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Culturally and Linguistically Appropriate

December 28, 2013 Politics-2013 No Comments

A passage that I couldn’t resist sharing after stumbling upon it …

The standards shall ensure that the summary is presented in a culturally and linguistically appropriate manner and utilizes terminology understandable by the average plan enrollee.

This is a quote from Title 1 of the Affordable Care Act – the part that outlines the “DEVELOPMENT AND UTILIZATION OF UNIFORM EXPLANATION OF COVERAGE DOCUMENTS AND STANDARDIZED DEFINITIONS.”

I would strongly suggest that something similar could be found in a variety of bills. The requirement is essentially a “common language” or “no legalese” clause. It just smacks of some obvious irony that a federal version of this mandate would include so many multi-syllable words – ultimately disqualifying itself for inclusion in the very document being developed.

It’s moments like this that I wish I had a hotline to Washington Monthly’s Charles Peters.

Once again …

Once again, the workday is a bit too much fun-filled with research projects to dive too deeply into subjects that I wish I had the time to blog about. One point to interrupt that for, however, is to extend an open invite to any/all folks who might wish to partake of some political activity tonight. And on that note, my State Rep is kicking off his 2014 campaign season at our favorite Italian Restaurant: Barry’s Pizza. So consider this an invite to join us between 5 and 7pm for free food and drinks.

Aside from that, there’s a little serendipity in reading Steven Teles’ “Kludgeocracy in America” thesis while also reviewing the House Appropriations hearing on the state CPRIT agency’s botched grant process. Specifically, the agency’s expressed desire during the committee to go ahead and award grants approved during the moratorium period that they were under at the time:

Should outgoing Governor Perry opt for a more four-eyed Presidential run in 2016, I look forward to hearing how this is totally different from any failings of Obamacare.

Election-Eve Aggreposting …

July 30, 2012 Politics-2012 No Comments

One final sampling before the votes start trickling in tomorrow …

» Washington Post: Let’s shatter the myth on Glass-Steagall
I’m glad to see a bit of provocative thinking on this topic. Of course, I’m old enough to remember that it was the late Sen. William Proxmire who led the charge to get Glass-Steagall undone. Proxmire wasn’t exactly a Phil Gramm carbon copy, so it bears some attention that there was a liberal critique of the law, as well. Whether the final, passed version of the law was something Proxmire still found merit with or whether there were any issues that came up afterward that might make him change his mind, I don’t know. But I’m not certain that just putting Glass-Steagall back in place is much of a solution.

» NY Times: Genetic Data and Fossil Evidence Tell Differing Tales of Human Origins
If science and whatnot isn’t your bag, just think of this as pre-historic multiculturalism and diversity.

» NY Times: Political Fortunetelling
Fanciful fiction, to be sure. But I don’t think every one of the names mentioned will be absent enough political ambition on the top job. Cuomo should be a certainty. But even after that, I’d expect a few of the rest. As far as the sponsorship element to the tale, I’m more doubtful. But the two strands of the story do weave in with the over-celebritization of politics.

» Dan Froomkin: You Know What the ‘Voter ID’ Push Is All About, So Say So
What? … and tell the truth?

On the Wednesday-through-Friday reading pile:

» NY Times: What Can Mississippi Learn From Iran?
» New Yorker: We Are Alive – Bruce Springsteen at sixty-two.
» New Yorker: Fussbudget – How Paul Ryan captured the G.O.P. (Ryan Lizza)

Highly coincidental that today’s batch includes two writers who I think are very much missed from their previous employers: Froomkin from the Washington Post and Lizza from The New Republic.

In other news, I’ve got a quick one-day getaway “vacation-let” planned for San Antonio at the end of the week. If the heat doesn’t kill me while I’m there, I hope to see enough of the outdoors to do a bit of blogging about some beautiful sights, scenes, and sounds from another little dot on the map.

Runoff, Pre-Early-Vote Aggrepost

July 20, 2012 Politics-2012 No Comments

No rest for the weary. Rock & roll, yes. Rest, no …

And for newsier-ish events and whatnot, here’s a bit of a sampler so that I don’t feel too far behind on all the goings-on around here:

» Wash. Post: In Virginia, frenzied weekend highlights fight ahead in state for Obama, Romney
» LA Times: Nevada isn’t a sure bet for Obama
I’m told there’s still a Presidential election going on. Too early to really take polls seriously. But that shouldn’t stop anyone from gnawing away a few precious fingernails to deal with the anxiety.

» GC Daily News: Jason Murray to spend 7 months in jail
A good poster-child for voters paying more attention to who they vote for down-ballot.

» FW Star-Telegram: Keller City Council nixes proposed food truck park
Nice to see a conservative little corner of Tarrant County so concerned about too much competition in the food industry.

» Kevin Drum: Medicaid Expansion May Turn Out to Be an Offer States Can’t Refuse
Kudos to KDrum for picking up on this. And also kudos to Arkansas for honestly reviewing the tradeoffs involved in expanding Medicaid.

They figure that in 2015 the new law would cost them $42 million and save them $131 million. So it’s a clear winner. But that’s because the federal government picks up 100% of the tab for expansion during the first three years. That declines to 90% by 2020, and Arkansas figures that by 2021 the expansion of Medicaid would cost them $3.4 million per year.

Now, that’s $3.4 million out of a $4 billion Medicaid budget, of which Arkansas pays $750 million. So it’s not a lot of money, especially considering the number of people it would help.

There are still critiques to be had with the expansion and Drum cautions that Arkansas’ mileage may vary from others. But it sure would be nice to see Texas try a little honest accounting on this issue. It would certainly be a lot better than …

» Chron: Passing on Medicaid expansion is the right call for Texas
Signed by State Sen. Bob Deuell (R); State Rep. Charles Schwertner (R); State Representative Mark Shelton (R); and State Rep. John Zerwas (R). Most interesting, because …

» Kaiser Health News: Businesses Will Push Perry to Rethink Medicaid Expansion

“Fights seem to follow the money, and there is a lot of money at stake in Texas on this,” said Phil King, a Republican state representative from outside Fort Worth who opposes the Medicaid expansion. “Maybe you need to rename this ‘The Full-Employment Act for Lobbyists.’”

With world-renowned medical institutions such as the University of Texas and a large part of its Medicaid coverage handled by private insurers such as Amerigroup, the state’s health industry is “just behind oil and gas” in size and influence, said Vivian Ho, a health economist at Rice University. “Given how much Amerigroup has to gain from a Medicaid expansion in Texas, they may be one of the most effective organizations to lobby Perry and the state legislature to fund the expansion.”

Founded in the mid-1990s in Virginia Beach, Va., Amerigroup contracts with 13 states to manage Medicaid care, generally for a fixed fee per member. Now grown to Fortune 500 size, the company had twice as many Texas members last year — 632,000 — as in any other state.

Oughtta provide a good deal of entertainment in the lege come January.

Oh yeah, and this happened:

And just for a little bit of retro-linkage, here’s an interesting local story from 1986 on how familiar names may or may not have wrecked havoc on political primary outcomes. Elsewhere, TBogg notes a hilarious example of Randian hypocrisy.

Whaddaya Know …

June 28, 2012 Politics-2012 No Comments

» Washington Post: Supreme Court upholds health-care law, individual mandate

The only provision that seems to have been struck down is the one that removes Medicaid funding from states if they opt out of expanding Medicaid coverage. That’s a far cry from the Toobin-esque certainy I’ve expressed that the court will make a political decision against either the law as a whole or merely the individual mandate (which would have been a means to simply undermine the entire bill without overturning it). I’m certainly happy for the sake of the Commerce Clause that I’m wrong about that. For the sake of what I still consider to be an overly expensive re-write of health insurance law, not so much.

It will be interesting to see what happens to popular opinion of Obamacare and/or the individual mandate as a result of this decision. Also worth watching for is how the “repeal and replace” argument evolves. There’s still an election to go through and for all those who think that the ACA was health care reform, it’ll take that election to truly uphold the law before much of the bill goes into effect.

Obamacare Goes to Court: Day Two

March 28, 2012 Politics-2012 2 Comments

» NY Times: Hard Questions From Justices Over Insurance Mandate

Doesn’t sound like the individual mandate had a good day in court yesterday. Says Ezra

The quick read is that today went very badly for supporters of the individual mandate. As one of the experienced Supreme Court watchers who runs SCOTUSblog tweeted, “Paul Clement” — the attorney arguing against the health-care law — “gave the best argument I’ve ever heard. No real hard questions from the right. Mandate is in trouble.”

… and Toobin is more blunt in his assessment:

“This was a train wreck for the Obama administration …. This law looks like it’s going to be struck down. I’m telling you, all of the predictions including mine that the justices would not have a problem with this law were wrong… if I had to bet today I would bet that this court is going to strike down the individual mandate.”

So it looks like the only question left is whether the scope of the opinion will be narrowly tailored to nix the individual mandate, or if the majority in the court will strike for bigger gold in limiting the commerce clause.

The Washington Post interviews Randy Barnett of Georgetown Law and captures his take on the issue at hand …

… the duty to pay taxes is part of your duty to support the government in return for the protections the government gives you. What the government is claiming here is this power — and this ought to disturb people on the left — to make people do business with private companies when Congress thinks it’s convenient.

That’s a fair encapsulation of why I’ve consistently found the individual mandate troubling. The argument that we’re all engaged in the health care market, hence we should pay for it by some means, is problematic on logical grounds. First, the only reason it’s offered is because of a Hippocratic Oath that doesn’t exactly bind any doctor to see any patient on any grounds whatsoever. At least not in any legally codified manner that I’m familiar with. Secondly, the assumption is that the entirety of the uninsured do not manage to cover the health care costs that they end up incurring. I’m sure that the net effect is a loss of dollars, but I’ve not seen anything that outlines the scope of the problem (ie – what percentage of uninsured contribute to the problem). I’m uninsured since I don’t know when (minus some time during 2010). I have incurred zero health care expenses in the past decade. The last time I did, I paid my bill in full. So why do I need to be forced into the insurance market against my will to fix a problem that I don’t contribute to?

In sum, the so-called “health care reform” bill signed into law is, in effect, nothing more than a health insurance reform in this regard. And that brings me to the final problem I have with the mandate: why are we sanctifying the insurance market? Is that really the highlight of liberal thought, these days? … forcing people to deal with the insurance industry? That seems a far cry even from Al Gore’s trope of “the people vs the powerful.”

Obamacare Meets the Court

March 26, 2012 Politics-2012 No Comments

Today’s the day. The Supreme Court begins four days of hearings on four aspects of the administration’s health care reform. There’s no such thing as instant gratification when it comes to these things, though. We won’t have an opinion until the summer in all likelihood. And the courtroom is officially a twitter-free zone. A lot is already known about how both sides are going to make their arguments. But the spectacle this week is to see what can be determined about individual justices’ questions, doubts, and leanings in the questions they raise. Audio of the hearings will be released by the end of each day of arguments. Fun times.

Here’s a small sample of the overviews:

» Wonkbook: Absolutely everything you need to know about health-reform Supreme Court debut
» Kaiser Health News: The Health Law And The Supreme Court: A Primer For The Upcoming Oral Arguments
» Kaiser Health News: Scorecard: What The Health Law Has Delivered, Or Not

That ought to get you up to speed on the outline of the court’s case and some objective merits of Obamacare’s success or lack thereof to date. Not that the latter matters to the court … but since most of us aren’t forming our opinions of the law in constitutional terms, I happen to think its worth a review at this point. Make of it what you will.

If its a little bit of the pre-game tic-toc you want …

» NY Times: In Health Care Case, Lawyers Train for 3-Day Marathon
» Wash. Post: Supreme Court to hear arguments on timing of health-care ruling

And there happens to be ample coverage of the lawyers who will be making the most noise this week …

» NY Mag: The Paul Clement Court
» NY Times: A Lawyer Who Can Simplify the Complex Draws a Big One: Obama’s Health Overhaul

Jonathan Cohn has pretty much been building up to this point and here’s a single instance of where he’s opining these days …

» New Republic: If Medicare Is OK, Obamacare Should Be Too

As for me, I’ve had my marker on the table for quite some time. I think the court strikes down the individual mandate … even if it means a supposed “fractuous” 5-4 ruling. Roberts, et al can certainly make a logical argument that strikes a few chords of constitutional law. But for all intents and purposes, it will be another political ruling from this court.

Now, what that means for the rest of the law or the fate of health care reform as passed, still remains to be seen. Given that the grand bargain of health reform seemed contingent upon there being an individual mandate, I don’t see how it survives without. Whether it could be salvaged with something like Paul Starr’s recommendation for an individual mandate, we’ll see how much room there is for that during the summer.

ADD-ON: Some more good reading from the twitter chatter that does exist …

» The Atlantic: How Obamacare Will Be Settled: A Primer on the Commerce Clause
» ACA Litigation: Some things to look for tomorrow

CONCLUSION: Day one looks like the easiest of them all. Up for discussion today was whether the justices could or could not rule on a law that hasn’t fully taken effect yet. And it seems that much of what took place was that the justices browbeat the very attorney they hired to argue that they shouldn’t. Yeah. You read that right. Government for ya …

In the first day of hearings at the Supreme Court over President Barack Obama’s signature health care law, justices seemed skeptical Monday about arguments that they have no authority to decide the key issues now. Eight of the nine justices put challenging questions to Robert Long, the lawyer who argued for postponing a decision on the case.

That’s from Politico’s email after today’s hearing. It’s all downhill from here.

Sebelius’ Defense

January 7, 2012 Politics-2012 No Comments

» Wash. Post: The Affordable Care Act, helping Americans curb health-care costs (Sec. Kathleen Sebelius)

Consider this piece the overview/defense of Obama’s health care reform endeavor.

If health-care costs continue to rise unchecked, they will threaten America’s ability to compete and will become unaffordable for most families. One of the major reasons we passed the Affordable Care Act was to bring down costs, something the health-care law does in three ways: by increasing insurance-market competition, assisting those who can’t afford coverage, and tackling the underlying cost of medical care.

One of many reasons that I’m a sceptic is the effort is that many of the items Sec. Sebelius mentions are fairly minor things that can be (and I would expect to see) undone with a single vote in Congress. Take enough chips away it through small-ball votes rather than big-ticket “repeal” measures, and the plan is the gift that keeps on giving – weekly or monthly “end Obamacare” votes. And many of them are reforms that I’m sure the insurance industry will find the means to defeat and no constituency to defend exists. The 1099 measure is a perfect case in point for this.

Not that a slow-bleed attack wouldn’t happen to any health care reform approach. But for the price of this one, I see the “savings” still seem far more ephemeral and the costs far more real. If you spend north of $800B, I’d like to feel more confident that something good would come from it. It’ll take a bit more than general defenses of the plan to convince me of that.

Aggre-blogging: The Post-Christmas Lull

December 27, 2011 Politics-2011 No Comments

Still slaving over pixels, demographics, and writing. I trust that your extended weekend was better. An abbreviated news roundup as the rest of the news world took a few days off.

» San Antonio Express-News: D.C. judges see Texas bias
Standard disclaimer: you’re just not following redistricting’s legal round properly unless you’re reading Michael Li’s blog. The DC Circuit court has spoken up on Texas Redistricting … and the early news is not good for the Texas GOP. There’s also some interesting tidbits in the court’s decision regarding coalition districts. It’ll be interesting to see what that means for the HD26/137/149 corridor in the Houston area. (Related: Michael has the Houston-area Organization of Chinese-Americans’ amicus brief posted for more reading on the treatment of those three districts.)

» Wash. Post: Code for America: An elegant solution for government IT problems (Vivek Wadhwa)
It sure would be great to have local government that saw value in something like this. Just sayin’.

» New Republic: The Mandate Miscalculation (Paul Starr)
» New Repubic: Was the Mandate a Mistake? (Jonathan Cohn)
Yeah, so I’m still with Paul Starr on this one. It’s arguable that the health care mandate cost Democrats their governing majority, although I’m also of the opinion that if Obama signed into law a mandate that we all like puppies, that would have served as a suitable substitute. Still … I think the puppy thing would have faded as an issue by now. Staking your political reputation as being a “BFD” on health care reform by forcing everyone to go buy health insurance, not so much.

» Economist: The faith (and doubts) of our fathers
I’ve always found it odd that the relatively modern “War on the Founders” was a necessary pre-condition to the Christian faith. That and creationism and forced prayer in school. Steven Waldman’s “Founding Faith” is a good enough rebuttal to the first while still noting the importance that Christian faith had in the founding.

» Demos: From Citizenship To Voting: Improving Registration For New Americans
Bookmarked for future reading.

» A bit of Greg Trivia for the few who might care: I’ve never seen Van Halen with David Lee Roth. I’ve seen Van Hagar and Van Cherone (which was a great live show, FWIW). I didn’t catch either the Sammy Reunion tour of 2004 or the first DLR Reunion tour of 2007. I did manage to take in the Sam & Dave show in 2002. Dave’s voice was shot and I left after his very horrible set. But the allure lives on. Still, I may have to entertain the idea of catching this version of the reunion for a while. At least until I see how expensive the tickets are.

Van Halen – Long Version Trailer from Van Halen on Vimeo.

A Mandated Roundup

February 8, 2011 Politics-2011 No Comments

I’m not even going to pretend to have enough time to dive into all of these, individually. But since they do make for some pretty good reading on the current state of either health care reform or the commerce clause (however you decide to see it), I’d be the worst blogger in the world if I didn’t at least pass them on.

» NY Times: Doing the Judicial Math on Health Care (Adam Liptak)
» Tapped: The Mandate Alternative (Paul Waldman)
» NY Review of Books: Is Health Care Reform Unconstitutional? (David Cole)
» Post-Partisan: Give me liberty or give me health care (Charles Lane)
» The Plum Line: The flawed conservative case against the mandate (Greg Sargent)
» Ezra Klein: If not the insurance mandate, then what? (Derek Thompson)
» Ezra Klein: Courts are political, news at 11 (Dylan Matthews)
» Wonkbook: What the Vinson ruling means (Ezra Klein)

While there’s nothing in there to make me move from my opposition to an individual mandate, I still think there’s a high possibility of any constitutional ruling of it taking the commerce clause of the Constitution too far being very dangerous for a lot of other laws that rely on that clause.

Among all the reading on the topic, I do find it mildly amusing that there are still people willing to state that we just don’t know whether the Supreme Court will issue a 5-4 ruling or something with more consensus. Obviously, my marker is still on a 5-4 ruling, with the likeliest scenario that it would be 5-4 against (at minimum) the mandate. Interesting to see a lot of other folks coming to that conclusion.

Among the links, the NYRB article has a good comparison to the New Deal court that’s worth reading. One complaint I have with it is that I think the comparison made is a bit too broad. Cole alludes to the Court shifting from generally anti-New Deal rulings toward pro-New Deal rulings, but doesn’t highlight that it was fundamentally two specific changes that had much to do with it: Justice Owen Roberts changed much of how he was voting on the court (for whatever reasons you and/or history choose to believe) and the 1937 retirement of Justice Willis Van Devanter. In other words, the court didn’t simply “reverse course” … two very specific things happened that enabled the outcome of votes on the Court to end up. I don’t see much chance for similar specific changes happening to the court in a short amount of time.

Individual Mandate: The Vinson Round

February 1, 2011 Politics-2011 No Comments

I haven’t thought to make any mention of the latest GOP judge to rule against health care reform. Primarily, that’s because it was totally expected and it doesn’t really alter anything that’s already in motion for sending the issue to the Supreme Court. But since two other bloggers have an interesting take in the aftermath of Judge Vinson’s ruling, who am I to leave the issue alone?

Steve Benen (Washington Monthly):

Yes, there may be folks who don’t want to buy insurance, who would be penalized under the law. But under our system, those folks still get sick, still go to the hospital with medical emergencies, and — here’s the kicker — still get care.

I don’t think it requires one to disagree with this point if you merely realize that not everyone who gets the care Benen makes an example of isn’t freeloading on the system. In several cases, the visits that people make to get care in these situations is not of the $10-20,000 hospital stay variety. I would suspect that the majority of these instances would not be in the far more affordable range. As to what the percentages are, I’m not sure. But I think that would be pretty vital information if you’re going to lean heavily on arguing that because X-number of dollars are made into societal costs due to this situation, do the percentages of uninsured people not paying their way really necessitate a truly socialized cost on all uninsured people? Obviously, I’ve never been convinced of that point.

Damon Root (Reason):

Justice Anthony Kennedy often does cast the crucial fifth vote, sometimes siding with the Court’s liberal bloc, other times with the conservatives. And the legal challenge to ObamaCare certainly won’t be over until the Supreme Court weighs in. But the Kennedy-as-decider scenario also assumes that all four conservatives will vote against the individual mandate. Can we be so sure about that?

Yes, you pretty much can be sure of that. Root makes a good, solid effort to get at the underlying philosophical views of Scalia and Roberts from their writings (or worse – their Senate testimony!). But I still maintain that the only thing you need to know is the figurative letter next to the respective judges’ names. Consistency isn’t going to be something that the four court conservatives strive for in this instance. It will be a politically-motivated decision and the outcome of that decision is not in doubt. While I might not mind so much to see the individual mandate never come into existence, I think there’s a lot more to worry about what follows from the ultimate stripping down of the commerce clause. My fear (and I’d love for this to end up being unfounded) is that the ruling may impact more than just the requirement to purchase health insurance.

Reforming High Risk Reform

December 30, 2010 Politics-2010 No Comments

» Wash. Post: Health plans for high-risk patients attracting fewer, costing more than expected

There’s a lot to take from this article, so by all means read the whole thing. The lack of enrollment strikes me as somewhat related to a point I made yesterday. But in this case, there were certainly hard numbers to go by for projecting demand for this. And it’s for that reason that I focus on the cost of the insurance as a central point of interest:

… Will Wilson, 57, of Chicago said he is “really, really, really, really discouraged.” After he received an AIDS diagnosis in 2002, he discovered that his insurance at the time paid only $1,500 for medicine each year. His AIDS drugs cost $3,000 a month. He ended up in bankruptcy.

Wilson became an activist for health reform, circulating petitions, going to demonstrations. And the day after the president signed the bill into law, a Chicago Sun-Times column quoted him as saying, “I’ve had a grin on my face all day” at the prospect of the high-risk pool he could join. That was before the rates were announced in July and Wilson discovered that the premium – nearly $600 a month – “was almost as much as my rent. It was like, no way! I was floored.”

The law contains rules to make the high-risk pools more affordable than older ones that many states have run; the new ones cannot charge more in premiums than the average premium for other individual insurance in a given state. But “the individual market is expensive,” said Jean P. Hall, a University of Kansas researcher studying the new plans. “From my perspective, it is not a good match for people who have expensive conditions.”

There are several “bridge” programs already enacted as part of the ACA – temporary plans designed to bridge the high cost of ultimately shoving customers into whatever part of the insurance market they belong in by subsidizing them. The Early Retiree Reinsurance Program is a good example – so good that even opponents of it are signing up. I’m not sure why this isn’t done here as it seems like a textbook case for temporary subsidization.

Given the enrollment gap, it’ll be interesting to see how much of the difference can be made up in marketing of the program and how much of it will remain because of the cost. I’d still expect to see a big gap when it all averages out. And bear in mind – the individual cost for this program is presumably lower than market. If so, that should suggest that there might be more than purely economic factors that work on whether people get insurance. And I don’t think it’s because they’re all sitting around thinking “Meh, the government will pick up the tab.”

Necessary and Proper

December 29, 2010 Politics-2010 2 Comments

» NY Times: Terrain Shifts in Challenges to the Health Care Law

In case you were wondering what lines of argumentation the SCOTUS might look at the individual mandate on, here’s the smart money pick:

The cases, which are presumed to be headed to the Supreme Court, center on whether Congress’s power to regulate interstate commerce is so expansive that it can require citizens to buy health insurance. But as the litigation advances, the “necessary and proper” clause is taking on greater prominence in briefs and oral arguments, with the Obama administration asserting that it shelters the insurance mandate and state officials arguing that it buries it.

It certainly makes sense. The Dem judges who have upheld the mandate have seemingly accepted the premise that inability to purchase health insurance is an action of it’s own nature – that you are acting to have someone else pick up the tab when you ultimately go to the hospital. And they’ve also accepted the point that follows that – that mandating purchase of insurance is within the realm of “necessary and proper” in order to regulate that form of interstate commerce.

Now, I don’t think there’s anything to this that negates the fact that the decision will be made on political grounds – that’s why it’s a safer assumption that Alito, Roberts, Scalia, et al will overturn this portion of the law. We know what color their uniforms are and the fact that some have written opinions that would otherwise stand to be glowing in their support of something like the health insurance mandate … we all know that they won’t rule to uphold it. But even still, they’ll have to base their argument on something and it certainly seems like the biggest opening for a court to rule on grounds that are murky regardless of how clearly Robert Bork thinks that Madison, Jefferson, and the gang addressed all this in the 18th century.

What I’m curious about is this: Of those people who don’t purchase health insurance, how many actually end up going to a hospital and leaving the bill for someone else to pick up? I obviously don’t doubt that several do and that the cost of doing so is painfully real to governments at all levels. But what’s the ballpark here? 90%? … 50%? … 20%? Bear in mind that several people end up paying their hospital bills and that some pay back partially. But this strikes me (even if only me) as central to defining whether or not the method is really “necessary and proper” from a policy perspective.

My inclination is to pick the low end of the range – and possibly lower than any of the options I’ve listed. And that fuels a bit of why I think the mandate is wrong on policy – just because you have the hammer to fix something (the mandate) doesn’t mean that the problem in need of a solution (uninsured leaving govt with health care tabs) is indeed a nail.

Here We Go, All Over Again

December 27, 2010 Politics-2010 No Comments

» NY Times: Obama Returns to End-of-Life Plan That Caused Stir

When parody writes itself …

Several Democratic members of Congress, led by Representative Earl Blumenauer of Oregon and Senator John D. Rockefeller IV of West Virginia, had urged the administration to cover end-of-life planning as a service offered under the Medicare wellness benefit. A national organization of hospice care providers made the same recommendation.

Mr. Blumenauer, the author of the original end-of-life proposal, praised the rule as “a step in the right direction.”

“It will give people more control over the care they receive,” Mr. Blumenauer said in an interview. “It means that doctors and patients can have these conversations in the normal course of business, as part of our health care routine, not as something put off until we are forced to do it.”

After learning of the administration’s decision, Mr. Blumenauer’s office celebrated “a quiet victory,” but urged supporters not to crow about it.

“While we are very happy with the result, we won’t be shouting it from the rooftops because we aren’t out of the woods yet,” Mr. Blumenauer’s office said in an e-mail in early November to people working with him on the issue. “This regulation could be modified or reversed, especially if Republican leaders try to use this small provision to perpetuate the ‘death panel’ myth.”

Moreover, the e-mail said: “We would ask that you not broadcast this accomplishment out to any of your lists, even if they are ‘supporters’ — e-mails can too easily be forwarded.”

I’m not sure Rep. Blumenauer gets the concept of email. Once it’s out there … it’s out there. And asking people to keep a secret is usually a big fat tipoff that there’s something in the email that might be worth your friendly media contact’s interest. Welcome to the new millenium, Earl.

Of course, now that the crazies were given a nice Christmas Day present by the New York Times (they of the so-called “liberal” media) and Congressman Blumenauer, perhaps we can revisit the whole concept of how the so-called “death panels” were intellectualized by think tank partisans and rightwing bloggers far and wide as they tried to rationalize the tweetings and the facebookings of Sarah Palin. The jist is simple: any government cuts to health care represent evil decisions for those likeliest to suffer: “the sick, the elderly, the disabled, of course.” So now that GOP gains have been made in statehouses from nearly-coast to oh-so-close-to-coast, let’s see how that logic holds up as Rick Perry attempts to rationalize his cuts in health care spending cuts, just as we will for Bobby Jindal’s, or for newly-minted Oklahoma Governor-elect, Mary Fallin. Will their cuts be any more humane? Just wait and see what the Palin apologists contort themselves into believing in January. To the surprise of nobody, it will be the exact opposite of what they beleived in June 2009.

The Audacity of Flip-Flops

December 18, 2010 Politics-2010 No Comments

» Boston Globe: The New Mitt: Same as the Old Mitt (Scot Lehigh)

Lehigh gives the nickel version of Mitt Romney’s flip-flops and punctuates the matter with this:

Topping it all off, Romney’s camp next announced Mitt agreed with US District Judge Henry Hudson that the individual mandate in President Obama’s new health care law is unconstitutional. But wait, wasn’t ObamaCare modeled on RomneyCare? And doesn’t RomneyCare have a similar requirement?

Now, when it comes to verbal escapes, Slick Willard, Mitt’s dodgy doppelganger, is a virtual Houdini. So you won’t want to miss the hair-splitting it will take for him to inveigh against the federal law even as he defends the state statute that served as its model.

In the past, I’ve worried that Mitt might make a solid Presidential nominee if only because he can deliver such reversals with a straight face. At some level, though, you have to wonder what it would take for a candidate like this to leave a debate audience keeled over in laughter.

Individual Mandates Among Us

December 17, 2010 Politics-2010 7 Comments

Reading the National Review’s gleeful acceptance of Judge Hudson’s strike against the individual mandate (as opposed to the silence over his acceptance of the rest of the law), I can’t help but wonder why the debate over the mandate keeps coming back to a comparison of the provision to buy auto insurance if you drive. Why not compare it to the laws on the books that lock up homeless folks for not purchasing (or bartering, or whatever) a residence? It would seem to me that if you want to suggest that government cannot infringe on one’s right to do nothing, then the comparison to not procure a residence would be far more fitting.

Federalism as a Pretext

December 16, 2010 Politics-2010 No Comments

» Bottom Up: On the Constitutionality of ObamaCare

Interesting post by Tim Lee on the individual mandate. It’s a qualified defense of it, with the use of the tax code being the point of comparison. This part of his take obviously caught my attention.

The test case for conservative seriousness about federalism was Raich v. Gonzales, the medical marijuana case. Justices Scalia and Kennedy flubbed that opportunity, ruling that a woman growing a plant in her backyard was engaging in interstate commerce and that this activity could therefore be regulated by the federal government. If Scalia and Kennedy now vote with the majority to strike down portions of ObamaCare, it will be pretty obvious that they regard federalism as little more than a flimsy pretext for invalidating statutes they don’t like. Or, worse, for giving a president they don’t like a black eye.

I fully expect Scalia, in particular, to have absolutely zero qualms about the unconstitutionality of the individual mandate. And intellectual consistency won’t matter. It’s a far more political court now than we’ve ever had in my lifetime. So Lee’s conclusion is pretty prescient.

Look Who’s Mulling Now

December 16, 2010 Politics-2010 No Comments

» NY Times: Ruling Has Some Mulling the Necessity of Mandating Insurance

Not sure about the mulling part. Some of us were practically pounding a shoe on the podium about it in year’s past … and applauding then-candidate Obama when he sided against it in 2008. So far, the single best “alternative” is that proposed by Paul Starr. But it’s a long time before the issue becomes timely, at least in terms of implementation.

Of course, it might be more of a story if someone other than Ben Nelson were doing the “mulling.”

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January 5, 2013

Today, I’m off to settle into a new workspace and a temporary residence in order to work with my new State Representative, Gene Wu, in Austin. Before anyone thinks to call, comment, or text about how exciting any of that is, you should be reminded that I was raised to loathe all things Austin. While […]

2007-11 Citizen Voting Age Population Update

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