Month: January 2017

Let me preface this by saying that I attended the Women’s March in NYC. I won’t say I marched–I stood in a crowd for three hours. All those people you saw on TV who actually marched devoted 8 – 12 hours of their Saturday if not more just to be able to move through the clogged streets. They were committed. Here I want to offer some perspective: David Brook’s column offers a wake up call for those of us who hope that the Women’s Marches will change our political situation. In short: though our bubble felt a lot bigger on Saturday, we are still inside of it. A few points:

1/5: Do not over interpret the crowd sizes (i.e. we must to spread impact outside of the cities). The fact that many hundreds of thousands of people showed up for a march against Trump in major cities should not be all that surprising. While it is true that Trump only just barely won the election (by 77,000 votes in three key electoral college states) he was still the preferred candidate in 84% of the nations 3,144 counties. Hillary only won 487 counties, compared to Obama’s 689 in 2012. Yes she got more total votes, but the votes she needed and did not get were outside of the big cities. A lot of people didn’t know that these marches were even happening last weekend. If people are going to travel an hour or more to attend one of these, maybe next time they should attend events in small to medium sized towns outside of the reach of a metro line. (By the way, it is also not surprising that Obama’s inauguration was larger than Trump’s considering that it was held in a city Obama won by 92% and Trump only got 4%.)

2/5: Look inside yourself and be sure that you can articulate your own sense of patriotism. If you can’t, then when you march you are just venting your own negative emotions. Stay home. We don’t need you. Yes, Im talking to you, my fellow Iowa City resident flag burner.

3/5: Take off the ‘pussy‘ hats. It is perfectly understandable and fitting that the first Trump protest is a spectral image of the first woman president Inauguration we all thought we would be attending. But if this movement is to grow, we will need a symbol that even Trump voters can get behind: the 42% of women (53% of white women), the 29% of Latino voters, and for that matter the 53% of male voters who all supported Trump. This symbol needs to be general–rooted in a larger national theme, not narrow identity. It should be catchy and a little silly. The tea bag is already taken, but it’s a good model. After all, within a couple years of its introduction, there were over 60 new members of congress who were legislating as members of the Tea Party.

4/5: The political activism of the Women’s Marches should begin to direct its energies toward a specific political party, probably the Democrats. As Brooks wrote in his advice to/critique of the marchers: “Sometimes social change happens through grass-roots movements — the civil rights movement. But most of the time change happens through political parties: The New Deal, the Great Society, the Reagan Revolution. Change happens when people run for office, amass coalitions of interest groups, engage in the messy practice of politics.” Maybe my political imagination needs expanded, but I just can’t think of another model for what we need than the Tea Party: A grassroots movement (which became heavily funded by the donor class) that galvanized opposition to a sitting president and his party’s control of congress. They were not agnostic about political party. They were GOP all the way, unless they were threatening to supplant the GOP with a new conservative party. This was so effective that even today, the Tea Party Caucus will likely be the deciding factor in how much Trump gets through congress. If anti-Trump activism doesn’t get new people elected to Congress in 2018 it will all have been for not.

Final Thought on the Women’s March: What is the cause all about? Were we all just venting our frustration and fear? Is there a political objective we can rally the country around? What will be the message? It’s not clear to me. And after reading the organization’s Unity Principles I’m more doubtful that the politics behind the Women’s March will gain traction or grow a movement. If you read the list you will see a greatest hits of the Hillary Clinton campaign themes, which just lost a national presidential and congressional election. Fresh thinking may be in order.

This week, the Republican talking point is that Obamacare will collapse all on its own because it is not sustainable. Therefore it must be repealed. A second argument you are beginning to hear is that Obamacare is such a disaster that the aftershock of repealing it (market chaos, premium spikes for everyone) will be the fault of the law itself–and Democrats–not the fault of the repeal…. Hmm.

For now, let’s take them at their word that they actually want to replace the law so to mitigate the disruption of repealing it. If they really mean that, then we all need to be fully aware of the positive things the law actually accomplishes so we can measure whether GOP “repeal and replace” is worth the trouble. (The other option of simply fixing the current law appears to be off the table for now.)

Some facts to keep in mind during the debate:

• 10.2% of Americans have insurance through Obamacare–over 20 Million people
• Historic low number of uninsured: Only 10.9% of Americans are uninsured, down from 17.1% in 2013.
• Only 5% of children are now uninsured, and the percent of Poor/Near Poor and Hispanic uninsured have both been cut in half since Obamacare went into effect. (See the graphs on this CDC report.) If Republicans want to repeal Obamacare, are they willing to put a program in place that will cover this amount of people? Or will they say it is not worth the cost?
• Rate Increases: rate increases are coming for some people who get insurance through the Obamcare marketplace, but only 3% of Americans who receive unsubsidized insurance will be affected (see the chart further down in this link). If the main evidence of Obamacare’s imminent collapse is rate increases, how can hikes that only affect 3% of the country be considered a collapse?
• Maybe you’ve heard Republicans blame ALL recent employer-based insurence rate hikes on Obamacare–as if insurance rates never increased before the law went into effect. Yes, rates are expected to go up over 6% this year, which is high but not as high as it was in the 90s and 2000s with double-digit increases. According to one survey, post-Obamacare increases have been 3.1% compared to 5.6% in the 10 years before the law. Repealing Obamacare will not stop insurance rates from rising, and doing so may make rates rise faster and higher.
• 80% satisfaction rate of Obamacare recipients. Republicans seem to want to save people from a terrible service that users overwhelmingly approve of.

• There were 300,000 sign ups for Obamacare in the week after Trump’s election, which is tens of thousands more people than in the same period last year. The enrollment period will continue until 11 days after Trump’s Inauguration. Many people are flocking to a program that Republicans argue nobody wants.
• Bending the Cost Curve: Healthcare costs are rising much less steeply than they were before Obamacare:
• 
• Phasing out Fee-for-Serivce Care: Other than providing near-universal coverage, the other main goal of Obamacare was to replace the fee-for-service economic model with value-based care that incentivizes medical decisions that produce greater health over greater cost. The idea is to heal people in a way that requires fewer hospital visits, fewer tests and treatments, by being proactive, intentional and coordinated. The law created a two bodies–the Center for Medicaid and Medicare Innovation, and the Accountable Care Organization–that empower hospitals and doctor’s networks to develop local solutions. Basically people in the health care industry propose a value-based care program, get it funded, and test the results. For example in Dayton, simply by setting up a phone bank panel of nurses to answer phones calls from certain types of patients who called the hospital they were able to prevent 500 ER visits in 2016. Another Obamacare-funded program that was able to avoid 3,000 ER visits and 1,800 hospital admissions per year. Read about these here.                                                                                               More than a third of Medicare payments to providers are now are for value instead of volume. The entire industry is in the middle of a transition to a cheaper and healthier business model. Any reform of Obamacare should keep this momentum going, not reverse it.