Parameter name: request
Translate Request has too much data
Parameter name: request
There will be two national elections before the new health overhaul is substantially implemented (in 2014) and a third election the year it is supposed to be implemented.
Question: Will the voters reward office holders who supported the Affordable Care Act (ACA), or will they vote for their opponents? In thinking about this question, forget all the public opinion polls. Can you predict the outcome based on what you know about political science alone?
My prediction:? Supporters of the new law are going to get creamed. As I explained at my own blog the other day, there are four reasons: The law violates two bedrock principles of coalition politics that have been successful for the past 80 years; it abandons core Democratic constituencies; and it ignores the fundamentals of the politics of the health care sector.
Franklin Roosevelt's First Principle of Successful Coalition Politics: Create benefits for people who are concentrated and organized, paid for by people who are disbursed and disorganized.
The ACA ?violates this principle in spades. The main beneficiaries are many (but not all) of the new law are 32 million to 34 million newly insured people who otherwise would have been uninsured. Far from being organized and focused, most people in this group do not even know who they are. Indeed, it is probably fair to say that never in American history have so many benefits been conferred on so many people who never even asked for them!
Another group of potential winners are those with pre-existing conditions. But if the low take-up rate for the newly created risk pools is any indication, people who are potentially in this group aren't rushing to embrace the new law either. Odds are, most of them are very uncertain about how they will fare.
People who are going to pay for the reform, by contrast, are organized, focused and aware that they are in the target zone.? If you work for a tanning salon, if you make wheelchairs, if you are a health insurance agent, etc., you may not know your exact burden, but you know that the law was not written for your benefit.
The administration also hurts its cause when it singles out the wealthy as deserving of special pain. If they talked about taxing capital gains and dividends, many people might wonder what that meant. But by repeating over and over again that there is a $250,000 income threshold, (and by vilifying everyone who exceeds it), almost everybody who is in the crosshairs knows full well he is in the crosshairs.
My bet: the organized and the focused will have disproportionate impact on election day.
Franklin Roosevelt's Second Principle of Successful Coalition Politics: Benefits should be visible and overt; the cost of those benefits should be hidden and covert.
The idea behind Roosevelt's National Industrial Recovery Act (NIRA) was politically brilliant. Following Mussolini's model of Italian fascism, each industry was to be allowed to collude and act like a cartel — restricting output and raising prices. The winners (the producers) had a good idea of what they could expect to gain, while the losers (the consumers) had no idea.
By contrast, most of the benefits of the ACA are distant and abstract. The costs are upfront and real. Granted, the administration is trying to get everyone focused on the measly benefits that are being dribbled out in the first few years. Its problem: there just aren't enough 26-year-old voters who really need to sign up on mom and dad's health plan.
By the way, we've been through this before — in health care! The Medicare Catastrophic Care Act of 1988 imposed costs that were upfront and clear in return for benefits that were distant and vague.? Congress came back the next year and repealed the whole thing.
Democratic Constituencies: Organized Labor, the Poor, the Elderly and Especially the Poor/Elderly. I keep forgetting to mention that the Obama White House and the Democratic Congressional leadership did a brilliant job of getting almost every special interest in Washington, D.C., to sign on to its health bill. This meant getting the American Medical Association to sell out doctors, AARP to sell out seniors, the trade unions to sell out their members, etc., etc., etc.? Indeed, I believe historians will rank this frenzy of backstabbing and betrayal as one of the great legislative accomplishments in American history.
Of course, this feat can survive election day only if the people being sold out don't know they have been sold out. Yet people have a strange knack for figuring out what's in their self interest.
The surprise in all of this was the willingness of Democrats to abandon their core constituencies:
Note that no one has ever voted for any of this! Democrats didn't think they were voting for this when they nominated Barack Obama. General election voters didn't think they were voting for any of this either when they elected him president. November will be the first time voters will have a chance to say what they think.
The Politics of the Health Care Sector: Doctors, Hospitals and Drug Companies. People generally like their doctors. They tend to think fondly of their local hospital. Very few people feel warm fuzzies about drug companies located — where? Some place in New Jersey?
Yet in the health bill, doctors get taken to the cleaners. Hospitals get massacred. And drug companies make out like bandits. Former Medicare Trustee Thomas R. Saving and his colleague Andrew J. Rettenmaier compared spending projections in the 2010 and 2009 Trustees reports. The difference, shown in the chart below, mainly reflects the effects of the Affordable Care Act. As the chart shows:
Of course, the drug companies promised millions to help Democrats get re-elected.
Will that work?? We'll see.
John C. Goodman is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s health policy blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.
Comments
And you know what, the majority of people who will attack this posting are interested first and foremost on what is in the best interests of the Democratic Party, not the public, not the core principles of doing what is right and responsible, and certainly not what is in the best interests of the patient-physician relationship. And I can say this without any doubt I am most likely right, because this Congress never really had an interest in the direct opinions of who was most impacted by this legislation: patients and physicians.
So, let's see who will be upfront and put out their disclaimer why they disagree so passionately with this post, and who will just write paragraphs of verbal nonsense and then expect readers to just believe them.
Here is my disclaimer: I took an oath over 20 years ago to treat people and do what is right and responsible, and the rest that will be more good than bad will follow. I am a registered independent, and never vote a party line in any election. And, I have no financial interests in any medical care organization or system, I have been for the most part a salaried physician for different health care systems in my career, and have never earned more than $150K in a year.
And, I know bs when I see it, and this legislation is not a joke, but foul, disgusting, intrusive garbage. I hope it sinks as many political careers as it can, and I will shed no tear for anyone who voted for it and is not reelected, but moreso, not for any incumbent in office more than 12 years. They as a collective group have failed in representing the American public, and if there is a god or force looking out for the better good, November 3rd is the beginning of hope.
I can't wait to read what follows this comment!!! I think this is a great post, thank you for writing it!
Posted by: ExhaustedMD | Oct 19, 2010 4:34:14 PM
Someone once quoted, 'the stand you take on a position depends on where you sit'... in other words we all have agendas-- be it pundits or physicians or me. And these bedrocks you quote, are more akin to the coda for magicians and crooks, aka misdirection. Look over here, while I take something from you over there. Let's face it the entire system is broken.
I am not a big fan of government driven approaches and neither am I a fan of corporate driven solutions. Neither has our best interest at heart and why the county is up in arms about HC reform, instead we should be up in arms for spending money on wars that were a waste of our money and policies of greed that have driven this country to the brink or moral corruption.
But all of us have an agenda, and until you put your own agenda out on a ledge, you cannot see the best for the Country or the world. Our politicians are not working in the best interest of the USA they are looking out for their next re-election. Neither party deserves to get re-elected as they are either Democrats running scared or Republicans who are obstructionists. I'll bet if we call this a War on Health, the politicians would rally.
So let's clarify some misconceptions- one the uninsured are already affecting the system. They are either showing up to an overburdened ED or they are deferring their treatment until they are really sick. Who does this hurt, well the disbursed, the disorganized, the centralized and the organized, and mostly those of us that are already insured be we middle class, employed or rich, in other words many of us. Because our insurance premiums are higher covering for those that are not covered or our hospital costs are higher because hospitals charge more to cover for unreimbursed expenditures.
What we really need is a system that incentivizes wellness and prevention and not post illness or diagnosis. Most states for example require car insurance or you cannot drive, why is the HC reform any different? Why are you all agog over requiring HC insurance. Most states require some form of preventive maintenance (smog tests, annual inspections) to catch problems before they affect the greater whole. But for some reason we cannot see or do this for ourselves.
Instead we all sit on our comfy couches watching TV/ internet, eating unhealthy food products and ultimately ending up sicker than we should, because of poor choices. I for one do not want to pay for someone elses poor choices and neither do I want to pay for the uninsured at a much higher cost, because they do not have access to primary care or wellness programs.
The exhausted physician, you have an agenda, and I get that, but this informed patient is telling you to become more efficient(learn to use a computer /EHR), work in hospitals that are leaner, help us reduce pharmaceutical dependence and reduce costs in the process. Let's look out for the disbursed and the disorganized because they are costing us anyway in more ways than we can imagine.
Posted by: Informed Patient | Oct 19, 2010 5:57:08 PM
"Note that no one has ever voted for any of this! Democrats didn't think they were voting for this when they nominated Barack Obama."
"Of course, the drug companies promised millions to help Democrats get re-elected."
The above quotes typify the right wing blarney you can always expect from the clown who fired Bruce Bartlett for daring to say Bush wasn't conservative.
Posted by: cliffk | Oct 19, 2010 6:11:04 PM
Wow!!! Certainly unique post.... I haven't seen "brilliant" and Mussolini mentioned in the same context in a very long time....
Posted by: Margalit Gur-Arie | Oct 19, 2010 6:34:22 PM
" .. haven't seen "brilliant" and Mussolini mentioned in the same context in a very long time...."
Odd. OWE-bama and FASCISM have been jointly mentioned daily for months.
Time to start actually believing in free speech ..
Posted by: Frank | Oct 19, 2010 7:31:00 PM
Well, that was quite the frenzy of attempted evisceration. Some of that wild stabbing even hits the mark.
However, mostly it misses. On the one hand, we have the comment that people have a "knack for figuring out what is in their self interest." And yet the large subsidies for health insurance to the working poor are going to be given to people who, "far from being organized and focused, most people in this group do not even know who they are. Indeed, it is probably fair to say that never in American history have so many benefits been conferred on so many people who never even asked for them!"
Remarkable how that knack disappears when convenient.
And the whole piece is like this. On the one hand, we have costs that are too high, but on the other hand when Medicare costs are projected to go down relative to current trend (not in absolute terms), that is a betrayal and will harm seniors (rather than result in any reduced inefficiencies and waste which we all agree are needed).
Posted by: jonathan (jd) | Oct 19, 2010 7:44:05 PM
Frank, it wasn't an Obama and Mussolini link she was referring to, but a comment that Roosevelt imitated Mussolini and was "brilliant" in doing so.
As for the association of Democrats with fascism, this has been a sustained effort on the part of the right for several years. Jonah Goldberg made a splash doing this, and it has gotten more pronounced since then. I suspect this is because for a long time the right was associated with fascism (and the left with communism), but right wing folks like Frank chafed under parallels drawn with Hitler and Mussolini, so decided to reinvent themselves and turn the tables. Nowadays, you'll find far more Hitler slurs thrown at the left than the right. It's like a campaign.
Posted by: jonathan (jd) | Oct 19, 2010 7:53:28 PM
"Of course, the drug companies promised millions to help Democrats get re-elected.
Will that work? We'll see."
http://www.opensecrets.org/industries/indus.php?ind=H04
As usual is the case, Goodman is either misconstruing facts or flat out wrong. In this case, it is both. Pharma typically is a heavy and reliable GOP donor as the charts indicate. Like most GOP donors, they hedged their bets a bit to make it more 50/50 with the Democrats full in control after the '08 elections by clear majorities in the Senate and House.
"The idea behind Roosevelt's National Industrial Recovery Act (NIRA) was politically brilliant."
Really? It cost Roosevelt a bit in the '34 elections and there were alot of Southern Democrats who were conservative and opposed much of the NRA because they felt the executive was taking over directing many functions that were clearly the provision of the Congress (I know crazy that Congress would actually stand up to the Executive Branch).
This lead to the formation of the Southern Coalition between Democrats in the South and some GOP members. Hell, the Supreme Court found aspects of the NRA unconstitutional in '35 and Roosevelt was no shoo-in to win the '36 election because parts of the NRA were so unpopular and many people (both Democrats and GOP members) thought FDR had overstepped his bounds.
Posted by: MG | Oct 19, 2010 8:29:13 PM
How was the NRA was 'fascist' when it guaranteed trade union rights, permitted the regulation of working standards, and promoted collective bargaining. Fascism is generally the unison of gov't aligned closely with corporate interests and those things aren't in the interests of 'corporations.' NRA was many things but labeled it 'fascist' is a stretch at best and more likely a misclassifcation but political history/theory aren't strengths of the American public as a whole.
Posted by: MG | Oct 19, 2010 8:37:42 PM
"I suspect this is because for a long time the right was associated with fascism".
While this statement is true of the European Right, it is not true of the historical origins or current reality of the US right. The US right wing has been generally understood to map to European classical liberal and Whig parties. Fascism is another form of collectivism, albeit a toxic one. The US right has, historically, been the least collectivist party in the US.
Posted by: MB | Oct 19, 2010 9:10:35 PM
The state of Texas Medical Board needs to hand over Robert Robinson medical MRI's they took of his upper extremity and neck. The Texas Attorney General Open Records needs to force the Texas Workers Comp to hand over Roberts Two MRI's one before the botch surgery and the one taken after the botch surgery under Dr. Gary Gartsman in Houston Tx at St Lukes Hospital. Now this is one of many issues that real people have in our health care, crap like this and what is more despising is having people working in these type of Government agency's that allow this crap to go on in our Health care . TIME FOR A CHANG
Posted by: robert | Oct 20, 2010 5:24:03 AM
To the extent that the American electorate can become educated (I'm not holding my breath) on what Obamacare contains, then politicians will be punished. Otherwise, never underestimate a politician's ability to pull the wool over the eyes of the average American voter.
Posted by: Brian Williams. | Oct 20, 2010 6:38:37 AM
Maybe this is not the best place for this link, but, having read it twice and felt the paragraph in the middle is so applicable to this site and the push for electronic medical records without regard for consequences, I'll note it here, include the link, and hope those who are open minded and interested in ideas, not quick fixes first, will read it:
Breee Barton is the author of the piece in USAToday:
"Welcome to life in 2010. We've never been more connected to the people around us. We've never been more disconnected, either."
http://www.usatoday.com/news/opinion/forum/2010-10-20-column20_ST1_N.htm
Trust me, when people start putting their faith and expectations that computers and technology will answer the questions and solve the problems, there will only be more aggravation and heartache when the human interaction is pushed further away. Computer access is only part of diagnosis and treatment, our nature is to seek out instanteous gratification, and only those who reframe problem solving and solution seeking make progress. And trust me further when I say a sizeable portion of the Medicaid population alone are not interested in reframing!
That is not an indictment of a population, but an observation that might have a healthy intervention for the better, but, not by this legislation!!!
Posted by: ExhaustedMD | Oct 20, 2010 10:00:24 AM
I am not from the US, so my perspective may be wrong. But if I understand anything about human psychology,especially that of poor people, then I can say that even when people are disorganized they know what is in their interest. I am certain the uninsured/ underinsured know exactly who they are. The question is will this benefit be good enough for them to change their voting decission.
Posted by: Pradeep | Oct 20, 2010 10:00:44 AM
You make some good points about the delay in getting the most important benefits implemented, but you are way way off on the rest -- for example --
The surprise in all of this was the willingness of Democrats to abandon their core constituencies:
"Labor union members will now see their health plans taxed." -- not all labor unions. The number of union plans that may be subject to tax is relatively small.
"People in Medicaid will have to compete with 16 million new enrollees in a medical marketplace that will have only a handful of new doctors and a significant reduction in Disproportionate Share payments for safety net hospitals. --" You fail to note the substantial amount of money that is being directed toward community clinics and safety net providers, and training of new physicians to help with the Medicaid expansion.
"Seniors as a group will bear more than half the cost of reform, as Medicare payment rates fall below Medicaid's before the decade is out.
Members of Medicare Advantage plans — elderly, low income, disproportionately minority (the very profile of a Democratic voter!) — will lose a third or more of their benefits by 2017 in many U.S. cities." That is just BS. I'm one of those beneficiaries and my plan is actually better for 2011 than it was in 2010. MA will continue to be in the market, and plans are already figuring out how to stay profitable. The savings will come out of the insurers' hides and hopefully the government and state regulators will have the guts to keep them honest.
BOTTOM LINE? I see you are part of an organization that promotes HSAs and CDHPs. They are NOT the answer to the health care crisis. You conservatives had 8 years to show what you could do to bring health care costs down under Bush and what did you do? Passed the Prescription DRug Act, which was NOT paid for, and will add a trillion to the deficit in the next ten years. Easy to criticize health reform, isn't it? Not so easy to really fix it.
Posted by: LindaB | Oct 20, 2010 11:09:10 AM
Exactly, LindaB, "not so easy to really fix it", and yet by your rhetoric we should just accept this legislation without dissent or pause? And having a better plan in 2011 ensures it will as good in 2017?
Legislators pass a bill the size of what, 2500 pages, and freely admit they did not read it? And you are ok with this attitude?
If you answer yes to that last question, not only are you part of the problem, you deserve the problems this legislation will create as time progresses!
Wow, ignorance is not just prevalent, it metastisizes!!!
And, by the way, while HSA's are not applicable to the population at large, this legislation will basically outlaw it for the sizeable population that could benefit from using it. Your Democratic agenda is very obvious, and, you gotta love people who promote that they care, when the law is careless!!!
Read the links, with some objective and unbiased ablility. Otherwise, wait for when the choir bites you when you least expect it!!!
Posted by: ExhaustedMD | Oct 20, 2010 12:43:55 PM
" .. Nowadays, you'll find far more Hitler slurs thrown at the left than the right. It's like a campaign."
Why .. of course. When the watermelons (green outside, Commie-red on the inside) win, the taxpayers are brilliant, kind and angelic.
And when they lose -- Nov. 2, hurry up -- the taxpayers are stupid, greedy fools.
USA taxpayers are so much smarter than the OweBama/Harvard Law crew, it isn't funny. They know when they are being LIED to.
Posted by: Bart | Oct 20, 2010 1:23:37 PM
John, you need to complemented for writing a well thought out post on such a difficult and divisive topic.
This could have been really legislation, until the special interests and political ideology hijacked it. While people complained about the HMO's, our healthcare system works, and works well.
Yes, costs are too high. That was mostly due to lack of competition and legal issues.
When the gov't decides winners and losers, such as the wealthy and unions, we all lose in the end. Sicne when is $250,000 rich today?
If the Obamacare legislation was so good, Dems would be running on it, not running from it.
Posted by: Ken | Oct 20, 2010 1:34:18 PM
Too tired to comment on the OP. But Ken, do you have any idea about income distribution in the US when you doubt that a person making 250K a year is rich?
Posted by: rbar | Oct 20, 2010 5:45:48 PM
Post a comment
This entry passed through the Full-Text RSS service — if this is your content and you're reading it on someone else's site, please read our FAQ page at fivefilters.org/content-only/faq.php
Five Filters featured article: Beyond Hiroshima - The Non-Reporting of Falluja's Cancer Catastrophe.
No comments:
Post a Comment