Is Healthcare Reform The Republicans' Waterloo?

There are two factors that Republicans seem unable to grasp as they seek to inflict their reverse Robin Hood agenda on America: (i) many GOP congressional seats are held because of gerrymandering, not because the GOP's policies are overwhelmingly popular, and (ii) Donald Trump won the presidency due to an Electoral College fluke - and the gutlessness of Electors - and overall won the vote of less than 30% of voters.  A third factor that may be also in play is the reality that a majority of Americans want the federal government involved in healthcare.  Indeed some pools suggest that a majority of Americans want a single payer system that would take away the power of health insurance companies that only care about making money and, frankly, do not give a damn abut taking cared their insureds or their insureds' best interest.  If the congressional Republicans had joined in passing Obamacare and been willing to take even more power from insurance companies and pharmaceutical companies, the nation would likely have a much improved and better perform healthcare system.  Instead, Republicans sold their souls to insurance companies and pharmaceutical companies and clung to the myth that the free market could improve coverage and reduce cost.  Anyone honest should concede that what the Republicans harp on even today is simply out of touch with objective reality.  Worse yet, a majority of Americans are catching on to the fact that the currently dead American Health Care Act was really all about give a trillion dollar tax break to corporations and the obscenely wealthy. . 

Conservative writer and columnist David Frum warned Republicans back when Obamacare was first being crafted that GOP obstruction and non-participation would haunt the party.  For his candor and insight, he was refarded by being figuratively ridden out of town on a rail by his Republican brethren. He's back again and once more suggests that healthcare and the public yearning for a well functioning national healthcare system will be the GOP's Waterloo.  He makes the case in a lengthy piece in The Atlantic.  It is a long piece, but worth the read and it shows what conservatism should be. Here are excerpts:

Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act.  . . . . Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.

A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism. The timing could not have been worse. At precisely the moment we were urging the GOP to march in one direction, the great mass of conservatives and Republicans had turned on the double in the other, toward an ever more wild and even paranoid extremism. 

At that time, I worked at the American Enterprise Institute, the most high-toned of Washington’s conservative think tanks. . . . The mood then was that supporters and opponents of the Obama administration were engaged in a furious battle over whether the United States would remain a capitalist economy at all.

It was no moment for advocates of compromise—indeed, it was precisely because I appreciated its unwelcomeness where I worked that I had launched an independent blog in the first place. There, to the increasing irritation of my colleagues and employers, I fruitlessly argued through 2009 and 2010 that Republicans should do business with President Obama on health-care reform.

It seemed to me that Obama’s adoption of ideas developed at the Heritage Foundation in the early 1990s—and then enacted into state law in Massachusetts by Governor Mitt Romney—offered the best near-term hope to control the federal health-care spending that would otherwise devour the defense budget and force taxes upward. I suggested that universal coverage was a worthy goal, and one that would hugely relieve the anxieties of working-class and middle-class Americans who had suffered so much in the Great Recession. 

[W]hen the Democrats indeed did pass the law without Republican input, just as I’d warned they would, a fury overcame me. Eighteen months of being called a “sellout” will do that to a man, I suppose. I opened my computer and in less than half an hour pounded out the blogpost that would function, more or less, as my suicide note in the organized conservative world.

The post was called “Waterloo.” . . . . Even more provocatively to Republicans already fixed on a promise to repeal the Obamacare abomination, I urged: "No illusions please: This bill will not be repealed." . . . . The next morning came a phone call inviting me to talk things over with AEI’s president. By Thursday, I was an ex-think-tank staffer.

Over the next seven years, Republicans would vote again and again to repeal the Affordable Care Act. Total and permanent opposition to the law would become the absolute touchstone of Republican loyalty. . . . . From time to time, some old veteran would recall my 2010 prediction that the law would endure and smilingly wonder if I wished to reconsider.

I never did, for the reasons that the whole world has witnessed in real time over this week of Obamacare’s 7th anniversary.

Some of the conservatives who voted “no” to the House leadership’s version of repeal may yet imagine that they will have some other opportunity to void the law. They are again deluding themselves. . . . . Too many people benefit from the law—and the Republican alternatives thus far offer too little to compensate for the loss of those benefits.

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

What happens now is that—a few bitter-enders aside—Republican politicians, especially in the states, begin the slow and belated process of entering the next era of health-care politics. . . . How generous should health coverage be? What should be done to control costs? Who should pay, and on what terms? To what extent should citizens be free to impose the cost of their unhealthy choices upon others? Conservative-minded people will converge on one set of intuitions; progressives on another. It’s possible to imagine a Republican health-care politics that rejects the ultra-redistributionary approach of the ACA and instead argues that since all benefit from health coverage, all must contribute to its costs via some kind of broad-based tax. 

It’s possible to imagine a Republican Party that cares about the details of health policy and is not satisfied with poorly informed hand waves toward outworn party shibboleths. It won’t happen soon, perhaps—but the sooner the better.

Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism—and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.

I take no pride or pleasure in saying “I told you so.” . . . . Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.

Frum is 100% on target and the sooner sane Republicans get on board with what he suggests, the better. That may mean jettisoning the hate-filled Christofascists who rallied to Obamacare repeal, but that would be a very positive development for the GOP.

The GOP's Delusional Invocations of "American Exceptionalism"

One thing that drives me to distraction is the Republican Party's constant bloviating about "American Exceptionalism."  Yes, Democrats, including Barack Obama, succumb at times to citing American exceptionalism, but the frequency of use pales compared to that of Republicans.  Worse yet, the GOP invocations of American exceptionalism always seem to include a re-writing of history, refusal to learn from past catastrophes - e.g., the Iraq War - and a blindness to the ugliness in America's past.  Without being honest about the past and accurate history, America is doomed to repeat past mistakes and allow injustices to fester.  A column in Salon that looks at history from the Vietnam War forward underscores the GOP's delusions on "American exceptionalism."  Here are excerpts:

The Vietnam War ended 40 years ago, yet this brutal episode continues to haunt America and affect our foreign policy, our culture, and our national identity. . . . the catastrophic war left the idea of American exceptionalism in tatters as the conflict came to be seen by many citizens as unnecessary and immoral, undermining the basic American belief that the United States is the greatest force for good in the world.

In his wide-ranging book “American Reckoning: The Vietnam War and Our National Identity” (Viking), historian Christian Appy explores the complex history of the war, from the Cold War fear and idealism that led to the initial American involvement to the ruthless and seemingly endless and grotesque conflict that perplexed the military, devastated Vietnam, and fueled an antiwar movement at home. Appy also looks at the aftermath of the war, analyzing the amnesia and pumped up patriotism in its wake as well as the wariness of further military intervention. But, as Appy observes, historical memory faded and policy makers after 9/11 ignored the lessons of Vietnam, launching protracted and indecisive wars in the Middle East as an imperial presidency directed foreign affairs without the consent of the citizenry.

[T]he evidence I found indicated that roughly 80 percent of the men who served in Vietnam came from poor or working-class families. The draft system of the era was class-biased in ways that allowed men with greater economic means far more opportunity to avoid military service or to find forms of service (like the military reserves) that kept them out of Vietnam. And few men of privilege volunteered.

To put it most plainly, [American exceptionalism] it’s the belief that the United States is the greatest nation on earth, unrivaled not only it its wealth and power, but in the quality of its institutions and values, and the character of its people. That faith has been with us for centuries and has often had a religious underpinning—the idea that we are providentially destined for our unique mission in the world. When it reached its heyday during World War II and the early Cold War, American exceptionalism was the driving ideological force of our particular brand of imperialism. It was founded on the appealing idea that we are the greatest force for good in the world and therefore have the right and responsibility to assert “global leadership.”

[I]n many ways the political and cultural values and institutions that have shaped American exceptionalism (republicanism, various kinds of freedom, etc.) were constructed on the backs of dispossessed native peoples, enslaved Africans, and, over time, the domination of many foreign lands and people. Of course, the faithful have tended to view all such devastating evidence as insignificant or temporary blemishes along the road to ever greater freedom for all.

The Vietnam War, in my view, was the first experience that shattered that broad faith. . . . . in the face of war crimes like the My Lai massacre in which a company of U.S. soldiers slaughtered some 500 unarmed and unresisting civilians in 1968, many war supporters proposed that all nations do similarly horrible things in war. Well, that excuse is itself a rejection of a core ingredient of American exceptionalism—the idea that we put a higher price on life than other nations and cultures.

Perhaps it’s a tell-tale sign of a dying empire when leaders know that their exercise of military power is failing but they continue the killing nonetheless in a desperate effort to avoid defeat, to avoid humiliation, to avoid looking weak.

I have a chapter called “Paper Tigers” that is really about the significance of gender in prolonging and expanding a war that American leaders believed was failing but did not have the moral courage to stop. . . . . their primary concern was maintaining “credibility” and that really boiled down to preserving an image of national and personal toughness.

Not only is that, in my view, a kind of insanity, but it didn’t work. The longer we stayed in Vietnam the more our international credibility was shredded. It didn’t even work for LBJ in personal political terms—the war led him to drop out of the presidential campaign of 1968. As for Nixon, his illegal efforts to silence antiwar criticism (and thus preserve his credibility) were the first crimes of Watergate that ultimately forced him to resign.

Forced relocation was designed to deprive the Viet Cong of civilian support in the countryside and it ultimately displaced 5 to 10 million people. Their ancestral villages were then burned down or bulldozed and proclaimed “free fire zones” where the U.S. claimed the right to fire at anything that moved in the area.

Far from “winning hearts and minds,” policies like these simply served to drive more and more Vietnamese to an anti-government, anti-U.S. position.

Although Iraq, Afghanistan and other nations of the Greater Middle East in which we engage in seemingly endless war are all vastly different from Vietnam (and each other) there are certainly commonalities in the way the U.S. has behaved in all of those places. Once again our troops have been sent to war under false pretexts, in faraway countries in which they are widely perceived as hostile invaders or occupiers, to prop up local regimes that lack the broad support of their own people, and to wage brutal counter-insurgency against an elusive and difficult-to-identify enemy (while also being told somehow to win the hearts and minds of the people). Moreover, our presidents have prolonged these wars, as in Vietnam, long after the American public has turned against them, and once again we have failed to achieve our stated objectives.

[F]inally dispense with American exceptionalism. I don’t think the historical record justifies the faith, it alienates other people and nations (for obvious reasons), and it contributes to public acquiescence to the tiny few who make foreign policy in our name and are all to ready and willing to assure us that they can be trusted to use our “indispensable” power as a force for good in the world.

[T]hose [presidential candidate] comments strike me as delusional and reflexive invocations of American exceptionalism based on the threadbare idea that we are a force for stability and peace in the world no matter how glaringly the facts contradict the claim. They remind me of the remark Vice President George H.W. Bush made in 1988 shortly after the U.S. Navy shot down an Iranian civilian airliner over the Persian Gulf killing all 290 passengers. Running for president at the time, Bush said: “I will never apologize for the United States of America. Ever. I don’t care what the facts are.”

Just as they don't want to face the reality that their religious beliefs are untrue, much of the GOP base refuses to face the fact that "American exceptionalism" is a myth that is dangerous.

Five Ways America's Health Care System is the Worst

Click image to enlarge

While constantly deriding the Affordable Health Care Act, the Congressional Republicans have provided no viable alternative to it and, instead want to go back to leaving the uninsured with hospital emergency rooms as their sole source of treatment.  Meanwhile, here in Virginia, the GOP is running ads claiming that Virginia cannot afford to expand Medicaid  conveniently ignoring the reality that (i) the state will be losing two billion in taxes paid to the federal government that will not return to Virginia and (ii) the 400,000 Virginians kicked to the curb will put further strain on the state's non-profit hospital systems and drive costs higher for everyone else.  Throughout all of this, the Republicans boast about America having the best health care system in the world - something that is patently not true.  At least not if one does not belong to the top 1% of the wealthiest Americans.  A piece in Vox looks at 5 ways in which America's health care system is literally the worst.  Here are highlights:

The United States comes in dead last in a new, international ranking of health care systems from a top health-care non-profit.

This doesn't mean that we're the worst in the world; there are plenty of less-developed countries that have worse systems than America's. But when the United States is compared against peer countries like France and Canada it does not come out well. It comes out the very worst.

A new Commonwealth Fund report looks at how the United States stacks up against other countries on things like access to doctors and quality of care. It pulls from three separate surveys conducted over the past three years: a 2011 survey of sicker patients, a 2012 survey of doctors and a 2013 survey of adults over 18. It also uses health outcome data from the OECD and World Health Organization. This means it captures the experience of the medical system from the people who use it a lot, those who use it a little and the doctors treating them.

The American health care system came in last both in the overall rankings, which pull together data on 11 specific measures of success for a health care system. This includes metrics like how easily residents can access health care, if that medical care is affordable and if its effective.

There was no measure where the United States came in first place — our best ranking was coming in third in the effectiveness of our medicine (more on what this means later).

In addition to coming in last overall, there were four specific measures where the United States came in last: cost-related problems, efficiency, equity and health outcomes.

Americans have the most trouble affording medical services; a higher percentage of Americans go without needed care because of cost than people surveyed in any other nation. 

Americans were almost most likely to report out-of-pocket expenses above $1,000 and to have serious problems paying their medical bills. The challenges that Americans have paying their medical bills likely stem from two unique characteristics of the health care system. First, American health care is expensive: the United States spends way more per person on health care than other industrialized nations. We have higher prices for drugs and imaging scans than other countries. 

The other part of the explanation: the United States is the only country in this study without universal coverage. 

[W]e have thousands of health insurance companies who negotiate individually with hospitals and doctors. Every knee replacement in the United States has a different price depending on what deal the insurer has set up with the provider.

This means we end up spending more than other country on the business of getting bills paid. The United States, for example, devotes 7.1 percent of total health care spending on administrative costs.  That's more than twice as much as the United Kingdom and three times as much as Australia.

The Institute of Medicine defines equity as "providing care that does not vary in quality because of personal characteristics" like income or location. The United States does not do a very good job of this. There are big gaps in how Americans with different incomes use the health-care system, with lower-earning Americans being more likely to skip recommended care. Like other measures, this reflects the high costs and insurance gaps of the American system.  

The whole goal of a health care system is to help people get healthier. The United States does spend a lot more money on health care than any other country in this survey. That could make sense if all that additional spending was leading to a better quality of life for Americans, if we lived longer, for example, or had healthier lives.
 
Unfortunately, the United States comes in dead last when ranked on healthy lives. This metric includes three basic indicators (the only ones available for cross-country comparisons). They are deaths that could have been prevented with care (we have more of those), infant mortality and life expectancy.

The take away?  Just like conservatives like to blather about imagined "American exceptionalism" so to do they ascribe to the nation's health care system characteristics that simply do not exist or which in reality fail to match the health care services available in other advanced industrial nations.  Claiming loudly that something is the best does not make it the best.

Right Wing Rages at Boehner Fiscal Cliff Debacle

Few things provide such enjoyable political sport as watching the unhinged elements of the GOP base - i.e., pretty much the entire base at this point - begin to attack one another and their simpering prostitutes in the Congressional GOP.  The debacle on John Boehner's "Plan B" has set off a fire storm of batshitery and internecine attacks that is  nothing short of delicious to watch.  Meanwhile, one can only hope that the American public comes to a realization that today's GOP is unfit to govern and that Republicans must be voted out of office until such time as the GOP regains sanity. Two pieces in Politico here and here look at the rants and accusations being tossed around.  Here are highlights:

Liberal and conservative commentators alike took to Twitter and blogs to blast House Speaker John Boehner as a “failure” after his fiscal cliff legislation did not pass in his own party Thursday.
Boehner’s “Plan B” legislation would have raised tax rates on Americans making more than $1 million as part of a broader deal to avert the fiscal cliff. Boehner (R-Ohio) and other Republicans had earlier this week expressed confidence that the measure would pass the House of Representatives, but ultimately the bill failed to receive sufficient backing from the rest of the party.

The Ohio Republican took heat from some on the right, including from those who has opposed Plan B.  “VICTORY for now. House goes home,” tweeted Erick Erickson of RedState.com after news broke of Plan B’s failure.

Hugh Hewitt, a conservative talk show host, slammed the speaker for keeping the negotiation process quiet.  “Negotiating. In secret and losing in public is a bad combo. Seek input for positions first. Good argument for a new Speaker,” he tweeted.

The Washington Post’s Jennifer Rubin, a conservative writer, saved most of her fire for the GOP caucus that opposed the measure — but she still called Boehner’s effort a “stunning miscalculation.”
“It is a stunning miscalculation, one that allows the president and Senate Majority Leader Harry Reid (D-Nev.) to essentially write whatever bill they can get through the Senate and then watch House Republicans either cave (to a deal that will certainly be worse) or effectively raise taxes for the entire country,” she lamented.

Reps. David Schweikert (R-Ariz.), Justin Amash (R-Mich.) and Tim Huelskamp (R-Kan.), all stripped of prized committee assignments earlier this month because of perceived sins against the party, did a three-amigos end zone dance as GOP leaders struggled and failed to get the votes for a tax-cut bill designed to empower Speaker John Boehner in negotiating the so-called fiscal cliff.

But Rep. Lynn Westmoreland (R-Ga.), a conservative and a member of the Steering Committee, said the real reason was an “a-hole factor.” Another member of the Steering Committee, seeking to distinguish between these lawmakers and others who might be difficult to deal with, called them the “most egregious a-holes” in the Republican Conference.  The meaning: These guys didn’t just vote no — they went extra miles in working against the interests of the GOP.

A conservative who is on the outs with Republican leaders contended that the failure of the Plan B bill represented “the beginning of the end” for the House GOP leadership team.

House leaders don’t have much of an operating margin now, and it will be slimmer come January when Democrats add seats. It seems clear now that they will also have to contend with four fellow Republicans who have little incentive to help them.

Petty egos, insanity, extremism, and a disregard for the best interests of the country now seem to best define the GOP.  The only question becomes one of how much harm will this unhinged party inflict on the rest of us as it crawls toward the insane asylum.

Outside of the GOP Bubble, Americans Believe Obama Has a Mandate

The delusions that continue to exist in the fantasy world inside the GOP bubble are amazing. Take for instance the House Republican's belief that they have a popular mandate to oppose the Obama/Democrat tax and budget proposals.  In the real world, a new Bloomberg survey finds that a majority of Americans, in fact, believe the exact opposite of the alternate reality within the GOP its Tea Party affiliate.  Indeed, Obama's overall approval numbers have increased and some 65% of Americans believe that Obama has a clear mandate.  Here are some highlights from Bloomberg:

President Barack Obama won the public argument over taxes so decisively that almost half of Republicans now say he has an election mandate to raise rates on the rich. 

Majorities of about 2-to-1 also read the election results as an endorsement of Obama’s pledge to protect Social Security and Medicare benefits, according to a Bloomberg National Poll of 1,000 adults conducted Dec. 7-10. 

The president’s job approval strengthened to 53 percent from 49 percent in September. The last time he enjoyed that level of public backing was December 2009, when his job approval was 54 percent. 

The combined findings give Obama “an opportunity to negotiate from a position of strength,” said Ann Selzer, the founder of Selzer & Co., a Des Moines, Iowa-based firm that conducted the poll. “This is what the public is saying he was elected to do.” 

The election “was basically a referendum that wealthy people could and would pay more,” said poll respondent Jim Johnson, 66, of Littleton, Colorado, a retired telecommunications executive and a Republican who voted for Mitt Romney. “It was perfectly clear. That was Obama’s stance throughout the election.” 

Poll respondent Gerald Watts, 75, of Lake Quivira, Kansas, a retired engineer and another Republican who voted for Romney, read the election results the same way.  “Every time we listened to him on TV, he’d start talking about raising taxes on the rich -- every news conference, every time he went up in front of a group,” said Watts. “He didn’t want to talk about anything else.” 

Even so, the differences among congressional Republicans on taxes, with Senator Bob Corker of Tennessee the latest to break from his leaders to call for raising rates on high earners, reflect a division among the party ranks. Fifty-three percent of Republicans say the election didn’t give Obama a mandate on taxes.

Public sentiment also strengthens the president’s position on entitlements. A 64 percent majority says Obama can claim a mandate to protect Social Security from “substantial budget cuts” and 62 percent see a voter directive to prevent “fundamental change” in Medicare.  

A 57 percent majority of Americans say voters gave a go- ahead on an overhaul of immigration law to provide a path to legal status for illegal immigrants, one of the administration’s priorities in its second term. Fifty-eight percent of political independents see an immigration mandate. 

Republican respondents’ differ, with 63 percent rejecting the idea that Obama’s victory implies public support for legislation enabling legal status for undocumented immigrants.

Andrew Sullivan has telling remarks on the GOP's refusal to accept reality:

The longer the Congressional Republicans remain in denial about this, the more isolated they will become.  .   .   .   .   These two men[the one's quoted in Bloomberg, above]  are smack in the middle of the GOP's current demographics. And, unlike the foam-flecked mouth-pieces on Fox, they are admirably civic in their understanding of politics. Listen to them, Mr Speaker. And lead.