Sunday, September 24, 2017

Monsignor thinks it would be better to change the subject

Concerned cat. Uncredited photo from Washington Post.
Well, we've got a request from Monsignor Ross Douthat, Apostolic Nuncio to 42nd Street, which is ("The Health Care Cul-de-Sac") would everybody please stop talking about health care?

sometimes, when a party has spent most of a year producing health care bills that excite almost nobody and that even the senators voting for them can’t effectively defend, it’s worth stepping back and thinking about our national priorities.
This goes for both parties: not only the stepping-on-rakes Republicans, but the suddenly single-payer-dreaming Democrats.
I wouldn't say those Republican health care bills excite almost nobody: somebody must be excited over the thought of getting rid of the Obamacare brand, or the employer mandate, or above all the concept of eliminating Medicaid as a federal program, or these things wouldn't keep coming back again and again from their zombie graves.

On the other hand, it's still less accurate to say the Democrats have spent most of a year producing unexciting health care bills that the Senators voting for them haven't been able to defend. Democrats have spent some time working on drafts of bills nobody's had a chance to vote on, inspiring various degrees of excitement, including the Sanders "Medicare for All" proposal launched on September 13 with endorsements from a really startling number of Democratic Senators including Tammy Baldwin, Elizabeth Warren, Kirsten Gillibrand, Al Franken, Patrick Leahy, Jeanne Shaheen, Mazie Hirono, Brian Schatz (though he's offering a bill of his own as well), Kamala Harris, and Cory Booker, and more, as well as 60% of the Democratic caucus in the House, and a public that may have gone back to its longstanding desire for government-guaranteed universal health care after giving up on it while we were waiting for the PPACA to come into effect—

and has evidently begun to prefer a "single-payer" type of system, though it's anybody's guess what they think that means.

Charts from Vox.
So I get why Republicans might be well advised to stop talking about health care, but Democrats should stop why, exactly?

If Obamacare repeal is really dead for the year 2017, both left and right have a chance to shake their minds free of the health care debate and ask themselves: What are the biggest threats to the American Dream right now, to our unity and prosperity, our happiness and civic health?
Yes, now that the debate is starting to go the Democrats' way, with public opinion hating those McConnell proposals and favoring the PPACA, as it generally has been since January, and a kind of Democratic unity starting to rise on the goal of health care legislation as you can see from that list of endorsements (though that doesn't mean exactly what you might think it means either), the Monsignor would like to change the subject.

That is, it's standard concern trolling. And then what are those biggest threats? Other than the possibility that Donald Trump could decide to blow up the Earth because Kim Jong-un called him a dotard (in which I don't quite believe, dangerously unbalanced as his behavior is) or the more and more violent weather brought on by greenhouse-gas warming could drown it?

I would suggest that there are two big answers, both of which played crucial roles in getting a carnival showman who promised to Make America Great Again elected president. First, an economic stagnation that we are only just now, eight years into an economic recovery, beginning to escape — a stagnation that has left median incomes roughly flat for almost a generation, encouraged populism on the left and right, and made every kind of polarization that much worse.
Second, a social crisis that the opioid epidemic has thrown into horrifying relief, but that was apparent in other indicators for a while — in the decline of marriage, rising suicide rates, an upward lurch in mortality for poorer whites, a historically low birthrate, a large-scale male abandonment of the work force, a dissolving trend in religious and civic life, a crisis of patriotism, belonging, trust.
So in the first place I think he ought to pause to ask why the US seems to be starting to emerge from the long stagnation just in the last 24 months or so. For example does the Affordable Care Act have anything to do with that, as Piketty economics suggests it should? Because of its very large redistribution of money from the ultra-rich to the relatively needy and its very targeted freeing of individuals with children to become entrepreneurs (through affordable insurance on the individual market—a survey of last October found that about a third of new entrepreneurs said they wouldn't have been able to strike out on heir own without the ACA). People finally started looking seriously at the economic effects of ACA only after the election made it seem likely that we'd lose it, but they would be very considerable:
repealing the ACA’s health-insurance subsidies and Medicaid expansion in an H.R. 3762-like plan would result nationwide in a loss of around 3 million jobs, $1.5 trillion in gross state products, and $2.6 trillion in total business activity between 2019 and 2023. Because hospitals often absorb the costs of patients who can’t pay, a plan stripping coverage from low-income people would also increase uncompensated-care costs by over $1 trillion for the decade after 2019. (Vann Newkirk II/Atlantic)
And every GOP bill turns out to be worse than the previous one.

Universal health care can also do something about the opioid crisis, rising suicide rates, lurching mortality among that WWC (which Douthat persists in regarding as the core Trump electorate, I'm getting so sick of this), and withdrawal of men from the work force if that's a problem:
there’s another theory that deserves mentioning, especially because it fits with recent research about the declining health outcomes among American men. That theory suggests that American men are dropping out of the workforce because they are suffering from serious health conditions that make it difficult for them to work. As their health deteriorates, they’re getting on pain medications, which then make it even more difficult to re-enter the workforce.
Princeton economist Alan Krueger argued this theory late last year at a conference at the Federal Reserve Bank of Boston, and in an October 2016 papercirculated by the National Bureau of Economic Research. In his research, he found that almost half of working-age men who were not in the labor force were taking pain medication on a daily basis, and that two-thirds of those men were taking prescription medication. These men also reported more functional disabilities: Krueger found that 43 percent of prime-aged men who are out of the labor force report their health as fair or poor, compared with 12 percent of employed men and 16 percent of unemployed men. Health-related problems “are a substantial barrier to work that would have to be addressed to significantly reverse their downward trend in participation,” Krueger writes. (Alana Semuels/Atlantic)
In fact it's been suggested that repealing the ACA could lower the birthrate

I think we could even get into a situation where people are delaying life decisions until this is resolved. Some women on an A.C.A. plan might put off getting pregnant as long as there’s a chance that they could lose their insurance and not be able to get on a new plan because pregnancy is now a “previously existing condition.” I don’t think it’s crazy to believe that repeal and delay could have a noticeable impact on the birthrate in this country. (Aaron E. Carroll/Upshot
And Obamacare has been credited with a declining abortion rate
The researchers estimated that there were 926,200 abortions in 2014, or 14.6 abortions for every 1,000 women of reproductive age. That was down 14% from three years earlier.
“We saw declines in abortion in almost every single state,” said Jenna Jerman, a public health researcher at the Guttmacher Institute, a reproductive rights think tank in New York, and coauthor of the study published Tuesday in the journal Perspectives on Sexual and Reproductive Health.
Though the study did not look at the reasons for the decline, the authors and other experts suggested that improved access to contraception played a big role by preventing unintended pregnancies.... [u]nder the Affordable Care Act (Nina Agrawal/Los Angeles Times)
And a truly universal health care system, however we approach it, in the debate growing out of the new Sanders bill, will do more of this job than the ACA as is.

I'm not saying universal health care could solve the patriotism crisis, assuming the Monsignor is right and that's a serious problem too, but I'm sure I'd be more patriotic if I didn't constantly feel the need to apologize for my country being behind Portugal and Taiwan on this issue. All in all, I think it's OK for Democrats to keep talking health care. But thanks, Ross, for your kind concern.

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