Health Care

In Praise of Designer Babies

One day, I will rule this measly planet. (Flickr/paparutzi)
Imagine you knew that you carried a gene for a debilitating illness. But doctors could go into your egg (or your spouse's) and remove that gene, enabling you to have a baby who, whatever other problems they might encounter through their lifetime, wouldn't have to worry about the illness. Would you let them? Most people would say probably yes, provided they were sure the technique was safe and wouldn't produce some kind of two-headed mutant centaur baby. That, after all, is what people were worried about when the first baby conceived via in-vitro fertilization was born in 1978—although in that case, they were worried about cyclops babies ( seriously ). It turned out in the end that IVF is perfectly safe, and now it's a common procedure, the ethics of which is questioned only by radical anti-choice extremists. Well we may be approaching the time when doctors can fix certain kinds of inherited diseases before an egg is even fertilized. And naturally, people are worried about "designer...

No, Really, Blame John Roberts on Medicaid

The Prospect 's Paul Waldman has a terrific piece noting the terrible effects of states refusing the Medicaid expansion contained in the Affordable Care Act. Slate 's Matt Yglesias notes who should get the blame for this: John Roberts and the other conservative Republican justices who—in an unprecedented decision—ruled that making existing Medicaid money from the federal government contingent on accepting the expansion was unconstitutional. Kevin Drum of Mother Jones , however, argues that we shouldn't blame John Roberts because he was right : I think this is unfair. In fact, there were only two justices who upheld the Medicaid expansion (Ginsburg and Sotomayor). All the rest, including the liberals Breyer and Kagan, struck it down. So it wasn't even a close call. The vote against the Medicaid provision was 7-2. And as much as I dislike the result, I can't find a lot of fault with this. The basic holding was simple: given our federalist structure, states can't be forced to help fund...

The Big Donors Behind the Shutdown

The big donors behind the crisis in Washington are finally being called out by the mainstream media. Yesterday, the New York Times had a major investigative piece about how the Koch brothers and other major conservative donors pushed the Republican Party toward its current extreme strategy of trying to stop Obamacare. I have been saying the same thing for some time, citing the key role played by the Club for Growth in threatening House Republicans with electoral retaliation at primary time if they don't go all out on Obamacare. But the Times story breaks new ground by spelling out exactly how deep pocketed donors are using their clout with Republicans in Congress. These donors have made defunding Obamacare a litmus test and have directed intense fire, in the form of TV and Internet ads against Republicans seen as not falling in line behind this push. This stands in contrast to the usual narrative about the government shutdown, along with debt ceiling brinksmanship—which is that it's...

The Myth of Obamacare's Bad Sales Job

Flickr/Brent Moore
When they went forward with their plan to shut down the government in order to undo, defund, or otherwise undermine the Affordable Care Act (ACA), conservatives convinced themselves that their plan was going to work because Americans hate Obamacare. If you look at it in an extremely narrow, context-free way, that's sort of true. If you just ask people whether they approve of the ACA, you get between 35 percent and 45 percent approval. But the closer you look, the more complicated it gets. Some people disapprove of it because they feel it didn't go far enough; add them with those who say they approve, and you'll get a majority. Furthermore, and most critical for what I'd like to discuss, the actual components of the law, like giving people subsidies to buy insurance, outlawing denials for pre-existing conditions, and so on, are extremely popular (the one exception is the individual mandate). One thing's for sure, though: You can't say that the ACA as an abstract entity is...

The Cruelty of Republican States in One Chart

Click through for exciting full-size version.
Many people are talking today about this article in today's New York Times , which focuses on the particularly cruel doughnut hole created when the Supreme Court allowed states to opt out of the expansion of Medicaid in the Affordable Care Act. The problem is that if you live in a (mostly Southern) state run by Republicans, you have to be desperately poor to qualify for Medicaid under existing rules. But it isn't until you get to 133 percent of the poverty level ($31,321 in yearly income for a family of four) that you're eligible for subsidies to buy insurance on the exchanges, because when the law was written the idea was that everyone under that income would get Medicaid. When all those Southern states decided to refuse the Medicaid expansion in order to shake their fist at Barack Obama, they screwed over their own poor citizens. So millions of people will be caught in the middle: not poor enough to get Medicaid, but too poor to get subsidies on the exchanges. But when we say "not...

What Happens to Conservatism When the Obamacare War Is Over?

Flickr/Fibonacci Blue
When we look back decades from now, one of the keys to understanding this period in our political history will be the story of how a set of market-based health insurance reforms that started as a proposal from the Heritage Foundation and then were successfully implemented by a Republican governor who later became the GOP presidential nominee, ended up being viewed by virtually all conservatives as not just an abomination but the very essence of statist oppression. Liberals have often expressed wonder or exasperation about the way conservatives changed their opinions about this particular brand of reform. But now that it's driving a government shutdown (and soon a potential default on the debt), we have to acknowledge that it's more than just a policy conservatives hate. The Affordable Care Act is far, far bigger than that. It has become the most important definer of conservatism in America circa 2013. It isn't that conservatives don't still want to cut taxes for the wealthy, or slash...

Daddy's Home!

AP Images/Edmond Terakopian
AP Images/Edmond Terakopian M any mornings this year Matt Nuttall and his friend Ryan Faulkner met up in one of several neighborhood parks located between their houses in Pleasant Hill, California. While they changed diapers, dispensed snacks, and made sure their little ones didn’t fall off the playground equipment, the dads “talked to each other in adult,” as Nuttall puts it. Before too long, their children would begin to fade, and they’d head back to their respective houses to prepare lunch and oversee afternoon naps. “We didn’t do much, just sat around and kept the kids and ourselves from going crazy,” says Nuttall, who teaches ninth- and tenth-grade English at Sacred Heart Cathedral Preparatory in San Francisco. After his wife returned to her job, Nuttall took 12 weeks off from his. For half of that time, he received $945 a week through California’s Paid Family Leave program. The program, which has been in existence since 2004, offers workers up to six weeks off with maximum pay...

Obama's Opening Salvo In the War of Words

President Obama making a statement today.
Starting today, Americans are going to learn three things when they watch media coverage about the government shutdown. First, they'll see Republicans say that Obamacare totally sucks and everybody hates it, and also that President Obama is being super-mean by not giving them what they want. Second, they'll learn that their fellow citizens have a pox-on-both-their-houses view on this whole thing, because nothing says "journalism" like going out on the Mall or to the local diner and getting a few quotes from average folk saying, "They're all acting like children!" And third, they'll hear Barack Obama say that with their intransigence, Republicans are hurting regular Americans. And not just regular Americans generally, but actual, specific regular Americans. Many of these Americans will be seen standing patiently behind the President as he tells their stories. That's what he did today in his first post-shutdown statement, which combined a celebration of the opening of the health-care...

Have Too Many Cooks Spoiled Obamacare?

AP Images/J. Scott Applewhite
It's safe to say that if Americans don't understand the Affordable Care Act (ACA) by now—and they don't —they never will. The slightly better news is that consumers don't have to understand it in order to benefit from it, but even so, almost all the problems the ACA has encountered or will encounter are a result of the law's enormous complexity. That complexity grew out of early decisions made by Barack Obama, but along the way Congress added their own layers of complexity in order to pass it, then conservatives on the Supreme Court added some more. There were reasons, most of them perfectly good, for each of these decisions; everyone thought they were responding to reality or doing what was in the best interests of the country. But as full implementation of the law is upon us, we should acknowledge how much damage has been done by all this complexity. In a recent article in National Affairs , Johns Hopkins political scientist Steven Teles bemoans the rise of "Kludgeocracy." The term...

Senator Talks for Hours, While in Real World, Things Proceed According to Plan

Politics is, to a degree we don't often notice, mostly about talking. Politicians describe what they do in heroic, usually martial terms—they "fight" for things, they wage "battles," and so on—but what they actually do is talk, and talk, and talk some more. They talk on the floor of Congress, they talk in committees, they talk to constituents, they talk to each other. There are a few of them, oddly enough, who are not particularly good at talking. But the successful ones are almost all good talkers. So it isn't too surprising that Ted Cruz, the former debate champion who is known as an exceptionally good talker, is able to get up and talk about the satanic plot that is Obamacare for 18 hours straight. There's something fitting about this last stand. Let's recall that just a few days ago, Cruz was being branded a traitor by Tea Partiers simply for acknowledging that the defunding effort will fail in the Senate. So what better way to get back in their good graces than a grandiose,...

The Conversation: What’s the Best Way to Die?

AP Images/J PAT CARTER
AP Images/J PAT CARTER W hat does it mean to have a good death? Few people long to spend their last hours with their bodies stuck full of tubes, listening to the hum of high-tech equipment under fluorescent lights. Yet every year, hundreds of thousands of Americans die in hospitals, where doctors’ aim is to cure at all costs, using expensive and often invasive treatments to prolong their patients’ lives by days, weeks, or months. For the past two decades, Sherwin Nuland, a surgeon and bioethicist at the Yale School of Medicine, has been advocating for a dramatic change in our attitudes toward death. In his 1994 book, How We Die: Reflections on Life’s Final Chapter , he argued for an approach to death that emphasizes dignity above treatment. How We Die spent months on the best-seller lists and won the National Book Award. But in the ensuing years, Americans’ zeal to stave off the inevitable seems to have grown rather than diminished, leaving too many caregivers and family members to...

Life Takes Visa—Except If You Want to Buy Pot

AP Images/Marcio Jose Sanchez
AP Images/Marcio Jose Sanchez E arlier this summer, Elliott Klug had a plumbing problem on his hands. There was a leak in the drainage line between his marijuana dispensary, Pink House Blooms in Denver, Colorado, and the street. It was a relatively simple fix, but when it came time to pay the plumber, things got more complicated. Because of federal regulations that restrict marijuana business owners’ access to financial services like banking, Klug had no choice but to hand the plumber an envelope with $25,000 in cash. When the plumber tried to deposit the payment, the cash was held in limbo until the bank could count all of the money and verify that it wasn’t laundered—standard operating procedure for such a large cash deposit. Klug says it’s just another daily hassle for marijuana dispensaries, which occupy a strange legal gray area. Under Colorado law, Pink House Blooms is just one more small business, but in the eyes of the federal government, Klug is illegally trafficking one of...

Can Republicans Buck the Tea Party?

AP Photo/Marc Levy
AP Photo/Harry Hamburg S ince the Tea Party emerged following President Barack Obama’s victory in 2008, Republican governors have frequently been the faces of some of the most extreme policies in recent political memory. Even before her infamous “finger point” at the president, Arizona’s Jan Brewer was signing and defending her state’s racial-profiling bill, SB 1070. In Ohio, John Kasich championed a law—later repealed by voters—to strip public employees of bargaining rights. In Florida, Rick Scott has pushed a plethora of hard-right policies, from drug screening of welfare recipients and government employees to reductions in early voting. Michigan’s Rick Snyder, who has a moderate streak, went to the extreme last December when he approved “right to work” legislation in a state built largely by union labor. Yet Brewer, Kasich, Snyder, and Scott are among the nine GOP governors who have staked considerable political capital on Medicaid expansion, a key piece of the Affordable Care Act...

The Last of the Late-Term Abortion Providers

After Tiller A t one point early in After Tiller , a new documentary on third-trimester abortion, a counselor at a late-term abortion clinic asks a patient to explain why she wants to terminate her pregnancy just a few months before she gives birth. “My baby’s got a disease, and it’s fatal in a lot of ways,” the woman explains between sobs. The camera zooms in on her hands, clenched around a ball of tissue. “He could be stillborn. He would have a very short life, full of surgeries and seizures until he would pass. He’s not a viable child. The most loving thing I can do is let him go now.” Stories like this echo throughout After Tiller , directed by Martha Shane and Lana Wilson, which opens today in New York City. The film follows the lives and work of the only four doctors in the country who perform abortions in the last trimester of pregnancy. Three of the doctors portrayed in the film—Stacey Sella, Susan Robinson, and LeRoy Carhart—worked for George Tiller, the late-term abortion...

The Conservative Plan for Medicaid Expansion

AP Photo/Osamu Honda
AP Photo/The Columbus Dispatch, Chris Russell A number of policymakers on both sides of the aisle cheered when, in April, the Arkansas Legislature passed a law both expanding Medicaid and transforming it into a service available in a marketplace of insurance options, a move known as the “private option.” Similar cheers erupted in June when Iowa Governor Terry Branstad approved a similar measure. The legislation marked a major accomplishment—not because the policies are necessarily improvements over traditional Medicaid but because they establish politically palatable paths for conservatives who want to increase access to health care. In Pennsylvania, GOP Governor Tom Corbett—who was against Medicaid expansion and this week announced he is is tepidly for it—has pointed to the these new plans as a model he might consider (among other, more controversial changes.) The private option may be a way to make comprehensive health-care coverage viable in other Republican states—but that depends...

Pages