Tag Archives: health care

What the CBO Really Said about ObamaCare and the Economy

February 10, 2014 – 8:10 am

File this under: “Liberal media? What liberal media?”

I doubt the Congressional Budget Office expected The Budget and Economic Outlook 2014 to 2024 to be front-page news. They put out these ten-year look-aheads every six months or so, and they don’t usually get much reaction.

But say some news outlets decided to pay attention. You might expect — the CBO probably expected — reporters to focus on the summary. After all, that’s why people write summaries to 182-page government reports with eight appendices. In particular, you might expect articles to focus on the summary’s first line:

The federal budget deficit has fallen sharply during the past few years, and it is on a path to decline further this year and next year.

That sounds like a big deal. Very Serious People have been telling us for years (or more accurately, since Inauguration Day 2009, when they suddenly stopped believing Dick Cheney’s “deficits don’t matter” maxim) that the deficit is going to destroy our entire society. We’re going to turn into Greece, locusts will devour our fields, toads will rain from the sky, and so forth. So the fact that this situation is rapidly improving ought to get the VSPs attention.

The numbers are striking: The combined Bush/Obama budget of FY 2009 (October, 2008 to October 2009) had a $1.4 trillion deficit. (Bush’s first proposal for a FY2009 budget had an $407 billion deficit, which had grown to a projected $1.2 trillion by the time Obama took office, due to the economic collapse at the end of Bush’s term. Obama’s stimulus pushed the deficit the final $200 billion on its way to creating 3.3 million jobs, according to a previous CBO study.) FY 2013 ended in October with a $680 billion deficit, and the CBO projects deficits of $514 billion in FY2014 and $478 billion in FY2015.

At that level, this year’s deficit would equal 3.0 percent of the nation’s economic output, or gross domestic product (GDP)—close to the average percentage of GDP seen during the past 40 years.

So unless you think we’ve been in a Deficit Emergency for the past 40 years, we’re not going to be in one this year or next.

But that’s not what caught everybody’s attention. Instead of looking to the CBO’s summary for the story, the media (led by the right-wing media) looked to Appendix C “Labor Market Effects of the Affordable Care Act: Updated Estimates”. Because, you know, appendices of government reports are always so fascinating, especially the third appendix.

But even if you only read the appendices, you still have some choice about what the story is. Appendix B, for example, says:

CBO and JCT [Joint Committee on Taxation] estimate that the insurance coverage provisions of the ACA will markedly increase the number of nonelderly people who have health insurance—by about 13 million in 2014, 20 million in 2015, and 25 million in each of the subsequent years through 2024 (see Table B-2).

So despite all the scary (and debunked) headlines about cancelled policies and increased premiums, the ACA will make substantial progress on its main goal: Millions more people will have health insurance.

But the cost of that coverage will explode the deficit, right? Well, this report reiterated a previous conclusion:

Considering all of the coverage provisions and the other provisions together, CBO and JCT estimated in July 2012 (the most recent comprehensive estimates) that the total effect of the ACA would be to reduce federal deficits.

But maybe you’re worried about the “insurance company bailout” Republicans have been denouncing, which the rest of the world calls “risk corridors”. If so, you’d focus on this part of Appendix B:

CBO now projects that, over the 2015–2024 period, risk corridor payments from the federal government to health insurers will total $8 billion and the corresponding collections from insurers will amount to $16 billion, yielding net savings for the federal government of $8 billion.

So the “bailout” is a re-insurance plan that the government expects to make an $8 billion profit on.

But anyway, what does Appendix C say?

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor … The reduction in CBO’s projections of hours worked represents a decline in the number of full-time-equivalent workers of about 2.0 million in 2017, rising to about 2.5 million in 2024.

It’s not hard for me to imagine why this might happen: My wife is a (currently healthy) over-55 two-time cancer survivor, and prior to ObamaCare she couldn’t possibly have gotten insurance on the individual market at any reasonable rate. She happens to like her job, but many people in similar situations might decide to retire early (now that they have that option) rather than hang on until Medicare covers them. Similarly, my college roommate has been frozen into his job for the last couple decades, because his son was born with major medical problems that a new employer’s insurance company might write off as a pre-existing condition. Other people might prefer to work part-time, but have been hanging on to full-time jobs for fear of losing their health coverage. Or maybe extended Medicaid or S-CHIP coverage or an ObamaCare subsidy could shift the balance in a struggling household towards having one parent stay home with the kids.

That’s the kind of thing the CBO is talking about: “workers … choose to supply less labor”. It’s a good kind of thing.

So naturally it got covered like this by the conservative media:

Fox News: ObamaCare could lead to loss of nearly 2.5 million US jobs, report says

Washington Times: ObamaCare will push 2 million workers out of labor market: CBO

National Review: The CBO just nuked ObamaCare

And not much differently by the mainstream media:

The Hill: O-Care will cost 2.5 million workers by 2024

UPI: ObamaCare to cost 2.3 million jobs over ten years

And even a 180-degree false CNBC headline: CBO says ObamaCare will add to deficit, create reluctant work force — later corrected to allow that ObamaCare “may not add to federal deficit” rather than the accurate “the total effect of the ACA would be to reduce federal deficits”.

CBO director Paul Elmendorf testified before Congress Wednesday morning, and set the record straight. The CBO believes that ObamaCare will increase demand for labor over the next few years, creating jobs rather than killing them.

When reporters began to understand that they’d been scammed into repeating Republican talking points, many of them blamed the Obama administration. National Journal‘s headline: “The White House is Still Terrible at Explaining ObamaCare“. You see, it’s not up to reporters to check facts and inform their readers rather than mislead them. How can they be expected to print the truth when no one spoon-feeds the story to them properly? And why didn’t the White House (which doesn’t control the CBO) anticipate the report, anticipate that Appendix C would be the story, and anticipate that Republicans would twist its statements into pretzels? Shouldn’t they have been prepared for this?

That’s your liberal media in action.

By weeklysift | Posted in Articles | Also tagged | Comments (7)

Rooting for Your Country to Fail is Unpatriotic

December 9, 2013 – 11:13 am

America has decided to implement ObamaCare. Are you with your country or against it?

In America, we argue about everything. Just because the Leader proposes something, we don’t all have to get in line behind it.

We argue about whether to go to war in places like Syria, Libya, or Iraq. We argue about taxes. We argue about how much money our government should spend and what it should be spent on. We argue about which drugs and medical procedures should be legal.

We argue; it’s what we do. If you didn’t argue for your beliefs, if you just knuckled under as soon as the Powers That Be made their will known, you wouldn’t be a real American.

But we also come to decisions. We have a Congress that is empowered to pass laws. We have a president who is obliged to either veto those laws or enforce them. We have courts you can appeal to if you think those laws exceed the powers the Constitution delegates to the federal government.

In short, there are lots and lots of ways you can register your objection to a proposed public policy. Our Constitution creates many pressure points where the flow of an idea into law can be blocked.

But we do eventually make decisions.

Even after a decision is made, you can still argue that it was wrong. You can argue that we shouldn’t have invaded Iraq. You can argue that we shouldn’t have bailed out General Motors or Bank of America. You can argue that the CIA shouldn’t be launching drone attacks into countries we aren’t at war with or that the NSA shouldn’t be tracking your cell phone.

That’s not just a technicality of freedom of speech. You can make those arguments as a patriotic American, because the country has a process for reversing course. If you can convince enough people agree with you, maybe the power of public opinion will change the minds of our office-holders. And if not, elections can turn those offices over to new office-holders who can make new policies and pass new laws.

That’s not working against America, it’s part of how America works.

But there’s a line between legitimate partisanship and lack of patriotism, and this is where it runs: After a decision is made, after it is upheld as constitutional, after America has decided to do something, you don’t root for your country to fail — and you certainly don’t take action to make your country fail.

That’s unpatriotic.

Democrats respected that line when a Republican administration did something we thought was wrong: invading Iraq. We never stopped arguing against it. We never stopped trying to elect people who would get us out Iraq. And eventually we succeeded. The fighting in Iraq continues, but American troops are out of it.

You know what we didn’t do? We didn’t try to sabotage the war effort. Democratic leaders weren’t out there publicly rooting for failure. We didn’t aid the Iraqi resistance or gloat over defeats. And we certainly didn’t cheer when American troops came home in body bags. If a stray voice on a blog or in a public forum started rooting for defeat or gloating over American corpses, we jumped all over him. No external force had to police us on that; we policed ourselves.

We were Americans. We opposed what our government was doing in Iraq, but we stayed patriotic.

But on ObamaCare, Republicans have crossed that line between patriotic and unpatriotic. Let’s review a few of the ways.

McConnell and the NFL. In June, Republican Senate Leaders Mitch McConnell and John Cornyn sent a letter to the National Football League, warning it not to cooperate in efforts to publicize the law and tell the public how to get the benefits it offers. (They were successful; the NFL did not cooperate.)

This is unprecedented. Private organizations, including sports leagues, frequently take part in public information programs. When Massachusetts passed RomneyCare, the Boston Red Sox helped publicize it. Private companies like CVS, Shaw’s supermarkets, and H&R Block pitched in. This wasn’t controversial, because it wasn’t taking a position on a proposal, it was educating the public about the law.

The Bush administration organized a similar public-information campaign to introduce the Medicare prescription drug benefit. Democrats had opposed the bill in Congress (because it was written to benefit drug companies more than seniors), and we objected to the tactics used to pass the bill. But Democrats did not interfere with educating the public about how to get the new law’s benefits.

McConnell’s logic is revealing. The NFL should refuse to participate because ObamaCare “is one of the most divisive and polarizing political issues of the day.” Actually, no, it had been a political issue, but it was now a law. McConnell admitted as much, but discounted that fact because “this law was enacted … on a strictly partisan basis”. In other words, the constitutional process is insufficient as long as Republicans disapprove.

The Koch Brothers’ creepy Uncle Sam. The Koch brothers have funneled millions of dollars into ads that aim to sabotage ObamaCare by getting young people not to sign up. Not only are these ads misleading — amounting to an anti-public-education campaign against the law — they also turn a symbol of America, Uncle Sam, into something sinister and threatening.

This is well within the Kochs’ legal freedom of speech — just as it would have been within the freedom of speech of anti–Iraq-War billionaires to run creepy and misleading ads telling young Americans not to sign up for the military. (No such ads ran.) But it is similarly unpatriotic.

The fake Cover California web site. Republicans around the country crowed over the problems of the HealthCare.gov web site. Crowing over your country’s failures is unseemly enough, but California Republicans took it one step further: They set up a fake web site to actively confuse Californians looking for health insurance.

California is one of the states that set up its own ObamaCare exchange with its own web site, Covered California. The state web site was working much better than the national one, so naturally something had to be done to monkey-wrench it. Republicans put up their own fake site, Covering Health Care California, where you can’t sign up for health insurance, but you can access anti-ObamaCare propaganda and misinformation. Republican state representatives then distributed a mailer publicizing the bogus web site.

This is not normal. You want to argue that ObamaCare is a mistake and should be repealed? Fine. You want to run on a repeal platform? Fine.

But America has made a decision to do something about its 50 million uninsured. That decision, made through our constitutional process, is to implement ObamaCare. When you take action to screw that implementation up, you are working against your country.

It’s that simple.

By weeklysift | Posted in Articles | Comments (9)

The ObamaCare Panic

November 18, 2013 – 10:13 am

Here’s what I like least about being a Democrat: Way too often, when the conservative media machine either exaggerates or completely invents an issue, our leaders — in the media, in Congress, and even the administration — wilt under the pressure. Rather than rather than defend good policy (or even defend reality sometimes), they start legitimizing the phony issue created by their enemies.

Remember the bogus ACORN pimp video? It was a fraud perpetrated by conservative “journalist” James O’Keefe, for which he and his partner ultimately paid an ACORN employee $150,000 in damages. But the truth came out only after Congress had been stampeded into passing a law  banning ACORN from applying for federal contracts. (Ultimately, a GAO investigation found no evidence that ACORN had mishandled federal funds.) ACORN was forced into bankruptcy and no longer exists. So Democrats in Congress assisted in destroying an organization whose main sins were registering poor people to vote and trying to raise the minimum wage.

Good job, guys.

Over the years panicked Democrats have authorized the Iraq invasion without looking too hard at the “intelligence” the Bush administration supplied, supported torture, abandoned a public option in ObamaCare even though the public wanted it, and given in to the idea that the deficit — and not creating jobs — is the top economic problem.

Remember when the Obama administration fired Shirley Sherrod? On the basis of yet another video doctored by conservative activists? Even Bill O’Reilly apologized for that one.

Just last spring, Democratic Senate Finance Chair Max Baucus proclaimed the IRS scandal an “outrageous abuse of power and a breach of the public’s trust” while Senator Joe Manchin railed: “The actions of the IRS are unacceptable and un-American. … The president must immediately condemn this attack on our values, find those individuals in his administration who are responsible and fire them.”

Yeah, that one was bogus too.

So now we get to ObamaCare. The HealthCare.gov* web site has been a problem and first month sign-ups were below expectations. That has created an atmosphere of trouble around the program, which the conservative media exploited by drumming up a bunch of ObamaCare-killed-my-dog stories. A lot of them have been fabricated from nothing, and most of the rest are exaggerations.

Small business. Sean Hannity devoted a whole show to “victims” of ObamaCare. A tiny amount of follow-up by Salon’s Eric Stern showed that none of Hannity’s guests were actually victimized.

First I spoke with Paul Cox of Leicester, N.C.  He and his wife Michelle had lamented to Hannity that because of Obamacare, they can’t grow their construction business and they have kept their employees below a certain number of hours, so that they are part-timers.

Obamacare has no effect on businesses with 49 employees or less. But in our brief conversation on the phone, Paul revealed that he has only four employees. Why the cutback on his workforce? “Well,” he said, “I haven’t been forced to do so, it’s just that I’ve chosen to do so. I have to deal with increased costs.” What costs? And how, I asked him, is any of it due to Obamacare? There was a long pause, after which he said he’d call me back. He never did.

There is only one Obamacare requirement that applies to a company of this size: workers must be notified of the existence of the “healthcare.gov” website, the insurance exchange. That’s all.

Fox’ Megyn Kelly did a similar segment on a car-wash-chain owner who claimed he sold his business because of ObamaCare. Stern again followed up. It turns out Kelly had asked for no information to verify the impact of ObamaCare on the business. Stern’s interview paints a more complete portrait: The guy had been thinking about selling out for several years, he didn’t like Obama anyway, and the prospect of figuring out how ObamaCare would affect his business gave him an aw-fuck-it moment. In short, not exactly a horror story.

Hannity claimed, “These are the stories that the media refuses to cover.” But in fact the stories that aren’t getting covered are the positive ones. TPM’s Josh Marshall is in the perfect position to cover ObamaCare’s effect on small business, because TPM is itself a 20-employee business. He sums up:

[A]t least on year one in New York State, Obamacare seems to basically be a wash for us in terms of premiums versus last year. However, it’s arguably saving us money since this will be the smallest year over year premium increase since we bought our first group policy back in 2005.

I’m sure Megyn Kelly will be featuring Josh on her show any day now.

Canceled policies. The whole point of ObamaCare was to solve two problems: Nearly 50 million Americans had no health insurance at all, and about another 30 million had bad insurance; they might be insured against a broken arm or something similarly minor and fixable, but their policies either

  • didn’t cover the health problems they were most likely to have (i.e., complications from pre-existing conditions)
  • or had benefit caps that made the policy useless in the face of a major health issue,
  • or the insurance company could cancel the policy if they had the audacity to get sick.

Consumer Reports tells this story:

Judith Goss, 48, of Macomb, Mich., believed that the Cigna plan she obtained through her job at the Talbots retail chain was “some type of insurance that would cover something.” When the store she worked at closed in January 2011, she even paid $65 a month to keep the coverage through COBRA.

“I was aware that it wasn’t a great plan, but I wasn’t concerned because I wasn’t sick,” she says. But in July 2011 she was diagnosed with breast cancer, at which point the policy’s annual limits of $1,000 a year for outpatient treatment and $2,000 for hospitalization became a huge problem. Facing a $30,000 hospital bill, she delayed treatment. “Finally my surgeon said, ‘Judy, you can’t wait anymore.’ While I was waiting my tumor became larger. It was 3 centimeters when they found it and 9 centimeters when they took it out.”

That’s what you should picture when you hear about canceled policies. Replacing junk insurance with real insurance is part of the good news of ObamaCare.

Of course if you don’t get sick, you don’t notice that your insurance sucks. Such was the case of Dianne Barrette, a Florida woman CBS found whose inexpensive policy is being cancelled. Her story went viral, so Consumer Reports looked into it:

“She’s paying $650 a year to be uninsured,” Karen Pollitz, an insurance expert at the nonprofit Kaiser Family Foundation, said. “I have to assume that she never really had to make much of a claim under this policy. She would have lost the house she’s sitting in if something serious had happened. I don’t know if she knows that.”

Yes, President Obama did say “If you like your health plan, you can keep it” in response to the liars who claimed that ObamaCare was a government takeover that would totally disrupt everyone’s health insurance. (Herman Cain, a cancer survivor whose coverage as a millionaire CEO would have been completely unaffected, claimed ObamaCare would have killed him.) Clearly Obama overlooked the possibility that you might like your junk insurance because you’re an effing idiot.

The media is also overlooking the possibility that when insurance companies say they have to cancel your plan and your new plan will cost more because of ObamaCare, they might be lying. TPM reports:

Across the country, insurance companies have sent misleading letters to consumers, trying to lock them into the companies’ own, sometimes more expensive health insurance plans rather than let them shop for insurance and tax credits on the Obamacare marketplaces — which could lead to people like Donna spending thousands more for insurance than the law intended.

Real ObamaCare “losers”. The exception are these folks, a couple found by Pro Publica. Because they were in a risk group cherry-picked by the insurance company to be people who never got sick, their premiums were lower than any policy for the general public can be. Since there’s no way to solve the overall health insurance problem while cherry-picking the healthy for special rates, they end up being ObamaCare “losers”.

But a TPM reader who shares their “plight” puts his situation in perspective:

Having insurance, even crappy insurance, in the individual market means we are almost by definition, healthy and relatively young. If we were not, we wouldn’t be able to get coverage of any kind in the non-group market. If our ACA-compliant replacement policy costs us more, it’s likely because we’re too affluent to qualify for subsidies.

It takes a remarkable degree of self-absorption and sense of self-entitlement to be healthy, young(ish) and affluent—and yet consider oneself a “loser.” It’s a label I reject out of shame (no matter how much the lazy, superficial MSM want to fixate on me and my “plight”) NOT because there’s anything shameful about being a loser; the shame is in thinking oneself a loser when one is actually fortunate.

Again, the positive cancelation stories aren’t getting covered. This week, one of my FaceBook friends posted his experience:

I got the notice yesterday from Anthem Blue Cross that my insurance isn’t ACA compatible and will be cancelled. I’m one of the million or so Californians to have their insurance cancelled.

If I do nothing, Anthem will automatically switch me to a comparable (slightly better) plan. The good news – it will cost $265/month LESS than the old plan! Woo-hoo! I think that the difference is because I no longer have to pay the higher HIPAA premium rate because of my pre-existing conditions. Thank you, Obamacare.

Wilting Democrats. If you believe that the major news properties are liberal, you might expect a lot of front-page stories debunking the ObamaCare panic stories. Guess again.

The so-called liberal media has piled on to the anti-ObamaCare memes promoted by Fox News, like a front-page NYT story comparing ObamaCare to Hurricane Katrina. The best response I found was this chart:

But what about Democratic politicians? Surely they are outraged at the unfair coverage and are jumping up and down to defend good policy and debunk BS.

You don’t know many Democratic politicians, do you?

The drumbeat of (largely bogus) negative media is having an effect on public opinion. President Obama’s approval rating is down to 39% in one poll. So of course the Democratic response is to deflect the short-term public ire by undermining the long-term viability of the program.

So when House Republicans put forward a bill that would give insurance companies the option to keep offering junk insurance plans — because it’s all about the rights of big corporations, not people — 39 Democrats voted for it.

Democratic Senator Mary Landrieu’s bill to let individuals decide to keep their non-compliant plans is just slightly better, but Ezra Klein points out the problem

Put simply, the Landrieu bill solves one of Obamacare’s political problems at the cost of worsening its most serious policy problem: Adverse selection. Right now, the difficulty of signing up is deterring all but the most grimly determined enrollees. The most determined enrollees are, by and large, sicker and older. So the Web site’s problems are leading to a sicker, older risk pool. Landrieu’s bill will lead to a sicker, older risk pool.

And that means premiums will go up. Similarly, President Obama’s “fix” will let insurers keep offering non-compliant plans for another year. It’s hard to tell how many insurance companies will “uncancel” canceled plans or what this will do to the risk pool. But the general effect is also to address a short-term political problem by making the long-term policy problems worse.

The most annoying thing from my point of view is that this short-term-politics/long-term-policy tradeoff probably won’t even work. It never does. Instead, it will just add to the vague public sense that ObamaCare is a bad law, rather than the huge improvement on the status quo that it is.

I’m with Chris Hayes on this one: The only way out is through. For the Democrats, the best thing to do politically is to do the best thing policy-wise. Going wobbly on ObamaCare is not going to get you any conservative votes in the next election. What’s going to get votes for all Democrats is to make this thing work.

After all, Democrats in Congress, you’ve gone squishy before in the face of short-term bad publicity. Iraq. Torture. ACORN. How has that worked out for you?

* By the way, I finally decided to try out HealthCare.gov Saturday morning, and it worked way better than press reports had led me to believe. The response time was good. Without creating an account, I was quickly able to see sample plans and rates in my area. It was easy to create an account and input information about myself and my wife.

I stopped short of applying for insurance, because we like the insurance we get through my wife’s job. (And like the man said, we can keep it.) So I can’t vouch for the end-to-end process, which apparently was still having problems as of Friday. But if you need or want health insurance and the horror stories have been keeping you from trying to get it, you should definitely make an attempt and see what happens. Probably, you’ll at worst get to a point where you’re one click from success. And then at some point the back end will be fixed and you can go do that click.

By weeklysift | Posted in Articles | Comments (6)

How Republican Congressmen Spent Their Summer Vacation

August 26, 2013 – 8:15 am

The conservative base wants to see a Charge of the Light Brigade against ObamaCare. Their congressmen are trying to distract them with less dangerous crazy talk.

Congress went into its summer recess with everything up in the air. None of the major appropriation bills to fund the government in fiscal 2014 (which starts October 1) are passed yet, and the House and Senate versions of them are still far apart. Even if compromises could be reached in time, the far right wants to shut down the government until President Obama agrees to delay implementing ObamaCare. Or, if they can’t block the FY 2014 appropriations, they want Congress to default on the spending it just approved by not raising the debt limit.

Other big policy decisions are also pending: The Senate overwhelmingly passed an immigration reform bill, but the House leadership has neither brought that bill to a vote nor offered an alternative. Proposals to fix the Voting Rights Act (which the Supreme Court gutted in June) are stuck in committee.

What to do?

The sticking point in all these negotiations is the Republican caucus in the House, and in particular its Tea Party faction. It represents only about a third of the Republicans, but that’s enough to prevent Speaker Boehner from passing anything without Democratic votes. And its red-meat rhetoric is popular enough with the grass roots to threaten a primary challenge against any Republican who compromises with the Democrats over its objections. So Tea Partiers feel they are in a position to call the tune for the Republican caucus, which calls the tune for the House, which in turn should call the tune for the country in spite of a Democratic Senate and President.

That minority-rule plan is symptomatic of what’s wrong with the Republican Party in general. Republicans tell each other that the majority of the country is conservative, so the more conservative the Party gets the better it represents the People. But leaders like Boehner and Mitch McConnell know that’s not true: If Republicans close Yellowstone and delay processing Grandma’s Social Security application in a quixotic attempt to repeal the law that allows Cousin-Bob-with-diabetes to get healthcare, they’re going to lose big in 2014.

[A poll done for Republican members of Congress showed that self-described “very conservative” Republicans (9% of the electorate) support a government shutdown 63%-27%, while the next most conservative 10%, the “somewhat conservative” Republicans, oppose it 62%-31%.]

So that set up the drama of the August recess: Republican congressmen would go home and meet with their constituents — typically not a representative sample, but invited groups of Republican supporters (“We’re actually talking to the choir,” Senator Coburn admitted to a meeting promoted by the Glenn-Beck-inspired Tulsa 912 Project) — who presumably would tell them to get in line behind the far right. They, on the other hand, would be trying to talk softly while slowly backing out of the padded cell — not directly confronting their base’s delusions, but also not promising to jump off any cliffs to prove their faith in the protective angels of the hidden conservative majority. (I wrote that padded-cell metaphor before seeing the following cartoon.)

For the most part, the congressmen preserved their conservative bona fides by pandering in areas that didn’t demand an immediate on-the-record vote, like doubting Obama’s birth certificate or fantasizing about impeachment.

ObamaCare. For the most part, far-right groups like Heritage Action and FreedomWorks succeeded in delivering rooms full of people so opposed to ObamaCare that they support a government shutdown, and most of the politicians succeeded in sticking to their I-agree-with-you-but response. (Senator Coburn, for example, kicked the can down the road from October 1, saying the debt-ceiling confrontation would be a better opportunity to defund ObamaCare. He cited the danger a government shutdown would pose to the economy, while conveniently ignoring the larger threat of casting doubt on the government’s willingness to pay its debts.)

Occasionally, though, reality seeped into even the most conservative townhall meetings. In Pennsylvania, Florida, North Carolina, and elsewhere Republicans had to face real people (middle-aged white people that they couldn’t instantly write off) with pre-existing conditions whose only shot at health insurance goes away if ObamaCare is repealed.

The disconnect here is that the provisions of ObamaCare are popular, even in states where the name “ObamaCare” is unpopular. That’s why Jim DeMint describes this fall as “the last off-ramp for us to stop Obamacare”, because after it gets implemented people will be dealing with the real thing rather than DeMint’s death-panel horror stories.

What makes facing ObamaCare’s real beneficiaries so tough for Republicans is that after four years of attempting to repeal the law, Republicans still have offered no alternative. So their basic message to the uninsured is: Rejoice in your “freedom” and pray you don’t get sick. (Their underlying problem is that ObamaCare is the Republican alternative to HillaryCare that the Heritage Foundation promoted in the 1990s and Mitt Romney signed as governor of Massachusetts in 2006. Republicans have no healthcare plan because Obama stole their old one — which they then felt they had to denounce as “socialism”.)

Immigration. Atlantic’s Molly Ball notes the dog that hasn’t barked: Opponents of immigration reform tried to pressure Congress with big rallies, but people just didn’t show up. We’ll see if that frees House Republicans to compromise with the Senate.

So far, it doesn’t sound that way. Immigration reform has to go through the House Judiciary Committee, whose chairman, Rep. Bob Goodlatte of Virginia, told a townhall meeting last Monday that the House should be “setting forward the right way to do things” … “even if it doesn’t go all the way through to be signed by this president”.

Impeachment. The weirdest thing to come out of the August recess was the talk about impeaching President Obama. None of Rep. Bentivolio of Michigan, Rep. Farenthold of Texas, or Senator Coburn of Oklahoma had the courage to tell their townhall questioners what they didn’t want to hear: that constitutionally President Obama can only be impeached for “treason, bribery, or other high crimes and misdemeanors” and so far Republicans have uncovered not a shred of evidence to support such a charge.

Bentivolio said it would be a “dream come true” to submit an impeachment bill, but his good intentions get frustrated by lawyers who ask “What evidence do you have?” and by a press that would “make a laughingstock” out of anybody who tried to impeach Obama without evidence. (The press, he adds, is “the most corrupt thing in Washington”.) But for those interfering lawyers and reporters, though, he’d be all over it even without evidence.

Coburn (in response to the meeting’s last question, beginning at about the 1:04 mark in the video) does say that impeachment “is not something you take lightly”, but dodges the question of whether impeachment is appropriate now, passing the buck to the House (where impeachment proceedings would have to start). “I don’t have the legal background to know if that rises to high crimes and misdemeanor but I think they’re getting perilously close.” (The meaning of “that” and “they” is never spelled out.)

Farenthold regrets that an earlier House didn’t look into “the whole birth certificate issue” and then passes the buck to the Senate:

if we were to impeach the President tomorrow, you could probably get the votes in the House of Representatives to do it. But it would go to the Senate and he wouldn’t be convicted. … I think there’s some potential damage to society that would be done with a failed attempt at impeachment.

At least when Democrats talked about impeaching President Bush, we had enough respect for the process to point to specific crimes. You define the crime first, then you collect evidence to prove it, and then you talk about impeachment. You don’t just say “I want to impeach this guy” and hope you can find evidence that he did something wrong.

Now what? During the August recess, the far-right base made it clear they want to see a last-ditch charge against ObamaCare, while polls show the American people in general don’t want a government shutdown. In general, I think the electorate wants to see more solutions and less drama, while the far-right base won’t be satisfied until it gets the apocalyptic battle it keeps fantasizing about. Nothing less will cause God’s hand to reach out of the clouds and give their Gideon-like band the victory.

I believe the stage is set for an epic conservative defeat. The only question is how much damage it will do to the country. We can only hope Tea Partiers keep identifying with Gideon, and not Samson pulling the Philistine temple down on himself.

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To Succeed, Fail Boldly

July 15, 2013 – 12:25 pm

Five doomed proposals for changing the national conversation

From one point of view, it all came to nothing.

Two weeks ago, liberals around the country thrilled to the story of Wendy Davis’ filibuster. With a few minutes of help from a raucous gallery of protesters, Texas State Senator Davis’ 11-hour speech ran out the clock on the special session of the legislature that Governor Rick Perry had called to pass a draconian anti-abortion bill.

Victory!

For two weeks, anyway. But Perry was still governor, so he called yet another special session. And the Republicans still had majorities in the legislature, so Friday the same bill passed the Senate and was on its way to Perry’s desk. In spite of massive protests, in spite of a viral video that made another new heroine out of Sarah Slamen, the legislative result is the same as if everyone had just stayed home.

Soon we’ll probably be able say the same thing about Moral Mondays in North Carolina. The Republicans have a supermajority in the legislature and they’re not afraid to use it, so they’re going to pass whatever they want, no matter how many religious leaders protest, no matter how many Carolinians they have to arrest.

So it’s pointless, right?

In the long term, no, it’s not pointless. This is the only way things change.

Losing my shrug. Let’s start with the obvious, even if it doesn’t seem all that consequential. A few months ago I’d have shrugged if you told me Texas and North Carolina were about to pass a series of laws that would impose real hardships on women and the poor. “The South,” I’d probably have said, “what can you expect?”

Well, Wendy Davis and William Barber have taken away my shrug. Like lots of other blue-state folks, I have been reminded not to write off Texas and North Carolina. Red states are not monolithic blocks of small-minded people. Progressive forces may be losing there right now, but they’re fighting. And people who keep fighting just might win someday.

If you don’t believe that, recall how the Religious Right and the Tea Party got where they are today. For decades, right-wing extremists rallied for proposals they couldn’t hope to pass into law, and mostly still haven’t: human life amendments, balanced budget amendments, the gold standard, defunding the U.N., and so forth. They failed and they failed again. And sometimes they succeeded when no one had given them a chance. (When the Equal Rights Amendment passed the Senate 84-8 in 1972, its ratification seemed a foregone conclusion.) But today their point of view has to be dealt with, and in some states is dominant.

Before you can win, you have to change the conversation. And the only way to do that is to fight battles the conventional wisdom says you can’t win. You’ll lose most of them. For a while you’ll lose all of them, because the conventional wisdom isn’t stupid. But that’s how things change.

The only way to change the direction of the wind is to keep spitting into it.

How conventional wisdom shifts. I have written in more detail elsewhere about how conservatives manipulate the supposedly liberal media. Journalism is not a conspiracy, but there is an unconscious group process that decides what news is, what can be stated as a simple fact, and what has be covered as controversial. Partisan groups can pressure that process and get their desired response, independent of whether most individual journalists agree or disagree with their views.

In that article I focused on how outside pressure can make known facts seem controversial. So, for example, global warming is almost always covered as if it were in dispute, when in a scientific sense it is well established. But powerful voices will argue with journalists who say global warming is a fact, so instead they write he-said/she-said articles, or leave the global-warming angle out of a story entirely.

Today I want to focus on the opposite side of that same unconscious media groupthink: Anything that is stated forcefully by one side and not contested by the other will be covered as if it were a fact.

So: Texans are all conservatives. Only people on the right care about “morality” or “the family”. “Moral issues” are the ones about sex — abortion, contraception, homosexuality — and the moral position is the conservative position. Feeding the hungry, caring for the sick, making sure workers get a fair wage — all that sermon-on-the-mount stuff — those aren’t “moral” issues.

If you don’t regularly and loudly contest those notions, they’ll get reported as facts. They’ll provide the background assumptions that frame the coverage of everything else.

Wolf Blitzer’s evangelism. The clearest recent example of this principle was Wolf Blitzer’s embarrassing interview with an atheist mother after the tornado in Moore, Oklahoma in May. Blitzer badgered the woman to “thank the Lord” for her and her child’s survival until she finally had to confess her atheism.

So is Blitzer is an evangelical Christian trying to push his religion on CNN? Nope. Wikipedia says Blitzer is a Jew, the son of Holocaust survivors. I can’t say from that precisely what he believes about God, but he was almost certainly not pressuring this woman to proclaim her Judaism.

Instead, Blitzer was applying two seldom-contested stereotypes:

  • Oklahoma is in the so-called Bible Belt, so everybody must be some kind of conservative Christian.
  • There are no atheists in the foxholes. When life and death hang in the balance, everybody becomes religious.

Probably Wolf had been hearing loud proclamations of Christian faith all day, and no voices on the other side. (This is another kind of groupthink. It’s not considered rude to thank Jesus in these circumstances — even in the presence of people whose loved ones Jesus apparently chose not to save. But conservative Christians would take offense if you said, “Stuff like this just shows that everything’s random and you can’t take it personally.”) So it became a background “fact” of his reporting that the people of Moore were having an evangelical Christian response to their survival.

Candle-lighting vs. darkness-cursing. We can wish for harder-working more-objective journalists who will seek out the truth and cover it fairly, regardless of the power dynamics. But in the meantime journalism is what it is, and we’re just being stupid if we let conservatives manipulate it and don’t fight back.

The facts on the ground today are that the media will challenge a pro-choice Catholic to reconcile the contradiction between his politics and his faith, but not an Evangelical who votes to cut Food Stamps or reject Obamacare’s Medicaid expansion. (Matthew 25:35-36: “For I was hungry and you fed me. … I was sick and you cared for me.”) Want to change that? Join the Moral Mondays protests in Raleigh, or start something similar in your own state capital.

In the short term, you may not change any votes in the legislature. But if enough people contest the previously uncontested “facts”, those “facts” leave (what Jay Rosen and Daniel Hallin call) “the Sphere of Consensus” and enter “the Sphere of Legitimate Controversy”. The conventional wisdom changes.

From defense to offense. So far the big progressive protests have been efforts to resist conservative aggression: rollbacks of women’s rights in Texas, unemployment insurance in North Carolina, workers’ rights in Michigan and Ohio.

It’s time to go on offense. In addition to resisting the regressive agenda of the right and timidly putting forward small proposals like universal background checks for gun buyers, progressives need a blue-sky positive agenda that we keep making people notice. Just because we can’t pass it in this term of Congress doesn’t make it impractical. (When have conservatives ever been constrained by that?) You have to keep proposing it until people get used to hearing it; only then will they look at it seriously.

So here are five bold proposals that are “doomed” according to the conventional wisdom. Their complete impracticality is a “fact” and will continue to be so until loud voices move them into the Sphere of Controversy, from which they can get serious consideraton.

  • The Equal Rights Amendment. The ERA passed Congress in 1972 and fell three states short of ratification when the ratification deadline passed in 1982. Supporters of the three-state strategy claim the deadline doesn’t count and in 2011 got ratification through one house of the Virginia legislature. But the ERA gets re-introduced in every session of Congress, most recently in March. Only the fact that the conventional wisdom says it can’t pass, protects politicians from explaining why they disagree with “Equality of rights under the law shall not be denied or abridged by the United States or by any state on account of sex.”
  • Single-payer health care. Of all the existing plans to help the 50 million Americans who lack health insurance, Obamacare is the most conservative. (It’s Romneycare, after all.) Conservatives opposing Obamacare have offered no plan to fulfill the “replace” part of their “repeal and replace” slogan. And yet, if you watch Sunday morning political shows on TV, Obamacare is the “liberal” position. It’s better than the status quo, and I support it on those terms. But single-payer is what gives Europe, Japan, and the industrialized parts of the British Commonwealth lower costs and higher life expectancies than we currently have. It would do the same for the United States.
  • End corporate personhood. Few actual humans defend the idea that corporations should be people with full constitutional rights. A variety of constitutional amendments have been proposed to reverse this piece of conservative judicial activism (which in particular has no basis whatsoever in the originalist constitutional interpretation conservatives claim to favor). Bernie Sanders’ Saving American Democracy Amendment says: “The rights protected by the Constitution of the United States are the rights of natural persons and do not extend to for-profit corporations.” Everybody who runs for office should be challenged to state a position on that.
  • A federal Reproductive Rights Act. The current reproductive-rights situation in states like Texas resembles Jim Crow: Women’s constitutional rights are not repealed directly, but are made impractical by a series of restrictions transparently introduced for that purpose. In the same way that the Voting Rights Act protected minorities’ right to vote (until recently), a federal Reproductive Rights Act should impose federal oversight on states that have a history of infringing women’s rights.
  • Replace the Second Amendment. The overall situation of weapons and society has changed so much since 1787 that it’s hard to attach any meaning at all to the full text of the Second Amendment. I don’t have a revised text in mind yet, but I think the amendment should defend the right of individuals to procure appropriate tools to defend their homes, while giving Congress the power to control military hardware.
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“Religious Freedom” means Christian Passive-Aggressive Domination

July 8, 2013 – 11:37 am

In an Orwellian inversion, “freedom” is now a tool for controlling others.

It’s over. Try something else.

For many anti-gay activists, the recent Supreme Court decisions on DOMA and Proposition 8 were the handwriting on the wall.

It wasn’t just that they didn’t get the result they wanted, but that in DOMA the Court’s majority simply didn’t buy the argument that homosexuality represents a threat to society. Neither does the general public, which supports that decision 56%-41%. (The margin under age 40 is 67%-30%, with 48% approving strongly.) The big post-DOMA public demonstrations expressed joy, not anger.

Just a few years ago anti-marriage-equality referendums were winning in states all over the country, but in 2012 one failed in Minnesota, while referendums legalizing same-sex marriage won at in Washington, Maryland, and Maine. Ten years ago, the first legislatures to make same-sex marriage legal were dragged by their state courts, but this year Delaware, Rhode Island, and Minnesota went there voluntarily, bringing the number of states where same-sex marriage is legal (as of August 1) to 13, plus the District of Columbia. (I’ll guess Oregon and Illinois will go next.)

It’s even clear why this is happening: Because gay millennials are not in the closet, everybody under 30 has gay and lesbian friends who dream about meeting their soulmates just like straight people do. To young Americans, laws blocking that worthy aspiration are pointlessly cruel and ultimately will not stand — not in Alabama, not in Utah, not anywhere.

So the generational tides run against the bigots of the Religious Right. Some still aren’t admitting it, but wiser heads are recognizing that it’s time to switch to Plan B.

The new face of bigotry: “freedom”. Fortunately for them, there’s a well-worked-out back-up plan: religious “freedom”.

Accept the inevitability of gay rights, advises Ross Douthat, but “build in as many protections for religious liberty as possible along the way.” Here’s the idea: If your disapproval of certain kinds of people can be rooted in church doctrine or a handful Biblical proof-texts, then forbidding you to mistreat those people violates the “free exercise” of religion you are promised by the First Amendment.

To make this work, conservative Christians need to divert attention from the people they are mistreating by portraying themselves as the victims. And that requires cultivating a hyper-sensitivity to any form of involvement in activities they disapprove of. So rather than sympathize with the lesbian couple who gets the bakery door slammed in their faces, the public should instead sympathize with the poor wedding-cake baker whose moral purity is besmirched when the labor of his hands is used in a celebration of immorality and perversion.

There’s a name for this tactic: passive aggression. It’s like on Sanford & Son when Fred would clutch his heart and start talking to his dead wife because Lamont planned to do something he disapproved of. Passive aggression is the last resort of people who have neither the power to get their way nor any reasonable argument why they should.

In fact the baker will be fine, as Willamette Week demonstrated by calling two such religious-liberty-defending bakeries and ordering cakes to celebrate a variety of other events conservative Christians disapprove of: a child born out of wedlock, a divorce party, a pagan solstice ritual. The bakers did not object, because their hyper-sensitive moral purity is an invention, a convenient excuse for treating same-sex couples badly.

But Jim DeMint insists that

A photographer in New Mexico, a florist in Washington, and a baker in Colorado have already been victims of such intolerant coercion.

And Matthew Franck is horrified that religious universities will have to provide same-sex married-student housing; religious “schools, universities, hospitals, hospices, and clinics; social service agencies, retirement homes, eldercare and childcare facilities, food pantries, and soup kitchens” who employ “teachers, doctors, nurses, psychologists, counselors and clinicians, caregivers, food-service workers, housekeeping and grounds staff, even pool lifeguards” won’t be able to refuse employment to people with same-sex spouses. Adoption services, marriage counselors, divorce lawyers, artificial insemination clinics etc. will have to deal with gay and lesbian couples … as if they were real human beings or something.

The race parallel. We worked this stuff out during the civil rights movement, because all the same ideas show up with regard to race.

Plenty of people claim a sincere religious belief in white supremacy, and root it in Biblical texts like the Curse of Ham. (This goes way back: American slave-owners found Biblical license for keeping their “property”.) But the law does not honor these claims, and somehow religion in America survives.

Here’s the principle that has served us well: In private life, you can associate with anybody you like and avoid anybody you don’t like. But if you offer goods or services for sale to the public, you don’t get to define who “the public” is. So when you’re making lunch at your house, you can invite anybody you like and snub anybody you don’t like, but if you run a lunch counter you have to serve blacks.

We’ve been living with principle for decades, and (other than Rand Paul) no one worries much about the racists’ loss of freedom.

That should apply to same-sex couples now: If your chapel is reserved for members of your congregation, fine. But if you rent it to the public for wedding ceremonies, same-sex couples are part of the public just like interracial couples are. You don’t get to define them away.

If that makes you reconsider whether you want to be open to the public, well, that’s your decision.

The sky will not fall. We just went through this with the Don’t Ask, Don’t Tell repeal, which supposedly would violate the religious “freedom” of evangelical military chaplains (who apparently had never before needed interact respectfully with people they believed were sinners). The Family Research Council’s Tony Perkins predicted:

You have over 200 sponsoring organizations that may be prevented from sponsoring chaplains because they hold orthodox Christian views that will be in conflict with what the military says is stated policy.

That stated policy was: “All service members will continue to serve with others who may hold different views and beliefs, and they will be expected to treat everyone with respect.”

AP went looking for chaplains who couldn’t live with that and found “perhaps two or three departures of active-duty chaplains linked to the repeal.” A Catholic priest overseeing 50 other chaplains reported “I’ve received no complaints from chaplains raising concerns that their ministries were in any way conflicted or constrained.”

If any of Perkins’ 200 religious organizations has stopped sponsoring chaplains because DADT is gone, I haven’t heard about it. The chaplains’ hyper-sensitivity to openly gay soldiers was imaginary, and went away when the government refused to take it seriously.

The abortion parallels. The reason the Religious Right believes their passive-aggressive “religious freedom” approach will work on same-sex marriage is that the same approach is already working on reproductive rights.

It all started with a reasonable compromise: After the Religious Right lost the battle to keep abortion illegal, laws guaranteed that doctors who believe abortion is murder can’t be forced to perform one. This is similar to letting pacifists be conscientious objectors in war, and I completely support it.

But from there, Religious Right “freedom” has become a weapon to beat down the rights of everyone else. Since 1976, Medicaid has not paid for abortions — at a considerable cost to the government, since birth and child support are far more expensive — because pro-life taxpayers shouldn’t have to fund something they think is immoral. There’s no parallel to this anywhere else: The taxes of pacifist Quakers pay for weapons; the taxes of Jews and Muslims pay the salaries of federal pork inspectors.

Conservatives like to accuse gays and blacks of claiming “special rights”, well this is a special right: The conservative conscience gets considerations that nobody else’s conscience gets.

And conservative special rights keep growing. The argument for defunding Planned Parenthood is that public money not only shouldn’t pay for abortions, it shouldn’t even mix with money that pays for abortions. (“Giving taxpayer funds to abortion businesses that also provide non-abortion services subsidizes abortion,” says one petition.) I had a hard time imagining a parallel, but I finally came up with one: What if Jews were so sensitive to violations of the kosher rules that Food Stamps couldn’t be used (by anyone, for anything) in groceries that sold pork?

That would be absurd, wouldn’t it?

In some states, medical “conscience” laws now protect anyone in the medical system who wants to express their moral condemnation: If the pharmacist disapproves of your contraceptives, he doesn’t have to fill your prescription. One of the examples cited by the model conscience law of Americans United for Life as something that needs to be fixed is “an ambulance driver in Illinois being fired for refusing to take a woman to an abortion clinic”.

Clearly that ambulance driver’s immortal soul was at risk. The hyper-sensitive pro-life conscience needs to be protected from any contact with women making use of their constitutional rights.

Religious “freedom” and contraception. The other front in the religious “freedom” battle is contraception.

The Obama administration has had a lot of trouble finding the proper religious exemption to the contraception provisions of the Affordable Care Act. That’s because it’s hard to find the “right” version of something that shouldn’t exist at all. Contraception coverage does not violate any legitimate notion of religious freedom for any religious organizations, religious affiliated organizations, or religious individual employers. Their claims should be rejected without compromise.

The principle here ought to be simple: The employer isn’t paying for contraception or any other medical procedure; the employer is paying for health insurance. Health insurance is part of a worker’s earnings, just like a paycheck. And just like a paycheck, what the employee chooses to do with that health insurance is none of the employer’s business. If I’m the secretary of an orthodox rabbi, his religious freedom isn’t violated when I cash my paycheck and buy a ham sandwich. Ditto for contraceptives, health insurance, and the secretary of the Archbishop of Boston.

Religious organizations’ hyper-sensitive consciences are pure passive aggression. The classic example here is Wheaton College, which couldn’t join other religious organizations in their suit against the ACA because it discovered that it had inadvertently already covered the contraceptives that the tyrannical ACA was going to force it to cover. This was such a huge moral issue for the college that nobody there had noticed.

Worst of all is the Hobby Lobby lawsuit, which got a favorable ruling on an injunction recently. The Hobby Lobby case is the mating of two bad ideas — corporate personhood and employers’ right to control the medical choices of their employees — to produce something truly monstrous. HL’s case hangs on its claim that it is a “person” with regard to the Religious Freedom Restoration Act of 1993, and so its corporate “religious freedom” allows it to restrict its employees’ access to contraception.

Persecution or Privilege? Here are the kinds of sacrifices I make for my readers: I listened to the full half-hour of James Dobson’s post-DOMA radio show, where Dobson, Perkins, and Bill Becker threw around phrases like “the collapse of Western civilization in one day” and “the whole superstructure … can come down”. They described Christians as “an oppressed minority” and agreed that “persecution is likely in the days to come”.

But what is “persecution” exactly?

Tony Perkins expresses the challenge like this:

Do you believe God’s word is true and therefore you’re going to live your life based upon that truth, or are you going to shrink back in the fear of man and of them calling you bigots.

Whenever Christians discuss their “oppression”, fear of being called bigots plays a central role. According to CNN’s Belief Blog,

[Peter] Sprigg and other evangelicals say changing attitudes toward homosexuality have created a new victim: closeted Christians who believe the Bible condemns homosexuality but will not say so publicly for fear of being labeled a hateful bigot.

In other words: Christians are oppressed unless they can express their moral condemnation of others without being subject to moral condemnation themselves.

Why would anyone imagine the existence of such a one-sided right? Simple: In practical terms, that’s a right they have had until recent years. Not so long ago, the James Dobson types were so intimidating that they could preach any kind of vicious nonsense about gays and face no response.

So what they are experiencing now isn’t persecution, it’s privileged distress, the anxiety a privileged class feels as its privileges fade and it slides towards equality with others. And rather than try to get over their distress and soothe their anxiety, they are intentionally pumping it up in a passive-aggressive attempt to claim victimhood and control the rest of us.

That bubble needs to be popped.

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What if there’s no spending problem?

February 25, 2013 – 10:56 am

Conservative blogs often post a graph more-or-less like the one below, which I got from the blog of Keith Hennessy, who is currently at the Stanford Business School and used to be Director of the National Economic Council under George W. Bush. (So: not somebody I usually agree with, but probably not a dummy either.) He claims that the numbers were computed for him by Bush’s Office of Management and Budget in 2007. (So: probably not a fabrication.)

It looks bad. Taxes as a percentage of GDP have stayed in a relatively narrow band since World War II, only occasionally peaking over 20%. But starting in about 2016, spending as a percentage of GDP starts to take off, reaching the incredible level of 40% by 2080 with no end in sight.

The typical liberal response to this, which I have given myself, is not that graphs like this are wrong, but that they hide the real problem: Government spending goes out of control because healthcare costs go out of control. But just capping what the government spends on Medicare and Medicaid (i.e., the Ryan plan) doesn’t fix anything. If healthcare costs are unsustainable, then what does it matter whether we’re paying those costs through government, through private insurance, or out of our pockets? Personally, it’s all the same to me whether I go broke paying taxes, paying health insurance premiums, or paying my doctor.

So a liberal would rather imitate the countries who already get better healthcare for less money than we do and increase the government’s role, ideally with a single-payer system.

Summing up: Liberals and conservatives agree that we have a long-term problem, but they argue about what kind of problem: a government spending problem or a healthcare cost problem.

Recently I ran into a potentially game-changing question: What if there is no problem? In other words, instead of being trapped in the dismal liberal/conservative argument about which apocalypse we’re headed towards, what if we’re actually not headed towards an apocalypse at all?

“That’s crazy!” That was my first reaction too. I mean, look at that graph. But the guy making the claim (William Baumol in the recent book The Cost Disease: Why Computers Get Cheaper and Health Care Doesn’t) has a track record that earns him a hearing.

Baumol is an economist who is most famous for identifying Baumol’s Cost Disease in the 1960s. His observation is that although the economy as a whole becomes more productive with the advance of technology, not all sectors progress equally, and some don’t improve their productivity at all. For example, a 21st-century farmer feeds far more people than a 19th-century farmer. Likewise, a worker at a modern shoe factory makes more shoes than a 19th-century cobbler. But it still takes four talented musicians to perform a Beethoven string quartet, and they don’t do it any faster than they did in Beethoven’s day. String quartets have not seen a productivity increase.

The economic consensus of the 1960s said that wages were tied to productivity. If that were true, then classical musicians would have seen their incomes crash relative to farmers and shoemakers, who would by now be vastly wealthier than the lowly performers of the New York Philharmonic or the Boston Pops.

In fact that didn’t happen, because in the long run the labor market has a supply side as well as a demand side, the result being that every profession has to pay enough to induce talented people to make whatever sacrifices are necessary to enter that profession. But something has to give somewhere, so we see the productivity difference as inflation: The price of a New York Philharmonic ticket is going to rise much faster than the cost of a loaf of bread or a pair of shoes.

So Baumol’s observation is that industries with a large component of personal service are not going to increase their productivity as fast as the rest of the economy, and as a result those industries are going to see higher inflation than the economy as a whole. Year-by-year those higher inflation rates might just be a nuisance, but over time exponential growth works its dark magic: If two products each cost $1 today, but one is subject to a 2% inflation rate and the other 10%, in 100 years the low-inflation product costs $7.25 and the high-inflation product costs $13,781.

Health care. Health care has a high component of personal service. It does not have high productivity growth.

Now this part gets a little tricky, because we all know how much medical technology has improved over the decades. But the improvement is almost entirely on the outcome side rather than the productivity side. Adrian Peterson could tear up his knee and be better than ever the next season, where half a century before Gale Sayers was never the same. But the amount of attention patients need from doctors and nurses has not gone down. Health professionals are doing better for their patients, but they are not processing more of them faster.

And most of us wouldn’t want them to. If you heard that one local hospital had one nurse for every five patients and another “more productive” hospital had one nurse for every 50, which would you choose for your surgery? If one doctor sees 30 patients in an hour of clinic time and another doctor only six, which would you pick as your PCP?

So back in the 1960s, Baumol looked at this situation and concluded that medical inflation was here to stay. Not because doctors are greedy or health insurance companies are evil or socialized medicine is inefficient, but just from the nature of health care. While other factors undoubtedly matter, the exponential growth would happen anyway.

This is borne out by the inability of any country to tame medical inflation. France, for example, is often held up as a model healthcare system. But its costs are also rising exponentially.

Government spending. And it isn’t just health care. Government services in general tend to be in what Baumol calls “the stagnant sector” — not due to bureaucratic waste or the power of public-sector unions, but because the services themselves require one-on-one attention.

In education, we call productivity by another name: students per teacher. But nobody wants his third-grader in a 150-student lecture hall. Everybody’s happy when an hour of labor builds more cars or mines more copper. But it’s not necessarily a good thing if social workers, public defenders, parole officers, or cops on the beat handle more cases faster.

So Baumol predicts that over time government spending will rise as a percentage of the economy.

But we can afford it. So far this is just a different spin on Hennessy’s graph. But here’s the difference: In Baumol’s model, government spending isn’t crowding out everything else. As a society, we aren’t doing without manufactured goods because health care is soaking up all our money; we’re just using less of our labor to produce the manufactured goods we want.

Despite their ever increasing costs, stagnant-sector services will never become unaffordable to society. This is because the economy’s constantly growing productivity simultaneously increases the community’s overall purchasing power. … If governments cannot be led to understand the ideas presented here, then their citizens may be denied vital health, education, and other benefits because they appear to be unaffordable, when in fact they are not.

In other words, even though orchestra tickets cost more now than in the 1800s, it’s ridiculous to claim that past societies could afford orchestras and our far richer society can’t.

Think about food. America’s Farmers estimates that an American farmer today feeds 155 people. By contrast, in colonial times a farm family barely did more than feed itself. Imagine going back to colonial times and telling people that by 2013 the non-farm part of the economy would grow so much that it would force a single farmer to feed 155 people! They would undoubtedly picture some cancerous expansion in the non-farm economy that could only be checked by mass starvation.

But that’s not what happened. The non-farm economy came to dominate GDP, but we’re not starving. That 1 farmer is providing his 155 eaters with too many calories, not too few.

This conclusion — that our descendants will likely be able to afford more health care and education as well as more of all the other goods and services they consume — may seem strikingly implausible … if health-care costs continue to increase by the rate they have in the recent past, they will rise from 15 percent of the average person’s total income in 2005 to 62 percent by 2105. This is surely mind-boggling. It means that our great-grandchildren in the year 2105 will have only a little less than forty cents out of every dollar they earn or otherwise receive to spend on everything  besides health care — food, clothing, vacations, entertainment, and even education! Yet as this book will show, this prospect is not nearly as bad as it sounds.

There are many possible objections to Baumol’s argument. (I wonder how it’s affected by the way that wages in general have come unstuck from productivity.) But here’s the message that I take from his book: When someone presents a graph like Hennessy’s and acts like the conclusion is obvious — say, that government spending can’t reach 40% of GDP by 2080, and so some catastrophe will have to intervene before that point — don’t buy it without a more compelling explanation.

The economy of 2080 or 2105 will be different from today’s in many, many ways. Maybe current trends will persist until then or maybe they won’t. But you can’t conclude anything from the mere fact that some statistic from the far future looks implausible.

The far future is going to look implausible to us, if we manage to survive long enough to see it. That’s the one prediction I have complete confidence in.

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Five Pretty Lies and the Ugly Truths They Hide

August 27, 2012 – 10:39 am

A week after Todd Akin’s “legitimate rape” comment, we should be long past the “OMG — I can’t believe he said that!” stage. It’s time to take a longer view and ask ourselves what the Akin incident says about the larger picture.

You can find takeaways at many levels. First, contrary to Akin’s personal damage control, he didn’t “misspeak“. He really believes that many pregnant women — like maybe this one — make up their rape stories.

At a slightly more general level, and contrary to Republican damage control, you can observe that Akin is typical of the party. Not only is his no-rape-pregnancy lie common, but Paul Ryan agrees with him about redefining rape, and the official party platform calls for banning abortion with no rape exception. (Mitt Romney claims to support such an exception, but as usual, he’s speaking out of both sides of this mouth. Whose delegates are writing this platform? And if he won’t actively oppose a no-exceptions party platform, what makes you think he’ll veto a no-exceptions bill when Congress sends it to him?)

But here’s what I think is the most important Akin takeaway. When confronted with an ugly consequence of his policies — women forced by law to bear their rapists’ babies — Akin papered it over by telling a pretty lie: It doesn’t happen; the female body doesn’t work that way.

Isn’t that pretty? Wouldn’t the world be nicer if no woman who “really” got raped had to worry about pregnancy? Of course it would.

Akin may not have intended to lie; maybe he believes what he said. But does he believe this bogus biology because it makes sense? Of course not. Because an expert told him? The “expert” is someone he sought out precisely for that purpose; real experts would have told him the opposite.

I have a simpler explanation: Akin believes the lie because it’s pretty. The lie tells him that he’s not a monster. It helps him avoid the ugliness of his beliefs.

That thought pattern makes him absolutely typical of the conservative movement today. When implemented, conservative policies cause a lot of ugliness. And when confronted with these ugly consequences, conservatives rarely adopt a more compassionate position. A few brave ones talk about necessary sacrifices and breaking eggs to make omelets, but most just paper over the ugliness with a pretty lie.

“Raped women don’t get pregnant” is just the first lie on my list. Here are four others:

2. The uninsured can get the medical care they need in the ER.

The lie. As he prepared to veto a 2007 bill providing health insurance to children, President Bush said it very clearly:

People have access to health care in America. After all, you just go to an emergency room.

That’s what Governor Rick Perry meant during his presidential campaign when he said:

Everyone in the state of Texas has access to health care, everyone in America has access to health care.

Mississippi Governor Halley Barbour agreed: “there’s nobody in Mississippi who does not have access to health care”

Why it’s pretty. It’s so distressing to hear statistics like 50 million Americans don’t have health insurance. (Texas and Mississippi rank #1 and #2 in percentage of the population uninsured.) But wouldn’t it be nice if that number didn’t really mean anything? if insurance was just a bookkeeping device, and nobody really went without care?

Why you shouldn’t believe it. It’s true that the uninsured can get emergency care. If you’re in a car accident, if you’re having a heart attack, if you’re not breathing when they fish you out of the lake — EMTs and the ER will do their best to save your life even if you can’t pay. But as the Houston Chronicle points out, emergency care can’t replace regular care:

About half of uninsured adults have a chronic disease like cancer, heart disease or diabetes. The lack of regular care for the uninsured is why they have death rates 25 percent higher than those with insurance; more than half of uninsured diabetics go without needed medical care; those with breast and colon cancer have a 35 percent to 50 percent higher chance of dying from their disease; and they are three times more likely to postpone needed care for pregnancy. Clearly, the uninsured don’t get the care they need

What it hides. Lack of health insurance kills people. It kills lots of people — more than car accidents or our recent wars. The technical public-health term is amenable mortality — the number of people who die unnecessarily from treatable conditions. An article in the journal Health Policy says:

If the U.S. had achieved levels of amenable mortality seen in the three best-performing countries—France, Australia, and Italy—84,300 fewer people under age 75 would have died in 2006–2007.

France, Australia, and Italy don’t have smarter doctors or better medical technology, but they do have something conservatives are determined to see that Americans never get: universal health insurance. When a questioner confronted Rick Santorum with these facts, he replied:

I reject that number completely, that people die in America because of lack of health insurance.

Of course he does. If he accepted what the public health statistics say, he’d have to admit that his policies condemn tens of thousands of people to death every year. “Pro-life” indeed.

3. Tax cuts pay for themselves.

The lie. The most recent vintage is from the Wall Street Journal’s defense of the Romney tax plan:

Every major marginal rate income tax cut of the last 50 years — 1964, 1981, 1986 and 2003 — was followed by an unexpectedly large increase in tax revenues

Or you could hear it from Mitch McConnell:

That there’s no evidence whatsoever that the Bush tax cuts actually diminished revenue. They increased revenue, because of the vibrancy of these tax cuts in the economy.

The claim is pretty widespread on the Right: Cutting taxes stimulates the economy so much that the government ends up collecting more revenue even at the lower rates.

Why it’s pretty. Everybody likes a tax cut, but deep down we all know that taxes pay for important things: roads, schools, defending the country, keeping the poor from dying in the streets, and so on. But wouldn’t it be great if we could pay less tax and pretend that money for all those things will appear by magic?

Why you shouldn’t believe it. This has been tried over and over again. It never works. Pointing out that it didn’t work for Bush is shooting fish in a barrel — nothing worked for Bush — but this didn’t even work when Reagan tried it. The Economist’s “Democracy in America” column looked up the numbers:

The federal government’s receipts for 1981-86, in billions of 2005 dollars:

1981    1,251.1
1982    1,202.6
1983    1,113.4
1984    1,173.9
1985    1,250.5
1986    1,277.2

Do you see the “unexpectedly large increase in tax revenues” resulting from the 1981 marginal rate income tax cut? Me neither! It took five years just to get back to par.

What it hides. A huge transfer of wealth to the rich. This lie is the first move in a cruel shell game: First, cut taxes with the promise that it won’t cause a deficit. Then, when it causes a deficit (as it always does), don’t respond “Oh, we were wrong. Let’s raise taxes back to where they were.” Say: “Government spending is out of control! We have to cut food stamps, education, Medicare …”

Stir the two steps together, and you get a cocktail voters would never have swallowed in one gulp: We’re going to cut programs people rely on so that the rich can have more money.

4. Gays can be cured

The lie. Homosexuality is a choice that results in an addiction, but (like alcoholics and drug addicts) gays can learn to choose differently and become ex-gay.

Why it’s pretty. Suppose you think gays are going to Hell, and then your son turns out to be gay. Or suppose you’ve been brought up to believe gays are evil, and then in junior high you start feeling same-sex attractions yourself. Of course you’re going to want to believe that this situation is fixable.

Why you shouldn’t believe it. It’s almost impossible to 100% prove a negative like “Gays can’t be cured”. But if a well-funded movement to teach people to fly had been running for years, and yet no one actually flew, reasonable people would develop a strong conviction that this wasn’t going to work.

That’s the situation with the ex-gay movement. The extreme lack of success has reached the point where the movement itself has started to splinter. The original ex-gay group, Exodus International, now rejects attempts to “cure” gays and instead focuses on “helping Christians who want to reconcile their own particular religious beliefs with sexual feelings they consider an affront to scripture.” This has caused a schism, with the new group, Restored Hope Network, continuing to promote therapies to cure gays.

What it hides. Pure bigotry is the only reason to discriminate against gays.

As discrimination wanes, it becomes obvious that unrepentant gays can find love, form long-term relationships, raise children who are a credit to the community, and (in short) do all the things that are usually thought of as part of a good life. They can also serve in the military, be good teachers, have productive careers in the private sector, pay taxes, do volunteer work — everything that constitutes good citizenship.

To prop up anti-gay discrimination (and even to try to reinstate it in places where it has been torn down), and to do so even though the people discriminated against didn’t choose to be gay and can’t change it — that’s pretty ugly.

5. Obama’s election proves racism is over.

The lie. John Hawkins put it like this:

So, the moment Obama was elected, people started asking the obvious question, “How serious of a problem can racism still be in the United States if a black man can be elected President?” The honest answer to that question is, “Not very.”

Just this summer, Boston Globe columnist Jeff Jacoby reacted the same way to a black man becoming head of the Southern Baptist Convention:

The pervasive racism [Martin Luther King] confronted is primarily a historical memory now, while King himself is in the American pantheon. … America’s racist past is dead and gone.

Why it’s pretty. Pat yourself on the back, white America! You used to have a problem, but you kicked it.

So if any blacks or liberals are still complaining, feel free to ignore them. They just want the government to give them “more free stuff” by taking what you earned, or to use the charge of racism as “their sledgehammer … to keep citizens who don’t share the left’s agenda from participating in the full array of opportunities this nation otherwise affords each of us”. If anybody’s really oppressed these days, it’s whites.

Why you shouldn’t believe it. Barack Obama’s election was definitely a sign of racial progress, just like Jackie Robinson joining the Dodgers in 1947, Jesse Owens’ Olympic gold medal in 1936, or Jack Johnson becoming heavyweight champion in 1908. But racism didn’t end in 2008 any more than it ended in 1908.

Let’s start by debunking the logic: In 2008, a year when everything broke wrong for the Republicans, Obama got 53% of the vote. For the sake of argument, let’s say that’s more-or-less what a white Democrat would have polled. Does that prove racism is over? No, it just proves that Republicans already had the racist vote.

Then we get to evidence that points the other way: Trayvon Martin. (Nobody jumps to the defense of black men who shoot unarmed white teen-agers.) Birtherism. (No white president has faced this kind of persistent, baseless accusation.) The racial dog-whistles in the Romney campaign. The racist anti-Obama pictures and cartoons that circulate in viral emails. (But don’t you get it? These are jokes. Like the “Don’t Re-Nig in 2012” bumper sticker. Clever, huh?) The attempt to legalize anti-Hispanic racial profiling in Arizona and other states. I could go on.

It’s not just that 1 in 3 black men will spend time in jail, it’s that this fact isn’t seen as an emergency that requires outside-the-box solutions. If white men were imprisoned at the same rate (no matter what they were imprisoned for), the number of possible explanations and solutions would skyrocket. But black men … that’s just how they are; what can you do?

(For a longer discussion of racism in the Obama era, see Ta-Nehisi Coates’ article in the current Atlantic.)

What it hides. Indifference to human suffering. At a time when poverty is at a level we haven’t seen in decades, the House has passed bills to gut safety-net programs like Medicaid and food stamps.

That can only happen if the white middle class is convinced that the poor are different and deserve their fate. And the best way to accomplish this is through racial stereotyping: The poor are black, and blacks are lazy. Both statements are false, but they work.

How to respond. This is far from an exhaustive list; I just picked the pretty lies I could document and refute fairly quickly, and I didn’t even touch well-covered lies like “Global warming is a hoax.” or “Abstinence-only sex education works.” But I hope the five I’ve listed are varied enough to establish the pattern.

If you have any conservatives friends, relatives, or co-workers, you probably hear pretty lies all the time. (“The poor have it good in America. They’re the lucky duckies who don’t have to work, because the rest of us are paying for their X-boxes and cable TV.”) Probably you’ve already tried to respond by googling up facts and presenting them, so you understand that this never works.

I sympathize with your frustration.

But it’s important take the next step and ask why presenting the facts doesn’t work. It’s simple: Facts are not the source of the belief. Conservatives aren’t mistaken, they’re hiding something.

What they’re usually hiding is cruelty. Conservative policies are cruel, but individual conservatives usually aren’t, or at least they don’t want to see themselves like that. The only way to square that circle is with a lie.

Once the lie is in place, “facts” will be found to support it. A whole industry is devoted to supplying fake facts. And since fake facts are easier to manufacture than to refute, you will never fight your way through the swarm.

I don’t have a foolproof method for converting conservatives, but I can tell you this much: You don’t understand a pretty lie until you’ve seen all the way through to the ugly truth it’s hiding.

That’s where you should be focusing your energy. Don’t just refute the lie. Expose the truth.

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How Lies Work

August 20, 2012 – 12:26 pm

If you’ve ever seen a five-year-old stand over a broken vase and say, “I didn’t do it”, you might think lying is easy. But as Mark Twain observed: “An awkward, unscientific lie is often as ineffectual as the truth.”

Effective lying in a political campaign is very hard work. The soil has to be tilled and the lie planted just so. You have to water it over and over again. And then, at just the right moment, you add that special ingredient that makes it sprout and flower.

Let’s look at the most effective lie currently spreading: President Obama is a threat to your Medicare. I live in a swing state (New Hampshire), so I’ve been seeing it in this ad:

At first glance, this looks like a rubber/glue lie: The guy who wants to turn Medicare into a privatized voucher program and then not fund it properly is Paul Ryan. How can the Romney/Ryan campaign turn that around and make themselves the defenders of Medicare?

They’re doing it, and it seems to be working. I can feel the pull of their ad, even though I know it’s false. How does that work? It’s a master class in propaganda.

Start with a kernel of truth. Whether or not you believe that current deficits are necessary to stimulate the economy, you should worry about the rising cost of health care: It’s not just that in the long run Medicare, Medicaid, and veteran’s medical benefits threaten to swamp the federal budget, it’s that health-care spending in general threatens to swamp the economy.

You can get spending growth down in two ways: Reform the system to deliver care more efficiently or deliver less care. The Affordable Care Act (ObamaCare) pushes the deliver-more-efficiently approach. Medicare benefits don’t change, but hospitals get reimbursed less for delivering them. (Some of the profit built into hospital payments covers the emergency-room costs of the uninsured. ObamaCare lowers the number of uninsured, so hospitals don’t need to charge the insured as much.) Also, the government curtails Medicare Advantage, a wasteful Republican attempt to build a private option into Medicare. (The private plans cost more, because the private sector is less efficient at things like this. The government has been picking up the difference.)

The result is an estimated $716 billion in savings over ten years.

That’s the kernel of truth: Because of ObamaCare, the government will spend $716 billion less on Medicare.

Till the dirty soil. Bad propaganda boomerangs, because people who recognize your ugly falsehoods resent you for telling them. So you never want to be caught telling a nasty lie.

However … you can’t be blamed for the false information, irrational prejudices, and ugly stereotypes that already sit inside people’s heads, waiting to be exploited. So good propaganda contains only enough false or repulsive information to leverage the ignorance and misinformation that’s already out there.

If you want to convince people that President Obama is sabotaging the Medicare they deserve, you’ve got a lot to work with.

Obama is black. Romney doesn’t say, “You can’t trust Obama because he’s black”, because even whites who don’t trust blacks would be horrified to hear it said out loud. In this post-civil-rights-movement era, it’s rare to meet an open I-hate-niggers racist.

Still, race matters. White America does not give Obama the level of trust or respect a white president of either party would get. (Picture the outrage if a black congressman had interrupted President Bush’s state-of-the-union address by yelling, “You lie!”) And it’s different when blacks do things we accept whites doing. (Picture armed blacks protesting in a Tea-Party-like manner, with signs calling for revolution. Picture a black senate candidate threatening “second amendment solutions” if his side loses the election.)

You till this soil by talking about how “foreign” Obama is, and how someone needs to teach him “how to be an American“. If you just imply “Obama isn’t like you”, many whites will fill in the racist parts for themselves.

Blacks are lazy. They want the government to give them what white people earned. When Newt Gingrich calls Obama “the Food Stamp president”, he’s counting on his audience to fill this in. If they aren’t making the racial connection, Gingrich gives a nudge:

I’m prepared, if the NAACP invites me, I’ll go to their convention and talk about why the African-American community should demand paychecks and not be satisfied with food stamps.

How did the NAACP get into this? Did they ever say they prefer food stamps to paychecks? No? Then what’s Newt talking about?

Ditto when Rick Santorum said:

I don’t want to make black people’s lives better by giving them somebody else’s money.

In context, that statement is a complete non sequitur unless the government-gives-white-money-to-blacks idea is sitting your head.

Romney himself has tilled this ground with the Obama-gutted-welfare’s-work-requirement lie, which he dispatched Gingrich to defend.

 

Liberals favor people who don’t work over people who work. They’ve been tilling this one for years. But the weekend, overtime pay, safe workplaces, and Social Security and Medicare themselves — those are liberal ideas. Conservatives were against them every step of the way.

Nobody knows what’s hidden in the Affordable Care Act’s 2000 pages. Of course, if it had been 10 pages critics could say, “Nobody knows how ObamaCare will be implemented, because they left out all the details.” There’s always an angle.

This ground was tilled with Sarah Palin’s “death panel” lie — Politifact’s 2009 Lie of the Year.

As a result, many of the simple things the ACA does are not understood — like getting rid of the donut hole in Medicare prescription drug coverage. (That’s just one of the benefits seniors get from the bill. It isn’t “not for you”.) The pieces of ObamaCare are actually fairly popular, when people find out what they are.

The middle class is vanishing because all the money is going to poor people. In reality, all the money is going to rich people, but that process is complicated. The story that your hard-earned money is being taxed away and given to layabouts is much easier to understand.

A bunch of related misconceptions help out, like “Illegal immigrants steal our jobs.” The common element is that if you’re looking for someone to resent, look down, not up. The rich are heroes, “job creators” — not vultures who made a killing outsourcing everything to China.

Plant. Now look at what the Romney ad says: You (an aging white man) paid into Medicare “every paycheck” (because you worked for a living). But now Obama has siphoned $716 billion of those dollars into ObamaCare, a “massive new government program” which is “not for you”.

So who is it for? People not like you — the young, the non-white, the people who didn’t work.

Years of effort have pushed the idea that ObamaCare is a suspicious program put forward by an illegitimate president in order to give healthcare away to people who don’t work. If you’ve been buying the Republican message so far, you’ve been expecting something like what this ad is telling you.

Supply “independent” verification. Most people are too smart to believe something just because a TV ad says so. Instead, they look for independent verification. So they shrug off the claim that something is “the #1 movie in America” until they find out whether anybody at work has seen it.

But Americans have a lot less direct human contact than they used to. The difference is taken up by voices on the radio or emails from strangers who sound real. Many of them are not real, and conservatives have learned to exploit this avenue of false verification.

Last November, a “brain surgeon” called in to the Mark Levin show to say that ObamaCare would deny brain surgery to anyone over 70. He had the inside scoop, because he’d just come from a American Association of Neuro-Surgeons meeting where the new HHS guidelines document had circulated.

A viral email picked that up, amplified it, and kept people accessing the clip online. A hospital employee heard a doctor repeat it.

It was all fake. There was no meeting; there was no document; the guy who called in wasn’t a brain surgeon. He was just a voice in the ether, telling you something that somebody wanted you to believe.

Now this is going around:

Your Medicare premiums are going to double because of ObamaCare! There it is — the exact numbers! — independently verified by somebody who leaked the information out of BlueCross. But it hasn’t appeared publicly because of Obama’s 2012 campaign!

Except … it’s all fake. BlueCross has nothing to do with it. The numbers are made up.

It’s just something somebody wants you to believe. And it rockets around the country from cousin to co-worker to classmate. Inside information! Conveniently verifying the false thing that Mitt Romney is telling you.

No one knows how many of these fakes are out there, and by the time they get noticed and debunked the deed is done.

Nobody has succeeded in tracing such hoaxes back their sources, other than to note that they are overwhelmingly conservative. But they can’t just happen. No one can accidentally create such well-designed lies.

Don’t underestimate the power of lies. You may see some ad like Romney’s and say, “Nobody’s going to buy that.” But the ad is just the tip of the iceberg. It’s the visible piece of a complete propaganda campaign, much of which happens in places you don’t see.

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What the Court Decided About ObamaCare

July 2, 2012 – 1:05 pm

Thursday, the Supreme Court announced its decision that the individual healthcare mandate, and hence the Affordable Care Act as a whole, is constitutional. It was a 5-4 decision, with Chief Justice Roberts siding with the Court’s four liberals and Justice Kennedy (the usual swing vote) joining the other three conservatives.

I was thrilled. Yes, Roberts got to that decision in an odd way (more on that later), and states were given the option to opt out of the Medicaid expansion. (I expect Republican governors to posture a lot about this, but I have a hard time believing they’ll actually refuse.) But the alternative was stark: We’d be back to square one on health care, stuck with 50 million uninsured Americans, spiraling healthcare costs that are already the highest in the world, and no plan on the table to fix any of it.

So we should all take a moment to do a happy dance.

Done? OK, now let’s look at this in a wider perspective.

History. Democrats have been trying to get some form of national health insurance since Truman. LBJ got Medicare and Medicaid passed in the 60s. Clinton tried and failed to get universal health care in the 90s.

Fear that Democrats might someday succeed in passing a Medicare-for-everybody plan that put private health insurance companies out of business caused the conservative Heritage Foundation to propose an individual mandate in the 1989 report Assuring Affordable Health Care for All Americans. The Republican alternatives to HillaryCare in the 90s usually claimed not to have mandates, but tax credits were jiggered to produce the same result: If you chose not to have insurance, you paid more to the federal government.

And of course, an individual mandate is a key and necessary provision of RomneyCare in Massachusetts, which Mitt explained here:

The interesting detail in all of this conservative campaigning for an individual mandate was that its constitutionality was never addressed as a problem. As long as it was a conservative alternative to Democratic proposals, no one challenged the mandate’s constitutionality.

In May, Salon’s Andrew Koppelman asked the question: When did the individual mandate become a constitutional issue?

The first exploration of Congress’s authority to enact a mandate was a paper by Mark Hall, which he posted on SSRN in February, 2009. (I have not been able to find even a hint of the constitutional objection before Obama’s election, even though mandates have been proposed, mainly by Republicans, since the early 1990s.) He concluded that the mandate easily followed from existing commerce clause jurisprudence. … The first published claim of unconstitutionality that I have been able to find is a July 10, 2009, Federalist Society paper by Peter Urbanowicz and Dennis G. Smith. They created the now notorious action/inaction distinction, declaring that “Congress would have to explain how not doing something – not buying insurance and not seeking health care services – implicated interstate commerce.”

Before that, nothing. Crickets.

What Roberts Said. So this is where we are: I did a happy dance because the Court’s partisan Republican majority only managed four votes to shoot down a Republican healthcare idea that Democrats finally managed to pass. Their constitutional objection was based on an ad hoc legal theory that simply did not exist until a few months before Congress passed the law.

Worse, in giving his OK to ObamaCare, Roberts still signed off on the ad hoc action/inaction theory and rejected the Commerce Clause justification that seemed obvious to everybody only two years ago. Instead, he re-interpreted the mandate as a tax and found justification for it in Congress’ constitutional power to tax:

The Federal Government does not have the power to order people to buy health insurance. Section 5000A  would therefore be unconstitutional if read as a command.  The Federal Government does have the power to impose a tax on those without health insurance. Section 5000A is therefore constitutional, because it can reasonably be read as a tax.

Now, I can’t complain too much about this, because I’ve been lamenting for months that the mandate would obviously be constitutional if Congress had just replaced the word penalty with tax. Of course, if they had done that, it’s possible that conservatives would have trumped up some novel legal theory that limited the Taxing Clause. Who knows? If you want to throw out a law badly enough, you can always come up with something.

The Ginsburg Dissent. If you want to see what would have been a 9-0 decision in the 1990s, and probably even an 8-1 or 7-2 decision two years ago, scroll past the 59 pages of Roberts’ decision and read the dissent by Justice Ginsburg. (She dissents from Roberts’ reasoning, but not his conclusion that ObamaCare is constitutional. So she is also technically part of the majority that Roberts is writing for.)

There is a very striking difference in tone between Ginsburg’s opinion and both Roberts’ opinion and the joint dissent by the four conservative justices. Ginsburg consistently talks about reality, giving examples and statistics about what is happening here and now in the healthcare market. Meanwhile, Roberts and the conservative bloc mainly discuss bizarre fantasies in which Congress might force everybody to buy broccoli.

At the root of the conservative rejection of the Commerce Clause justification is the idea that Congress’ power to regulate commerce does not include the ability to “create” commerce by forcing people to buy a product (health insurance) they otherwise would not. The objection rests on two points:

  • Individuals should be able to escape Congress’ commerce-regulating power by not participating in the regulated markets.
  • Individuals can choose not to participate in the healthcare market by not buying insurance, not going to the doctor, etc.

The first point sounds reasonable, but has no real basis in legal precedent. And Ginsburg correctly observes that because accident and illness strike even young and apparently healthy people without warning, and because emergency rooms are obligated to treat first and ask for payment later, the second point is just false. Individuals actually cannot avoid adding risk to the health-care system.

Insurance companies and health-care providers know that some percentage of healthy, uninsured people will suffer sickness or injury each year and will receive medical care despite their ina­bility to pay. In anticipation of this uncompensated care, health-care companies raise their prices, and insurers their premiums. In other words, because any uninsured person may need medical care at any moment and because health-care companies must account for that risk, every uninsured person impacts the market price of medical care and medical insurance.

This is also inherently a national problem, precisely the kind of thing that the Founders wanted Congress to have the power to solve.

States cannot resolve the problem of the uninsured on their own. Like Social Security benefits, a universal health-care system, if adopted by an individual State, would be “bait to the needy and dependent elsewhere, encouraging them to migrate and seek a haven of repose.” Helvering v. Davis, 301 U. S. 619, 644 (1937).

In normal times, that would be that. As a unanimous Court wrote in Katzenbach v. McClung (1964)

Where we find that the legislators, in the light of the testimony and facts before them, have a rational basis for finding a chosen regulatory scheme necessary to the protection of commerce, our investigation is at an end.

But these aren’t normal times, so Ginsburg has to attack Roberts’ examples directly.

An individual “is not ‘active in the car market,’” the Chief Justice observes, simply because he or she may someday buy a car. The analogy is inapt. The inevitable yet unpredictable need for medi­cal care and the guarantee that emergency care will be provided when required are conditions nonexistent in other markets. That is so of the market for cars, and of the market for broccoli as well. Although an individual might buy a car or a crown of broccoli one day, there is no certainty she will ever do so. And if she eventually wants a car or has a craving for broccoli, she will be obliged to pay at the counter before receiving the vehicle or nour­ishment. She will get no free ride or food, at the expense of another consumer forced to pay an inflated price.

So no, it doesn’t follow that Congress can make us eat broccoli if the Commerce Clause allows an individual mandate.

The Medicaid expansion. One of the ways ObamaCare increases the number of people with coverage is that it expands eligibility for Medicaid. Everybody under 65 with a household income less than 133% of the poverty line becomes eligible.

Medicaid is a federal/state partnership, so the expansion can only happen if the states go along. The ACA tries to make it painless for the states to cooperate by covering 100% of the cost of the expansion for the first two years, and 90% thereafter. It tries to make the expansion painful to turn down by saying that Medicaid is a take-it-or-leave-it deal. States can go along or lose the Medicaid funding they already get.

Roberts found that this was too coercive, though he didn’t specify what makes a non-cooperation penalty too high. Ginsburg finds that the Medicaid expansion is within the normal power of Congress to offer funding with conditions, and does not see the take-it-or-leave-it part as a penalty at all, since each year is a new appropriation, subject to its own conditions.

Future Congresses are not bound by their predecessors’ dispositions; they have authority to spend federal revenue as they see fit. The Federal Gov­ernment, therefore, is not, as the Chief Justice charges, threatening States with the loss of “existing” funds from one spending program in order to induce them to opt into another program. Congress is simply requiring States to do what States have long been required to do to receive Medicaid funding: comply with the conditions Congress prescribes for participation.

As I said above, I doubt the states will opt out anyway. If they do, then ObamaCare will cover somewhat less than 30 million new people, and the opting-out victims will be poor and near-poor people.

The conservative dissent. Justices Scalia, Thomas, Alito and Kennedy combine in a dissent that is both radical and polemic, full of scary quotes about the Commerce Clause turning into “a font of unlimited power” or “a general authority to direct the economy”.

Its conclusion is that the ACA must be thrown out in its entirety.

Think about that: Based on a legal theory that did not exist two years ago, and whose advocates are almost entirely in conservative think tanks, the Court came within one vote of striking down the biggest piece of social legislation in half a century.

Salon’s Paul Campo has an even scarier theory: Looking at internal evidence in the text, Campo speculates that the conservative dissent was originally written to be the majority opinion, and that Roberts changed his mind late in the game.

So we dodged a bullet, and the country gets to have RomneyCare. Unless it elects Romney. Then the Happy Dance will be over.

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