'll reduce the health insurance costs of employers by shifting that cost (and often more) onto the employees. So far, not a problem for Gingrich and friends. But Atul Gawande's recent coverage of "Super-Utilizers", the small percentage of patients who consume the lion's share of medical services, suggests that the exchanges probably have it right. That is, if you start insuring higher risk individuals through catastrophic plans, you can end up increasing the cost of medical care even to the employer.
[Researcher Nathan Gunn] told me about an analysis he had recently done for a big information-technology company on the East Coast. It provided health benefits to seven thousand employees and family members, and had forty million dollars in “spend.” The firm had already raised the employees’ insurance co-payments considerably, hoping to give employees a reason to think twice about unnecessary medical visits, tests, and procedures—make them have some “skin in the game,” as they say. Indeed, almost every category of costly medical care went down: doctor visits, emergency-room and hospital visits, drug prescriptions. Yet employee health costs continued to rise—climbing almost ten per cent each year. The company was baffled.Keep in mind that when we're talking about people buying through the exchanges, we're talking about people who won't be getting good health insurance through their employers. So we're really talking about workers in lower paid, more marginal positions of employment. If our goal is to shift those people into healthier lifestyles, get them to manage their medical conditions (such as diabetes and hypertension) properly, and to avoid having them become high-cost patients, pushing them toward insurance plans that are "cheaper" up front but force them to choose between their medications or to forego the care they need to manage their health conditions is likely, in many cases, to backfire. And what happens to that population when they become too sick to work? They end up on SSI, SSDI and Medicaid. Ouch?
Gunn’s team took a look at the hot spots. The outliers, it turned out, were predominantly early retirees. Most had multiple chronic conditions—in particular, coronary-artery disease, asthma, and complex mental illness. One had badly worsening heart disease and diabetes, and medical bills over two years in excess of eighty thousand dollars. The man, dealing with higher co-payments on a fixed income, had cut back to filling only half his medication prescriptions for his high cholesterol and diabetes. He made few doctor visits. He avoided the E.R.—until a heart attack necessitated emergency surgery and left him disabled with chronic heart failure.
The higher co-payments had backfired, Gunn said. While medical costs for most employees flattened out, those for early retirees jumped seventeen per cent. The sickest patients became much more expensive because they put off care and prevention until it was too late.
Part of the goal of healthcare reform is to emphasize cost reduction through preventive care. Gawande's column suggests that, to the extent that savings can be realized, the government can expect an enormous push-back by the industries that are presently reaping huge profits from the status quo. But even in a small picture sense, a lack of primary care can result in significant expense, a twenty-five year old who had run up more than $50,000 in medical bills over ten months:
She suffered from terrible migraines. She took her medicine, but it wasn’t working. When the headaches got bad, she’d go to the emergency room or to urgent care. The doctors would do CT and MRI scans, satisfy themselves that she didn’t have a brain tumor or an aneurysm, give her a narcotic injection to stop the headache temporarily, maybe renew her imipramine prescription, and send her home, only to have her return a couple of weeks later and see whoever the next doctor on duty was. She wasn’t getting what she needed for adequate migraine care — a primary physician taking her in hand, trying different medications in a systematic way, and figuring out how to better keep her headaches at bay.Can we count on doctors to be part of the solution instead of part of the problem? Although the doctor covered in the article was encountering some resistance in trying to create a positive customer service model in medical practice, one focused on saying "yes" instead of "no", and to reduce costs through increased quality of care instead of through rationing, but I expect that most doctors will get on board if presented with evidence that overcomes their skepticism about the feasibility and scalability of reform. However, some won't. As with any profession, some health professionals seem far more concerned about their profits than their patients' needs. Gawande offers some anecdotes:
Fernandopulle told me about a woman who had seen a cardiologist for chest pain two decades ago, when she was in her twenties. It was the result of a temporary, inflammatory condition, but he continued to have her see him for an examination and an electrocardiogram every three months, and a cardiac ultrasound every year. The results were always normal. After the clinic doctors advised her to stop, the cardiologist called her at home to say that her health was at risk if she didn’t keep seeing him. She went back.These anecdotes highlight the aforementioned need for a gatekeeper, so that a patient can make an informed decision when a doctor declares, "If you don't have this expensive medical test you could die." A patient with catastrophic coverage could see her savings depleted by a single visit with such a physician, and be left unable to pay her share of the cost of medical care she actually needs.
The clinic encountered similar troubles with some of the doctors who saw its hospitalized patients. One group of hospital-based internists was excellent, and coördinated its care plans with the clinic. But the others refused, resulting in longer stays and higher costs (and a fee for every visit, while the better group happened to be the only salaried one). When Fernandopulle arranged to direct the patients to the preferred doctors, the others retaliated, trolling the emergency department and persuading the patients to choose them instead.
“‘Rogues,’ we call them,” Fernandopulle said. He and his colleagues tried warning the patients about the rogue doctors and contacting the E.R. staff to make sure they knew which doctors were preferred. “One time, we literally pinned a note to a patient, like he was Paddington Bear,” he said. They’ve ended up going to the hospital, and changing the doctors themselves when they have to. As the saying goes, one man’s cost is another man’s income.
