JOHN CASSIDY ON WHY OBAMACARE WILL WORK (ON ITS OWN TERMS)

Aside

This Blog site is really not about the day to day of Pres. Obama, or the 24-hour news cycle of his healthcare role-out woes. It is about the big picture of the inevitability of a New Progressive arc in American politics. But it does help to look in on the pulse of What’s Happening Now, from time to time, learning from mistakes and studying the often bumpy path to enlightenment. More features and book reviews will come soon on related topics.
From John Cassidy’s Blog reprinted in the New Yorker ONLINE Oct 23 2013
October 22, 2013

Why Obamacare Will Work (on Its Own Terms)

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doctor-obamacare-580.jpegEvery day, it seems, more damaging details emerge about the rollout of the federal online insurance exchange at the heart of the Affordable Care Act. Today’s revelation, courtesy of the Washington Post: days before the launch, officials and government contractors conducted a test of the new Web site, during which it crashed when just a few hundred people tried to log in simultaneously. But the Obama Administration went ahead with the rollout anyway, only for the site to seize up just hours into October 1st.

Until the Administration gets the site working properly, this story will dominate the news and overshadow the underlying reality about Obamacare: judged on its own terms, the new health-care system is likely to work. In the coming decade, tens of millions of Americans will end up using the new health-insurance marketplaces—both the federal one and the state ones—and the number of uninsured will drop quite dramatically. Not everybody will end up being covered, but, excluding unauthorized immigrants, who won’t be eligible to use the new system, it seems likely that, at a minimum, the proportion of people who are uninsured will be cut in half.

What is the basis of these statements? Not any particular affection on my behalf for the new system, which largely preserves the private-insurance model that has proved so costly and inefficient. As somebody who grew up using the British National Health Service, I’ve always been more attracted to a single-payer system that guarantees coverage. (No, my Republican friends: introducing such a system wouldn’t amount to imposing an alien European-style socialism on the American public. Under the rubric of Medicare, almost fifty million Americans already enjoy, and value greatly, precisely this type of system.)

My confidence that the Affordable Care Act will meet its coverage objectives is based on a belief, shared by most economists, that financial incentives, if they are big enough, tend to work. Obamacare, once it gets up and running, will provide very large incentives for people to get coverage—subsidies of as much as ten thousand dollars a year for some low-to-middle-income families. Over time, the presence of these incentives, which include substantial fines for individuals who refuse to buy coverage, will almost certainly overcome any glitches or difficulties in the system of enrolling. When people think they are getting a good deal, they are willing to put up with a bit of hassle. And for many of the uninsured, Obamacare is a very good deal.

To make the new system work, the Administration is spending a great deal of money—about $1.4 trillion over the next ten years, according to the latest analysis by the Congressional Budget Office. About half of this will go toward subsidies for people who buy insurance policies on the new exchanges. The rest will go toward expanding Medicaid, the health-care system for the poor and indigent, which is jointly funded by the federal government and the states.

(Note, though, that despite the substantial expenditures it involves, the Affordable Care Act won’t increase the budget deficit by $1.4 trillion, or anything near it. That’s because it also features hefty cuts to the Medicare budget and a number of tax increases that will raise substantial amounts of new revenue. Indeed, the C.B.O. says that, over all, the Act will reduce the deficit slightly during the next ten years.)

The price of obtaining coverage on the new exchanges, and the precise subsidies on offer, vary from city to city and state to state. But with the aid of a very helpful online “subsidy calculator” from the Kaiser Family Foundation, I obtained a few representative figures. Take, for example, a family consisting of two parents (both age thirty-five) and three children that has an annual income of forty thousand dollars and lives in Nashville, Tennessee. According to the calculator, a silver insurance plan for such a family—i.e., one that provides more coverage than a bronze plan but less than a gold one—would cost $10,148 a year. The federal government would cover eighty-five per cent of that sum, which is $8,662. The actual cost to the family would be $1,485, or about a hundred and twenty-five dollars a month.

Generally speaking, smaller families will get less help from the government, but many of them will still receive sizeable subsidies. Consider a single mother of one living in Denver, Colorado, and earning thirty thousand dollars a year. A silver plan for her and her child would cost $4,366 a year, according to the calculator, but a federal subsidy of $2,567 would bring her actual cost down to $1,799, which is a hundred and fifty dollars a month. With these sorts of subsidies in place, it is hardly surprising that the new online exchanges have received a lot of visitors—in some cases, too many for them to handle.

Many single people and folks who earn a decent salary won’t get any subsidies at all. (If you are a single person living in New York or Los Angeles and earning fifty thousand dollars a year or more, that’s you.) But thanks to the individual mandate, such people will face substantial penalties if they don’t buy insurance. For 2014, the Obamacare “fine” has been set at a lowly introductory figure of ninety-five dollars per adult. Thereafter, though, it will climb steeply. From 2016 onwards, it will be six hundred and ninety-five dollars per person or two and a half per cent of family income—whichever is greater. For a single person earning eighty thousand dollars a year, that’s two thousand dollars. In some parts of the country, such a person would find it almost as cheap to buy coverage as pay the fine.

Maybe I’m wrong, but my feeling is these carrots and sticks will be sufficient to persuade most Americans to sign up for health insurance. Indeed, one of my concerns is that the new exchanges will prove too popular, and end up costing taxpayers a lot more than planned. As municipalities and private companies gain more knowledge about how the Affordable Care Act works, they will have an incentive to shift some of their employees and retirees from their existing plans onto the exchanges, where they may be eligible for federal subsidies. Chicago and some other cities have already indicated that they are thinking along these lines.

And let’s not forget Medicaid, which frequently gets ignored in the debate, and which is the cheapest and most effective way to provide low-income people with health care. Under the Affordable Care Act, Washington will provide states with enough money to cover almost anybody whose family earns less than a hundred and thirty-eight per cent of the poverty line. (For a family of three, that’s about twenty-six thousand dollars a year.) Last year, the Supreme Court decided that states could opt out of this expansion, if they wished to, and more than twenty G.O.P.-controlled states have done so. But the federal government is offering the states such a good deal (for newly eligible Medicaid recipients, it will cover all the costs until 2016 and at least ninety per cent of them thereafter) that Republican resistance is weakening.

On Monday, a panel of state lawmakers in Ohio approved the decision of Governor John Kasich, a Republican, to accept the additional money from Washington, which, according to a report by the Kaiser Family Foundation, will enable the state to cover an additional two hundred and seventy-five thousand residents, and cut the proportion of Ohioans who are uninsured by almost two-thirds. As time goes on, and voters in Republican states realize that their elected officials are leaving a lot of cash on the table that could be used to help their neighbors, it seems likely that other states will follow Ohio’s lead. Just how many more Americans across the country will end up being covered by Medicaid is anybody’s guess, but it’s sure to be a large number. (For what it’s worth, the C.B.O.’s estimate is thirteen million by 2023.)

If you put together the subsidies, the fines, and the expansion of Medicaid, you have a formula for substantially reducing the number of uninsured. Here, too, attempting to make precise predictions is perhaps silly. But the C.B.O., which is legally obligated to provide lawmakers with forecasts, reckons that between now and 2023 the number of uninsured Americans will fall from fifty-five million to thirty-one million. Excluding unauthorized immigrants, the agency says, the proportion of the population with coverage will rise from eighty-two per cent to ninety-two per cent.

Would such a jump justify all the cost and effort that has gone into the Affordable Care Act? Could it be accomplished more cheaply in other ways? And will the reforms slow down the over-all growth in health-care spending? These are questions that can be debated. But as far as I can see, there is little doubt that Obamacare will succeed in its primary aim of expanding health-care coverage.

Photograph by Brian Shumway/Redux.

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“PROGRESSIVE EDUCATION TESTING” NOT REALLY SO PROGRESSIVE

    1. Scroll down and check this out to watch a feisty New York teacher’s union lady give hell to the State Education Dept. head for the damage mandatory testing is doing to teachers and students. Lasts two minutes+ and is a funny look at democracy in action.
    What’s on your mind?
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http://thepjsta.org/2013/11/13/pjsta-president-beth-dimino-speaks-at-ward-melville-high-school/

JEB BUSH IN 2016? or…

HILLARY CLINTONjeb bushJEB BUSH IN 2016?

In our ongoing series on provocative political articles and opinion pieces that may help inform the reader of the thrust of our research and eventual book, we turn to a just unearthed from a pile of papers, Frank Bruni column from the Sunday New York Times, August 18th of this year (p. 58, Week in Review ) , entitled the “The Past’s Future Republican.”  It is a portrait of Jeb Bush, who carries—some might say is burdened by—the dynastic Bushes, the last name of the last two Republican presidents, Bruni reminds us. The op-ed piece is as valid now as it was two and one half months ago.

The thesis of the article, with our own gloss added, is that a conservative Republican—read “Romney and rightward”– has next to no chance of beating a strong Democrat to the White House. The names mentioned, apparently seriously, by the press as possible contenders for the Republican nomination are people like Marco Rubio, Ted Cruz, Rand Paul, and Paul Ryan, at least from the Congressional wing of the party. New Jersey’s Gov. Chris Christie, is thought more electable. Bruni implies and we say outright, that none of the potential contenders listed or anyone remotely that conservative has Any chance of winning against a strong Democrat. Increase that by a power of three if that strong Democrat is the overwhelming current favorite, Hillary Clinton

Our argument, based on Bruni’s case for Bush as a moderate pragmatist, critical of the scorched earth orientation of many Congressional Republicans, is that a Tea Party or even traditional Far Right Reagan-Goldwater-Buckley style Republican can be reasonably sure, barring scandal or felony revelations during the campaign, of winning 35 to 40 % of the (2012 based) national electorate. Hard core support for such a candidate we would put in the 30% range.

The same could be said of a respectable moderate to progressive Democrat such as an Elizabeth Warren or a Joe Biden (perhaps someone younger). At least 30% Bar-Nothing national support from the left-center-progressive end of the voter spectrum and, quite likely, 40% of the vote against any Republican, except perhaps, a Jeb Bush. Bruni notes that Bush’s appeal is enhanced by his Mexican wife, his command of Spanish, and his strong showing with Hispanic voters in Florida.

So imagine a Bush race (and he does have both the baggage and limited appeal of his older ex-president brother) against Any-Democrat-But-Hillary and, in our polarized political culture, a probable 20% of the electorate truly “in play”—in theory “undecided.” A dusted off, thoughtful, politically adult (at 63 in 2014) like Bush would be markedly more likely to cut into that “independent”, at play 20% than the others. (Clint Eastwood, having been born 20 years too early). Bruni notes that the dynastic factor of a “Third Bush” would be offset by a likely Second Clinton candidacy.

Which brings us to the obvious sunglasses favoring towering woman (“elephant” we avoid) in the room, Hillary Clinton, clear “heir-apparent”—mangled metaphor we suppose—to Pres. Obama. Now we get to progressivefutureusa.com’s deeper interest in such a contest. Clinton, clearly has the early advantage, the unbeatable Democratic resume’, it is conceded that the nomination is hers if she wants it, and that she would be  very difficult to beat for reasons we need not repeat here. Any Democrat with rock star name recognition such as hers, and a “redeemed—for some” “never that problematic—for others” husband, former President Bill, would surely unite Republicans, but then look how Obama united Republicans—or Romney for that matter—and consider the results. Given her senatorial and Secretary of State “latest careers”, that she is a woman forced to step aside in 2008, barely, for a magnetic African-American (post racial?) candidate (a sort of echo of the 1870 failure of women to get the vote along with black males in amendment XV.

In short, she would be a candidate that, barring the unforeseen (the latter does happen), could count on scoring in the high 40+ percent range with even a front porch (Chappaqua?) campaign, except these are nostalgic relics of the political past (1956? 1984?). But caution: some polls show NJ Gov. Chris Christie running a respectable 4-6 points behind her in a very early trial heat. Citizens United etc., may facilitate the reintroduction of Jeb Bush as a viable alternative to Christie. For progressives, it is unthinkable that either of these two relative lightweights would stand a chance against Sen./Sec./Ms. Clinton in a rational political universe.

But, to invert a droll political nostrum about Reagan and Nixon (and others): the Landscape may be littered with the corpses of those who, three years from now, think that Hillary’s will be a coronation not an election. Consider that John McCain and Mitt Romney were solidly beaten by Obama, but they suffered no landslides. We will have occasion to discuss this further, it is enough now to say that 1. Hillary Clinton will be hard but not impossible to beat if facing a Jeb Bush, and 2. the rosiest scenario for Democrats would be the nomination of Any-of-the-Above Hyper-conservative Republicans. The country might, we say Might, still be center-right, but it is moving leftward, if ever so slowly. Our book in progress says that the pace of this shift will increase, that the shifting of political tectonic plates will be just that, Tectonic, by the 2030’s.

The first part of the cited Frank Bruni August piece follows below:

Op-Ed Columnist

The Past’s Future Republican

                       

Ben Wiseman

By FRANK BRUNI

Published: August 17, 2013 340 Comments

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LET Rand Paul have his epic filibuster and Ted Cruz his scowling threats to shut down the government. Let Chris Christie thunder to a second term as the governor of New Jersey, his hubris flowering as his ultimate designs on the White House take shape.

 

Earl Wilson/The New York Times

Frank Bruni

Readers’ Comments

Readers shared their thoughts on this article.

Jeb Bush, lying low in the subtropics of Florida, has something they don’t: the unalloyed affection of many of the Republican Party’s most influential moneymen, who are waiting for word on what he’ll do, hoping that he’ll seek the 2016 presidential nomination and noting with amusement how far he has drifted off fickle pundits’ radar, at least for the moment.

Politics today has a shorter memory than ever. It also has a more furious metabolism, which Bush hasn’t fed much since March, when he was promoting a new book on immigration and created enormous confusion about whether he does or doesn’t support a pathway to citizenship for immigrants who came here illegally. (He later clarified that he does, with caveats, and even later praised immigrants for being “more fertile.”) That awkwardness gave some of his supporters pause, as they wondered whether he’d been too long out of the fray and was too clumsy for the split-second hyperscrutiny of the Twitter era. He hasn’t run for anything since 2002, when he was re-elected as the governor of Florida, an office he left in early 2007. A whole lot has changed since.

But with the exception of that immigration mess, Bush has been a more articulate advocate of a new tone and direction for the Republican Party than have Paul, Cruz, Christie or others currently in the foreground of the 2016 race, which has already begun, on both sides of the aisle. (Hillary Clinton gave a big policy speech last week and has another already announced.)

He has signaled more willingness for fiscal compromise with Democrats than Paul Ryan and Marco Rubio, for example, have. He has rightly emphasized the importance of social mobility to America’s fortunes and has rightly sounded an alarm that such mobility is on the wane.

At 60, he’s older than any of the five potential Republican presidential candidates I’ve already mentioned or than Scott Walker (don’t forget him), Bobby Jindal or Rick Santorum. His face is less fresh, thanks largely to a surname shared with the party’s last two presidents.

But here’s the first great irony, oddity, oxymoron or whatever you want to call it of the 2016 race: if Republicans care about safeguarding their future, their wisest and best bet may be to reach back into their past. In a pack not exactly brimming with moderate, sensitive voices, Bush’s stands out as less strident, more reasonable and more forward-looking than his potential rivals’.

Lately the news media’s attention has focused on Paul, Cruz and especially Christie, who was just on the cover of New   York magazine and has drawn headlines with veiled and unveiled swipes at fellow Republicans. He’s serving notice, as he did with his embrace of President Obama during Hurricane Sandy, that he puts less stock in party etiquette or ideological purity than in the practicalities of governing and the necessities of winning.

But he’s also scaring some Republican power brokers, and not solely or even mainly because he’s iconoclastic. It’s because he’s so very loud, so very proud, a ticking time bomb of self-congratulatory bellicosity and gratuitous insult. Would he really be the best nominee?

In a meeting with Republicans in Boston last week, he prematurely lashed out at several possible competitors, including Jindal, whom he no doubt had in mind when he reportedly said, “I’m not going to be one of these people who’s going to come and call our party stupid.” No, Christie’s much, much too tactful for that.

Bush has registered concern with the way the party can come across as “anti-science.” He has also referred to it as “the party of no,” correctly noting that Republicans right now are defined negatively, by all they’re against.

Copyright 2013 NYT

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