Friday, February 22, 2013

Reason #277: Winning

While full implementation of the Affordable Care Act is still a year away, its effects on the health care industry are already starting to be seen--and in some ways, may even predate the passage of the law itself.

One provision of the law that has gone into effect--as of September 2011--is a requirement that any company seeking to implement an insurance rate hike of over 10% must first be cleared by government regulators as "reasonable".

First of all, man; just saying that phrase "cleared by government regulators" makes me feel like I'm in the Twilight Zone. Regulations of any kind, let alone new ones, are like Haley's Comet these days. In any event, the great thing about regulation is that a lot of people would rather police themselves than get the feds involved (see: IRS audits), and sure enough, the graph above shows the proportion of proposed rate hikes larger than 10% plummeting from almost three-quarters in 2009 to about fifteen percent this year (so far).

In other words, simply a show of willingness to police rising costs is helping to keep costs down; Obamacare, simply by virtue of existing, is fulfilling its intended purpose.

Another big Obamacare story this week was Florida Governor Rick Scott's decision to opt into the law's extensive Medicaid expansion, becoming the seventh Republican governor to do so. He still doesn't like it--and even admitted as much in the course of his announcement--but the big change here is that with Obama's reelection, Republicans are slowly coming to accept the ACA as the law of the land, and rather than deny federal tax dollars to his poorest and uninsured-est constituents (while still feeding the state's own tax money into the expansion in other states), obviously Scott is going to get on board the Medicaid train.

So once again--it's there whether he likes it or not, so he might as well get to work on liking it. Republican participation, believe it or not, can only ultimately make the law better, and that shift in the debate, from "destroy this" to "make this better", is where the real change will happen.

Further Reading

Big health insurance rate hikes are plummeting

Why Republican governors are saying yes to Medicaid, no to Obamacare’s exchanges

Obamacare is winning

Poll: Obamacare’s biggest beneficiaries are skeptical of Obamacare

Friday, February 15, 2013

Reason #276: Citizenship

As I've made clear on this blog multiple times in the last, my feelingsabout drones are nothing if not complicated. I've said a lot here on the subject already, but there's one angle from which I haven't yet approached it, which has been a bigger and bigger deal in recent weeks: the nature of US Citizenship.

Innocent civilians are being killed by drones. The administration isn't coming out and saying that, as far as I've seen, but no one is really denying it. The main controversy right now--especially now that a big portion of the secrecy complaint has been mitigated by John Brennan's confirmation hearing and by the release of internal memos on the subject--is whether drones should be used against American citizens. Anwar al-Aulaqi being the prime example--a New Mexico-born Colorado State grad who went on to work with Al Qaeda out of Yemen until he was killed there in 2011.

Pretty much every debate I've seen on this is about al-Aulaqi's legal status as an "enemy combatant", which comes from joining a group engaged in open warfare against the United States, which is not--in my opinion--what is happening right now. Al Qaeda, by Obama's own admission, is currently a shadow of its former self, and even at its worst, I don't believe we can technically be at war with a nongovernmental entity. But that--and the "War on Terror" generally--is a whole different can of worms, and totally separate from my opinion that al-Aulaqi was absolutely a fair target.

See, my problem is not that he was an American citizen; my problem is that citizenship is even part of the discussion.

The Declaration of Independence does not say that all citizens are created equal. Nor does it say that all citizens are endowed with the inalienable rights of etc, etc. It says all men. Sure, it took us a little while to add women and black people to that category, but the point is, at no point is "men" presented as a legal classification; in fact, the aforementioned inalienable rights aren't said to come from the law, or even the Declaration itself, but from God.

Again: I'm not crazy about the drone strikes. While it's reasonable, I believe, to see them as necessary, I think they are still unquestionably immoral acts, and depending on how dogmatic you want to be, they could even be called evil acts. But the notion that killing nameless Pakistani children is somehow less disheartening than killing Anwar al-Aulaqi because they're not American citizens disgusts me. I am a pragmatist at heart, and I don't expect complete moral purity from my president. But I do expect consistency. A life is a life, no matter what paperwork it came with.

Further Reading

Reason #207: Number Twos

Reason #256: Classified

Obama: Americans deserve to know more about drone war

Wikipedia: Anwar al-Aulaqi

Friday, February 8, 2013

Reason #275: Progress?

For the record, Ezra Klein's Wonkblog is my new favorite thing, and not just because almost every article comes with its own thrilling graphs. Well, mostly because of that, but not just because.

The other day I came across an article describing how American households are now spending nearly as much on gas for their vehicles as they are on the vehicles themselves. What's surprising there isn't that gas is expensive, but that cars have gotten far more gas-friendly over the same period of time that the prices have been going up--the good news is, we're using far less gas per car, but the bad news is, prices are rising faster than usage is falling.

So that's not the greatest news, but it's an interesting example of how we can focus so much on one part of an issue--rising costs--that we can lose sight of others--improved fuel-efficiency.

Meanwhile, another delightfully-graphed article appeared at almost the exact same time explaining how, shock of shocks, out-of-pocket spending on health care as a portion of overall medical spending has plummeted to barely a third of what it was forty years ago. Meanwhile, private insurers' portion has increased about 50% to become the largest single share of spending, while the shares paid by Medicare and Medicaid, programs that the left is always complaining need to be expanded, have in fact roughly doubled. And for all the eye-rolling about the prescription drug industry, the percentage of spending devoted to drugs is also down a couple points--not an enormous change, but certainly not skyrocketing like many might think.

So just like with gas, on a philosophical level (how much citizens are forced to spend on their own health care) we are making enormous strides in the direction we should be going--at least according to progressive priorities. But the reality of the situation, actual out-of-pocket spending, is still so out of control that we can't appreciate the progress we are making.

But that doesn't mean we should lose sight of it.

Further Reading

Americans now spending most on gas since early 1980s

Patients’ share of health spending is shrinking. Yes, really.

How health costs wiped out a full decade of income increases

Friday, February 1, 2013

Reason #274: Crazy Ideas

At Chuck Hagel's confirmation hearing yesterday for Defense Secretary, Republican Senator Ted Cruz infamously wheeled out a television set so that he could play two clips of Hagel on an Al Jazeera call-in show--one in which Israel is accused of having committed war crimes, and one where America is called "the world's bully".

Not by Hagel himself, mind you, but by callers--at issue is the fact that Hagel didn't immediately decry the two claims, and went so far as to mention that the "world's bully" caller made "a good point". I happened to be on Twitter at the time this was going on, and I witnessed a litany of television personalities quickly pointing out that all sorts of batshit stuff gets brought up by people calling in to low-rent political talk shows, and if the guests involved were expected to explicitly condemn every crazy idea that someone raised, there'd be no time for anything else.

That's a perfectly fair point right off the bat, and should be enough to forgive these "mistakes" on Hagel's part, but I want to look at these two topics a little just the same.

First of all, America absolutely is the world's bully--maybe that's been dialing down a bit in recent years, but in 2009 (when the Al Jazeera show took place) we were still fresh out of the Bush era, Iraq was still going strong, and Obama was actually dialing Afghanistan up a notch. And even with those wars wrapping up, the overall characterization still holds--raiding Bin Laden's compound without alerting the Pakistani government and conducting near-continuous Predator-drone strikes in Pakistan, Yemen, and Somalia, also without international consent or without even admitting we're doing it, may or may not be defensible acts, but they're absolutely the actions of a bully.

Whether we should be doing these things is a debate we should always be having, because the minute we don't bother second-guessing those decisions is the minute we lose sight of ourselves. And part of having that debate is at least engaging with the possibility that we should stop. Chuck Hagel was one of the first Republicans to flip on the Iraq War--that suggests a man who doesn't automatically assume American military actions are morally and strategically sound by definition, and that's exactly what I'd want from a Defense Secretary.

As for Israel--I'm not going to list specific incidents and litigate whether any one thing is technically a war crime. Israel and Palestine aren't technically at war, for one thing, and I have zero doubt that any dastardly Israeli action could--and has been--met by an equally nefarious Palestinian action.

Which is the real point here, I think--on some level, both sides have righteous and valid motivations, and both sides have committed unforgivable atrocities. Any attempt to quantify evil is a failure from the start, and no attempt to move forward in this region that doesn't begin with that understanding will ever really be successful--otherwise you're just awarding points arbitrarily. I'd also like for my Defense Secretary to understand that, and not boiling into a froth at the mere mention of anti-Israeli views is a step in the right direction.

Further Reading

Hagel faces barrage of criticism during tense confirmation hearing

U.N. Panel to Investigate Rise in Drone Strikes

Drone statistics visualised