Obamacare – A Republican idea that needs bipartisan fix
From the St. Louis Post-Dispatch
Two years ago, Princeton University economists Anne Case and Angus Deaton disclosed a shocking finding: Between 1999 and 2014, middle-aged (45-54) white Americans with a high school education or less died at a rate never before seen in a modern industrialized society.
Alone among every other demographic group they studied, this group’s life expectancy was shrinking. The group’s annual mortality rate jumped from 281 per 100,000 to 415 per 100,000 during the 15 years studied.
Big reasons: Striking increases in the number of suicides, drug overdoses and liver disease caused by alcohol poisoning. Case and Deaton called them “deaths by despair.”
Now the two scholars have returned to try to explain why this is happening. In a report published by the Brookings Institution, they suggest that while income inequality and wage stagnation may play a background role, a lifetime of “cumulative disadvantage” catches up with this demographic.
They are the slice of the population who hit the job market as low-skill jobs were being mechanized, computerized and globalized. They grew into adulthood as cohesion-building social institutions like marriage, family and churches became weaker. Often they didn’t have spouses, pastors, work buddies or kids to back them up.
They did have opioid painkillers, which Case and Deaton say “added fuel to the flames, making the epidemic much worse than it otherwise would have been.” They cite a study from the Boston Federal Reserve that found that among men not in the labor force, nearly half are taking pain medication, most often by prescription.
Case is a professor of economics and public affairs; Deaton, her husband, was the 2015 Nobel laureate in economics. They admit their research is not a “smoking gun,” but it has ominous implications:
“This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65.”
Obviously the same forces affecting low-income middle-aged whites also affect poor educated middle-aged blacks and Hispanics. But mortality rates are decreasing among those groups and they don’t suffer high rates of deaths by despair. The authors speculate that expectations may be higher among whites, leading to greater disappointment when things don’t work out.
Many of these folks put their faith in Republican promises of help, and the GOP owes them something. Addressing opioid addiction is a place to start. So is keeping the social safety net intact. GOP politicians can boast about bringing back jobs and passing right-to-work laws, but voters must hold them accountable if they make things worse for the people the corporate economy has left behind. From the Los Angeles Times
There’s no question that anti-abortion activist David Daleiden surreptitiously recorded health care and biomedical services employees across the state of California with the intent of discrediting the health care provider, Planned Parenthood — something his heavily edited videos failed to do. There’s also no question that it’s against state law to record confidential conversations without the consent of all the parties involved.
But that doesn’t mean that California Attorney General Xavier Becerra should have charged Daleiden and his co-conspirator, Susan Merritt, with 15 felony counts — one for each of the 14 people recorded, and a 15th for conspiracy. It’s disturbingly aggressive for Becerra to apply this criminal statute to people who were trying to influence a contested issue of public policy, regardless of how sound or popular that policy may be. Planned Parenthood and biomedical company StemExpress, which was also featured in the videos, have another remedy for the harm that was done to them: They can sue Daleiden and Merritt for damages. The state doesn’t need to threaten the pair with prison time.
The videos — recorded in California and elsewhere — were published online nearly two years ago by Daleiden’s organization, the Center for Medical Progress. They caused an uproar, energizing anti-abortion activists and prompting threats against abortion providers. Officials of Planned Parenthood, whose staff members were seen on some of the recordings, denied any wrongdoing and were outraged that the tapes appeared edited to make it sound as if they were selling fetal tissue.
Daleiden describes the effort as journalism, although his methods were decidedly not those employed by respectable reporters. He and Merritt allegedly concocted fake identities and business records to dupe Planned Parenthood officials into taking the pair into their confidence, and misrepresented themselves throughout. Nevertheless, as misguided as they were, their aim was to change people’s views on important and controversial issues — abortion and fetal tissue research.
In similar cases, we have denounced moves to criminalize such behavior, especially in the case of animal welfare investigators who have gone undercover at slaughterhouses and other agricultural businesses to secretly record horrific and illegal abuses of animals. That work, too, is aimed at revealing wrongdoing and changing public policy.
That’s why the state law forbidding recording of conversations should be applied narrowly, and to clear and egregious violations of privacy where the motive is personal gain.
In this case, we don’t believe the videos revealed any wrongdoing on the part of Planned Parenthood. Nothing in the activists’ recordings proved that anyone was trafficking in fetal tissue. Nor is there any public policy that needs to be changed. A woman’s right to an abortion is well established, even if some like Daleiden continue to wish it away. And important research into the science of numerous illnesses and diseases is done with stem cells obtained from fetal tissue. The public policy in the U.S. on the use of this tissue is sound. Fetal tissue may not be sold or bought.
Still, the online posting of the edited tapes triggered more than a dozen different state investigations — all of which ultimately found Planned Parenthood not guilty of any wrongdoing — and several now concluded congressional investigations into whether fetal tissue was being sold. Even without evidence of wrongdoing, the tapes and the subsequent investigations have had an unfortunate chilling effect on the use of fetal tissue for groundbreaking scientific research.
There are avenues in civil courts for officials of Planned Parenthood and the biomedical service providers to strike back. And, in fact, Planned Parenthood has filed a lawsuit in federal court accusing Daleiden and his organization of fraud, breach of contract, and several other offenses.
But Becerra’s attempt to take this to the level of a criminal felony is misplaced here.
Republicans are finding that it is easier to burn the barn down than to build one. President Trump recommends letting Obamacare “explode” with no thought for the millions of people who would be hurt. Obamacare is not about to explode, but it could fail if Republicans sabotage its financial underpinnings. It has fixable problems. Like any new business, its start-up costs are high as the previously uninsured and sicker population seek coverage. The requirement that everyone eligible sign up for coverage, thus increasing the pool of people insured and spreading risk, is an essential principle of insurance.
Sadly, the Republican debate on Trumpcare in the House was about how many citizens to strip of their health care coverage, rather than how to improve Obamacare. The now-pulled Trumpcare bill would perhaps have reduced the deficit but at the price of throwing 24 million people under the bus. Obamacare was designed to pay its way through taxes and healthcare cost-saving measures. The ACA also contains many preventative care measures designed to keep people healthy and avoid more health care spending. In 2015, due largely to Obamacare, overall healthcare spending grew at the slowest rate on record since 1960. If our legislators would work together across party lines it can be fixed
The Republicans have been successful in convincing many Americans that Obamacare is worse than the Holocaust. Their favorite propaganda hot buttons fan fears like “taking away your freedom to choose the insurance plan you want, taking away your choice of doctors, and forcing you to buy insurance.” If they were trying to scare you about your car purchase, they would be telling you that the government is trying to take away your choice of car options by mandating safety glass, air bags, and seat belts, and they would be telling you that the state of Georgia is trying to take away your constitutional freedoms by forcing you to buy car insurance and having your proof of insurance available for the police to verify.
The drumbeat to repeal Obamacare is apparently more about taking one more swipe at President Obama than about making health care policy. Obamacare is actually based on Republican principles like private insurer CHARLES LOVE Jim Powell of Young Harris Clay Bennett, Chattanooga Times Free Press competition, regulated marketplaces and tax credits to aid the uninsured. In calling for repealing Obamacare, Republicans are rejecting ideas which have been espoused by Republicans for many years. In fact, as far back as the Nixon administration the conservative think tank, The Heritage Foundation, espoused market reforms centered on insurance exchanges, mandates and subsidies. These were the ideas adopted by the ACA. In an effort to obtain bipartisan support, President Obama chose the ideas which had long been favored by Republicans, rather than choosing a Single Payer system more to the liking of his own Democratic Party.
In 1989 those Heritage Foundation ideas inspired George H.W. Bush to propose a plan that would require individuals to buy insurance. Ironically, Bush’s political advisors warned that the plan was too conservative to survive a Democratic Congress. In 1993 Senate Minority Leader Bob Dole based the GOP’s official policy response to Hillarycare on one of the Heritage Foundation’s proposals. Ten years later, Mitt Romney relied on the same model to create what he called “the ultimate conservative plan” in Massachusetts — the plan that would go on to serve as the basis for Obamacare.
If President Trump and the Republican-controlled Congress want to serve the best interests of the people rather than trying to score political points by continuing to divide the nation, they should work with Democrats to improve the ACA. If they put aside partisan biases and commit to a common goal — what is best for Americans — the Congress could craft revisions to the Affordable Care Act that would improve Americans’ access to health care while also containing costs. The Administration can call the new plan whatever it wishes if the result is to strengthen the American health care system. This action could give credibility to President’s Trump’s promise to Make America Great Again.