On the Affordable Health Care Act

John Robert Behrman is an economist, retired, and was formerly State Democratic Executive Committeeman for SD-13, including the Texas Medical Center.

==============

The Supreme Court, including Chief Justice Roberts, has stepped back from the brink by not gutting the Affordable Care Act (Obamacare). I guess I should be happy.

But the still conservative majority on this court may have simply recognized that they risked more public support for the President and a move closer to a single-payer system with another radical, split decision. The court majority still have the complexity and unpopularity of the new law working for them. They know that Washington concession-tenders cannot make a relatively simple disability insurance program work for Iraq and Afghanistan veterans.

Democrats at every echelon of government (other than the Supreme Court) have to make this aw work despite (a) its constitutional near-death experience, (b) the very nature of health insurance policy sales racketeers they partnered with, and (c) the actual complexity, from state to state, of our motley institutions of public health and medical care. That is what we have: public health and medical care. “Healthcare” is oxymoronic lobby-jargon. The fact that our party’s national policy elite -- bundlers and consultants -- believe in “healthcare”, the “Latino vote”, the Easter Bunny, and so on portends how hard this will be and how perilous the present situation still is.

Here’s a suggestion:

Oregon and Washington State should opt out of Obamacare, as the president has invited them to do. They can create a system of public health and medical care that is fiscally and actuarially sound. Moreover, this would support them in worldwide competition for jobs and capital for the region: Seattle, Portland, and Tacoma. These two states would even have four senators in Washington, D.C., one of whom, Ron Wyden, actually knows what he is talking about in these matters.

So Oregon and Washington should be proud and can lead the nation.

As a legacy of WWII shipbuilding, aircraft factories, and nuclear ordnance, these two states have comparatively strong institutions of public health and medical care, including Kaiser-Permanente and Group Health of Puget Sound health maintenance organizations, as well as very reputable medical schools. These are embedded in other healthy industrial and commercial institutions. Moreover, public health authorities in these states have to deal with two of the most hazardous occupations in America: fishing and logging. In sum, Oregon and Washington are comparatively proficient in public health and medical care. Their patriotic, liberal, and scientific institutions are not unduly burdened by legacies of “scientific racism”, although they may have been somewhat tainted before and during WWII by anti-immigration bias and eugenics.

In short, these two states have the economic and technical scope and scale –- also every political and economic incentive –- to do a fine job of national health insurance built on other wholesome civic and professional institutions they have. This is something our federal, not our national, system of politics and government can accomplish in a highly regionalized global economy.

Moreover, the success of Oregon and Washington should be a signal to Texas Democrats. We could be the national leader in combining energy, industrial, and environmental policy as soon as 2014. We were once before, “back in the day”. We could swap some tips: Oregon and Washington are not leaders in combining energy, industrial, and environmental policy, quite the contrary.

In the midst or aftermath of huge wars, progressive policy has been dumped by a prestigious, victorious government in Washington on small or backwards states. Lyndon B. Johnson could even play Otto von Bismarck, and did so, by creating Medicare, barely and just before losing the war in Vietnam. However, even though “Obama got Osama”, the old flood-down paradigms of “Military Keynesianism” and post-war progressivism will not work for our beleaguered President or utterly marginalized state party today.

We have to try something new, even if it is actually old.

This post is dedicated to the memory of my childhood friend, the late Cicele Bostrom. Raised in Houston and Gonzales, Texas, she became President of Group Health of Puget Sound and a distinguished member of the Washington State Board of Medical Licensure. The flow of labor, capital, and culture between US states and our overseas trade partners that she epitomized is more progressive than the trickle-down of pork and patronage from state or national capitals.

Our so-called conservatives don’t know that and the so-called liberals have forgotten it.

It stands.

I'm still not quite ready to believe that Justice Roberts joined the liberal wing in the majority. I would not have ascribed a 1% chance of that happening.

Excerpts follow from the SCOTUS(live-)blog.

SCOTUS holds that mandate violates the Commerce Clause, but is constitutional under legislative branch's power to levy and collect taxes.

In his opening statement in dissent, Kennedy says: "In our view, the entire Act before us is invalid in its entirety."  

Amy Howe: 

In Plain English... The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.

I'll assemble various reactions later today.

Update: A fairly hilarious Twitter aggre-reaction. The first Tweet there is in response to CNN's initial webpage update, quickly pulled down, that said the ACA was rejected. And Republicans in Congress Tweeted that the law had been struck down, and then deleted them once they figured it out had it explained to them by a fifth-grader.

Update II: Lyle Denniston of SCOTUSblog:

Salvaging the idea that Congress did have the power to try to expand health care to virtually all Americans, the Supreme Court on Monday upheld the constitutionality of the crucial – and most controversial — feature of the Affordable Care Act. By a vote of 5-4, however, the Court did not sustain it as a command for Americans to buy insurance, but as a tax if they don’t. That is the way Chief Justice John G. Roberts, Jr., was willing to vote for it, and his view prevailed. The other Justices split 4-4, with four wanting to uphold it as a mandate, and four opposed to it in any form. 

Update III: Fox News' losing efforts to declare ACA unconstitutional. Their only recourse now is to impeach... Chief Justice Roberts.

Update IV: "(T)he ‘Scalia Freakout’ ended up being the big tell about this morning’s ruling."

Update V: Mitt Romney just had his reaction televised, and you would have thought his dog had died. Well, maybe his dressage horse. Then again, maybe his wife. OK, his political fortune. Seriously, I've seen more joy expressed in eulogies.

Harold Cook has a sly take:

So to review: the Supreme Court concluded that health care reform is constitutional, including the individual mandate (although SCOTUS apparently characterized it as a tax). The Republicans will try to spin the hell out of the "tax" part, even though it's only a tax for those Americans who fail to do what is required under Mitt Romney's health care plan.

The individual mandate only exists because it was the mechanism Republicans said they liked, and the mechanism their own Presidential nominee said is essential. Then the Republicans immediately decided that their own plan was terrible, evil, and unconstitutional, because it happens to be signature legislation of a President they hate, and Republicans sued to have it overturned.

So remind me again - what aspect of affordable health care to Americans can Republicans take credit for? Zero. Less than zero. They even fought like hell against their own funding mechanism to ensure its failure. Fortunately, they have apparently failed.

Those 14 original Republican Attorneys General who sued to overturn the plan? They'll spend the rest of the day complaining, and rename "Obamacare" to "the Obamacare Tax," all without presenting a new idea of how they would have made health care affordable.

Vast and Spurious

Before the Republicans' big bad day kicks off, let's all take note of the fact that the Bureau of ATF agents allegedly involved in a Mexican gunwalking conspiracy told Fortune magazine that it didn't happen.

Never happened.

This "Fast and Furious" bullshit that conservatives have been screaming about for a couple of years turns out to be a fairy tale. A myth. An urban legend.

But they never let the facts get in the way of a lynching before. Why start now?

Has Fox News mentioned anything about it yet? As the Most Interesting Man in the World has said: "I don't always watch comedy masquerading as a news broadcast, but when I do... it's on Fox."

Just thought I'd help get this development out there before the political world explodes in a few hours over health care.

As we wait for tomorrow's decision on health care...

Here's a little light reading.

HOUSTON – Last year, Luis Duran drove almost 200 miles to San Antonio to have a colonoscopy because he didn't want to wait six months for an opening at a county clinic.

A few days later, the doctor in San Antonio – a friend of a friend who had performed the screening for free – called to break the news that Duran, 51, had advanced colon cancer and needed immediate surgery.

"I kind of broke down," recalled Duran, a machine operator whose employer had terminated his health policy.  "I said, 'Doctor, I don't have insurance, and I don't have much money, but I won't refuse to pay. Please help me.'"

They say everything is bigger in Texas, and the problem of the uninsured is no exception. The Houston metropolitan area has one of the highest rates of uninsured people in America, and a health safety net imploding under the demands of too many people and too few resources.  Almost one in three residents – more than a million people -- lack health insurance, and about 400 are turned away every day from the county hospital district's call center because they can't be accommodated at any of its 23 community or school-based centers.

Those seeking care at the public hospital's ER, meanwhile, arrive with blankets and coolers full of sandwiches and drinks in anticipation of waits that may go 24 hours or longer.

"If the Affordable Care Act is overturned, the rest of the country should take a good look at the situation in Texas, because this is what happens when you keep Medicaid enrollment as low as possible and don't undertake insurance reforms," said Elena M. Marks, a health policy scholar at Rice University's James Baker Institute for Public Policy and a former city health official.

No, they are NOT all Ill Eagles.

With its fiscally conservative philosophy and cash-strapped state budget, Texas does not offer Medicaid coverage to childless adults unless they are pregnant, disabled or elderly. Parents of children covered by welfare are eligible for the state-federal health program only if they make no more than $188 a month for a family of three.

At the same time, the proportion of Texas workers with employer-sponsored insurance is almost 10 percentage points lower than the national average of 61 percent, in part because of the state’s high concentration of jobs in the agricultural and service sectors, which often lack benefits.

"They're hourly wage earners, nannies, [people] working in lawn care services or dry cleaning or real estate, or people working two part-time jobs and neither will pay for health care," he said. "Many are small business owners who are well-educated and well-dressed."

Any Republicans you know think this is a problem? And if they do, can any of them acknowledge that something needs to be done about the problem without blaming undocumented people for the problem?

Update: "We need to accept the principle that sometimes the poor will die just because they are poor."

Grady wants a border wall; Sadler parts company with platform

Oh, the joy of conservatism in the Texas Democratic Party.

Two underfunded US Senate candidates battling for the Democratic Party's nomination squared off Tuesday in hopes of escaping the shadows of their GOP opponents and capturing a statewide victory for the first time since 1994.

A brief pause before continuing: in this post-Citizens United environment, with all of the public support for reversing the flow of money into our politics, does it disillusion anyone else that "underfunded" is still written about in the corporate media as a bad thing?

Former state Rep. Paul Sad­ler and retired educator Grady Yarbrough, who said they have spent a combined $165,000 campaigning, agreed on many of the issues including same-sex marriage, Social Security benefits and foreign policy. They split on border security and decriminalizing marijuana.

Yes. They. Did. And not just with each other, but with the majority of Texas Democrats (and possibly the entire nation).

Both applauded the court's decision to repeal parts of Arizona's immigration law. Each also said the court should have struck down the entire bill, including the provision that requires residents to provide citizenship papers to police when questioned.

The candidates differed on border security, though they agreed it is a top priority for Texans. Yarbrough said the state and federal administration should assist the Mexican government in mitigating the violence on the border. He said the United States should use "whatever method is at our disposal" to secure the border including, "I hate to refer to this, but the Berlin Wall was pretty effective."

Yes it was, Grady. At keeping people in, for a few decades at least, as long as the East German guards were crack shots with a rifle. With this remark, Yarbrough places himself to the RIGHT of Rick Perry when it comes to immigration.

Let's see how many Republican votes that gets him. Please turn on your sarcasmeter, adjust the setting to 'high', and re-read yesterday's endorsement of Yarbrough. I still mean it as much today as I did yesterday.

The candidates were divided on an issue that appears on the state Democratic Party's platform, decriminalizing and regulating marijuana.

Yarbrough supports the notion, citing medicinal use and discrimination to low-income citizens.

"There are things in everybody's platform they wish weren't there, and this is one of them," said Sadler. "The people of this country are not ready for that."

That statement is laughably and abjectly false, Mr. Sadler. And we don't have time to stand around and wait while you catch up on your reading, either. You also apparently missed my post last month on the Libertarians, who have nominated a pro-pot judge from California as vice-president.

Say whatever else you like about these two men, the truth is that neither Sadler nor Yarbrough can be mistaken for 'liberal'.

If either managed to find himself in the Capitol's upper chamber next January being sworn in, the one thing you could count on is that the spirits of Joe Lieberman and Ben Nelson would be alive and well despite their physical absence. Joe Manchin ain't got nothin' on them.

I will remind Texas progressives -- those that haven't already given up on voting altogether -- that they will have an excellent option on November's ballot. Sending a message to the TDP by voting Green in this race tells the party that they can no longer take your vote for granted.

It's the only way things will ever begin to change in Texas for the better.

Update: TexTrib has more and video of the debate.

Texas Democratic Senate candidates debate today

You can't watch it live, however.

If the debate between two Democrats battling for a U.S. Senate nomination debate is not broadcast live, does it make a sound?

You can follow the live-blog here.

KERA will host a second U.S. Senate debate between the Democrats who finished first and second in the May primary. Former state representative Paul Sadler and retired educator Grady Yarbrough will tape a one-hour television debate that will be broadcast on KERA Channel 13 on Wednesday, June 27 at 7 p.m. and in other Texas markets at various times.

Here are some of those other markets and times. Houston gets it on Friday evening on PBS.

Folks, I think I have to vote for Grady in the runoff.

He's from humble origins and has a great story about hitchhiking to college each day from his parents' East Texas farm. He taught in public schools for about 50 years.

He lives the simple life of a man happy with a one-bedroom apartment on the third floor of a nondescript, no-elevators San Antonio complex. Every two weeks or so, he fires up his 1985 pickup and drives back to East Texas to tend to his small herd of cattle.

He's friendly, the great-grandson of slaves, beholden to nobody, optimistic and informed on the issues of the day.

For Texas Democrats long aching for a statewide win, Grady Yarbrough sounds like just what the doctor ordered. And he might be, if he wasn't the headache they fear they could wake up with the morning after their July 31 U.S. Senate runoff.

Beyond the sheer hilarity of the utter futility of it, Yarbrough has populist history on his side (and I'm not talking about his non-existent familial association with Ralph, either).

He's always run shoestring campaigns, depending, perhaps, on a name that could remind some folks of U.S. Sen. Ralph Yarborough, who served from 1957 to 1970. Yarbrough rejects the Yarborough theory.

"If my name resembles someone who may have served in the United States Senate some 35-40 years ago, living or dead, it's purely coincidental," he said, insisting any name recognition he enjoys stems from his three previous statewide races.

And if Yarbrough has benefited from the name game, there's evidence he's also suffered from it. He lost the 1986 GOP land commissioner runoff to M.D. Anderson Jr., who had nothing to do with the renowned cancer hospital. (For the record, Paul Sadler has nothing to do with Jerry Sadler, who held a variety of offices from 1938 through 1970. And I'm not former Glendora, Calif., Mayor Ken Herman.) FYI, Yarbrough ran in 1994 as Grady Yarborough. His mistake, he says.

But seriously... didn't some fellow do this once before?

The Dems' 1996 nominee was Victor Morales, an East Texas teacher who drove a white pickup truck (a 1992 Nissan that was Bentleyesque compared to Yarbrough's Chevy) to a surprising primary win over two incumbent U.S. House members. Morales lost to GOP Sen. Phil Gramm.

A real Mr. Smith Goes to Washington; an actual citizen populist. Name recognition-surfing and prior Republican branding aside -- or maybe together -- this is the perfect, tried-and-true candidate for Texas Democrats. He's got my full support (but only for the runoff).

And if he wins, just think of all the thousands of dollars Texas Democrats can save by not donating to his campaign. Why, that will leave them more to send to President Obama -- who, in keeping with tradition himself, won't spend any of it in Texas -- or to one of those tightly contested Senate races in places like Massachusetts.

Grady Yarbrough for US Senate. It's proud Texas Democratic tradition, for Jeebus' sake.

The First Weekly One Hundred Degree Wrangle (of 2012)

The Texas Progressive Alliance is in search of a shady spot and a cold beverage as it brings you this week's roundup.

Off the Kuff analyzes the Democratic DA primary and the race for HCDP Chair in Harris County.

WCNews at Eye on Williamson posts about striking janitors in Houston and tax payer give-aways to corporations: Texas is a cheap labor state, and it shows.

PDiddie at Brains and Eggs wonders out loud if the new chair of the Texas Democratic Party might have some explaining to do about the goings-on in Cameron County.

CouldBeTrue of South Texas Chisme wants everyone to know that tort reform didn't lower health care costs.

At TexasKaos, Libby Shaw writes about what is obvious to everyone with half a brain. Sadly, it still has to be said: Voters voted for Jobs in 2010. The GOP Delivered Witchhunts.

Neil at Texas Liberal offered thoughts on the death of Rodney King.