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I think Robert Samuelson has the correct political read on Health and Human Services secretary Kathleen Sebelius’ recent decision. The health care policy moves by the Obama administration since the 2010 election all seem to be about trying to minimize as much as possible health care reform as a political issue in the 2012 election. From Sameulson:
Sebelius ducked this question by requiring each state to define essential health benefits based on existing policies in that state. Almost no one anticipated this. The ACA does not suggest it. Sebelius asked for advice from the nonpartisan Institute of Medicine (IOM). Its report talks of a national standard for essential health benefits, although it also notes that the ACA allows the secretary to provide state-by-state waivers beginning in 2017.
Politically, Sebelius’ decision is a masterstroke. One Republican criticism of Obamacare is that it imposes a “one-size-fits-all” straightjacket on health care. Mitt Romney — the ex-governor of Massachusetts and author of that state’s universal health insurance plan — has made this point repeatedly. President Obama can now retort: “No, we’ve left crucial decisions to the states.” He can also argue that Washington isn’t dictating “how medicine should be practiced.”
I would add to this the unprecedented move by Sebelius to overrule the FDA about the emergency contraceptive Plan B and President Obama’s decision to endorse the Wyden-Brown bill to move up the start date for the state innovation waivers.
Obama’s decision to endorse the bill reeked of the same basic political calculation as this recent move by Sebelius on essential benefits. If Obama really wanted the earlier start date he could easily had it included in the original Affordable Care Act when it passed, instead he only endorsed the idea when it was clear it had no chance of becoming law.
Despite claims that Obamacare would become popular after it was passed and promises that the Democratic leadership would keep fighting hard to win the PR war over the law, it has remained very unpopular. With the law designed to not even begin trying to make good on its big promises until over a year after the 2012 election, there is just no reason to believe the law is going to get popular by the election.
It seems the Obama team has basically made the calculation that they simply can’t win on this issue so they can only try to minimize the amount the issue of health care will be talking about.
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Meanwhile, the biggest non-Mormon-related reason the GOP base has for opposing Romney is his creation of the Massachusetts version of the ACA. It’s telling that Obama, who spent two years pushing this through on behalf of AHIP, PhRMA and the other big wheels in the health-care lobby, who spent far more time and energy and political capital on this than he ever did on the stimulus package, now suddenly is pretending it doesn’t exist.
Jane’s been saying over and over again for nearly three years now what a disaster this would be and has been for the Democrats — and how they knew it was a disaster from the get-go, yet did it anyway, in true Paths of Glory fashion.
“He can also argue that Washington isn’t dictating “how medicine should be practiced.”
ACA is not and never was about how “medicine should be practiced”. ACA is only about how insurance must be purchased.
So, when it is politically expedient, Obama won’t even stand by his “signature” achievement? Do tell.
Most blatantly evil president ever.
Not sure ‘evil’ is the right word for him. Something closer to second-rate or worse seems more accurate. He has no core. One thing’s sure: he’s taken triangulation to a new level. I thought Clinton had hit the practical ceiling on that.
The solution is to create our own community clinics as a parallel health care system. None of us can afford to pay insurance premiums plus 100.00 a pop to go get stitches at the emergency room anymore. We can take care of our own healthcare, at least for the small predictable injuries. I have had it with over priced healthcare doctors, hospitals, pharmacies, and the blood sucking insurance industry which lives off of them.
He’s not stupid. He knows his “achievement” was a great big give me to the health insurance industry. Now his intent is to collect the money from his give me group(insurers) and minimize the damage and *hope* that people haven’t noticed that their premiums have gone up and that their actual benefits have gone down. The best he can hope to parrot is that 2 million kids that might not have had access to insurance still have access to their parent’s insurance and that enough people who had preexisting conditions are benefiting from the pcips that are set up.
Coach Bill and PW shoot, score, game over.
Bless ya both, straight to the point and end game.
Happy Holi Daze all of yas . . .
;-)
Actually, all the comments above are solid and right on Bob . . . .
Youse firebaggers are a wonderful and talented lot, so Happy Holi Daze tto ALL of us, Mz. Hamsher and the rest of the FDL Team who inform and dazzle us daily.
*bows*
I agree.
Now that ACA is imploding, what “signature accomplishment” will they invent to take its place during the campaign?
Slapping a label on swapping soldiers for contractors and calling it “ending the war in Iraq”?
Bragging about being tougher on terrorism than the Repubs?
Maybe the astonishing negotiation feat of forcing the Republicans to accept a tax cut, just the other day. If he’s really tough with them, maybe they’ll agree to deregulate or privatize something.
It’s so telling that the Obama Administration is backing away from declaring ACA one of, or “the”, signature achievement of the Administration.
What I am concerned about is the horrendous acceptance of, and continuation of, the nightmarish insurance billing issue for practitioners. And, Sibelius’ (and Obama’s) decision to even add to the number of various policies with which practitioners have to deal, continues to exemplify the disregard for practitioners’ and client/patients’ concerns.
In effect the complicated and fragmented way we delivery and bill for care just got worsen x 50. Horrendous for practitioners who have even more policies to research BEFORE providing care. If Sibelius/Obama had gone the national minimal benefit route, it would have simplified the financial/billing aspect. But, this is more about the corporations than the people.
Taking ACA out of the election will be in SCOTUS’ hands. I think the best they can do for Obama is to shoot down the mandate but honor its (nonexistent) severability from ACA. They’ll find a way if they want to. That is, the “want” would come first, then they’ll ferret out a path.
The lack of severability is either a fascinating error or clever strategy. If it causes ACA to blow up, though. . . which of the original boosters will be blamed?
Otherwise, SCOTUS either shooting down the whole law or leaving it as is seems to offer more problems for Obama. Still, he should sleep better now while the GOP self-destructs, ACA or not. There’s so much bile spewed between them there can’t be credible running mates or endorsements among them once the front runner floats to the surface. Maybe they expect the public to forget?
There will actually be 51 plans. Congress and WH have their own health care plan to give them an alternative to the various state plans. Which do you think will be better? What could possibly go wrong?
At first with ACA I thought Obama was naively trying to have his cake and eat it too: comprehensive coverage retaining the for profit model. Now That Emperor Obama, the proud Eisenhower Democrat, has shown his true colors as the country’s #1 corporate Pimp, I realize the mandate was always the end sum game. 40 million new customers delivered into the tender mercies of the insurance/pharm Mafia.
I guess I owe the Tea Partiers an apology. I never thought I would be rooting for a Roberts 5-4 decision voiding the mandate.
Oh, the complete Bullshit. There is no fucking way that Obama is going to try and “take Health care out of the 2012 election” it’s going to be front and center. And it should be.
Why in the world would Obama run from providing insurance to 2,500,000 people between 21 and 26? He wouldn’t you’re making shit up.
Why in the world would Obama run from providing free preventive care for millions of people, at the expense of the insurance companies? (Corporate pimp, my ass)
Why would he run from closing the doughnut hole and thus saving senior billions?
Why would he run from the 80% loss ratio? A provision that has already saved the taxpayers billions at the expense of the insurance companies (so much for him being a “corporate pimp”)
Why would he run from providing tax incentives that have ALREADY allowed smaller businesses to provide insurance for their workers? He wouldn’t.
As far as the alleged unpopularity of the bill goes: it’s about time the “journalists” at FDL get some cojones and admit your responsibility. People are uninformed about what’s in this bill because YOU misinformed them. At that last article you wrote where you basically wished that Spike would politely die rather than inform the public of the positive effects of this bill, i was stunned to see how many people on this site didn’t even know about the high risk pool. I shouldn’t of been stunned. The fact is they don’t know because they read this blog. The people that read this blog are no more informed then Faux news junkies because YOU haven’t informed them. Because, like them, instead of taking it upon yourself to inform your audience you and they decided a better use of your time was to engage in a jihad against this President
This bill will not be “run” from because there’s no reason to run from it. When Romney or Newt says they will end “Obamacare” President Obama will be able to say “Oh, really? how will that play to the seniors, students and small business owners that are currently USING the bill”. Not to mention people, like myself, and spike, and the ungrateful Susie Madrak who would not even have insurance if it weren’t for this bill.
Do facts EVER enter your political calculus? Or are you so enamored with the idea of this being a “disaster” that you just refuse to consider them?
This bill is not a “disaster” for me, Spike or Susie Madrak i have health insurance because of it.
It’s not a “disaster” for the millions of senior paying less for prescription drugs because of it.
It’s not a “disaster” for the 2.5 million people below age 26 who now have insurance because of this bill.
It’s not a “disaster” for the millions of senior who have received free wellness because of this bill.
It’s not a “disaster” for the millions more receiving free preventive care because of this bill.
It IS a “disaster” for the insurance companies that now have to provide free preventive care.
It IS a “disaster” for the insurance companies that can no longer make unlimited profits.
It IS a disaster for the insurance companies who can no longer pick and choose who they cover.
It IS a disaster for the insurance companies which have been forced to give back billions to their providers.
It’s one thing for FDL to peddle this line of bullshit before it was in effect. But now that they’ve been proven wrong about it, you’d think they’d man up and admit their mistake. Millions are better off because of this bill, that’s a fact that can’t be denied anymore.
Oh, not that i’m buying into the argument that Romneycare and Obamacare are the same, but Mass care is extremely popular in Massachusetts. Just an FYI.
The affordable care act calls for a committee on best practices and it also calls for an end to “fee for service” in 2015. So you’re just wrong.
Well shit, if there’s going to be a committee on best practices in 2015, color people here stupid for their concerns.
Best practices will be in place in 2014 along with the exchange. The end of pay for service happens in 2015.
Sebelius is a piece of work, and Obama is the kind of kniving political calculator that he campaigned against back in ’08. So I turn the channel when I see either of them on TV.
That seems possible! It will be like 51 FAAs controlling air traffic across the US.
Seriously, the Feds could leverage mandates out of each state gov’t which would not be unconstitutional in the sense that a Fed mandate might be.
All it would take is the lure of money from DC, or the lack thereof as a penalty. The GOP will sign onto this I’d bet, to avoid the much better alternative of single payer, no mandates, which they would call “socialized medicine.”
Might the ensuing fight then be cast as what the 51 mandates could do or not? Will one state be allowed to dishonor another state’s mandate if that requires less coverage? Purchasing across state lines?
Much of what’s in your list can be accomplished without ACA or mandates from DC. The enemies here are the insurance companies, big pharma as well.
Also, the proliferation of ACA waivers to date is a symptom a very sick process brewing. I’d bet they’ll be quickly renewed rather than being just a temporary bridge to anything.
The only good solution would be single payer, and ultimately single payer / single source. That responds to the rationale that healthcare is a right which should be for all at substantially the same level of service. That mindset seems to be taking hold in society.
So knocking the rungs out of ACA is a starting point, I think, to get to single payer in the future. Otherwise if SCOTUS gelds the mandate without tossing out ACA entirely, Congress could still reassign mandate responsibilities to the states in return for A Fed subsidy to each participating state. We’re still stuck with the industries skimming money there. — there could also be a valid issue with quality control that way, though.
The waivers are being granted for low-end businesses to allow them to get very low-end insurance up until the exchange gets in. These low end insurance policies will not be allowed into the exchange as they don’t meet the minimum standards of free preventive care and other requirements provided by law in the bill.
Aside from the fact that you can’t tell me where the votes were in the last Congress for single payer, the fact remains that single payer is not the only good solution. There are other countries that have great health care system and they don’t have single payer. They just regulate the hell out of insurance companies- EXACTLY what the PPACA calls for.
But even if it is your steadfast belief that it’s single payer or bust. That anything short of that is inadequate, how in the world does attacking the PPACA get you closer to that goal? MOST progressive goals have been obtained in increments the 1967 civil rights act was proceeded by the 1964 Civil rights act which was proceeded by the 1957 Civil rights act. What you think of the 1972 clean water act was actually a series of amendments to the 1968 Clean water act.
The fact is that the BEST method of getting to single payer is supporting the bill and pushing to expand on it rather than insisting that we tear it down and start over. Instead of castigating the high risk pool for being inadequate why not celebrate that someone life is being saved by it? Why not celebrate the fact that 2.5 million kids are insured now that weren’t before? Why not celebrate the millions of seniors saving 500 bucks a year already because of the doughnut hole being closed? There are millions of real people- 99 percenters all- being HELPED by this bill, including myself, and you would NEVER know that from looking at the reporting of FDL. That is wrong, no matter how you slice it and Jane Hamsher and Jon Walker should be ashamed of themselves.
The idea that destroying the ACA brings us closer to single payer is idiotic. This bill brings us closer to single payer for 2 primary reasons 1. Despite the propaganda here it DOES weaken the insurance industry, they’re already firing lobbyists because of the 80% loss ratio. They can’t justify lobbying as a medical expense. 2. It shows that government CAN do good things and really help people.
But that second part only works if there is a media that wants to tell the truth about the bill and the good things it has done. Unfortunately there’s a HUGE segment of our media on both the left and the right that is going out of its way to disparage the bill to minimize any good that it is doing and to exaggerate its supposed shortcomings.
I mean doesn’t it bother you at least a little bit that the conclusion Jon Walker came to- Obama running from his most significant accomplishment- is the same type of conspiratorial bullshit that you can read from Newsmax or Redstate? I mean sure they arrive at it from different angles, but the conclusions are always the same: The Democratic President with the most impressive liberal accomplishments in 40 years is betraying the country.
Doesn’t it bother you that Jon Walker is trying desperately to spin away all the good of this bill the exact same way Bill, Rush or Sean would? And he’s doing it for the exact same reason. He is personally invested in this President’s failure.
Wow, sounds like we’ve got someone here well-versed in how to recite elaborate variations on Obama talking points! Complete with enough handwaving to power a small town!
Riddle me this, inspid: If the ACA was such a stunningly popular piece of work, why is it that the only people currently talking up how fabulous it is are Obama’s internet surrogates like you?
Why aren’t we seeing Obama ads and prominent Democrats in general saying things like “Republicans want to take away the ACA! Stop them!”? They’re doing lots of talk about how Republicans want to take away Medicare and Social Security — why not similar amounts of talk about Republicans threatening Obamacare? (Answer: Because it’s not popular with most Americans! The most popular part of the proposed plan was the public option, and that was dealt away in exchange for industry support.)
As for why the ACA is such a bad deal and enriches insurance companies by forcing all Americans to be their customers or face heavy fines, just follow these links:
http://fdlaction.firedoglake.com/2009/09/23/carper-public-defends-secret-phrma-deal-in-exchange-for-support-ads/
http://fdlaction.firedoglake.com/2011/12/16/ezra-klein-then-and-now-on-health-care-exchanges/
http://news.firedoglake.com/2010/10/05/the-deal-with-the-hospital-industry-to-kill-the-public-option/
http://www.huffingtonpost.com/miles-mogulescu/ny-times-reporter-confirm_b_500999.html
http://fdlaction.firedoglake.com/2010/03/17/dennis-kucinich-will-return-money-to-donors/