Health care reform in the United States

Failures of Spin

Flickr/Gage Skidmore

Republican Senate leader Mitch McConnell is ordinarily a spinner of unusual skill. He's relentlessly focused on his message and doesn't let any interviewer frame a question in a way he (McConnell) doesn't like. Which is why it was a little odd to see Fox News' Chris Wallace catch him without a handy talking point when it came to covering the uninsured. This excerpt is a little long, but you have to see the whole thing:

Romney's Other Health-Care Contradiction

The health-care law either kills jobs or will cost employees their insurance—it can't do both.

(AP Photo/Charles Dharapak)

In vowing this morning to do what the Supreme Court didn’t—repeal Obamacare—Mitt Romney trotted out all his arguments against the newly constitutionally sanctioned health-care law. Among them were these two points: First, that Obamacare would cause 20 million Americans to lose their health insurance, and second, that it would be a job-killer to boot.

Problem is, these two arguments directly contradict each other.

The Benefits of Medicaid

The Affordable Care Act

In tomorrow's New York Times, Annie Lowrey has an interesting story about a study researchers were able to do in Oregon when the state had to hold a lottery to give people Medicaid coverage, leading to the perfect conditions for a randomized field experiment on what effect obtaining insurance could have. The results were pretty encouraging:

In a continuing study, an all-star group of researchers following Ms. Parris and tens of thousands of other Oregonians has found that gaining insurance makes people healthier, happier and more financially stable...

Republicans Possibly Pretending to Be Mad At Other Republicans Definitely Pretending to Care About Health Care

Congressional Republicans discuss health care. (Flickr/nkenji)

The Supreme Court will rule on the constitutionality of the Affordable Care Act soon, and that has concentrated some Republicans' minds. It was all well and good to shout "repeal and replace!" when there wasn't really anything they could do about it, but if the Court actually strikes down some or all of the law, they'll be under greater pressure to put their money where their mouths are. The central quandary is this: if the law's least popular provision—the mandate for everyone to carry insurance—is struck down, that means the law's most popular provision—the requirement that insurance companies accept everyone, regardless of pre-existing conditions—has to go as well. Not only that, some other popular provisions, like the requirement that insurers allow young people up to age 26 to go on their parents' insurance, would disappear if the Court strikes down the whole law.

Should that happen, President Obama and other Democrats will immediately begin attacking Republicans for taking away these popular benefits. After all, the overturning of the ACA is a Republican project from start to finish, from the lawsuits brought by Republican attorneys general to the Republican judges on the Court who will undo it. So what do you do if you're a Republican member of Congress? Well, you start pretending that when you get around to that whole "replace" thing, you'll keep the stuff everybody likes.

Facts? We Don't Need No Stinking Facts.

The New York Times does Mitt Romney a favor.

People like me often complain about "he said/she said" reporting, which treats all claims by competing political actors as having equal validity, and doesn't bother to determine whether one side or the other might not be telling the truth. There are lots of reasons why that kind of reporting is harmful, but it's important to understand that it doesn't just keep people soaking in a lukewarm bath of ignorance, it can actively misinform them, leading them to believe things that are false.

Today's New York Times has a textbook example of what happens when political reporters can do when they refuse to adjudicate a factual dispute between candidates. In the story, Michael Barbaro doesn't just allow Mitt Romney to deceive, he actively abets that deception in the way he constructs his narrative. Here's the key excerpt:

Repeal and Pretend to Replace

(Flickr/Gage Skidmore)

Maybe Republicans aren't so opposed to health care reform after all. After grandstanding against the Affordable Care Act for the past few years, Republicans aren't ready to let the entire bill die should the Supreme Court overturn the law later this summer. Congressional Republicans are crafting a contingency plan to reinstate some of the popular elements of the bill in that scenario, according to Politico. It's a clear indication that the GOP has learned the same lesson as Democrats: while the all-encompassing idea of Obamacare may fair poorly in the polls, voters typically support individual elements of the bill.

The Only Reasonable Response Is Alarm

(Jamelle Bouie/The American Prospect)

I’m not surprised that Michael Gerson, architect of “compassionate conservatism,” has convinced himself that this generation of Republican leaders is carrying on in his footsteps (via Mike Allen):

Obama’s overreach has also produced another conservative reaction – a Reform Conservatism. The key figure here is Paul Ryan … Its brain trust includes thinkers such as Yuval Levin, James Capretta and Peter Wehner. The reform movement … looks for ways to achieve the ends of the welfare state both through more private means and more efficient public means. … Speaker John Boehner has adopted Ryan’s reform approach as the de facto ideology of the House Republican majority. [Emphasis mine]

Three Roads from the Supreme Court

None of the options for health-care reform is ideal, but the most likely path forward would be through action in the states.

Sitting in the Supreme Court on March 27, I was stunned by the oral argument on the Affordable Care Act (ACA). From their first questions to Solicitor General Donald Verrilli, the conservative justices seemed to echo the arguments against the individual mandate that the opposing lawyers had set out in their briefs. When it was over, I was not 100 percent sure that Justice Anthony Kennedy would vote to overturn the mandate and related penalties. But if he does, the Court may well strike down the law’s other critical provisions, staging what amounts to a conservative judicial coup.

The Long Moral View

Map of the uninsured by NPR

Someday, all Americans will have access to health care, just as all people in Germany and France and Japan and Sweden and every other advanced industrialized democracy do today. It may take a decade or two after the implementation of the Affordable Care Act in 2014 (if it survives the whims of Anthony Kennedy) to fill in the gaps the law leaves behind, or it may take decades beyond that. But it will surely happen eventually. And at some point after it does, we'll come to a consensus as a society that it was a collective moral failure that we allowed things to be otherwise for so long.

After the Affordable Care Act

Flickr/José Goulão

Today, the members of the Supreme Court will meet in private to begin deciding the fate of the Affordable Care Act, and the millions of Americans whose lives and futures stand to be made more secure because of the ACA. It's entirely possible that Anthony Kennedy will discover some place in his heart where integrity and a respect for the true role of the Court are supposed to be and the Act will be upheld, but at the moment you won't find too many people willing to bet on it.

So I'd like to spend a few moments working through what might happen if the Court takes the middle course, which could be the most likely—striking down the individual mandate, but leaving the rest of the law intact—both in the short and long term.

Americans Prefer Having Cake, Eating It

President Obama signs the Affordable Care Act.

The wise Harold Pollack has argued that health care reform is in some ways the best covered social policy story in the history of American journalism. That isn't to say there hasn't been plenty of crappy coverage, but there has never been the same volume of informed and insightful reporting and analysis available in so many places on a pressing policy debate.

And yet it's easy to get depressed about the impact all that good work didn't have...

Single-Payer and the Supreme Court

(Flickr/surroundsound5000)

When the Supreme Court begins its extraordinary three days of hearings on the constitutionality of the Affordable Care Act, one of the oddities will be an amicus brief challenging the act’s individual mandate from 50 doctors who support national health insurance. They point out the inconvenient truth that, contrary to the administration’s representations, the government did not need to require citizens to purchase insurance from private companies in order to meet its goals of serving the health-care needs of the populace. Congress could have enacted a single-payer law. 

Three Things to Know About Paul Ryan's New Budget

(Gage Skidmore/Flickr)

Later this morning, House Budget Chairman Paul Ryan will unveil his latest budget plan, “The Path to Prosperity.” Like the “Roadmap” released last year—and passed by House Republicans—the Path to Prosperity fits neatly within Ryan’s self-described Randian ideology: It would slash social and entitlement spending and direct the savings to lower taxes on rich people and corporations. Despite this, as Matthew Yglesias points out, Ryan has a habit of portraying his policies as somehow beneficial to the broad majority of Americans. I plan to be in the audience for Ryan’s unveiling, but in the meantime, here are a few things to remember and look out for as Ryan tries to sell his program to the public.

Another Kind of Mandate

While it’s hard to make a bad advertisement with Clint Eastwood, this would be good even without “The Man With No Name.” The basic message is straightforward— it’s “halftime in America.” Yes, the country suffered a major setback four years ago, but we have the strength and reserve to press forward on the current path and succeed.

Encouraging Health Doings in Montana

Well lookey here (via Think Progress):

HELENA - Gov. Brian Schweitzer said Wednesday he will ask the U.S. government to let Montana set up its own universal health care program, taking his rhetorical fight over health care to another level.

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