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Showing posts with label Affordable Care Act. Show all posts
Showing posts with label Affordable Care Act. Show all posts

Monday, December 30, 2013

Annus Horibilis


1992 marked the 40th anniversary of Elizabeth II's ascension to the British throne.  She had already served almost three times as long as her farther, well on her way to being, thus far, the second longest serving monarch in British history.  She should have looked back on '92 with both joy and satisfaction.  She did not.  For Elizabeth, 1992 was an Annus Horibilis, a horrific year.  Her daughter Anne divorced.  Her younger son Andrew was separating from "Fergie", his fun loving wife.  A tell-all book was published detailing the affairs of Princess Dianna, the estranged wife of Crown Prince Charles.  If that were not enough, a destructive fire broke out at her beloved Windsor Castle.

2013 inaugurated Barack Obama's second term.  After a decisive win in November, the president might have expected a strong start.  Of course — and this isn't news — he experienced just the opposite.  A combination of relentless and often vicious mean-spirited rightist opposition coupled with a number of his own missteps resulted in his Annus Horibilis.  As the year comes to the close, his poll numbers are the lowest of his presidency.  Most troubling is that the confidence Americans have had in him has badly eroded.  A December Pew/USA poll showed that only 45% of Americans approve of his job performance.  Even worse, according to Pew: "The percentage viewing Obama as 'not trustworthy' has risen 15 points since January – from 30% to 45%.

That lack of trust can in part be attributed to Obama's erroneous claims that insured Americans could hold onto the policies they liked.  It is truly mystifying to me that the president could have allowed himself to repeatedly make that claim and that his "smart" staff didn't try to stop him from doing so.  Didn't he know it was inaccurate, didn't they?  If nothing else, they should have been aware of the fact that insurance is generally written for a single year and that companies routinely change or even cancel individual policies, especially those they deem unprofitable.  More to the point, the AFA specifically disallows policies that fail to meet minimum standards — ones that are bad insurance or effectively no insurance at all.  So, unlike what the president promised, not everyone could keep their policies even if they are "happy" with them.

Of, course while this misguided claim may have tipped the trustworthy numbers, the inept rollout overall did the core damage, a failing — or the ongoing perception of failing — that keeps on giving.  Before getting to that, let me say that I believe the Affordable Care Act will go down as one of Barack Obama's great achievements.  It won't be overturned and hopefully when the dust settles its real deficiencies, and there surely are some, will be addressed constructively and hopefully corrected.  Even then, will it fall short of what the country really needs?  Absolutely.  Until we achieve universal healthcare — Medicare for all — many Americans are likely to be seriously shortchanged.  That said, the ACA is a major step forward and its benefits should not be underestimated.  Think of just three transformative examples: disallowing denying coverage because of pre-existing conditions, equalizing premiums for women and men and eliminating lifetime caps.  These all translate into huge benefits — the first and last protecting many families from the treat of losing life savings or even bankruptcy if a major extended illness strikes.

From the day of its passage, Obama, one of our most gifted presidential orators, has been unable to explain or properly sell the Affordable Care Act to the nation.  For sure he has had to endure a constant barrage of political and interest groups opposition, people who are working tirelessly and spending heavily to prevent its success.  Just as Regan discredited liberalism by pejoratively calling it the L-Word, Republicans dubbed the AFA Obamacare, a branding aimed it discrediting it from the start — his personal overreaching plan, not the law of the land.  They followed with a systematic and relentless campaign of misinformation.  They created a mythology that has helped confuse the public, often leading to negative views that objectively speaking run counter to its own self-interest. 

But all that doesn't excuse Obama and his administration's deficiency.  Considering the importance of the ACA to their legacy, it's nothing less than astounding (and maddening) that they so mismanaged the early rollout.  Telling us that the website is not the program is clearly the case.  So, too, is the fact that constructing a site of this complexity is bound to produce startup glitches.   But that isn't an excuse for its complete opening days breakdown.  Not only weren't potential users properly cautioned, Obama predicted an ease of use comparable to making purchases on Amazon or buying an airplane ticket.  Insurance is not a book, a toaster or even booking a round trip flight.  The site has largely been fixed but the damage to the president and to this important program remains.

It isn't only the ACA cockup that contributed to Obama's Annus Horibilis.  The Edward Snowden affair, which exposed the extent of NSA surveillance, added greatly to our discontent.  Of course, Obama didn't start these programs.  As discussed in an earlier post, their real origin can be traced back to the Cold War in the late 1940s and 50s.  Moreover, every major government around the globe that has the means and the will engages in various forms of espionage, including cyber empowered eavesdropping.  So, much of the global outcry has been disingenuous to say the least.  But the revelations came on Obama's watch highlighting two important things.  First is that, with his approval, the seemingly overreaching surveillance initiated after 9/11 has continued unabated.  Second, and perhaps equally important, Obama's campaign for the presidency, his record and (not inconsequentially) our expectations of him suggested something quite different.

As with the ACA, perceptions play a significant role here, but in just the opposite way.  The ACA is far better than the perception, but it turns out that the reality of the NSA under Obama's watch falls far short of what we had perceived it would be.  With regard to Iraq, Afghanistan and even Gitmo, we can somehow excuse action falling behind rhetoric by recognizing that campaigning is different than governing.  Iraq took longer to exit as is Afghanistan and Guantanamo still hasn't been closed.  We may not like the reasons, but can at least understand them.  The seemingly unchecked eavesdropping is something else entirely, not the least for the fact that, unlike the other three, it directly impacts on all of us and our daily lives.

Those of us who consider ourselves the President's supporters are frustrated, perplexed and even infuriated by the inept rollout of the ACA.  We fear that if it isn't quickly and, most importantly perceptibly, fixed early in 2014, it may tip the balance in the Senate and effectively end any semblance of a meaningful Obama presidency going forward.  With regard to the NSA revelations, even if they should not have come as a complete surprise (as noted that earlier post), they leave many of us with a varying sense of outrage.  However great that may be for us individually, we are left disheartened by the gap between the dream and, in this instance, the reality of Barack Obama's presidency.  We understand that Democrats, especially those who lean somewhat left rather than right, have constantly to prove themselves on national security.  That may be especially the case for those who have not served in the military.  But it's not an excuse we can buy.  We wanted more, expected more.

These frustrations and disappointments bring me to the Annus Horibilis for Americans at large.  Of course, it hasn't been that bad a year for those at the top of the American scale and that goes well beyond the 1%.  The economy is recovering, housing prices have firmed and the stock market is at all time highs.  Of course that means the rich are richer, but millions of others are seeing a rise in their retirement accounts and the value of our homes.  Unemployment is down which means that some people who were out of work last January have found a job.  New York City's incoming mayor campaigned on a platform focused on the two Americas — one riding high, the other in or near a deep hole.  For the second group, and for more of us than was the case not so long ago, 2013 was yet another year of challenge.  Incomes continue to stagnate and they are falling further behind with each inadequate paycheck or no paycheck at all.  To borrow Michael Harrington's term, the Other America may be concerned about the ACA and the NSA, but survival takes precedence and that has become more problematic for a larger swath of the citizenry.

So in some very important ways very many of us are bidding farewell to an Annus Horibilis.  But we dare not let it get us down.  There are some hopeful signs on the horizon, or at least we should be making something out of what went wrong this year — some lemonade out of the lemons.  The ACA stumbled, but it has brought some people into the class of insured and it has gotten us to talk about healthcare and how to make it better.  President Obama is expected to make some, hopefully meaningful, changes in the NSA program.  And, while way overdue, there seems to be a rising conversation about income inequality.  Late in the year Obama forcefully spoke out about the inequities, as did the new pope.  In New York where so many things seem to be going well — a strong post 9/11 recovery — an overwhelming majority opted for the candidate who put economic inequality at the top of his agenda.  We'll see how all this turns out, how it translates from rhetoric into action.  It's not in my nature to be unhopeful.

Tuesday, November 19, 2013

Time out.


Okay, everyone, take a very deep breath.   No, deeper than that.  Things have been pretty dicey these last few weeks, actually much longer than a few weeks.  I'd characterize it as an amplified mess.  As to the mess, the launch of the Affordable Care Act (ACA) has been a colossal embarrassment with its not-ready-for-primetime website and communicative missteps.  The Administration screwed up and badly!  As to the amplified, a not so surprising rocky start to a very complicated undertaking has been blown way out of proportion.  This would have the ACA doomed and President Obama on his way to oblivion.  Right.  That may well be today's storyline put out by the program and his opponents, one opportunistically fueled by the media, but we're only about a month in for a program designed to last for many years to come.  Moreover, this is hardly the first time the President has been written off.  Remember that widely predicted (though never substantiated by polls) cliffhanger of a presidential election?

That deep breath, please!  Let's start with the basics.  There is nothing wrong or malfunctioning with the ACA program as enacted into law.  If it has faults, they lie in its doing too little, covering too few, not in doing too much or being too intrusive.  This legislation is the product of big time compromises. Republicans like to paint it as socialized medicine.  In truth, the private insurance industry, which lobbied hard against anything close to universal Medicare, was and is a big winner.  There has been a big brouhaha about people being thrown out of their (mostly sub-par) insurance plans.  In fact, not only are the vast majority of covered Americans keeping their plans, they no longer have to worry about pre-existing condition turndowns when or if they move to new ones.  Women can no longer be penalized with higher premiums.  And, perhaps most important, the kind of lifetime caps that brought families to the poorhouse are no longer legal.   Basic Medicare stands unchanged except for a significant enhancement: closing the so-called doughnut hole in prescription drug coverage.  Finally, unless living in a state like North Carolina or Texas controlled by (seemingly mean-spirited and cruel) right-wingers, millions of the heretofore-uninsured poor will have access to expanded Medicaid.

There is an abundance of misinformation about the ACA, facilitated in part by the fact that insurance — all insurance — is complicated.  This is a murky fine print terrain.  What is not in question is that even before its start, Republicans, especially but not exclusively in the House, have been relentlessly fighting it.  As of this writing they have voted to repeal or defund the program 47 times.  They made it a principal issue in 2010 and again in the 2012 presidential election.  They tried to use defunding as a bargaining chip during the manufactured crisis that ended up closing the government and threatening the country's full faith and credit.  They made gains in the House in 2010 but President Obama was reelected and with a higher margin than any recent chief executive.  So, despite all their efforts, the act is moving forward and by the still months away deadline millions of the uninsured will likely have signed up.

What the Republican opponents have been up to of late, including purposeful misinformation and fear mongering, is nothing new.  Back in 1961 Ronald Reagan, then a spokesman for the business right, cut a record for the American Medical Association opposing the establishment of Medicare.  Reagan considered the proposed approach to healthcare contrary to the American free enterprise way.  The future president argued that it was simply a foot-in-the-door toward socialism. 

Reagan concluded his argument and call to action with this dire warning about the bill's passage:
I promise you...just as surely as the sun will come up tomorrow and behind it will come other federal programs that will invade every area of freedom as we have known it in this country until one day...we will wake to find that we have socialism, and...one of these days we are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.
Needless to say, his prediction was totally off the mark.  Not only is Medicare an excellent and essential program, no American could even imagine being without it.  And in case you haven't noticed, our free enterprise system is alive and well with businesses raking in the billions, far more than back in 1961. Reagan was wrong, but worse was his fear mongering.

He remains the hero of today's Republicans — Reagan's party not Lincoln's.  Some say, the current crop are much more conservative, but look at this anti-Medicare message and you'll likely come to a different conclusion.  There is clearly a sense of déjà vu consistency in what Reagan's ideological descendants are doing and why they are so worked up about the AFA.  It isn't just about health insurance but about a perceived threat to their way of life.  One has to wonder what that "way of life" might be relative to other Americans, most especially those who have been deprived of something as basic as healthcare.

We should keep this in mind in watching the drama of a so-called ACA failure unfold.  We should remember that those who are yelling loudest about the launch problems are exactly those who oppose its implementation in the first place.  Their voiced concerns about difficulties in sign up are, to be generous, disingenuous.  They don't want to expand coverage, which they surely see (or pretend to see) as what Reagan characterized the end of our freedom.  Some Democrats in Congress, concerned about their own reelection in swing districts are being sucked into this hysteria — shame on them.  The Affordable Care Act is a modest step forward in bringing all Americans under the umbrella of healthcare coverage.  A bump in the early road to its implementation is troubling, but we can't let it stand in the way of progress.  We can't allow ourselves to be swayed by the calculated hysteria.  Far from being the end of the America that should be, it is a major step forward.  Let's all take that deep breath, see what's going on for what it really is, and continue our support.

Friday, October 18, 2013

It ain't over.



Once more unto the brink dear friends, once more unto the brink. 

I trust those who uphold the Bard's bright light will forgive the lift.  In his day after State Dining Room talk President Obama declared, "...let's be clear. There are no winners here."  As to the immediate battle, that might not be entirely true.  On an individual basis, the President himself has to be considered a winner.  Unlike some previous showdowns, he stood fast from start to finish so that those who brought us to the brink walked away empty handed.  That's good for both his and other presidencies and for all of us. 

Tom Foley, who died earlier today, saw himself as Speaker of the whole House.  That can't be said of John Boehner, especially during this crisis.  Nonetheless he might be called a winner with the far right of his caucus.  He surely wasn't able to control them, but they ended up giving him high marks — I guess for that lack of assertive leadership.  And the same very narrow partisan win can be given to Ted Cruz who took a huge gamble and came out the hero of his own natural constituency outflanking Rand Paul who had been their darling.  For these two, it seemed that self-interest (in the Speaker's case self-preservation) was paramount.  Their personal victories came at a very high cost to the nation.  That doesn't mean that they will be held accountable, though their party's historically low approval rating (28%) should give them some pause, especially relative to national politics and 2016.  In that sense, theirs may have been pyrrhic victories.

Opponents who chose the wrong issue (more on that later) and seemed to have had no real battle plan essentially handed Obama his victory in this ugly mess.  Since coming to the House as self-assured renegades, the Teas have exercised their legislative responsibility largely by saying and voting no.  It isn't that they don't stand for something, but rather that they have largely been unable to put their views forward in any positive manner.  The current miscalculation was that they assumed saying no would work when the stakes were really high — a government shut down and threatening the full faith and credit of nation. 

It's unclear whether they will learn anything from this, but it might help them to remember that America has built its strength on saying yes rather than no.  We have always been a positive, can-do, nation.  "No" goes contrary to our basic instincts, if not to our genetic makeup.  That's also true in politics.  Perhaps being against everything — especially in a time of rough waters — can get you elected early on, but at some point voters want to know what you are for.  Recent polls suggest that beyond the GOP having lost favor, the Tea Party has lost major ground in and out of their party.  Of course, with heavily gerrymandered districts made up of the like-minded the usual rules may not apply, at least not now.

Just as Obama held fast, the Democrats on both sides of the Hill displayed a unity not usually associated with their party.  So, perhaps you can call them winners as well.  The same can be said for the Senate that, Cruz and his cronies aside, actually took on the adult role envisioned for it by the Constitution.  And speaking of the Senate, Mitch McConnell, the Republican's dealmaker may be considered a winner, though in his Rand Paul state that may translate into an even stronger primary challenge from his right.

Politically Obama was right not to claim a win for himself and in a larger sense his assertion that there "are no winners here" is absolutely correct.  We the people may have dodged the biggest bullet, but there is no doubt that we were not winners in this battle nor have we been winners in a very long time.  The disarray and dysfunction of our government hurts us badly and is as much our problem as theirs, perhaps more so.  When the divide is so deep that nothing gets done, we all fall further behind.

Perhaps the so-called establishment Republicans learned something from these past weeks, including how little sway they have over the party they once ran.  But it's unlikely that the House Teas view what happened as anything more than a bump on the road.  It isn't only that they occupy relatively safe seats but that they know discontent abounds across the land.  So they will wait for another day and another destructive, or they would say disruptive, fight.  Their hate for Obama has not abated and in fact is probably greater in the face of his having prevailed.  Their focus especially on the Affordable Care Act will continue.  That is something about which he and we should think.

It was already too late when the President's opponents realized that they had made a major tactical error at the start of their fight.  Defunding or even delaying Affordable Care was a non-starter, destined to fail.  Had they instead focused on its problematic signup epitomized by a disastrous website execution, the story might have been quite different.  Without question the Act's passage, albeit far short of what should have been, was and remains a great accomplishment.  But is also the administration's potentially worst vulnerability.  From the start Obama and his team have done an abysmally poor job of explaining and then selling it to the American public.  That has opened the way for a systematic campaign of misinformation.  Opponents have also leveraged the public's general mistrust of government to their advantage focusing on mandates as a symbol of intrusion.  Concerns about NSA surveillance, while comparing apples to oranges, have only reinforced the public's unease in that regard.  Thus far, both the misunderstanding the signup glitch remain in place.

Were it not for the poisonous atmosphere in Washington, heads would be rolling at HHS, including that of Secretary Kathleen Sebelius.  Ironically the Teas and others who are her harshest critics are saving her job.  The last thing the President wants or can afford is a nomination fight over a new Secretary.  And perhaps it's a good thing that her job is not on the line, that she can't be made the scapegoat.  In truth the failure here must be laid right at the Oval Office's doorstep.  Considering that this legislation might be Obama's principal legacy, it's astounding that he didn't make sure that the program's critical launch execution point was ready for prime time.  Now that what he rightly calls the manufactured crisis is temporarily over, one would hope this matter would rise to the top burner.

It was sheer luck and perhaps a sign of inexperience that the Teas made their tactical error.  It's unlikely to happen again.  That alone should give some urgency to the task of correcting what's gone wrong on the path to getting millions of Americans insured.  I understand the President's interest in pursuing immigration and tax reform, but letting the Affordable Care vulnerability go on will only weaken his presidency.  It is a problem that must be solved if for no other reason than what has happened in the last few week is likely only a beginning.  It ain't over and these vulnerabilities won't help during the next battle.

Wednesday, October 2, 2013

Identity struggle.


The government shut down has little and everything to do with the Affordable Care Act.  Certainly Tea Party extremists in the House want to hold hostage what is an important but still deeply compromised and thus modest "reform" of our healthcare system.  But what concerns them has much more to do with the nation's identity than any individual program.  The battle going on in Washington is said by some to be a philosophical one about the size and role of government.  Traditionally Republicans have wanted it smaller, Democrats larger.  Another way of stating that is, less rather than more engaged.  And there is something to be said for that explanation, but it's not new and, in my view, secondary in this instance.  Healthcare, the size and role of government are not at the core of the current crisis.  It is rather who we are and who we are going to be as a nation.

This is something I've written about in previous posts and in a profound sense it has more to do with changing demographics than the parties' philosophical differences per se.  The idea that we are a White Anglo-Saxon Protestant nation, one that has taken on mythical proportions over the years, has been undermined by facts on the ground.  If current trends persist, and there is no reason to believe they won't, a white majority America may be history by 2042.  That unnerves many people.  I didn't use the word "mythical" in connection with our WASP identity lightly.  Myths are hugely powerful and to be confronted with the fact that our myth is just that or that it is out of sync with reality can be earthshattering.  That's exactly what is happening across the land, especially in places where the myth translated into an assumed way of life, way of the world.

Memories, especially in this history-resistant "young" country are short, but many of our presidents were subjected to out-of-proportion visceral hatred.  That was true for two of our greatest chief executives, Abraham Lincoln and Franklin Roosevelt, but also more recently for Bill Clinton.  In some cases, this hatred was rooted in uncertain times — the Civil War for Lincoln and the Depression for FDR — but it also was a manifestation of unease with a leader who "is not like us".  Clinton, despite his being both white and Protestant, just wasn't accepted as being a legitimate WASP.  That lack of acceptance into the real American tribe haunted him from his first day in office to his last — from Whitewater to the impeachment they tried to force him from office.  And illegitimate is a word that comes to mind with the current incumbent of the White House.

Shameful and painful as it is, it's hard to overlook that much of the opposition to Barack Obama — a man who himself suggested has a "strange name" — is the embodiment of that myth-crashing other that so unnerves a portion of Americans who see their old ways slipping away.  As I, and others, have noted before, race plays a huge rule in this drama.  For many in the South, but not only there, Obama is a recall to Reconstruction, a moment they didn't witness personally but one that had an indelible place in the history that they do take seriously.  Reconstruction was a symbol of defeat and disgrace but also, and significantly, a loss (albeit temporarily) of power.  The slave became the master.  What is a man like Obama, a man who looks like that, doing in the WHITE House?

Race and bigotry are at play here and some of that may be personal, but I'd suggest that the black man Obama is as much a metaphor as an individual.  His elevation to the highest office in the land tokens the seismic demographic change that is altering a balance of power that had been assumed as a given.  His presence is a reminder of an increasing number of Latinos, Asians and others in our midst, some of whom maddingly insist on speaking to each other in their birth-tongues.  He is a symbol of those people who are "ruining the neighborhood".  It is the kind of mentality that precipitated the late 1950s "white flight" out Newark New Jersey where I grew up.  And it is the same phenomenon in reverse recounted by Tom Friedman in his October 2ns NY Times column. "Lily-white" Republican stronghold neighborhoods are experiencing counter national trend growth as more whites move in to reinforce their unquestioned majority.  It is a coalescing of this kind of whiteness that gives Tea Party legislators license of "go for it" without fear of losing their jobs.

And they are not alone.  Increasingly all of us are moving into neighborhoods of the like-minded.  It's doubtful that I would have relocated from New York to, lets day Charlotte where our ultra-Conservative governor was mayor.  Chapel Hill's politics and demographics mirror my Upper West Side of Manhattan making it the perfect bubble enclave for someone of my ethnicity and political views.  Indeed, the idea of America, the integrated melting pot, is almost if not equally as much a myth as America the WASP nation.

What's happening in Washington may seem irresponsible, and it is, but taking the long view it is also understandable.  The Tea Party folks are still a small minority; indeed a fringe group, and will likely remain so.  At the moment gerrymandering, probably far more than Citizens United, has given them extraordinary power.  Holding the threat of a primary challenge over their fellow Republicans heads and the Speakership over Boehner's, they have essentially immobilized the House.  One could argue, and I do, that they are taking what is in effect a "Custer's last stand".  The battle is fierce and bloody.  Of course, Custer fought against Native Americans and ultimately his side won the war if not the battle.  Immediate history was on his side.  That's not the case today, which probably accounts for both the fierceness and seemingly irrational stance being taken.

All of this poses significant dangers for the immediate future especially, as has been pointed out so consistently, with regard to the debt ceiling.  But it doesn't bode well for the months and even years beyond.  The struggle to hold on will not end with the inevitable end of the current shut down.  Desperate people, especially those who see their home and family under threat, which is what we're talking about, don't give up easily.  The broader economic inequality that pervades in the land may provide them with short-term allies in the near term.  There are many in the greater population who are also feeling disenfranchised, even if in a different way, and who are equally stressed.  Questioning our government and institutions is something that crosses ideological right-left lines.  That will not change so long as the government we have is failing many of us in so many ways.  In fact, certainly on the House side, it's an embarrassment.