One person's experience with “If you like your health insurance, you can keep it.”

David Frum has recently written a column on The Daily Beast’s site, dated Oct. 29, 2013, entitled “The Obamacare Ripoff: More Money for Less Insurance,” and beginning with the following header:

The president said over and over again that if I liked my health insurance I could keep it. Now I'm one of the thousands of people with canceled policies.

The actual text of the posting follows:

It's always exciting to be part of a chapter in American history. I happen to be one of the hundreds of thousands of people whose insurance coverage was canceled for not complying with the terms of the Affordable Care Act. As a result, not only will I pay more, but I have had to divert many otherwise useful hours to futzing around with websites and paperwork.

President Obama promised, “If you like your health insurance, you can keep it.” It was a more ambiguous promise than it sounded. Who likes his or her health insurance? But it was there, and it did its job.

I probably need to be clear straight off that I am not presenting myself as any kind of hard-luck case. Maybe from some social justice perspective it's perfectly fair and reasonable to load all the costs of health reform onto people like me. The trouble is, this administration has been less than candid about what those costs would be.

As best I can tell, the ACA will require me to pay $200 a month more for a policy that is marginally worse than the one I have now.

Get that? He’s going to get a plan that is worse, albeit only “marginally,” than his present plan, yet he’s going to have to pay $200 more per month — $2400 per year — than he’s paying now.

Here's the before and after contrast:

My family was enrolled in a Carefirst high-deductible plan that cost $667.63 per month. In-network deductible, $5,400; out of network, $10,800. Out-of-pocket limit: $6,400 in-network; $12,800 out of network. The plan was joined to an HSA.

Now, before getting into the details of what he has to settle for under the ACA, Frum makes an observation that I’d never seen before:

The ACA was ingeniously designed to deliver benefits to Democratic constituencies and impose costs on Republican ones.

I wish he’d been more explicit there; I’d have liked to see this spelled out in some detail. But he now goes on:

The most directly comparable plan on the D.C. health exchange will cost $865. The deductibles are somewhat higher: $6,000 and $12,000. The out-of-pocket limits are very slightly lower: $6,000 and $12,000.

That $200 a month differential seems to be the cost of community rating: I had to answer a bunch of questions about my health before qualifying for my prior plan; the new plan will be issued, no questions asked. Presumably somewhere there is a D.C. resident who smokes or who has some pre-existing condition who will receive a corresponding $200 a month windfall.

If that extra $2,400 per year in insurance premiums were the end of my ACA costs, I'd congratulate myself on getting off easy: I'll also be paying considerably more than that in higher taxes to support the program. As I said, I'm not a hard-luck case.

Now Frum repeats himself – perhaps he didn’t proofread his post carefully:

The ACA was ingeniously designed to deliver benefits to Democratic constituencies and impose costs on Republican ones. The big surprise in the ACA rollout is that this design is going awry. It's not only plutocrats and one-percenters who will find themselves worse off; not only the comparatively affluent retirees enrolled in Medicare Plus programs. Self-employed professionals who earn too much to qualify for ACA subsidies will soon discover what I have discovered: They are paying more for a worse product.

Frum then goes on with an observation about politics in the District of Columbia, which is worth reading as well:

The District of Columbia is an expensive place in which to live. Those Washingtonians who earn too much to qualify for subsidies probably do not regard themselves as wealthy. An extra $2,400 a year to keep a high-deductible policy may feel to many of them like—if not a hardship—then certainly a serious nuisance. Unlike me, they probably voted for President Obama. Unlike me, they probably believed his promise that the ACA would deliver improvements for them personally.

How do they feel right now? Or, more exactly, how will they feel when and if they find the time to work their way through the kludgey website to discover what I've discovered?

Need anything be added to this? Probably not.

Now they're pinning Obamacare's failures on the GOP?

There is a post by Debra Saunders, a columnist for the San Francisco Chronicle, on the Real Clear Politics website which I was happy to read, because it points out a lot of useful background on the Obamacare disaster. It was dated October 27, 2013, and titled “Lies the Dems Tell Themselves,” and I reproduce it here:

During the Obama years, a potent mythology has taken root in Democratic circles. In this narrative, Democrats are victims, martyrs even, whereas Republicans are wily tricksters.

Last year, there was a hyped-up fable about Senate Minority Leader Mitch McConnell. President Barack Obama told “60 Minutes,” “When I first came into office, the head of the Senate Republicans said, ‘My No. 1 priority is making sure President Obama's a one-term president.’” Sen. Dianne Feinstein even told the San Francisco Chronicle's editorial board she heard McConnell speaking to that effect on the Senate's opening day.

The thing is that the quote in question first appeared nearly two years later — in an October 2010 interview with the National Journal's Major Garrett.

The latest iteration of Democrats-on-the-cross works like this: Obamacare hasn't delivered the big savings promised by the president — $2,500 annually for the average family — because Democrats ditched the single-payer model to mollify Republicans. In the Los Angeles Times, Harvard professor Jane Mansbridge writes,

“The Democratic Party reluctantly adopted RomneyCare, a.k.a. Obamacare, to get Republican approval.” What's more, House Republicans “coerced the Democrats into adopting a Republican health insurance reform plan.”

A reader emails me, “The Republicans who hate Obama would not permit the creation of a decent single payer plan which would allow private insurance carriers to participate on a competitive uniform benefit program.” Another insists, “We wanted single payer! The GOP did not — that was the compromise, and it was one of many from this president.”

So, Democrats are now calling Obamacare a compromise, crafted to be acceptable to Republicans? As Saunders points out, this is a rather strange sort of a compromise:

Really? The Affordable Care Act did not win a single Republican vote on the House or Senate floor. If Senate Majority Leader Harry Reid and then-House Speaker Nancy Pelosi abandoned single-payer to win GOP votes, they are the most incompetent negotiators in history.

Actually, it got one Rebublican vote in the House. But the basic thesis of Saunders here is correct. And certainly, there is clear evidence that the Democrats were not looking for compromise:

Former Sen. Olympia Snowe, R-Maine, voted for the Obama stimulus package and a measure to end “don't ask, don't tell.” In her book, “Fighting for Common Ground: How We Can Fix the Stalemate in Congress,” Snowe recalls how 40 House Republicans voted with 249 Democrats to expand the State Children's Health Insurance Program, only to watch Democrats unveil a stimulus package with no GOP input a week later.

There was little spirit of bipartisanship when Pelosi crowed: “Yes, we wrote the bill. Yes, we won the election.”

When Sen. Max Baucus, D-Mont., rolled out his draft legislation in 2009, he didn't have a single Republican at his side. When the Senate Finance Committee voted on two Democratic public-option proposals — to allow government plans to compete with private insurers — Sen. Orrin Hatch, R-Utah, denounced the public option as “a Trojan horse for a single-payer system.” Let it be noted that centrist Democrats joined Republicans to defeat both measures.

And where was President Obama in this process?

In “The Audacity of Hope,” Obama laid out a plan for universal coverage that allowed private carriers, such as Blue Cross and Aetna, to compete with new state pools. Still, he didn't stick his neck out to push for Democrats' public-option proposals.

In a 2003 speech, Obama, a second-term state senator, called himself “a proponent of a single-payer universal health care program.” PolitiFact, however, couldn't find a similar blank-check statement. The fact-checking organization observes that as Obama became a more well-known national figure, he spoke “favorably of single-payer in concept, but always (added) qualifiers.”

Snowe voted for the Democrats' health bill to get it out of committee, but it never won her support on the floor. You see, Snowe foresaw Obamacare's big problem. As she wrote (my italics), “not one single member in Congress — Republican or Democrat — could answer whether the newly created health insurance plans would be affordable, yet we hurtled headlong toward a final vote on a monumental bill affecting every American.”

Saunders continues, picking up other Democratic pleas for single-payer insurance (which, by the way, has immense problems in Canada, so it would be unconscionable to have it here!):

In a savvier Republicans-ruined-Obamacare argument, Washington Post wonk-blogger Ezra Klein contends that the Democratic part of Obamacare — Medicaid, which is single-payer — works. But: “The part of Obamacare that's troubled is the part Democrats lifted from Republican policymakers. It's the part that tries to integrate private insurance companies with government systems in order to create a universal insurance system that's subsidized by the state but run by private companies.”

Get it? If Obamacare fails, it's because Obamacare is a Republican plan.

In conclusion, Saunders points out:

Now, I won't deny that two decades ago, some conservative think tank swell came up with the term “individual mandate” — which allowed other wonks to try to pin the tail on the elephant. But if liberals have to fish for a 1989 Heritage Foundation policy paper that had no Republican support in 2008, 2009 or 2012 to establish Republican paternity for the Affordable Care Act, that tells you one thing: They think Obamacare won't work.

So when you find Democratic sources claiming “Obama is a centrist; he actually embraced a Republican plan,” perhaps they should read Saunders' column. It tells the real truth.

Obviously, he still doesn't understand.

President Obama, in his weekly address to the American people, chided Republicans for “rooting for [Obamacare's] failure.” He still doesn't understand the reason one would do so.

Because of Obamacare, employers do not want to hire people who would count as “full time.” They are keeping hours under 30 for the people they already have on their payrolls. So people are underemployed or unemployed directly as a result of Obamacare. And this is just one reason Obamacare is hurting our economy. Since Obamacare is hurting the economy, to make the economy better, it is necessary to get Obamacare to fail, and to fail so big that the Democrats will admit it has failed and allow it to be scrapped.

So that's why Republicans are rooting for Obamacare to fail, and why the American people — especially those who are suffering from unemployment and underemployment — should root for it to fail as well.

Who won? Who lost?

I am amazed when I look at the things being written about the recent shenanigans over the budget. On the one hand, there are people like the editors of The Nation, who wrote an editorial dated October 16, 2013, entitled “Even When the GOP Loses, It Wins,” whose thesis is that it was in fact a Republican victory because:

The GOP now goes into budget talks with sequestration as the new baseline, primed to demand longer-term cuts in Medicare, Medicaid and Social Security. And they still hold the gun of a US default to the nation’s head in the next debt ceiling showdown.

But on the other hand, Obamacare is still in place, and we read such things as Timothy Noah's posting on MSNBC's site:

[W]hat the GOP’s right flank is experiencing right now, in government and the court of political opinion, is failure.

Both these posts come from the political Left, so it is not a case of the Left seeing it as a Right win because they had to give up some and the Right seeing a mirror image of this. It is clear that John Boehner feels that he lost:

“We fought the good fight. We just didn't win,” Boehner told Cincinnati radio station WLW on Wednesday after the Senate stepped in to effectively end the legislative impasse.…“Every time I've gotten into a discussion with the President, the Vice President, the Democrats here in Washington, and talk about entitlement changes, trying to make these programs sustainable, all they want to do is raise taxes. Well we can't do that,” Boehner said.

“If they're going to hold onto their position that we're always going to raise taxes, then we're not going to come to an agreement.”

As I said in a previous post, they just kicked the can down the road. Who will come out ahead in the long run, I just don't know.

A British view of the recent happenings

An interesting blog post on the site of the British newspaper, The Telegraph, recently appeared. It was written by Tim Stanley and dated October 16^th, 2013, and entitled: “US debt ceiling crisis — Barack Obama has won the shutdown. His prize is a lame duck presidency.” It is quite interesting to see how the events of the last week or so are viewed by others; of course, The Telegraph is a conservative paper, so this needs to be taken into account. But the title alone makes it clear that, to Mr. Stanley (who is a historian whose area of specialty is the United States) at least, President Obama has won a battle, but at a serious cost to his own ability to govern:

The shutdown is basically over and the President has won. Or, at least, he's won because the Republicans have definitely lost. Not only did they not get what they wanted — that “life or death” delay on Obamacare implementation — but they've given the impression of dragging partisanship to new lows. Obamacare had been passed already, the Supreme Court had okayed it and Obama had won an election on it, yet the GOP was still prepared to bring the country to the brink of ruin to cripple it. When Grover Norquist is saying that the Right went too far (he of the “drown government in the bath tub” fame) then the Right probably went a bit too far.

So much for the “won a battle” part. Then, however, he continues:

But there are caveats to that narrative. First, the Republicans aren't the only ones who ought to hang their heads in shame. It was the Democrat-controlled Senate that first rejected the House's bill and so sparked the crisis. It was the President who refused to talk to anyone about it (and went campaigning instead). It was the federal government — even when in shutdown — that behaved like a spoiled child, covering war memorials in fences and trying to stop military priests from saying Mass. And it was the mainstream media that took the side of the President and helped foster the impression that the GOP is run by a bunch of blowhard crazy people. For example, Dave Weigel points out that, contrary to reports, wild child Ted Cruz actually had “no intention” of delaying the critical final vote in the Senate. His image of being Sarah Palin 2.0 is entirely a media myth.

Many of these things, particularly regarding the Senate, the President, and the media, coincide with my own recent posts, so naturally I was happy to see someone else in agreement.

Continuing, Mr. Stanley writes:

Second, what has Obama really won? He keeps his precious healthcare reform and he gets government open again — but tomorrow morning he'll still have the same gridlocked political system that he had the night before. The shutdown is a rare example of him winning, but remember that this lame duck president has not only had a very simple (and, frankly, inoffensive) gun control bill killed in the Senate but was so spooked by bad poll numbers that he tried to dump responsibility for military action in Syria onto the Congress — before quietly dropping the idea altogether. Any thought that the shutdown payoff will be that he can sail an immigration reform package comfortably through Congress is pure fantasy. This is a broken presidency living out its last few years either holding off Republican attacks or lazily cruising the country on some pointless, endless, fatuous campaign trail. Obama's administration is politically bankrupt.

Very interesting. The media in general are unwilling to concede this, but I believe Mr. Stanley is right. The House of Representatives must approve any new legislation, and after this débacle, the House will be less inclined than before to pass anything with Obama's stamp of approval on it.

And finally, Mr. Stanley writes:

The talk for the next week will be about how the Tea Party is dead and Republicans must elect a politically correct, middle-of-the-road, unimaginative, establishment, compromising candidate in 2016 (preferably a singing sloth, cos the polls show that Americans just love those). But the reality is that US politics right now is a mess for both Left and Right, and the country is stuck in partisan limbo until the 2014 midterms or even the 2016 presidential election. This is not a Republican problem, it is an American problem.

Here, I part company to some extent with Mr. Stanley. A “middle-of-the-road, … compromising candidate” is necessary. There is no way a Rick Perry or Rick Santorum could get elected in this country in 2016. This, of course, is why I have been pushing Chris Christie. He will show, in three weeks, how he can get votes even in a deep blue state like New Jersey. This is clear. And no Republican can win unless he can get at least some people who are not convinced Republican voters to pick him. This is an important factor, which Mr. Stanley does not point out, and perhaps which he does not realize to be the case.

Kicking the can down the road

The Senate has put forth a bill to avert the crisis for now, by the overwhelming majority of 81-18. And the House has accepted the Senate bill, by a substantial, nearly ²/₃ margin, 285-144. President Obama has signed the bill. Nothing much has happened, except that the Government reopens, and the debt limit is raised. Under the terms of the bill, we will go through the same situation in a few months.

What this shows is that it's a great advantage to control the media. The Democrats could portray the Republicans as unwilling to compromise, despite it being that they were the ones unwilling to compromise. And the American public, according to polls, believed the Democrats' charges.

Where do we go from here? I don't know. Ted Cruz, Marco Rubio, and Rand Paul were among the 18 Senators who refused to support the Senate bill. This means all three will have solid Tea Party credentials. But while, on this issue, the Tea Party had a lot of logic on its side — Obamacare is killing the economy and needs somehow to be derailed — the American public (which agrees that Obamascare is a bad thing, in poll after poll) does not want the Government shut down, or the debt limit increase threatened, or anything that might prevent the inexorable march forward of Obamacare. It's probably the media's fault, as I said. The media can't sell the public something as awful as Obamacare, but it can paint the GOP's attempts to stop it as so bad that the party is hurt. And that's really what the media want.

And I have no clue how to combat this.

A good summary of Obamacare's problems

Today I saw a post on the Bloomberg.com site by Megan McArdle, dated Oct 14, 2013, entitled “Obamacare Needs a Drop-Dead Date.” It makes fascinating reading:

Exactly how bad are things on the federal health-care exchanges? The working assumption among most journalists, including me, is that they would be fixed in a few weeks — that is, by the end of this week. But yesterday’s New York Times brought a deeply reported piece from Robert Pear, Sharon LaFraniere and Ian Austen. There is too much information in the piece for an excerpt to do it justice, so I’ll summarize, with some editorial comments — but you should read the whole thing to get the full flavor:

One person familiar with the project says it’s only about 70 percent of the way there, and has heard estimates of somewhere between two weeks to two months to fix it. As a programmer I know points out, “two weeks to two months” is the programming equivalent of “40 days and 40 nights”: “A long time, but I have no way of knowing how long.” When I used to hear estimates like that, I used to assume it would be coming in on the late end of that range, earliest.

The administration delayed writing major rules until after the 2012 election, because it didn’t want to give Republicans any ammunition for their campaign. (This actually was noted at the time: “When it comes to health care, delaying regulations could help the president politically by avoiding discussion of the controversial health reform law. But that makes life difficult for states and industries that need to prepare for the coming changes,” wrote the National Journal. But most of us didn’t understand just how badly this was affecting implementation.)

Despite evidence to the contrary, the administration kept insisting that everything was absolutely on track to launch Oct. 1.

This passage is so extraordinary that it requires excerpting:

“Deadline after deadline was missed. The biggest contractor, CGI Federal, was awarded its $94 million contract in December 2011. But the government was so slow in issuing specifications that the firm did not start writing software code until this spring, according to people familiar with the process. As late as the last week of September, officials were still changing features of the Web site, HealthCare.gov, and debating whether consumers should be required to register and create password-protected accounts before they could shop for health plans.”

Suddenly, two months sounds optimistic.

The Centers for Medicare & Medicaid Services inexplicably decided to take on the role of central project manager itself, assuming responsibility for integrating all the various software pieces they’d subcontracted, rather than assigning that role to a lead contractor. CMS is not known to maintain a pool of crack programming talent with extensive project management experience that can be deployed to this sort of task.

Henry Chao, the Health and Human Services Department's digital architect of the insurance marketplace, seems to have been sounding the alarm bells internally. (He certainly was externally; he famously told a group of insurers in March that “I’m pretty nervous — I don’t know about you. … Let’s just make sure it’s not a third-world experience.”) Chao was worried that the systems wouldn’t work, a concern to which higher-ups apparently responded by basically telling him in effect that, according to the Times piece, “failure was not an option.”

Neither the consumer side nor the insurer side is working. A New York Times researcher made more than 40 attempts from Oct. 1 to Oct. 12 to log in, with no luck. Meanwhile, the Times confirms Bob Laszewski’s report that insurers are getting virtually no usable data from the exchanges. As the Times puts it, “just a trickle of the 14.6 million people who have visited the federal exchange so far have managed to enroll in insurance plans, according to executives of major insurance companies who receive enrollment files from the government. And some of those enrollments are marred by mistakes. Insurance executives said the government had sent some enrollment files to the wrong insurer, confusing companies that have similar names but are in different states. Other files were unusable because crucial information was missing, they said.”

Insurers began warning in 2012 that they were worried about these systems making their delivery dates, a concern that the Government Accountability Office echoed in June. Now we know why: The systems weren’t on track to meet their delivery dates.

This is stunning. It’s far worse than I imagined, and I am pretty cynical. The law’s supporters are engaged in some high-speed blamestorming: It’s the Republicans' fault for not giving the law more money, or it’s the fault of Republican governors who didn’t build their exchanges, or maybe it’s one of the vendors — CGI, the firm with the largest contract, is the most favored target, but at various times, the administration has clearly been teeing up to blame Experian or Oracle. Or perhaps the fault lies in federal procurement rules, which prevented the government from getting the right kind of staff and service. A lot of that shows up in the article; there’s a long prelude about the political barriers that the administration faced. But ultimately, the litany of mistakes that the administration made overwhelms these complaints.

I’m a longtime critic of federal contracting rules, which prevent some corruption at ruinous expense in money, quality and speed. But federal contracting rules are not what made the administration delay writing the rules and specifications necessary to build the system until 2013. Nor to delay the deadline for states to declare whether they’d be building an exchange, in the desperate hope that a few more governors might decide — in February 2013! — to build a state system after all. Any state that decided to start such a project at that late date would have had little hope of building anything that worked, but presumably angry voters would be calling the governor instead of HHS.

Federal contracting codes, so far as I am aware, do not emit intoxicating gases that might have caused senior HHS officials to decide that it was a good idea to take on the role of lead contractor — a decision equivalent to someone who has never even hung a picture deciding that they should become their own general contractor and build a house. Nor can those rules explain their lunatic response when they were told that the system was not working — “failure was not an option."

Nor can you really blame the Republicans — an argument that makes sense only if you don’t examine it very closely. It starts by assuming (but never stating) that the administration passed a law that didn't work as written, and then posits a civic duty for the opposition not to oppose laws that they oppose, but instead to help the majority party turn an unworkable law into something more to said party’s liking. This is absurd. Moreover, it’s not even a very good explanation for most of these problems. Maybe CMS turned lead contractor because they couldn’t get more funds to hire private help, but lack of funds does not explain why HHS took so long to write regulations and specifications, keeping insurers at loose ends until as late as this summer, and preventing their biggest contractor from writing code until spring. It does not explain why officials decided to launch a system that was so badly behind schedule, or to keep insisting, against all evidence, that it wasn’t broken. What explains this long train of poor decision-making is some combination of bureaucratic inertia, a desire to hide what they were doing from voters who might not like it and a terrifying insouciance about how easy it might be to build a system of this size and complexity.

My best guess is that by the time HHS officials realized that they hadn’t left enough time, the only possibilities were: 1. Ask Republicans for a delay; or 2. Launch a not-very-well-built-or-tested system upon an unsuspecting public. No. 1 would have been unpleasant for several reasons. Obviously, it would have been a huge political black eye. Republicans would probably have responded by joyously agreeing to a delay — of a year or more, which would either mean launching right before the 2014 elections or possibly never launching at all. Administration officials weren’t going to put the president’s signature achievement at risk that way.

After all, if they launched a nonfunctioning system, at least the state exchanges would hopefully work, and if enough people in the states signed up, it would be too late for Republicans to demand a rollback. They’d get the system working in a few weeks, and then everything would be fine. I’m guessing that even at the end, the senior officials didn’t realize just how bad this was.

But given that they didn’t even announce that they were taking the system down for more fixes this weekend, I’m also guessing that it’s pretty bad. Bad enough that it’s time to start talking about a drop-dead date: At what point do we admit that the system just isn’t working well enough, roll it back and delay the whole thing for a year?

Yes, I know what I’m suggesting is a major, horrible task. And I’m aware that since I opposed the law in the first place, people will take my suggestion with a huge grain of salt. Fair enough, but hear me out.

If the exchanges don’t get fixed soon, they could destroy Obamacare — and possibly, the rest of the private insurance market. The reason that the exchanges were so important was that they were needed to attract young, healthy people into the insurance system. The worry was that if insurance is hard to buy — if you have to do your own comparison shopping and then call the insurance company, and fax in some paperwork and two years of tax returns — that the young and the healthy simply won’t do it. Sick people and old people who were getting huge subsidies — and maybe the ability to buy insurance on the private market for the first time in a long while — would overcome any obstacles, because if you’re spending $15,000 a year on health care, it’s worth a lot of your time to make sure that you have insurance. But if your biggest annual health-care expense is contact lens solution, you may just decide to skip it and pay the fine.

The administration estimates that it needs 2.7 million young healthy people on the exchange, out of the 7 million total expected to apply in the first year. If the pool is too skewed — if it’s mostly old and sick people on the exchanges — then insurers will lose money, and next year, they’ll sharply increase premiums. The healthiest people will drop out, because insurance is no longer such a good deal for them. Rinse and repeat and you have effectively destroyed the market for individual insurance policies. It’s called the “death spiral,” and the exchanges, like the mandate, were designed to keep it from happening.

Without the exchanges, the death spiral seems almost assured. The amount of work required to find a policy, figure out your subsidy, buy coverage and file the paperwork will be very high. And it’s unlikely that folks who can’t even be bothered to go to ehealthinsurance.com right now will do it. The Affordable Care Act made the task of signing up young healthy people on the exchanges even harder with its much-loved requirement that companies allow kids to stay on their parents’ policies until they’re 26, which took millions of potential buyers out of the pool. The ones who are left are going to be disproportionately poorer and less well educated than the middle-class offspring who can get cheap insurance through mom and dad. There’s a reason that virtually every person you’ve seen written up in an article as they tried to get insurance at a community center or clinic is some combination of over 55, retired or afflicted with a serious chronic condition.

Once the death spiral happens, it’s very difficult to recover from. That’s why if the exchanges don’t work soon, we need to hit the reset button and try again next year. This will be very, very difficult: Insurers are already selling policies under the new regulations, and those regulations have driven up costs for existing buyers. People who have been counting on being able to buy insurance through the exchanges will have to spend another year without. And of course, it will be politically embarrassing. But it will be even more politically embarrassing to get to December and find out that we have commanded millions of Americans to buy insurance on a system that doesn’t work. And it is not a good bargain to cover some people now, but in doing so, to make insurance unaffordable for millions more in a few years. If we can’t launch the system correctly, then we need to wait until we can.

In the private sector, this system would already have been rolled back, probably less than 48 hours after it was rolled out. The government has more time, but not that much more, because every day they wait adds to the chaos that will occur if they have to pull the plug in December. If the system cannot reliably process 50 percent of its users on Nov. 1 — and I mean from end to end, including sending a valid enrollment file to the insurer — then the administration should ask for a one-year delay of Obamacare’s various regulations, including the individual mandate. Congress, including Republicans, should be ready to give it to them, with no strings attached.

Perhaps Nov. 1 seems too aggressive to you. I chose that date because it’s when Jon Kingsdale, who ran the Massachusetts exchange for its first five years, said we would be “really in deep doo-doo.” Well, let’s say Nov. 15 — the date when almost all the experts I’ve heard say we really need to be running at full speed, to handle the crush of applications sure to come between Thanksgiving and the mid-December deadline for buying insurance that starts in January.

Whatever it is, that date needs to be set now. Otherwise the political temptation will be — as it clearly has been all along — to declare that everything’s fine and we should keep going just in case it all works out in the end. The administration’s desire to avoid a giant political embarrassment is entirely understandable. But the rest of us have an even deeper and more important interest in a functioning market for health insurance.

This tells a lot — particularly about how the Administration was so caught up in making Obamacare happen that it failed to take the steps that might make it do what it was supposed to do.

More reason for the Republicans to do as much as they humanly can to hold up as many of the parts of Obamacare as they can — even if repeal is not possible until Barack Obama is replaced in the White House.

Paul Krugman's idea of "compromise" — what world is he living in?

A lot of the time, when I quote a column or a blog at length, it's because I agree with it, and would like to echo the sentiments posted there. This time, however, I wish to quote one which I think is so far from making sense that it boggles the mind to think that there are people who actually think that way. The column I am discussing was one dated October 13, 2013 on The New York Times' site, called The Dixiecrat Solution by Paul Krugman. He begins:

So you have this neighbor who has been making your life hell. First he tied you up with a spurious lawsuit; you’re both suffering from huge legal bills. Then he threatened bodily harm to your family. Now, however, he says he’s willing to compromise: He’ll call off the lawsuit, which is to his advantage as well as yours. But in return you must give him your car. Oh, and he’ll stop threatening your family — but only for a week, after which the threats will resume.

Not much of an offer, is it? But here’s the kicker: Your neighbor’s relatives, who have been egging him on, are furious that he didn’t also demand that you kill your dog.

The analogy that Krugman seems to be making assumes that President Obama and the Senate Democrats have a right to all they want to do with our government, that any attempt to oppose those plans is spurious, and that the Republican attempts to try to arrange a compromise is a phony compromise — in other words, that they are asking for everything and yielding almost nothing. In fact, if anything, it is the Democrats who have insisted they get everything they want — President Obama has even said that first they need to give up everything and only then will he talk! So when Krugman says:

And now you understand the current state of budget negotiations.

Stocks surged last Friday in the belief that House Republicans were getting ready to back down on their ransom demands over the government shutdown and the debt ceiling. But what Republicans were actually offering, it seems, was the “compromise” Paul Ryan, the chairman of the House Budget Committee, laid out in a Wall Street Journal op-ed article: rolling back some of the “sequester” budget cuts — which both parties dislike; cuts in Medicare, but with no quid pro quo in the form of higher revenue; and only a temporary fix on the debt ceiling, so that we would soon find ourselves in crisis again.

it is clear that Krugman's idea of “compromise” is a weird one. As he himself puts it:

I do not think that word “compromise” means what Mr. Ryan thinks it means. Above all, he failed to offer the one thing the White House won’t, can’t bend on: an end to extortion over the debt ceiling.

But this so-called “extortion over the debt ceiling” is the only weapon the Republicans have in the face of Democratic insistence that their entire program be allowed to go into force and the sequester rolled back. Krugman's idea of “compromise,” in short, is to allow the Democrats to have the whole of their wish list, without any give-back. This is a compromise? I certainly think not. And so, when he continues:

Yet even this ludicrously unbalanced offer was too much for conservative activists, who lambasted Mr. Ryan for basically leaving health reform intact.

it is clear that he considers Ryan's offer “ludicrously unbalanced,” without the slightest realization that it is his supposed compromise that would better be described in those terms.

I'm not going to continue further with his column, because it is easy enough to see how wildly out of touch with any notion of fairness Mr. Krugman is. And I assume he is not stupid. So my only question is, how can anyone take his ideas seriously?

Who is insisting on 100%?

There seem to be a lot of people assailing the Tea Party for refusing to compromise. President Obama is quoted as saying,

I cannot remember a time when one faction of one party promises economic chaos if it can't get 100 percent of what it wants. That's never happened before, and that's what happening right now.

But it's not the Republican Party, or even the Tea Party, that's insisting on “100 percent of what it wants.” It's Obama and the Senate Democrats. When the Republicans passed a bill that simply delayed for a year some of the more objectionable features of Obamacare — scarcely 100% of what the Republicans want, which is an outright repeal of the act — the Senate turned it down. The Republican House of Representatives has passed bills to fund particular parts of the Government and avert some of the negative effects of the Government shutdown, but the Senate refuses to go along. And President Obama has echoed the Senate, saying he'd veto this type of bill if it comes to his desk. Who is insisting on 100%?

A biologist's comment on the question "When does life begin?"

I don't know what PLOS means, but they run a site with science-oriented blogs on it, and I just saw a post, dated October 3, 2013, by Ricki Lewis, Ph.D. entitled “When Does a Human Life Begin? 17 Timepoints.” It's good stuff, and I'd like to quote it in full before giving my own comments. Since Dr. Lewis is a biologist, and as she says in her post, the author of a biology textbook, her comments deserve some attention. This is what she writes:

On September 24, the direct-to-consumer genetic testing company 23 and Me was granted patent no. 8543339, covering the selection of traits in offspring by genotyping eggs and sperm. (“Gamete donor selection based on genetic calculations.”) An analysis of the ethical issues the patent raises is published today in Genetics in Medicine. (Coincidentally, a co-author of the paper was so critical of a recent DNA Science blog post that comments had to be cut off. Small world.)

I’d started thinking about today’s post a few weeks ago, when a prominent science writer posted on a listserv “What was the CEO of AAAS thinking?” and then quoted Alan I. Leshner telling the New York Times: “K-12 students need to know the nature of science, how scientists work and the domains and limits of science. Science can’t tell you about God. Or when life begins.”

“Um…when life begins is a pretty basic idea in biology,” commented the originator of the compelling listserv thread that followed. Actually, no.

I’m the author of an intro college biology textbook called “Life,” my having nabbed that title before Keith Richards did. Life science textbooks from traditional publishers (I’m with McGraw-Hill) don’t explicitly state when life begins, because that is a question not only of biology, but of philosophy, politics, psychology, religion, technology, and emotions. Rather, textbooks list the characteristics of life, leaving interpretation to the reader. But I can see where the idea comes from that textbooks define life as beginning at conception. Consider a report from the Association of Pro-life Physicians. After a 5-point list of life’s characteristics from “a scientific textbook,” this group’s analysis concludes with “According to this elementary definition of life, life begins at fertilization, when a sperm unites with an oocyte.” Sneaky.

Being a biologist, a textbook author, and a mother, I’ve thought a great deal about the question of when a human life begins. So here are my selections of times at which a biologist might argue a human organism is alive. I’ll save my preference for the end.

1. Life is a continuum. Gametes (sperm and oocyte) link generations.

2. The germline. As oocytes and sperm form, their imprints – epigenetic changes from the parents’ genomes – are lifted.

3. The fertilized ovum. Of the hundreds of sperm surviving the swim upstream to the oocyte, one jettisons its tail and nuzzles inside the much larger cell, which obligingly becomes an ovum, completing its own meisosis. A fertilized ovum = conception.

4. Pronuclei merge, within 12 hours. After fertilization, the packets of DNA from male and female — the pronuclei — approach, merge, and the intermingling chromosomes pair and part, as the first mitotic division looms. A new human genome forms. Following that first division, some genes from the new genome are accessed to make proteins, but maternal transcripts still dominate development.

5. Cleavage. Divisions ensue. The cells of an 8-celled embryo (day 3) have not yet committed to becoming part of the embryo “proper” (one with layers) or the supportive membranes. Such a cell can still, on its own, develop. An 8-celled embryo whose cells are teased apart could lead to an octomom situation.

6. Day 5. The new genome takes over as maternal transcripts are depleted. The inner cell mass (icm) separates from the hollow ball of cells and takes up residence on the interior surface. It will become the embryo proper, distinguishing itself from the remaining part of the ball fated to become the extra-embryonic membranes. The icm is what all the fuss about human embryonic stem (hES) cells is about — the stem cells aren’t the icm cells, but are cultured from them.

7. End of the first week. The embryo implants in the uterine lining.

8. Day 16. The gastrula. Tissue layers form, first the ectoderm and endoderm, then the sandwich filling, the mesoderm. Each layer gives rise to specific body parts.

9. Day 14. The primitive streak forms, classically the first sign of a nervous system and when some nations set the deadline for no longer using human embryos in experiments.

10. Day 18. The heart beats.

11. Day 28. The neural tube closes, within which the notochord, preliminary to the spinal cord, will form, while the bulge at the top will come to house the brain. If the tube doesn’t close completely, a neural tube defect (anencephaly, spina bifida, and a few others) results.

12. End of week 8. The embryo becomes a fetus, all structures present in rudimentary form.

13. Week 14 or thereabouts. “Quickening,” the flutter a woman feels in her abdomen that will progress to squirms and kicks from within.

14. Week 22. A fetus has a chance of becoming a premature baby if delivered.

15. Birth.

16. Puberty. The Darwinian definition of what matters on a population and species level, when reproduction becomes possible.

17. Acceptance into medical school. I don’t know where this came from, a joke about Jewish mothers, but in some circles it might now apply to acceptance into preschool. Or when one’s grown offspring leave home.

My answer? #14. The ability to survive outside the body of another sets a practical limit on defining when a sustainable human life begins.

Having a functional genome, tissue layers, a notochord, a beating heart … none of these matter if the organism cannot survive where humans survive. Technology has taken us to the ends of the prenatal spectrum, yet not provided too much for the middle, other than fetal surgeries for a handful of conditions. We can collect and select gametes, now thanks to patent no. 8543339. We collect and select very early embryos in pre-implantation genetic diagnosis, allowing those without a specific disease to continue development. And although the gestational age at which a premature infant can survive has crept younger, it hasn’t by much, not since I starting thinking about these things back when I was a stage #16.

Until an artificial uterus becomes a reality, technology defines, for me, when a human life begins, rather than biology. Alternative views are welcome!

Notice that she says that a human life begins at the point of viability, her 14^th timepoint. I would actually hold out for her #1 option, that life never really begins, but is in a continuous span across the generations. But her viability criterion is, I would say, the point that a new and independent human being starts to exist. It's not the start of life, but the start of an independent human life. And so I would agree that up to that point, I would permit abortions, because up to then the fetus is simply a parasite living off the mother.

Who is trying to get their own way without compromise?

An interesting post was made on The Federalist.com site by David Harsanyi, dated October 2, 2013, called “Guess What? History Didn’t Begin The Day Obamacare Passed: Trying to erase the past to dictate the future.” It deserves reading, and I quote it:

Hitting legend Stan Musial once allegedly declared that the “first principle of contract negotiations is don’t remind them of what you did in the past; tell them what you’re going to do in the future.” That neatly sums up how liberals would like to treat these budget /debt ceiling showdowns. Take for example: (from Greg Sargent @ThePlumLineGS 8:06 AM - 2 Oct 2013)

Serious Q: Has any R explained cogently *why* Ds should give Rs unilateral concessions in exchange for funding gov at sequester levels?

Now, if history had kicked off five minutes ago this would be a reasonable question, but since politics is a continuum and Obamacare doesn’t exist in a vacuum it’s a misleading one.

In reality, the only characteristic of the Affordable Care Act that’s “unilateral” is the manner in which it was passed; without consensus and without the minimal compromises that would have rendered long-term Republican opposition to Obamacare untenable. If Democrats had, back in 2009-2010, capitulated on one or two conservative objectives – out-of-state insurance markets or tort reform, for instance – this moment would be impossible.

Today, left-wing pundits wring their hand about partisan inflexibility and conventional wisdom of the media has coagulated around the “hostage taking” storyline. Back then, they were less concerned the health of Washington. Any alleged concessions made by the Administration in 2010 were aimed at corralling wayward Red State Democrats, resulting in the removal of the public option and the adding of bogus guarantees on abortion funding. And any concessions on bringing the price tag below a trillion dollars – a claim that was a specious even then – was necessary to try and close the deal with the public. When one party dictates every term of a massive reform effort, the inevitable result is what we’re seeing today.

Which bring us to a related talking point: Embedded in one of the most painful misinterpretations of the Federalist Papers you may ever read, James Downie of the Washington Post writes:

Here are the facts, Republicans: The legislative branch passed the Affordable Care Act. The executive branch signed it into law. The judicial branch upheld it as constitutional. The American people voted to reelect the president who championed it. Since the act was passed, Americans who favor and/or want the law expanded have consistently outnumbered those who oppose the law. And now Americans are already clearly opposed to Republicans’ shutdown tactics. If this were a game, we’d call the result a blowout.

No doubt many of you may quibble with Downie’s assertion about the law’s popularity, but generally speaking he’s right — and none of it matters.

DOMA passed with a 342–67 margin in the House and a 85–14 margin in the Senate, yet it was consistently challenged in the courts and by politicians. Citizens United was found constitutional and almost immediately the president attacked the Court. (As you know, some decisions are more sacred than others.) Americans twice elected a president who championed the Iraq War and yet progressives never stopped opposing it. In 2001, No Child Left Behind passed the House by a 384–45 and the Senate 91–8 margin. Yet, almost immediately liberal groups, and soon after elected officials, began their attempts to dismantle it.

Democrats had every right to engage in those pursuits. In fact, it’s healthy that they did. Health-care legislation isn’t chiseled into stone tablets and it’s not enshrined in the Constitution. The entire Obamacare legislation was a “concession” by conservatives. So even if Republicans tactics are unwise politics, trying to renegotiate and undo the majority’s will is not unprecedented. And to argue about what’s going without perspective is unrealistic.

It's a valid point. And one worth keeping in mind during this budgeting impasse.