For first time in my life, I won’t be voting on principle…

…alone.

This occurred to me the other day when my wife and I were having one of those “kitchen table talks” about finances. I have always taken a kind of foolish pride in telling myself that I was casting my ballot for what I felt was best for the whole country, and not just what was best for myself personally, at least in the short term.

I never really talked about it much because even I am not so oblivious that I didn’t understand that not much could be more annoying than someone sanctimoniously explaining that his vote is based on principle, not some selfish need like lesser citizens.

And the truth is that at least in 1992 and 1996 my vote was definitely in my self-interest, both in the short term and the long term. It’s just that I was young enough then that I didn’t really consider my vote to be that consequential to my immediate well-being, and it wasn’t the criteria I used. Like many Americans I looked at the candidates, looked at their plans, and voted for what I thought was best for the country, and figured that would benefit me indirectly as well.

In the elections of 2000, 2004, and 2008 I could legitimately make a case that I was voting against my immediate self-interest. Of course long-term self-interest is a different story, and being a Democrat I believe that it is in all Americans’ long-term interest to vote for a more progressive candidate, so it’s not like my votes were some sort of sacrifice or anything. But in my thirties retirement seemed far enough away that my votes for Democratic candidates were based on principle, principally.

This year is different. Suddenly retirement doesn’t seem that far off. My wife’s and my retirement planning consists of basically four things: we’ve been maxing out on 401k contributions for a number of years and will continue to do so; our home will be paid off when I retire, allowing us to live here with only property taxes to pay; Social Security; Medicare.

If Mitt Romney wins, I fully expect that Medicare will eventually be turned into a voucher program; that’s what Paul Ryan repeatedly proposed in Congress and I believe that’s what the majority of the Republican caucus wants to do. Instead of guaranteed benefits and coverage, we’ll be forced to try to find insurance on the private market, while suffering from the pre-existing condition of being old.

If Mitt Romney wins, I fully expect that Social Security will eventually be privatized (or “personalized”); that’s what Paul Ryan repeatedly proposed in Congress. Instead of a guaranteed monthly lifetime benefit, we’ll be spending our retirement trying to manage another shrinking personal account in addition to our 401k.

I’ve been paying into Social Security and Medicare for 27 years. I would really like them to exist when I retire. Republicans and conservatives will counter that their drastic actions are necessary to “save” the programs. I’m sorry, but you cannot “save” Medicare by turning it into Vouchercare. You save Medicare by saving Medicare. You cannot “save” Social Security by turning it into another 401k program. That’s not what Social Security is. There’s nothing wrong with a 401k; but it’s not a guarantee.

The biggest lie that conservatives have been able to successfully push into our national consciousness is that we cannot afford these programs. Even a lot of Democrats will talk about “tough choices” and “sacrifices” that must be made in regards to what they call “entitlements,” rather than the “earned benefits” that they actually are. We spend more on Defense than the next ten countries combined. We are the richest nation on the planet. We can afford these programs; they can be paid for. It requires political will, not rocket surgery.

It doesn’t end there. Recently we had a scare in our family when my younger son’s pediatrician ordered some tests for what would have been a very serious illness. Everything is fine, but if they hadn’t been, we would have been in a situation where we would have very easily maxed out the lifetime caps on coverage that insurance companies used to impose before the president signed Obamacare. If Mitt Romney wins and fulfills his promise to repeal Obamacare on day one, those lifetime caps will be back. Some families like mine, who have had insurance and have paid all their premiums, will be hit with tragic illnesses and will go bankrupt trying to pay for treatment after their insurance companies are allowed to stop paying for treatment. That will happen.

I’m not sure if having a personal stake in the outcome of this election makes my vote less principled or not; I don’t really care, frankly. Either way, for reasons of principle and for reasons of practical and tangible benefits, I am enthusiastically supporting the re-election of President Barack Obama.

DNC day one reaction

Wow.

Well, it wasn’t boring, at least not if you’re a Democrat. I’ve been watching the political conventions for 24 years now and I was not expecting the emotional night that the Democrats put on last night in Charlotte. Yes, yes, I’m a fanboy, guilty as charged, but I’m not suggesting that last night was the best convention night I’ve ever seen or anything, just that I was pleasantly surprised by the excitement that the Democrats in the hall showed and the quality of the speakers.

I think it was probably because last week’s RNC kind of lulled me into thinking that these conventions are usually pretty boring, or at least the first couple of days usually are. Sure, the RNC did get pretty, um, unusual, there at the end, but the first couple of days before (and the hour after) that bizarre moment were pretty boring.

Everyone is talking about the Michelle Obama speech, and I will too, but first I want to point out what I think is the biggest campaign development that we learned about last night: the Democrats are embracing Obamacare. They aren’t running from it; they’re not playing some kind of “well it’s better than nothing” game with it; they are calling it “Obamacare” proudly and not just defending it; they are campaigning on it.

Here is Stacey Lihn, a mother of a little girl born with a congenital heart defect explaining how the regulation in Obamacare that prevents insurance companies from capping lifetime payments is allowing her daughter to get the care she needs to survive, and keeping the family from bankruptcy.

That’s the reality of Obamacare. This is the woman who Republicans would like to tell, “sorry, those regulations that are keeping your daughter alive and your family from bankruptcy? Yeah, we’re repealing those on day one. Good luck on the Free Market!”

Democratic Massachusetts Governor Deval Patrick tore it up last night, showing everyone why they think he might be a contender in 2016. As the man who succeeded Mitt Romney in MA, he had the devastating line of the night:

As governor, Mitt Romney was more interested in having the job than doing it.

Keynote speaker and Mayor of San Antonio Julian Castro was also brilliant, telling his wonderful life story and making this observation that perfectly illustrates the difference between the GOP vision and the Democratic vision for our country:

We know that in our free market economy some will prosper more than others. What we don’t accept is the idea that some folks won’t even get a chance.

This is a point I have tried to make dozens of times over the last 20 years since I first voted for a Democrat named Bill Clinton. Contrary to the dishonest straw man position that  conservatives always attempt to assign to us, liberals are not seeking equality of outcome. We aren’t even really seeking perfect equality of opportunity. We are just trying to ensure some adequate level of opportunity for all Americans so that everybody has the best shot possible of reaching their potential.

But the star of the evening was our wonderful First Lady Michelle Obama. I’m a fan. I’m a really big fan. She had the entire audience in the palm of her hand and on a night that had already seen some very good speakers making very good speeches, she showed everyone why she might actually be the best speaker in her family. The line of the night, for me, was this, which a friend of mine sent me:

Wonderfully said.

Michelle Obama didn’t have to yell, “I love you women!” as Ann Romney did, because everyone already knows. If you missed it for some reason, then why do you hate America? do yourself a favor and watch the whole thing:

Just a great evening.

Michelle Obama generated over twice as much Twitter activity during her speech on Day One of the DNC than Mitt Romney did in his acceptance on the RNC final night. What does that mean for November? Probably nothing. But I still thought I’d share.

I’d love to say that a great speech like that seals the deal and that Obama is sure to get reelected, but it’s not the case. (Nor should it be, obviously. Policy matters more than speeches.) Last night on Facebook one of my conservative friends was posting about how the entire night made her ill, and another of her friends posted this delightful screed:

Sanity!

That’s the kind of vitriol that conservatives have for the president and his family. Just completely unhinged and lacking any link to reality. It’s going to be a tough election. Still, I’m glad I don’t have to work myself into a hate frenzy for the opposition and his family in order to get myself in to the ballot box this November. It really really helps when you actually like the candidate for whom you are voting.

Before we argue about Obamacare

The Kaiser Foundation created a short quiz of 10 true/false questions about Obamacare that does a pretty good job of illustrating how much misconception there is about the law. If you want to take the quiz without being “spoiled” do it now before reading further.

After taking the quiz I was told that I got a 10/10 (smoooooth brag) and that my score was better than 99.6% of people taking the quiz. This means that only 4 out of every 1,000 people who take the quiz are able to answer all the questions correctly. For the sake of comparison, flipping a coin should result in just about 1 out of every 1,000 people getting a perfect score. This is sort of depressing.

(I took this last week, but haven’t had a chance to write about it until now. I saved the output from then so if some of the numbers I quote below are different now, that’s why.)

Of the 10 questions asked, the question with the highest percentage of correct answers was this one:

Will the health reform law provide financial help to low and moderate income Americans who don’t get insurance through their jobs to help them purchase coverage?

This was the “easiest” question but still only 72% of people taking the quiz were able to answer that question (yes) correctly.

The question with the lowest percentage of correct responses was this one:

Will the health reform law require all businesses, even the smallest ones, to provide health insurance for their employees?

Only 25% of respondents were able to answer (no) correctly. This goes beyond any statistical possibility of chance. The fact that three quarters of respondents could not answer this question isn’t just about ignorance (pure guessing should have resulted in a 50% success rate) but about actual misinformation. Conservatives spent a year lying about what Obamacare would do before it was passed, and then after it was passed, they just kept on lying about what the bill contains. This is the result of their mendacity.

Another question with a high percentage of wrong answers was this one:

Will the health reform law create a new government run insurance plan to be offered along with private plans?

Maybe the reason that so many conservatives remain convinced that Obamacare is a Single Payer Trojan Horse is that this question was answered correctly (no) by only 27% of respondents.

One of the lies that Republicans used over and over in the 2010 congressional campaign and that Romney repeated after the SCOTUS decision was that Obamacare cut $500 billion from Medicare. Keep that in mind when looking at the results for this question:

Will the health reform law cut benefits that were previously provided to all people on Medicare?

The correct answer is no, but only 40% of people were able to answer correctly.

Remember: thousands of flipping coins would score ~50% on all these questions. Any aggregated result below 50% represents actual misinformation rather than just people guessing.

It’s nearly impossible to have a substantive debate about policy if all parties aren’t well-informed about the facts regarding the issue. If one side is deliberately spreading misinformation, it becomes even more difficult. Media hacks will point to quiz results like this and shake their heads sadly and say that the Obama administration has failed in its messaging, completely absolving themselves of their responsibility to inform the public.

Sometimes I’m not sure we deserve to survive as a species.

Obamacare in 20 years

The other day I twitter-twatted this missive to my legions of 43 Twitter followers:

And while I was obviously trying to be funny, I was also at least partially serious. If Obamacare survives (and it’s still not completely out of the woods yet) it will become an exremely popular piece of legislation that politicians will endanger at their own peril.

As an example, let’s look at Ronald Reagan preaching to his conservative choir about the evils of socialized medicine back in 1961.

That’s an actual LP that Reagan recorded to convince Americans that the Democratic proposals for what would eventually become Medicare would lead to a result in which children would ask their parents why they didn’t defend freedom. Yes, Medicare was originally opposed as the end of freedom as we know it in America.

How has that turned out? Well, we’ve seen the signs:

And it’s not just the Tea Partiers marching to save the end of freedom called Medicare. In 2010 Republicans won the House partially by running ads that (dishonestly) attacked Democratic House members who voted for Obamacare and to “cut $500 billion from Medicare.” That same talking point was inserted into Mitt Romney’s reaction to the SCOTUS decision to uphold Obamacare.

(And by the way, you really have to hand it to Romney for having the Reaganballs to attack President Obama for cutting Medicare while simultaneously embracing the Paul Ryan budget that ends Medicare. It’s really something to see.)

And so Republican leaders are now vowing to make a concerted effort to completely repeal Obamacare. It’s their platform. They seem to believe they have no choice, and I think the reason is obvious. They know that the Democrats have given them an enormous gift by deferring the most important benefits of Obamacare until 2014. If the Republicans can kill it before those benefits kick in, then they will be able to keep the majority of Americans convinced that it was a bad program. If they can’t, then they will never be able to repeal it, ever, and they know it.

Conservatives who were shocked and angered last Thursday by the SCOTUS ruling, by Friday were energized about the “sleeping giant” that had been awakened and the increased enthusiasm that would surely propel Mitt Romneycare Romney to victory in November.

John Boehner gave an interview with Norah O’Donnell in which he could not come up with any specific Republican alternative to Obamacare. He simply repeated his talking about about a “common sense approach” over and over.

Mitch McConnell went on Fox News to say pretty much the same thing. Watch this (via Balloon Juice):

McConnell lets the cat out of the bag here, when he was asked about the 30 million additional people who will be insured under Obamacare, and what the Republicans would do about covering them. His answer: “That’s not the issue.”

It’s nice to hear that confirmation of the theory that I offered last week.

I suspect that what it might actually come down to is this: conservatives aren’t really interested in providing universal coverage. It’s just not that important to them. They don’t think that access to health care should be considered a right.

Republicans created the Ronald Reagan Free Rider problem that has been driving healthcare costs through the roof for almost 30 years, but they have no plan to fix it, and when it comes down to it, they’d probably just rather not fix it anyway. I’m not accusing them of wanting poor people to die due to lack of insurance; I just don’t think they care that much. Other priorities.

One thing the healthcare debate has done is expose this conservative principle. In addition to McConnell’s admission on Fox News, we have this conservative quote from Tyler Cowen:

Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor.

That’s what is at stake on healthcare in November. The working Republican strategy for dealing with poor people when it comes to healthcare is “let them die.” They usually do a much better job of hiding that principle but recent events have exposed their true feelings. And make no mistake, if Mitt Romney wins in November and the Republicans retake the Senate, they will repeal Obamacare and put their “let them die” policies in place.

Obamacare upheld, the next day

I’m off work today for my older son’s birthday so I won’t be checking in too much. But while he’s busy chasing the dog with his new RC helicopter, I thought I’d share some thoughts about what yesterday’s decision means.

As I said yesterday when the news first broke, I hadn’t made any predictions about what might happen because I’m not a lawyer and so any prediction I’d make would just be a guess. If I had made a prediction, I would have been hilariously wrong as the prospect of John Roberts breaking with conservatives to uphold the law would not have occurred to me. Likewise, you should remember that I’m not a lawyer when I share these thoughts about what I think this means going forward.

I think this picture sums up the general feeling about people like me expressing opinions about the ramifications of SCOTUS decisions about constitutionality:

Having said that, let me dazzle you with my unqualified view.

The first thing that struck me was that the Court found that the mandate was NOT constitutional under the Commerce clause, which was the justification used by Congress when passing the bill. My first reaction to this was that it was a pretty big deal as much of what we see as the New Deal and 20th century America is based on an interpretation giving Congress wide powers under the Commerce clause. If the decision was changing our understanding of Commerce, then that would be a big deal and a significant conservative shift.

Obviously I wasn’t alone in that initial interpretation but other (actual?) scholars pointed out that the ruling might actually be pretty narrow. The decision seems to say that inactivity (not buying insurance) does not fall under Commerce, but doesn’t significantly change the justification for previous laws passed with the Commerce clause.

Roberts held that the mandate was constitutional because the mandate may be construed as a tax, which is clearly constitutional, regardless of whether the authors intended the mandate to be a tax, or even if they knew it was a tax but were trying to pretend it wasn’t. Roberts rules that the court has an obligation to adopt the framing of a law that allows it to be constitutional. Taxes are clearly constitutional, and since the mandate can be seen as a de facto tax (with a rebate given to those who have or purchase insurance), the court must find the law constitutional.

Is anyone surprised at the conservative freakout over this? Conservatives who claim to love the constitution and love their country and who 48 hours ago thought John Roberts was a great Chief Justice are now threatening to move to Canada (LOL), resort to violence, and dreaming of ways to remove Roberts from the bench. Some conservatives only respect the institutions of government, including the constitution, when they provide the results they want.

The other major ruling didn’t receive nearly as much attention but may (or may not) be very consequential. SCOTUS ruled that the federal government could not punish states who opt out of the Medicaid expansion that provides insurance to people making up to 133% of the poverty line. Elena Kagan, who conservatives were absolutely sure could not possibly be impartial in this case and demanded her recusal, joined with the majority in ruling against the administration on this part of the law.

People are speculating on whether the Romney campaign will now use the healthcare issue to argue for his election, or if he will drop the issue and focus on the overall economy instead. His lackluster speech yesterday sure hinted that he would make it an issue, but by tomorrow he may have Etch-a-sketched a new strategy. The conservative base is certainly fired up for repeal and reports are that Romney raised millions of dollars “organically” within just hours of the decision.

Some are arguing that Romney will drop healthcare because in order to repeal it he will have to stop a lot of reforms that people really like. If he aims to keep those reforms uninterrupted, the “repeal” of Obamacare will not just be a single-page bill as promised, but one of those thousand-page monstrosities that conservatives claim to hate so much.

Others say that there’s no way that the Republicans will have a filibuster-proof majority and therefore won’t be able to repeal Obamacare anyway. There is also some disagreement whether the mandate becoming a “tax” means that it can be repealed through reconciliation. Both of these opinions ignore that Republicans won’t care about a filibuster or reconciliation if Romney takes the White House and they get 50 Senators. If that happens, the Republicans will “reform” the filibuster and the Senate will once again become a body where simple majorities pass legislation. Bank on it. (And for the record, I fully support the abolishment of the filibuster, whoever wins in November.)

So I expect that Romney will campaign on repealing Obamacare, and I expect that if he wins, and the Republicans take the Senate, it will be history. This isn’t over, and it all depends on winning the election in November.

Well, I had more thoughts but in a development that is surprising to no one at Casa de Wiesman, my son’s RC helicopter has already stopped working. I’ll be driving him to Radio Shack for a replacement (I very uncharacteristically purchased the “extended warranty” for this toy, which has turned out to be a win) and probably won’t be posting for the rest of the day. Have a good weekend everyone.

Now that it’s here to stay…

Some of you might want to actually learn about what is in Obamacare, or the Patient Protection and Affordable Care Act. Someone sent me this link to a thread on Reddit that does a pretty good job of summarizing all the important provisions in the bill. Since our mainstream news outlets do not think it is their job to actually tell people things they need to know, I guess it’s up to us to find out for ourselves.

This is a pretty good list, although it doesn’t have all the exact thresholds for when certain people are eligible for certain benefits. For example, IIRC, people will be eligible for expanded Medicaid if they earn less than 133% (which is ~$29,000) of the poverty line, and eligible for subsidies to pay for private insurance on a sliding scale up to 400% of that ($88,000) .

Already in effect:

  • It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)
  • It increases the rebates on drugs people get through Medicare (so drugs cost less)
  • It establishes a non-profit group, that the government doesn’t directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( Citation: Page 665, sec. 1181)
  • It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( Citation: Page 499, sec. 4205 )
  • It makes a “high-risk pool” for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of “pre-existing conditions” altogether. For now, people who already have health issues that would be considered “pre-existing conditions” can still get insurance, but at different rates than people without them.
  • It renews some old policies, and calls for the appointment of various positions.
  • It creates a new 10% tax on indoor tanning booths. ( Citation: Page 923, sec. 5000B )
  • It says that health insurance companies can no longer tell customers that they won’t get any more coverage because they have hit a “lifetime limit”. Basically, if someone has paid for health insurance, that company can’t tell that person that he’s used that insurance too much throughout his life so they won’t cover him any more. They can’t do this for lifetime spending, and they’re limited in how much they can do this for yearly spending. ( Citation: Page 14, sec. 2711 )
  • Kids can continue to be covered by their parents’ health insurance until they’re 26.
  • No more “pre-existing conditions” for kids under the age of 19.
  • Insurers have less ability to change the amount customers have to pay for their plans.
  • People in a “Medicare Gap” get a rebate to make up for the extra money they would otherwise have to spend.
  • Insurers can’t just drop customers once they get sick. ( Citation: Page 14, sec. 2712 )
  • Insurers have to tell customers what they’re spending money on. (Instead of just “administrative fee”, they have to be more specific).
  • Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they’re turned down.
  • New ways to stop fraud are created.
  • Medicare extends to smaller hospitals.
  • Medicare patients with chronic illnesses must be monitored more thoroughly.
  • Reduces the costs for some companies that handle benefits for the elderly.
  • A new website is made to give people insurance and health information. (I think this is it:http://www.healthcare.gov/ ).
  • A credit program is made that will make it easier for business to invest in new ways to treat illness.
  • A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they’re not price-gouging customers.
  • A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn’t paying for the Aspirin you bought for that hangover.
  • Employers need to list the benefits they provided to employees on their tax forms.

8/1/2012

  • Any health plans sold after this date must provide preventative care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge.

1/1/2013

  • If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word “tiny”, a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we’re talking about people in the top 5% of earners.

1/1/2014

This is when a lot of the really big changes happen.

  • No more “pre-existing conditions”. At all. People will be charged the same regardless of their medical history.
  • If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it.
  • Insurers now can’t do annual spending caps. Their customers can get as much health care in a given year as they need. ( Citation: Page 14, sec. 2711 )
  • Make it so more poor people can get Medicaid by making the low-income cut-off higher.
  • Small businesses get some tax credits for two years.
  • Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.
  • Limits how high of an annual deductible insurers can charge customers.
  • Cut some Medicare spending
  • Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them.
  • Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage.
  • Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won’t be footing their health care bills any more than any other American citizen.
  • A new tax on pharmaceutical companies.
  • A new tax on the purchase of medical devices.
  • A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.
  • The amount you can deduct from your taxes for medical expenses increases.

1/1/2015

  • Doctors’ pay will be determined by the quality of their care, not how many people they treat. Edit: a_real_MD addresses questions regarding this one in far more detail and with far more expertise than I can offer in this post. If you’re looking for a more in-depth explanation of this one (as many of you are), I highly recommend you give his post a read.

1/1/2017

  • If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers).

2018

  • All health care plans must now cover preventative care (not just the new ones).
  • A new tax on “Cadillac” health care plans (more expensive plans for rich people who want fancier coverage).

2020

  • The elimination of the “Medicare gap”

Obviously it’s tyranny.