The meta on Republicans

The Thinker by Rodin

Of course, Washington D.C. is consumed by shutdown madness. It’s all we can talk about in this federal town because, really, there isn’t much else to talk about. It’s kind of like Detroit not manufacturing cars, or Hollywood during an actors’ strike. Governance is what we do, imperfectly perhaps, but it’s our thing.

The shutdown seems kind of crazy and arguably it is crazy. How this happened is well known. It amounts to Democrats staying home during the 2010 election, in retrospect a fatal mistake. It put those with an animus to vote to come out, and we ended up with the Tea Party controlling the House. The Tea Party can now get Speaker John Boehner to dance on a dais like an elephant at a circus. What was lost were legislators that were willing to compromise. That turns out to be a huge problem with no real solution.

The current shutdown is a classic case of an irresistible force meeting an immovable object. It’s unclear what it will take to fund the government again. Forces should favor the Democrats as they control both the Senate and the White House but of course nothing is guaranteed because Republicans in the House, at least those holding the leash around Speaker Boehner’s neck, seem content to burn the house down if necessary to get their way. Their strategy for winning this battle was summed up by Senator Ted Cruz (R-TX): “Don’t blink”. Only of course either someone has to blink or there has to be genuine compromise. For a change it appears that Democrats don’t intend to blink. Time will tell if it is true, but it’s understandable that Republicans figure Democrats, or at least President Obama, will blink in time. After all, he has in the past and past behavior is a reasonable predictor of future actions.

Some things are crystal clear: Republicans are very angry, with Democrats in general of course, but with President Obama in particular. Their rage is focused on the “Obamacare”, i.e. the Affordable Care Act, which they claim was enacted without bipartisan support. The latter point is true, but it’s not like Democrats did not do a lot of reaching out. A bipartisan “gang” in the Senate worked seven months on a bipartisan bill, but Republicans got cold feet. As I documented, President Obama went out of his way to get input from Republicans when health care reform started. He was icily spurned. Republicans were not serious players in this negotiation because they did not want health care reform. They still don’t. There is not even an alternative plan to the ACA that enjoys widespread Republican support.

What is fueling this anger? Is it really President Obama and his mixed race? Is it really that people they don’t like may get to live longer because they will be able to afford some health insurance? How do you reach political compromise when the very idea is anathema to Republicans?

I believe that understanding the true source of their anger may help affect a positive solution. In my opinion, Marcos Moulitsas, owner of DailyKos.com, inadvertently uncovered the real animus in this word cloud. A word cloud is a list of words that come up frequently in discussions with Republicans. Some words come up a lot including “worried”, “concerned”, “scared”, “anxious”, “nervous” and “discouraged”. To understand Republicans, you have to focus on these core emotions. They are engaged in an exercise in bravado which points out they understand the underlying truth: their way of life is dying, probably for good, which means they are desperate. They hold on to some political power via governorships, state legislators and in the House via gerrymandering, but they know it can’t last, so they must hold onto it as long as possible.

Conservative are value programmed to resist change. They are like a dog backed into a corner, hissing and snarling at anything that approaches and ready to lunge forward and bite to prove their sincerity, while secretly hoping they don’t have to because they know their bark is their power, not their bite. The proof is already out there in polls that show Republicans are getting disproportionate blame for the shutdown. They are setting their party up for a more rapid decline than necessary in the 2014 elections. Their current approach is giving Karl Rove cold sweats, as the house of cards he constructed in the late 1990s appears to be swaying.

Arguably Democrats should use this opportunity to kill the sad spectacle that is today’s Republican Party. Benign neglect is not a bad strategy either. As I noted before, demographics will be the Republican Party’s undoing. Like it or not, the country is becoming colored and more tolerant. Attempts to restrict access to voters they don’t like may win a battle or two, but this is ultimately a war that they cannot win and keep their values too. They really have just two choices: transform their party into something else that can attract a lot of women and independents, or prepare to go the way of the Whig Party. Ironically, the Republican Party was forged from the remnants of the Whig Party. What we are seeing taking place in the House is not so much a battle between Republicans and Democrats, but a nasty intra-party Republican fight. As John Boehner goes, so goes the Republican Party, but the party is doomed to lose in the end. There simply are not enough Republicans to hold this party together much longer. This dike is about to burst.

Here’s what an enlightened Democratic Party could do: create safe zones for Republicans to be Republicans. The real animus against the Affordable Care Act is because it is a federal mandate: red states have to follow this law they loathe and which pushes all their panic buttons as well. It’s about being forced to adhere to someone else’s values. So here’s one compromise this Democrat would be willing to make on the Affordable Care Act: let red states opt out of the ACA altogether if they want, providing they will allow those states that do want the ACA to have it. This is not a “my way or the highway” solution, but “you can do things that fit your state’s culture, and blue states have the same privilege.” Allow states to opt in or opt out. The price of this accommodation: no changes to this rule until at least 2020, to give the ACA time to work.

This sounds like surrender but I am not worried. Yes, I would like to see the uninsured in red states get health insurance like the rest of us. But I am not worried that red states would opt out of the ACA for long. The experience in blue states will teach citizens of red states that there is nothing to fear. They will soon learn that the lack of containment of health care costs will work to their state’s disadvantage. Soon, they will choose to opt in. They will find, hey, that money from the federal government to subsidize the care of our poor citizens is a good thing. But they cannot come to this conclusion until their ideological fever fades.

It will work the same as it is happening now with gay marriage. The values of this country are changing to be more progressive, but that doesn’t mean the future shock underway will happen gracefully. Right now we are building a huge national bonfire of threats and rhetoric. Opposing forces are screaming at each other from opposite sides of the fire. We need to put the fire out and to let tempers cool. With a little time I believe that common sense will return.

As for red states, they too are becoming colored and will become more progressive as well. They cannot change their demographic trends either. Change will happen but it will probably happen better if it happens gradually in these states. Resentment builds a new bonfire that could burn across generations. There are lots of feelings to process and this will take time. This Republican frog needs to be boiled slowly.

Moreover, our nation needs healing. It does not need more polarization. Enlightened Democrats need to respect these feelings through local accommodation if possible. These demographic changes underway do not have to be 8 on the Richter Scale. Done the right way, they can be minor trembles instead. In the long run, this approach is a better way to heal our polarized nation.

Republicans can’t kill Obamacare

The Thinker by Rodin

One of the ironies of the Affordable Care Act is that Republicans were the ones to derisively name it “Obamacare”. So when it works, as it is going to, President Obama is going to get all the credit. This will make the Republicans look particularly stupid, not that they need a whole lot of help looking stupid lately. It might kill them as a party.

Perhaps it is the fear that it actually will work which is having them go into overdrive with desperate, last minute attempts to make it fail by convincing people not to enroll. They are doing so by refusing to set up state health exchanges but more recently by placing burdensome state regulations on Obamacare “navigators” (people paid to promote the insurance with uninsured communities) that effectively keep them from “navigating”. These tactics likely won’t work and worse are unconstitutional because of the supremacy clause to the U.S. constitution, not to mention the right of free association. Their hope is that by throwing sand into its engines before the courts tell the states their laws are invalid that it will cause the program overall to fail.

Good luck with that Republicans, because it won’t work. Granted, there may be some fits and starts to get the Affordable Care Act fully in gear. Whether or not navigators promote the law or not, it’s a straightforward matter for anyone who wants to get health insurance to acquire it: just get on line and sign up! On the national or state health exchange they can sign up for health insurance regardless of preconditions. If they don’t make a lot of money the government will subsidize some portion of their premiums.

The only ones to truly get screwed by Obamacare will be the working poor in red states, at least those red states like Texas which won’t accept Medicaid subsidies to expand the insurance pool. This is only possible, of course, due to the Supreme Court’s decision earlier this year that gave states the right to opt out of this part of the law. Now that decision definitely threw some sand into the Obamacare engine, but it was not fatal. It just meant that the poor, as usual, would continue to get screwed over in many red states. That will change with time.

So many ironies! It turns out that red states are essentially screwing themselves. By turning away free money to pay the medical expenses of their poorest citizens, these people will simply clog emergency rooms for costly “free” health care. This unofficial tax will be added to the price of health care services for the insured of these states, making their premiums proportionately higher than in states where Obamacare goes into full effect. This, in effect, makes blue states more desirable places to live because there is less health care cost shifting going on: health care expenses become more predictable. “Live free or die,” is the state motto of New Hampshire and by inference much of red America. But of course “freedom is not free”, as states like Texas will discover to their sorrow. The only interesting part of this exercise is how long they will hold out before they realize the futility of their own pigheaded stubbornness. There will be a whole lot of money that could have been used to build bridges and fund schools that will be needlessly squirreled away into higher health care costs instead.

This is because the whole point of insurance is to spread the risks, and thus the costs, lowering costs for everyone and thereby providing services that would otherwise be unaffordable. I don’t expect my house to burn down this year, so in the eyes of red America I am probably wasting money sending $600 a year or so to USAA. Essentially I am giving my money to someone else who will use it to rebuild their house when they have a fire. Of course should I have a fire, I’m out $600 in premiums and likely some costly but not catastrophic deductibles. But I am not left to rebuild my house with money from my savings account or using some loan that is based on my creditworthiness. $600 seems amazingly cheap for this investment of $500,000 or so. Essentially I pay .12 cents per dollar of the house’s value so I don’t have to pay to rebuild it in the event of catastrophe.

The same idea works with health care costs, of course. Only a very stupid wage earner when they measure their potential financial shock without health insurance will pass it up if they can possibly afford it. And with subsidies, they will be able to afford it, well, unless they make so little they count as working poor. If the states won’t take the federal money to insure these people then these low-wage workers will get screwed if they develop a costly condition. Many of them will die prematurely, but most will linger in pain and in poverty while racking up huge hospital bills that they cannot pay, but whose costs will simply be passed on to those who can: the insured.

Anyone who can possibly afford insurance is going to want to get it, and if they think they cannot they will find the cost of dodging it will increase every year with fines collected on their federal income taxes. At some point they will say, “If I am going to spend this much money not to be insured, maybe I should just be insured.” For now, these red states are hoping that ignorance will kill Obamacare. Keep the cheap to insure out of the market and it raises premium costs for the rest. In short they are betting on ignorance, hence their obsession with keeping “navigators” from navigating. It may work for a short while, but not forever, and if it works it will be locally, not nationally. Eventually some peer is going to tell them that they are insured now and it only costs X dollars and they are being subsidized with Y dollars of free money. It’s like a 401K employer match. Free money will get their attention, so let’s hope those navigating the navigators tell them to pitch it like this.

Despite attempts by some states to “overturn” Obamacare, it cannot be overturned by a state’s fiat. It is a done deal, a law largely upheld by the Supreme Court. It can only be repealed through an act of Congress signed into law by the president, or by a Congress that overrides the president’s veto.

It’s just like that scene from the movie Lincoln when, after the passage of the 13th amendment Lincoln meets with the vice president of the Confederacy who is making peace overtures. “Slavery,” President Lincoln informs him, “is done. Finished.” Check and mate! The Affordable Care Act is finished too. It can’t be overturned because it wasn’t overturned. Certain red states will screw themselves for a while as they try to make it not work in their states, but it won’t work nationally. Obamacare is done. It is potentially possible to repeal it, but it won’t happen without a Republican House, Senate and White House, and only if there are sixty or more Republican senators. In reality, at this point it can only be amended, and by amending it, it will only be strengthened, not weakened.

Obama may screw up his legacy by sending missiles into Syria to avenge the use of chemical weapons by its government. But he won’t screw it up through Obamacare. Ten years from now most people even in red states will be scratching their heads wondering why they opposed it in the first place. They probably won’t like paying their health insurance premiums and copays too much. I don’t like paying mine either. But I do like knowing one costly illness won’t wipe me out financially. So will millions of Americans simply trying to reach old age in a state resembling solvency.

Perhaps the most ironic part of Obamacare is that Obama will get credit for something he largely did not contribute to. He basically said he was for the idea of national health insurance but left the details to Congress. The Affordable Care Act was what emerged. Republicans named it “Obamacare” to tar it to President Obama, who they obviously loathe, and the frame stuck. Even the president now calls it Obamacare. It will be seen as the major accomplishment of his term of office. At least President Franklin D. Roosevelt truly instigated the New Deal. Obama, the man Republicans love to hate, will be gratefully remembered for Obamacare in the generations to come. He will wear laurels placed on his head by Republicans, who thought they were putting on a crown of thorns.

The real credit for the legislation though should go to the Democrats who controlled Congress at the time. Senator Harry Reid and Speaker Nancy Pelosi should be wearing those laurels, but also the sixty Democratic senators who, as a block, held themselves accountable when push came to shove and overcame cloture in the Senate. It was an improbable act of great bravery. Sadly, their contributions and these moments will be largely footnotes.

Republicans: Let’s talk real national security

The Thinker by Rodin

There is a little irony that a day after the Supreme Court narrowly decided the Affordable Care Act was constitutional after all, that I would undergo surgery. The surgery to correct a deviated septum (known as septoplasty) was actually scheduled six weeks earlier. My mother in law’s untimely death and my plastic surgeon’s busy schedule meant I had to wait until today for the outpatient surgery. It went well, but my time in the recovery room took longer than usual, perhaps due to aging. While waiting for the surgery, the TV playing in the waiting rooms was all about the Affordable Care Act decision.

My surgery was theoretically elective, but that did not seem to be the case for others in the waiting room. They included a ninety plus woman, virtually deaf due to plugged inner ears, who needed to get some tubes put into her ear so she could hear again. She looked miserable and her son acting for her largely could not communicate with her. Yet she was lucky. She was covered by Medicare. I was lucky too as I am covered by Blue Cross, and they approved my surgery. Even so I know there will be a whole slew of bills waiting me. It was nearly $900 just for the hospital to admit me. Doubtless the anesthesiologist and surgeon will bill as well, and there will be substantial copays for their services too. I’ll be lucky to escape this surgery for less than $2000, and that’s just for the copays. Blue Cross pays 85%.

I was back home by noon, my septum duly aligned and with various sinus polyps removed. Maybe this surgery will mean that I won’t need to spend my sleeping life tethered to a BiPAP machine for my sleep apnea. It’s a big maybe. Most likely I will continue to need the machine, but with the improved airflow, perhaps I can adjust the pressure settings downward, which would likely make sleep far more restful. Meanwhile I am downing Keflex and extra strength Tylenol every six hours and wearing a guard over my nose that is attached to little diapers to capture the bloody discharge from the surgery. Recovery from this sort of surgery is generally straightforward, and involves lots of use of QTips and hydrogen peroxide.

Mostly I am lucky because I am insured. My employer cares enough about me to provide it as a benefit, with me providing about a third of the cost of premiums. I am even luckier because even before the ACA I was already in a plan that required insurers to accept all comers. You see we federal employees have been been enjoying “Obamacare” for decades, and those employees I might add include members of Congress eager to repeal the ACA. And I must say, I like it. For decades I have been covered by health insurance, as has my wife and daughter. Insurers in the Federal Employees Health Benefit Plan have to accept people into their plans regardless of age and preexisting conditions. There are dozens of plans to choose from. On rare occasion, a health insurer will drop out of FEHBP, but it is a very rare occurrence. Mostly, health insurers are glad to cater to our market.

As I age, unsurprisingly, I have been using more health care services. I am quite certain that in spite of premium and my voluminous copays, we consume more in services than we pay in direct costs. It’s likely to be this way for the rest of my life. I don’t feel guilty about this. I feel grateful. I also feel like I’ve paid my dues. For the first twenty years or so that was likely not the case. I was paying for those older and sicker in the system. I did not resent this. It comes with the insurance territory. Health insurance only works if we are all in this together.

Essentially, the Supreme Court agreed yesterday. While Chief Justice Roberts surprisingly voted with the majority to uphold the law, and while he was silent about whether he personally thinks the ACA is a smart decision, he decided it is constitutional. This is good for our nation because by upholding the law at least for the moment he has likely fended off our devolution to a second world country.

Republicans are always anxious to vote more dollars for national security. I find it sad but curious that they don’t understand that national health insurance is also vital to national security. Most other first world countries figured this out decades ago, but we dithered. It is not surprising to me that since then we moved from greatest creditor country to greatest debtor country, and that our standard of living has devolved. National security is measured in many ways and it’s not just in the strength of our armed forces and intelligence. It is also measured by our willingness to invest in the human capital of its citizens so we can stay a prosperous country. In this we have been getting failing grades for some time.

We seem unwilling to pay the freight when it comes to education. We cheapen our public schools by increasing class sizes and shortening school years. We shortchange our public universities and expect students to mortgage more of their future by increasing tuition rates so they need to take out larger and larger student loans. This is keeping many from even attempting college, although many also have the talent. We also dumb down our curriculums. Courses like art, music and civics are considered expendable. Instead, we push highly structured and dumbed down standardized tests. Colleges are not immune from the phenomenon. As The Washington Post reported recently, college educations are becoming dumbed downed, or at least less time consuming. The Internet certainly makes research faster and more efficient. For most majors, the need for a full time college student to spend twelve hours a day on education, including often on weekends, as I did, is a thing of the past. I suspect this is to our detriment.

Education is vital to our national capital, but so also is our national health. It baffles me why this is not completely obvious. A healthy workforce is going to be more productive than a non-healthy one. If you are suffering from a health condition, your productivity is going to be compromised. If you suffer from a chronic condition, you may not be able to work at all. Where’s the good in that? Aside from inflicting needless misery on our citizens, why throw away the talent of so many of our citizens because they have a chronic condition? It’s such a tragic and needless waste and speaks poorly about what we really think about our fellow Americas. By throwing away our most precious asset, the skills of our own citizens, we guarantee our devolution as a nation. This is equally as dangerous to our national security, if not more dangerous, than securing our borders from illegal immigrants.

Mostly though while I waited for my surgery today I felt a mixture of relief and anger, not nervousness. The ACA, if we can keep it the law of the land, will do enormous amounts to make us a healthier and more productive nation, not just those like me still lucky enough to have health insurance. It will also relieve incredible amounts of unnecessary misery. Mostly though I felt anger that so many of my citizens are so ideological that they can no longer see our common humanity, who appear to think sadism is a virtue. These people, in the name of ideology would, like that heckler at a GOP debate last year, be enthusiastically rooting for people to be miserable and die.

The ACA gives us the opportunity once again to show our better nature. Let’s hope we find it again.