Health Care

Bad Faith and Budget Politics

Obama has to do business with people who cannot be trusted to own up to their side of a deal.

AP Images/Jacquelyn Martin

Compromise is often an unhappily revealing art. “Ideals may tell us something important about what we would like to be. But compromises tell us who we are,” the philosopher Avishai Margalit writes. In finding compromises with Republicans on the federal budget, Democrats need to remember not only who they are but who the voters depend on them to be.

Face It: You're Crazy (But So Is Everyone Else)

Flickr/Mark Turnauckas, Carling Hale

Commonly referred to as "the DSM," the Diagnostic and Statistical Manual of Mental Disorders is often referred to as psychiatry's "Bible." If that's the case, imagine the outcry if an overzealous publisher merged the Gospels of Luke and Mark, and you have a pretty good idea of the controversy surrounding the release of the manual's fifth edition.

The Military's Suicide Scandal

AP Images/Charles Dharapak

What a drag it’s been these past few weeks to watch the military brass—those kings of accountability when it comes to other people’s behavior—huffing and bluffing and outright lying about what they knew and when they knew it. First we had to endure the sight of them gaping over the news that the sexual-violence crisis they’ve done nothing to squelch since the assault of 83 women and seven men at the Tailhook Air Force convention in 1991 has worsened. Now those same Pentagon officials are shocked, simply shocked, by the military’s spiking suicide rates, despite the fact that those numbers, which have been rising steadily for the past 12 years, come from their own reporting system (and some claim are still an undercount).

A Few Words about Angelina Jolie's Breasts

AP Photo/Alastair Grant

Angelina Jolie—a woman with some of the world’s most famous breasts—has explained in a thoughtful New York Times op-ed this week why she's had them prophylactically removed and replaced. Jolie’s mother died young, after a decade living with ovarian cancer; when Jolie herself got genetically tested, she learned that she had a BRCA1 genetic mutation that gave her an 87 percent chance of getting breast cancer. To protect her children from losing their mother too young, she opted for surgery, which she describes in some detail.

Eight Months Until the End of Job Lock

Flickr/walknboston

For years, even before Barack Obama was elected, one of the many complaints liberals (mostly) had about the current employer-based health insurance system was "job lock"—if you have insurance at your job, particularly if you or someone in your family has health issues, then you're going to be hesitant to leave that job. You won't start your own business, or join somebody else's struggling startup (unless they provide insurance), and this constrains people's opportunities and dampens the country's entrepreneurial spirit.

That this occurs is intuitively obvious—you probably know someone who has experienced it, or have experienced it yourself. And today there's an article in that pro-Democrat hippie rag The Wall Street Journal entitled "Will Health-Care Law Beget Entrepreneurs?" Amid the worrying about the implementation of Obamacare in January, and the quite reasonable concern that the news could be filled with stories of confusion, missteps, and dirtbags like that Papa John's guy cutting employees' hours rather than give them insurance, to avoid the horror of increasing the cost of a pizza by a dime, it's a reminder that there will probably be lots of stories like this one in the news too, stories about people whose lives have been changed for the better by the fact that Americans will have something they've never had before: health security.

How Low Can Part-Timers' Hours Go?

AP Images/Adam Richard

Say you’re an employer with an employee who works 30 hours a week. If you have 50 employees or more come next year, you’ll be required either to provide her with health-care coverage, which the Affordable Care Act will by then mandate for all employees who work at least 30 hours a week, or you’ll have to pay a $2,000 penalty for failing to cover her.

Or, you could just cut her weekly hours to 29. That way, you won’t have to pay a dime, in either insurance costs or penalties.

Why the Fight over Obamacare May Never End

Since the Affordable Care Act was passed in early 2010, I've held more than one opinion on just how the American public will feel about it as time goes by. Initially, perhaps influenced by the momentousness of the Act's passage, I wrote that once it was actually implemented, it would be much harder for Republicans to attack. They would no longer be able to frighten people with phantoms of death panels, and instead would have to talk about reality. Since people would have their own experience with the law to judge from as opposed to some hypothetical future, the attacks would lose their potency, Republicans would back off, and the law would rise or fall in public esteem on its own merits.

Then I began to have second thoughts. One of the biggest problems, which I wrote about a few months later, is that Obamacare isn't a single program like Medicare that people can come to love. It's a whole bunch of pilot programs and new regulations, many of which involve private insurance or existing programs like Medicare and Medicaid, and when people are affected by those changes they won't necessarily see them as being part of Obamacare. For instance, beginning in January, insurance companies will no longer be able to deny you coverage based on pre-existing conditions. But to most people, interacting as they will be with private companies, it will look like Aetna or Blue Cross or whoever just got more humane, and they may not even know that the government made them do it. Even the exchanges, if they work well, will just be the place where you go to shop for private insurance. Your relationship with the insurer you choose will certainly be affected deeply by the ACA's regulations, but most people still won't understand exactly how.

Among the consequences are that Republicans will be absolutely free to continue to blame every problem anyone has with the health care system on Obamacare, without concern of producing a backlash from the law's supporters.

The Unending War on Obamacare

Flickr/Fibonacci Blue

I'm not a historian, so maybe there's something I don't know, but it seems to me that there may never have been a piece of legislation that has inspired such partisan venom as the Affordable Care Act. Sure, Republicans hated Medicare. And yes, their rhetoric at the time, particularly Ronald Reagan's famous warning that if it passed, "We are going to spend our sunset years telling our children and our children's children, what it once was like in America when men were free," was very similar to what they now say about Obamacare. But once it passed, their attempts to undermine it ran more to the occasional raid than the ongoing siege.

I bring this up because Kevin Drum makes an unsettling point today about the future of Obamacare:

Obamacare's Delicious Ironies

We don't have health insurance, suckers! (Flickr/Elvert Barnes)

As the various "gangs" in the House and Senate were writing their immigration proposals, it became clear that to win the support of Republicans, the provisional legal status undocumented immigrants were going to get had to be punitive. No coddling those law-breakers; if they're going to get on a path to citizenship, it had better be an unpleasant path. It had to last for a long time—10 years, in the end. And there had to be a requirement that during that time, you couldn't get any federal benefits like food stamps or welfare.

But this has produced a rather amusing irony.

The Gosnell Case and the Two Kinds of Media Criticism

Fox is on it.

As you might have heard, conservatives are up in arms that the trial of Kermit Gosnell, the Philadelphia abortion doctor charged with multiple murder counts, hasn't gotten more coverage. They claim that the media have ignored the story because of their pro-choice bias. You should read Scott Lemieux's five lessons of the case, but a lot of liberals have been shaking their heads over conservatives' complaints, because the right's argument about the case is wrong in almost every one of its particulars. The truth is that though there hasn't been a lot of coverage in the mainstream media until now, many feminist writers have written about the case at length. And what allowed this horror to happen is exactly what conservatives want more of: a system where there are few (or no) legitimate abortion providers, sending poor women with few options to the back alleys, where they can be preyed upon by people like Gosnell.

But I want to talk about the media angle to all this. As Kevin Drum points out, there have essentially been two phases in the conservative media's attention to this story. In phase 1, they ignored it. In phase 2, they write stories complaining that because of liberal bias, the media are ignoring it. What's missing, of course, actual coverage of the story itself, despite the fact that conservatives have all these media outlets that could be doing what they claim the mainstream media aren't. The Washington Times, for instance, ran one AP story about the start of the trial, followed by 7 separate pieces on how the media are ignoring the story. Did it send its own reporters there to cover it? Nah, why bother? They do, however, have an online poll in which you can answer this vital question: "Online outrage is forcing some media outlets to cover the Kermit Gosnell abortion trial. Will MSNBC be able to continue its blackout?"

There are essentially two kinds of media criticism you'll see if you pay attention to these things. The first is an analysis that has some specificity to it, and aims to address some genuine ongoing weakness of press coverage. The second is just about browbeating and getting people you don't like on the defensive. It's the difference between "Let's see if we can get a discussion started about this problem and make some progress toward fixing it," and "Here's our chance to get those bastards on their heels." The left does both. The right only does the latter.

Five Lessons from the Gosnell Abortion-Clinic Controversy

WikiMedia Commons

The hot conservative story of late last week, starting with a USA Today op-ed by Kristen Powers, was the failure of the mainstream media to cover the horrifying case of Kermit Gosnell, a Philadelphia doctor accused of committing infanticide, and maiming and, in some cases, killing his patients (most of them poor women) in an unsanitary abortion clinic. Perhaps the story does deserve more coverage than it has received, but the lessons to be drawn from it are different from the conclusions conservatives are making. Here are five points currently being overlooked in the coverage of the controversy.

The President's Morning After

Getty Images/Joe Raedle

Last Friday, Judge Edward Korman ruled that the federal government must abide by U.S. Food and Drug Administration (FDA) recommendations and make emergency contraception available over the counter without age restrictions. Cue the freak-out about girls having unprotected orgies followed by Plan B snorting parties. Emergency contraception, often referred to as “the morning-after pill,” or by its brand name, Plan B, is designed to be taken in, well, emergencies—the condom breaks, you got carried away in the moment and didn’t ever quite get to the birth control, or in cases of sexual assault or coercion in which the victim doesn’t have much choice about contraception.

On Abortion, the GOP Tacks Right

Flickr/Paul Weaver

In March of 2012, Virginia governor Bob McDonnell was in trouble. The Republican-dominated state legislature had passed a measure that would require women seeking abortions in the early stages of pregnancy to have a transvaginal sonogram—a procedure in which a wand is inserted into the vagina. Pro-choice activists jumped on the bill, calling it “state-sanctioned rape.” The outrage went national, and the conservative governor with aspirations to higher office backed off. A version of the sonogram bill did make it into law, but it does not specifically require transvaginal sonograms, just the better-known “jelly on the belly” type.

Prospects for Legal Marijuana? Higher and Higher

Flickr/Torben Bjørn Hansen

Anyone who still saw the marijuana-reform movement as a hopeless collection of hippies and slackers got a reality check last November, when advocates successfully passed three major initiatives. Massachusetts became the 18th state to allow for medical marijuana and, most notably, Washington and Colorado became the first two states in the country to legalize recreational use of the drug. Now, less than five months later, a slew of pro-marijuana measures has been introduced in legislatures across the country. At least six have a good chance of passing. Seventeen states have bills to allow medical marijuana. Nine others would make the punishment for possession a fine rather than jail time.

When Public Is Better

Flickr/Mirsasha

Long before we thought of founding The American Prospect in 1989, I came to know Paul Starr through a prescient article titled “Passive Intervention.” The piece was published in 1979, in a now-defunct journal, Working Papers for a New Society.

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