September 8, 2014--Two Cheers for Obamacare

I've been wondering why we've been hearing relatively little recently from Republicans about Obamacare. It had been thought that in the run up to the November midterm elections the GOP would be all over it, savaging it as an assault on both our freedom and the federal budget. It was to be their political trump card. The route to majority control of both houses.

Could it be that there is now relative silence because Obamacare is actually . . . working.

Many millions have signed up, and with the exception of some anecdotal horror stories the vast majority with health care coverage for the first time are happy with it; and, perhaps most surprising, in spite of all the scary stories about how the Affordable Care Act would bust the budget, it has in fact not only been cost effective but has already been contributing to deep cuts in the federal deficit.

Just as Obama said it would.

So then two cheers for Obamacare. It is too soon to offer three because, though the nonpartisan Congressional Budget Office's projections show significant downward trends in overall Medicare costs (the result in part of aspects of the ACA law) and thus dramatic deficit reductions over the decade, we still do not know how many more will sign up, how much subsidy they will require, and the nature of the care these new enrollees will require.

The CBO, adjusting for inflation, recently reported that the average amount spent annually per Medicare recipient declined from $12,000 each in 2011 to $11,200 this year and will be reduced further to $11,000 per Medicare enrollee by 2017. Technically, this is called "negative excess cost growth."

All told, the CBO is projecting that, as a result, over the next ten years the federal deficit will be reduced by $715 billion. Nearly three-quarters of a trillion dollars.

To be fair, this good news is not fully the result of the ACA. This downward trend is also a consequence of "young" Baby Boomers becoming eligible for Medicare for the first time and the apparent, not entirely understood, reduction in costly tests, treatments, and drug use. All good things as our health care system has grown bloated with over-testing and the over-selling of unneeded treatments and medications.

This $714 billion in savings dwarfs all deficit reduction plans being discussed, including Paul Ryan's draconian budget.

Wouldn't it be good if we could stop playing demagogic games with the budget and health care and get on to the real problems we face--how to create more jobs, improve the treatment of veterans, fix our crumbling infrastructure, improve public education, and tackle the inequality crisis.

Why am I not optimistic?

April 9, 2014--Republicans Are "For Nothing"

When Frank Rich is booked to appear on the Rachel Maddow Show I try to tune in. I like the way he sees through the hypocrisy that passes for political discourse and though he is an unashamed progressive is not above giving Democrats corrective grief when he sees them pandering or posturing. Which is often.

The other night he joined Rachel to mark what they claimed was the end of the Obamacare debate. With up to 10 million newly signed up to be covered through health insurance exchanges or enrolled in Medicare, plus millions more young people covered by their parents' policies, they proclaimed there will be less political advantage to Republicans to keep bringing it up.

It's a done deal, they said, and as the benefits really begin to phase in and even people who were reluctant to be forced to buy insurance or be subsidized to do so see how good a heath care delivery system it is, they will become as fervent in their support of it as people were who hated the idea of Medicare ("socialized medicine") but now will defend it to the death. Or minimally, to the ballot box.

As evidence of this, Rich and Maddow cited the latest version of the Ryan budget which calls for the full repeal of the Affordable Care Act. They mocked him for being both politically tone deaf (again, it's a done deal) and for not having an alternative to propose. They showed clips of him making the rounds of the Sunday talk shows fumbling when asked what he was proposing as a substitute to the tens of millions who would be denied coverage or would see their coverage severely restricted since he and his colleagues also want to turn Medicare into a version of a voucher system.

Ryan said, "We're working on alternative proposals." He didn't mention that his budget is the third or fourth in an annual series of Ryan budgets, each not much different than the others, and that coming up with a viable alternative proposal should not have be taking this long to develop.

This shows, Frank Rich said, that Ryan and his fellow Republicans are against everything, that they are, as he put it, "for nothing."

For a moment this did not feel to me like much of an exaggeration. Republicans are clearly not for Obamacare; they are clearly not for Medicare or Medicaid as it currently exists; they are not for food stamps; they are not for environmental protection; they are not for financial systems regulation; they are not for taxes; they are not for . . .

Listening to Rich and Maddow make this list, it sounded as if the GOP is indeed for nothing. (Though they are for increasing defense spending.)

But on further thought this seemed simplistic. Even unfair. Disagree with them as you will, most Republicans are in fact for something. Actually, many things.

Being against Obamacare and Medicare and especially Medicaid is being for less government participation in healthcare.

Being against raising the minimum wage is being for letting the market determine workers' wages.

Being against extending long-term unemployment insurance is being for a Darwinian economy.

Being against regulations is being for allowing markets to self-correct.

Being against taxes is being for trickle-down economics.

You get the point. They achieve their goals but doing as little as possible. Being for something by seemingly being for nothing.

In sum, Republicans are not for nothing. Quite the opposite.