Kevin Drum

More Good News: Obamacare Has Not Overwhelmed the Health Care System

| Wed Apr. 1, 2015 11:20 AM EDT

Obamacare has provided health insurance to millions of people who previously lacked it. And yet, doctors' offices aren't jammed, as some people feared. Sarah Kliff takes a look at why this is, and I think this is the key point:

Federal data released earlier this month shows that the uninsured rate has fallen 35 percent since the coverage expansion began in 2014....In that way, the health law's insurance expansion was big. But put another way, it's also small: 14 million people gaining coverage in a country of more than 300 million residents is kind of a drop in the bucket. We're talking about 4 percent of the country going from uninsured to covered.

And it's not just that. Of that 4 percent, a lot of them were healthy people who simply didn't have much need for medical attention but were forced by the Obamacare mandate to purchase insurance anyway. So they got insurance, but since they were healthy, they still didn't go in to see their new doctors much. In reality, I suspect that the number of new patients with real medical needs probably amounted to 2-3 percent of the population. That's an extra burden on the health system, but not a huge one.

Medicare turned out to be similar when it began in 1965. As Kliff says, "In practice, these programs are relatively small: each only insured a small chunk of the population. Even though they're remaking American health care, they're doing so in a small, slow progression. That helps explain why none of these coverage expansions have overwhelmed doctors, despite our expectations."

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IS Expansion Is More Illusion Than Reality

| Wed Apr. 1, 2015 10:58 AM EDT

Islamic State has been getting a lot of attention lately, and not just for its grisly beheading videos coming out of Iraq and Syria. It also seems to be expanding rapidly, with offshoots taking credit for atrocities across northern Africa and the Middle East. But the LA Times wisely suggests today that this should all be taken with more than a pinch of salt:

Like an accelerating drumbeat, the deeds of groups purporting to be linked to Islamic State have mounted, each seemingly designed to exact a toll more cruel than the last....But many intelligence officials and academic experts are skeptical that the parade of gore represents a leap in the degree of command and control being exerted across the region by the group's leadership in Syria and Iraq.

....Some evidence points instead to looser arrangements that nonetheless carry significant benefits for Islamic State and its professed offshoots....Under such informal pacts, opportunistic but relatively obscure militant groups can make themselves appear to be far more powerful players in their chosen arena of conflict, while the media-savvy Islamic State can depict itself as having dramatically widened its geographic spread, an assertion that fits neatly with the group's grandiose claim that its "caliphate" is destined to hold sway across the Muslim world, while also diverting attention from its struggle to hang on to territory seized in Iraq and Syria.

There are homegrown terrorist groups all over the Middle East. Most of them have local grievances, but nonetheless find it useful to be viewed as an ally of a group like IS, which has a useful reputation for extreme brutality. Likewise, IS benefits from a public image of massive, unstoppable growth.

But both are more illusion than reality. Neither the amount nor the target of terrorist activity has changed much over the past year. We're just seeing the publicity results of a very loose "franchise" model combined with a lot of bluster, much as we did with Al Qaeda in the past decade. There's much less here than meets the eye.

That's not to say there aren't some dangers inherent in this model, and the Times does a good job of spelling them out. Generally speaking, though, IS remains in serious trouble in its home territory, and no amount of PR alliances elsewhere really changes that.

Quote of the Day: Republicans Hate Obamacare Except for the Parts They Don't

| Tue Mar. 31, 2015 11:19 PM EDT

From Republican Rep. Cathy McMorris Rodgers, who asked for horror stories about Obamacare and was instead deluged with stories from people who have been helped by it:

The stories are largely around pre-existing conditions and those that are getting health insurance up to age 26.

Well, sure. Everyone likes the idea of making sure that people with pre-existing conditions can get health insurance. Unfortunately, as Greg Sargent points out, Republicans can't just say they support Obamacare's pre-existing conditions provision but oppose the rest of it:

It’s true that Republicans tend to support provisions like the protections for preexisting conditions; after all, they are very popular. But they can’t be tidily untangled from the law. The ACA’s protections for preexisting conditions rely on the individual mandate, because without it, people would simply wait until they got sick to sign up for insurance, driving up premiums; instead, the mandate broadens the risk pool. And the mandate requires the subsidies, so that lower-income people who’d face a penalty for remaining uninsured can afford to buy coverage.

This is something that Republicans steadfastly refuse to admit, even though it's obvious to everyone with even a passing knowledge of how this stuff works. Sargent has more at the link about how this ties into the King v. Burwell lawsuit and Republican claims that they want to replace Obamacare with something better.

If Hillary Clinton Testifies About Her Emails, She Should Do It In Public

| Tue Mar. 31, 2015 4:12 PM EDT

Here's the latest on Hillary Clinton's emails:

The chairman of the House committee investigating the Benghazi attacks asked Hillary Rodham Clinton on Tuesday to appear for a private interview about her exclusive use of a personal email account when she was secretary of state.

....Mr. Gowdy said the committee believed that “a transcribed interview would best protect Secretary Clinton’s privacy, the security of the information queried, and the public’s interest in ensuring this committee has all information needed to accomplish the task set before it.”

Go ahead and call me paranoid, but this sure seems like the perfect setup to allow Gowdy—or someone on his staff—to leak just a few bits and pieces of Clinton's testimony that put her in the worst possible light. Darrell Issa did this so commonly that it was practically part of the rules of the game when he was investigating Benghazi and other Republican obsessions.

Who knows? Maybe Gowdy is a more honest guy. But since Clinton herself has offered to testify publicly, why would anyone not take her up on it? It's not as if any of this risks exposing classified information or anything.

Ditch the Keyboard, Take Notes By Hand

| Tue Mar. 31, 2015 11:45 AM EDT

Joseph Stromberg reports on recent research suggesting that taking notes by hand is way better for students than taking notes on a laptop:

The two groups of students — laptop users and hand-writers — did pretty similarly on the factual questions. But the laptop users did significantly worse on the conceptual ones.

The researchers also noticed that the laptop users took down many more words, and were more likely to take down speech from the video verbatim....As a final test, the researchers had students watch a seven-minute lecture (taking notes either on a laptop or by hand), let a week pass, then gave some of the students ten minutes to study their notes before taking a test.

Having time to study mattered — but only for students who'd taken notes by hand. These students did significantly better on both conceptual and factual questions. But studying didn't help laptop users at all, and even made them perform slightly worse on the test.

The researchers explain this by noting previous research showing the act of note-taking can be just as important as a later study of notes in helping students learn. When done with pen and paper, that act involves active listening, trying to figure out what information is most important, and putting it down. When done on a laptop, it generally involves robotically taking in spoken words and converting them into typed text.

Makes sense to me. No matter how good a typist you are, writing by hand is a more natural process that doesn't engage your entire brain—but it's also slower. You have to figure out what's being said and how to paraphrase it, and that act is part of learning. Rote note taking isn't.

Plus of course laptops are distracting. So put 'em away. Use the Cornell system if you want a system. But either way, use pen and pad, not keyboard and mouse.

Yemen "On the Verge of Total Collapse"

| Tue Mar. 31, 2015 10:54 AM EDT

As expected, things are going from bad to worse in Yemen:

The United Nations’ human rights chief, Zeid Ra’ad al-Hussein, warned on Tuesday that Yemen was on the brink of collapse, as his office said that heavy fighting in the southern port city of Aden had left its streets lined with bodies and its hospitals full of corpses.

....Houthi forces were reported to have forced their way into Aden’s northeastern suburbs despite airstrikes by the Saudi Air Force and a naval blockade intended to sever the flow of weapons and other supplies to Houthi forces.

Well, perhaps the pan-Arab military force announced a few days ago will restore order? Unfortunately, Laura King of the LA Times reminds us that the last time Arabs fought together was during the 1973 war—which ended in disaster:

Now, nearly 50 years later, Arab states are joining forces again — this time, with the immediate aim of restoring order in chaotic Yemen, and moving as well to quell other regional conflicts.

But analysts say the nascent military alliance, whose planned formation was announced over the weekend by Arab leaders meeting in Egypt, could usher in new regional crises and intensify existing ones, sharpening sectarian differences between Sunni and Shiite Muslims and complicating already tangled national conflicts.

Yemen, whose tribes have for centuries been hostile to outsiders, could prove a deadly quagmire if conventional infantries from elsewhere in the Arab world attempt to wage a ground war against a homegrown, battle-hardened guerrilla force, the Shiite Muslim Houthi rebels. And a momentary sense of unity among Arab comrades-in-arms may fade as their sometimes-conflicting agendas come to the fore.

Read the whole thing. If it wasn't obvious already, King's piece makes it clear that the various Arab actors all have different goals and different agendas in Yemen. This is not likely to end well.

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Yes, Jeb Bush and Scott Walker Are Different Kinds of Conservatives

| Mon Mar. 30, 2015 1:13 PM EDT

Jeb Bush may project a warmer, fuzzier, less hardnosed conservatism than Scott Walker, but is there really much difference between them? Greg Sargent isn't so sure:

Here’s what I’ll be watching: How will this basic underlying difference, if it is real, manifest itself in actual policy terms? On immigration...both support eventual legalization only after the border is secured. Will their very real tonal difference show up in real policy differences?

On inequality, Walker may employ harsher rhetoric about the safety net than Bush does, but the evidence suggests that both are animated by the underlying worldview that one of the primary problems in American life is that we have too much government-engineered downward redistribution of wealth....Will Walker and Bush differentiate themselves from one another in economic policy terms in the least?

Ed Kilgore agrees:

The important thing is not assuming Bush and Walker represent anything new or different from each other just because they offer different theories of electability and different ways of talking to swing and base voters. Much of what has characterized all the recent intra-party "fights" within the GOP has reflected arguments over strategy and tactics rather than ideology and goals. I'd say there is a rebuttable presumption that will continue into the 2016 presidential contest.

You'd think that the way to get a grip on this question would be to look at the 2000 election. Jeb's brother, George W. Bush, ran as a "compassionate conservative," and during the campaign he even made good on that. Remember his criticism of a Republican proposal regarding the EITC: "I don't think they ought to be balancing their budget on the backs of the poor"? Compassionate!

So how did that work out? Well, that's the funny thing: it's hard to say. Liberals tend to see Bush as a hardline conservative, but that's mainly because of the Iraq War and Karl Rove's hardball electoral tactics, which drove us crazy. Conservatives, by contrast, don't believe he was really all that conservative at all. And I think they have a point. In fact, I made that case myself way back in 2006 in a review of Bruce Bartlett's Imposter:

Bush may be a Republican—boy howdy, is he a Republican—but he's not the fire-breathing ideologue of liberal legend.

Don't believe it? Consider Bartlett's review of Bush's major domestic legislative accomplishments. He teamed up with Ted Kennedy to pass the No Child Left Behind Act, which increased education spending by over $20 billion and legislated a massive new federal intrusion into local schools. He co-opted Joe Lieberman's proposal to create a gigantic new federal bureaucracy, the Department of Homeland Security. He has mostly abandoned free trade in favor of a hodgepodge of interest-group-pleasing tariffs. And after initially opposing it, Bush signed the Sarbanes-Oxley bill with almost pathetic eagerness in the wake of the Enron debacle, putting in place a phonebook-sized stack of new business regulations.

Want more? He signed the McCain-Feingold campaign finance bill, a bête noir of conservatives for years. His Medicare prescription-drug bill was the biggest new entitlement program since the Great Society. He initially put a hold on a wide range of last-minute executive orders from the Clinton administration, but after a few months of "study" allowed nearly all of them to stand. And he has increased domestic discretionary spending at a higher rate than any president since LBJ.

Obviously there's more to Bush's record than this—tax cuts, judicial appointments, the Iraq War, etc.—and he certainly counts as a conservative when you look at his entire tenure in office. The question is whether there's a difference between his brand of conservatism and, say, Scott Walker's or Ted Cruz's. I'd say there is, and that there's probably also a difference between Jeb Bush's brand of conservatism and the harder-line folks represented by Walker, Cruz, Santorum, and others. Tonal shifts and tactical choices often turn into real differences in who gets appointed to various cabinet positions and which priorities a new president will set. Jeb Bush is obviously no liberal. But would he govern differently than Scott Walker? My guess is that he would.

I Have a Pseudo-Flu

| Mon Mar. 30, 2015 12:44 PM EDT

When I was told that my daily injections of Neupogen would give me "flu-like symptoms," I wondered what that meant. Well, last night it meant that I felt a lot like I had the flu. I felt crappy indeed.

But there's some good news! "We want you to feel bad," my doctor told me last week a little apologetically. That means the drug is working. (That is, it's producing white blood cells and my body is reacting as if there were some kind of virus that had triggered this production.) So I guess it's working. Hooray!

I feel a little better this morning, but then, I usually feel a little better in the mornings. So we'll see how things go. It's just one thrill ride after another these days.

Sorry Mike, Indiana Is Neither Kind Nor Welcoming to Gays Anymore

| Mon Mar. 30, 2015 12:05 PM EDT

George Stephanopoulos tried really hard on Sunday to get Indiana Gov. Mike Pence to clarify the intent of his state's shiny new religious freedom bill. It didn't go well:

Stephanopoulos: I'm just bringing up a question from one of your supporters talking about the bill right there. It said it would protect a Christian florist. Against any kind of punishment. Is that true or not?

Pence: George, look....You've been to Indiana a bunch of times. You know it. There are no kinder, more generous, more welcoming, more hospitable people in America than in the 92 counties of Indiana. Yet, because we stepped forward for the purpose of recognizing the religious liberty rights of all the people of Indiana, of every faith, we suffer under this avalanche for the last several days of condemnation and it's completely baseless.

....Stephanopoulos: So when you say tolerance is a two-way street, does that mean that Christians who want to refuse service, or people of any other faith who want to refuse service to gays and lesbians, that's legal in the state of Indiana? That's a simple yes or no question.

Pence: George, the question here is, is if there is a government action or law that a individual believes impinges on their freedom of religion, they have the opportunity to go to court....This is not about disputes between individuals. It's about government overreach. And I'm proud that Indiana stepped forward. And I'm working hard to clarify this.

But it turns out this isn't quite true. Indiana's RFRA really is different from most others. Garrett Epps explains:

The Indiana statute has two features the federal RFRA—and most state RFRAs—do not. First, the Indiana law explicitly allows any for-profit business to assert a right to “the free exercise of religion.”....What these words mean is, first, that the Indiana statute explicitly recognizes that a for-profit corporation has “free exercise” rights matching those of individuals or churches. A lot of legal thinkers thought that idea was outlandish until last year’s decision in Burwell v. Hobby Lobby Stores, in which the Court’s five conservatives interpreted the federal RFRA to give some corporate employers a religious veto over their employees’ statutory right to contraceptive coverage.

Second, the Indiana statute explicitly makes a business’s “free exercise” right a defense against a private lawsuit by another person, rather than simply against actions brought by government. Why does this matter? Well, there’s a lot of evidence that the new wave of “religious freedom” legislation was impelled, at least in part, by a panic over a New Mexico state-court decision, Elane Photography v. Willock. In that case, a same-sex couple sued a professional photography studio that refused to photograph the couple’s wedding. New Mexico law bars discrimination in “public accommodations” on the basis of sexual orientation. The studio said that New Mexico’s RFRA nonetheless barred the suit; but the state’s Supreme Court held that the RFRA did not apply “because the government is not a party.”

Remarkably enough, soon after, language found its way into the Indiana statute to make sure that no Indiana court could ever make a similar decision. Democrats also offered the Republican legislative majority a chance to amend the new act to say that it did not permit businesses to discriminate; they voted that amendment down.

Hoosiers may indeed be the kindest and most welcoming folks in the country, but that cuts no ice in court. In court, any business can claim that it's being discriminated against if it's forced to sell its services to a gay couple, and thanks to specific language in the Indiana statute, no court can throw out the claim on the grounds that a business is a public accommodation.

That's different from other RFRAs, and it's neither especially kind nor welcoming. Indiana has taken anti-gay hostility to a new and higher level, and Pence and his legislature deserve all the flack they're getting for it. They should be ashamed of themselves.

On the other hand, if you're thinking of running for president, I guess it's a great entry in the base-pandering, more-conservative-than-thou sweepstakes. So at least Pence now has that going for him.

The US Has No Clean Battle Lines in the Middle East

| Sun Mar. 29, 2015 11:11 AM EDT

From The Corner:

The United States is sending mixed signals to its allies in the Middle East by simultaneously giving support to the Saudi-led Sunni coalition fighting in Yemen and negotiating with Shiite Iran on its nuclear program, according to NBC chief foreign correspondent Richard Engel.

Engel pinpoints an apparent contradiction: Even as the U.S. is assisting Saudi Arabia and other nations in “confronting the Iranian-backed rebels in Yemen” by providing intelligence and other support, it continues to negotiate with Tehran on its nuclear program, and to collaborate with Iranian forces in the fight against the Islamic State in Iraq.

As a result, Engel says, “the Saudis, and the larger Sunni Muslim world, doesn’t [sic] feel the U.S. can really be trusted.”

Gee, no kidding. Saudi Arabia is a Sunni ally of the US that hates Iran. Iraq is a Shiite ally who's cozy with Iran. The US itself is hostile toward Iran, but shares a common enemy in ISIS. Syria is a total mess with no clear good guys. And, yes, a good nuclear deal with Iran would be a bonus for the safety of the entire region.

That's it. That's the way the world is. The United States is not allied solely with Shiite or Sunni regimes and hasn't been since at least 9/11. It's confusing. It's messy. And maybe President Obama hasn't handled it as skillfully as he could have. But who could have done any better? There just aren't any clean battle lines here, and the sooner everyone faces up to that, the better off we'll be.