Monday, April 22, 2013

Are The Democrats Blowing It Again?

Six years in office and 2006 brings a stinging Republican defeat, because the Republicans blew it.  They could have consolidated their victory if they hadn’t been so incompetent. 

Two years in office in 2010 and the Obama forces are routed.  Obama’s whole career shows the fruits of Republicans blowing it, not to diminish the undoubted campaigning expertise and energy of Obama.  Bobby Rush was his last really credible opponent who didn’t blow it.  But in office, their trumpet becomes a weak reed, they don’t know how to put spine in the country, the stock market reels and Obama says hardly a word – he is an economic illiterate, which doesn’t help, and the advisors are poor.  So they lose big time.  Lost the big mo.

2011-12 – Republicans have it in the bag, an incumbent never having won with such weak jobs numbers.  OK, good Obama campaign, smart, smart on the ground electronic cyber campaign.  But, the Republicans field the worst set of candidates this side of Mad Magazine.  Even then, weak as Romney and the Republicans were, they probably would have won, were it not for the 47% video, and other self-immolations.  Did Obama win, or did Romney lose?  It was a cooperative effort.

Cut to my taxi ride home Sunday night.  My voluble but eloquent Pakistani driver, age perhaps 50, inquired about my trip, and as I told him about the Academy of Pediatrics and my worries about Obamacare, he averred that he was strongly for it.  “People need insurance,” he said.

He makes about $60,000 a year,  “I’ll get it, right?” he said.

I said that my best guess, not knowing as much as I would like about the plan – which shows something in itself, since it is my field and I am not lazy about getting information – would be that at that level of income he would have to pay about half of the cost of insurance himself.  That took him back a bit.

Then I said, it’s not certain that your family would be covered.  A recent IRS decision was that for an employed individual, if the cost of the insurance policy for just the employee would be 9.5% or less of his or her income, the insurance policy would qualify.  But the cost of family coverage could be much more.  In this case the penalty for not getting insurance would not be applied.  In other words, for a substantial section of the employed public, families would not be covered.  This was what I hoped for as a business owner, which I no longer am, since I thought it would damage my business.  As a citizen, a Democrat, and a health care policy analyst, I think it’s ridiculous if families won't be covered.

So it’s possible my taxi driver, if he is an employee, could have his family out in the cold.  He said to me, “You are making me nervous.”  I told him I was nervous myself.

Here is a man who is telling his friends that Obamacare will be a good thing.  Will his hopes be dashed?  Will his friends turn on him and say, “See?  You were foolish to be taken in by the government and the politicians.”

It will all be coming down in 2014, which I know I needn’t remind you, dear reader, is a midterm election year, when the party in power is at maximum risk.

Recall the conversation in the Theda Skocpol seminar last week, where the gathering speculated as to why the “good news” of Obamacare hadn’t swept the nation, and why the Democrats hadn’t trumpeted more strongly.  My own diagnosis was incompetence.  Who would trumpet?  Obama doesn’t know details, and he is only responsible for a clarion call now and then.  Nancy Pelosi is not articulate, although she is a hero of mine.  Harry Reid?  Sibelius does talking points only and not very convincingly.  There is no one from the White House.  We are getting sounds of silence.

What we need is management of expectations.  There needs to be a knowledgeable, articulate spokesperson.  Probably Don Berwick hoped to be that person, but he was banished by the Republicans.  Daschle probably wanted to be that person also.  But in fact, the Democrats never found that someone.  The advantages of Obamacare need to be highlighted now, one by one, as they come in, and the challenges they are facing and hoping to overcome, and a play by play recitation mixing hope with reality.  Hope and progress needs to be heralded by trumpets and drums.  Instead, what we will get is a denouement that startles everyone with the deficiencies, and leaves the taxi driver embarrassed and embittered, and leaves the Democrats with a 2014 that resembles 2006.

And health reform?  I think it’s here to stay, but enthusiasm and appreciation of the positives would sure make for a better entrance than disappointment in the inevitable deficiencies.

Anyway, that’s my fear.

Budd Shenkin

Wednesday, April 10, 2013

More Incompetence

OK, two posts in one day.  New record. 

Here is another note from Kaiser Health News -

Consumer Groups Fear Patients Could Be Hit With Large Out-Of-Pocket Costs.

Why will this happen?  Because the Administration has not yet figured out - they have only had three years - how to adjust employers' arrangements for health insurance that combines multiple policies.  Health plans and employers ask for a delay, and they get it with no comment from HHS.  I have heard the excuse - seriously - that while the government was not sure how the lawsuits against the constitutionality of PPACA would come out, they were reluctant to allocate resources to preparing for implementation.

Really?  Do I hear the cry of further incompetence?  You would think, if PPACA is the "signature statement" of the Obama Administration, it would not be government business as usual.  It is just disheartening.

Budd Shenkin


PPACA - Get Ready For the Incompetence

Last week I attended a lecture and subsequent discussion of the Patient Protection and Affordable Care Act at the Goldman School of Public Policy at UCB, my alma mater.  The lecturer was Theda Skocpol, a  liberal political scientist enthusiast and booster from Harvard.  (Don't read her book, it's mainly boosterism.)  One question in the discussion remained unanswered -- why has the Obama Administration and the Democratic Party not done better publicity for the virtues of PPACA? 

The opposition has done very well, by contrast.  It's the media's fault!  Of course, it's always the media.  But one audience participant said, hey, I used to be a political reporter, and I don't think it's the media's fault at all.  So the question was just left to lie there.

I wanted to put in my opinion - big surprise there - but I had other fish to fry as I commented on the lack of understanding of the professional political forces.  Skocpol and others lumped doctors and hospitals together, and there was collective derision of the high salaries doctors earned, and derision when a primary care doctor of one of the discussants told him that it was tough to attract doctors to her group because they could only offer $145K as an initial salary.  Collective derision -- who do these people think they are?  Why should they earn more thus us academics? 

Another discussant compared the forces around Medicare and those around PPACA.  It was left to yours truly to point out the stark differences between then and now.  The AMA is now shattered, and mattered little in PPACA.  Medicine has been corporatized.  Hospitals matter much more than doctors.  If there is a bill for a procedure in a hospital, the doctor will bill $500, the hospital will bill $15,500 - at least.  The professional specialty societies and academic medical centers matter more than the AMA.  I was supported in this view by discussant Steve Shortell, Dean of the School of Public Health, but it was amazing to me that Skocpol seemed not to be aware of this.

But back to the point - why did support for PPACA not come from the Administration and the Democratic Party the way one would expect?  Where was the bully pulpit?  My answer is -- did anyone ever hear of incompetence?  The President's bench is thin.  Where are the health heavyweights?  Where was the aggression necessary for the 2010 elections?  Nowhere, because they aides suck, and Obama himself doesn't know details - he is rather health illiterate.  Sibelius seems not to know much, and is not persuasive - she is a talking points person.  Obama is great at big picture rhetoric, but not in nitty gritty.  They just don't have it.

This will be a problem as we go down the road - incompetence in HHS will make the going very rough.  Today comes a report from Kaiser Health News that only a pittance is budgeted for enrolling people in the Health Insurance Exchanges.  Healthy people won't get the coverage, and the finances will suffer.  Why?  KISS.  It's just incompetence.  Deadlines keep slipping, the type of insurance will continue to emphasize high deductibles, I predict, and Universal Crappy Health Insurance (UCHI) will reign.  When I brought this up in my brief remarks, Skocpol replied that she is too old not to accept the imperfect. 

Jesus, what a cheerleader.  For a smart lady, she is too willing to overlook incompetence, in my view.  But maybe I'm wrong, and it is all just the necessary first steps.  Maybe the compromises were not incompetence, but just necessary.  I only worry that poor first steps can lead to a long ramp up.  Like, how long does it take teams to overtake a history of bad draft picks?  Answer: a long time.

Budd Shenkin