Thursday, July 26, 2012

CBO:It will cost the deficit more to repeal Obamacare than to keep it

Well, GOP. Hope you are a little embarrassed this morning.  The Congressional Budget Office “scored” the Republican bill just passed by the House to repeal Obamacare and the impact of the Supreme Court decision on the health care reform legislation.  Since 2010, all we have heard from the GOP was that it would cost trillions and bankrupt us; we cannot take on a new entitlement program; we cannot afford it.
All along, the CBO had said “not true”; it would reduce the deficit.  The Simpson Bowles report came to the same conclusion. The GOP response has always been: the Democrats just asked the CBO the wrong questions and tried to shoot the messenger on this one issue. 
 Yesterday, in a letter to House Speaker John Boehner, the Congressional Budget Office “scored” the repeal legislation and concluded that  the deficit would be hurt more by repeal of Obamacare than if it was sustained in the form it is now.  That is because the costs have a “pay for” and the cost savings built into the Affordable Care Act would relieve  health care costs to the federal government.  According to an Associated Press report, and carried in the Denver Post yesterday, repeal would itself “boost the deficit by $109 billion from 2013 to 2022.” From the letter by CBO director Douglas Elmendorf: “Repealing the health care law will lead to an increase in budget deficits over the coming decade”.  Per the AP report: “The law’s mix of spending cuts and tax increases would more than offset new spending to cover the uninsured people, Elmendorf explained”. …”The Congressional Budget Office consistently projected that Obama’s overhaul will reduce the deficit…At the time  it was approved in 2010, CBO estimated the law would reduce the deficit by $143 billion from 2010 to 2010…though the CBO gave no updated estimate …(but that) about3 million fewer uninsured people will gain health coverage because of last month’s Supreme Court ruling granting states more leeway, and will cut the federal costs by $84 billion”.
The next time you hear someone continue to claim Obamacare will drive us into bankruptcy,  you can be justified in responding with “horse feathers”.
Note that I did not post yesterday’s column in the Sky Hi News. It was essentially a reworking of the blog regarding the Aurora theater massacre that I posted the morning after the tragedy.

Friday, July 20, 2012

Reflections on the Aurora shooting this AM. Is something wrong with Colorado?

July 20, 2012

I am sitting in the same living room that I watched on TV as the Columbine shooting unfolded in 1999. Today it is the mass shooting in the Aurora movie theater.   Flash backs to that day in 1999  were superimposed on today’s horror covered by both national and local news TV coverage.  My feelings reflect my Denver daughter’s text just before 5 am this morning: “ Seriously, now we will not be able to go to the movies in peace.  Ummmm, it is not the foreigners we need to be frightened of….”
Tom Costello, former TV reporter with KUSA TV in Denver, now with NBC,  was interviewed on MSNBC, and he asked “What is wrong with Colorado” and he talked about covering the Chuck E Cheese massacre  in Aurora  in 1993.  I, too, wondered myself.
Looking on an Associated Press site that provided   a list of mass shootings, similar incidents  have happened world wide,  from  the recent ones in Scandinavia, some in China and points in between.  World wide, too, this is known as the “Columbine Effect”.  Some of the countries  have good  mental health support systems in place.  The US mental health services are woefully lacking, but thanks to Columbine, our emergency responders have become well prepared for repeat incidents. Unlike the US, not all of the countries have our freedom to bear arms.   Costello asked…is it the gun mentality or something else in our state?  One thing is sure, Colorado will be doing some self examination in the days to come.
My daughter has reason to be particularly attuned to the events. She is a school teacher in an elementary school that feeds into Columbine. Jefferson County and her school are constantly drilling should a copy cat event like that happens.  She is a frequent movie goer and the mother of three teens.  There are many around the world,  as the President himself just commented on TV speaking from Florida, who can imagine themselves and their children being victims, including his two daughters.
Even we in the Granby, Colorado area have had our own dose of an angry, revenge seeking member of our community who carried out his emotions in 2004 in a converted bulldozer outfitted like a tank. Marvin Heemeyer set about destroying property  owned by the objects of his disaffection and ended the rampage by taking his own life. Fortunately, it was only property that was victimized,   there were those who sympathized with his motivation, and he served as their proxy.  Credit him at least for respecting human life; the shooter today had none. Regardless of our feelings about Heemeyer,   we have had our own experience with human beings unloading their rage on innocent people. This, too made news throughout the world…not because of the numbers killed (Heemeyer himself was the only loss of life), but because his methods of venting were unique.
A brief Google Search and posting by others of psychiatric  profiles of those who commit  mass shootings, I learned that the motivations and states of mind vary  greatly.  One about serial murders, which also applied to mass killings( got my attention: “They are driven by selfish, powerful and uncontrolled desires…the origins of the personality type may be numerous and sometimes disputed. Certain commentators believe a person is born with the possibility of acquiring such a personality. Note, however, that all accept that upbringing, especially relationships and parents and the amount exposure to violence as a child, has a major impact on their development.”
Perhaps the permeation of violence in our modern societies exposed to so many through modern media may be part of the picture. Another is the ability of modern armaments permits one shooter to do so much damage.
It is still is early in our digestion of the Aurora events, but from interviews with witnesses in the theater say that the shooter fired during a fighting scene in the preview beginning of the Batman movie.  Whether the violence of such films provided some motivation for the shooter acting out a fantasy or was a cover to give the shooter a better chance to get off more rounds, we do not yet know. Nonetheless, it is time for us in Colorado to do some serious reflection as we ask “why”.

Wednesday, July 18, 2012

Urban myths: Obamacare costs trillions and will bankrupt us and patients will not have a choice of doctors and hospitals

The column 7/18/2012 in the Sky Hi News

The futile attempt by the House Republicans to repeal Obamacare last week prolonged the debate and kept it a hot topic. 

President Obama got a gift, a second chance to sell his health care reform law and to shoot down some urban myths.

Health care reform issues are extremely important to the more than 20 percent of Grand County residents who cannot afford health insurance now. Those of us who are already insured, including those on Medicare, should also sit up and take note of the impact on us if Obamacare is repealed and not replaced. 

The greatest urban myth concerns costs and the deficit. While Obamacare indeed costs trillions, the GOP has deceptively made an issue of only the cost side of the balance sheet, ignoring the sheet's other side, the savings and revenue offsetting federal expenditures Obamacare (aka ACA) requires. According to the Congressional Budget Office on March 13, 2012, “… the ACA will, on net, reduce budget deficits over the 2012-2021 period.” The Simpson-Bowles bipartisan deficit reduction commission examined the relationship of Obamacare to the deficit and recommended “Controlling health care costs by maintaining the Medicare cost controls associated with the recent health care reform legislation.”

Other urban myths: The GOP litany, that Obamacare would not give consumers choice of plans, doctors, or hospitals, or cut Medicare benefits is, horsefeathers. Nothing changes the choice employees have if their employers provide insurance. States have been given the option of setting up their own market exchanges to cover the uninsured. Colorado's exchange will give currently uninsured Grand County residents a choice of as many as 12 affordable private plans and will subsidize the cost based on their ability to pay.

For those insured, if Obamacare were repealed, closing the senior drug donut hole would be lost, covering pre-existing conditions for children and adults would be lost, keeping young adults on parents' insurance policies, eliminating co-pays for mammograms and other tests, or requiring insurers to spend greater percent of your premiums on actual health care services — all lost. There would be no protection against lifetime caps, outrageous co-pays or kicking a patient that got sick off their insurance.

Mitt Romney has departed a little from his House Republican brethren by proposing “common sense” alternatives, paying lip service to both the concept of covering pre-existing conditions and admitting that the uninsured should have more affordable access to health care. He may talk in fiery terms that he will repeal Obamacare day one — a difficult task unless he controls both houses of Congress — but he must also propose a way to fund the same popular benefits as some of the Obamacare provisions. So far he has come up nearly empty on the “how to” part.

The problem is Romney's “common sense” replacements, cross state insurance sales and malpractice reform, just add up to too few cents. They have already been scored by the Congressional Budget Office. They found that those measures would lower the cost of health insurance, but only enough for 3 million more to afford insurance, leaving 27 million still seeking health care in the ER and shifting the costs on to the rest of us. He has been silent on closing the Medicare donut hole. 

Romney's proposal to cover high risk patients by setting up state pools, as Colorado has done, is already funded by Obamacare until the law is in full effect in 2014. The cost of providing the subsidies is extremely high and unaffordable to consumers who cannot afford any kind of health insurance now. The mandate makes possible pooling high-risk patients with healthier insured so that the system is cost effective for all. In short, Romney's replacement plan is just another urban myth.

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Wednesday, July 11, 2012

Where would unemployment figures be today if the GOP had been in power

My column today in the Sky Hi Daily News
While last week's report showing jobs are still being added to the economy, the number was not as good as predicted. While a weak performance, if averaged with earlier robust job growth, it was hardly the total failure the GOP claimed. The President was more of a victim of rising expectations than that far off the mark. The Romney campaign could barely conceal their glee and used the opportunity to encourage us to vote for anyone but the guy in charge. If we repeal Obama, Mitt Romney's challenge is to convince more voters he is the guy to replace him.

Those GOP economic plans Romney promotes failed us before. Both are a doubling down on George W. Bush policies of unfunded tax cuts to the rich and de-facto deregulation of Wall Street. In short, the policies supported by the GOP of cutting taxes to the “job creators” and turning the financial sector loose to be irresponsible lost us 8.3 million jobs and caused the worst economic crash since the Great Depression. Economists believe that it takes at least eight years to recover from a severe financial crisis and we are half way there, with trend lines still moving up in starts and fits, and the creation of over four million private sector jobs.,

But that is wonky thinking . Facts, figures, statistics and history rarely make for great political rhetoric, so it is more effective strategy to gin up fear by speculation, listing every faintly possible or plausible failure in the future, and to disrespect independent expert messengers who disagree. No wonder business expansion and consumer demand are paralyzed by the fog of uncertainty about the future. The GOP at every opportunity has fueled more angst by promoting a gloom and doom future and asking voters to delay any Congressional action until they control Washington so they can repeal anything smacking of Obama.

Currently, GOP's anti Obamacare scare is that it will cost us trillions and be a job killer, but such projections are not backed up by the Congressional Budget Office. The grossest exaggeration by the GOP is that Obamacare's mandate penalty/tax would “ raise taxes on us all”, but in reality, it would affect only 1 to 2 percent.

Does Mitt Romney offer a plan to boost jobs on Day 1?. Hardly. The fuzzily detailed plans he has proposed take time to trickle down. His goal, to bring down unemployment to 6 percent sometime in the distant future, is in keeping with the CBO projections to happen anyway. Romney's plan: even more tax cuts to the rich paid for by cuts to the poor's safety net and repealing Obamacare with no plans to cover most of the 30 million uninsured or a method to pay for even provisions treasured by the already insured.

Obama's “day one” jobs bill this year, stonewalled by the GOP, would have put over one million laid off teachers, firefighters, building contractors, and highway and road workers to work. If the GOP had been in control of the House in Obama's first two years in office, the stimulus bill would have never been passed, yet it did create nearly 3 million jobs as planned. Had Mitt Romney been president, the auto bailout would not have happened, and even more would have been part of the unemployment statistics. . 8.2 unemployment today would have looked like a desirable goal instead of a disappointment if the GOP had blocked both the stimulus and the auto bailout. The GOP has even thwarted long term solutions proposed by Obama that are similar to the bi-partisan Bowles-Simpson plan that provides a workable long term solution to the debt problem because their party has been hijacked by anti tax zealots.

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Wednesday, July 4, 2012

Supreme Court's upholding Obamacare is a victory for consumers

There is an ad running in Colorado on behalf of Pres. Obama’s reelection that contains  a point  besides the one it intended.  The ad features an older woman with Parkinson’s like symptoms who said that when Bain capital (Mitt Romney’s firm) bought the profitable company  for which she had worked for many years and ran it into bankruptcy, she lost her health insurance  and pension..  The punch line: “Mitt Romney…….he made me sick”. The obvious  message of the ad is that Romney did not care about the damage his business practices caused to human beings. , but the ad also illustrates a nagging,  widespread  fear that loss of a job means loss  of health insurance. .    Had Obamacare been in effect, that  laid off worker  in poor health could have been able to get insurance  .    
 Supreme Court’s decision upholding  the constitutionality of  Obamacare   is more than just a political victory for the President.  It is a victory for  consumers..  The health system we have had has failed, both those who could not afford insurance and even the insured. .  Estimates are that 26,000 people die early because they did not have access to insurance. The number one cause of bankruptcy is inability to pay health care bills and many of those bankrupted  are insured with inadequate policies. Care providers pass their costs not covered by patients’ payments  on to the insured .
After the Supreme Court decision, I received calls from family members and close friends who were relieved .  One was self employed and could not afford health insurance for himself and his family. He will be able to afford it January 2014.  Another has college age children who will now be assured they can stay on their family’s insurance until they are 26. 
Another   was at work  and trying to pay off $20,000 worth of co-pays for cancer treatments not covered by her employer provided insurance.  She has been living in sheer fear of layoffs  and one incompletely covered major illness   would have driven her to bankruptcy or loss of her  home.  After COBRA would have run out,  she would be uninsurable due to her pre-existing conditions.  She has been very grateful for the part of Obamacare that is already in effect that requires coverage of necessary and frequent mammograms without a co-pay. 
We seniors are also relieved that the donut hole is covered.   Buried in the law is that the cost of the health system will be lowered due to some important cost savings measures,  Medicare just got at least 8  years tacked onto its life and my benefits are not reduced.   We are informed and aware  the so called “death panels” are prevented by the law from making any edicts that would have power over those end of life treatments.
We are also small business people and in spite of the GOP campaign of disinformation, we understand that we who have less than 50 employees do not have to provide health insurance, but if we do, we get generous tax credits. Our employees  can seek affordable insurance in the new market place exchange instead.
All of us understand that nothing in Obamacare will interfere with our relationships with our doctor. In fact, the uninsured will finally be able to afford to have a doctor with whom they can have a relationship.   Health care will  no longer be rationed by private insurers’ arbitrary denials and anyone’s ability to pay for care. 
These  benefits are what Mitt Romney and the GOP want  to take them away from consumers , though Romney is professing to keep some, but not all. He has offered no mechanism to fund them. He is in a difficult  situation, explaining why the policies of Romneycare for Massachusetts, the model for Obamacare, is wrong for the nation. 
A version of this also appears in the e and print editions of the Sky Hi Daily News ( today.

Tuesday, July 3, 2012

Democrats should make Obamacare a campaign issue

This is a plea to the Democrats not to ignore the Obamacare issue.  If it is not the main strategic message, it still deserves attention as a tactic  because it gives the Democrats a  new opportunity to attack the GOP and Mitt Romney , to win over the few undecided and independents , and to dampen the GOP rank and file’s passion to  vote because of their opposition to Obamacare.  It might in the long run  save Obamacare from being repealed.
The quandary facing the GOP and the Democrats is whether to make an issue of Obamacare  or run from it. It depends on which level, Presidential or Congressional, and in which states.   The focus will  be more critical in  the Senate races since it probably a given the TeaParty GOP will hang onto the House of Representatives. While it is  unlikely,  the Senate has the potential to see the partisan  balance change  enough  so that the GOP could have enough votes to control the filibuster and the reconciliation process and could possibly either repeal or cripple Obamacare. .  Neither Colorado senators are up for election this year, so that the Presidential race will be the focus.  Elsewhere the races for the senate will be more crucial for the preservation of Obamacare.
On the Presidential level,  Pres. Obama and his surrogates have an opportunity to get a fresh start in  selling  Obamacare, to rebut the distortions and flat out lies opponents use against it, and to attack Mitt Romney and the GOP.  There is value in keeping Obamacare on at least the second burner, if not the first, in the both the House and Senate races that would benefit the President.
  The inclination of Democrats is  to run away from Obamacare  because the US is still split 50-50 on the issue and the only ones left to convince are the few independents and less astute voters who are indifferently  fence sitting.  If Obamacare is buried in the campaign rhetoric, he is missing an opportunity to put Romney and the GOP on the defensive and to dampen GOP rank and file enthusiasm and motivation to vote because of their distorted  understanding of Obamacare.   There is nothing like a near death experience to focus attention on the values of life and what is lost in dying .
By giving some attention to Obamacare, the President  also can help educate the voters in contested Congressional races, but at the same time educate the Democratic candidates  so they can argue, debate, and position themselves effectively.  Polls show that the GOP rank and file is motivated to vote because of their dislike of Obamacare.  
 The opportunity is important because the Obama administration has done a miserable job of a positive approach  in selling Americans that Obamacare would be good for them whether they are happily insured by an employer now or one of the thirty million uninsured who do not have access to insurance because of cost or pre-existing conditions. A negative approach:” here is what the GOP will take away “would work better to get the truth out.   Ads featuring real people who are or will benefit from Obamacare  attacking the GOP for wanting to take away their benefits could be very effective.  The prospect of losing those benefits should make the voters be more willing, open and motivated to try to understand the positive aspects of the  law. It could also infuse more enthusiasm in the Democratic base, as well, giving Democrats a cause to fight for.

Romney has every reason in the world to ignore the issue, trying to explain why Romneycare, the model for Obamacare, is good for Massachusetts and a success, would be a failure or wrong for the rest of the nation. It is  an  awkward  position and there is an opportunity the Democrats to make hay with it. Romney also has said he would replace some of the benefits of Obamacare but no method to fund them if he repealed the mandate.  Whatever he says he wants to do, cover pre-existing conditions, restore the popular benefits, or make insurance affordable to the 30 million left out of the system now, would be impossible to fund and would butt heads with the Teaparty folks who do not want to replace Obamacare with anything.
Democrats can also use the Obamacare  issue in combination with or part of other issues to define Romney on character issues. If Obama does that, he can force the GOP on the defensive and show that not only are they inhumane, as is their out of touch standard bearer, they also have no real replacement that is comparable and fundable; a fuzzy policy maker.
By the Democrats ignoring the issue, they have missed an opportunity to attack him on poor leadership and being a pig in a polk he is asking voters to buy.  Combined with Romney’s fuzzy thinking on the immigration issue, there is an opportunity for Obama to attack him for being a weak leader, countering GOP claims Obama is a weak leader and defining  Romney as fuzzy.  (Remember the fuzzy math political attacks of years past?)
What the Democrats ought to be doing now is educating their candidates in the Congressional races on the ins and outs of the health care reform law so they can function as their own fact checking truth squad,  fight the GOP distortions effectively and attack their GOP opponent as wanting to deny voters of the benefits of Obamacare.    They also must be knowledgeable enough to defend against any attempt by a GOP strategy to tie Obamacare to the debt and deficit, and know the positive impact Obamacare will have on the debt and on Medicare, for example.  They must have at their fingertips the rebuttal  to such lies  that Obamacare will raise taxes to the middle class, cost trillions, and cause small business not to create jobs.  If the Congressional candidates can do this effectively, they can also help Obama get re-elected and save Obamacare.