When Barack Obama made the decision to design a universal health-care program based on the private-insurance market, he faced one key problem. If you require insurance companies to accept anyone regardless of pre-existing conditions—as everyone wanted—you face the threat of "adverse selection," in which only those who are sick (and therefore expensive) get insurance. Just as the system of car insurance needs those who go long periods without having an accident to pay premiums so there's enough money to fix the cars of those who do have accidents, the health-insurance system needs the currently healthy to keep paying to support the currently sick. The answer was the individual mandate, which pulls people into the system and expands the risk pool. And especially critical to expanding that risk pool is getting as many young, healthy people as possible to get insured.
As part of the agreement to reopen the government, a House/Senate conference committee was formed to negotiate a new budget. The last time we tried this, with the "Supercommittee," the two sides couldn't agree, and that failure triggered sequestration, which was supposed to be so terrible for both sides (defense cuts that Republicans don't like, domestic spending cuts Democrats don't like) that it would force them to do anything to avoid it. But it now seems that Republicans don't have too much of a problem with sequestration. They're moving toward the position that undoing sequestration isn't something everyone agrees should happen, but instead is a concession Republicans would be making to Democrats, for which they'd have to be repaid with something they want, like cuts to Social Security and Medicare.* Sound familiar? It's not that different from when they said they didn't want the government to shut down, but not shutting the government down was a concession for which they'd need something in return.
While anything could happen, it seems that the odds are stacked against the conference committee being able to come to an agreement. Republicans want not only to cut social insurance, but also to slash all kinds of domestic spending. Democrats don't want that. Democrats would like to see more tax revenue. Republicans don't want that. Finding agreement is going to be hard.
But there is a way out. What if everybody put aside their demands, just for a year? What if they passed a budget that didn't do anything big at all, but just funded the government at about the level it's at now? No sweeping changes to the tax code, no draconian cuts, just an ordinary old budget where we tweak some things here and there. Would that be so bad?
I'll confess that I was pretty surprised about the difficulties healthcare.gov has been having. After all, despite all the complexities of creating this system, and de it wasn't exactly hard to foresee that the workability of the exchange website would be a very big deal. So you'd think that once a day or so for the last six months, the President would be calling the Secretary of Health and Human Services and saying, "This is going to go smooth as silk, right? Don't let me down, Kathleen." And she'd light a fire under everybody reporting to her to make damn well sure it did, so they wouldn't have to scramble like mad to fix a hundred problems once it had already launched. While the different things the site has to do certainly present technical challenges, they're hardly insurmountable.
Now, you might just put it down to the fact that the whole thing was outsourced to private corporations, and we all know you can't trust the private sector to do anything without screwing it up (ha!). But while there's no doubt the Obama administration deserves plenty of criticism for the difficulties, ask yourself this: Ten years from now, will the workability of healthcare.gov be something we as a nation are going to be spending a lot of time talking about?
Even before the shutdown crisis was over, President Obama was already making it clear that his next priority was going to be immigration reform. So can it actually happen? Right after the 2012 election, one Republican after another was saying that if reform didn't pass, their party was all but doomed, since they'd be blamed for stopping it, and the country's largest minority group would be driven even further away from them. You might think that after the political disaster of the shutdown, Republicans would be even more eager to find something, anything that would improve their party's image.
But maybe not. Over the weekend, Marco Rubio said that Republicans wouldn't allow immigration reform to pass because Obama was super-mean during the shutdown. "The president has undermined this effort, absolutely, because of the way he has behaved over the last three weeks." Rubio's not the only one with hurt feelings. "It's not going to happen this year," said Rep. Raul Labrador (R-ID). "After the way the president acted over the last two or three weeks where he would refuse to talk to the Speaker of the House ... they're not going to get immigration reform. That's done."
OK then. The thing is, even if Obama were sure there was next to no chance of succeeding in passing reform, there are few things he could spend time talking about over the next few months that would do more damage to his opponents.
Dick Cheney felt moved to write an entire book about the heart troubles he's had over the years, which I can understand. After all, we all find our particular maladies fascinating. What I don't get is why anybody else would care, since we don't tend to find other people's maladies interesting in the least. If you'd let me, I'd love nothing more than to blather on about my various knee injuries, but since I'm not RGIII, I have the sense to know that you really don't give a crap. Nevertheless, there's apparently an interesting tidbit or two in Cheney's book, including this, which may validate what you already thought about him:
Cheney had [his defibrillator] replaced in 2007 and his doctor, cardiologist Jonathan Reiner, with whom he wrote the book, had the device's wireless function disabled so a terrorist couldn't send his heart a fatal shock. Some years later, Cheney was watching an episode of the SHOWTIME hit "Homeland," in which that terrorist scenario was woven into the plot. "I was aware of the danger...that existed...I found it credible," he responds to Gupta when asked what went through his mind. "I know from the experience we had and the necessity for adjusting my own device, that it was an accurate portrayal of what was possible," says Cheney.
Did he also avoid sea travel, since the terrorists could use their nuclear-powered subs to send microwaves at him and fry his brains? What world was he living in?