In the Land of Perpetual Outrage

Outrage is tiresome – but if you think that, you’re probably one of those east-coast intellectual types with your fancy-pants degrees and a Volvo in the driveway too. You didn’t vote for Sarah Palin back in 2008, hoping that the sometimes puzzlingly moderate John McCain would be gone soon enough, nor are you a member of the perpetually outraged Tea Party now. That Mitt Romney and Paul Ryan, the last time around, didn’t scream that this or that was absolutely outrageous, and had to stop right now, didn’t bother you at all, even if their lack of appropriate hourly outrage drove the Republican base crazy. You just find outrage tiresome.

Benghazi! No thank you. You’re probably more aligned with the British – Keep Calm and Carry On – or the world-weary French, who since the existentialists in the fifties have found outrage sadly and maybe tragically absurd. What’s the point? Or maybe you’re Czech and find outrage comic, as in the novels of Milan Kundera, or darkly comic as in Kafka. Or maybe you’re a bit of a Canadian – you see what’s going on, and dutifully note what each side is saying, to be polite about it, and then go on with your own life, simply enjoying it.

However you look at it, you’re not very American. America is an outrage machine, fueled by Fox News and, on the radio everywhere, by Rush Limbaugh. It’s somehow always the end of the world as we know it, and No-Drama Obama is the real problem. He may be a clever Anti-Colonialist Muslim Socialist, born somewhere overseas that most of us couldn’t locate on a map – and he may have “wormed his way into American power, using his smarmy wiles to charm and trick ‘kind-hearted’ but gullible Americans into electing him their president” and all the rest. What can be more evil than that? His calm is just as galling. Outrage should be met with outrage. It’s just not fair when it isn’t. It’s un-American.

Outrage, then, might be the most American of traits, or our defining trait, but there’s a problem when there’s just not enough stuff to be outraged about. All fires need fuel. Back in the sixties, the Vietnam War provided that fuel – the left was outraged, then after the Pentagon Papers were published, the center was too, although the shift started when Walter Cronkite stepped out of his usual role one memorable evening and told his national audience that this particular war was pointless. The mounting outrage finally ended that war, and a few years later Watergate provided a lot of fuel for outrage, even if that whole business took more than a year to unfold. It would do, and Nixon was soon gone, but Bill Clinton’s dalliance with young Monica just wouldn’t do. Clinton was impeached over that, and cleared, after the nation had decided that Bill Clinton being a jerk wasn’t the same as his being outrageously evil. There was no outrage, just incredibly bad judgment mixed with quite ordinary middle-aged-male horniness, and a young willing partner.

Republicans paid a price for that impeachment. No one would ever take their outrage seriously again, or as seriously as they took whatever high crimes and misdemeanors they saw everywhere. And Hillary Clinton didn’t murder Vince foster with her bare hands either. And now, in the age of No-Drama Obama, everything we’re told is outrageous turns out to be nothing much. The Fast and Furious gun-running scandal, an entrapment program designed to catch those who were arming all the nasty drug lords from the Rio Grande south to Tierra del Fuego, started under the Bush administration, actually worked pretty well. We hadn’t provided arms used to kill our own agents. The IRS scandal, where the IRS was targeting Tea Party organizations so they couldn’t get tax exempt status, wasn’t what it seemed – they were targeting organizations on the left too, and it was all done by rather confused low-level bureaucrats, badly too. Benghazi seems to have been a tragedy caused by a turf war between the CIA and the Department of State, over who was providing security that night. Obama never said let our ambassador and those three others die, because he wanted al-Qaeda to take over the world – it was just an organizational screw-up, and such things can be fixed.

As for Obamacare, filter out all the sanctimonious self-pity and the angry shouting, and the waving of Confederate flags and tea bags, and you’re left with something quite innocuous – a way for thirty or forty million more Americans to have the opportunity to purchase low-cost subsidized health insurance, from private for-profit third party underwriters, which is hardly the end of the world as we know it. There’s no public option, some Medicare-for-all scheme. It’s not a single-payer scheme either, and it’s hardly socialized medicine. The big boys will make big bucks and live even larger – so all that was once good and right about America will be safe, if funneling everything to the private sector, where private profit somehow equals public good, is what’s good and right about America. Obama actually gave up on everything the progressives wanted. It was the only way he could get anything at all passed, and even then not one Republican voted for the Affordable Care Act, after he had given them what they had insisted they wanted. In fact, he gave them Romney’s Massachusetts plan, with the “individual mandate” that the Heritage Foundation had thought up years before, so there’d be no freeloaders playing games with the system. The Heritage Foundation hates Takers after all.

What did Obama get for that? He got mild disappointment on the left and furious outrage on the right, outrage that made little sense. There were no death panels, just millions of new customers for the private sector guys, and the government was even guaranteeing their premiums. It was a sweet deal. The only thing was that the Affordable Care Act set minimum standards for all health insurance policies – they had to be offered to all, even those with preexisting conditions, without yearly or lifetime caps, with reasonable deductibles and co-pays, and they had to cover the basics – routine doctor visits and hospitalization and x-rays and lab work and all the rest, including family planning, which includes birth control. There’d be no more policies that covered the first three dollars of your problem and the rest was up to you, or policies that paid twenty percent of your costs only after your first hundred thousand out-of-pocket dollars. There’d be no more crap-policies you could buy for ten bucks a month, which covered nothing much at all. The government was going to subsidize healthcare policies, but it wasn’t going to subsidized nonsense, nonsense that hurt people. There’d be standards.

The first outrage was all about those standards regarding family planning, which of course included birth control. If all healthcare policies, nationwide, had to cover that, then that would mean someone whose religious beliefs included the belief that birth control is evil, would be in the position of being forced to provide his employees something that was purely evil, something that God forbids, that’s somewhere in the Bible, if you look hard enough. You can’t force people to do what they consider immoral and evil and the same as murder or whatever. You cannot force anyone to violate their religious beliefs. We do have religious freedom in America, or so the argument went, which is still festering. Of course some have the religious belief that all of medicine is an affront to God, tantamount to saying that you don’t trust Him, and anything and everything can be cured by prayer. Do you force such people to offer their employees healthcare policies where their employees actually go to actual doctors? What about the religious freedom of those employers, and what about employers who believe laughter is the best medicine?

There’s a lot to work out here, much of it rather stupid, but everyone should have seen the outrage of the day coming a mile away, because it was structural:

Before the Affordable Care Act became law in 2010, President Obama promised Americans they could keep their healthcare plan if they liked it. But already hundreds of thousands of citizens are receiving notification that their plans are being cancelled because they don’t comply with the new law, and, according to NBC News, the Obama administration has known for at least three years the cancellations were coming.

While campaigning for health care reform in 2009, Obama went out of his way to make one thing perfectly clear: if you like your current health care plan, you will be able to keep it.

On June 15, 2009, Obama said this: “We will keep this promise to the American people. If you like your doctor, you will be able to keep your doctor. Period. If you like your healthcare plan, you will be able to keep your healthcare plan. Period.”

In 2012, he echoed that sentiment, saying, “If [you] already have health insurance, you will keep your health insurance.”

However, many are finding that not to be the case. More than 300,000 cancellation notices have been sent out in Florida, according to Kaiser Health News, and another 180,000 in California. In New Jersey, the number of cancellations tops 800,000, the Star-Ledger reports.

He lied! He lied! He lied! That’s the outrage:

Steven Hayward – Obama Lied, My Health Care Died

Moe Lane – Up to 10.5 million on track to have Barack Obama / Democratic Party Take Away Their Health Insurance

Noel Sheppard – White House Has Known For At Least 3 Years Millions Would Lose Coverage Due to ObamaCare

Jim Hoft – Obama Administration Knew MILLIONS Would Not Keep Their Health Insurance

Matt Vespa – Obama Administration Knew Millions Would Lose Healthcare Coverage

Noah Rothman – CBS News Features Distraught Woman Paying 10 Times More for Insurance Due to Obamacare

Allison Coyle – Florida woman’s insurance rate increases 1,000 percent under Obamacare

There are hundreds of such items, but for an obvious reason:

According to NBC News, approximately 50 to 75 percent of the 14 million Americans who buy their health insurance individually should expect to receive a cancellation letter over the next year “because their existing policies don’t meet the standards mandated by the new health care law.”

This could result in millions of Americans being forced to purchase different policies, potentially at higher premiums.

Yep, they’d have to buy real insurance, insurance that actually covers things. Food used to be cheaper too, before there were standards about worms, and fecal matter, salmonella, and all the rest. We lost the freedom to buy the cheap stuff there, and we’re losing it here too, and the administration is on the defensive:

Monday, former Obama adviser David Axelrod said on MSNBC’s Morning Joe that “most people are going to keep their own plan.” When asked about Axelrod’s admission of “most” as opposed to all, White House spokesman Jay Carney acknowledge that some individual’s plans will be cancelled, but countered that the plans they switch to will be better and affordable.

“What the president said and what everybody said all along is that there are going to be changes brought about by the Affordable Care Act to create minimum standards of coverage,” Carney said. “… So it’s true that there are existing health-care plans on the individual market that don’t meet those minimum standards and therefore do not qualify for the Affordable Care Act.”

Actually, what the President said back in 2009 was “[the Affordable Care Act] is for people who aren’t happy with their current plan. If you like what you’re getting, keep it. Nobody is forcing you to shift.”

Maybe he shouldn’t have said that. Maybe he should have said something different. You know how you can’t buy rotten meat full of maggots, because we have the FDA, which you think is a good thing? It’s like that.

The New York Times’ Ross Douthat suggests that the whole success of Obamacare may depend on how well it’s accepted by young, middle-income families who face these premium increases because the law bans laughable insurance policies with huge copays and almost no coverage – “The politics of the rollout will probably be defined by how (and how vocally) middle-class Americans just above the subsidy threshold react to this ‘pay more, get more, subsidize other people’ deal.”

Maybe so, but Kevin Drum suggests that’s not many people:

This probably doesn’t describe a huge demographic – people who are just barely above the subsidy threshold and currently have individual coverage and are young enough to see premium increases – but there’s no question they exist.

Drum cites the Los Angeles Times with an example of this:

Pam Kehaly, president of Anthem Blue Cross in California, said she received a recent letter from a young woman complaining about a 50% rate hike related to the healthcare law. “She said, ‘I was all for Obamacare until I found out I was paying for it,’” Kehaly said.

Drum is not impressed:

That’s America in a nutshell, isn’t it? I suppose it’s every other country in a nutshell, too. Still, it’s not clear how many people are genuinely going to get hit by sticker shock. In most of the stories I’ve read, including this one, people are simply taking the word of their insurance company about how much a new policy will cost. They may find out that things are better once they actually shop around and check out the subsidies they qualify for. Others may find that the higher premiums pay for themselves in lower out-of-pocket expenses throughout the year. And even for those who have done their homework, the new policies might turn out to be a good deal.

After all, the Times article also offers this:

Fullerton resident Jennifer Harris thought she had a great deal, paying $98 a month for an individual plan through Health Net Inc. She got a rude surprise this month when the company said it would cancel her policy at the end of this year. Her current plan does not conform with the new federal rules, which require more generous levels of coverage.

Now Harris, a self-employed lawyer, must shop for replacement insurance. The cheapest plan she has found will cost her $238 a month. She and her husband don’t qualify for federal premium subsidies because they earn too much money, about $80,000 a year combined.

“It doesn’t seem right to make the middle class pay so much more in order to give health insurance to everybody else,” said Harris, who is three months pregnant. “This increase is simply not affordable.”

Drum:

I don’t know for sure how this plays out in the real world, but I’d be shocked if Harris’s $98 plan covers expenses related to pregnancy. If it does, the out-of-pocket max is probably astronomical. A bronze plan under Obamacare is still no picnic, but I’m willing to bet it covers a whole lot more of Harris’s maternity expenses than her current plan. In other words, there’s a pretty good chance that she’ll make up for her extra annual expense of $1,700 by sometime around, oh, April or so.

This is what makes it so hard to predict how all this is going to play out. Right now, even in places like California that have working exchange sites, a lot of people are still guessing about how Obamacare will actually affect them. There’s no question that some people will end up paying more, but that number could end up being a lot smaller than we think at the moment. Better benefits and federal subsidies are going to have a big impact, and that impact probably won’t be clear until Obamacare has actually been up and running for a while.

Plus, of course, there will be the millions of people that Obamacare just flat-out helps.

Yes, but what about the people who want to buy rotten meat full of maggots, if that’s what they want to do with the money they have, and what about those who want to sell them rotten meat full of maggots, to make good money and support their families? That’s how capitalism is supposed to work. It’s all about freedom.

That lapsed Republican over at Business Insider, Josh Barro, has a different take on this, arguing that rate shock is actually essential to healthcare reform:

Before Obamacare, our health insurance system was already a thicket of subsidies and transfers. The law doesn’t simplify the system, but it does make the thicket of subsidies and transfers more sensible: directed more at people who have low incomes or high health needs, and greatly shrinking the share of the population that doesn’t have health coverage at all.

Making the thicket more sensible will mean that some people’s costs go up, producing “rate shock.”

The healthcare market never was free in the first place:

Take a look, for example, at Sen. Ted Cruz (R-Texas). Cruz has frequently noted that he declines the health plan that is offered to him as a member of Congress. Instead, he is covered through insurance that his wife gets as a Managing Director at Goldman Sachs.

Health care economist Austin Frakt ran the numbers on that Goldman plan. As of 2009, Goldman’s health insurance coverage for employees at the managing director level and higher cost a stunning $40,000 per family. (The typical cost for a family health insurance plan in the United States is around $16,000).

Health insurance benefits are not taxable income, so Cruz and his wife get a big tax break on that plan. The break cut their tax bill by about $15,000 as of 2009, the last year for which we know the plan’s value. The Cruzes aren’t alone; every American who gets health insurance coverage through work gets this tax break, but the Cruzes enjoy an especially large one because their plan is so expensive and their tax rate is high.

For comparison, Medicaid coverage for two adults and two children cost about $11,000 in 2010, meaning (unless Goldman has radically changed its health benefits since 2009) Cruz is getting a tax break worth more than the benefits a family on Medicaid gets — even though he is a Senator and his wife is a highly paid investment banker and they have no need for subsidies to obtain health coverage.

This is insane health policy, and the Affordable Care Act changes it.

Ted Cruz was having a fine time working the system, so Barro is fine with what’s happening with Obamacare:

It’s a lot cheaper to provide health insurance coverage if you exclude a lot of the people who need it most. Making insurance available to people with pre-existing health conditions costs money. Obamacare funds this transfer to the chronically ill in part by raising premiums on healthy people.

There are other ways this transfer could have been funded. For example, we could have a single-payer health care system. That would provide disproportionate benefit to people with chronic illness, and it would be funded with some sort of broad-based taxation, almost certainly meaning people with higher incomes would pay the lion’s share of the cost.

I don’t think conservatives would like that solution, or other solutions that have the government directly take on the cost of insuring the chronically ill. Republicans in the House of Representatives have shown no enthusiasm for high-risk pool plans, sometimes touted by conservative health wonks, which would use government subsidies to provide care to people with expensive chronic conditions who get left behind by current insurance markets.

In the absence of a direct-subsidy approach, Obamacare’s cross-subsidy approach is a pretty good way to get care to people who need it.

In short, this will have to do for now, because the Republicans have nothing else for America:

The new system of subsidies and cross-subsidies that Obamacare sets up is far from perfect. But perfect is not on the table. The question is “is it better than the old system, where huge subsidies go to people with no need for them and tens of millions are left uninsured?” That answer, if you consider the costs and benefits honestly, is yes.

But conservatives don’t do that.

For the last few weeks, I have seen a vast outpouring of conservative sympathy for young, healthy, prosperous people whose health plan premiums are going up. These poor, poor things! How could Barack Obama do this to them?

But what about the tens of millions of Americans who currently lack health insurance and are about to get access to available, affordable coverage? Where is the conservative sympathy for people who would be worse off if the law doesn’t go forward?

Nowhere – because for all the needless complexity of liberals’ approach to improving health insurance and helping the sick, conservatives don’t have one at all.

Hey, they need their outrage, even if it doesn’t make a lick of sense, and that’s odd. After their disastrous convention in Chicago in 1968 and after McGovern got trounced in 1972, Democrats decided that perpetual outrage was self-limiting. After the Republicans impeached Bill Clinton in late 1998, and failed at that, they decided perpetual outrage was pretty nifty, which might explain this year’s government shutdown. They say they’re the Real Americans, and it may be that to be an American is to be outraged – but then we did elect No-Drama Obama twice. They could be wrong about that. Keep calm and carry on.

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About Alan

The editor is a former systems manager for a large California-based HMO, and a former senior systems manager for Northrop, Hughes-Raytheon, Computer Sciences Corporation, Perot Systems and other such organizations. One position was managing the financial and payroll systems for a large hospital chain. And somewhere in there was a two-year stint in Canada running the systems shop at a General Motors locomotive factory - in London, Ontario. That explains Canadian matters scattered through these pages. Otherwise, think large-scale HR, payroll, financial and manufacturing systems. A résumé is available if you wish. The editor has a graduate degree in Eighteenth-Century British Literature from Duke University where he was a National Woodrow Wilson Fellow, and taught English and music in upstate New York in the seventies, and then in the early eighties moved to California and left teaching. The editor currently resides in Hollywood California, a block north of the Sunset Strip.
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