Tag Archives: ACA

The Unarguable Benefits of Universal Healthcare

As political posturing over the Affordable Care Act (aka “Obamacare”) continues, the fiscal and social benefits of expanded access to healthcare become steadily more obvious.

The journal Health Affairs recently reported an 8 percent increase per year in the number of early-stage colorectal cancer diagnoses since passage of the ACA. Extrapolated across the country, the researchers estimate the ACA led to approximately 8,400 additional early-stage colorectal cancer diagnoses among seniors between 2011 and 2013.

A 2015 study published in JAMA found that the ACA had increased the number of early-stage cervical cancer diagnoses in women aged 21 to 25.

Early diagnosis doesn’t just increase the likelihood of successful medical intervention; it significantly reduces healthcare costs. When cancer is caught earlier, it is cheaper to treat.

America’s healthcare costs have long been far higher–and our outcomes considerably worse-– than in countries with universal systems. The lobbying clout of Big Pharma and Big Insurance continue to make a cost-effective “Medicare for All” politically impossible, but even with its problems, the ACA has vastly increased the number of Americans who are insured while significantly slowing the rise of healthcare spending; last June, Fortune Magazine reported

The United States will save about $2.6 trillion on health care expenses over a five-year period compared to initial projections made right after the passage of the Affordable Care Act.

While health spending spiked briefly in 2014, evidence shows that it has once again slowed down and will help save Americans trillions between 2014 and 2019, according to a new study by the Urban Institute and Robert Wood Johnson Foundation.

Spending declines will happen across both private health insurance as well as Medicare and Medicaid. Centers for Medicare and Medicaid Services actuaries predicted that total Medicare spending between 2014 and 2019 would be $455 billion lower than the ACA baseline forecast. Projected Medicaid spending over the same time period is expected to be $1.05 billion lower than previous ACA estimates, while private insurance spending projections declined by $664 billion.

I simply do not understand the Republicans’ hysterical opposition to the ACA. Both health outcomes and cost controls have improved, and problems with the program can be fixed with relatively minimal tweaking. The program’s popularity has also improved. (According to survey research, approximately half of those who do remain unhappy with Obamacare complain that it doesn’t go far enough–they would prefer a single-payer system.)

It isn’t just the ACA. Paul Ryan and the GOP are threatening to dismantle both Medicaid and Medicare–programs with low overhead and proven effectiveness– and they are intent on defunding Planned Parenthood, which delivers critical medical services to millions of poor women.

It isn’t as though a free market system could work for healthcare. Market transactions require a willing buyer and a willing seller, both of whom are in possession of all information relevant to the transaction. Equal bargaining power doesn’t describe real-world doctor-patient relationships. In that real world, insurance companies have virtually total control over the options available to those fortunate enough to have coverage.

It seems inconceivable that Ryan, et al, simply do not see the multiple fiscal and social benefits of universal–or at least expanded–access to healthcare. So what accounts for their persistent hostility to programs that have proven their effectiveness? Why are they intent upon substituting block grants for Medicaid, turning Medicare into a “voucher” system, destroying Planned Parenthood and eviscerating the ACA?

If the answer to that question is what I think it is– slashing social programs that benefit millions of Americans will allow them to subsidize the insurance and pharmaceutical industries even more generously and deliver more tax cuts to their wealthy patrons–I wonder how they sleep at night.

Why Do They Hate the ACA?

Yesterday, I noted the anger directed at the Chief Justice by Republicans furious that he failed to strike down the Affordable Care Act. It was yet another aspect of Republican fury over any effort to extend access to health insurance.

The Capitol Times, a Wisconsin newspaper, recently ran an article about the GOP’s fixation on repealing the hated “Obamacare.”

What is this Republican obsession about what was once so derisively called Obamacare?

It makes no difference if it’s a supposedly enlightened Republican like Paul Ryan or an over-the-top right-winger like Ted Cruz. Neither can get through a speech without blaming the Affordable Care Act for all of the nation’s problems and insisting that it be repealed — yesterday, if not sooner….

Evidence continues to pour in that Obamacare has dramatically changed for the better the lives of millions of Americans. None of that fazes the Republicans in Congress or those on the presidential trail.

Let’s be honest. If opposing Medicare wasn’t so politically damaging, most Republican conservatives would advocate its repeal, too. I’m old enough to remember the hysteria and outrage that accompanied passage of Medicare, and the dire predictions that it would erase incentives for people to go to medical school–after all, why spend all that time and money learning to heal people if you couldn’t make out like a bandit once you established a practice?

Apparently, people are still going through medical school, and Medicare has worked well enough that it has joined the “third rail” political status enjoyed by Social Security. Not so the Affordable Care Act, aka “Obamacare.” At least not yet.

The real question–to which I have no answer–is why every attempt by government to expand access to basic medical care meets with such deeply-seated animosity from conservatives.

Let me be very clear: objecting to the way a particular program is fashioned, disputing whether this or that provision is likely to achieve its goals, concerns over cost-benefit ratios and the like are perfectly appropriate matters for debate. To the extent that arguments about the ACA are “deep dives” into the policy weeds–legitimate differences of opinion about the best way to achieve a goal–they are both reasonable and productive; they can only help improve the law.

But no one who has actually followed the GOP’s multiple efforts to repeal Obamacare could conclude that the party’s objections are based upon anything other than a visceral rejection of the very idea that government has a role to play in extending access to health insurance to people struggling to afford it. That rejection is sometimes clothed in policy pretenses, but the pretense is obvious. Probably the most honest exchange was at the GOP Presidential debate that included Ron Paul (not Rand); when a moderator asked him how he proposed to make healthcare available to poor people, he basically said “let them die.” 

And the audience, if you will recall, applauded wildly.

“Let them die” is at the bottom of this frantic rejection of the ACA, and it’s what I don’t get. Any psychiatrists or psychologists out there who can explain this particular lack of humanity and compassion?

The United States is the only modern western democracy that does not have universal access to healthcare. Our refusal to implement a single-payer system doesn’t just allow poor people to die, as I have previously explained, it actually costs us much more money and impedes economic development.

What’s wrong with us?

When You Take the Crazy Train….

A recent New York Times column by Linda Greenhouse follows the latest evolution of the Right’s attack on America’s judiciary.

Her introduction is arresting, to put it mildly.

Do you hold Chief Justice John G. Roberts Jr. responsible for the ascendancy of Donald Trump? The thought never crossed your mind? Then you probably haven’t been reading the conservative blogosphere, where Chief Justice Roberts, target of bitter criticism for his failure to vote to dismantle the Affordable Care Act, is now being blamed in some quarters for Donald Trump as well.

Evidently, the Chief Justice’s refusal to rule against the constitutionality of the Affordable Care Act was a “sucker punch,” that robbed the Tea Party of a victory it “expected and deserved.” This defeat on an issue of constitutional interpretation meant–in the twisted “logic” of Tea Partiers–that there is no point relying on the courts.

Greenhouse says the lesson they internalized was “if you want to beat Obama you have to get your own strongman.” Guess who?

Even before the Trump-focused blame game started, Chief Justice Roberts was well on his way to becoming the political right’s favorite punching bag. In a rambling speech on the Senate floor last month, Senator Charles E. Grassley, the Iowa Republican who heads the Judiciary Committee, defended the Republican refusal to move forward with President Obama’s nomination of Judge Merrick B. Garland to fill the Supreme Court’s vacant seat. Playing off an observation the chief justice had made shortly before Justice Antonin Scalia’s unexpected death, to the effect that the Senate confirmation process had become unfortunately divisive and political, Senator Grassley said it was the Roberts court itself that was political. “Physician, heal thyself,” he said, and then offered this observation:

Justices appointed by Republicans are generally committed to following the law. There are justices who frequently vote in a conservative way. But some of the justices appointed by Republicans often don’t vote in a way that advances conservative policy.

This is a reprise of an old song: if the Courts don’t rule the way I want them to–if they reach decisions incompatible with my preferences–they are “activist” and illegitimate and we are entitled to undermine both the individuals serving on them and the concept of separation of powers that is at the heart of our system of government.

Most lawyers I know would classify the Chief Justice as pretty conservative; his instincts seem to be to support institutional power, whether corporate or governmental. I have disagreed with several of his decisions, and with his articulation of a judicial philosophy. That said, he is clearly a brilliant lawyer whose jurisprudence falls within a longstanding American legal tradition.

The problem is that much of our current political leadership is unfamiliar with that tradition, ignorant of the role assigned to the Courts, and child-like in the belief that whenever a court renders a decision they don’t like, it must be illegitimate.

The problem is also larger than a bizarre attack on John Roberts. It is even larger than the profoundly damaging attack on the Supreme Court by Senate Republicans who are refusing to allow that body to discharge its constitutional duty of advice and consent.

The problem is, America is currently governed by  petty, uninformed, ahistorical and (in several cases) deranged individuals who have commandeered the Crazy Train and are taking the rest of us with them.

THAT Explains It….

I’ve never been able to understand the hysteria of Obamacare’s opponents.

I certainly “get” political disputes, policy disagreements, differing approaches to economic analysis…but the mean-spiritedness, the over-the-top vitriol, the consistent lies about what the law does and how it works, and the ongoing contrived legal attacks motivated solely by a desire to deny poorer Americans access to medical care have astonished me.

From whence the paranoia?

A recent story at Talking Points Memo may provide an answer.

In case the situation with the latest Obamacare lawsuit, King v. Burwell, wasn’t surreal enough, along comes the anti-Obamacare lawyer Michael Carvin, and some of his, um, more colorful ideas about why the Affordable Care Act is bad law. Trying to contrast the ACA with the constitution, Carvin characterized the ACA as “a statute that was written three years ago, not by dead white men but by living white women and minorities.”

It’s startling to see an Obamacare opponent so bluntly characterize efforts to destroy the law as a way to preserve white male privilege in this way, much less taking it so far as to suggest the privileges of dead white men count for more than the needs of living women and people of color. But it shouldn’t be. The race- and-gender-based opposition to the ACA has been baked into the fight against it from the beginning, when the bill was very nearly derailed by opponents claiming that it would somehow override federal bans on funding abortion.

Since then, though rarely with as much directness as Carvin, the conservative fight against Obamacare has been about needling the gender- and race-based resentments of the conservative base in an effort to demonize Democratic efforts to create universal health care.


Social science, as Paul Waldman showed in the Washington Post last May, bears this out: Attitudes about race and about the ACA are tightly interwoven. Research has shown that negative attitudes about black people increase hostility to health care reform, that opinions about health care reform polarized by racial attitudes after Obama’s election, and that nativist attitudes predicted hostility to health care reform. Research has found that white people with high racial resentment, regardless of their opinion on Obama, view health care reform as a giveaway to lazy black people. You can see why people don’t say these things out loud in public, but the eyebrow-wriggling and hinting has been strong throughout this debate.

The gender-baiting, in contrast, has been way more explicit. Ever since the HHS announced that contraception would be covered as co-pay-free preventive service, conservative media has gleefully portrayed the ACA as a program to give hot young sluts an opportunity to screw on the public dime, an argument that managed to get this narrow provision all the way to the Supreme Court. Never mind that young women with private insurance are no more on the public dime than any other people who have private health insurance. The idea that sexy young things are having fun without you but making you pay for it has been just too provocative for conservative pundits to let facts get in the way.

I’d love to reject this thesis, but its explanatory power is too persuasive.



The Socialists are Coming! The Socialists are Coming!

Okay–consider this my Sunday Sermon….

We know that America has an equality problem. We also have a language problem that makes issues of equality more difficult to discuss rationally.

Pundits across the political spectrum, the so-called “chattering classes,” increasingly use words as epithets, rather than as a way to describe reality. Terms like “liberal”—which used to mean “open minded,” “generous,” or a follower of the philosophy of John Locke—have become a content-free insult to be hurled at anyone favoring a marginally more activist government or slightly more robust social safety net.

When “liberal” gradually lost its sting, partisans moved on to “socialist.”

The problem is, few people using the term these days seem to know what socialism is, and even fewer recognize that socializing the solution to a problem can often be very good for capitalism (another system which few can define with any precision), by ameliorating more savage inequalities and thereby avoiding social instability.

The Affordable Care Act—aka “Obamacare”—is unremittingly attacked for being “socialism.” And it is absolutely true that it’s an effort to socialize access to health insurance. But what does “socialism” in this context really mean?

Rhetoric to the contrary, the ACA is hardly an unprecedented departure from a purely market-based system. (Prior to its passage, governments at all levels were paying nearly 70% of America’s healthcare costs, albeit through a grossly inefficient patchwork of programs.) More to the point, ours is a mixed economy, meaning that over the years policymakers have determined that some services are more appropriately or efficiently provided communally–“socialized” through units of government–while others are best left to the market.

We socialize police and fire protection. Most cities have socialized garbage collection. Federal and state highways and city streets are public goods provided by governments and paid for through (largely redistributive) taxes—that is, socialized. Add publicly-financed parks and museums and public schools. Medicare, Medicaid and Social Security all offer “social insurance.” After some 100 years of policy debate, we have finally added health insurance to the list.

The ACA is far from perfect. Many Americans would prefer a single-payer system similar to those that operate in many European countries. Others fault the law’s complexity. Interest groups that stand to lose profits under the new accounting rules argue about the fairness of those provisions. Such complaints are to be expected when any major new program is introduced. Much as we saw with the evolution of Medicare, we can expect significant modifications going forward.

Policy debates are to be expected. What is much harder to understand is the level of hostility aroused by the suggestion that struggling Americans should be provided with access to affordable health insurance. Opponents of the ACA call it “socialized medicine” (it isn’t; at most, it is “socialized insurance”) as though the very label should be evidence that it is anti-American to use tax dollars to subsidize coverage for those who cannot afford it. People who live on their Social Security benefits and love their Medicare positively froth at the mouth at the notion that America has any obligation to extend the reach of such programs to less fortunate folks.

The irony here is that the very people who are fighting tooth and nail to bring down the ACA—bringing lawsuits, supporting candidates who vow to repeal it—are already among the Act’s beneficiaries. America’s previous non-system—the most expensive in the world by far—was widely acknowledged to be unsustainable. The cost of health insurance was a major impediment to job creation, and a drag on the whole economy. In the wake of the ACA’s passage, the indicators have all improved, benefitting all of us.

The ACA hasn’t just improved our economic health. It has also improved our moral health.

There is something very wrong with a society that rations healthcare on the basis of one’s ability to pay—a society willing to tell its most vulnerable members that they are expendable, that they do not deserve even the most basic medical care. Whatever we call this decision to even the playing field just a bit, to mend this major hole in the social safety net, it brings us closer to that elusive thing called civilization.

If that requires a bit of socialism, so be it.