Thursday, April 17, 2014

Health Care Horror

You'd think that people were dying because they signed up for health insurance. You'd think that people were going broke because they had to leave behind their old policies that didn't cover needed expenses and treatments. You'd think that the opponents of the Affordable Care Act would come up with a specific, viable alternative that they could run on this November.

Oh, the horror. None of this is happening.

I will say for the final time that the website rollout was terrible and horrible, but it's now time to move beyond that because over 7 million people now have health insurance and the numbers keep going up. Citizens living in the most prosperous country in the world will not have to worry about medical costs bankrupting them or forcing them to lose their houses or their livelihoods. People can now make decisions based on their own life choices, rather than having to stay at a dead-end job because of the benefits.

Oh, the horror?

The real horror is being perpetrated by the states that refuse to take free federal money to expand Medicaid and cover even more people. These states are led by governors and legislatures that are acting on ideology rather than common sense. They have convinced themselves that president Obama wishes to enslave their citizens through federal programs, making them dependent on the government for their happiness. It's irrational and will eventually lead to defeat for the politicians that are erecting the legal roadblocks to health care.

The history of the United States has moved inexorably in one direction, and that's towards equality, access and enhanced civil rights. The Affordable Care Act will survive and thrive because it enables citizens to live better lives. In the end, it is truly American.

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Thursday, April 3, 2014

The Abortion Freeport Doctrine

In 1857, the US Supreme Court ruled in Dred Scott v. Sandford that slavery was legal and that slaves were property. Illinois Senator Stephen Douglas, in debates with challenger Abraham Lincoln in 1858, was a supporter of popular sovereignty on slavery, That is, he wanted to let the people of a territory decide if it was to be legally free or slave. This, obviously, wouldn't be possible given the Court's decision because the justices said that slavery could not be banned. So Douglas came up with a dance that came to be called The Freeport Doctrine. This doctrine would allow slavery, but would encourage territories to enact high legal boundaries to its implementation, rendering it moot in practice.

Despite the Supreme Court's decision in Roe v. Wade in 1973, anti-abortion groups have stopped at nothing--not even the law--to enact high legal hurdles that inhibit the right of every women to control their reproductive lives and health choices. In one of the presidential debates in 2004, George W. Bush even invoked Dred Scott as a guiding principle for his judicial choices. Abortion equals slavery. Welcome to the Abortion Freeport Doctrine.

Three states have taken this tactic to new extremes. Texas passed an onerous law that will result in the closing of more than half of the remaining clinics in the state. Arizona passed a law, now under judicial review, that would restrict medication abortions. And Mississippi Governor Phil Bryant said today that he will sign a law that will prohibit abortions after 20 weeks of pregnancy, and with no exception for rape or incest This is all on top of restrictive laws that have been passed, and have passed judicial muster, over the 41 years that Roe has been the law of the land. The Supreme Court is now weighing whether the Affordable Care Act can require all employers to cover contraception for all of its employees, because those companies consider some contraception to mimic abortions.

This is an emotional issue and the debate over abortion does not yield any middle ground. But we can find a way to make abortions less likely, provide contraception and sex education, and allow women and their doctors to make decisions that are in the best interests of the patient. That's called freedom of choice and it's something I hear a great deal about from those on the political right who want the government out of our lives, except in the bedroom. Or kitchen. Or back seat. Or...you get the point.

My solace comes from the belief that the conservative tide has crested and that we're seeing the worst of the restrictions now. Many will stay in the most conservative states, but the idea that a women's body is her own is pretty much a settled social idea that the court overturns at the country's peril. It's worth remembering that the Freeport Doctrine went nowhere. It's also worth remembering that it took another hundred years for African-Americans to gain their full legal rights. I hope we're not still debating the choice issue 60 years from now.

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Sunday, March 30, 2014

March 31 Is Only The Beginning

I suppose it would have been fitting if the Obama Administration had scheduled April Fool's Day as the last day to sign up for health insurance under the Affordable Care Act. We've certainly been treated to a smorgasbord of ineptitude, shifting deadlines, executive pronouncements that let certain economic sectors off the hook, and some rude, disrespectful, sometimes hateful objections from the right wing about the entire business.

That's why March 31 is so important. It represents the end of the first, and possibly most vital, stage of the implementation of the act. Millions of people have signed up for heath insurance. Millions of others are now covered by Medicaid. The federal and state websites are still balky, but they work. The end of the beginning is upon us. It can only get better from here. And the best part is that the law is working.

Republicans have dropped their demand that the law be scrapped, which six months ago looked like a possibility as they shut down the government and Healthcare.gov showed exactly what can go wrong when the government attempts to shortchange the software cycle. Now the arguments are that the law needs to be fixed, although GOP candidates are running against it to the exclusion of everything else, except perhaps voter ID laws that will guarantee a Republican majority in the House for the foreseeable future. Even Democrats in tossup races in Louisiana and North Carolina are talking about fixing the law so it doesn't ensnare the middle class and endanger employer-provided health insurance.

The problem is that, over time, that's exactly what the law will accomplish. We are moving into uncharted waters, where the employer mandate will shift and companies will start to drop health insurance from their benefit plans. How this will work is the key. Will companies give employees a voucher with a dollar amount attached to it to buy insurance? Will they raise wages so people can pay for their own policies? Will insurance companies bring down the cost of policies so they can remain viable? Will we eventually get a public option that takes private insurance out of the economy? These are the questions that will define how successfully the ACA reforms the health care industry. Follow the money. That's always been the gold standard of social change.

My sense is that employer-sponsored health insurance will be gone from most industries within 7-10 years, and the fallout won't be as bad as some have predicted. Companies have a vital interest in the health of their workers and insurance companies won't want to price people out of plans. Without the major expense of providing health insurance, companies will be able to pay workers more, though not too much more. The minimum wage will be less of a burden as it rises. Workers will need to make healthier choices and get checked more often before health issues become major concerns. The GOP calls this personal responsibility, and they accuse the Democrats of coddling the country with social programs. The ACA will do more for people taking control of their health than anything we've done in the United States. Remembers, the ACA is based on Republican ideas. That's why the law is both a curse and a blessing.

All of that is in the future. For now, President Obama's approval numbers are in the tank. History will remember him far more positively.

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