The Dish

by Dish Staff

Yesterday, the Centers for Medicare and Medicaid Services (CMS) released a report on projected healthcare spending. What Jonathan Cohn sees as the “main takeaway”:

We’re making progress on controlling the cost of health care. We might even be making a lot of progress, although it’s too soon to tell.

Why the report may be too pessimistic:

Keep in mind that CMS actuaries are famously conservative. In the past, they’ve tended to overestimate how much spending will rise—not because they’re imprecise or biased, but because they tend to err on the side of caution. In a conference call Wednesday, several actuaries made clear they weren’t discounting the possibility that the health care industry is becoming more efficient. One actuary said “Right now it is still too early determine” how much the health industry has changed. Others expressed similar sentiments.

“If the payment reforms have the kind of effect advocates of them expect, these projections could turn out to be conservative,” Larry Levitt, senior vice president at the Kaiser Family Foundation, told me later via e-mail. “The actuaries tend to take a wait and see approach to new developments where there is little evidence as to what effect they’ll have. We are in somewhat unchartered territory here.”

Jason Millman adds important caveats:

A few points worth noting about the actuary’s projections: Taking a cue from the trustees overseeing Medicare, the actuary’s office assumes that Congress will once again approve a “doc fix” to avoid the scheduled 21 percent cut to Medicare physician payments. The actuary also assumes that the Affordable Care Act’s temporary bump in federal reimbursement to Medicaid doctors will go away at the end of the year as planned, though some Democrats and physician groups are pushing for an extension of the policy to encourage more doctors to take Medicaid patients as the program expands.

Philip Klein, as he does with most ACA-related news, puts a negative spin on the report:

As the economy improves, Obamacare continues to expand, and the Medicare age population explodes, health spending is expected to rise by an average of 6 percent a year over the 2015 to 2023 time period. Though this would be lower than the 7.2 percent average over the 1990 to 2008 span, it would still outpace the growth of the economy.

Because of this, health spending as a share of gross domestic product is expected to increase from 17.2 percent in 2012 to 19.3 percent in 2023 – representing nearly one in five dollars of the economy.

Kliff frames the numbers differently:

Medicare actuaries expect that health care costs will outpace economic growth by 1.1 percent. That’s not ideal; most health economists would like to see the two numbers grow at the exact same pace. But it’s still a smaller gap than what has existed historically. Between 1990 and 2008, health cost growth outpaced the economy by 2 percent.

This is big. The Medicare actuaries are saying that, while they do expect a slight rebound in medical spending post-recession, they don’t think we’re headed back to the super-fast growth that, for decades, has been a hallmark of the health care industry. And when health care eats up a smaller chunk of the economy (and the federal budget) that leaves more money to spend on other important things like education and infrastructure.

by Dish Staff

Rotherham council is a damning indictment of the Labour Party pic.twitter.com/sYG0Fx3v83

— Jon Scraggle (@JScraggle) September 4, 2014

Margaret Talbot examines the role of political correctness in the sexual exploitation scandal taking place in Rotherham, England:

One explanation for why these crimes went on for so long, more or less unchecked, is that police officers didn’t believe what they were hearing: they thought that the social workers who reported a pattern of sexual abuse involving Pakistani gangs and young girls were exaggerating or misinterpreting. The scale of it could have seemed implausible—an understandable human response, perhaps, though not the most useful one for law enforcement.

The other leading explanation is that, because most of the perpetrators were Pakistani and most of the victims were white, local officials were reluctant to proceed, worried about inflaming ethnic tensions. Last week, the British Home Secretary, Theresa May, denounced what she called “an institutionalized political correctness” at work in this case.

Though this might sound like a rhetorical flourish, there seems to be some truth to this claim.

Rotherham is an economically stressed city of two hundred and fifty-eight thousand people, with an ethnic minority population of about eight per cent. The Labour Party has long controlled the town council, but, in recent years, the Party has been joined by a few members of the populist right-wing faction U.K.I.P. When investigating individual cases, the Rotherham report found no evidence that ethnic consideration had determined outcomes for children. But, when it came to setting policy, a certain skittishness seems to have played a role. According to the report, “Several councillors interviewed believed that by opening up these issues they could be ‘giving oxygen’ to racist perspectives that might in turn attract extremist political groups and threaten community cohesion.” Perhaps that, too, is a concern that deserves some sympathy—though because its immediate result was a failure to rescue children from brutal circumstances, the sympathy only goes so far.

A few days ago, Hugh Muir challenged that interpretation:

[C]an it really be true – as the tabloids and the right robustly claim – that a significant contributor truly was political correctness; the fear of officials that by intervening appropriately in cases where the suspects were Pakistani Muslims, they themselves would be castigated as racist? If it is, it is outrageous. It is also ludicrous.

Political correctness – if we are to persist with that hackneyed term – required members of a diverse society to accord to others the level of dignity they would want for themselves. The right conflated its meaning so as to describe any prescription on its behaviour that it didn’t like. Everything, from the description of coffee to adoption policy, became “political correctness gone mad”. Perhaps the idea was to discredit the concept by hoisting it into the realm of absurdity. But even then, the concept never, ever required anyone to turn a blind eye to the mass abuse of the vulnerable by criminals. And anyway, to do so on grounds of political correctness would never have made sense.

If a backlash was feared, where would it have come from? There is no minority lobby for criminals and paedophiles. So long as communities knew the issue was one of law enforcement rather than an assault on those communities themselves, they would have supported tough action by the authorities.

by Dish Staff

The big political news from last night:

The race for U.S. Senate in Kansas no longer has a Democrat in it. In a stunning development, candidate Chad Taylor asked Wednesday that his name be removed from the ballot, paving the way for independent candidate Greg Orman to face U.S. Sen. Pat Roberts head-on in November.

Sam Wang, who posts the above chart, calculates that the Democrats’ odds of keeping the Senate have skyrocketed:

Right before Taylor’s announcement yesterday, according to data from the Princeton Election Consortium, the Democrats had a sixty-five per cent chance of retaining control of the Senate. (Polling wonks will notice that this number is significantly different than what has been put out by outlets like theWashington Post’s Monkey Cage, the New York Times’ Upshot, and Nate Silver’sFiveThirtyEight, all of whom give an edge to the Republicans. The Princeton Election Consortium, which I founded, only relies on polling data and does not factor in so-called “fundamentals,” such as campaign finances and incumbency. In the past, our purely poll-based approach has yielded extremely accurate results.) As noted here, with Orman facing off alone against Roberts, the probability of Democratic control shot up to eighty-five per cent.

Silver’s analysis is less favorable to the Democrats. He remarks, that “if Roberts winds up beating Orman by a few percentage points, it wouldn’t be so surprising”:

Another question is which party Orman might caucus with should he win. The default answer would be the Democrats. Orman was formerly a Democrat, he’s mostly taken the political positions of a moderate Democrat, and the Democratic candidate just dropped out of the race. But the more Orman appears to be affiliated with the Democratic Party, the less attractive he might be to Kansas’s red-leaning electorate. … If we do program the model to treat an Orman win as a Democratic pickup, then the Democrats’ chances of retaining the Senate would improve to 38 percent from 35 percent.

Andrew Prokop also wonders who Orman will caucus with:

Orman has said that if he wins, and if one party ends up clearly in the majority, he will “seek to caucus” with that party. But if the Democrats end up with 49 seats to the Republicans’ 50, a victorious Orman would be the vote deciding Senate control, and would be intensely courted by both sides. “Ultimately, I’m going to caucus with the party that’s … most willing to address some of the biggest issues we have,” Orman said Wednesday, according to Politico’s Manu Raju and Kyle Cheney.

Orman describes himself as “someone who is fiscally responsible and socially tolerant,” and has criticized both parties and their leaders. However, he is pro-choice, a critic of the Citizens United decision, and a supporter of comprehensive immigration reform. And, as McCaskill’s actions indicate, Democratic support will likely coalesce behind Orman, while Republicans will try very hard to help Roberts keep his seat, which seems like it could have some impact on Orman’s decision about who to caucus with.

Sabato’s Crystal Ball sizes up the race:

Our Kansas sources stressed two things Wednesday evening. First, Republicans are absolutely furious at Roberts for turning in such a clumsy, second-rate primary performance and allowing this contest to linger in a year when every Senate battle could determine control of the chamber. Second, these same sources — when pressed — believed that ultimately Roberts would be able to fight off the challenge with enough outside assistance.

We’ll see whether the latter view turns out to be realistic or optimistic. For the moment, we’ll put a thumb on the scale for “realistic.” However, Orman has gone to great lengths to emphasize his independence by noting his vacillation between the two parties. He obviously hopes that Kansans will be more amenable to voting for him if they don’t think of him as a Democrat. Republicans, inevitably, are going to try to make Orman as much of a Democrat as possible. Conservative journalists on Twitter are already discussing attack ads aimed at Orman with this theme: “The O in Orman stands for Obama.” In fact, Orman considered running as a Democrat in the 2008 Senate race against Roberts before declining to become a candidate.

Before the Kansas news broke, Nate Cohn looked more broadly at the Senate landscape:

Anything, of course, is still possible. Labor Day is traditionally the start of the campaign, not the end. But what may be more likely than a Republican rout is that 2014 ends up somewhere between 2010 and 2012. Not a Republican landslide or a Democratic victory, but a fairly neutral if Republican-tilting year in which the G.O.P. benefits from a large number of competitive races in red and purple states.

John Sides’ model now gives Democrats nearly a 50-50 chance of keeping the Senate:

[It’s] not that races have narrowed, but that the model has begun weighting information differently — mainly by (a) incorporating polling data (where possible) after the relevant primaries, and by (b) increasing the weight that polls have in the forecast.  What this suggests is that in several states, Democrats are arguably ‘out-performing’ the fundamentals. This doesn’t always translate into a high chance of the Democrat actually winning (see: Kentucky) but it does help the Democrats’ overall chances of retaining a majority.

by Dish Staff

It appears we’ve passed it:

A new George Washington University “Battleground” poll shows that, on the list of things that people think are wrong with this country, Obamacare actually ranks pretty low. As in behind-“other” low. The poll shows seven in 10 likely voters think the country is off on the wrong track. But unlike other pollsters, it then asked a follow-up question about why people were unhappy. Of the 70 percent who said the country was off on the wrong track, just 5 percent offered a reason having to do with Obamacare. In other words, only about 3.5 percent of all Americans think Obamacare is the bane of American existence right now.

Chait passes along other good news for the ACA – the DC Circuit court will re-hear Halbig:

The short explanation of what this means is that it has closed off the easiest path to crippling Obamacare. … What happens next is that the entire D.C. Circuit will hear the case. Since the logic of the lawsuit is so ludicrous only a wildly partisan Republican jurist would ever accept it, it stands zero chance of success.

Jason Millman unpacks the news:

The entire D.C. circuit is expected to uphold subsidies through the federal-run exchanges, which would eliminate conflicting decisions in the appellate courts. That makes it less likely that the Supreme Court will eventually take the subsidy challenges, though the justices can still decide to do so.

Cohn also eyes SCOTUS:

Most legal experts I know think the justices will, at the very least, wait to see how the full D.C. Circuit rules before taking the lawsuits seriously. The D.C. Circuit rehearing is set for November and that court probably won’t issue a ruling until spring or summer of next year. If those judges end up reversing the decision, the Supreme Court justices might pass on the case altogether, although two other cases are in much earlier stages of the judicial process and could still produce conflicting rulings. As Andrew Koppelman, a constitutional law expert at Northwestern University, notes, “If the Court was going to blow up Obamacare, it would have done so in the big case in 2012. After Roberts paid a big political cost for doing that, why would he now adopt this hyper-technical and unpersuasive legal argument, yanking away benefits that a lot of people are already receiving?”

But remember: It takes only four Supreme Court justices to vote in favor of hearing a case. We know, from that 2012 Obamacare case, that four conservative justices were prepared to throw out not just the individual mandate but also the rest of the law.

by Dish Staff

Yesterday, a Louisiana judge upheld the state’s marriage ban:

Throughout his thirty-two-page opinion, the judge noted the near unanimity that has prevailed in other courts on the same-sex marriage issue, and he did not criticize other courts for having done so.   He said those rulings amounted to “a pageant of empathy” for same-sex couples. But he concluded his opinion with an essay on the virtue of leaving such a vigorously debated topic to the choice of the people, acting as legislators at the ballot box or through their state legislative representatives.

An appeal of this decision to the U.S. Court of Appeals for the Fifth Circuit is nearly certain.

Mark Joseph Stern notes that Judge Martin Feldman, “is not the first judge since 2013’s United States v. Windsor to uphold a gay marriage ban. He is, however, the first federal judge, a key distinction that gives his ruling significant clout”:

The thrust of Feldman’s ruling rests on a misinterpretation of the so-called animus doctrine. According to the Supreme Court, laws motivated exclusively by anti-gay animus toward gay people violate the equal protection clause of the 14th Amendment. After the court struck down a federal gay marriage ban in Windsor, the vast majority of judges have concluded that all gay marriage bans are presumptively motivated by animus. That’s a logical conclusion, given the Windsor court’s assertion that the federal ban’s “principal purpose and necessary effect” was to “demean” and “degrade” gay people.

But as I’ve written before, the animus doctrine has a weak spot: It’s pretty easy for an eager judge to put a fig leaf over the hostility that motivates anti-gay laws. Feldman, for instance, is shocked that gays would even suggest such a motive, berating them for insisting that Louisiana’s ban “could only be inspired by hate and intolerance.” Rather, denying gay people the right to marry is a perfectly reasonable way “to achieve marriage’s historically preeminent purpose of linking children to their biological parents.” To insinuate that the law was passed to “vilify” gays, Feldman scoffs, is absurd and insulting.

Rob Tisinai pokes holes in the ruling:

[A]bout that societal interest in ensuring that fundamental social change be cultivated via the ballot or legislature instead of the courts: this is an invitation never to find any law unconstitutional, no matter how great an affront to the Constitution it may be. Feldman hedges his way out of this with the qualifier, “in this case.” But why, in this case? He never explains. The closest he comes is in his comments about linking children to their biological parents. But this is inadequate. Such a policy goal explains why the state permits biological parents to marry. It explains not at all why other marriages should be banned. This is a huge hole in Feldman’s reasoning, and I suspect there really is nothing that could fill it.

Savage extends Feldman’s logic:

Preventing same-sex couples from marrying does not prompt opposite-sex couples to marry. If the state has an interest in “intact” families headed up by “two biological parents,” it would make more sense—and come far closer to achieving the state’s supposedly legitimate interest—if the state made pre-marital sex illegal, compelled straight men to marry the women they’ve impregnated, and banned divorce for straight couples with children.

Garrett Epps suggests that “not coincidentally, [the ruling’s] heart is drawn from an opinion written earlier this year by Justice Anthony Kennedy—whose vote will very likely determine the result when the marriage issue reaches the Court”:

Kennedy is a man with a large but complex heart. On the one hand, it tugs him toward his beloved “dignity” for gay couples and their children; on the other, it draws him toward the privileges of the states and the newly discovered “fundamental right” of majorities. The outcome of that contest is still in doubt, and Feldman’s opinion shows why.

Allahpundit bets Kennedy will side with equality:

One of the core points in Kennedy’s prior landmark opinions in gay-rights cases, especially the case striking down sodomy laws, is that gays are entitled to the same constitutional protections for intimate behavior that straights are. It would be odd if he followed that up by reading the right to marriage the way Feldman does, as a right inherently limited to people of different genders. And it’s not just RINOs who think so: Scalia, dissenting in the Windsor case, laughed at Kennedy’s opinion for being a transparent precursor to eventually finding that the Due Process Clause grants citizens the right to marry another person, not a right to marry only a person of the other gender. I think Feldman’s destined to be overturned, but this is a hopeful note at least for opponents of SSM.