A study in contrasts

Here is a Fox News article discussing Obama's speech at a fundraiser where he used the word "madness" in describing Republican economic policy. Fox News quotes exactly five word spoken by the President during the speech ("madness", as well as a completely unrelated comment that Abraham "couldn't win the nomination" in today's GOP).

Here is a CNN article discussing the same speech. CNN quotes a much larger section:

"They would gut things that we've always believed is at the core of making America great - education, science, caring for the most vulnerable." the president to chants of "four more years" in a packed Portland, Maine gymnasium. "They are wrong.

"The idea that you would keep doing the same thing over and over, even after it's proven not to work, that's the sign of madness," he also said of Republican-backed economic policies.

They also quote other sections of the speech.

I know that we all know Fox News sucks. But here is a news article, not an opinion piece, which makes no effort to place its headline in anything approximating the context in which it was spoken.

This is no way for voters to get their news.

Correcting Alito, Part 2

Yesterday, I analyzed Justice Samuel Alito's math on costs and benefits for the currently-uninsured under the mandate. Alito continued to return to these costs and benefits in more than one question, so it seems the comparison is important to his thinking on the case. These errors in thinking were not the only shortcomings Alito demonstrated during the arguments.

On page 32, line 3 of the transcript, Alito says:

If you took the group of people who are subject to the mandate and you calculated the amount of services this whole group would consume and figured out the cost of an insurance policy to cover the services that group would consume, the cost of that policy would be much, much less than the kind of policy that these people are now going to be required to purchase under the Affordable Care Act.

Here he is again discussing the $854/$5,800 comparison analyzed yesterday. But he also demonstrates a critical misunderstanding of who will be affected by the mandate. The mandate includes many minimum coverage requirements, including $0-copay preventive care and no annual or lifetime limits to benefits. As a result of the mandate, a huge class of people who currently have low-quality insurance will trade up to a better plan that meets these minimum requirements. 78% of people who have a medical bankruptcy have health insurance, and these people will be affected by the mandate. But Alito appears unaware that these people exist, thinking it is only the uninsured affected by the mandate and ignoring the underinsured.

Alito also draws a comparison between between burial insurance and health insurance. Most of us will get sick, and all of us will die, so if you can mandate health insurance, why can't you mandate burial insurance. This is a comparison which demonstrates ignorance of the differences between the markets. A burial costs what it's going to cost, and you know it's a cost you'll pay once and then be done with. There is no significant cost-dumping by people who aren't able to afford burial onto those who can afford it. But in health care, you don't know what your costs will be; I could consume $500 in services this year, or I could consume $500,000. If I don't have insurance and don't have $500,000, I could wind up sticking the system with hundreds of thousands of dollars in costs, shifting these costs to my fellow citizens.

Alito can't seem to grasp these distinctions. He demonstrates a fundamental lack of knowledge about health insurance and the mandate. Hopefully he will educate himself before the Court renders its judgment in June.

More generally, Alito's lack of knowledge demonstrates a huge problem in the concept of the Supreme Court as currently constituted. The Court has all these standards by which it attempts to analyze this or that aspect of a law before them, and as demonstrated by Alito, they wind up not having the knowledge necessary to render effective judgment. It's not that Alito is dumb, but it's not possible for a Justice to be an expert on everything he's asked by our system to judge.

Rather than trying to analyze every aspect of the cases they review, which is impossible to do well, the Judiciary needs to have more deference to the democratically-accountable branches of government. Justices are experts on the law, not on economics, finance, or anything else. Our system should not cause an unequipped judge to decide based on faulty understanding whether tens of millions of people will get insurance or not.

Correcting Alito

I've been over the transcript of Tuesday's oral arguments a few times now, and I keep coming back to a section where Samuel Alito appears to demonstrate a woeful lack of knowledge about the insurance industry and the individual mandate on which he sits in judgment. Most of the questions he asked of the government's lawyer involved the cost of insurance versus the benefit they will receive in return for that cost, so it's clear that this issue is central to his thinking about the case.

Alito begins, on page 8 line 23 of the transcript, while discussing :

You can correct me on these numbers if they're wrong...

Don't worry, I will.

...but it appears to me that the CBO has estimated that the average premium for a single insurance policy in the non-group market would be $5,800 in 2016... The Respondents (that is, the 26 states suing to eliminate Obamacare) estimate that a young, healthy individual targeted by the mandate on average consumes $854 in health services each year. So the mandate is forcing these people to provide a huge subsidy...

What a simplistic "analysis"! He simply takes these two dollar amounts and appears to conclude that the mandate would force the currently-uninsured to pay $5,000 into the system and get nothing in return. He fails to consider a number of factors, which causes one to doubt his ability to properly render judgment on the matter.

For starters, let's look at where the numbers come from. The $854 number is based on Appendix 22a of an amicus curiae brief (.pdf, page 67), which is based on an analysis of numbers from 2008. The $5,800 from the CBO analysis (.pdf, page 7) is a projection for 2016. Assuming a 5% rate of health care cost inflation, which I take from another CBO analysis (.pdf, page 5), that same care that in 2008 costs $854 would cost $1,262. So Alito should have definitely at least cited that number instead of $854, to compare apples to apples.

But underestimating the cost by more than 30% is far from the most significant error Alito makes. The 50% increase on one side of Alito's ledger assumes that the insured and uninsured people will consume identical amounts of health care. Having insurance will allow the citizen to have better access to care. These insured services will increase the value received for their $5,800.

By being able to more easily see a doctor, they will be generally healthier, allowing them to miss fewer work days, adding even more to the good side of the ledger, not to mention the more intrinsic value of not being sick as much. Paying for more preventive medicine now, the patient won't have to spend as much money later by having better control of their blood pressure, cholesterol, etc. By establishing a market where people of all ages pay the same rate, current young people also gain the benefit of having lower rates when they are older.

what is clear is that Alito's understanding of the facts of the case and the market involved is overly simplistic. He ignores multiple factors which affect the costs and benefits for those affected by the mandate. Since these costs and benefits were the main focus of his questions, one would have hoped he'd have put more thought into it.

It's getting late, so I'll finish my critique of Alito's position tomorrow.

Obamacare in deep trouble

Obamacare's individual mandate, the heart of the law which makes the guaranteed issue (can't reject people for pre-existing conditions) and community rating (can't charge sick people more) work, appears on its way to being struck down. Scalia, Alito and Thomas are clearly against it, while Ginsburg, Kagan, Sotomayor and Breyer definitely for it. That leaves Roberts and Kennedy as the deciders. If either one voted in favor of the law, it would stand, but both expressed significant reservations about the constitutionality of the mandate during oral arguments yesterday. CNN's legal analyst and former Harvard Law Review editor Jeffrey Toobin said this morning he believes the individual mandate is "doomed".

Both Roberts and Kennedy seem to think that the individual mandate is an unprecedented expansion of government power. This is unfathomable to me, given the realities of Social Security and Medicare. It's settled that, if the government wants, it can take your money and set up massive federally-run systems with it. It can throw you in jail if you refuse to give up this money (payroll taxes). But the court appears on the verge of saying that the government can't require you to spend your money with the provider of your choice. It seems obvious that the mandate is less of a use of government power than Medicare. So why is Kennedy talking about the mandate as if it's a step down a slippery slope?

Roberts asked the government's lawyer if the government could use the precedent potentially set by upholding the mandate to force people to buy cell phones for use in calling 911 in an emergency. The difference here is that there is not a biological certainty that you will eventually need to call 911, as there is a biological certainty that you will need health insurance.

More generally, it's unbelievable that health insurance for 30 million people can be eliminated after only 6 hours of public discussion. Multiple reporters present for the arguments yesterday noted that the government's lawyer coughed at the start of his presentation, and apparently it "threw him off his game". If one guy having a tickle in his throat matters, the system doesn't work. It's too high stress/high stakes of a situation to be a good way to come to the right decision.

We'll see how it goes. Maybe Kennedy or Roberts were just looking for reassurance of what they already think. But I'm definitely not feeling good about things at the moment.

Gonna need to walk this one off

I've been reading today's transcript of the arguments before the Supreme Court regarding the individual mandate. It's been quite a roller coaster, running the gamut from utterly depressing to mildly hopeful. Ultimately, I settled on mildly hopeful. I'm too beat to do a full post, but here's one quick point:

This decision by the Court is overwhelmingly important, no matter where you come down on the issue. Its far-reaching implications will alter the flow of trillions of dollars, affect whether millions of Americans have access to non-emergent health care, and (equally importantly) how I earn my living. Given this importance, why is it that open discussion of the issue is only worth six hours of the justices' time? And even then, only with a few lawyers out of a nation of 300 million who mostly aren't lawyers?

Just askin'.

Romney's Seinfeld Campaign

Why does Mitt Romney want to be President? In his heart of hearts, what does he want to accomplish with 4-8 years in the Oval Office? On issue after issue, he has held views across the spectrum, as previously discussed here and here and here.

In a recent interview, Romney said the following:

“One of the things I found in a short campaign against Ted Kennedy was that when I said, for instance, that I wanted to eliminate the Department of Education, that was used to suggest I don’t care about education,” Romney recalled. “So I think it’s important for me to point out that I anticipate that there will be departments and agencies that will either be eliminated or combined with other agencies. So for instance, I anticipate that housing vouchers will be turned over to the states rather than be administered at the federal level, and so at this point I think of the programs to be eliminated or to be returned to the states, and we’ll see what consolidation opportunities exist as a result of those program eliminations. So will there be some that get eliminated or combined? The answer is yes, but I’m not going to give you a list right now.”

So he's going to eliminate/reorganize huge swaths of the Federal government, but he's going to tell us nothing about which ones he will close, how he'll replace them, or why.

Awesome.

He is exploiting the ignorance of the actual facts among voters I'd discussed in my first post in 2011. If people are ignorant of how government spends money, it is easy to say "government is too big" and insist on cuts. But if people are told what those cuts will mean, which is what Romney says above that he'll refuse to do, they might not be so supportive. So Romney appears to be comfortable with allowing voters to cast their vote out of ignorance. This is not a positive development for our system.

Romney's campaign is about nothing. Like most people (including me), Romney appears to believe that a generic, bland Republican would have a great chance to win this year, and he's trying to be as non-descript as he possibly can, taking both sides of issues, being evasive, and now, flat out refusing to describe his positions on issues and plans for what to do once he is elected.

Romney's record on energy

Great article about Romney's history when it comes to energy. In a nutshell, Romney used to be for everything he's now against.

Honest question: Does anyone feel like they have any idea how Romney would govern if he were to be elected?

Health insurance not just any product

Many conservatives argue that Obamacare is unconstitutional because Congress doesn't/shouldn't have the power to regulate inactivity. It's fine to force people to buy car insurance or build factories that pollute less because these are economic actions people have chosen to make, and Congress has a clear role to regulate interstate economic activity. But punishing inaction, as the Obamacare mandate does, is unprecedented, and the law should therefore be thrown out as Congress does not have this power under the Constitution. But given that we are mortals who will eventually get sick and die, we must one day involve ourselves with the health care industry, and Congress has a role in regulating how this involvement is paid for. This has been previously discussed in this space.

Let's talk a bit more about why this distinction is important. We will all eventually get sick and need care. If one decides to not buy insurance, they are really deciding to get their medical care from emergency rooms and to pay for their future medical bills with a combination of savings, borrowing from friends, credit cards and charity. Obamacare says that this combination of decisions, which cause about $43 billion in uncompensated care every year, which is passed on to those of us with insurance, is illegal. The Supreme Court has held in Wickard v Filburn and Gonzalez v Raich that Congress can regulate personal private activity if it causes disruptions in the larger market. In Wickard, it was a farmer who wanted to grow wheat for his own personal use, in violation of 1930's era quotas. In Raich, it was a medical marijuana patient who was growing weed for her own use.

Congress has the right to impose an individual mandate due to the unavoidable involvement of every citizen with the health insurance injury. This is what makes a mandate for health insurance different from a "slippery slope" inspired proposal for a mandate for daily intake of broccoli; biology necessitates involvement with health care, but not broccoli.

Given that choosing to self-insure (through savings/borrowing/credit cards/charity) is just as much economic activity as choosing to buy insurance, I am confident that the Supreme Court will follow precedent and uphold Obamacare.

Obama embraces "Obamacare"

I'm signed up for the e-mail lists for the DNC, Obama for America and other left-leaning organizations. Yesterday, I got an e-mail from "David Axelrod" (which is the name of a bigwig in the Obama campaign) discussing that lefties should be proud to call health reform "Obamacare". I had just posted a similar sentiment the day before. I spent a good 30 seconds thinking that my post had somehow been read by someone at the campaign, and this was an e-mail from the campaign designed to encourage micro-bloggers like myself. I was amazed that the Obama campaign might go through the effort to have a computer program following blogging sites like blogspot.com/blogger.com for posts tagged "Obamacare" and sent a form e-mail in response. Eventually I realized it was a mass e-mail sent to anyone on the e-mail lists of those sites. But for a few seconds yesterday, I had a few seconds of mild delusions of grandeur. I never even considered that Axelrod was actually trolling blogger.com or anything, but I thought that through the miracles of a well-designed social media operation, my humble blog might have been noticed.

Just thought it was a potentially-amusing chain of events.

Obamacare is pretty much the entire reason I'm posting. It's by no means perfect, but it's a huge step in the right direction. To be honest, one of my primary goals with this blog is to convince a few people to go vote for Obama so that health reform will survive to be enacted in 2014. Seems only fair that I inform y'all of this fact.

"Etch a Sketch" as meme

On Wednesday, a Romney senior advisor had this to say about the candidate:



There is some debate amongst prominent columnists as to the significance of the gaffe. Joe Klein at Time Magazine believes it's a disaster on the order of John Kerry's"I voted for it before I voted against it" fumble in 2004. Ezra Klein (no relation) argues that it isn't that big of a deal because it doesn't tell us anything new; we already knew Romney would easily change positions, so this doesn't change anything.

I come down on Joe Klein's side on this. While Ezra's right that it doesn't tell us anything new, the Etch-A-Sketch image makes a convenient, bite-sized summary of Romney's total lack of core convictions on many issues. A low-information voter isn't going to read the awesome article on Romney's abortion stance I linked to last week (have you read it yet? You should!), but they will remember "Romney's the Etch-a-Sketch guy". For famously-wonky guys like Ezra, the image doesn't change his understanding of Romney, but for the average voter, it will make a big difference.

(I'll attempt to do another post this evening on ObamaCare.)

"ObamaCare" ok with me

Usage of the term "ObamaCare" has pretty much been limited to opponents of the Affordable Care Act. I don't really understand why supporters of reform don't use it more. The fate of reform and the fate of Obama are inextricably linked. If Obama loses, most if not all of ObamaCare will vanish. If he wins, the bulk of the reform will kick in as planned in 2014, and it will be next to impossible to get rid of it after that. With millions of voters gaining insurance under the law, taking that coverage away will be extremely difficult politically. Obama and his legacy will sink or swim along with the fate of his signature policy achievement, so he should be proud to have his name attached to it.

While I always care about the outcome of an election, the fate of ObamaCare makes this the most consequential of my lifetime. At its core, reform is an attempt to encourage preventative care. As a primary care pediatrician, I wholeheartedly agree with this goal.

Next week, the constitutionality of the individual mandate will be argued before the Supreme Court, with a decision likely in June. So I'm going to focus more on ObamaCare over the next few posts.

Conservatives lying about ObamaCare costs

Last week, the Congressional Budget Office released a report projecting the costs of ObamaCare over the next 10 years. In 2010, 10 year projections ran from 2010 to 2019, which included 4 years of minimal spending as the exchanges, subsidies and expanded Medicaid which all get up and running in 2014. The new projection runs from 2012 through 2022 (11 years total), with only 2 of those years, 2012/2013, being before the 2014 start date. Not surprisingly, the headline cost of the new projection is significantly higher, given the additional years of actual ObamaCare, as opposed to cheap years before the programs actually start.

The total projected cost in the new analysis (.pdf, Table 2) is $1.76 trillion. In 2010 (.pdf, Table 4), the cost was $940 billion. Here's a graph I made from the CBO numbers that includes every year included in both analyses:

The blue 2010 projection includes those two tiny bars for 2010 and 2011, along with the rest of the decade from 2012-2019. The red 2012 projection includes the same 2012-2019 stretch along with those three big bars for 2020-2022. 91% of the entire cost difference between the two projections is entirely attributable to the different years included in the analyses.

To get a true sense for how the new projection changes the expected costs, let's focus in on the years included in both analyses:

The total costs for these years included in both analyses increased from $933 billion in 2010 to $1.01 trillion in 2012, an increase of $77 billion, or 8.3% of the originally projected cost for these years. Most of this increase is due to more people being poor as a result of the recession and slow recovery and needing government help to afford insurance.

Conservatives have greeted the new report not with reasonable but answerable concerns that the cost has gone up by 8.3%, but to say that "costs have almost doubled". There are multiple writers from multiple organizations making this claim. Even Rep. Tom Price, the #4-ranked GOP house leader, parrots the claim.

This claim is amazingly dishonest. It is comparing apples (2010-2019, 10 years, including 4 with minimal costs) to oranges (2012-2022, 11 years, including only 2 with minimal costs) and asserts that we were somehow misled during the initial passage.

Our system only works if voters are given the information to make decisions on the issues of the day. If one side or the other is willing to make ridiculous assertions like this, the whole thing doesn't work. There are plenty of legitimate criticisms of ObamaCare. The "costs have doubled!" lie isn't one of them.

Trayvon Martin

I've been finding myself wrapped up in the story of Trayvon Martin, a 17 year old boy from Florida who was killed in a struggle with a neighborhood watchman while he was getting snacks down the street from his house, with the shooter not arrested even though he admitted to police he pulled the trigger. Here's the wikipedia page, and here's a summary by CNN of all the info gained from 911 calls and the police report.

So far as I can tell, the undisputed facts of the case are that the shooter, George Zimmerman, pursued Martin because he looked "suspicious" despite having no police authority and having witnessed nothing even approximating criminal behavior, Martin attempted to run away, Martin was an A/B student with no criminal history who was unarmed and had no drugs or stolen property on him, Zimmerman outweighs Martin by 100 pounds, and that Zimmerman shot an unarmed man in the chest.

For Zimmerman's account to make sense, Martin would have had to go out of his way to attack Zimmerman despite Martin knowing, of course, that he had no weapons, drugs or other illegal items in his possession and had done nothing illegal. He would have had to do this despite initially, per Zimmerman's 911 call, running away. Why would he turn and fight a much larger man, instead of running back to his friend's house to enjoy some Skittles and iced tea?

Much is being made of the "Stand Your Ground" law in Florida, which expands one's right to self-defense. It says that one "has the right to stand his or her ground and meet force with force, including deadly force if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself."

Given the facts of the case as thus far presented, it seems clear that Zimmerman at least needs to be arrested. I'm all for innocent until proven guilty. But at the very least, even with the most pro-gun reading of Stand Your Ground, there are multiple reasons to doubt that Zimmerman had a reasonable belief that he was in danger from an unarmed man who was trying to run away and whom he admits chasing despite witnessing nothing illegal. This is something to be determined at a public trial.

Any self-respecting Republican

Transcript of Romney interview

How could a Republican vote for a candidate for commander-in-chief who would respond to questions on a current American war like Mitt Romney did this weekend on Fox News. In only 3 responses, he manages to criticize Obama for having a withdrawal date, suggest the date may need to be moved up, and deny the ability to take a "stand" on the war until he can get more info. We've been there a decade, during most of which he was running for President. That he would claim ignorance on the subject as a way to avoid taking a firm position on what might be a war fought under his leadership demonstrates the man's utter lack of political courage.

Setting a top

The last few years have been defined politically by the Republican Party's breakneck run to the right. While Mitt Romney was considered the "conservative alternative" to the eventual nominee, John McCain. He has continued moving to the right in the intervening four years, but he now finds himself portrayed as a "Massachusetts moderate". The rightward move hasn't been limited to Republicans, such as Obama adopting McCain's "all of the above" energy policy.

Romney now finds himself locked in a protracted struggle for the Republican nomination with Rick Santorum. In 2010, GOP voters nominated a series of poorly organized, extremely conservative candidates for major office like Christine "I'm not a witch" O'Donnell and Sharron "2nd amendment remedies" Angle because they were the most conservative candidates in the primaries, even if they had huge shortcomings as candidates. Candidates who failed to toe the hard-right line were beaten in primaries, and incumbents learned that being perceived as a compromiser would lead to a primary challenge.

In this environment, Romney finds himself matched against Rick Santorum, who pretty much defines hardcore conservativism, at least in the pre-Tea Party era. Without Santorum's glaring weaknesses as a candidate, Santorum would run away with the nomination. This is an electorate that nominated Angle and O'Donnell, after all.

That Romney appears on the way to winning the nomination represents GOP voters setting a limit to how much they value extreme conservativism. While they still appear to prefer Santorum's principles, they recognize that a guy who can't even file complete delegate slates in big primary states won't be able to beat Obama. This is a level of political awareness they didn't seem to have in 2010 where their extreme candidates cost them control of the Senate.

So while Romney is clearly a superior and more-electable candidate, he has to fight Santorum on the latter's ideological turf. Despite being the more moderate candidate, he is winning. In the Tea Party version of the GOP. So it's not surprising that he's not storming his way to victory; that he's winning at all is impressive, given the makeup of the electorate.

Santorum v porn

According to Rick Santorum's website:

Current federal “obscenity” laws prohibit distribution of hardcore (obscene) pornography on the Internet, on cable/satellite TV, on hotel/motel TV, in retail shops and through the mail or by common carrier. Rick Santorum believes that federal obscenity laws should be vigorously enforced. “If elected President, I will appoint an Attorney General who will do so.”

Yikes...

Why is Romney not destroying this guy?

Tomorrow, why Romney is not destroying this guy.

Fantastic article on Romney's abortion record

This article, which appeared on Slate.com last month, is the most thorough and illuminating exploration of a candidate's position, and character, I've ever read. It explores Mitt Romney's progression from pro-choice Senate and governor candidate to a governor who supported federal funding for stem-cell research to a governor who vetoed any abortion bill whether pro-life or pro-choice to a strongly pro-life presidential candidate. He claimed that he had one view-changing epiphany on the matter in 2004, despite taking positions in 2005 and 2006 which were still pro-choice. He has repeatedly, demonstrably lied about his history on the issue, and the article has all the historical proof to prove it.

It's a very long article, but definitely worth a read. If you're only going to read one thing about a candidate, this should be it.

Weekly debates

Ours is a nation in which 18.7 million people tune in to American Idol, which gets three hours of network air every week. 13.3 million watch the average Monday Night Football game. Millions of people listen to Rush Limbaugh and Rachel Maddow discuss the issues of the day. At the same time, our politicians, including Obama and Romney, spend many of their nights raising funds from rich guys in New York. In a campaign that will be marked by billions spent on attack ads, focus groups and lobbying, the actual direct interaction between the nominees will be limited to something like 3 debates of about 90 minutes each.

Why not have weekly debates between the candidates during the entire campaign? With all the time they spend fundraising and glad-handing the rich, couldn't they find an hour or two a week to talk to the American people? By actually interacting with each other, it will be much more difficult for each side to villify their opponent. Forcing Fox News and MSNBC viewers to regularly hear viewpoints from the other side, with their most articulate representatives sharing their views, would be healthy for our democracy.

It's not like you'd have to muddy the process with corporate sponsors. A couple microphones, a camera, a moderator and a set don't cost very much, and C-SPAN already exists as a commercial-free, widely-available platform to carry the program, or they could be broadcast on a rotating basis by the over-the-air broadcasters as a condition of getting their FCC licenses.

These debates would greatly decrease the effectiveness of political advertisements and, therefore, political money. With millions of viewers watching, candidates could respond to smears and force their opponent to stand behind them or refute them. Buying hundreds of hours' worth of 30-second ads when there are only 4-5 hours of direct interaction makes those ads very important to the outcome. They are reduced to a sideshow if voters get an hour a week to hear the candidates directly discuss the issues.

why would newt get out?

coming to you live from sushi 86 in cleveland, so it's an unformatted, uncapitalized post today. sorry. after losing in both mississippi and alabama, which were probably his best shots at winning any more states, there is mounting pressure for newt gingrich to get out of the race. for newt, however, there is no motivation for him to leave. based on his past history, it's reasonable to assume that after the election newt will return to peddling his influence among those in power. over the next several months, those in power will fall in line behind the nominee, and that nominee will almost certainly be mitt romney. it would therefore behoove newt to be on mitt's good side. what does newt have at this point to offer mitt? by staying in the race until romney gets the nomination, newt will continue to drain anti romney votes from santorum. should romney fall short of a majority, newt would likely have accumulated enough delegates, given the system of proportional allocation of delegates (i.e., you don't have to win a state to get a few delegates) to put mitt over the top. we know that newt, being 68 years old, won't be running again, so his standing with the voters doesn't matter. so unless he thinks santorum will be the nominee, newt has no reason to get out, and in fact benefits romney, and therefore himself, by staying in.

Rovian Romney

Karl Rove, the political mind behind George W. Bush's campaigns, was a master of dealing with his candidate's weaknesses and attacking his opponents' biggest strengths. The best example of his approach is attacking John Kerry on his military service record, when Kerry was a decorated veteran and Bush got a coveted spot in the National Guard, far away from Vietnam.

Mitt Romney's campaign took a page from Rove's handbook yesterday by releasing a memo that accuses Obama of trying to "end Medicare as we know it". One of the strongest lines of attack Democrats will have against Republicans is the GOP plan to change Medicare into a voucher system. Romney seeks to blunt this by clouding the issue and creating a false equivalence between Obama's reforms to Medicare under ObamaCare and the Paul Ryan plan to actually end Medicare as we know it.

There's a great discussion of Romney's memo by Brian Beutler at Talking Points Memo. Allow me to summarize (and occasionally expand upon) the main points:

Romney asks "Why is President Obama ending Medicare as we know it by allowing it to go bankrupt in less than 15 years?" The plan Romney advocates holds Medicare funding to the same levels as Obama's plan. So if Obama's plan will allow it to go bankrupt in 15 years, so will Romney's. And there's reason to think the cost-cutting measures in ObamaCare will help the program be more fiscally sound.

Romney also accuses the President of trying to "end Medicare as we know it by funding Obamacare through $500 billion in medicare cuts for today’s seniors". This is because ObamaCare results in cost savings for hospitals, which are the largest providers of services to Medicare beneficiaries. If you show up in a hospital needing care but without insurance, most hospitals will provide care free of charge, or at a reduced rate, and make up the difference by overcharging people with insurance, such as Medicare. ObamaCare will result in millions more people having health insurance, so hospitals won't have to overcharge Medicare as much. Medicare can therefore become cheaper without any benefit cuts for seniors. That Republicans were able to ride this line of attack to majorities in Congress is a failure of our political system.

Romney next attacks the Independent Payment Advisory Board as an "unaccoubtable board to ration care for today's seniors." The IPAB is explicitly set up to find cost savings without affecting coverage or quality. Its goal is to find areas of waste, of which I have seen many examples during my training. Medicare and other insurances pay for treatments which are more expensive than other possible treatments without any known advantage to the more expensive treatment. The IPAB seeks to identify these areas of waste, without harming the care provided to seniors. It will in no sense ration care.

Next up, Romney goes after Obama for going after Medicare Advantage, which is a program in which Medicare gives money to private insurers to provide insurance for seniors instead of getting their coverage straight from the government. The government's average cost of Medicare for an average beneficiary is given to the private company, but the company is allowed to cherry-pick which seniors they want to cover. They pick younger, healthier seniors who are cheaper to insure than the average beneficiary and therefore can pocket the difference. Getting rid of this corporate welfare is a good thing and in no sense ends Medicare as we know it, as it results in no cuts in benefits for seniors.

Romney concludes by dinging Obama over not having a permanent solution to the "doc fix", which is needed due to a mistake previously passed by Congress which results in dramatic underpayments for doctors who care for seniors. While it's true that Obama hasn't proposed a better solution than just spending more money and paying doctors what they should be paid, Romney hasn't proposed a better solution, either.

Nothing Obama proposes results in benefit changes for seniors, while Romney advocates a plan that devastates the ability of future seniors to find care. We can't let him get away with trying to portray himself as a defender of a program he intends to destroy.

Part 3 Addendum

I spent a couple hours yesterday fruitlessly trying to find numbers regarding the actual changes in funding that would come about as a result of Romney's plan to overhaul Medicaid by turning it into a block grant program. Finally found an analysis, from the Center on Budget and Policy Priorities, of a similar plan, one by Paul Ryan which has a slightly different but similar formula to determine funding.

To summarize the analysis, had the policy been put into place in 2000, total federal Medicaid funding, which accounts for up to 80% of all Medicaid funding for a state, would have fallen by 29% in 2009. Were the policy put in place in 2013, it would result in a 49% cut in funding by 2030. By the time most of my readership is approaching the nursing home stage of life, where 60% of current residents are on Medicaid, federal funding would be a tiny fraction of what it would be without the Republicans' change.

Again, it is absolutely legitimate to propose changes to Medicaid to help balance the budget. But it is not a change that should be made with only vague calls to "cut, cap and balance" the budget using historical spending rates to justify it, despite those historical spending rates not including those federal programs that millions of Americans are counting on.

Romney is actually on the right track with the idea to give more power to the states to tailor their Medicaid programs to the needs of their people. But Romney betrays his true goal by how he goes about reforming the program. He will lock funding cuts into the law and THEN hope that states can find the savings to provide their citizens with the help they need. The primary principle that he starts building from is that funding will be cut; continuing to provide necessary services is secondary. Were he to instead empower states first, along with financial incentives for states to find savings, and move to cut funding only after states demonstrate improved efficiency, we would know that he cares about the health of Americans more than slashing the budget. But that's not what he's proposing.

It's a very illuminating distinction.

Cut, Cap and Bullshit, Part 3

Today I continue a review of Mitt Romney's spending proposals, which center on the idea of Cut, Cap and Balance, which seeks to limit federal spending to 20% of GDP, despite the continuing explosion in medical costs, the current federal share of which will approach 20% all by itself in the lifetime of at least some who are reading this post (source).

We have already discussed the implications of the Republican plan to replace Medicare with a voucher system. On Romney's website, he says one of his goals will be to "[p]ass the House Republican Budget proposal, rolling back President Obama’s government expansion by capping non-security discretionary spending below 2008 levels". The House Republican Budget proposal includes the Ryan voucher plan.

Additionally, Romney's website outlines his plan to "reform" Medicaid. Now, Medicaid is often portrayed as free health care for lazy people. But 37% of all pregnancies are supported with Medicaid funds. Fully 60% of current nursing home residents are on Medicaid. Given increasing lifespans and longer dying processes of modern medicine, it seems likely that most of us will wind up depending on Medicaid.

Under the current Medicaid system, states run Medicaid programs which get most of their funding from the federal government. There are various federal rules to which these programs must conform; my experiences with the West Virginia and Ohio programs have therefore been more or less the same.

Romney's plan includes having the federal government give a chunk of money to each state to do with pretty much as they please, instead of the current system of regulations and matching funds. The theory goes that each state will be more free to design a plan that fits the needs of their state, as well as to provide 50 opportunities for experimentation. This is, actually, kind of a good idea, assuming that there are protections to keep Oklahoma and Texas from telling their elderly, children and disabled to fuck off.

The problem comes with Romney's proposal for how much money each state gets. The plan, similar to Ryan's Medicare plan, is to limit the growth of the program to the overall inflation rate, as measured by the Consumer Price Index (CPI), plus one percent. What would this mean for long-term future of Medicaid and, more importantly, for its beneficiaries?

Romney assumes, based on nothing I'm aware of, that states will be able to continue to provide the same benefits to citizens even with much less funding. But what if they don't? Passing these funding limitations will likely lead to massive cuts in these programs, unless the magical state government competence fairy shows up.

Rather than putting these massive cuts in place and just hoping that states are able to create savings, it makes more sense to give states increased flexibility while maintaining funding at current rates, along with financial incentives for states to innovate and save costs. Then, if states are able to find the savings Romney hopes for, we could work on decreasing funding.

So why doesn't Romney do it that way? It's because the real goal is to force huge cuts in these programs and the rest of government (except, of course, for the military). If he were to be honest about the true results of his policies, he'd be laughed out of the race. But by hiding these results, he hopes to sneak into office without voters really knowing what they're voting for.

Cut, Cap and Bullshit, Part 2

Yesterday, I lamented that Mitt Romney and the Republican Party are attempting to make a massive change to the role of government, their Cut, Cap and Balance plan, without informing voters of the implications of that change. Romney's website includes a section on spending. It's quite a document, to say the least, and at least gives us some hints as to the likely damage to the nation that would be done by a President Romney. Let's go through it item by item; this will take a few days:

As president, Mitt’s goal will be to bring federal spending below 20 percent of GDP by the end of his first term. Reduced from 24.3 percent last year; in line with the historical trend between 18 and 20 percent.

You know who never had a year with federal spending below 20% of GDP, per the OMB (.xls)? Ronald Reagan. Neither did Reagan's successor, George Bush. The best either did was 21.2%, in 1989.

Close to the tax revenue generated by the economy when healthy.

That's actually true, per the Excel/.xls link above. Way to go, Mitt!

Requires spending cuts of approximately $500 billion per year in 2016 assuming robust economic recovery with 4% annual growth, and reversal of irresponsible Obama-era defense cuts

The $500 billion number is pretty accurate, based on the OMB .xls data above. The 4% annual growth number is optimistic for the next few years, given that in the past 11 years we have only just barely touched 4% briefly in 2004.

Romney intends to cut $500 billion without touching the ridiculously-bloated military budget. We're in such terrible financial straits that we have to make all the draconian cuts that we'll discuss, but we MUST continue to spend 450% more than our nearest competitor, apparently.

Tomorrow, we'll look at Romney's plan to devastate Medicaid and Medicare, which millions of Americans depend on for their health. But we can't touch even one penny of the military budget!

Cut, Cap and Bullshit, Part 1

In Mitt Romney's primary night speeches, he regularly reiterates his support for the "cut, cap and balance" plan. According to the reasoning of this plan as elucidated on Romney's website, we should cap federal spending at 20% of Gross Domestic Product "because since the 1950s, federal spending as a percentage of GDP has hovered around 20 percent.." The following graph, which I made based on data from the Office of Management and Budget (.xls), shows the percentage of GDP spent by the federal government each year starting in 1950 and ending with projections through 2017:



Cut, Cap and Balance sounds good in theory. If 20% has worked for the past 60 years, it should work into the future, right? But this ignores that most Americans expect the government to help pay for their health care when they get old or disabled, and the costs of that care for the federal budget will explode in our lifetimes. The Government Accountability Office projects that the federal government's share of health spending will grow to 20% of GDP all by itself by 2080.

It's perfectly legitimate to argue for a 20% spending cap. But the way Republicans present it as an abstract concept without informing voters of the true implications of such a cap is dishonest. Over the next few posts, I'll look at various issues involved in bringing spending to this limit.

A mandated free lunch?

I continue to read conservative columnists/bloggers attacking the contraceptive mandate on the grounds that there's no such thing as a "free lunch". But of course, it's not free, because in order to get your "free" lunch (health insurance including contraception), you're giving up a similarly priced but worse lunch (health insurance without contraception) to get it, as previously discussed.

One of the better conservative arguments I've read on the subject was on The Health Care Blog. The author points out that "If insurers saved money handing out contraception for free in the first place, they would have started to hand it out for free years ago."

So why don't they? It has to do with how long a beneficiary is with a particular health insurer. I honestly had a lot of trouble finding a statistic for that, so let's look at the average time a worker spends working a particular job; I think it works as a stand-in given that most people get their insurance through their employer. This article from the Wall Street Journal estimates that the typical worker will spend 4.1 years.

With that fact in mind, a health insurance company doesn't give a shit about how expensive your health care will be 5 years from now. This undoubtedly skews the cost-benefit analysis of insurance companies on the question, if they don't have to worry about health costs for health care during school years for the children who result from their limited coverage. More generally, it's also why there are still health insurance companies that don't pay for other preventative measures like the HPV vaccine, or as I describe it to patients, the cervical cancer vaccine. If you're not the insurer that is responsible of paying for a lifetime of Pap smears and a possible bout of cancer, it's not in your interest to pay the hundreds of dollars to provide the HPV vaccine.

For an individual insurance company, giving free contraception might not make any sense, because they would probably lose money. But if every insurer does it, the costs throughout the entire system go down. This is why the ObamaCare mandate includes a requirement for contraception and other preventative services without a copay.

The fractal primary campaign

I've always liked fractals. From Wikipedia, "Fractals are typically self-similar patterns, where self-similar means they are "the same from near as from far."

The defining state primaries of this season have been microcosms of the larger race. The overriding story of the entire campaign has been the steady stream of flavors of the month who rise up to challenge Romney, only to have Romney overwhelm them with superior resources. Santorum rose up in Iowa only to be smacked down in the next several races. Gingrich won in South Carolina only to be devastated by negative ads in Florida. Santorum racked up impressive but delegate-poor wins in the Midwest a few weeks ago only to lose in a heads-up match in Michigan.

Last night's Super Tuesday elections were another example of the self-similar campaign. At the start of the night, as at the start of the campaign, Romney was looking like a prohibitive favorite. He won big in Virginia, thanks to poor organization by his opponents resulting in only Ron Paul appearing on the ballot alongside him. He also won early wins in Massachusetts and Vermont. But his early momentum was blunted by fairly early wins by Santorum in Tennessee, Oklahoma and North Dakota. I found myself thinking that Santorum might actually carry the night, if he could maybe carry Ohio and Alaska, with Paul perhaps winning the caucuses in Idaho. But, as he's vanquished quick-rising challengers before, Romney wound up carrying a majority of delegates awarded on the night, including a close win in Ohio.

Zooming in on the fractal campaign even more reveals more self-similar patterns in the Ohio results. Romney led early in the night, only to have Santorum overtake him and lead for much of the night. Santorum was doing well among the rural, more conservative counties, while Romney was winning big in Cuyahoga and Hamilton counties, which are urban, usually Democratic areas (zooming out briefly, most of the states Romney has won were also blue states won by Obama in '08). Romney ultimately overtook Santorum just after 11pm last night, just as he pulled ahead of Santorum in the polls in the few days right before the election.

Projecting the patterns of the campaign forward, it appears even more clear that Romney will ultimately be the nominee. By preventing Santorum from getting any momentum-building surprise wins while also racking up a majority of the delegates, Romney continues his solid but not awe-inspiring performance. He will continue to use his superior resources to go on to victory, but it won't be overwhelming. He's probably going to struggle in the upcoming elections in Alabama, Mississippi, Hawaii, Kansas, Missouri, Illinois and Lousiana, with Gingrich likely doing well in the South, Santorum in the Midwest, and Ron Paul at the caucus in Hawaii.

False equivalence

I'd been mentally preparing a post about the false equivalence some conservatives are drawing between Rush Limbaugh's recent comments and those made by liberals like Ed Schultz or Bill Maher, with Schultz calling Laura Ingraham a slut and Maher calling Sarah Palin a, well, a word I don't even like to type but that starts with C. But Josh Marshall over at TalkingPointsMemo.com beat me to it, so give it a read.

Please vote (carefully)

It's Election Day in Ohio, where most of my readership resides, so I'll be brief. I'd just like to remind you that you don't have to vote in every single race on the ballot. If you don't know anything about either candidate running for probate judge or whatever, just leave it blank. "Random" voting is how Cuyahoga County winds up with tons of judges with Irish names and 4 named Russo. So find a voter guide from your local newspaper and do a bit of reading before heading to the ballot box. Or just vote for the issues and more major offices.

Romney's unexplained conservativism

After a two-day detour to Rush-ville, we're back to talking about Romney's lack of biographical explanation for his 20 year rightward trend. Apart from naked political ambition, there is no other justification given for his conservativism, and I think that's most of the reason that the Right hasn't embraced him. With Rick Santorum, you understand the source of many of his views. For instance, he caught a lot of flak for coming out against prenatal testing, on the grounds that it would encourage abortions if a disease such as Down Syndrome is discovered. Given that Santorum has a daughter with Trisomy 18 (extra copy of chromosome 18, where Down Syndrome is an extra copy of chromosome 21), his views on the issue make sense.

If Romney had a similar story, conservatives could trust him more. As it is, we have statements from all over the map over the past 20 years. Even recently, he has occasionally made statements that call his conservativism into doubt, such as his initial statement opposing the Blunt amendment or his recognition that cutting spending would at least temporarily slow the economy. If he's elected President, how could anyone, conservative or liberal, claim to know what Romney will do when it really matters. He might return to his more moderate/liberal roots when the fate of the world is at stake.

For a movement demanding ideological purity, like the Tea Party, you have to have either a long history of demonstrated adherence to dogma, or a biographical explanation to justify your lack of such a record. Romney has neither, and because of it he is incapable of being truly accepted by the GOP.

Rush's utterly inadequate apology, continued

In Part 1, we started breaking down Rush's "apology" which fails to show any actual contrition. Now, the thrilling conclusion:

Where do we draw the line? If this is accepted as the norm, what will follow? Will we be debating if taxpayers should pay for new sneakers for all students that are interested in running to keep fit?

Well, yeah! If you can save $100 in health care spending by spending $50 on shoes, it would be silly to not do it. But that's more of an argument about the issue, not Rush's insult, so it's not particularly relevant. Except that Rush took over half of his "apology" to defend his position on the issue, not to just apologize and move on. Rush continues:

In my monologue, I posited that it is not our business whatsoever to know what is going on in anyone's bedroom nor do I think it is a topic that should reach a Presidential level.

Again, it's not our side that sought to carve out special rules for one particular type of medicine. And it's not only a matter of anyone's bedroom. Rush, Georgetown and other conservatives are unreasonably focused on the sexual/reproductive aspect of these medications. As Ms. Fluke testified, and as Kerri pointed out on Facebook, there are other reasons for a woman to need hormonal therapy. Rush concludes:

My choice of words was not the best, and in the attempt to be humorous, I created a national stir. I sincerely apologize to Ms. Fluke for the insulting word choices.

Rush seems to think that the only thing he's done wrong here is using the particular words "slut" and "prostitute". It is the choice to personally attack a young woman, and that he demonstrates a complete lack of knowledge of the subject. It was not a poor word choice, but a conscious decision to repeatedly, over the course of several days, slander an honorable woman who has done nothing more than passionately advocate for her classmates.

His demonstrated lack of understanding of what he has done wrong, and his failure to show true contrition, makes his "apology" meaningless. I will continue to boycott any and all of his sponsors, as well as Clear Channel radio stations, until he shows actual understanding, gives a real apology, and takes steps to keep from repeating the behavior in the future.

Rush's utterly inadequate apology

Within a few hours of yesterday's post, Rush issued an "apology". Guess he just didn't think he could stand the heat now that The Political Doctor was on the scene!

Let's go through Rush's "apology":

For over 20 years, I have illustrated the absurd with absurdity, three hours a day, five days a week. In this instance, I chose the wrong words in my analogy of the situation.

This was not a matter of just wrong words. It's not like the only things wrong with his statement were the "slut" and "prostitute" words. He chose to 1) show his ignorance of the issue by thinking that because someone might have more or less sex, that they'd have to spend more or less on birth control, 2) blatantly mischaracterize Ms. Fluke's testimony by saying she talked about needing contraception coverage because she has so much sex, not that her classmates had medical issues that required hormone therapy that they were unable/dissuaded from getting due to Georgetown's policy, and 3) to continue and indeed escalate the personal attacks for the next several days, only backing off when a backlash to his comments led to a boycott that hit him in the pocketbook. Continuing on:

I did not mean a personal attack on Ms. Fluke.

Calling someone a prostitute and a slut who has too much sex and needs to keep her knees together is a strange way to show you don't mean a personal attack. He absolutely meant to attack this woman, and he should own up to it. Something like a "It was absolutely wrong of me to attack Ms. Fluke in this way. I am working with my therapist/minister/whatever to address my own issues which contributed to this. I will make an $x donation to the charity of Ms. Fluke's choice and suspend myself from my EIB (his production company) broadcast for y weeks" would actually show remorse, not these empty words. Rush continues:

I think it is absolutely absurd that during these very serious political times, we are discussing personal sexual recreational activities before members of Congress.

It is not our side that brought personal "sexual recreational activities" into the argument. ObamaCare established a principle that any and all preventative medical therapies which are justified by the medical literature, common medical practice, and the decisions patients make with their doctors should be covered without a copay. It is Republicans/conservatives who raised the need for an exception in the case of birth control, even though someone's personal health choices can't damn someone else to hell. Moving on:

I personally do not agree that American citizens should pay for these social activities.

So fucking what? Even if taxpayers didn't want to cover your oxycontin or your cochlear implant that you needed as a result of your addiction, it's none of their business. Not to mention these insurances are paid for by the beneficiary via their work, or, in the case of Georgetown Law School, not paid for in any way by anyone but cash from the beneficiary.

What happened to personal responsibility and accountability?

What Republicans are advocating is a prohibition on a private citizen and her health insurance company from making a change to their agreement, without the citizen's employer needing to be involved at all, to cover contraception instead of pregnancies and babies and surgeries for huge ovarian cysts caused by untreated polycystic ovary syndrome. Ms. Fluke was advocating for the right to change one's own, personal policy.

That's the halfway point of Rush's "apology", and I've gotta go to the maple sugar festival in Burton, Ohio, Pancake Town USA. So we'll finish the other half when I get back this afternoon.

Rush needs to go

Rush Limbaugh is by most objective measures an awful human being. But he outdid himself this week, and his sponsors need to be boycotted until he is off the air. And, frankly, I think this could be a controversy that could have major repercussions for the Republican Party as a whole. Here is a description of the controversy from Rush himself.

To briefly summarize, a Georgetown (Jesuit/Catholic university in Washington, DC whose health insurance policy doesn't cover contraception) law student named Sandra Fluke testified before Congress about the hardships faced by classmates who need hormone therapy for conditions like polycystic ovary syndrome. Rush responded by saying:

"What does it say about the college co-ed Sandra Fluke, who goes before a congressional committee and essentially says that she must be paid to have sex, what does that make her? It makes her a slut, right? It makes her a prostitute. She wants to be paid to have sex. She's having so much sex she can't afford the contraception. She wants you and me and the taxpayers to pay her to have sex. What does that make us? We're the pimps."

Let's forget for the moment that Rush seems to think that you'd need to pay more for contraception if you have more sex, which is true for condoms but not for most forms of contraception. Ms. Fluke was testifying about the medical conditions of her friends and colleagues and the health implications for them if Republican policies were put in place. Rush responded with the most blatant case of slander in the history of the world.

He is a monster. He has no place in civil discourse and has no business broadcasting across the country. This is not a matter of an off-color joke that got out of hand. He has continued to slander Ms. Fluke for the rest of the week. He also said to Ms. Fluke "and the rest of you Feminazis, if we're going to pay for your contraceptives and thus pay for you to have sex, we want something for it. We want you to post the videos online so we can all watch." He also offered to pay for "as much aspirin to put between their knees as they want," echoing comments by Santorum big-money supporter Foster Friess, previously discussed here.

THE FOLLOWING LINKS CONTAIN SEXUALLY EXPLICIT IMAGES! DON'T CLICK ON THESE LINKS AT WORK! DON'T CLICK ON THESE LINKS AT WORK! By the way, someone really needs to educate Rush, Friess and the rest of their ilk that just because you keep your knees together doesn't mean you can't get pregnant. DON'T CLICK ON THESE LINKS AT WORK! DON'T CLICK ON THESE LINKS AT WORK!

Rush's comments betray the true feelings of many (though not all, I'll grant) who oppose Obama's plan to ensure quality preventive health care for all Americans. An ongoing boycott of Rush's advertisers can allow the huge majorities of people in this country who use and/or support the use of contraceptives to rake Rush and his ilk over the coals on this issue, which is more fundamentally important to many women than any other issue of the campaign.

Rush is constitutionally incapable of apologizing or ever admitting he is wrong. He will continue to insist that Ms. Fluke and women like her are "sluts" and "prostitutes" because they use contraception, and given his status in the conservative movement, millions of conservatives will continue to defend him. By keeping the issue in the news, Rush will take the Republican Party down with him.

Here's a list of sponsors of Rush's program:
Carbonite
Lending Tree
LifeLock
ProFlowers
Sears
TaxResolution

Please comment if you know of other sponsors.

Romney needs some tragedy

Mitt Romney is, objectively, a political chameleon. In 1994, when liberal Republicans still roamed New England, he tried to out-liberal Teddy Kennedy, tellling (.pdf) the Log Cabin Republicans that "as we seek to establish full equality for American's gay and lesbian citizens, I will provide more effective leadership than my opponent," and "we must make equality for gays and lesbians a mainstream concern. My opponent cannot do this. I can and will." Then in 2002, as the old concept of the moderate-liberal Yankee Republican was in its death throes, Romney tacked to the right and was elected as a moderate governor. Once he decided he would run for President, he continued moving rightward, pulling out of a multi-state cap-and-trade program and being a pro-life governor despite running as a pro-choice candidate. In the 2008 campaign, he ran as a center-right candidate, just to McCain's right. This time around, after the rise of the Tea Party, he portrays himself as "severely conservative".

It would be one thing if Romney had a great personal story to help voters understand his political shifts, with moments of crisis leading to changes in his views. But instead Romney projects the image of a man who has never had any tragedy in his life at all. He was born to a father who ran a large auto company and later became governor and a mother who was a candidate for U.S. Senate in 1970. He went to good schools and wound up making hundreds of millions in venture capital. He's been married for 42 years and has five good-looking sons and five good-looking daughters-in-law.

As a reasonably informed voter, I am not aware of any true moment of crisis in his entire life. Instead of a compelling personal narrative that would explain his growing conservativism, he appears as an out of touch rich guy who makes $10,000 handshake bets, hangs out with NASCAR team owners, owns multiple Cadillacs, and pays a lower tax rate than most Americans. His political shifts therefore appear nothing more than callow political opportunism.

Bluntly ridiculous

Today, the Senate voted down an amendment to ObamaCare put forth by Sen. Roy Blunt (R-MO). The Blunt amendment (.pdf) would have allowed any employer to refuse to cover any health care service just by saying the service is "contrary to the religious beliefs or moral convictions of the sponsor" of the plan. Were the amendment adopted, there would be absolutely no restriction placed on which services an employer can refuse to cover. They could refuse to cover diabetes, blood pressure and cholesterol medicines because to do so would encourage gluttony and sloth. They could refuse to cover HIV testing and treatments because they believe AIDS was sent by God to destroy the homosexuals. They could refuse to cover antibiotics because fuck you that's why.

Now, it's true that an employee could choose to quit and find a new job that has better coverage. But switching jobs isn't easy. It takes months to find a new job. If you've got a medical condition that requires care, you might not have months to wait.

This all comes back to your health insurance being an earned benefit, just like your paycheck, with which you can do what you want without endangering anyone's immortal soul. 48 senators, including 45 of 46 Republicans who cast a vote, chose to stand on the side of the rich people with the shitty argument who are not materially affected by the issue instead of the people whose very health and survival depend on having access to medical care. We'll see if there's a political price to pay.