Posts Tagged ‘Patient Protection and Affordable Care Act’

Dying at 75

October 13, 2014

Ezekiel Emanuel has written a somewhat controversial piece in The Atlantic on his hopes to die at the age of seventy-five. He doesn’t hope to be able to live to that age. He hopes he won’t live much past it.

Seventy-five.

That’s how long I want to live: 75 years.

This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90.

I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.

But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.

 

He does not intent to commit suicide on his seventy-fifth birthday, to be sure.

Let me be clear about my wish. I’m neither asking for more time than is likely nor foreshortening my life. Today I am, as far as my physician and I know, very healthy, with no chronic illness. I just climbed Kilimanjaro with two of my nephews. So I am not talking about bargaining with God to live to 75 because I have a terminal illness. Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.

I am talking about how long I want to live and the kind and amount of health care I will consent to after 75. Americans seem to be obsessed with exercising, doing mental puzzles, consuming various juice and protein concoctions, sticking to strict diets, and popping vitamins and supplements, all in a valiant effort to cheat death and prolong life as long as possible. This has become so pervasive that it now defines a cultural type: what I call the American immortal.

He will not take any active means to extend his life any further.

Once I have lived to 75, my approach to my health care will completely change. I won’t actively end my life. But I won’t try to prolong it, either. Today, when the doctor recommends a test or treatment, especially one that will extend our lives, it becomes incumbent upon us to give a good reason why we don’t want it. The momentum of medicine and family means we will almost invariably get it.

I must say that I am at least somewhat sympathetic to this point of view. Anyone who has ever watched a loved one growing older into senescence and decay must wonder if longevity is really something to be desired. What good is it to live to be ninety if the last decade is spent chronically ill and miserable? There is also something unseemly and even futile about this quest we have to live ever longer. We cannot be immortal. No matter how healthy our lives, we will die eventually.

If I eat the right sorts of foods and get the right amount of exercise, perhaps I will live to be eighty rather than seventy. So what? Compared to eternity, ten or twenty years is an infinitesimal amount of time. If I ate a diet of bean curd, perhaps I might live to be one hundred. What good is that if I am miserable every day because I am eating food I hate? Of course, I am being a fool. Living in a healthy body is more pleasant than living in an unhealthy body. But, then this is a matter of quality of live as opposed to quantity of life.

For a Christian, it is especially unseemly to cling to this life. We believe, in theory, that this life is only a prelude to a greater life to come. Why cling to the shadow when we can have the substance? Perhaps our attitude should be that of Pope Pius IX on his deathbed. When told that people around the world were praying for his recovery, he jokingly rebuked his advisors saying, “Why do you want to stop me from going to Heaven?”. Why are we determined to stay out of Heaven? Many other religions have similar views.

I don’t quite agree with Ezekiel Emanuel’s position, all the same. For one thing, I do not have the authority to choose the time of my death any more than I had to choose the time of my birth. It is common to say that this is “my body” or “my life”, but it really isn’t. None of us created ourselves. It would take a PhD in several fields to even begin to understand the processes that keep us alive. If any of us were given conscious control of every biological and chemical reaction in our bodies, we would die within seconds. Properly speaking, my body and my life belongs to the One who made them.

Perhaps Mr. Emanuel might agree with me, although I have no idea what his religious views are. As I noted, he does not plan to actively seek death.

This means colonoscopies and other cancer-screening tests are out—and before 75. If I were diagnosed with cancer now, at 57, I would probably be treated, unless the prognosis was very poor. But 65 will be my last colonoscopy. No screening for prostate cancer at any age. (When a urologist gave me a PSA test even after I said I wasn’t interested and called me with the results, I hung up before he could tell me. He ordered the test for himself, I told him, not for me.) After 75, if I develop cancer, I will refuse treatment. Similarly, no cardiac stress test. No pacemaker and certainly no implantable defibrillator. No heart-valve replacement or bypass surgery. If I develop emphysema or some similar disease that involves frequent exacerbations that would, normally, land me in the hospital, I will accept treatment to ameliorate the discomfort caused by the feeling of suffocation, but will refuse to be hauled off.

Surely there is something to be said for this attitude. Yet again, I do not quite agree with him. I do not and cannot know what my ultimate fate will be and it seems presumptuous to decide that after a certain age I am finished. For all I know the plan might be for me to live to ninety-five in reasonably good health. It would be foolish not to take reasonable steps to keep myself well. If one must accept Mr. Emanuel’s reasoning, surely a consideration of overall health and quality of life is a better basis for deciding when to stop getting checkups, etc, than an arbitrarily chosen age. In any case, I will simply take what comes.

Ezekiel Emanuel states that he is opposed to euthanasia or physician assisted suicide, and I see no reason to doubt his word. He does not even recommend that every one agree to his ideas.

Again, let me be clear: I am not saying that those who want to live as long as possible are unethical or wrong. I am certainly not scorning or dismissing people who want to live on despite their physical and mental limitations. I’m not even trying to convince anyone I’m right. Indeed, I often advise people in this age group on how to get the best medical care available in the United States for their ailments. That is their choice, and I want to support them.

And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy. What I am trying to do is delineate my views for a good life and make my friends and others think about how they want to live as they grow older. I want them to think of an alternative to succumbing to that slow constriction of activities and aspirations imperceptibly imposed by aging. Are we to embrace the “American immortal” or my “75 and no more” view?

He wants medical research to focus on better treatments for the diseases of old age rather than simply prolonging life or extending the process of dying. But, does he not see that he is actually making some very good arguments for euthanasia? He spends the middle part of his article noting that creativity tends to decline with age, even when there is no dementia. The minds of the elderly no longer work as well, just as their bodies no longer function as well.

Even if we aren’t demented, our mental functioning deteriorates as we grow older. Age-associated declines in mental-processing speed, working and long-term memory, and problem-solving are well established. Conversely, distractibility increases. We cannot focus and stay with a project as well as we could when we were young. As we move slower with age, we also think slower.

It is not just mental slowing. We literally lose our creativity. About a decade ago, I began working with a prominent health economist who was about to turn 80. Our collaboration was incredibly productive. We published numerous papers that influenced the evolving debates around health-care reform. My colleague is brilliant and continues to be a major contributor, and he celebrated his 90th birthday this year. But he is an outlier—a very rare individual.

American immortals operate on the assumption that they will be precisely such outliers. But the fact is that by 75, creativity, originality, and productivity are pretty much gone for the vast, vast majority of us. Einstein famously said, “A person who has not made his great contribution to science before the age of 30 will never do so.” He was extreme in his assessment. And wrong. Dean Keith Simonton, at the University of California at Davis, a luminary among researchers on age and creativity, synthesized numerous studies to demonstrate a typical age-creativity curve: creativity rises rapidly as a career commences, peaks about 20 years into the career, at about age 40 or 45, and then enters a slow, age-related decline. There are some, but not huge, variations among disciplines. Currently, the average age at which Nobel Prize–winning physicists make their discovery—not get the prize—is 48. Theoretical chemists and physicists make their major contribution slightly earlier than empirical researchers do. Similarly, poets tend to peak earlier than novelists do. Simonton’s own study of classical composers shows that the typical composer writes his first major work at age 26, peaks at about age 40 with both his best work and maximum output, and then declines, writing his last significant musical composition at 52. (All the composers studied were male.)

Perhaps he does not intend it, but this is dangerously close to valuing individuals not as human beings created in the image of God but on a utilitarian basis according to what they can be expected to contribute to society. If we are going in that direction, we might as well open up the death panels right now. We had also better be honest enough to admit that most of us are not going to contribute very much to the arts and sciences and might be fair game for such a panel at any age.

As for me, I will take whatever comes

 

 

I wonder if a lot of the conservatives who written about his article have actually read it.

The Incredible Shrinking President

June 13, 2014

That is the title of an article Walter Russel Mead has written in the Daily News. When you consider the contrast between the hype when President Obama was first elected and the public’s increasingly negative view of his job performance, he certainly seems to be shrinking. He came into office promising to heal the planet and now it seems he can’t get anything done. As Mead puts it,

It wasn’t supposed to be like this.

Less than two years after voters gave President Barack Obama a strong mandate for a second term, the White House is struggling against perceptions that it is losing its grip.

At home, the bungled rollout of the Obamacare website and the shocking revelations about an entrenched culture of incompetence and fraud in the VA have undercut faith in the President’s managerial competency.

Abroad, a surging Russia, an aggressive China, a war torn Middle East and a resurgent terror network are putting his foreign policy credentials to the test. With the GOP hoping to seize control of the Senate in November’s midterm elections, and the inevitable decline in presidential power that occurs as second term presidents move toward lame-duck status, Obama risks being sidelined and marginalized for the remaining two years of his term.

Mead has more to say about the president’s troubles but it is the second to last paragraph that intrigues me.

With 30 months to go, Obama still may have a chance to regain control of both the domestic and international agendas, but to do that he’s going to have to change his approach. He needs to focus on the nitty-gritty, day-to-day business of governing; six years into his administration, the public is fed up with promises and hungry for concrete accomplishments.

That has always been the problem with Barack Obama. He seems never to have been very interested in the day to day business of governing at any point in his political career. His colleagues in the Illinois State Senate and the US Senate remarked that he pref erred giving speeches on the Senate floor rather doing the actual work of preparing legislation in committees. He didn’t seem all that interested in the details of his most important legislation as president, Obamacare.

It is worth contrasting President Obama with another liberal Democratic president who had an ambitious agenda to change America, Lyndon B. Johnson. Both men believed in the power of the federal government to make life better for every American and both entered office with bold plans.On the whole, Johnson was more successful than Obama has been. Johnson was able to get Congress to pass his Great Society programs and civil rights legislation by large, bi-partisan majorities. Johnson took a personal interest in his policies and had an active part in designing the Great Society. Lyndon B. Johnson had spent twenty-four years in Congress before becoming John F. Kennedy’s vice president, serving in both Houses. He knew just who to talk to in order to get a bill passed and he knew how to persuade, intimidate or neutralize his opponents. He was a gregarious man who seemed to genuinely love politicking and policy.

That just isn’t Obama’s style and I doubt it ever can be. He just doesn’t seem to like dealing with members of Congress of either party all that much. There are reports that he is frustrated by the need to lobby people in Congress to get bills passed and would prefer to meet with world leaders and interesting people. He seems to believe that he can get things done by making grand proclamations and then every right-minded person will rush to make his policies happen. It seems that he does not believe that the people who oppose his policies might have different values or priorities and some compromise might serve the interests of both sides. Instead he thinks that any opposition can only be to personal dislike, racism, greed, or some other base motive. Johnson had great skill in crafting legislation to appeal to a broad majority. Obama seems not to be interested in trying

Since it is unlikely that a fifty-two year old man will be able to change his entire personality, the next two years of Obama’s presidency will undoubtedly be much like the last six. It’s going to be a long two years.

Don’t Tread on Me

March 25, 2014

Organizing for Action wants to give me a free bumper sticker.

tread

 

 

 

 

 

 

 

This is a parody of the Gadsden flag often seen at Tea Party rallies.

250px-Gadsden_flag.svg

 

 

 

 

 

 

 

The Gadsden flag dates from the Revolutionary War. It was designed by Christopher Gadsden in 1775 and was one of the first flags used by Americans until the Stars and Stripes. Benjamin Franklin explained the significance of using a rattlesnake as a symbol for the American spirit.

I recollected that her eye excelled in brightness, that of any other animal, and that she has no eye-lids—She may therefore be esteemed an emblem of vigilance.—She never begins an attack, nor, when once engaged, ever surrenders: She is therefore an emblem of magnanimity and true courage.—As if anxious to prevent all pretensions of quarreling with her, the weapons with which nature has furnished her, she conceals in the roof of her mouth, so that, to those who are unacquainted with her, she appears to be a most defenseless animal; and even when those weapons are shown and extended for her defense, they appear weak and contemptible; but their wounds however small, are decisive and fatal:—Conscious of this, she never wounds till she has generously given notice, even to her enemy, and cautioned him against the danger of stepping on her.—Was I wrong, Sir, in thinking this a strong picture of the temper and conduct of America?

It makes a lot more sense than his proposal that the new nation’s national bird be the turkey.

Notice the difference in significance of the two symbols. The one, the Gadsden Flag, shows nothing more than a desire to be left alone, with the implied threat to those that meddle. The other, the Obamacare Sticker shows a desire for services paid for by other people. Has the American character really degenerated so far?

Perhaps this image from the People’s Cube might work better.

Tread_Obamacare_Hammer_Sickle

 

 

 

 

 

 

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Awkward Holiday Debates

December 20, 2013

Once again, the Democrats are ready to help out with those awkward holiday political debates. This time the Truth Team has sent some talking points to use against that conservative relative.

David —

We all have that one relative — we won’t name names — who just loves to argue about politics.

It’s like clockwork — every year, the same conversations. And you just know that health care is going to come up this year — this time, make sure you’re ready. There’s a lot of good news on our side.

So here’s an extra large serving of truth, in the form of must-read Obamacare success stories from news outlets across the country.

Check them out and pass them along:

— Got a relative railing about health care costs? Well, according to The New York Times piece, thanks in part to Obamacare and its cost-control measures, “the slowdown in health care costs has been dramatic.” Not only that — according to the Times, the biggest savings might be yet to come. (Share on Facebook | Share on Twitter)

— Here’s a great round-up of a few success stories from the Los Angeles Times your relative probably missed, including this great quote from a new enrollee, “If not for the Affordable Care Act, our ability to get insurance would be very limited, if we could get it at all.” (Share on Facebook | Share on Twitter)

— A personal enrollment story featured in The Huffington Post from a self-employed blogger, including how much he loves his new coverage, and what he thinks about the push-back from his conservative friends. (Share on Facebook | Share on Twitter)

— A great story from a recent health care enrollee in North Carolina featured in the Raleigh News & Observer — and how easy it was for her to sign up. (Share on Facebook | Share on Twitter)

If you have a good talk about health care this holiday season, be sure to share your story with us — funny, inspiring, or even challenging, we’d love to hear how your conversations are going.

Last, but certainly not least — I want to say thank you for being such a champion for health care this year. You’ve been critical in helping get the good word out about Obamacare — and supporters like you will be all I’m talking about with my family this holiday season. You are inspiring. And you’re why I know that no matter what special interests throw at us, they won’t beat what we’ve got.

Have a healthy, relaxing holiday — don’t worry, there’s more truth coming soon.

Erin

Erin Hannigan
Health Care Campaign Manager
Organizing for Action

I certainly hope they won’t start naming names. It might be slightly creepy, in a Orwellian sense if Organizing for Action knew which of my relatives liked to argue about politics. Actually, they probably do have access to NSA files. Anyway, it seems to me that the best way to have a healthy, relaxing holiday might be to avoid getting into debates about politics with your relatives. Besides, who wants to turn into this guy?

Douchey-Obamacare-Guy

Not me!

 

Team Obamacare

December 16, 2013

Organizing for Action‘s  Truth Team wants me to spread the truth about Obamacare’s amazing success far and wide.

David —

Here’s an Obamacare number that’s hard to argue with:

1.2 million.

That’s how many Americans have signed up for coverage so far since October, according to new data released this week.

This is exactly why people like us fought so hard for reform for so long — to actually help people get better, more affordable care. These are results worth writing home, or at least on Facebook and Twitter, about.

Share this number far and wide today:

The anti-Obamacare crowd might have more money than our side does, but they don’t have numbers like this. This is great news, and shows we’re definitely moving in the right direction — but we’re not done yet. So while they keep running their messaging wars with deception and scare tactics, there’s nothing better than fighting back with facts like this.

Share the news about these 1.2 million Americans with your friends and family on Facebook:

http://my.barackobama.com/Share-this-Number-FB

Or tweet it out:

http://my.barackobama.com/Share-this-Number-TW

Seriously, thanks for all your help.

Erin

Erin Hannigan
Health Care Campaign Manager
Organizing for Action

They also want me to join Team Obamacare.

David —

It’s almost unthinkable that some people wake up every day determined to take away access to affordable health care from millions of Americans.

But it’s happening. Interest groups have spent almost $10 million against health care reform just this year.

They’re outspending us — but they’re not going to beat us. If you’ve ever cared about health care reform before, you should step up again right now.

Join Team Obamacare, and let’s fight back:

http://my.barackobama.com/Team-Obamacare

Thanks,

Lindsay

Lindsay Siler
National Director of Issue Campaigns
Organizing for Action

I notice that they are trying to portray themselves as just a plucky little group of activists fighting the big money interests and I have to wonder who they think they are trying to kid. Organizing for Action is just Barack Obama’s campaign team renamed and made over to help enact Barack Obama’s agenda. It’s head, Jim Messina, was Obama’s campaign manager and it’s executive director, Jon Carson, was a White House staffer. The whole operation is practically run from the White House. Maybe they are being outspent, I wouldn’t be too sure about that, but with the kind of connections they have, they really don’t need to raise much money, except to pay the salaries of their top officials.

 

The Word is Slavery

November 5, 2013

One of the problems with Medicare and Medicaid is that the amount these programs pay physicians is often not enough to cover their costs in treating the patient. For this reason, an increasing number of doctors are refusing to see patients with medicare or medicaid. This is a problem that is likely to grow. Fortunately Kathleen Murphy, a Democratic candidate for a seat in the Virginia House of Delegates has the solution, pass a law to force doctors to accept medicare and medicaid patients. Here is an account by the Mason Conservative.

You would think that when your party is burying a hole that is getting harder and harder to get out of, you wouldn’t want to that hole get deeper faster.  But here is Kathleen Murphy, Democrat running for the House of Delegates against Barbara Comstock, telling a forum in Great Falls that she believes it should law to force doctors to accept Medicare and Medicaid patients.  Forced by government decree, mind you.  A birdie sent me this:

FYI last night at the Great Falls Grange debate, Democrat delegate candidate Kathleen Murphy said that since many doctors are not accepting medicaid and medicare patients, she advocates making it a legal requirement for those people to be accepted.  
She did not recognize that the payments are inadequate to cover the doctors’ costs.  She also did not recognize there is a shortage of over 45,000 physicians now and that it is forecast to be 90,000 in a few years.  
Democrats appear to want to make physicians slaves of the state, but Democrats don’t admit they would just drive more doctors out of practice into retirement and other occupations.  The Obamacare law and regulations are causing millions of people to lose their health insurance, drop many doctors and hospitals. The HHS internal forecast is 93 million Americans would lose their health insurance due to the Obamacare law and rules about adequacy of insurance.
There is a word for forcing people to work without payment or their consent. That word is slavery.

 

The Truth Team Tackles the Obamacare Fail

November 2, 2013

In the latest message that I have received from the Truth Team, they straighten out the lies and misconceptions that so many people have about the recent introduction of Obamacare, especially the silly idea that people are hurting because their insurance plans have been cancelled.

David —

This one’s important:

We’re hearing a lot of hot air out of Washington these days about some insurance plans that are changing — for the better — because of Obamacare. It can be pretty confusing to follow, and some people on the other side aren’t making it any easier by being intentionally misleading.

Let’s be clear: What they’re talking about is the fact that if insurance companies decide to downgrade or cancel an insurance plan that doesn’t include the minimum consumer protections legally required, they must offer you an alternative plan that does include those protections — like the guarantee that you won’t run up against lifetime caps on coverage, you won’t have to pay for preventive care, and you can’t be denied coverage due to a pre-existing condition.

We think President Obama said it best on Wednesday — share what he said with your friends and family and help clear the confusion:

When you boil it all down, the “controversy” here is really about the fact that — thanks to Obamacare — Americans are going to get better, more affordable coverage.

The people who want you to think that it’s some scandal are going to have a tough time explaining it, once everyone knows the facts.

Share the truth about this on Facebook:

http://my.barackobama.com/Share-the-Truth-FB

Or tweet it out now:

http://my.barackobama.com/Share-the-Truth-TW

Thanks,

Erin

Erin Hannigan
Health Care Campaign Manager
Organizing for Action

When you boil it all down, the very real controversy is that the President specifically said that if you like your plan, you can keep it. That has turned out not to be true. Either President Obama did not know what was in the most important legislation of his administration, or he was lying.

I have noticed that in their defense of these insurance cancellations, the Progressives have been letting the mask slip a little bit to reveal them for the power hungry authoritarians they really are. If your insurance got cancelled it was because they have decided it was not good enough for you. If you want a choice between a cheaper plan that doesn’t cover so much and a more expensive plan that covers everything, well too bad. Your betters will decide what kind of coverage you need.

And again, as I have kept saying, nobody will get more affordable coverage if the insurance companies are obliged to accept anybody with any pre-existing condition and are compelled to offer mandated levels of coverage, whether or not their customers want or need them. If health care reform makes it more expensive for insurance companies to operate, they will have to pass on the costs to their customers, or go out of business. If health care reform increases demand for health services without a corresponding increase in the supply available, health will get more expensive. Barack Obama may believe that he can control the tides. He and the Democrats cannot simply ignore the laws of supply and demand indefinitely.

Update: This is what I was talking about.

Appearing on Piers Morgan’s CNN program on Tuesday night, HBO’s Bill Maher explained that while President Obama did indeed lie to the American people about keeping their insurance, he had to do so in order to help the dumb Americans. “I think the country in general is on a decline,” Maher explained. That’s because, Maher said, Americans are getting “stupider.” And that means that they must be lied to: “It sure is hard if you’re a politician—not that I’m really that sympathetic to them—to try to get information into people’s heads. I don’t think Obama should’ve lied to people…”

Maher then explained that it was insurance companies’ faults that Americans were losing their insurance programs. Then he continued, “But, yeah, he probably should’ve not been so blatant about saying you…iron clad guarantee. On the other hand, since he got no Republican votes and no Republican help. And since three years after it’s a law, they’re still fighting it, can you imagine what it would be like if he said, ‘Yeah, some people, your rates are going to go up.’ I mean the thing passed by this much. If they had said that, they might’ve lost the whole thing.”

I can’t imagine what watching a show with both Bill Maher and Piers Morgan must be like.

Ezra Klein Admits it’s a Disaster

October 17, 2013

It has become so clear that the introduction of the Affordable Care Act,
or Obamacare, as it has become known, is such a disaster that even
liberals have to admit it. I found Ezra Klein‘s thoughts
on the subject to be more than a little interesting. At least, he
is honest about the problems that have developed and the likely
causes. He does do his share of Republican bashing, though.

1. So far, the Affordable Care
Act’s launch has been a failure.
Not “troubled.” Not
“glitchy.” A failure. But “so far” only encompasses 14 days. The
hard question is whether the launch will still be floundering on
day 30, and on day 45. As Sarah Kliff noted, Medicare Part D was, at
this point in its launch
, also considered a
disaster.”When online shopping for prescription drug programs
launched back in 2005, things went so badly that the federal
government didn’t even get off the ground until three weeks after
its scheduled launch.” Today, Medicare Part D is broadly considered
a success. But Medicare Part D had something the Affordable Care
Act doesn’t: An opposition party that decided
to be constructive
. The federal health-care law’s not
going to get much help from the Republican
Party.

Obamacare passed without a single
Republican vote in either house of Congress. Throughout the process
neither Obama nor the Congressional Democrats ever even tried to
get any support from most Republicans. Because they had large
majorities in both Houses, they believed that they need not
consider the Republicans opinions. The problem is that our
constitution is expressly designed to keep any one party or faction
from simply ramming legislation through. The Democrats’ attitude
and the irregularities by which the bill was passed antagonized the
Republicans and between that and their base being against the act,
they were determined not be be constructive. I should note that
President Johnson also
had a large Democratic majority in Congress, yet he
was able to get Medicare and civil
rights legislation passed with substantial support from both
parties. Indeed, Republican support was crucial for the civil
rights acts, since the Southern Democrats were set against them.

2. Are there problems behind the
problems?
In the weeks leading up to the launch I
heard some very ugly things about how the system was performing
when transferring data to insurers — a necessary step if people
are actually going to get insurance. I tried hard to pin the rumors
down, but I could never quite nail the story, and there was a wall
of official denials from the Obama administration. It was just
testing, they said. They were fixing the bugs day by
day.

There really shouldn’t be many bugs in the
system. They have had years to plan and implement this. This is not
filling anyone with confidence. I will skip number three and go on
to four.

4. One thing has gone
abundantly right for the Affordable Care Act: The Republican
Party.
Their decision to shut down the government on
the exact day the health-care law launched was a miracle for the
White House. If Republicans had simply passed a clean-CR on Oct. 1
these last few weeks would’ve been nothing — nothing at all —
save for coverage of the health-care law’s disaster. Instead the
law has been knocked off the front page by coverage of the
Republican Party’s disaster. Six weeks later, there would’ve been
another opportunity to close the government. And it’s entirely
possible the federal health-care law still wouldn’t be working. At
that point, the Republican Party would’ve had a very good argument
for delay — and certainly a very good argument for delay of the
individual mandate. It would be the logical outgrowth of both their
messaging and the reality of the law. But that’s not what happened.
Instead, Republicans managed to make themselves so unpopular that
they’ve actually
made the law more popular
. Many Americans believe,
reasonably but wrongly, that the reason Obamacare isn’t working is
that the Republicans shut the government down. And if the
Affordable Care Act does begin to improve in the coming weeks
Republicans will have lost their chance to harm it. And it’s not as
if nobody tried to warn the Republican Party that this was exactly
what would happen

All right, gloat.
I don’t think there is much danger of Obamacare getting any more
popular, at least not if many people experience rising costs and
increasing frustration with their healthcare. I am also not sure
how much the shutdown diverted attention from the disaster. It’s
not like the mainstream media would have devoted much coverage to
it. Number five is the important point.

5. This isn’t about
politics.
A lot of liberals will be angry over this
post. A lot of conservatives will be happy about it. But it’s
important to see the Affordable Care Act as something more than a
pawn in the political wars: It’s a real law that real people are
desperately, nervously, urgently trying to access. And so far, the
Obama administration has failed them. The Obama administration’s
top job isn’t beating the Republicans. It’s running the government
well. On this — the most important initiative they’ve launched —
they’ve run the government badly. They deserve all the criticism
they’re getting and more.

This is actually the
whole problem. I have never gotten the impression that Barack Obama
is very interested in the day to day job of actually running the
government. In his brief careers in the Illinois State Senate and
the US Senate, he was not too involved with the details of the
legislative process. His colleagues commented that all he ever
wanted to do was make speeches. I know that in politics you want to
beat the other party. This is natural and expected. The idea that
both parties should put aside partisanship and work for the common
good is a fantasy because different people, even with the best
will, have different ideas of what constitutes the common good and
how to obtain it. Nevertheless, at some point you do have to work
together and govern. Obama’s experience as a community organizer
has taught him to divide people and demonize his opponents. It has
not taught him to bring people together or to lead. Related
articles

Americans Love Obamacare

October 6, 2013

When I first saw the article titled The Truth is, Americans Love Obamacare in the Los Angeles Times, courtesy of Real Clear Politics, I thought that the author, Michael Hiltzik, must be delusional. After all, almost every poll has shown that Americans hate Obamacare, usually by fairly wide margins. As I read the article, I saw that Mr. Hiltzik is not delusional, but instead is displaying the sort of condescension often seen on the left when large numbers of Americans do not support their policies. This is the sort of attitude that leads them to write books called What’s the Matter with Kansas, in which they explain that the people who oppose them simply are too stupid to know what is good for them. Here is the article.

Among the many delusions guiding the Republican campaign against the Affordable Care Act, surely the most consistent is the idea that the public detests the law and is clamoring for repeal.

Here’s the truth: The American public loves Obamacare, with as many as 88% in favor, according to one survey.

How can that be, when polls regularly show a plurality of respondents with an “unfavorable” view of Obamacare? (In a September Kaiser Family Foundation tracking poll, the difference was 43% unfavorable to 39% favorable.)

The answer, of course, is that most Americans have no idea what’s in the law. In the Kaiser survey, 57% said they didn’t have enough information to know how it would affect them. When they’re asked how they feel about specific provisions, however, they’re almost always thunderously in favor.

Here are figures from Kaiser’s March 2013 poll:

Tax credits for small businesses to buy insurance: 88% in favor.

Closing the Medicare drug benefit doughnut hole: 81% in favor.

Extension of dependent coverage to offspring up to age 26: 76% in favor.

Expanding Medicaid: 71% in favor.

Ban on exclusions for preexisting conditions: 66% in favor.

Employer mandate: 57% in favor.

If you agree with those provisions, congratulations: You love Obamacare. Yet when respondents are asked how they feel about “Obamacare,” they’re against it.

The one provision that always polls negatively is the individual mandate. Unfortunately, the mandate is necessary if you’re going to outlaw exclusions for preexisting conditions. Without it, you’d bankrupt every health insurer in the country, because people wouldn’t enroll until they’re sick.

The only possible conclusion from all this is that the law’s opponents have succeeded brilliantly in marketing “Obamacare” as something it’s not, and its defenders have failed miserably at communicating what it is.

But that defines the history of Republican-versus-Democratic messaging over the last couple of decades. It’s the same stunt that brought us “death panels,” or that redefined the estate tax as the “death tax.”

The key moment was the 2010 midterm election, when Democrats ran away from their healthcare achievement as if it were poison, leaving it to their GOP opponents to place their own brand on the law; they should have stood up proudly for their handiwork.

The harvest is today’s government shutdown, which is predicated on the voters’ supposed hatred for a law they actually support.

See? Americans love Obamacare. They are all just too dumb to know it.

Mr. Hiltzik is correct in stating that without the individual mandate, none of the rest of Obamacace works. Insurers do not exclude people with preexisting conditions because they are run by mean people who like to torture puppies and kittens. They might very well be mean people who torture animals, but they know perfectly well that if they didn’t exclude preexisting conditions, no one would bother to get health insurance until they had such a condition. If you are going to make health insurance available to all, you are going to have to make people get it while they are healthy.

It is possible that rather than being fools who have been taken in by the Republican’s brand on the law, the Americans who oppose Obamacare may be quite reasonably concluding that however much they may like certain aspects of Obamacare, they are not willing to be compelled to purchase health insurance, whether they want it or not, in order to gain those parts they like. They may have all too clear an idea of what the law entails. The Democrats who ran away from their achievement might have known a thing or two about what the people thought that Hiltzik has been missing. After all, they jobs depend on how well they know what the voters want.

As for the death panels, I have stated before that death panels are going to have to be part of any healthcare system in which the government provides “free” healthcare. If Obamacare works out the way I think it will, it will not make healthcare more affordable. The combination of increasing demand and stable or decreasing supply will cause costs to skyrocket. If the free market is not used to balance supply and demand through pricing close to the actual costs, than healthcare will have to be rationed by the government or by the providers. This means that people will have to be refused treatments that are not deemed worthwhile, thus death panels. It doesn’t matter if Obama and every single Democrat supporting Obamacare have no intention of ever instituting death panels. The economics of the situation will ultimately demand it.

Civil War Levels

September 28, 2013

Senator Tom Harkin has expressed his opinion that American politics has reached the level of divisiveness not seen since just before the Civil War. Here is an account of his words at National Journal.

As the clock ticks down toward a possible government shutdown, Sen. Tom Harkin, D-Iowa, isn’t holding back.

On the Senate floor before 10 a.m. Friday, the senator gave a speech describing how American politics have reached the level at which “a small group of willful men and women who have a certain ideology”—read: the tea party and Sen. Ted Cruz, R-Texas—have been able to take over the congressional budget debate in the last week. “Since they can’t get their way,” Harkin said, “they’re going to create this confusion and discourse and hope that the public will be so mixed up in who is to blame for this, that they’ll blame both sides.”

This isn’t just congressional business as usual, Harkin said. It’s much, much more dire:

It’s dangerous. It’s very dangerous. I believe, Mr. President, we are at one of the most dangerous points in our history right now. Every bit as dangerous as the break-up of the Union before the Civil War.

This isn’t the first time the senator has spoken out about the spiraling budget and the fight over Obamacare. Harkin suggested Thursday that Cruz looked “foolish” for his “little tirade” that lasted from Tuesday afternoon until Wednesday morning. Harkin called out Cruz as being part of “the most extreme tea-party wing” of his party, and for his “ideology-driven obstructionism.”

I think that Senator Harkin should go back a read a few books about the Civil War. Until we start seeing Senators actually physically attacking one another, we are not quite that far gone.

Congressman-Brooks-pummels-Senator-Sumner-300x196

Although fist fights in the Senate would make C-Span worth watching.

 

By the way, I should also say something about Senator Cruz’s reference to the Nazis.

Harkin isn’t the first to pull out a dramatic historical analogy on the Senate floor this week, either. During his 21-plus hour speech, Cruz hearkened back to Nazi Germany for a comparison to “pundits” who think Obamacare cannot be defeated:

If we go to the 1940s, Nazi Germany—look, we saw it in Britain. Neville Chamberlain told the British people: Accept the Nazis. Yes, they will dominate the continent of Europe, but that is not our problem. Let’s appease them. Why? Because it can’t be done. We cannot possibly stand against them.

In America there were voices who listened to that; I suspect the same pundits who said it couldn’t be done. If this had happened in the 1940s, we would have been listening to them. Even then they would have made television. They would have gotten beyond the carrier pigeons and letters and they would have been on TV saying: You cannot defeat the Germans.

Would it be too much to ask that we not compare any of our fellow Americans to the Nazis?

 


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