Tuesday, March 27, 2012

WEST VIRGINIA: TWO PARTIES, ONE IDEOLOGY (Pub Date TBD)


What are the differences in the positions of Governor Earl Ray Tomblin and Republican challenger, Bill Maloney, on taxes, economic development, coal and gas, the environment, healthcare, worker safety, abortion, and same-sex marriage?


The answer? There are no differences or, if differences exist, the men’s positions are but a hair’s breadth apart.


Both support tax reduction – particularly on businesses -- as the primary strategy for economic development. Both oppose same-sex marriage and abortion. Both are strident advocates for coal and gas development. Both aggressively oppose the Environmental Protection Agency and question or deny the existence of man-made global warming. Both oppose most or all of Obamacare, with Tomblin pleading that his actions to implement the law are undertaken only because he is legally required to act. Neither supports worker safety protections, particularly in coal mining, beyond those mandated by the federal government.


In fact, the only discernible differences in the political postures of the two men are that Maloney fervently supports judicial reform, which Tomblin opposes, and Tomblin is an ally of unions, which Maloney generally opposes. But, even those differences have less to do with matters of principle than they have to do with whose supporters stand to gain or lose – trial attorneys and teachers for Tomblin and businesspeople and the Chamber of Commerce for Maloney.


It’s pretty much one political ideology and two candidates whose primary interests lie in taking care of their own.


This sameness of ideology isn’t confined to gubernatorial politics. After they win their parties’ respective nominations, Senator Joe Manchin and Republican John Raese will compete again this fall for the US Senate. Raese will face the daunting challenge of finding issues on which he differs from Manchin. Once Raese thought he had openings on Obamacare and Cap and Trade legislation. But, Manchin took those away by announcing just prior to the last election that he had changed his position and would henceforth oppose Obamacare. Then he famously put a bullet through the Cap and Trade bill.


Sometimes the sameness of ideology in West Virginia is ironic. In the last election cycle, ethically-challenged first district Democratic congressman, Alan Mollohan, lost his primary race to former state senator, Mike Oliverio. Mollohan tried to cast his opponent as a pawn of right wing interests because Oliverio was the West Virginia co-chair of the American Legislative Exchange Council (ALEC), a right-wing think tank funded by the arch-conservative Koch brothers and an assortment of corporations. Mollohan might have had a point since ALEC is the source of many highly conservative “model bills” that inspired the Wisconsin law attacking state employee collective bargaining rights; voter ID laws that are accused of disenfranchising students, old people, and minorities; an assortment of measures designed to repeal Obamacare at the state level; and the “stand your ground law” made famous in Florida’s Trayvon Martin case, which has also been enacted in West Virginia.


The effectiveness of Mollohan’s accusation was blunted, however, by his own bad behavior and by the fact that Oliverio’s predecessor as the West Virginia chair of ALEC was one Joe Manchin. In true bipartisan spirit, the current West Virginia ALEC chair is Republican state Delegate and Tea Party favorite, Eric Householder. And ALEC’s most enthusiastic supporter may be local Delegate Jonathan Miller who is challenging Republican Congresswoman Shelley Moore Capito from the right.


Even West Virginia news media are largely monochromatic. West Virginia MetroNews, content-provider to 57 radio stations statewide and home to the popular Hoppy Kercheval, is owned by the afore-mentioned senate candidate, John Raese, to whom Kercheval is a campaign contributor as well as an employee. Meanwhile, the state’s largest newspaper chain, Ogden Publications, Inc., which owns the Journal in Martinsburg and five other daily newspapers in the West Virginia, is reliably conservative and pro-business in its editorial positions.


Taken together, West Virginia’s political class is almost invariably allied with business interests and largely silent on issues that make West Virginia last in the nation in nearly every measure of well-being. We don’t have Democrats and Republicans. We have an “Accommodationist Party” with two only slightly differentiated wings.


West Virginia is in dire need of new perspectives. We need voices that, instead of reflexively condemning Obamacare and ignoring the state’s health crisis, will propose ways of achieving universal coverage and expanded access to care. We need voices addressing the state’s lowest-in-the-nation level of educational attainment and proposing policies that will make advanced education and four-year degrees an expectation, if not an inevitability, for all West Virginia students. We need voices pointing out that simple-minded tax cutting is a myopic, inadequate, and failed strategy for attracting investment to the state and that, instead, we must address shortcomings in infrastructure, workforce, and quality of life. We need voices demanding action on licit and illicit drug use, the associated rise in violent crime, and our dearth of prevention and treatment options. We need other voices pointing out that coal is a dying industry and that it along with natural gas, while having value, has not been, is not, and will never be a major engine of prosperity for West Virginia. And we need recognition that the coal industry, in its death throes, is cannibalizing the state economically and environmentally and that it has already shed 80% of the jobs it once provided and they aren’t coming back.


But, in our homogenized political environment, these points go unmade and there is no debate. And we are the losers because of it.

Friday, March 23, 2012

OBAMACARE AND THE FALSEHOOD THAT THE COST HAS DOUBLED

Yesterday's issue of the Washington Post and some West Virginia newspapers ran a column by Charles Krauthammer which criticizes the Affordable Care Act on a variety of grounds, but leads with the claim that, "From 2013 through 2022, the CBO reports, the costs of Obamacare come to $1.76 trillion — almost twice the phony original number."

It is simply untrue that the cost of the ACA is twice the original number or that the original number was "phony". In fact, the first page of the CBO report says,

"CBO and JCT now estimate that the insurance coverage provisions of the ACA will have a net cost of just under $1.1 trillion over the 2012–2021 period—about $50 billion less than the agencies’ March 2011 estimate for that 10-year period."

That's right. The cost is LESS, not more than originally estimated. So, on what basis does Krauthammer make his claim? As Paul Krugman points out here and Ezra Klein documents here, the difference in 10-year cost estimates is attributable entirely to the passage of time.

The original 10-year estimate was for the period 2010-2019, however many of the ACA's provisions and, therefore, its costs don't kick in until 2014. So, the new 10-year estimate, which understandably starts in 2013, includes three additional years of full funding.

This is entirely consistent with the original figure and it is simply untrue to say, as Krauthammer and some Republicans have, that the cost has doubled.

Thursday, March 22, 2012

OBAMACARE ISN'T PERFECT, JUST GOOD (Pub date TBD)


In a free-market economy private health insurance is paradoxical. Participants pay relatively small and predictable premiums in return for the knowledge that they will not be hit with financially catastrophic medical costs. This happy result is possible because insurance distributes the cost of individuals’ medical care, including intensive care for those who need it, across large populations.


In other words, private health insurance is a kind of market-based socialism. Whether you call it sharing or distributing or socializing costs, it amounts to the same thing. Individuals do not fully own the financial consequences of their healthcare needs.


That’s a good thing for everybody. Participants don’t have to worry about their financial well-being suddenly vanishing due to random illness and society and the economy benefit because financially secure people feel free to spend and invest their money.


But, the paradox of private health insurance isn’t that it’s socialism in market clothing. It’s that, as insurance companies improve their product, the value declines for individuals and society.


That’s because, advances in medical knowledge and technology constantly improve companies’ ability to predict peoples’ likelihood of falling victim to disease or injury. This knowledge helps them calibrate premium amounts and benefits and identify who they would like to cover.


Insurance companies call this practice “tailoring”. Others call it discrimination, but, the terminology is irrelevant. The point is that, as knowledge and predictive abilities improve, costs and coverages become more individualized and less socialized. Consequently, we own more of our costs and the benefits for individuals and society gradually and inexorably decline.


We resist this dynamic by mandating coverage for pre-existing conditions and specific diseases. We also pass privacy legislation limiting the personal information available to insurance companies. But, in the end, we’re like the little boy using his fingers to plug holes in the dike.


Behind the dike, the body of medical knowledge, personal information, and increasingly sophisticated predictive models grows, exerting mounting pressure on insurers to individualize coverage.


The inevitable result is rising premiums and fewer Americans with insurance. Just since 2001 the number of Americans with employer-provided medical coverage has dropped from 70% to 54%.


What happens to those who lack coverage? Some are picked up by Medicare and Medicaid, but many go without and, when they incur medical expenses they can’t pay, the costs are passed along to the rest of us.


Still, as a matter of conscience, we won’t deny care to people in need because of an inability to pay. That’s another reason why socializing medical costs, even by private insurers, is a good thing. But, the aforementioned forces still, inexorably erode private insurance’s ability to perform that function.


So we must either help private insurance or replace it. There is no other choice and tweaks such as increasing competition by removing regulations that interfere with companies’ ability to operate across state lines, do nothing to address the underlying forces.


The Affordable Care Act (ACA), or “Obamacare” as some opponents call it, or “Romneycare” as other opponents call it, is an attempt to help private insurance continue to meet our needs. Whatever its other strengths or weaknesses, the law removes many of the incentives that private insurers otherwise have to discriminate in premiums and coverage.


And the approach seems to work. Mitt Romney’s similar law has been in place in Massachusetts for six years during which time, according to a Blue Cross / Blue Shield Foundation study published last year, the number of uninsured people has dropped to 3% as compared to 18% nationally. Doctor and dentist visits have increased by 10%. The number of employers offering health coverage has increased while declining nationally. Private insurers have more customers now than they did before the law’s enactment. Finally, the number of people reporting medical expenses greater than or equal to 10% of their income has dropped from 10% to 4%.


The primary criticisms of the law are its individual mandate to purchase coverage, although that element makes the plan affordable by requiring people to pull their own weight, and the law’s failure to decrease healthcare costs as some of its proponents claimed it would. But neither has it cost Massachusetts more than expected.


I should note that the Cato Institute, in an earlier study, came to different conclusions about both costs and increases in coverage in Massachusetts, but the preponderance of studies done thus far seems to support the Blue Cross / Blue Shield conclusions.


So, what would the ACA’s impact be for West Virginia?


When fully implemented, the ACA will insure the vast majority of the 20.6% of West Virginia residents who currently lack insurance, 256,000 people in all. A Families USA analysis by Dr. Jonathan Gruber, an MIT economist, shows that West Virginia families who currently have insurance will see annual premiums decline by an average of $473 while overall out-of-pocket costs will decline by $246. Plus, there are the provisions that allow children to stay on their parents’ policies until age 26, that help seniors pay for prescriptions, and that provide coverage for people with pre-existing conditions.


Repeal of the ACA would destroy all that and the irresistible market forces described above will continue to erode private health insurance’s ability to meet our needs individually and as a society. So, going back doesn’t make sense. And the single-payer system some of us would like to see has been rejected.


Other solutions? Opponents of the ACA haven’t come up with one yet.


Sean O’Leary can be contacted at seanoleary@citlink.net.
 
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