The Real Obamacare

Even before the Affordable Care Act had become law, its opponents cleverly dubbed it “Obamacare.” Their intentions were obvious: to capitalize on a substantial proportion of the public’s disapproval of our President and conjure up images of “socialized medicine” simultaneously. To some extent, the tactic has worked. It’s unclear that opposition to the law was generated by the intentional misnomer, but a substantial proportion of Americans–somewhere between 40 and 60 percent, depending on who’s asking–are opposed to the law. Of course, it’s debatable how many of them actually understand the intricacies of the law, as polls also show broad support for many of its key provisions. Heck, even Mitt Romney–who has pledged to repeal the law if elected–likes many parts of it. (Of course, he should, he signed essentially the same bill into law into Massachusetts while he was Governor.)

President Obama has not shied away from the law’s GOP-given nickname, either. In fact, during one of the recent Presidential debates, he admitted that he liked it. After all, it is giving him direct credit for one of, if not the single-most important policy achievements of his first term. America had tried and failed to enact health reform for nearly a century. Obama helped to realize the dream. He has every right to be proud of that. But, the name is still misleading.

I’ve written about many aspects of this before. For example, I’ve said that it’s not entirely accurate to give the President sole credit. The really difficult work happened in Congress. I’ve also said repeatedly that this is not socialized medicine, but rather a last-ditch effort by the federal government to use the power of competition in the private insurance market to help save the American health care system. I’ve discussed how the closest thing to socialized medicine that was even considered was simply a program modeled after Medicare. That program, the so-called “public option” was ultimately removed from the bill in order to secure its passage to the disappointment of many progressive members of Congress.

In short, none of the things that were being hinted at, suggested, or downright lied about by using the name “Obamacare” have ever been a threat to opponents, because they haven’t been real. Examples abound, but foremost among these are the notion of “death panels.” Sarah Palin and Betsy McCaughey dreamed that one up, and Paul Ryan’s still been talking about it. Folks, it’s simply not true. What has happened, is that young adults can stay on their parents’ insurance plans until age 26, prescription drug coverage and preventive care have been made more affordable for seniors, and individuals can no longer be denied coverage for pre-existing conditions. But that’s only what’s happened so far. There’s more to come.

By 2014, the health insurance exchanges will be operational, and you’ll be able to find quality coverage for yourself and your family at a competitive rate. The Medicaid program will expand in most states to provide coverage to low-income Americans. And, if neither of those options helps you, you’ll be able to purchase coverage through a federally-sponsored multi-state insurance plan. This isn’t the public option, but it’s close. It will still be private coverage, but it will be contracted for by the federal government. If you have insurance through your employer now, you can think of this as another similar option, with the government serving in the same role as your employer currently does. What does it mean for you? More plan choices. Potentially lower costs through competition. A plan endorsed by the federal government that isn’t looking to cut corners to make a profit. This, folks, is the real Obamacare, and you should remember that on November 6th.

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Oh, Now You’re Jack Kennedy?

For Obama-Biden supporters, last night’s debate was a breath of fresh air on the heels of the President’s less-than-stellar performance in the first presidential debate. The left is calling a clear victory for Joe Biden, the right happy to call it a draw. Personally, I was just relieved that Biden opened his mouth and refused to let Paul  Ryan get away with what the Vice-President labeled “loose talk,” “stuff,” and “malarkey.” It was refreshing to hear Biden mention specifics and do so passionately, and disconcerting to hear Ryan once again fail to give specifics just as passionately. After all, he’s the numbers guy, so why didn’t he provide any?

This moderator, ABC News’ Martha Raddatz, did a far and away better job than PBS’ Jim Lehrer. She jumped in, cut off both candidates, and ran a tight ship. I really hope that Candy Crowley can follow in her footsteps when we get to the town-hall format on Tuesday. I also hope that President Obama decides to show up this time, and that he forces Governor Romney to explain his positions, rather than making vague statements in a last-ditch effort to pander to the middle. After all, both candidates have actual positions. It’s just that disclosing those positions isn’t always the best way to convince a plurality of Americans to vote for you. Particularly when you’ve already written off 47% of them.

Will last night’s respective performances matter? I doubt it. In that respect, I do think that the GOP is correct to call this a tie. Had Biden been as sluggish as Obama, or as gaffe-prone as he often is, it might have been seen as strike two, and could have further slowed Obama’s momentum, while increasing Romney’s. That didn’t happen. Right now, the overall score in this 4-game series seems to be tied 1-1. That makes Tuesday important, in that it gives the winner a slight edge, and the potential to close things out 3-1. Even then, though, it is questionable how much of an impact the debates will have on this election, as most folks have already made up their minds, and many of the undecideds may not turn out at all.

 

Health Wonk Review, David Williams-Style

David Williams hosts the latest edition of the Health Wonk Review. As usual, he has done a stellar job, and there’s a lot of election season content. Check it out here.

 

America, “We’ve Lost a Pod”: What Romney and Obama Didn’t Say…

While polls immediately following Wednesday’s Presidential debate in Denver suggested that Mitt Romney came out of the contest way ahead of Barack Obama, the real winners were clearly America’s fact-checkers and policy wonks. Sure, Romney may see a bump in his poll numbers after his performance, but it’s the detail-oriented folks—some might say experts—that really get to delve into the content as they aim to correct and rationalize the multitude of competing arguments and “data”. By contrast, the evening’s losers were: Michelle Obama, who spent her 20^th wedding anniversary watching the debacle; everyone on Twitter disinterested by politics; and moderator, Jim Lehrer, who “lost a Pod” due to poor facilitation. That’s right. After a full 90-minutes of debate, Lehrer was unable to keep the candidates’ comments concise enough and we missed out on what might have been the most exciting part of the debate: an open back-and-forth between Obama and Romney.

Nevertheless, health care comprised a large portion of the debate with both candidates touching on everything from the origins of ObamaCare—a label for the Affordable Care Act that Romney apologized to Obama for using, but one which Obama said he actually welcomed—to insurance premiums and a discussion of the Medicare Independent Payment Advisory Board, or IPAB. Still, given all the misinformation put forth by both Romney and Obama during the second Pod, it appeared by the end that neither had actually read the Affordable Care Act and that both needed new accountants.

But perhaps we should give the candidates the benefit of the doubt. Maybe, just maybe several important and highly anticipated topics were not simply forgotten or purposefully overlooked by the candidates, but were rather innocent victims of the last, lost Pod. Had the last Pod not become a casualty of debate, we might have heard about the following:

The Supreme Court Decision on the Affordable Care Act. Given the numerous amicus briefs, intense public emotions and extensive media coverage surrounding the President’s signature bill, it was shocking that neither President Obama nor Romney touched on the case. With the next four years offering an enormous opportunity to dramatically alter the landscape of the Court, and the highly partisan spin taking place during the debate, it was surprising that we didn’t hear either candidate discuss the case. Obama could have pointed to the ruling to give more credibility to health reform, while Romney could have capitalized on the close 5-4 decision arguably rewritten by Chief Justice Roberts to make the claim that ObamaCare— particularly the unpopular individual mandate—isn’t the best way to implement reform. We could have heard that, but we didn’t.

Then there was the diabolical 47 percent. Seriously. This was a softball lobbed right down the middle for President Obama. It hung there in the air in front of him for a full 90 minutes, untouched, while he took swings at several other topics and missed. Obviously, this gaffe isn’t one that Romney would be expected to draw attention to himself, but why on earth didn’t Obama go after the low-hanging fruit? Was he worried that he’d come off as too attacking? Perhaps. But the President never brought it up, and he should have. You can bet that Romney was ready with a prepared response on the topic. Too bad we never got to see him use it.

Reproductive rights. This past year has seen monumental coverage of reproductive rights as the Affordable Care Act and state legislatures have gone head-to-head over funding. Planned Parenthood and Susan G. Komen Foundation have clashed over support, Plan B became a battleground for HHS and the FDA, and politicians have made one gaffe after another (think “putting an aspirin between your knees for birth control” and “legitimate rape” for starters). Yet, once again, President Obama didn’t bring up a topic where he enjoys a lot of popular support for his position on the issues. Romney and the GOP have been behind most of the chaos and it would have been very easy for Obama to associate Romney with Todd Akin and the lack of women’s rights many women associate with the GOP. This was certainly a missed opportunity for Obama as women will undoubtedly be the deciders of this election.

A humanizing glimpse of Mitt Romney. It’s well known that Romney’s wife, Ann, has Multiple Sclerosis.It’s also been pointed out repeatedly that the Romney campaign has shied away from discussing the disease and its impact on their family. However, in last night’s debate, Governor Romney spent a lot of time and effort to come across as compassionate and in touch with the average American. In fact, he essentially led off his comments talking about health care and the economy, telling personal narratives about the impact of our broken system and the Great Recession on Americans. He focused on others, but he never focused on himself. Although I’m sure many would advise him to stay away from any topics that associate him with money, disease and his personal experience would have endeared him to so many. In a recent interview Ann said her husband’s response to the disease had been, “He said to me, ‘I don’t care how sick you are. I don’t care if you’re in a wheelchair. I don’t care if I never eat another dinner in my life. I can eat cereal and toast and be just fine. As long as we’re together, everything will be OK.’” That paints the picture of a man who actually cares about others, which is an image Romney desperately needs to convey to undecided voters. Perhaps he was just waiting to be accused of his comments about the 47% before unleashing this most personal secret weapon. Alas, America, we lost a pod, and the world may never know.

 

Unraveling the Hypocrisy of Mitt Romney, Education, and Big Bird

Last night’s presidential debate between Barack Obama and Mitt Romney was difficult to watch for two reasons: First, Mitt Romney said a lot of things that were misleading at best, blatantly false at worst, or otherwise devoid of details the rest of the time. Second, President Obama did very little to directly object to these half-truths and untruths. As one colleague of mine put it, the President was playing a prevent defense–not trying to score points, just trying not to make any terrible gaffes while hoping that Romney didn’t score enough points to win the debate and perhaps the election.

On that score, polling shows that Romney handily won last night’s debate. Now, history is less clear on whether the results of that single debate will have much of an effect on the outcome of the election, but at issue for me is a larger point: I feel compelled to speak up where the President did not. Unfortunately, I cannot do so for every issue that was discussed last night, nor do I have any misgivings that I will reach even a respectable fraction of the people who saw last night’s debate. Rather, for me, this is about principles. In particular, it’s about not letting misleading information be peddled to the American public as if it were true. It’s about respecting you to much to let you be pandered to. And, it’s about helping Big Bird keep his job.

Last night, both President Obama and Governor Romney extolled the virtues of education. They both agreed that America’s education system is lacking and that this creates deficiencies in our young people that ultimately have a negative effect on our economy as jobs are shipped overseas and new technology is developed elsewhere in places where math and science curricula are pursued relentlessly. The difference of opinion came about when each candidate spoke of their specific plan to improve education.

President Obama said that he would create a program that would produce 100,000 new math and science teachers (which also creates jobs, coincidentally). He said that he would work to keep college tuition more affordable, and he has actually backed this up with action already: introducing a special student loan consolidation program that puts a little extra money back in the pockets of people just like me, who have accumulated debt from pursuing higher education.

Governor Romney, on the other hand, said we need to improve American education, but then gave no specifics of how he would do so. Later in the evening, however, as he was addressing the federal deficit, he cited funding for the Corporation for Public Broadcasting, parent company of PBS Television as an example of the type of program he would cut. When he realized that the debate’s moderator, Jim Lehrer, works for PBS, he was quick to indicate that he likes both Big Bird and Newshour (Lehrer’s show). There are three problems with this.

First, only about 15% of PBS funding comes from federal support, with the other 85% coming from private donations. This means that even if Romney had his way, and pulled all federal funding for the network, it’s not clear that PBS would have to resort to selling advertisements, as Romney has suggested they should. A small increase in private donations could be enough to offset the lost support. Second, the amount of federal funding to PBS represents less than 0.01% of the federal budget. This is problematic because Romney is citing the proposed cuts to PBS as a way of reducing the deficit and balancing the budget. Something that’s less than one one-hundredth of a percent isn’t going to do that. He could cut PBS 100 times and it would only be 1% of the budget. Deficit reduction will require two things: generating additional revenue, and reducing spending of large programs, like Medicaid, Medicare, and Social Security. Governor Romney wants to do all of that, too, (well, not the revenue-raising part) but he didn’t mention it, because he knows those cuts are unpopular. Of course, Big Bird is popular, too, but fortunately for Romney, children can’t vote.

Finally, and most importantly, it’s problematic because it provides some insight into Governor Romney’s policy positions on American education. On the one hand, he says the system needs to be improved. On the other hand, he’s willing to cut all federal funding for PBS, which is an important component of early childhood education in this country, even though it stands to have next to no impact on reducing the deficit. So, does he really care about improving education for the American public as a whole? I don’t think so. I think he sees education as he sees everything else, including health care: If you work hard and are successful (i.e., wealthy), you can buy all the education and health care you want. If you’re lazy, unsuccessful, or weren’t born with a silver spoon in your mouth, you don’t deserve an education or health care. In all of this, Romney seems to be forgetting that his own father was once on welfare, and that his mother credited that program with giving them the solid foundation and the support they needed to become successful. I guess it’s easy to take it all for granted if that’s all you’ve ever known. Maybe if he would have watched Sesame Street as a child, he could appreciate just how important it–and programs like it–are to American children. Especially the ones who will never have the opportunity to go to a nice Ivy League university on their daddy’s dime.