Obamacare: Mend it, Don’t End it

Joe Klein , April 3, 2014

 

The Affordable Care Act has problems. But the GOP campaign to junk it is now finished

 

The endless, blindingly obtuse debate about the Affordable Care Act–also known as Obamacare–has been almost entirely about politics, not substance. There are two reasons for this. We haven’t had much real substance to go on. And politics is a lot easier for us wizards of the media to report and opine upon. The abysmal debut of the HealthCare.gov website is a lot easier to comprehend–government can’t tie its own shoelaces–than the heroic efforts to bring the site back to life. The people who “lost” their insurance because of new coverage requirements are more famous than those who were able to get better, cheaper coverage through the new government health care markets. (Actually, they’re many of the same people.) The fact that 7.1 million people signed up for insurance is more important than who they actually are: Were they uninsured in the past? Will they pay their bills? Will they get the care they’re paying for? Will the system be able to handle all the new traffic?

But we have now turned a corner. the system is up and running. It has 7.1 million customers (plus 4.5 million more in the expanded Medicaid program). The word of mouth seems to be … not bad: a recent ABC News–Washington Post poll actually had more Americans in favor of Obamacare than opposed to it, by an overpowering 49% to 48%. Those numbers may well improve over time as the public learns that the program isn’t the socialist cataclysm that Republicans predicted. It may even happen by November. It is not impossible that Americans will be pleased that a significant social injustice has been rectified: the hardworking poor finally have health care protection, just as the indigent on Medicaid have had. Indeed, there is one political thing that we know for sure: the Republicans have lost this debate substantively. The law won’t be repealed. “There is no off switch,” says Professor John DiIulio of the University of Pennsylvania, who is studying the system from the bottom up in 35 states. “There are financial obligations to the people who have signed up [and receive subsidies from the government]. There are 50 different stories here. The program is different in every state. That makes it difficult to formulate a national policy response,” whether it be repeal or sweeping reform.

Which doesn’t mean the Affordable Care Act doesn’t need reform. It is a slovenly piece of legislation that will need constant modification and in some cases structural overhaul. The very notion that there are 50 stories here demonstrates a glaring inefficiency. There should be four or five regional exchanges–they should be supermarkets, not corner stores, providing greater economies of scale. There ought to be (as six moderate Democratic Senators proposed) a wider variety of insurance options, including plans with lower premiums and higher deductibles. There should be fewer mandated coverages: if the Jones family believes it receives all the mental-health counseling it needs through its church, it shouldn’t be required to pay for mental-health coverage. Businesses that currently provide health coverage for their employees in the private market, especially moderate-size companies, should be free to shop for better deals in the health care exchanges. The President has been open to negotiation on most of the above, as well as conservative evergreens like medical-malpractice reform.

A recent Kaiser family foundation poll shows that 59% of Americans want to see this program improved, not repealed–another reason the Republicans have lost this debate. There are legitimate arguments against government expansion, but the Republicans haven’t been making them. Instead they’ve resorted to fear tactics (remember “death panels”), demagoguery (socialism!), concocted bad-news stories and irrelevant bean-counting. One reason the 7.1 million people signing up became such a big deal is that Republicans made it a litmus test. Given public disgust with the noxious atmosphere in Washington, you might expect that the GOP would be ripe for a reset on this issue. They could argue, We’re gonna reform this thing, make it an efficient free-enterprise model for the world. After all, the bone structure of Obamacare–the exchanges, the individual mandate–came out of the conservative Heritage Foundation 25 years ago.

But no. John Boehner and other GOP leaders sent a reflexive message to the 7.1 million enrollees: they’re still against it, no retreat, no surrender. That makes political sense in a dull, conventional-wisdom way. Current polls have them winning the House and perhaps the Senate in November. But what happens if Obamacare brings better coverage to millions of Americans between now and then? What happens if the good-news stories start outplaying the bad? Politics is never static, especially seven months from Election Day.

Now she tells us! Sebelius: Health care launch 'terribly flawed'

WASHINGTON (AP) — The Obama administration's timeline for having ready the new health care law's online sign-up system "was just flat out wrong," outgoing Health and Human Services Secretary Kathleen Sebelius said in an interview that aired Sunday.

 ,,,she acknowledged the rocky rollout for the online sign-up system fraught with technical problems that left Americans frustrated.

"Clearly, the estimate that it was ready to go Oct. 1 was just flat out wrong," Sebelius said.

Thank you very much Kathleen. Now shut up and go away. You screwed up 1/6th of the economy.

The Battle of Bunkerville

Rancher's son says force was necessary to stop cattle seizure

By Jennifer Dobner

BUNKERVILLE, Nevada Sun Apr 13, 2014 10:49pm EDT

A Nevada ranching family claims victory as government releases cattle (01:00)

Related Video

A Nevada ranching family claims victory as government releases cattle

(Reuters) - A show of force was necessary to stop the government seizure and sale of embattled cattle rancher Cliven Bundy's cows, his son said on Sunday, a day after an armed standoff between federal agents and hundreds of Bundy's supporters.
"We were dedicated to opening those gates and peacefully walking through to retrieve those cattle," Ammon Bundy said in an interview. "The presence of weapons was needed in order to intimidate them."
The federal Bureau of Land Management began a roundup of the cattle from the Bundy ranch a week ago, contending he owes more than $1 million in back fees, penalties and other costs for grazing his cattle on public land and has ignored court orders.
Bundy stopped paying monthly grazing fees in 1993. The ranch is about 80 miles northeast of Las Vegas.
The issue simmered for a week with verbal and physical altercations and reached a boil on Saturday after nearly 1,000 supporters, included armed militamen from several western states, rallied on foot and on horseback with the family.
The four-hour standoff temporarily shut down Interstate 15 and ended when the bureau stopped rounding up cattle citing safety concerns and then agreed to return the cows.
The Clark County sheriff Doug Gillespie had delivered a bureau offer to leave, but keep the cows, and then helped negotiate the eventual end to the standoff, Bundy said.
"When we went up there, they knew we were serious," Ammon Bundy said. "They wanted to go. This thing was building and building and was going to continue."
Bundy said about 350 of the ranch's cows were recovered from bureau holding pens. Some of the animals were injured and a handful of calves, some so new their umbilical cords remained attached, were being bottle fed, he said.
Bureau officials could not be reached immediately for comment on Sunday. In a statement on Saturday, Director Neil Kornze said the bureau ended the cattle gathering because of serious concerns about the safety of employees and the public and would work to resolve the matter administratively and through the courts.
About 100 Bundy supporters, many wearing camouflage and carrying firearms, gathered on Sunday with the family for an informal church service at a makeshift protest command center.
Speakers offered a mix of prayer and religious testimony, denounced the federal government for excessive oversight on several issues, and called for the preservation of individual constitutional rights.
An Arizona state representative in attendance, David Livingston, said the battle over the Bundy cows would serve as a unifying event for lawmakers across 11 western states working on state sovereignty issues.
"This was a major tipping point," Livingston said.
Cliven Bundy, 76, said he had been touched by the supporters who stood by his family over the past week.
"I was really quite humbled to the fact that there are so many good people," Cliven Bundy said.

Federal government stops fight with Nevada rancher over grazing land 

The Bureau of Land Management announced Saturday it would no longer enforce an order on Nevada rancher Cliven Bundy to prohibit him from using a piece of land for grazing for his cattle. Violence erupted Wednesday when the government began rounding up his cattle due to Bundy’s refusal to comply.

BY Joel Landau

NEW YORK DAILY NEWS

Saturday, April 12, 2014, 2:56 PM

Protesters place a sign on a bridge near the Bureau of Land Management 's base camp.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

JIM URQUHART/Reuters

The Nevada range war of 2014 is over.
The federal government announced Saturday it will no longer enforce a court order to remove about 900 animals from a stretch of land in rural Nevada over a decades-long dispute regarding grazing fees.
"Based on information about conditions on the ground, and in consultation with law enforcement, we have made a decision to conclude the cattle gather because of our serious concern about the safety of employees and members of the public," Bureau of Land Management Director Neil Kornze said, according to ABC News.

George Frey/Getty Images Rancher Cliven Bundy's son, Ammon Bundy grimaces as he shows taser marks on his chest on April 11.

The situation, labeled a range war by Cliven Bundy — owner of Bundy's Ranch about 80 miles northeast of Las Vegas — was disputing the federal government's claim he owed about $1.1 million in unpaid grazing fees from federal land his cattle was using.
The situation escalated quickly on Wednesday when federal agents and members of Bundy's family and his supporters engaged in a violent altercation when the bureau began rounding up Bundy's cattle. The BLM will release about 100 seized cattle.
Ammon Bundy, was shocked twice until he bled, while his 57-year-old sister, Margaret Houston, said she was thrown to the ground by a BLM officer.
Many of Bundy's supporters said the federal government's actions were an overreach on their power.

Protester Scott Drexler carries a rifle on a bridge next to the Bureau of Land Management's base camp where seized cattle, that belonged to rancher Cliven Bundy, are being held at near Bunkerville, Nevada.

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Nevada Gov. Brian Sandoval told TV Station KSNV he was happy the bureau listened to the public's concerns.
"The safety of all individuals involved in this matter has been my highest priority," the email said. "Given the circumstances, today's outcome is the best we could have hoped for," he said.

Read more: http://www.nydailynews.com/news/national/u-s-stops-fight-nevada-rancher-grazing-land-article-1.1754457#ixzz2yru05mB4

Obama mum on Scottish secession

Just for Louman the real truth about the free telephone

1. Ok un-informed tea party types, Free phone service for the poor was started in 1985 although it's just another ongoing service you want to pile on Obama because you don't know any better. Landline service has been provided for low income people since 1985 under the program known as Lifeline. Geez that's under your boy Ronald Reagan's watch. The cell phone idea came about in 2005. (oops still no Obama is there)( and a totally controlled government, by the republicans). It was started in 2008 in that wonderful tax free conservative bastion of the State of Tennessee. And it gets better here's the real kicker, the service is provided by the individual states as part of the welfare program not by Barack Obama and not by the federal government. In fact YOU ,I,  everyone with a cell phone pays for it. Look for your Universal Service Fund/fee on your next pay date. And why is this here on every telephone bill in America? It's called the telecommunications Act of 1996. This act made explicit that phone providers had to make universal service available to all citizens at reasonable rates regardless of income regardless of location. It's the phone companies that made the call on free service. This wonderful piece of legislation was of course passed by your own. The senate and the house were both controlled by the republican party in 1996. Thank Mr. Newt Gingrich and Mr. Trent Lott for the service. Hum both southern republicans. I'll start having my poor friends with phones publically thank you all. More right wing myth that Obama invented the free phone. Guess right wing talk really does dumb you down. Can't you guys remember any of your fine ideas from the past, such as the individual mandate on health insurance first proposed by your vaunted Heritage Foundation in 1989.
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   http://www.ntia.doc.gov/legacy/otiahome/top/publicationmedia/newsltr/telcom_act.htm#UNIVERSAL SERVICE
4. http://www.fcc.gov/encyclopedia/universal-service

http://healthcarereform.procon.org/view.resource.php?resourceID=004182

EU looks to curb corporate pay

http://www.irishexaminer.com/business/eu-looks-to-curb-corporate-pay-264883.html

Amazing stuff

Paralyzed patients regain movement after spinal implant: study

By Sharon Begley

NEW YORK Tue Apr 8, 2014 12:11am EDT

1 of 2. Kent Stephenson lies down during voluntary training while Katelyn Gurley tracks his level of muscle activity and force at the Human Locomotion Research Center laboratory, Frazier Rehab Institute, as part of the University of Louisville's Kentucky Spinal Cord Injury Research Center, in Louisville Kentucky, as pictured in this handout photo courtesy of University of Louisville.

Credit: Reuters/University of Louisville/Handout via Reuters

(Reuters) - Four men who had each been paralyzed from the chest down for more than two years and been told their situation was hopeless regained the ability to voluntarily move their legs and feet - though not to walk - after an electrical device was implanted in their spines, researchers reported on Tuesday.
The success, albeit in a small number of patients, offers hope that a fundamentally new treatment can help many of the 6 million paralyzed Americans, including the 1.3 million with spinal cord injuries. Even those whose cases are deemed so hopeless they are not offered further rehabilitation might benefit, scientists say.
The results also cast doubt on a key assumption about spinal cord injury: that treatment requires damaged neurons to regrow or be replaced with, for instance, stem cells. Both approaches have proved fiendishly difficult and, in the case of stem cells, controversial.
"The big message here is that people with spinal cord injury of the type these men had no longer need to think they have a lifelong sentence of paralysis," Dr Roderic Pettigrew, director of the National Institute of Biomedical Imaging and Bioengineering, part of the National Institutes of Health, said in an interview. "They can achieve some level of voluntary function," which he called "a milestone" in spinal cord injury research. His institute partly funded the study, which was published in the journal Brain.
The partial recovery achieved by "hopeless" patients suggests that physicians and rehabilitation therapists may be giving up on millions of paralyzed people. That's because physical therapy can mimic some aspects of the electrical stimulation that the device provided, said Susan Harkema, a specialist in neurological rehab at the University of Louisville's Kentucky Spinal Cord Injury Research Center (KSCIRC), who led the new study.
"One of the things this research shows is that there is more potential for spinal cord injury patients to recover even without this electrical stimulation," she said in an interview. "Today, patients are not given rehab because they are not considered 'good investments.' We should rethink what they're offered, because rehabilitation can drive recovery for many more than are receiving it."
BASEBALL STAR
The research built on the case of a single paralyzed patient that Harkema's team reported in 2011. College baseball star Rob Summers had been injured in a hit-and-run accident in 2006, paralyzing him below the neck.
In late 2009, Summers received the epidural implant just below the damaged area. The 2.5-ounce (72-gram) device began emitting electrical current at varying frequencies and intensities, stimulating dense bundles of neurons in the spinal cord. Three days later he stood on his own. In 2010 he took his first tentative steps.
His partial recovery became a media sensation, but even the Louisville team thought that epidural stimulation could benefit only spinal cord patients who had some sensation in their paralyzed limbs, as Summers did. "We assumed that the surviving sensory pathways were crucial for this recovery," Harkema said.
She and her team had little hope for two of their next patients. Neither had sensation in their paralyzed legs.
One was Kent Stephenson, who had been paralyzed in a 2009 motocross crash when he was 21. After months of rehab in Colorado, "they said I would never move my legs again, and there was no hope," he said.
Eleven days after he began receiving the deck-of-cards-size RestoreAdvanced stimulator, which is made by Medtronic and used for pain control, Stephenson moved his "paralyzed" left leg while lying on his back.
"My mom, who was in the room when they turned the stimulator on and told me, 'Pull your left leg up,' cried when I did it," Stephenson said. "I got a little watery-eyed, too. I'd been told I'd never move voluntarily again."
The researchers didn't expect him to, either, said Claudia Angeli of the Frazier Rehab Institute and KSCIRC, who co-led the study: "So when Kent moved, we thought, huh, this might actually be working."
Andrew Meas, whose head-on collision with a car while he was riding home on his motorcycle in 2006 left him paralyzed from the chest down, made even more progress. He can move even when the stimulator is not emitting electrical signals.
The first time he was able to move his legs "it made me feel like a normal person again," he said. After months of rehab post-implant, "I can pick up both my legs without the stimulator on, and can also stand without it. My record is 27 minutes, and I'm still progressing."
At first, Meas could move his legs only when the implant's 16 electrodes were zapping their spinal neurons at full power. Over 28 weeks of daily physical therapy, he gradually became able to move his toes, feet, ankles, knees, legs and hips with less electrical stimulation.
ELECTRICAL BARRAGE
Meas's experience offers clues to how epidural stimulation works in patients with spinal cord injury. Just as continuous exposure to an allergen can eventually make people so sensitized that they sneeze and wheeze at a single grain of pollen, so the electrical barrage "resets the level of excitability of spinal cord neurons," said NIH's Pettigrew. As a result, "even input from exercise could be enough to trigger a motor response."
In addition to regaining voluntary movement, the patients put on muscle mass and felt less tired and generally happier. Summers is coaching baseball. Stephenson goes whitewater rafting and motocrossing in a sidecar.
Even researchers who have pioneered competing approaches, using cells, praised the new work. "It's not a cure," said Dr Barth Green, a neurosurgeon at the University of Miami, whose Miami Project to Cure Paralysis is trying to treat spinal cord patients with cell transplants. "But it could be part of a combined biological and bioengineering strategy to help patients not just walk again but also gain control of their bowel and bladder," which many paralyzed patients identify as even more important to their quality of life.
The Louisville researchers suspect that with better stimulator technology, spinal cord patients will be able to "work toward stepping," as they carefully phrase it to avoid the hype associated with "walking again." The electrodes in the current device must either be all on or all off, for instance; alternately stimulating the left and right sides might be more effective.
The bioengineering institute at NIH is funding research to develop noninvasive stimulators. That way, the electrical pulses can be delivered through the skin rather than requiring surgery to implant a device, Pettigrew said.
Even in patients with severe spinal cord injuries, and even after experts have pronounced them incapable of recovery, "we believe there is still a capacity for recovery," Harkema said. "It's not necessarily the case that you will never move again."

Cruz Paul Bush Christie

Recent conservative straw poll.

With more than 60,000 ballots cast, U.S. Senator Ted Cruz (R-TX) was the clear winner with 43% of the vote. U.S. Senator Rand Paul (R-KY) finished second with 18%. Here are the results:

• Sen. Ted Cruz (TX) - 42.67% (26,114)
• Sen. Rand Paul (KY) - 18.00% (11,018)
• Gov. Scott Walker (WI) - 10.05% (6,153)
• Other: (write-in candidates) - 6.85% (4,192)
• Fmr. Gov. Mike Huckabee (AR) - 6.15% (3,765)
• Gov. Rick Perry (TX) - 4.15% (2,540)
• Sen. Marco Rubio (FL) - 2.41% (1,478)
• Fmr. Gov. Jeb Bush (FL) - 2.18% (1,333)
• Gov. Chris Christie (NJ) - 1.83% (1,122)
• Rep. Paul Ryan (WI) - 1.64% (1,006)
• Gov. Bobby Jindal (LA) - 1.24% (760)
• Fmr. Sen. Rick Santorum (PA) - 1.02% (627)
• Gov. John Kasich (OH) - 0.65% (398)
• Gov. Mike Pence (IN) - 0.45% (273)
• Gov. Nikki Haley (SC) - 0.39% (240)
• Gov. Susana Martinez (NM) - 0.31% (187)

I'm Fighting to Restore a Free Society

Instead of welcoming free debate, collectivists engage in character assassination. 

I have devoted most of my life to understanding the principles that enable people to improve their lives. It is those principles—the principles of a free society—that have shaped my life, my family, our company and America itself.

Unfortunately, the fundamental concepts of dignity, respect, equality before the law and personal freedom are under attack by the nation's own government. That's why, if we want to restore a free society and create greater well-being and opportunity for all Americans, we have no choice but to fight for those principles. I have been doing so for more than 50 years, primarily through educational efforts. It was only in the past decade that I realized the need to also engage in the political process.
A truly free society is based on a vision of respect for people and what they value. In a truly free society, any business that disrespects its customers will fail, and deserves to do so. The same should be true of any government that disrespects its citizens. The central belief and fatal conceit of the current administration is that you are incapable of running your own life, but those in power are capable of running it for you. This is the essence of big government and collectivism.
More than 200 years ago, Thomas Jefferson warned that this could happen. "The natural progress of things," Jefferson wrote, "is for liberty to yield and government to gain ground." He knew that no government could possibly run citizens' lives for the better. The more government tries to control, the greater the disaster, as shown by the current health-care debacle. Collectivists (those who stand for government control of the means of production and how people live their lives) promise heaven but deliver hell. For them, the promised end justifies the means.
Instead of encouraging free and open debate, collectivists strive to discredit and intimidate opponents. They engage in character assassination. (I should know, as the almost daily target of their attacks.) This is the approach that Arthur Schopenhauer described in the 19th century, that Saul Alinsky famously advocated in the 20th, and that so many despots have infamously practiced. Such tactics are the antithesis of what is required for a free society—and a telltale sign that the collectivists do not have good answers.
Rather than try to understand my vision for a free society or accurately report the facts about (    ) Industries, our critics would have you believe we're "un-American" and trying to "rig the system," that we're against "environmental protection" or eager to "end workplace safety standards." These falsehoods remind me of the late Sen. Daniel Patrick Moynihan's observation, "Everyone is entitled to his own opinion, but not to his own facts." Here are some facts about my philosophy and our company:
(      ) companies employ 60,000 Americans, who make many thousands of products that Americans want and need. According to government figures, our employees and the 143,000 additional American jobs they support generate nearly $11.7 billion in compensation and benefits. About one-third of our U.S.-based employees are union members.
(      ) employees have earned well over 700 awards for environmental, health and safety excellence since 2009, many of them from the Environmental Protection Agency and Occupational Safety and Health Administration. EPA officials have commended us for our "commitment to a cleaner environment" and called us "a model for other companies."
Our refineries have consistently ranked among the best in the nation for low per-barrel emissions. In 2012, our Total Case Incident Rate (an important safety measure) was 67% better than a Bureau of Labor Statistics average for peer industries. Even so, we have never rested on our laurels. We believe there is always room for innovation and improvement.
Far from trying to rig the system, I have spent decades opposing cronyism and all political favors, including mandates, subsidies and protective tariffs—even when we benefit from them. I believe that cronyism is nothing more than welfare for the rich and powerful, and should be abolished.
(        ) Industries was the only major producer in the ethanol industry to argue for the demise of the ethanol tax credit in 2011. That government handout (which cost taxpayers billions) needlessly drove up food and fuel prices as well as other costs for consumers—many of whom were poor or otherwise disadvantaged. Now the mandate needs to go, so that consumers and the marketplace are the ones who decide the future of ethanol.
Instead of fostering a system that enables people to help themselves, America is now saddled with a system that destroys value, raises costs, hinders innovation and relegates millions of citizens to a life of poverty, dependency and hopelessness. This is what happens when elected officials believe that people's lives are better run by politicians and regulators than by the people themselves. Those in power fail to see that more government means less liberty, and liberty is the essence of what it means to be American. Love of liberty is the American ideal.
If more businesses (and elected officials) were to embrace a vision of creating real value for people in a principled way, our nation would be far better off—not just today, but for generations to come. I'm dedicated to fighting for that vision. I'm convinced most Americans believe it's worth fighting for, too.

By
• Charles G. Koch

Mr. Koch is chairman and CEO of Koch Industries.
 http://m.us.wsj.com/articles/SB10001424052702303978304579475860515021286?mobile=y

Comparison Shopping?

WASHINGTON (AP) — Medicare says it's preparing to release billing data for more than 880,000 doctors, giving consumers an unprecedented look at how personal physicians stack up compared to others.

Medicare deputy administrator Jonathan Blum says in a blog that the data could be available as early as April 9.

The files contain data on every test and procedure billed for in 2012 by individual doctors in all 50 states, who together received $77 billion that year through Medicare's Part B coverage for outpatient services.

Although individual patient information will remain off limits, the files will identify physicians by name.

Consumer groups, insurers and employers have long sought access to the Medicare data to help track quality. The American Medical Association says it's an invasion of doctors' privacy.