Karl's Bog

The murky world of politics (and other things) as seen from the Bog

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1–2 minutes

Tag: ACA

  • Republicans:  Say What You Mean on Health Care

    The Republicans should stop messing around with health care bills, state their goal clearly and get on with it.  They could have a vote and be on to the next subject in a week.

    The problem they are having is that they keep trying to create a bill that both takes all the money away, strips the government’s involvement (individual mandates, essential benefits, etc.), gives individuals more control and options and simultaneously continues to provide some acceptable level of care to 20 million people more or less.  This is the eat-nothing-and-lose-five-pounds-of-fat-while-gaining-ten-pounds-of-ripped-muscle-without-excercise-in-one-week diet.

    What they need to do is state the obvious:   (more…)

  • Obamacare – Another Congressional Success Story

    Congress takes a lot of abuse!  Their popularity is at all time lows.  Most Americans now claim they would vote even their own representatives out of office.  They never cooperate with the other party!  Well, maybe that claim isn’t quite accurate.  In fact, I think they cooperate all the time!  Let’s look at one example of a program where the parties in Washington have done a wonderful job of working with each other to divide and conquer the difficult issues facing the country!

    We’ll look at Obamacare or, as it is more formally known, ACA.  (Note – Because many people like ACA but hate Obamacare, I need to clarify that they are in fact the same thing.  Sorry).  I’ll call it ACA because that’s easier to type.  This is the president’s signature program and illustrates what Congress can accomplish when they really put their hearts into it.

    The original goal of ACA was to provide affordable health insurance to most of the 15% (47 million) of Americans who are uninsured.  The short-term goal is 7 million by March 2014 and an estimate of about 16 million by year-end 2014 in a combination of Medicaid and ACA with the rest coming over time.  Note that about 12 million of the 47 million are illegal immigrants and not eligible.  To date, the results are unknown.  They can’t be until initial sign-ups are completed in December.  So both parties agreed to make up their own facts and distort the few honest projections that exist.  Problem solved!

    ACA is intended to have the work and administration done by the private sector with the rules being set by the feds.  Thus, all uninsured Americans will need to purchase a health care insurance policy from a private carrier.  All private carriers will stop “rating up” individuals for pre-existing conditions and will give up the ability to decline coverage. That creates a larger group of insured people.  To the extent that people who are uninsured actually participate, there is a downward pressure on the price of insurance.  However, the feds also set rules on the minimum coverages for individual plans as well as ending rating for pre-existing condition and requiring guaranteed issuance.  They chose a minimum coverage that is a good deal higher than many people were voluntarily choosing.  (In the interest of full disclosure, the selection of a “floor” preceded Congress’ new program of cooperation.  It occurred during the passage of the law which was a fully partisan event and includes all the Democrat’s pet health issues like mental health, preventive medicine and erectile dysfunction).  Not that these are bad coverages but their mandatory inclusion in all policies can only be an upward force on price.  As part of their agreement, the Congressional Republicans agreed only to talk about the upward pressures while the Democrats agreed to deal only with the downward pressures.  That gives each of them own set of talking points.  It also avoids the ugly prospect of talking to each other about how both their positions might be true.  That, after all, might offend the base voters that the politicians so carefully selected through redistricting.

    Also, as was evident in the inquisition of Kathleen Sibelius this week, the parties agreed to split up the “bad guys”.  The Republicans agreed to put all the blame on Obama and the Democrats who passed the bill (more than three years ago) without a single Republican vote.  The Democrats agreed to blame the IT contractors and insurance companies.  Both agreed not to do a real investigation into the true causes of the website malfunctions.  To do that of course  would require waiting for the facts to become known and that would delay the theater.

    The final part of the cooperation pact was to avoid discussing why both parties have done nothing substantive in over three years to fix or to test the suspected problems in ACA.  That agreement gave the Republicans over forty opportunities to pass symbolic and pointless votes to repeal ACA without having to help their constituents by improving it.  The Democrats gained the chance to stay in the background and not have to appear as though they were criticizing the plan that they wrote.

    So, far from disagreeing about everything, the parties in Washington are actually working in close cooperation by agreeing not to tread on their rivals’ turf and to continue living in their own, separate virtual worlds.

  • What is greatest threat to the US?

    Once again, our estimable Congress has elected not to solve nor even deal with our country’s problems but to continue the cycle of distrust, antagonism and political gamesmanship.  This cycle has reached new lows since December 2008 when Republican leadership announced that their goal for the next four years (oops, eight years) was  defeating president Obama.  Not moderating liberal policies, not solving the nation’s long-term fiscal issues, not even to looking thoughtful and grown up in preparation for the next election but only to deny success for the administration regardless of the effect on the country.    To be fair, this basic instinct to win at any cost is as old as humanity.  However, a functional democracy demands something better,

    America has some serious problems.   For example, growing economic disparity and forty years of income stagnation among the middle class, education, jobs, our declining international standing and influence, dysfunctional government, jobless recovery, the  long-term financial trouble facing the federal government, most states and many cities.

    Our healthcare system does not work as well as it should for the cost.  For example, compared to other industrialized countries, US healthcare spending as a percentage of GDP is highest, our life expectancy is lowest, we have the highest infant mortality and the highest medical cost per capita.   See http://www.ft.com/cms/s/0/bca4c114-29d8-11e3-bbb8-00144feab7de.html#ixzz2gxmLgVgc.  A US study a few years ago also showed that the level of preventable medical deaths was roughly the equivalent of a 747 crashing everyday!  A hip replacement is three times as costly in the US as in Great Britain.

    So there is a very legitimate discussion to have on the healthcare system and ways to fix it.  But, the House of Representatives’ most conservative members have sacrificed more than forty opportunities to hold that discussion.  I am confounded as to why they went out of their way so many times to avoid addressing the problems that the ACA brings with it or other problems in the health care “system”.  ACA has some problems but it is not the end of the world and certainly does not encompass all the other health care issues.  So why is ACA everything in the view of the House Republican minority?

    I can only conclude a few things.  One is that ACA does not poll very well and may be a potential winner for Republicans on that basis.  Another is that they don’t know how to fix the problems.  They then prefer to take  symbolic votes on the problem that polls best.  That’s smart – avoids any sort of accountability while leaving the issues available for later use like sticking in front of a CR or debt ceiling debate. Or perhaps they don’t actually want to fix the problems but prefer to have someone else to blame for them.

    At the start of the shutdown, they began to argue for a delay in the individual mandate claiming they just want to improve ACA so the world won’t end.  That’s good.  I’m not in favor of the world ending just yet.  But, if they wanted me to believe that they have my welfare in mind, they would have started putting forward suggestions that were practical and had a chance of becoming law.  They squandered more than forty opportunities to point out weaknesses, simplify the law, do something to educate the public or do anything else good.  Instead, they used all forty efforts to pass symbolic measures that had no chance of becoming law.

    And now that the polling again turns against the shutdown and in favor of increasing the debt limit, the minority of the Republican minority is saying “Well, what we really want is a conversation on the budget and debt and the size of government”.  Great discussion!  The Senate has been waiting for months for the House to appoint conferees to negotiate the differences between their budgets.  Too bad the House is so focused on fighting symbolic fights.