Posted tagged ‘affordable care act’

Year End In Sight

December 29, 2014

As the 31st draws closer, it is always useful to look at the past 12 months. What type of a year has it been?  What has gone well and what would we wish have gone better?  Should we hope for 2015 to be as good or much better than 2014?

If I were President Obama and I were reviewing 2014, this is what I would think.

I would think 2014 was a grind.  I would also think the outcomes were much better than the media was giving me credit for.

If I were a really honest Barack Obama I would be thinking of all the missed opportunities where I could have convinced Americans that the Administration and its policies were making life better for all Americans.

And if I did not cross my fingers and was straight honest, I would admit that I had blinked or hesitated too long at certain points and as a result provided political opponents ample opportunity to frame the public’s perception.

The nice thing about time is that given a sufficient amount, results become clearer and even the cleverest politicians run out of excuses. For 6 years the GOP has said “no” and denounced President Obama’s actions and policies. Their predictions of doom and gloom simply have never come true and instead, the American economy is steadily improved and now is the envy of the world.

Healthcare has improved access for many Americans.  There are signs that the out of control healthcare cost increases have been slowed. The national shame of Americans being denied basic coverage because they earn too little or are sick too much is still with us but the reasons and occasions  are fewer. The GOP claims of job losses and an upcoming “train wreck” were overstated and essential misleading.

Internationally President Obama can be satisfied that he has read the world situations mostly correctly.  He has followed policies (for the most part) that have kept Americans (most but not all) out of war. The President, however, can still improve his international stage speaking skills. He can do a much better job speaking to international nations. Like why lecture other countries about human rights when you can pick up any US newspaper and read about similar transgressions here. Have you consider the human rights aspects of dome strikes, or holding uncharged detainees for over 12 years, or the US domestic incarceration rate and its racial make-up?

But even more important on the international stage is the public versus private dialog. Making foreign country demands for delivery on the US 6 o’clock news is far less effective than sending messages through normal diplomatic channels. And generally speaking, making demands which have not considered correctly how the other country will respond is foolish. Bluffing with domestic politics is problematic but if things go wrong, the consequences are confined to the US. Bluffing internationally is quite a different story.

The President’s inner circle will continue to advise him and as in the past, President Obama will need to decide which set of advice to follow.  With reflection on these successes, he should be able to make good future decisions.

Next year, Cuba, Immigration and the Affordable Healthcare Act will attract much GOP attention. The President needs to resist the urge to slap down the GOP for their regressive ideas and instead defend his decisions with measurable predictions.

Time will again allow a period to assess the President’s policies at this next year or maybe the year after.

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2016 – What Will The GOP Run Against?

December 3, 2014

A NBC poll released today showed former GOP Presidential candidate Mitt Romney leading all perspective 2016 nominees. Romney logged in with 20% preference by those polled. In second place was Ben Carson with 10%. All the other Sunday talk show guests lined up as little ducks with descending percentages. Hmmm.

Romney’s preference can certainly be assigned to the fact that there has been little money spent to date for the 2016 race. The boat load Romney spent in 2012 makes him the most recognizable GOP candidate even though Romney has consistently said he is not a candidate for a third try.

Here’s some ideas for the eventual GOP candidate.

  • The Economy. Candidate “A” can claim he/she will get the economy going again. Hmmm. Considering the mess President Bush left, and the steady climb back, the current US economy is second to none in the world. And, the return to a strong economy was accomplished without any tax give away programs for corporations or the very wealthy. What can the GOP claim? Maybe they might point to the many Americans who do not feel they are participating in the recovery because their jobs do not pay enough. Hold your breath and lets see what this daring GOP candidate offers as the path to fairer income distribution.
  • Good Jobs. This would be a worthy goal for either party. The difficulty both will have is where would “good jobs” come from and how would the government play a role in enabling? Chances are no GOP candidate will offer anything substantive in reference to type of jobs or how to enable their creation (conflicts with small government goals). Simply saying, Candidate “B” stands for more good jobs will probably be the extent. For example, being specific like wanting to complete the XL pipeline because it will create good paying jobs, while partially true will also help depress the price of oil and refined products (good for most consumers). The lower oil prices will simultaneously create unemployment as current oil producers find their sunk costs exceeding the new lower price of crude. Hmmm.
  • The Affordable Care Act. It will be practically irresistible for GOP candidates to not cry for repeal of ACA. Candidate “C” will pronounce it a “train wreck”. Unfortunately for Candidate “C”, the facts do not support the train wreck description. No longer are Americans denied coverage due to a pre-existing condition or have their coverage canceled due to catastrophic illness. Uninsured Americans can obtain affordable coverage when in the past only the healthiest could. And, while it is still early, estimates are being made that the ACA’s emphasis upon reducing hospital errors is actually reducing health care costs. Hmmm. The wise GOP candidate, however, will move from repeal to “repair” ACA and point out certain aspects which should be fixed based upon experience.
  • Foreign Affairs. Most GOP candidates will puff up and say they favor a strong national security posture. More spending by the Defense Department will be their call. These demagogues will point to Russia, the Ukraine, China, and the Middle East as proof that the Obama Administration has botched foreign affairs. Oh, really? The Russian ruble is in free fall due to non-military sanctions put in place to counter Russia’s Crimean and Eastern Ukrainian policies. The Middle East mess, which began with President Bush’s ill-advised invasion and occupation of Iraq and his Administrations frequent calls for “democratic elections” in middle east countries, can only be resolved by the Middle East countries themselves. Any GOP candidate who proposes another invasion will be in for a rude surprise.
  • Immigration. Potentially the hottest potato of all. What can an honest GOP candidate say? Studies by even the most GOP minded business groups all point out the economic advantages of immigration reform. Common sense compels one to see the foolishness of any attempt to deport over 11 million undocumented. Probably the best advice would be to try the “Dick Nixon Vietnam approach”. Candidate “D” could say he has a secret immigration reform plan but can’t reveal it during the campaign because if he did, some could game the system… and Candidate “D” would want the reform to be fair to all.

President Obama will not be running this time. The presumptive Democrat candidate, Hillary Clinton, can both defend and modify the Obama track record based upon the passage of time… things change.

Should the Democrats infact nominate Hillary, the GOP will have the real red meat they seek. Run against Hillary (and Bill).

So maybe the Affordable Care Act, and the Economy, or Jobs, or Foreign Affairs will not be the issues, just Hillary. Hmmm.

Today’s News

June 3, 2014

In today’s Philadelphia Inquirer, there were two articles involving the Philadelphia Catholic Archdiocese. The front page carried the story detailing community concerns arising over the closure of a neighborhood church.

The Church is closing 16 churches, either outright or through merger with nearby churches. The closures reflect demographic shifts as well as a new era where growth is no longer where it was before. The old saying “it takes money to make money” seems to be playing out. Churches in less affluent neighborhoods are giving way to suburban mega centers (at least much larger).

The Archbishop has explained that the diocese’s serious financial condition makes it no longer feasible to keep open all the neighborhood churches. While available public information supports this position, there is a sensitive emotional reaction taking place just the same over each closure.

Each parish has members who have bonded to their particular church. These bonds have been formed over time and through life’s journey and personal commitment. In a much larger, ever changing world, the neighborhood church has offered some people solace. The church was in effect their club.

The second article was a brief one which noted that the Philadelphia Archdiocese had filed a lawsuit in Federal Court to enjoin the government from enforcing the Affordable Care Act. The Philadelphia Archdiocese has objected to the contraceptive requirements contained in ACA.

The decision over church closures can be understood in business terms. Displaced parishioners are encourage to find another still open church.

Denying contraceptive insurance coverage to those seeking such coverage the Church claims is based upon faith, religious freedom, so to speak.

Those who have had their church closed were already catholics. Those potentially being denied full ACA provisions may or may not be catholic. Hmmm.

Religious freedom certainly plays no role in church closures. Church affiliated businesses (like schools, hospitals, or charities), operate in the secular world where by definition (First Amendment) the government is restrained from establishing any religion.

How can Courts find in the Catholic Church’s attempt to impose its religious views on others, especial those with different religious traditions.  I wonder whether Justices will consider that over 90% of catholic women use contraceptives?

All male institution, hmmm.

Thinking Backwards

May 8, 2014

Recent polls are showing the tide of support favoring GOP candidates. If the tide continues, President Obama can look working with a GOP controlled Congress.

One of the most quoted reasons is voter disgust with the Affordable Care Act. The two reasons cited are (1) the individual mandate (that is everyone must buy health insurance), and (2) the loss of the coverage, either totally or at least the policy individuals had before ACA.

Both of these reasons are suspect. While the reasons themselves are undoubtably true for some people, but how many? Most Americans still obtain their health insurance through employer administered programs. Everyone should be suspect of those who oppose the individual mandate.

Health insurance avoiders are gaming the system and costing everyone else big bucks through use of emergency room services or outright inability to pay hospital and doctors charges. For those who have had their employer provided coverage taken away, shame on the employer, not shame on ACA.

With respect to those previously elected to purchase less costly policies with less coverage, in a strange way most of them were also gaming the system… unless they were fully prepared to cover all doctors and hospital costs.

Logic suggests that it is unlikely any voters are choosing one party over the other due to healthcare. Rather, there are reacting to impressions developed from negative Super Pac ads. The boat load of conservative negative advertisements very likely has a finger, if not the whole hand, in this.

Super Pac money could have a much greater impact if these donors were really interested in healthcare. Flooding the airwaves with information about how European healthcare works, what its results are, and how much it costs would be an eye opener.

If the GOP said, “that’s what we will bring Americans”, I would say “sign me up”.

Different Horses

April 12, 2014

The saying “different horses for different courses” came to mind yesterday when I saw President Obama introducing his new Secretary of Health, Sylvia Matthews Burwell, while thanking her predecessor, Kathleen Sebelius. Ms Sebelius had run the good race in the thankless task of implementation, that is establishing the Affordable Care Act following its passage into law.

She lead her organization through uncertainties ranging from the Supreme Court, State Governments’ confusion, and open hostility from the House of Representatives. She did this while the major cheer leader in chief, President Obama, remained too often in the background. This was dirty, tough, work requiring great patience and poise, (work that frankly bored the President).

Someone had to slog it out, and Ms Sebelius did with great dignity.

Her resignation, of course, was not a surprise. Following the near disastrous roll out of “heathcare.gov” and the initial damage that the roll out did to ACA’s reputation, many had called for her resignation. The President stuck with her not allowing anyone the space to claim he had picked an incompetent Cabinet member.

In the end, Ms Sebelius has been exonerated. The ACA has added over 7 million people to the rolls of insurance holders despite the rocky start. Without a doubt, this was a mark of success.

Looking ahead, however, the challenges are different. The ACA must be managed in a way that it becomes user friendly and ultimately depended upon by enough Americans that repealing it will be a sure way to lose an election. The President’s choice of Mathews-Burwell signals clearly this recognition, less political, more management.

In an unexpected way, President Obama has steered this difficult situation so that there can be two cabinet winners. Oh, and don’t forget, the biggest winner will be all those who now have access to healthcare coverage.

Settling Into Reality

April 11, 2014

There has been much said about the Affordable Care Act and how the Obama Administration has brought ruin to America. There has also been much said about foreign policy and how Obama’s “leading from behind” style has proven ineffective. And there continues to be much said about the deficit and debt and proposals of draconian measures to balance the budget.

All of this brought to us by the GOP.  Reality, however, has not supported the GOP claims.  Hmmm.

In 2010 the story was the Administrations focus should be on job creation. The impression was left that with only minor changes, like abandoning regulations and lowering taxes, the US could be awash in jobs. Even more dire was the prediction that the country was headed for chronic low growth shattering the American dream for the next generation. Hmmm.

The prospects for a return to the American dream experienced by those returning from WWII and their children is very problematic. Simply stated the world has changed as much as night to day. In 1950, the US possessed 60% of the world’s manufacturing capacity. This was a basis to “print money” and, of course, create millions of jobs and prosperity for other Americans.

Today the manufacturing capability is spread around the world. What determines what is made where is economics. Globalization has lead to large numbers of US manufacturing jobs to migrate to foreign locations. It is simply less expensive to make things in Mexico or China than in Ohio or Michigan. These are facts which know no political party. Never the less, we have heard a constant beat that the GOP knows how to create jobs and the Obama Administration does not.

What progress has been made in reducing the unemployment rate is labeled “too little, too late”. And if you are someone seeking a job these are words that ring true. Unfortunately, these words are neither true or helpful. The GOP’s rant does not deal with actual reality.

Globalization coupled with the 2008/9 recession (almost depression) has exposed the unpreparedness of our work force to move to better paying jobs which require more skills than those that have gone overseas. BMW has had to start its own apprentice program in South Caroline in order to find enough qualified workers for its new auto manufacturing plant.

The GOP “job creators” may know how to create low paying jobs but the American dream has always been tied to “good” jobs.

Looking at other GOP claims we find the deficit, while still too large, is shrinking. We also find that other countries who have tried to deal with deficits by drastically cutting spending (the austerity path) have seen stagnant economic results. And yes, amongst the Western economies, the US is out performing all of them.

Foreign affairs is more difficult to assess. What President Obama has done in his two terms may not be clear in its world impact for years. The same can be said for President Bush’s terms where the invasion and occupation of Iraq marked his view of foreign policy. Do you wonder whether the Arab Spring or the Russian return to Soviet era antics might be related?

But the largest GOP non-reality statements have been aimed at the Affordable Care Act. Already there are very positive signs that ACA will insure more Americans, will prevent more personal healthcare bankruptcies, and will slow the growth (and could possibly reduce) the annual per capita US healthcare spend. How could anyone get a policy so wrong?

Elections, however, are like horse races because no ever one agrees on every subject. There would be no horse races if everyone picked the same horses to win. So, it is possible the GOP could gain control of Congress or win the White House the next time despite their apparent lack of a grasp of reality.

It is my guess that policies like the Ryan federal budget or the Jindal ACA alternative will be seen for what they are in 2014 and 2016.  These are policies that do not address the needs of most Americans. As a consequence,  the election results will be much less than what the GOP hopes.

Voter feedback would inform the GOP that they must focus on American’s real problems and opportunities. Of course, the GOP should be expected to select its own policies to achieve these goals.  They must remember, however, that a changing demographic will produce a new electorate.   The “in your face” GOP pandering to big money just won’t cut it. (Democrats like big money too, they are just far more discrete about how they reward big money.)  In short, the GOP must begin to focus upon the average American.

Will the GOP get this message?

Strange Behavior

April 3, 2014

It is unclear whether politicians with their eye on the 2016 GOP Presidential nomination intentionally vier to the right or that they are predisposed towards this strange behavior. Representative Paul Ryan and Governor Bobby Jindal offered this week two examples of “what are you thinking” politics.

Ryan released his committee’s budget recommendation with the headlines, “proposed budget to reduce spending by $5 trillion (over next 10 years)”. One might be struck by this as a sign of fiscal responsibility. But if one is not careful, one is sure to get struck by the “dumb stick”.

What are the details that Ryan proposes to achieve these savings?

The Ryan (Republican) plan is to chop discretionary spending across the board and cap government spending on Medicare and Medicaid. Medicare would be gradually phase into a fixed government grant to individuals who in turn would buy private insurance.

Medicaid would be changed to a block grant program and States could use that grant as they felt appropriate. These measure represent a big pill to swallow if you are anybody but the very wealthy. To put a little salt in the wound, Ryan proposes to increase military spending. Hmmm. But that’s still not all. Ryan proposes to reduce taxes to two tiers, 10% and 25% It is almost laughable that any national politician would propose this massive a present to the wealthy while taking so much from the most needy.

Gindal made news focusing only upon the Affordable Care Act. He assembled already proposed talking points which also converted Medicare to private insurance program and Medicaid to block grants. Everyone else would go back to sort of what like things were before ACA. Back to the future.

On one hand, I give credit to these GOP members for taking a shot at fiscal reforms. Democrats, who own the moral high ground, have not offered proposals on how to make the current government spending fiscally sound. In an entirely different way, Democrats are letting down the very people they publicly say they are defending.

Putting the government on a fiscally sound basis must involve capping and reducing the cost of healthcare. Affordable Care Act is a step in that direction. ACA, of course, may not work as envisioned, or ACA may still not keep rising health costs in check. With so many other countries enjoying better health outcomes at 1/2 the cost, it will become more and more difficult to keep proposing GOP solutions which also will do nothing to control costs.

With respect to military spending, there can be no less stringent a review of where money is spent than with the rest of discretionary spending. Without a doubt there is waste in the DOD budget. Real world realities may, however, require continued high spending in order to deal with rogue countries. While that is not justification to maintain high discretionary spending too, the issue of fairness will need a full explanation if defense goes up and discretionary goes down.

These reactions, however, are not new. Many have called the GOP out on these proposals in the past. As we think about this week’s Supreme Court decision allowing even greater political donations, one finds it hard to avoid thinking that the real goals are not a balanced budget, or a more workable healthcare system, or even reformed entitlements.

The GOP number one goal must be first and foremost lower taxes and let the fall out be as it will be. Adding to that “benign neglect”, indifference towards women, gays, and immigrants, I can’t see how the GOP can expect to do better in 2014, let alone 2016.