Obamacare

Pin It

Medicaid in Oregon: Does it Really Matter?

by Elias Isquith on May 5, 2013

NewImage

God help me, I just don’t understand conservatives sometimes. I disagree with them most of the time, but I usually understand where they’re coming from. But sometimes my best acts of imagination pale in comparison to their given task. Human beings are complicated, mysterious, even phenomenal creatures; explanations that boil down to Because They’re Bad won’t cut it.

And yet, for the life of me, I can’t figure out why conservatives have seized on this Oregon Medicaid report with such tenacity and glee.

Which is not to say I don’t get the politics of the move. Those are all too easily understood. While the study found that access to Medicaid improved the mental and financial health of 10,000 Oregonians accepted into the program on a one-time basis, it also found that their overall physical health did not improve at a level deemed statistically significant. For seemingly 90-plus percent of conservatives, the end of that sentence was all they heard. It was all they needed.

That’s unfortunate, of course, because, well, the results were a lot more mixed than that! As stated, people’s mental health improved (dramatically) once they got on Medicaid. Their finances too. In fact, Kevin Drum argues that the physical health effects were more consequential than the “statistically significant” qualifier would lead you to believe: “the study showed fairly substantial improvements in the percentage of patients with depression, high blood pressure, high cholesterol, and high glycated hemoglobin levels [but] the sample size of the study was fairly small, so the results weren’t statistically significant at the 95 percent level.”

Now, I’ll admit having some biases here, being someone with not-always-awesome mental health and not-always-disaster-proof personal finances — but I’m comfortable with these biases; millions of others have them too. And speaking for us hand-to-mouth sad-sacks, the prospect of greater happiness and decreased stress sounds mighty fine indeed. Certainly reason enough to support a reasonable change in public policy. Increasing happiness and stability; is that really so bad?

If the question is put in those terms, obviously, it’s a bit loaded. But most of the smarter conservative trumpeters of this report aren’t addressing this question differently, they’re more or less ignoring it altogether. A debate over whether or not it’s proper for government to expand opportunities for happiness and stability is in danger of being subsumed into a secondary, less-important, and technical issue of statistical significance. That fact that, in this study, access to Medicaid did not clear a threshold for reducing high blood pressure, this is being shoehorned into a larger argument against Medicaid itself.

It’s a red herring, an argument proffered by those who seem to understand that if the debate were held on its basic, most democratic level, they would lose. I think they’re right.

{ 31 comments }

Pin It

Obamacare’s Bad Politics

by Elias Isquith on May 2, 2013

Obamacare

With the implementation of Obamacare soon to really begin in earnest, some conservatives have begun preemptively crowing over what they’re convinced will be a disastrous transition period. Considering they’ve spent the past three years gumming up the bureaucratic works as much as possible, they very well may be right.

But even if they aren’t, the American Prospect’s Paul Waldman worries that the bedtime story liberals tell themselves about Obamacare, that it will soon be just as beloved by the masses as Medicare and Social Security are today — and that Republicans will consequently shy from attacking it head-on — is going to look foolish in hindsight:

One of the biggest problems…is that Obamacare isn’t a single program like Medicare that people can come to love. It’s a whole bunch of pilot programs and new regulations, many of which involve private insurance or existing programs like Medicare and Medicaid, and when people are affected by those changes they won’t necessarily see them as being part of Obamacare…Your relationship with the insurer you choose will certainly be affected deeply by the ACA’s regulations, but most people still won’t understand exactly how.

Among the consequences are that Republicans will be absolutely free to continue to blame every problem anyone has with the health care system on Obamacare, without concern of producing a backlash from the law’s supporters. Compare that to how they talk about Medicare, a program they’ve hated since the moment it was proposed. Because they know how much seniors love their Medicare, they have to pretend they would never harm a hair on the program’s lil’ ole head…

That ridiculous kabuki Republicans are forced into is what protects Medicare from the shivs they’d love to jam into its hide. But nobody is going to shout, “Take your hands off my Obamacare!” because Obamacare isn’t going to be perceived as a thing you have. It’s just a bunch of rules governing how other things run.

I recall this argument being raised a few years ago, back when wild supposition about a bill years away from implementation was still cool. I thought it was probably right then, and still think so now.

It’s certainly a fact of American politics that the public, by and large, has no idea idea how much and what their government does. And when you’ve got a program like Obamacare, one that in so many ways embodies what is called the submerged state, a disconnect between what the public gets and what it thinks it gets — and why! — is highly likely if not outright inevitable.

So let’s stipulate that the public will never conceive of a thing called Obamacare, that Obamacare is a panoply of changes, most of them bureaucratic, that will improve people’s lives to a degree almost inverse to its presence in their consciousness. Next question is easy: why did Democrats put so much at stake for a bill that, just on the political level, is kinda-sorta terrible?

Well, this is where ideology comes in — particularly the fact that America remains very much enthralled to the ideology behind the free market. I know a lot of true-blue market absolutists would find conflating Obamacare with the free market risible; but that’s a product of temporal partisan bickering rather than a true philosophical divide. And while more than a few liberals went overboard, it’s still true that, fundamentally, Obamacare is patterned off of center-right proposals.

Living as we are in a time when, at least among elites, free-market dogma seems immune to the intellectual disfavor you’d expect after the worst financial crisis in 80 years, the prospects for progressive legislation that doesn’t take the form of the submerged state are simply lousy.

To put it simply, what chances could a less market-oriented, more statist plan truly have in an environment where Obamacare, a consummately neoliberal (i.e., liberal ends through conservative means) bill is fast-transformed into the trojan horse with a panel of Dr. Kevorkians inside? Until that question seems like an outlandish, Cassandra-esque hypothetical, the submerged state is probably the best liberals can hope to get.

{ 35 comments }

Pin It

The Realm of the Political

by Elias Isquith on April 13, 2013

Afpgetty 147343979

To begin, allow me to quote myself:

That was a pretty popular tweet, at least by my standards. And when I wrote it I was thinking primarily about same-sex marriage, which is rapidly — and through no small amount of effort on the part of activists and Father Time — becoming the kind of thing that many people don’t see as having to do with politics at all. That’s a win for supporters of LGBTQ equality, even those who don’t particularly thrill to see the further embrace of what they see as an inherently conservative institution.

I must admit, though, that I think of this concept most often when pondering the arguments of those on the Right. And a new long-read from National Review’s Yuval Levin and Ramesh Ponnuru is something of a case-in-point.

Both Matt Yglesias and Kevin Drum do a fine job of disassembling Levin and Ponnuru’s plan, but I honestly don’t think it’s worth the time getting into, unless you’ve simply got a jones for health care policy arcana (an affliction I do not have and never will). The plan isn’t that different from Paul Ryan or Mitt Romney’s vision of America’s health care future. Less federally provided coverage, less taxes on the wealthy to pay for it, and a decent amount of magical thinking about how competition will clothe the naked, feed the hungry, and heal the sick.

What the plan doesn’t do is treat universal coverage as the end-goal of reform. This isn’t made explicit, because it’s a politically untenable position (“Die quickly” caught on for a reason), but it’s true. The conservative approach to health care privileges reducing costs over providing coverage. And in a way that’s fine. Sure, a lot of the handwringing over health care costs is simply handwringing over the prospect of having to pay more taxes to support the Baby Boomers; but someone has gotta worry about costs and just so long as we’re not talking warfare or upper-class tax cuts, that someone is the GOP.

As you can tell, however, I don’t really care about cost control. I think it’s a way overhyped concern that acts as something of a trojan horse for the weakening of the welfare state. (But like Floyd Gondolli says, that’s just me.) What I care about is the moral imperative, as I see it, for a wealthy nation to provide all its citizens with health care. I want a future where injury or disease isn’t a financial death knell; I want a future where people don’t need to worry about their health any more than they want to; I want universal coverage that’s as cheap for the patient as possible. That’s it. That’s the goal.

You could say a lot of things about my ideal. One thing you couldn’t say is that it’s the same as Ponnuru’s or Levin’s. Everything I’d focus on, the bleeding heart stuff, they’d rather not consider political in nature. For example, just as we don’t have long political debates over solutions to strangers acting passive-aggressive, seeing it as a problem government could not even begin to address, conservatives tend to argue as if providing full health care — not just insurance in the case of catastrophe — should not be a political concern.

Here’s how Drum puts it:

…about a third of the country, maybe more, just flatly can’t afford decent healthcare for their families. No amount of smooth talk about HSAs and tax treatment and catastrophic care will change that. So you can either pay for this coverage via tax dollars or you can let them go without, and chalk it up to nature red in tooth and claw.

Taking health care out of politics and putting it back into nature. That, in a phrase, is the GOP position on the issue. It’s similar to lefty attempts to take same-sex marriage out of the realm of the political — to make it an unimpeachable reality of society, too sacred to be sullied with debate and legislation. You could probably find better ways to explain American politics. But you could definitely do worse.

{ 10 comments }