Health Care

The Contraception-Mandate Cases Aren’t Really About Contraception

Ap Images/Tony Gutierrez

Earlier today, the Supreme Court announced that it would hear not one, but two challenges to the Obama administration’s contraception mandate; they’ll be heard together in an action-packed hour of oral arguments sometime in the spring. Both cases deal with conservatives’ ever-growing penchant for anthropomorphizing corporations—this time, the justices will decide whether companies can be exempted from the mandate to provide birth control at no cost to employees because of the owners’ religious beliefs.

Are the Obamacare Clouds Breaking?

Flickr/Sean MacEntee

This morning, I was listening to NPR—because yeah, I'm an effete pointy-headed liberal and that's how I roll—and I heard a story about people in California who got insurance cancellation notices, but then wound up getting better coverage and couldn't be happier about it. And the other day there was this story in the Washington Post about droves of poor people in rural Kentucky getting insurance for the first time in their lives—free, through Medicaid—because of the Affordable Care Act. In other words, after spending weeks telling the tales of people losing their health coverage (who in truth could get other health coverage), the media are finally putting at least some attention on the people who are benefiting from the ACA.

And encouraging news seems to be breaking out all over.

No, the Failure of Obamacare Would Not Lead to Single-Payer

Flickr/Public Citizen

More than a few conservatives are of the opinion that should the Affordable Care Act fail to achieve its goals, it would make the adoption of single-payer health insurance in the United States more likely. The reasonable ones who believe this argue that their side hasn't done enough to come up with ideas to address the very real problems in the health care system, so if the ACA doesn't work, they don't have much to offer in response. If the question is, "Well now what?" and their response is, "How about making it impossible for you to sue your doctor if he cuts off the wrong leg? And can I interest you in a health savings account?", the American public may well turn to the big-government solution instead. I've spoken to conservatives who think that scenario is a real possibility. Carnival barkers like Rush Limbaugh, on the other hand, are telling the rank and file that the rocky rollout of the ACA was all part of the secret plan: things would go wrong, and then the socialist in the White House would be able to swoop in and implement single-payer before anyone realized what was happening.

And there are plenty of liberals who would say, "Sounds good to me!" Not that they're rooting for the ACA's problems to remain unsolved, but they are trying to make people understand that the difficulties are a result not of the ACA containing too much government, but of it not containing enough (this is a point I've made myself). But a belief that the ACA's failure would make single-payer more likely fundamentally misreads our political history.

Insurance Companies Got You Down? Stupid Obamacare!

White House photo by Pete Souza

It has been said many times over the last few years that now that Democrats successfully passed a comprehensive overhaul of American health insurance, they own the health-care system, for good or ill. Every problem anyone has with health care will be blamed on Barack Obama, whether his reform had anything to do with it or not. Your kid got strep throat? It's Obama's fault! Doctor left a sponge in your chest cavity? Stupid Obama! Grandma died after a long illness at the age of 97? Damn you, Obama!

OK, so maybe it won't be quite as bad as that, but pretty close. Here's an instructive case in exactly how this plays out

Razing Arizona Women's Health Care

AP Images/The Fort Worth Star-Telegram/ Dave Kent

Like Napoleon forging into the Russian winter, anti-choice politicians are loath to give up on abortion restrictions, however minor, until the Supreme Court forces them to. On Wednesday, Arizona Attorney General Tom Horne asked the Supreme Court to reinstate a law that would strip Medicaid funding from doctors and clinics who perform abortions. Poor women already can’t use federal dollars to cover abortion procedures—that’s been illegal since the late 1970s. The law, which was struck down by the Ninth Circuit Court of Appeals in August, instead would prevent the state’s abortion providers from being reimbursed by Medicaid for providing any kind of care to low-income women, whether it’s breast exams, cervical cancer screenings, or contraceptive services.

America, Where Even the Desperately Ill Say They're Healthy

More graphy goodness like this inside.

The Organisation for Economic Cooperation and Development has released their latest health indicators report, and while you may not find 200 pages of charts and graphs on cross-national health comparisons as fascinating as weirdos like me do, let me just point to a couple of interesting things. Most of the findings will be pretty familiar to people who have followed the health care issue in the last few years, but there's at least one thing that surprised me, which I'll get to in a minute. First though, I have to point to this graph, which shows just what an outlier the United States is in terms of what we spend on health care and what we get. It shows the relationship between spending and life expectancy:

No, Ladies—Birth Control Pills Won’t Make You Go Blind

AP Images/Jens Kalaene

Over the course of the past day or so, you may have seen some alarming news: Long-term use of birth control pills, according to a study released at the Annual Meeting of the American Academy of Ophthalmology, may be linked to glaucoma, one of the leading causes of blindness in the US. If you happen to be one of the more than 80 percent of women who has used oral contraceptives during her life, you’d be forgiven for feeling a little nervous. Long-term contraception is pretty much unavoidable for sexually active women who would rather not get pregnant.

How Both Republican and Democratic States Are Helping Obama

Last week, President Obama announced a "fix" to the problem of people in the individual health insurance market getting cancellation notices from their insurance companies: he'd allow the insurers to offer those substandard plans for another year. Does he want the fix to work? We can't read his mind, but depending on how you define "work," it would be better for the Affordable Care Act's ultimate success if it didn't. And as things have played out over the last few days, there are reasons that as a political problem this could fade.

As you may know, insurance markets are governed by officials in each state, and if a state's insurance commissioner doesn't want to allow the substandard plans to be sold, he or she can say no, no matter what the President might want. And a few of those insurance commissioners—from Vermont, Rhode Island, and Washington state—have already said they won't allow it. So what you have here are heavily Democratic states not supporting Obama. But here's the key to the story: those states also chose to run their own health exchanges, and all of them are working well.

We could end up with a situation in which the states that adopt Obama's fix are the ones most opposed to Obamacare, and the states that support Obamacare don't adopt it. And I wouldn't be surprised if that's just fine with Obama.

How Republicans Lost the Chance to Win Obamacare

AP Photo/Dylan Lovan

The argument for the national government administering things over the states has always been summed up, I thought, by an old James Carville joke: I’ll race you from Disneyland to DisneyWorld. I get to take the federal roads.

That joke, however, has been turned upside down by implementation of the Affordable Care Act (ACA). The whole sequence has been weird. After all, the law—as a concession to moderate Democrats who feared Republican attacks about a federal-government takeover—wound up asking the states, and not the federal government, to run the exchanges. But Republican-led states refused to do so. When the federal-run crashed, the odd result is that the current winners of the federalism battle—which is often waged, at least rhetorically, by Republicans dead set on keeping the feds out of their local government—are Democratic states such as California and New York where things are running reasonably smoothly. Or at least far better than the federally-run exchanges.

Obamacare Panic to Enter Even Stupider New Phase

Jason Eppink

I want to follow up on what I wrote Friday about those who are deciding that because of a) web site problems and b) the largely manufactured controversy over people who have one private insurance plan but now face the unfathomable horror of moving to a different private insurance plan, the Affordable Care Act is an unrecoverable disaster that has destroyed Barack Obama's second term. I'm sensing that this is about to move into a new phase of inane speculation that we should think about before it starts.

20-Week Abortion Bans: Coming to a City Near You?


If you want to take a plunge into the roiling id of the anti-choice movement, go to Albuquerque. Tomorrow, the half-million residents of New Mexico’s most populous city will vote on a ballot measure that would ban abortion after 20 weeks. Although 13 states have enacted similar laws, if Albuquerque’s measure passes, it will become the first municipality to impose a 20-week abortion ban.

Memo to Democratic Chicken Littles: The Sky Is Not Falling

White House photo by Pete Souza.

Ah, now this is what politics is supposed to be like: Ruthless Republicans, gleeful at the prospect that they might increase the net total of human suffering. Timorous Democrats, panicking at the first hint of political difficulty and rushing to assemble a circular firing squad. And the news media bringing out its "Dems In Disarray!" headlines that have been used so many times before. The problems of the last couple weeks "could threaten Democratic priorities for years," says Ron Brownstein. It's just like Hurricane Katrina, says the New York Times (minus the 1,500 dead people, I guess they mean, though they don't say so). "On the broader question of whether Obama can rebuild an effective presidency after this debacle," says Dana Milbank, "it's starting to look as if it may be game over." Ruth Marcus also declares this presidency all but dead: "Can he recover? I'm sorry to say: I'm not at all confident."

Oh please. Everyone just chill out.

Judging Obama's ACA Fix

President Obama at a press conference today.

So today, trying to stem the tide of hand-waving and panic that reminded us all of how Democrats have traditionally acted, Barack Obama announced that people who have health insurance plans they bought in the individual market but don't meet the standards of the Affordable Care Act may get to keep those plans. So how should we feel about this?

On the most basic level, it's not a good thing. Any time someone stays on a junk insurance plan instead of entering the larger risk pool of the exchanges, that pool is weakened. Having said that, the specifics of what Obama proposed do seem designed to minimize the damage.

Obamacare's Critical Moment

And to think, we actually thought the hard part was over.

At times like this, with the Obama administration weathering yet another controversy regarding the stumbling beginnings of the Affordable Care Act, it's useful to remind ourselves that this too shall pass. I've been plenty critical of how has been handled (see here, or here, or here), but eventually it will get fixed, at least to the point at which it works well enough. Likewise, the fears now being experienced by people with individual insurance policies will, by and large, turn out to be unfounded. There will be some who have to pay more than they've been paying, but in almost all cases they'll be getting more too.

But there's no doubt that this is an escalating problem for the administration. The person who got sold a cheap insurance policy on the individual market because the insurer was confident that either a) they probably wouldn't get sick any time soon, or b) the policy was so stingy (whether the customer knew it or not) that the insurer wouldn't have to pay anything even if they did, has now become the victim whom all agree must be made whole. We're all talking endlessly about Obama's "If you like your current plan, you can keep it" pledge, but the fact is that if you have one of these junk insurance plans, you only like it if you haven't had to use it. But no matter—the people on these plans (and not, say, people who are finally getting Medicaid, because they're poor so who cares) are now the only people that matter. Congress is obsessed with them, the news media is obsessed with them, and Something Must Be Done.

The administration is clearly spooked, and so are Democrats. But everyone needs to take a breath and ask themselves whether what they do in the next couple of weeks is something they'll be able to live with in a year or five years or twenty years.