The larger story is that the Medicaid expansion is emerging as an early Obamacare success — a rare area where the law may already be putting Republicans on the defensive. A new report from the Centers for Medicare and Medicaid Services finds that over 1.4 million people in October were deemed eligible to enroll in Medicaid or CHIP. There was a far larger jump in applications where states are expanding Medicaid than where they aren’t — another sign Obamacare may benefit far more people in states where GOP governors are not trying to block the expansion.
Last week, Alex MacGillis argued that the politics surrounding the Medicaid expansion are shifting:
Governors and legislators rejecting the expansion have been warned over and over that they are leaving hundreds of millions in federal dollars on the table. But now other numbers are coming to bear as well – states are rejecting expansion are actually being [fiscally impacted] twice, because they are not only leaving that money on the table but also bracing for big cuts in federal funding for hospitals that see an unusually high share of uninsured patients. The law calls for cuts in that funding since the whole idea was that fewer patients would now be uninsured. Already, at least five hospitals have closed in states where Medicaid wasn’t expanded. This gives even more ammunition to the health care industry lobbyists in states urging lawmakers to come around on expansion. Meanwhile, it’s becoming more evident just how much expansion-accepting states are benefiting at the expense of taxpayers in expansion-rejecting ones, a fact that politicians in the the latter states, including some Republicans, are sure to latch onto sooner or later.
Drawing upon Rumsfeld’s memoir, Bradley Graham’s Rumsfeld biography, and The Unknown Known (which director Errol Morris discusses above), Mark Danner tries to get inside the mind of the former defense secretary:
Having watched from the Oval Office in 1975 the last torturous hours of the United States extracting itself from Vietnam—the helicopters fleeing the roof of the US embassy in Saigon—Rumsfeld would be condemned to thrash about in his self-made quagmire for almost four years, sinking ever deeper in the muck as nearly five thousand Americans and hundreds of thousands of Iraqis died. He was smart, brash, ambitious, experienced, skeptical of received wisdom, jealous of civilian control, self-searching, analytical, domineering, and he aimed at nothing less than to transform the American military. The parallels with McNamara are stunning.
And month after month in his arrogance and tenacity he would deny an insurgency had taken root. Month after month, as the shortcomings of the army he had sent into Iraq—too small, too conventional, not configured or equipped or trained to fight an insurgency and thus fated in its impotent bludgeoning to make it ever worse—became impossible to deny, he would go on denying them, digging in his heels and resisting the change he had to know was necessary. And even as it became undeniable that Rumsfeld’s war, far from deterring or dissuading prospective terrorists, increasingly inspired and fostered them—that the image of strength and dominance he sought had become one of bumbling and cruelty and weakness—the power of his personality and of his influence over the president meant that for month after month, year after year, he was able to impose his will—and define the world we still see around us.
I think it’s worth comparing – even though the differences are as stark as the similarities – the response to failure in Iraq in Bush’s second term with the response to the failure of healthcare.gov in Obama’s. Bush and Rumsfeld and Cheney simply refused to acknowledge any failure at all. They were incapable of it. But more important, their fellow Republicans absolutely refused to break ranks or air criticism. The neocons knew their central project had collapsed in the sands of Mesopotamia and in the tortured gulag of black sites around the world, but they sure as hell weren’t going to rock the boat before the mid-terms. Bush was famously asked to name a failure of his in his first term in the 2004 debates – and couldn’t. In his second Inaugural, instead of reflecting on the catastrophe in front of everyone’s eyes, he upped the ante to the goal of using force of arms to wipe all tyranny off the face of the earth!
Now compare Obama, who swiftly copped to a massive error, allowed himself to be knocked about like a punching bag at a press conference, squarely explained why in his mind he had not actively deceived Americans about not losing their plans, and pivoted to fixing the error.
The Democrats, far from remaining in lockstep unity, are all over the map, as they so often are. Their instant panic is almost as bad as the Republicans’ denialism. But only almost. Because of their skittishness and his own integrity, Obama is capable of acknowledging reality and adjusting to it in ways Bush never was. He has not publicly told Kathleen Sebelius that she is doing a heckuva job. He hasn’t actually joked about people losing their insurance, as Bush once did about not finding weapons of mass destruction, at the White House Correspondents’ Dinner.
Rumsfeld was both completely divorced from reality, while also constantly affirming that he, and he alone, was in close contact with it. That proved to be a particularly damaging – and arguably sociopathic – combination for this country and the world. Obama is very different. We wanted a president who could admit error, take responsibility and adjust. We got one. Even though so many have now forgotten what a rare and precious thing that is.
Obamacare enrollment numbers are picking up. But it remains unclear what percentage of enrollments are being transmitted correctly to insurance companies:
Bob Shlora of Alpharetta, Ga., was supposed to be a belated Obamacare success story. After weeks of trying, the 61-year-old told ABC News he fully enrolled in a new health insurance plan through the federal marketplace over the weekend, and received a Humana policy ID number to prove it. But two days later, his insurer has no record of the transaction, Shlora said, even though his account on the government website indicates that he has a plan.
The enrollment records for a significant portion of the Americans who have chosen health plans through the online federal insurance marketplace contain errors — generated by the computer system — that mean they might not get the coverage they’re expecting next month. The errors cumulatively have affected roughly one-third of the people who have signed up for health plans since Oct. 1, according to two government and health-care industry officials. The White House disputed the figure but declined to provide its own.
Sarah Kliff has been unable to get much information about these errors from the administration:
We don’t know how many inaccurate 834 transmissions went out. Three reporters — one from the Los Angeles Times, one from The Wall Street Journal and I — asked Bataille for information on how many of the 834s sent out so far have had an error. This is a question that I’ve asked on three previous calls, a point made by the Los Angeles Times’s Noam Levey as he asked for his second time.
This is where Monday’s media call started to get more tense than the dozens that have happened in the past, with reporter after reporter asking about the numbers of 834 errors and not getting a response from the administration. As The Wall Street Journal reporter reasoned, if the administration knows that 80 percent of the errors are coming from a certain bug — then simple math should figure out the total number.
Back in October, Laszewski explained why this could be a disaster:
[If] they fix the front end for consumers and thousands of people or hundreds of thousands of people being enrolled before they fix the back end, we’ll have a catastrophic mess. When insurers are getting 10 or 20 or 50 enrollments a day they can clean the errors up manually. But they can’t do that for thousands of enrollments a day. They have to automate at some point.
Last week, Ezra talked to Mark McClellan, who helped implement Medicare Part D, about this problem:
Come January there will be people who had their plans canceled by Obamacare but didn’t or couldn’t sign up for new insurance. There will be people who signed up for new insurance but their application got lost in the tubes. Some of these people will be sick, and interruptions to their care will be dangerous — not to mention widely publicized. “There’s is a 100 percent chance that this will happen to a nontrivial number of people,” McClellan, who’s now at the Brookings Institution, said. “So the Obama administration needs some kind of plan in place for resolving those cases as rapidly as possible and making sure they get the care they need.”
The notion that bigot has “its origins in the general notion of close-mindedness” would be news to etymologists. The origins of the word ”bigot” are unknown, but the current theory holds that it is an import from Middle French denoting someone who was sanctimonious or hypocritically religious. Alwan is concerned about the word bigot becoming “perverted,” to exploit “its toxicity.” But this happened long before Alec Baldwin. As late as the 1700s, the word was brought to English with its French meaning. That it was perverted into other meanings is unremarkable. Language does not exist encased in glass and formaldehyde. And the perversion of words is not a cosmic felony, it is how language actually works. …
Alwan’s definition of a bigot, as a “global” label encompassing their humanity, as someone who is wholly unpersuadable, wholly without conflict, and wholly without doubt, is not a description of humans, it is a description of myth.
Reviewing the recently released Orwell: A Life inLetters,David Pryce-Jones bizarrely calls the question “a puzzle that none of his biographers or critics have been able to solve.” His own answer? That a “sense of enjoying unfair advantages was enough to make rebels of a good number of Eton scholars,” including Orwell, which led to the “social masochism” that Pryce-Jones goes on to describe:
In the intensive effort to be déclassé, he well and truly put himself through it. Changing his real name of Eric Blair to George Orwell suggests the manufacture of a new and different personality fit for writing. A disturbing glee emerges from the accounts he gives of the hack journalism and flawed novels he is obliged to publish, all the while sinking lower and lower among down and outs. Cheap housing, grime and dirt, bad smells, and horrible duties in a kitchen are to him what country house settings and their trappings were to Jane Austen. Describing how close to death he was at one point in a Paris hospital, he makes sure that the reader is more attentive to the slumminess of the ordeal rather than the fact of his survival.
Uncomfortable and deprived of basic amenities, the houses he lived in were riddled with health hazards to someone with chronically weak lungs. Wherever he settled in the countryside, he set about growing vegetables and raising hens—Was this out of a genuine feel for nature, or role-playing about being poor and needy? Did he enjoy fishing for the sport, or because it is supposed to be how English proletarians spent their leisure time? As to money, he wrote to his friend the social anthropologist Geoffrey Gorer, “it will always be hand to mouth as I don’t see myself ever writing a best-seller.” Meeting up with him, [Cyril] Connolly was appalled that hardship had left “ravaged grooves that ran from cheek to chin” on his old school-friend’s face.
And, of course, he died far too young of untreated bouts of pneumonia that all but destroyed his lungs. But Pryce-Jones, I think, is being absurdly obtuse. There’s no mystery here at all. Orwell made it plain why he was a socialist in countless articles and reviews and books.
He viewed capitalism as horribly predatory for the poor and cared about them; he believed that ending private education could reduce all the quotidian cruelties that a rigid class system entails; he felt that only socialism could truly face down fascism; he was still naive enough to want to abolish the stock exchange because he wanted an economy that benefited the many and not the few; he passionately supported a robust welfare state on the lines of the post-war Labour government out of a patriotic love of his fellow countrymen and women. He despised Toryism, privilege and jingoism in all their manifestations. He was also, of course, a serious anti-Communist, which is why some now on the neoconservative right cannot fathom him.
Above all, I think, he believed that class numbed people to the lives of their fellow citizens. It wasn’t masochism that prompted him to slum it in London and Paris; it was a desire to understand what was actually going on by living more fully on the margins and writing about it with candor and freshness. His project was the fore-runner of the new journalism, as well as so much else. I don’t share Orwell’s socialism a bit, even though it is much more understandable from the viewpoint of someone surviving the 1930s and the war than it would be today. But I love him despite that, even as I read him in my Thatcherite teens. Because he was so much more than ideology. And so much more than just a writer.
That tweet reminds me again of how anti-Christian contemporary Republicanism is. The notion that racism can “end” misreads a core Christian truth about human nature. Our vulnerability to hatred, condescension, fear of others, resentment, and generalizations about “the other” are intrinsic to what it means to be human. Racism, like greed or envy or pride, will never end. We are all always susceptible to these flaws, to what Christians have called “original sin,” and which is perhaps better expressed in the concept of the “The Human Propensity To Fuck Things Up.” Of course, these core sentiments that are part of our primate inheritance can wax and wane, they can be unleashed or restrained, and they can be instantiated in institutions and laws and customs, or not. But hatred is for ever. It knows no geographical or historical boundaries. It is intrinsic to being human, which means it is intrinsic to being American.
What Parks and so many others did was chip away at the legal architecture of institutionalized hatred and loathing. This matters – because we humans are an impressionable herd and can be encouraged to acts and thoughts of great evil by authoritative permission. So slavery was not just an evil in itself; but an incalculable fomenter of evil. Ditto segregation.
Ending these abominations can severely reduce the lazy hatred of tribe for the other – but they will never extinguish it from the human soul. The same should be said for ending the legal architecture that kept gay people in the category of “the other”. I have no illusions whatsoever that gay kids will ever be free from the taunts of others – because they are so very different at a time in life when groupthink is so overwhelming and cruel. Which is why the only long-term effective response to these hatreds is forgiveness, not revenge, to escape the cycle by self-esteem, not more anger, however justified. Eradicating hatred is a utopian folly, still entertained on the left (as in the absurdity of hate crime laws), but now also embraced by the right as a way to deny any power to history or to the fallenness of humankind. It is a Christian heresy. Which is why it has taken root in today’s “exceptionalist” far right.
For them, simply being American is itself absolution from sin. I remember once hearing Newt Gingrich actually claim that America had abolished envy. He was serious. And how can one forget that Michele Bachmann truly believed that the Founding Fathers ended slavery in their lifetimes? Once a country has replaced God as an object of worship, it can, of course, do no wrong. And history must be rewritten to account for that. This is a fantasy and a lie, and conservatism, properly speaking, should have nothing to do with it.
The last two days have apparently seen a surge in ACA enrollments on Healthcare.gov – in two days as many new Obamacare beneficiaries as in the whole of October. David Corn sees Obamacare’s introduction as make or break for both parties:
[W]ithin months, it may well be that abstract arguments over the nature of Obamacare will be trumped by the realities of the Affordable Care Act. Eventually, there will be stats and facts to consider: how many people receive insurance through the exchanges, what happens with premiums, the direction of health care costs, customer satisfaction, and the like. Though the results may be open to debate for a while, it is distinctly possible that one side or the other will be proven right (or wrong). If the website functions, millions sign up, and the health care market doesn’t crash, and premiums don’t zoom up—and this will be on top of the already existing benefits of Obamacare, including removing preexisting conditions restraints, allowing young adults to remain on their parents’ policies, reducing out-of-pocket prescription drug costs for seniors, and forcing insurance companies to devote a higher percentage of premiums to health care coverage—where will the Republicans be? Not only will they be failed doomsayers; they will have lost the No. 1 item on their why-you-should-vote-GOP list. Their anti-government crusade will be derailed. They will be a train without a motor.
Should Obamacare not work, then Obama’s vision—which reflects the progressive tradition of the past century—will be a flat tire. He will no longer be able to advance the cause of government activism. Expand Head Start? Create an infrastructure bank? Why should government be allowed (or trusted) to increase its reach? He can talk about helping the middle class. But how? The failed rollout of the website was a problem in so many ways but especially because it suggested that government cannot perform competently. A more extensive failure with Obamacare would suggest that government cannot be used in the manner Obama wishes to see it utilized.
What’s at stake in this never-ending debate over Obamacare are the foundational premises of each party. The success of Obamacare could be close to a death blow to the GOP. Ditto for Obamacare and the Democrats, should it collapse.
Yes and no. I don’t really want to see government expand from its current size and cost and ambition. I’m not a progressive and backed Obama because of his pragmatism. The reason I support the ACA is partly moral – if I can’t in good conscience employ anyone without health insurance, I can’t in good conscience acquiesce to a system that leaves millions out in the cold; part fiscal – I don’t believe in free-riding and see the need to reform a system that has close to no effective cost controls; and part because of all the possible proposals to end the cruelties of the past – bankrupting people with pre-existing conditions, yanking insurance from people just when they need it – Obamacare squares the most circles. So I wouldn’t mind very much if Obamacare both addressed these core problems better than the past and nonetheless prevented liberalism from going after any more lofty progressive objectives. In fact, that would be my ideal result. But, of course, I may be a parish of one again.
By the middle of 2014, Obamacare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown. People with employer health care will still have it and very few will notice even a minor change in their normal routine.
Given all this, it’s hard to see Obamacare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. Obamacare’s taxes don’t touch anyone with an income less than $200,000. Aside from the tea partiers who object on the usual abstract grounds that Obamacare is a liberty-crushing Stalinesque takeover of the medical industry, it’s going to be hard to gin up a huge amount of opposition. And that’s doubly true since, as Sargent says, the Republican Party will have no credible alternative for a benefit that lots of people will already be getting.
Bernstein expects Obamacare to eventually fade away as an issue:
That doesn’t mean that health care won’t be an issue. Expect, for example, Republicans to eventually fight over subsidy levels (and, perhaps, both parties to try to refashion subsidies to avoid perverse incentives on earnings). Expect, too, Republicans to eventually try to reduce ACA-connected taxes. There’s been some of that, but so far it’s mostly been restricted to things that could be outright repealed. Expect, too, plenty of oversight by this and future Congresses over all phases of it. After all, there’s more to oversee now.
The point is that even as the debate about “Obamacare” eventually fades away, we shouldn’t expect health care to vanish as an issue. Indeed: expect it to be more central to U.S. politics going forward.
Politico is still acting like a politician riding out a scandal by refusing to engage it, rather than a newspaper dedicated to transparency. Allen’s fusion of advertizing clients and personal relationships and puff pieces – a veritable nest of conflicts of interest – is apparently beyond reproach because, well, er … just because. Jim Vandehei’s latest reluctant defense of Allen is elegantly summed up by Chait: “a comical stream of evasive tripe.” It is indeed.
Reviewing a number of newbooks on Machiavelli, Michael Ignatieff argues that the author of The Prince was “hardly the first theorist to maintain that politics is a ruthless business, requiring leaders to do things their private conscience might abhor.” So what set him apart?
He believed not only that politicians must do evil in the name of the public good, but also that they shouldn’t worry about it. He was unconcerned, in other words, with what modern thinkers call the problem of dirty hands. The great Princeton philosopher Michael Walzer, borrowing from Jean-Paul Sartre, describes the feeling of having dirty hands in politics as the guilty conscience that political actors must live with when they authorize acts that public necessity requires but private morality rejects. “Here is the moral politician,” Walzer says: “it is by his dirty hands that we know him.”
Walzer thinks that we want our politicians to be suffering servants, lying awake at night, wrestling with the conflict between private morality and the public good. Machiavelli simply didn’t believe that politicians should be bothered about their dirty hands. He didn’t believe they deserve praise for moral scruple or the pangs of conscience. He would have agreed with The Sopranos: sometimes you do what you have to do.
But The Prince would hardly have survived this long if it was nothing more than an apologia for gangsters.
With gangsters, gratuitous cruelty is often efficient, while in politics, Machiavelli clearly understood, it is worse than a crime. It is a mistake. Ragion di stato [reason of state] ought to discipline each politician’s descent into morally questionable realms. A leader guided by public necessity is less likely to be cruel and vicious than one guided by religious moralizing. Machiavelli’s ethics, it should be said, were scathingly indifferent to Christian principle, and for good reason. After all, someone who believes he has God on his side is capable of anything.
In other words, Machiavelli’s innovation was not to teach evil, but to remind us that agonizing over it was the real mistake:
He insisted that when tough or risky political decisions have to be made, Christian charity or private empathy simply will not serve. In politics, the polestar must be the health of the republic alone. Following the querulous inner voice or tacking to and fro when moralizers on the sidelines object is just weakness, and if your hesitations put the republic at risk, it is contemptible weakness. Machiavelli’s ethics valued judicious decisiveness in politics over the anguished search for rectitude.
He was the original person who regarded torture, for example, the same way that Dick Cheney did: as “a no-brainer.” Previous Dish on Machiavelli here, here, and here. A reader adds:
