Health Care

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Repealing the Affordable Care Act

The Republicans have made a mantra out of repealing the ACA aka Obamacare.  I’ve lost track of how many times they have voted to repeal it, but close to 60, I think.  The surprising thing is how unprepared they really are to “repeal and replace”.  They seem to have the repeal part down, but in all the years it has been since the law was enacted, they haven’t come up with a replacement plan.  I think that even supporters of the ACA know that some things need fixing but no Republicans were willing to work with Democrats and President Obama to do so.

They could just repeal it.  This would create chaos in the health care system and upset millions.  I don’t think they want to deal with loss of support right away.  I’m not sure that voters who say they don’t like the ACA understand that things like free vaccinations, physical exams, and mammograms are part of the Act.  On the other hand, Republicans cannot seem to agree on a plan to replace the ACA.  There are a lot of ideas, but no plan and not even a framework for a plan as far as I can tell.

In the January 4 edition of the New York Times, Robert Pear had an interesting and informative article, Republicans’ 4-Step Plan to Repeal the Affordable Care Act.  In it he outlines the things that have to happen before Repeal.

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Vice President-elect Mike Pence, second from right, listened as the Senate majority leader, Mitch McConnell, spoke after a Republican luncheon on Wednesday.

Step One is to pass a budget resolution that is filibuster proof in the Senate.

The Senate intends to pass a budget resolution next week that would shield repeal legislation from a Democratic filibuster. If the Senate completes its action, House Republican leaders hope that they, too, can approve a version of the budget resolution next week. Whether they can meet that goal is unclear.

Step Two would add details.

Republicans say they will delay the effective date of their repeal bill to avoid disrupting coverage and to provide time for them to develop alternatives to Mr. Obama’s law. They disagree over how long the delay should last, with two to four years being mentioned as possibilities.

Step Three adds in ideas from President Trump.

Within days of taking office, President-elect Donald J. Trump plans to announce executive actions on health care. Some may undo Obama administration policies. Others will be meant to stabilize health insurance markets and prevent them from collapsing in a vast sea of uncertainty.

“We are working on a series of executive orders that the president-elect will put into effect to ensure that there is an orderly transition, during the period after we repeal Obamacare, to a market-based health care economy,” Mr. Pence said at the Capitol on Wednesday.

Step Four is replacement.  For which there is no consensus.

Meanwhile Democrats are also taking action.

In the Senate next week, Democrats will demand votes intended to put Republicans on record against proposals that could protect consumers. Defenders of the law also hope to mobilize groups like the American Cancer Society and the American Heart Association to speak up for patients.

This process is far from over.  Even Republicans put implementation of a new health care law a minimum of 2 years out – just in time for mid-terms- and more likely, 4 years away – just in time for the next Presidential election.

Photograph:  Doug Mills/The New York Times

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Random thoughts on the state of the world on the first day of spring

Today, the first day of spring, is warmish outside.  I think it actually broke 50!  We had a few hours of sun, but now it is mostly cloudy.  I finally purchased John Grisham’s “Sycamore Row”.  I had been resisting but succumbed because I loved “A Time to Kill” and I ended up getting 45% off the cover price.  Don’t know if a new Grisham is a sign of spring or not, but I’m going to take it as one.

It is hard for me to concentrate on much the last few days.  There is just too much news! Between the missing Malaysian airliner, Crimea, and worrying about the Democrats retaining Congress in the fall, things are pretty depressing even for someone who tends to be an optimist.

Unfortunately, I think that time ran out a long time ago for the passengers on the airliner and now all we can do is watch as the world tries to locate the remains of the plane and the black box.  While everyone points out that they did eventually find the Air France plane that went down in the Atlantic, it was very difficult even though we had a much better of idea of where it went down.  I see the families on television and wonder what I would feel if I just didn’t know what happened.  At this point one almost has to treat it as a forensic mystery to be solved.

I don’t think we are on the verge of a war over Russia and the Crimea, but I do think that things will be difficult internationally for a while.  This will affect negotiations in Iran and Syria as well as people in the Ukraine and Crimea.  But the ultimate losers may be the Crimeans.  David M. Herszenhorn had an article in the New York Times yesterday which pointed out that the troubles there may just be starting.

Many A.T.M.s in this sun-dappled seaside resort city in Crimea, and across the region, have been empty in recent days, with little white “transaction denied” slips piling up around them. Banks that do have cash have been imposing severe restrictions on withdrawals.

All flights, other than those to or from Moscow, remain canceled in what could become the norm if the dispute over Crimea’s political status drags on, a chilling prospect just a month before tourist season begins in a place beloved as a vacation playground since czarist times.

He points out that Ukraine could cut off electricity and water supplies and that there is no direct overland route between Crimea and Russia.  The story ends with this

Some Crimeans said they were already feeling the financial sting from political instability.

As crowds in the cities of Simferopol and Sevastopol held raucous celebrations well into Monday morning after the vote, here in Yalta, Ihor B., the owner of a small travel business, went to bed with a growing sense of dread: The roughly two dozen bookings that he had received since the start of the year had all disappeared.

“I got 10 requests from Germany, and 10 assignments from Ukrainian agencies for Western tourists; a couple of requests from Dutch tourists and cruise ships,” said Mr. B, who asked that his last name not be used for fear of reprisal by the new Russian government. “At the moment, all of them, absolutely all of them, are canceled.”

In the same issue of the Times was a long cautionary story about South Ossetia which was liberated from Georgia five years ago.  But things have moved on and South Ossetia is not doing very well.

When Russia invaded Georgia, repelling a Georgian attack on South Ossetia and taking control of the separatist enclaves of South Ossetia and Abkhazia, it seemed most unlikely that the Kremlin was thinking about long-term consequences.

As in Crimea, the war was presented to Russians as a humanitarian effort to protect its citizens, and more broadly as a challenge to encirclement by the United States, which was aligned with Georgia. Television stations gave the intervention blanket coverage, and it was wildly popular in Russia, lifting the approval ratings of Dmitri A. Medvedev to the highest point of his presidency.

The aftermath of recognition, however, has presented Russia with a long series of headaches. This week, economists have warned repeatedly that Crimea, if it is absorbed, will prove a serious drag on Russia’s budget, but their arguments have been drowned out in the roar of public support for annexation.

Aleksei V. Malashenko, an analyst at the Carnegie Moscow Center, said Russian officials “will be shocked” with the challenges they face when trying to manage Crimea — reviving its economy, distributing money and influence among its ethnic groups, and trying to control the corruption that accompanies all big Russian projects. And, judging from precedent, the public’s euphoria will fade, he said.

“I think that in Russia, the majority of the society forgot about Ossetia, and if it weren’t for the Olympics, the majority of the society would also forget about Abkhazia,” Mr. Malashenko said. “Of course, Crimea is not Ossetia. But anyway, the popularity of Crimeans, and the Crimean tragedy, will be forgotten in a year.”

So maybe we don’t need to do anything except some sanctions and make sure that Russia and Putin’s next move is not to march into eastern Ukraine.  Forget John McCain’s mockery and advice.

As for domestic politics, I recalled Andrew Sullivan’s March 13th blog entry on The Dish. The Boring, Relentless Advance Of Obama’s Agenda.  To read the entire piece one has to subscribe [which I would encourage you to do], but here is his conclusion.

…One side is theater – and often rather compelling theater, if you like your news blonde, buxom and propagandized. The other side is boring, relentless implementation. At any one time, you can be forgiven for thinking that the theatrics have worked. The botched roll-out of healthcare.gov, to take an obvious example, created a spectacular weapon for the GOP to hurl back at the president. But since then, in undemonstrative fashion, the Obama peeps have rather impressively fixed the site’s problems and signed up millions more to the program. As the numbers tick up, the forces of inertia – always paramount in healthcare reform – will kick in in defense of Obamacare, and not against it. Again, the pattern is great Republican political theater, followed by steady and relentless Democratic advance.

Until the theater really does create a new majority around Republican policies and a Republican candidate, Obama has the edge. Which is to say: he has had that edge now for nearly six years. Even if he loses the entire Congress this fall, he has a veto. And then, all he has to do is find a successor able to entrench his legacy and the final meep-meep is upon us. And that, perhaps, is how best to see Clinton. She may not have the stomach for eight years in the White House, and the barrage of bullshit she will have to endure. But if you see her as being to Barack Obama what George H.W. Bush was to Reagan, four years could easily be enough. At which point, the GOP may finally have to abandon theater for government, and performance art for coalition-building.

Plus, it is spring.

Mutts by Patrick McDonnell

Mutts by Patrick McDonnell

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The state of health care reform

As everyone knows, the rollout of the Affordable Care Act has been pretty bumpy what with website problems, Congress not providing funding for getting the word out, and states refusing expanded Medicaid even if it is free money.  There have been surprises also.  The red state of Kentucky with a Democratic Governor, Steve Beshear, is running a successful program.  Connecticut has an online program that it is thinking of selling to other states.  Massachusetts with the original universal health care program hired the same folks that messed up the federal website resulting in problem after problem resulting in a backlog in processing paper applications.

In the meanwhile, the Congressional Republicans would still like to either eliminate or defund the ACA, but as Greg Sargent wrote recently in the Washington Post people are beginning to move away from supporting those actions.

Obamacare is a disaster for Democrats, and a certain winner for Republicans. That’s what we keep hearing, anyway.

So why does it look as if the percentage of Americans who favor repeal may have actually shrunk since its rollout problems began?

That’s what the February tracking poll for the Kaiser Family Foundation suggests. To be sure, the new poll finds that opinion of the law is more negative than positive: 47 percent of Americans view the law unfavorably, while 35 percent view it favorably (though opinions have improved a bit since October).

But unfavorable views have not translated into support for the GOP position of repeal; indeed the repeal position may have lost ground since the October rollout problems, while a clear majority favors keeping and improving the law.

Some Kaiser survey results

Some Kaiser survey results

I think most people, including President Obama, would say that the ACA could be improved.  Any piece of legislation of that scope is going to have parts that don’t work well or have unintended consequences which need fixing.  And they need fixing in a systematic way and not just on the fly through delays and exceptions as the administration has been trying to do.  The poll results show support for making fixes.

The poll shows that 48 percent want to keep and improve the law, and another eight percent want to keep it as is — for a total of 56 percent who want to keep it. (50 percent of independents want to keep and fix.)

Meanwhile, 19 percent want to repeal the law and not replace it, while 12 percent want to repeal and replace with a GOP alternative — totaling 31 percent.

Back in October Kaiser found that 37 percent want repeal/replace or just repeal, versus 47 percent who want to keep/expand it. There was a temporary spike for repeal in December, at the height of the problems; now it appears to be back down to below where it was.

In fairness, the wording is not directly parallel. The new poll offers respondents the option of keep and improve, while the October poll offered folks keep or expand. But this underscores the point: When people are offered keep and improve — the Dem stance — support for keeping the law grows.

Paul Krugman pointed out in his last New York Times column that Republican attempts to find horror stories have so far not really succeeded.

Remember the “death tax”? The estate tax is quite literally a millionaire’s tax — a tax that affects only a tiny minority of the population, and is mostly paid by a handful of very wealthy heirs. Nonetheless, right-wingers have successfully convinced many voters that the tax is a cruel burden on ordinary Americans — that all across the nation small businesses and family farms are being broken up to pay crushing estate tax liabilities.

You might think that such heart-wrenching cases are actually quite rare, but you’d be wrong: they aren’t rare; they’re nonexistent. In particular, nobody has ever come up with a real modern example of a family farm sold to meet estate taxes. The whole “death tax” campaign has rested on eliciting human sympathy for purely imaginary victims.

And now they’re trying a similar campaign against health reform.

Krugman cites the Response to the State of the Union Address.

 In the official G.O.P. response to the State of the Union address, Representative Cathy McMorris Rodgers alluded to the case of “Bette in Spokane,” who supposedly lost her good health insurance coverage and was forced to pay nearly $700 more a month in premiums. Local reporters located the real Bette, and found that the story was completely misleading: her original policy provided very little protection, and she could get a much better plan for much less than the claimed cost.

Louisiana is running ads about people losing health care insurance with actors.

In Michigan, Americans for Prosperity is running an ad that does feature a real person. But is she telling a real story? In the ad, Julia Boonstra, who is suffering from leukemia, declares that her insurance has been canceled, that the new policy will have unaffordable out-of-pocket costs, and that “If I do not receive my medication, I will die.” But Glenn Kessler of The Washington Post tried to check the facts, and learned that thanks to lower premiums she will almost surely save nearly as much if not more than she will be paying in higher out-of-pocket costs. A spokesman for Americans for Prosperity responded to questions about the numbers with bluster and double-talk — this is about “a real person suffering from blood cancer, not some neat and tidy White House PowerPoint.”

Even supporters of health reform are somewhat surprised by the right’s apparent inability to come up with real cases of hardship. Surely there must be some people somewhere actually being hurt by a reform that affects millions of Americans. Why can’t the right find these people and exploit them?

The most likely answer is that the true losers from Obamacare generally aren’t very sympathetic. For the most part, they’re either very affluent people affected by the special taxes that help finance reform, or at least moderately well-off young men in very good health who can no longer buy cheap, minimalist plans. Neither group would play well in tear-jerker ads.

There is about a month left to sign-up before one has to pay a tax penalty for not having coverage for 2014.  The last number reported was 4 million sign-ups.  A priority:  Get the young and healthy to sign-up.

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Chart from Kaiser via the Washington Post

Picture of buttons from sites.tufts.edu

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Predicting 2014

I don’t have a crystal ball and haven’t thrown the I Ching, so I can’t really say what will happen. but Mark Bittman had an amusing column in yesterday’s New York Times about years ending in four.  Bittman seems to be of the opinion that nothing much that is good happens during such years, but we can hope that he just has a selective memory.

Bittman begins with 1944, but I’ll add 1914.  That was the year Austria-Hungary declared war on Serbia to begin World War I. On the plus side, the Panama Canal opened and the Boston Braves won the World Series.
Bittman writes

1944 Those of us who don’t remember this year are lucky; a soldier cited in Rick Atkinson’s brilliantly horrifying saga of the last two years of the war in Europe, “The Guns at Last Light,” quotes King Lear: “The worst is not, So long as we can say, ‘This is the worst.’ ” The end of the war was in sight; getting there was the trick, and millions were killed in the interval. Things have not been this bad since.

1954 If there was a golden era of United States foreign policy, it ended here, as Eisenhower warned against involvement in Vietnam while espousing the domino theory. Good: Joe McCarthy’s power began to ebb. Not good: The words “under God” were added to the Pledge of Allegiance.

1964 The last year of the baby boom was mind-blowing. In the 28 months beginning that January, Bob Dylan made five of the best albums of the era — and there were the Beatles.

Nelson Mandela was sentenced to life in prison, and Lyndon Johnson single-handedly sent everyone into a tizzy by signing the Civil Rights Act, sending more “advisers” to Vietnam, talking about bombing North Vietnam and proposing the Great Society. Huh? The first anti-Vietnam War demonstrations and draft-card burnings took place. Pot smoking officially began. (Not really, but sorta.)

1964 was also the year my husband graduated from high school.  I’ll call that a plus.

Skipping to 1994

Whoa: Not only did Nelson Mandela not spend his life in jail, but he became president. The Brady Law went into effect, and Bill Clinton signed the assault weapons ban. (It expired in 2004.) O. J. Simpson spurred a national obsession. Four bombers were convicted of the 1993 attack on the World Trade Center.

Reagan was implicated in the Iran-contra cover-up, but it seemed more important to torture the Clintons over a bad real estate investment. (Still, Paula Jones wasn’t the Republicans’ fault, was she?) Clinton fired Joycelyn Elders for discussing masturbation.

The first credit default swap was created. Nearly everyone in Rwanda became either a killer or a victim, or so it seemed. And there was that messy thing in “the former Yugoslavia.”

Netscape Navigator was released.

1994 was an important year for me.  We got married and I moved to Boston.  Thomas Menino was mayor but not yet The Mayor.

Which brings us to 2004.

2004  Barack Obama spoke at the Democratic convention and there seemed reason for hope; then John Kerry went windsurfing and W., incredibly, became president again (what were 62 million of us thinking?) several months after endorsing a constitutional amendment banning same-sex marriage, which Massachusetts had already legalized. (By 2013, even Utah is on the right side of this issue.) W. also promised to improve education and access to health care; we all know how that worked out. Lance Armstrong won his sixth Tour de France; we all know how that worked out, too.

And also in 2004, the Red Sox won the World Series for the first time in 86 years ending the mythical curse of Babe Ruth.

So, 2014.  I know what I hope for:  the Democrats retain control of the Senate and, at a minimum, creep closer to a majority in the House. I hope the ACA enrolls so many people who like their benefits that we don’t have to listen to Ted Cruz reading “green eggs and ham” again.  I hope, though it seems unlikely, that we get tax and immigration reform.  I hope that President Obama has a better year. And I hope everyone comes home safely from Afghanistan.  I wish Marty Walsh all the best as he becomes mayor and I hope that Michelle Wu gives up her crazy idea of voting for Bill Linehan for City Council president and picks Tito Jackson instead.  Most of all, I hope that all of us have a safe and healthy year.

2014

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Trying to made sense of it all

I think I may be ready to retreat to my cocoon to read trashy books and watch baseball and reruns of NCIS before my head explodes from trying to make sense of what is going on out there.

Yesterday, Boston Globe columnist Adrian Walker had a little anecdote from my Congressperson, Mike Capuano.

…Capuano said he was in an airport last weekend flying home from Washington when a TSA screener stopped him and said, “You really need to cut our taxes!” Capuano was incredulous to hear that from a federal employee, though he probably shouldn’t have been.

“I asked him, ‘Do you know taxes pay your salary?’ ” Capuano said with a laugh.

I wish I knew what the silly TSA screener said then.  It is an example of how divorced from reality so many people are.  Maybe we should expand the shut down to include furloughs for half of the screeners.  This would cut flights so many of the members of Congress would have trouble getting home.  I don’t think this would be a bad thing.  Maybe if they stayed in Washington more, they would figure out how to talk to each other informally over a beer.  That could only help.  Maybe some of them would get a grip on reality.

As I was getting ready to write this, I Googled  both “Republican Alternate Reality” and “Republican Alternate Universe”.  Turns out people have been writing about the topic for a number of years now.  It is one thing to talk sans facts, but another to act.  And what is happening now is the action that they have all wanted:  a government shutdown.  I think they are hoping that a few weeks without government will show people they can live without it.  Maybe a good plan except that there are already Republicans complaining that monuments in Washington are closed so veterans can’t visit them.  Duh!

Back in August 2012 (2012 not 2013), Michael Cohen wrote a piece in the Guardian about the Presidential campaign.  If you recall, they had a slogan “You didn’t build that”.

On 17 July, President Barack Obama spoke at a campaign rally in Roanoke, Virginia. It was a typical event for an incumbent president who is seeking a second term. In his remarks, he offered his vision of government’s role in spurring entrepreneurship and creating jobs in the United States:

“If you were successful, somebody along the line gave you some help. There was a great teacher somewhere in your life. Somebody helped to create this unbelievable American system that we have that allowed you to thrive. Somebody invested in roads and bridges. If you’ve got a business – you didn’t build that. Somebody else made that happen. The internet didn’t get invented on its own. Government research created the internet so that all the companies could make money off the internet.”

This is all fairly boilerplate rhetoric – a basic recitation of how Democrats view the role of government and its interplay with the private sector. But in this statement, there was one phrase that Republicans have grabbed on to like a famished dog with a new bone:

“You didn’t build that.”

That single phrase, taken out of context by Republicans, has become the GOP’s symbol of Obama’s supposed contempt for the free market and entrepreneurship, and for his socialist assault on America.

The Affordable Care Act is a prime example of government overreach and socialism even though it is built on private insurance companies.

“You didn’t build that” became “We built that”

And so, the Republicans made “We built that” the theme of Tuesday’s convention proceedings. Speaker after speaker hammered on this theme, accusing Obama of disrespecting small business. But they did so with almost a wilful sense of hypocrisy. For example, Delaware lieutenant governor candidate Sher Valenzuela attacked Obama for the line despite the fact that, just a few months ago, she gave a detailed speech to a business group about how they could do a better job getting government contracts.

Cohen goes on to detail a number of instances where the speakers at the Republican Convention ignored facts and concludes

But all of this is at pace with a conservative worldview that considers government to be nothing more than malevolent interference with the smooth operation of the private sector – except when it’s not. “Jobs don’t come from government,” said Texas Senate candidate Ted Cruz last night, a view that basically sums up GOP economic thinking. But if you listened to Republican governors on Tuesday, you might have found yourself surprised to discover that, in their states, the government has played an oddly integral role in spurring job creation. If you listened to Mary Fallin, governor of Oklahoma, extol the virtues of the energy industry in her state and bemoan “more government, bigger spending and more regulation”, you might never know that the oil and gas industry is deeply reliant on – and spends millions lobbying for – tax breaks from the federal government.

One can believe that government should play a less direct role in the workings of the private economy – clearly, this is a defensible notion. But to listen to Republicans harping on Obama’s “you didn’t build that” line is to hear a party that views “government” in the most simplistic imaginable terms. This isn’t a governing philosophy; it’s a caricature of how the economy actually works.

To be sure, it’s hardly unusual for political rhetoric to take liberties with the truth, or to stretch an argument to breaking-point, but with Republicans today, the issues runs much deeper. Very simply, the way they talk about what the federal government does or should do, and about the role of spending, taxation and regulation, is more than just a compendium of lies: it describes an alternate reality.

In the GOP’s defense: at least they can argue they built that.

So now they have shutdown the federal government which was a goal all along.  They built it.  And in their alternate universe, President Obama and the Democratic congressional leadership should negotiate with them.  Nancy Pelosi has tried to explain what she calls “regular order”:  The Senate passes a bill.  Then the House passes one.  Then there is a conference committee.  Budget bills were passed back in March, but the House declined to appoint members to a conference committee.  Contrary to what some members of Congress seem to believe there are rules and conventions as to how to proceed.

Gail Collins has a response in the New York Times.

On Wednesday, House Republicans pushed to refund bits and pieces of the government that the members particularly like, such as veterans and the National Guard. Also anything that lends itself to a dramatic press conference, such as national parks and cancer treatment for children. Since the House proposals are never going anywhere in the Senate, there’s a limit to what you want to know about what went on during the debate. Let’s summarize:

Democrats: “Meaningless political theater!”

Republicans: “Come to the table!”

Coming to the table has now replaced strangling Obamacare as the most popular G.O.P. war cry. There is a longstanding political rule that when all else fails, you demand more talking. If you’re running for office against a guy who’s got 70 percent in the polls, it’s time to call for a debate. If you’re already having four debates, it’s time to call for six.

“Why don’t we sit down and have a conference committee about how we’re going to fund the federal government?” demanded Representative Ander Crenshaw of Florida. Republicans have posed this question a lot, and it would be an excellent one if they were not the same folks who have spent the last half-year refusing to sit down and have a conference committee about the federal budget.

Representative John A. Boehner, the House speaker, arrived at the Capitol on Thursday with his security personnel on the third day of the government shutdown.

Representative John A. Boehner, the House speaker, arrived at the Capitol on Thursday with his security personnel on the third day of the government shutdown.

I’ll give the final word on reality to Elizabeth Kolbert in her New Yorker posted this morning.

…Shuttering the government is a dumb idea under pretty much any circumstances. Still, the objections that Republicans in Congress raise to the health-care law might be worth considering if they bore any relationship to the law in question. Rarely do they.

Some lawmakers’ comments have been so off the wall that they defy parody. A few months ago, for example, Representative Michele Bachmann announced on the House floor that Obamacare needed to be repealed “before it literally kills women, kills children, kills senior citizens.”

“Let’s not do that,” she added helpfully. “Let’s love people.”

“All of this would be funny,” President Obama noted the other day, after bringing up the Bachmann line, “if it weren’t so crazy.”

The crazy list goes on and on. As the economist Paul Krugman has repeatedly pointed out in his Times column, congressional Republicans these days seem to think that they can override not just the laws of physics but also the rules of arithmetic. They insist that the federal budget is so bloated it could easily be cut by hundreds of billions of dollars. But when a transportation bill was drafted this summer that would have actually reduced spending, they refused to vote for it. (The bill had to be pulled from the floor.) It’s hard to cut the federal budget if you’re not willing to reduce the amount of money the government spends. “What Republicans really want to do,” Krugman wrote recently, is “repeal reality.”

…

It’s been so long since reality has made much of a difference on Capitol Hill that it sometimes seems it genuinely has been repealed. But the thing you can always count on with reality is that it has staying power.

I hope I can hold out until reality and fact make a comeback.

Photograph: Doug Mills/The New York Times

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Why are we still fighting over birth control?

The Affordable Care Act aka Obamacare, included a provision for insurance to cover the cost of birth control.  After all, it has been estimated that 99% of all women use birth control at some point in their lives.  This is not just non-Catholic women.  Contraception is not cheap.  Without insurance, birth control pills can cost up to $100 a month.  Not affordable to lower income women who are also ones who can least afford to have unplanned children.  The pill is used for hormone regulation, not just birth control, a fact often ignored.

In fact, regardless of what the Pope and Cardinals and Archbishops in the United States think, Catholic women do use birth control.  I’m sorry, but no one has explained to me why a bunch of celibate men want to control women.  If you are against abortion, birth control would seem to be reasonable.  Of course, if you believe that life begins at the moment of conception, then some methods are problematic.  But we have no idea how many fertilized eggs just naturally abort, but I guess the distinction here is one is natural and the other has an artificial cause.  I should say that birth control also faces opposition from fundamentalist churches that are not Catholic.  The other thing that plays into the objection to birth control is that sex is to be reserved for marriage and for procreation.  There:   The objections to both birth control and gay marriage in one neat package.

The Obama administration has been twisting itself into knots to make sure that women who choose to use birth control have it covered under their health insurance.  The most recent proposal was outlined by the New York Times.

The Obama administration on Friday proposed yet another compromise to address strenuous objections from religious organizations about a policy requiring health insurance plans to provide free contraceptives, but the change did not end the political furor or legal fight over the issue.

The proposal could expand the number of groups that do not need to pay directly for birth control coverage, encompassing not only churches and other religious organizations, but also some religiously affiliated hospitals, universities and social service agencies. Health insurance companies would pay for the coverage.

The latest proposed change is the third in the last 15 months, all announced on Fridays, as President Obama has struggled to balance women’s rights, health care and religious liberty. Legal experts said the fight could end up in the Supreme Court

You can see the Department of Health and Human Services (HHS)  fact sheet here.

Religious groups dissatisfied with the new proposal want a broader, more explicit exemption for religious organizations and protection for secular businesses owned by people with religious objections to contraceptive coverage.

The tortured history of the rule has played out in several chapters. The Obama administration first issued standards requiring insurers to cover contraceptives for women in August 2011, less than a month after receiving recommendations to that effect from the National Academy of Sciences. In January 2012, the administration rejected a broad exemption sought by the Roman Catholic Church for insurance provided by Catholic hospitals, colleges and charities. After a firestorm of criticism from Catholic bishops and Republican lawmakers, the administration offered a possible compromise that February. But it left many questions unanswered and did not say how coverage would be provided for self-insured religious organizations.

Under the new proposal, churches and nonprofit religious organizations that object to providing birth control coverage on religious grounds would not have to pay for it.

Female employees could get free contraceptive coverage through a separate plan that would be provided by a health insurer. Institutions objecting to the coverage would not pay for the contraceptives.

Yesterday the Catholic Bishops weighed in

“The administration’s proposal maintains its inaccurate distinction among religious ministries,” said Cardinal Timothy M. Dolan of New York, the president of the United States Conference of Catholic Bishops. “It appears to offer second-class status to our first-class institutions in Catholic health care, Catholic education and Catholic charities. The Department of Health and Human Services offers what it calls an ‘accommodation,’ rather than accepting the fact that these ministries are integral to our church and worthy of the same exemption as our Catholic churches.”

The bishops’ statement, issued after they had reviewed President Obama’s proposal for six days, was more moderate and measured than their criticisms of the original rule issued by the White House early last year. Cardinal Dolan said the bishops wanted to work with the administration to find a solution.

The administration had no immediate reaction to the bishops’ statement, other than to say it was not a surprise.

One thing is clear, the Obama administration does not want to start saying the private business owners can opt out of paying for insurance that covers things they find objectionable.  What if we go from birth control to vaccinations to flu shots?

The birth control issue will end up in court and probably the Supreme Court.  For people who say they don’t want the ACA because they don’t want government controlling their health care, this the ultimate irony.  In case they haven’t noticed.  The Supreme Court is a branch of government.

So until the courts decide, Emily Douglas at the Nation has prepared this handy chart for you.

How to pay for your bith control

I guess I sound bitter, but I thought we already had this fight 40 years ago.  Contraception is supposed to be a routine option for women’s health care.

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Why we need univeral health care

I’ve written about this before particularly when the Affordable Health Care Act (aka Obamacare) was in the works, but this is a really good example of why we need it.  Yesterday the New York Times had a long story about the hospital crisis in North Dakota.  This is the same North Dakota where we are having an oil boom and where there is no unemployment.  But there is a health care crisis.

The patients come with burns from hot water, with hands and fingers crushed by steel tongs, with injuries from chains that have whipsawed them off their feet. Ambulances carry mangled, bloodied bodies from accidents on roads packed with trucks and heavy-footed drivers.

The furious pace of oil exploration that has made North Dakota one of the healthiest economies in the country has had the opposite effect on the region’s health care providers. Swamped by uninsured laborers flocking to dangerous jobs, medical facilities in the area are sinking under skyrocketing debt, a flood of gruesome injuries and bloated business costs from the inflated economy.

These are men is mostly unskilled jobs without health insurance.

Hospitals cannot simply refuse to treat people or raise their rates. Expenses at those 12 facilities increased by 15 percent, Mr. Bertsch added, and nine of them experienced operating losses. Costs are rising to hire and retain service staff members, as hospitals compete with fast food restaurants that pay wages of about $20 an hour.

“Plain and simple, those kinds of things are not sustainable,” he said.

Many of the new patients are transient men without health insurance or a permanent address in the area. In one of the biggest drivers of the hospital debt, patients give inaccurate contact information; when the time comes to collect payment, the patients cannot be found. McKenzie County Hospital has invested in new software that will help verify the information patients give on the spot.

To their credit, public officials in North Dakota are trying to do something.

Mr. Kelly has pushed for the state, which has a surplus of more than $1 billion, to allocate money intended for the oil region specifically to health care facilities in the area. He has also asked for the state to grant low-interest loans so hospitals can borrow money for facility improvements and for the governor to convene a task force to study health care issues in the oil patch.

Aides to Gov. Jack Dalrymple say he is taking steps to bolster medical training in the state, proposing to spend $68 million on a new medical school building at the University of North Dakota and $6 million to expand the nursing program at Lake Region State College. Mr. Dalrymple, a Republican, has also increased Medicaid financing for the state’s rural hospitals.

US residents with employer-based private healt...

US residents with employer-based private health insurance, with self insurance, with Medicare or Medicaid or military health care and uninsured in Million; U.S. Census bureau: Income, Poverty, and Health Insurance Coverage in the United States: 2007 (Photo credit: Wikipedia)

If we had universal health care, every one of those men would carry a card.  If we had computerized records that were actually accessible the doctors would have a medical history.  Right now the best we can hope for is that some of them will get employer paid insurance next year as the ACA continues to be implemented.  In the meanwhile, the health care system will struggle.

The cramped housing camps where many oil workers live can add to health issues. On a recent afternoon at McKenzie County Hospital, a man limped into the emergency room complaining about a dry, red patch of skin on his leg. Dr. Gary Ramage, the hospital’s sole full-time physician, said it was a bite from a brown recluse spider, which had most likely nested under the trailer where the man lives.

…

But for now, Dr. Ramage, a gregarious Canadian who has worked here for 18 years, is left shouldering much of the load. Before the oil boom started a few years back, Dr. Ramage covered both the clinic and the emergency room. Now he mostly works at the clinic, while the hospital hires roving physicians to cover the emergency room. He is well known in the community, and people call him at home when they are sick. But now, he does not know many of the patients he sees.

“My work is no longer small-town work,” he said. “My work has now been transformed from that of a small family practitioner to basically an E.R. doc.”

Dr. Gary Ramage treating a patient at McKenzie County Hospital in Watford City, N.D. The hospital now averages 400 emergency room visits per month.

Photograph: Matthew Staver for The New York Times

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Roe v. Wade at Forty

Posted this morning on Maddow blog this new chart which includes information from an NBC/Wall Street Journal poll.

Exactly 40 years ago today, the U.S. Supreme Court issued its Roe v. Wade ruling. In a 7-2 decision, the court majority decided that Americans have a constitutional right to privacy, which includes being able to terminate an unwanted pregnancy.

I think that the Republican efforts to curtail abortion, to close clinics and to subject women who want to terminate an unwanted pregnancy are having an opposite effect than the one they want.  Kinda like voter suppression which just made people angry enough to stand in line for hours.

The high level of support for Roe comes with some underlying issues that we need to work on.  Bryce Covert just posted some interesting charts at the Nation about the economics of having an abortion.  The charts come from the Guttmacher Institute.  Here are two.

Guttmacher poor women

GuttmacherProviders

The support for keeping Roe has been steadily increasing.  Now we have to figure out how to implement the decision so it means something.

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Looking back at 2012 progressively

2012 was a pretty good year for those of a progressive/liberal political point of view and Winning Progressive has compiled a good summary.  You can read the entire article here, but I’ve pulled out some of my particular favorites – in my own order of significance.

First I have to talk about Mitch McConnell who not only lost his effort to make President Obama a one-termer, but last night voted to increase taxes.  (Although since it happened after we technically went off the cliff  at midnight, he will probably spin it as a decrease.)  I think he an John Boehner were the big losers last year, not Mitt.  Mitt is done with politics, but McConnell and Boehner have to continue to try to herd their Republican members and get re-elected.

President Obama re-elected

So now to some accomplishments.

* President Obama Re-Elected With A More Diverse and Progressive Congress– The November elections saw the re-election of President Obama and the election of four new progressive U.S. Senators – Mazie Hirono (D-HI), Elizabeth Warren (D-MA), Chris Murphy (D-CT), and Tammy Baldwin (D-WI).  In addition, Joe Lieberman (I-CT) is finally leaving the Senate!  On the House side, the Democrats elected in November will be the first major party caucus in US history that is majority female and people of color.  New House progressives will include Alan Grayson (FL-09), Jared Huffman (CA-02), Dan Kildee (MI-05), Ann McLane Kuster (NH-02), Grace Meng (NY-06), Patrick Murphy (FL-18), Rick Nolan (MN-08), Mark Pocan (WI-02), Raul Ruiz (CA-36), Carol Shea-Porter (NH-01), Mark Tacano (CA-41), Hakeem Jeffries (NY-08), and Kyrsten Simena (AZ-09).  On the flip side, tea party conservatives Allen West (FL), Chip Cravaack (MN), Bobby Schilling (IL), Roscoe Bartlett (MD), Ann-Marie Buerkle (NY), Francisco Canseco (TX), and Joe Walsh (IL) were all defeat and, hopefully, will never be heard from politically again.

* LGBT Equality– 2012 was, of course, a banner year for advancing LGBT equality.  For the first time in US history, equality was supported by a majority of voters facing ballot proposals approving marriage equality in Maine, Washington, and Maryland, and refusing to ban equality in Minnesota. The first openly lesbian U.S. Senator, Tammy Baldwin (D-WI) was elected in November as were a record seven openly-gay House members.  President Obama publicly supported marriage equality, and anti-equality forces in Iowa failed in their effort to recall a state Supreme Court justice who declared that state’s ban on marriage equality unconstitutional.  In February, a federal appellate court ruled California’s anti-marriage equality Proposition 8 unconstitutional, and two federal courts in 2012 did the same with the Defense of Marriage Act.

* Health Care Reform – In a decision that surprised many commentators, the U.S. Supreme Court upheld the Patient Protection and Affordable Care Act, aka “ObamaCare.”And while the GOP-controlled House has voted at least 33 times to repeal ObamaCare, President Obama’s re-election in November virtually guarantees that will never occur.   In implementing ObamaCare, the Obama Administration, standing up to strong opposition from conservative religious organizations, finalized rules requiring that contraception be included as a preventive health service that insurance policies must cover with no co-pay.  This will help millions of women afford access to birth control and also save money by reducing unintended pregnancies.

Those are my personal big three.

Yes, there is a lot left to do and a lot that happened that I didn’t particularly think was terrific, but on the first day of a new year, we should celebrate our successes!

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Obama and Women’s Healthcare

While I was working on the last post about Akin, Ryan etc., I ran across this great summary of what the Affordable Care Act does for women.  In a column titled Obamacare(s) for Women, Katha Pollitt published in the Nation she provided this handy list of benefits.

Women will get a lot out of the Affordable Care Act. Here are just some of the ways:

1. As many as 10 million will get coverage in 2014 under Medicaid expansion, and by 2016, thanks to other provisions of the ACA, that number will grow to 13.5 million women.

2. By 2014, all plans sold to individuals will be required to cover maternity care. According to the National Women’s Law Center, 12 percent of those plans include that. Remember when Arizona’s Jon Kyl said he didn’t think his insurance should have to cover pregnancy and childbirth because he would never need it? The ACA destroys the mindset that care needed only by women is of no general concern.

3. More than 20 million women will get expanded coverage of preventive services—prenatal care, mammograms, pap smears, breast-feeding supplies, testing for sexually transmitted diseases, well woman checkups, immunizations, birth control and more.

4. Insurance companies will be barred from dropping women’s coverage when they become pregnant or sick.

5. Companies will be barred from denying coverage because of “pre-existing conditions,” like having had breast cancer, being pregnant (funny how that keeps coming up), having had a Caesarean or being the victim of domestic violence.

6. No more “gender rating”—charging women more for coverage just because they are women. This practice, already banned in some states but permitted in thirty-seven others, costs women a staggering $1 billion a year.

7. Older women will receive expanded preventive services through Medicare, like bone-density screenings for those at risk of osteoporosis.

8. The expansion of Medicaid will cover people who make up to 133 percent of the poverty line (about $31,000 a year for a family of four). True, enabled by the recent Supreme Court decision, at least eight red-state governors have said they will reject it. Let’s see how that works out for them.

9. The birth control provision is mammoth all by itself. Not only will it be costless to the patient; all methods must be covered. That means women will be able to choose the kind of birth control that works best for them, which means they are more likely to use it consistently. In particular, it means insurance must cover the most effective methods, including the IUD, which many plans exclude. At up to $1,000 upfront, it is too expensive for many women to shell out for, even though the IUD is one of the cheaper methods when you consider that it lasts for ten years or more. If anti-choicers really wanted to lower the number of abortions, they would be cheering this huge expansion of access to contraception. But no.

If Romney wins, women can wave goodbye to what Planned Parenthood has called “the single biggest advancement in women’s health in a generation.” Think about that next time someone tells you there’s no difference between the candidates. It’s just not true.

The President signs the Affordable Healthcare Act.  Photo by AP Photo/J. Scott Applewhite