Paul Waldman

Things that Are Still True about Health Care

It isn't quite as bad as this, but there are still problems. (Flickr/Doug Kline)
It's been a pretty intense month on the health-care front, what with the beginning of open enrollment for the new exchanges giving rise to lots of disingenuous fulminating from Republicans, not to mention a whole lot of crappy journalism. Any time a story dominates the news for a couple of weeks, there's a temptation to believe that what's happening now will change everything. So I thought it might be a good idea to take a step back and remind ourselves about some things that are still true about the Affordable Care Act and still true about health care in America. Over the long term, the problems with Healthcare.gov won't have much of an effect on the success or failure of the law. Yes, it has been a huge screw-up, with both the administration and the contractors sharing responsibility. Yes, it has caused a lot of people trying to sign up for new insurance a lot of hassle. But it's the thing everybody's focused on now in part because it's the only thing happening with the law, until...

Why Winning Elections Is the Last Thing the Tea Party Wants

Flickr/Rob Chandanais
Keith Humphreys asks a provocative question: Does the Tea Party even want to win elections? This comes up in response to a long article in the National Review by Ramesh Ponnuru and Rich Lowry telling the Tea Party to get its head out of the clouds and start doing things that will help Republicans win. While it's tricky to ascribe specific desires and intentions to a large, complicated collection of people like the Tea Party, to the extent we can, I think the answer to whether they want to win is pretty clearly no. And there's a certain logic to it. The reason is that the Tea Party is an oppositional movement, and oppositional movements only thrive when they're in the opposition. They can talk all they like about both Republicans and Democrats being part of the problem, and being opposed just to "Washington," but we all know that at its heart it's about Barack Obama and everything he represents. If Hillary Clinton or another Democrat becomes president in 2016, most of the anger and...

Facebook Is Watching You

There's an old saying in media that if you're getting something for free, then you are the product. When you listen to commercial radio, the advertisers are the customers, and you're the product that the station sells to their customers. But if you're the company selling those eyeballs or ears, it's best to convince the humans attached to them that you care deeply about them and have their best interests at heart. So I'm wondering exactly how Facebook thinks it could persuade its billion users that this is anything less than horrifying: Facebook Inc. is testing technology that would greatly expand the scope of data that it collects about its users, the head of the company’s analytics group said Tuesday. The social network may start collecting data on minute user interactions with its content, such as how long a user's cursor hovers over a certain part of its website, or whether a user's newsfeed is visible at a given moment on the screen of his or her mobile phone, Facebook analytics...

The "War of the Worlds" Myth

Wikimedia Commons/Henrique Alvim Correa
Seventy-five years ago today, the CBS radio network aired Orson Welles' radio dramatization of H.G. Wells' War of the Worlds . Welles took Wells' book and transformed it into a series of radio news reports, duplicating in form and presentation what people would hear if Martians were actually invading Earth. As you probably know, mass panic ensued, with millions of Americans running screaming through the streets, having heart attacks, and generally believing that the world was coming to an end. It's a great story; the only problem is, it didn't happen that way. Not that there weren't some people who flipped out, because there were a few. All indications were that those who believed it was real were socially isolated and highly suggestible for one reason or another. But there was no mass panic, nobody firing their guns at passing clouds, nobody committing suicide rather than be scooped up by the alien invaders. So why has this tale persisted? The simplest answer is that it's a great...

He's a Mean One, Mr. Boehner

John Boehner just read his latest poll numbers. (Flickr/Gage Skidmore)
What place does John Boehner hold in the American psyche? That's a question that, according to the National Journal , Democrats are going to test out in next fall's congressional election, when they try to tie every Republican in a competitive race to the honey-hued Speaker of the House. Will it work? I'm a little skeptical, but it is true that Boehner's approval ratings have plunged. In fact, they've gone down as low as Nancy Pelosi's were before the debacle of the 2010 election. They made this nice picture from CNN polling data comparing the two: This is mirrored in other polls ; on average, around a quarter of the public likes Boehner, and around half dislike him. But there's a difference between telling a pollster you have an unfavorable opinion of a political figure and being persuaded to vote against said candidate when that political figure's picture is thrown up next to someone they don't particularly care for. As that article points out, while Boehner is at the same overall...

Time to Investigate Those Insurance Company Letters

As a follow-up to this post , I want to talk about the thing that spawns some of these phony Obamacare victim stories: the letters that insurers are sending to people in the individual market. People all over the country are getting these letters, which say "We're cancelling your current policy because of the new health-care law. Here's another policy you can get for much more money." Reporters are doing stories about these people and their terrifying letters without bothering to check what other insurance options are available to them. There's something fishy going on here, not just from the reporters, but from the insurance companies. It's time somebody did a detailed investigation of these letters to find out just what they're telling their customers. Because they could have told them, "As a result of the new health-care law, your plan, StrawberryCare, has now been changed to include more benefits. The premium is going up, just as your premium has gone up every year since forever...

Another Phony Obamacare Victim Story

NBC News' Obamacare victim, who it turns out is not actually a victim.
In the last couple of decades, a particular technique of news-story construction has become so common that I'm sure you barely notice it as something distinctive. It's the use of a device sometimes referred to as the "exemplar," in which a policy issue is explained through the profile of one individual, whose tale usually begins and ends the story. It's ubiquitous on television news, but print reporters do it all the time as well. As the Affordable Care Act approaches full implementation, we're seeing a lot of exemplar stories, and I've been noticing one particular type: the story of the person who seems to be getting screwed. If it were true that most Americans were indeed being made worse off by the law, that would be a good thing; we'd learn their stories and get a sense of the human cost of the law. The trouble is that in the real world, there are many more people being helped by the law than hurt by it, and even those who claim to be hurt by it aren't being hurt at all. To see...

The Biggest Design Flaw in Healthcare.gov

The pathway to disaster.
In my column today , I argue that the Healthcare.gov disaster has its roots in the government-contracting system, where big projects that go past deadline and over budget is standard operating procedure. There is one particular design flaw, however, that I didn't get a chance to discuss there but is worth noting. My guess is that it wasn't given all that much thought, or at the very least, somebody had what sounded like a good reason at the time to do it the way they did. But the result was that the administration needlessly multiplied the headaches it would have with the rollout and made everyone's experience significantly worse, and it didn't have to be that way. Before I tell you what it is (the suspense is killing you, I know), let's stipulate that Healthcare.gov did indeed present an extremely complex challenge, much more so than just creating an ordinary website. That's because it isn't a closed loop, but rather needs to communicate in real time with a bunch of outside systems,...

Healthcare.gov 2: The Contractors' Search for More Money

AP Photo/John Amis, File
AP Photo/HHS E veryone agrees that the rollout of Healthcare.gov has been something between a fiasco and a disaster. One of the mysteries is how a famously tech-savvy administration, headed by a president whose campaigns broke new ground in using digital technology to accomplish their goals, could have presided over this kind of screw-up. The answer is nearly as complicated as the website itself, but as the administration has said, the problems are not insurmountable and the site will be fixed (hopefully sooner rather than later). The next important question is what we can learn from this episode. There are vital lessons to be absorbed about how our government functions—not the Obama administration in particular per se. Instead, we got a good peek at what happens when private companies adept at squeezing billions from the taxpayers are hired to build something big. There's plenty of blame to spread around, from the White House to the Department of Health and Human Services to the...

Politician Tries to Be Cool Dad, Destroys Career

Party politicians in the house tonight/Everybody just have a good time...
If you don't live in the D.C. area, you probably haven't heard about the increasingly amusing travails of Doug Gansler, Maryland attorney general and candidate for governor. But his latest problem raises a question we as a nation must confront: Under what circumstances should a politician make the heavily freighted moral decision to be a total buzzkill? To back up a bit, Gansler is a common type: the firm-jawed, ideologically unremarkable yet intensely ambitious politician who'll rise pretty high but may or may not reach the upper echelons of elected office. Chances were that he'd eventually lose the primary (and thus the governorship in this most Democratic of states) to Lieutenant Governor Anthony Brown, who has the support of the current governor and future presidential candidate Martin O'Malley, among many others. Brown has a glittering resume (Army veteran, Harvard Law School, etc.), hails from vote-rich Prince George's County, and would be the state's first African-American...

Terrible Republican Idea Exposed as Even More Terrible

Flickr/adwriter
Yesterday, the Congressional Budget Office came out with a report assessing the budgetary impact of something many conservatives have supported, raising the Medicare eligibility age from 65 to 67. What they found was that the change would save far less money than had previously been assumed: only $19 billion over the next decade. The main reason is that many of the people no longer eligible for Medicare would be eligible for either Medicaid or insurance subsidies through the health exchanges, so the net effect on the federal budget would be small. But more important than that, this is an opportunity to remind ourselves that when government is doing something worthwhile, doing less of it isn't a good idea even if it saved a lot of money. And if cutting back only saves a modest amount of money, it's a really bad idea. You know what else would save a lot of money? Eliminating the United States Navy. But I'm guessing that most conservatives think having a navy is a good thing. Medicare is...

The False Glow of Remembered Childhood

Wait a minute - are you saying that my perspective on this might be colored by the fact that I'm ten years old? No way!
Three years ago, John Boehner was doing an interview when he lamented, perhaps with a tear peeking its way through the corner of his eye, that Democrats "are snuffing out the America that I grew up in." As Michael Tomasky noted at the time, the America Boehner grew up in (the 1950s) featured things like strong private-sector unions, a 90 percent top income-tax rate, enormous public-works projects, and a moderate Republican party, presumably all things Boehner wouldn't like, not to mention Jim Crow, terrible discrimination against women and gay people ... you get the point. But of course, "the America that I grew up in" is a place that exists only in the imagination— everyone's imagination. This is from an interview in Salon the other day with Adam Goldberg, creator of The Goldbergs , an ABC sitcom set in the 1980s: Why do you think audiences will be interested in a family show specifically set in the 1980s? I think the '80s works for a TV show because it's the last time the world was...

No, Healthcare.gov's Problems Will Not Offer the GOP Political Deliverance

Some of the healthcare.gov contractors testifying today.
Today marks the beginning of what will surely be a series of hearings in Congress at which members will fulminate and shake their fists at various people who had responsibility for creating Healthcare.gov. It's quite something to see some congressman who's still struggling to figure out how to work the Blackberry his staff gave him asking questions about beta testing and error logs and a bunch of other stuff he doesn't begin to understand. But maybe the weirdest thing is the feeling one gets from the GOP over the last few days, which can be summarized as, "We got 'em now!" They seem to believe that the website problems are going to provide the deliverance they've been waiting for after the political disaster of the government shutdown. Here's a little prediction: Feigned Republican outrage over the ACA web site is going to be just as effective in reversing the GOP's current fortunes as feigned Republican outrage over Benghazi was in undoing Barack Obama's re-election bid. Nevertheless...

The Key to the Broffordable Care Act's Success

Flickr/CNDOZ
W hen 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. So it may have been inevitable that young people would become targets for both the law's advocates and its opponents. A...

Instead of a Grand Bargain, Let's Have a Little Bargain

Flickr/Julia Taylor
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...

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