Obamacare has been in the news so much this week because of the looming deadline, it got me to thinking more about the real people who are impacted by it directly. Living in the mid-west (sorry kids, Kentucky ain't the South), and having grown up in a very nice whitey-McWhitey-pants suburb, it's not surprising that I have a lot of conservative friends. To clarify, when I use conservative I mean it in the true sense, not the Fox News idiot sense (although I have some friends in that category too). I mean people who don't like big government, and people who generally support free and open markets. If you think the government should be involved in banning gay marriage or protecting religious bigotry, you're not a conservative (but there's a good chance you're a jerk).
Anyway this means I have a lot of friends who hate Obama, and also hate Obamacare. I have a generally favorable opinion of both, though I fully recognize they're not without their flaws (see my recent post on why I prefer national health care). I didn't vote for Obama because I think he walks on water (as some Democrats do), and I know the ACA represents massive government interference in one of the biggest sectors of our economy, it'll cost a ton of money and we won't know if it's achieving its goals for several years. But we desperately needed something, and I think this particular something is better than nothing.
Sure, lots of people lost their coverage and/or couldn't keep it due to Obamacare's new minimum standards for insurance. And Obama was an idiot to promise that "if you like your insurance you can keep it," which we all now know was a lie. A lot of Americans were paying for insurance policies that covered almost nothing. They fall into three groups:
Some percentage of those Americans knew what they had, and are rightfully upset that they can't keep their crappy coverage. I argue that those Americans are not much better than the ones who choose to not carry insurance at all - both groups are likely to end up receiving free care when something bad happens. If you, like me, believe that we have a problem with a lack of individuals taking responsibility for themselves and their own actions in this country, and if you know the statistics about how much free care doctors and hospitals give out in this country and how that "free" care translates into the higher premiums the rest of us pay, then you almost have to agree with me that those people are freeloaders. Conservatives hate freeloaders.
Some percentage of those people with crappy plans had no idea that they were buying crappy insurance, and are right now a) mad at the company who sold them the snake oil policy and b) signing up for Obamacare because they want actual coverage for wacky things like preventative care.
Some percentage of those Americans knew what they had but also knew that there were no viable alternatives to them. They lost their policy but they're NOT mad about it because now they have a viable option for real insurance. These people are also singing up for Obamacare.
Remember, 70% of the country gets health insurance from their employer or the government (Medicare/Medicaid/Veterans Administration). So we're really only talking about the 30% who don't. There was an argument that tons of employers would stop offering coverage because of Obamacare; that they'd simply pay the fine for not offering coverage and dump their employees off onto the public exchanges. This has not happened. There was an argument that small businesses would go bankrupt from being forced to offer coverage. This has not happened, largely because there are massive tax incentives to offer coverage and any small business operator with two brain cells will take advantage of an opportunity to 1) attract & retain employees while simultaneously 2) lowering her tax burden.
Now let's go to the polls. Americans hate Obamacare. More than half of them say they "don't want it." But from what frame of reference are they looking at Obamacare? 45% of Americans get coverage from their employer. Do they get to complain about Obamacare? I suppose so, because they are also tax payers and it's an expensive program. But these people don't need the coverage Obamacare offers to people who previously had no alternative, and I think that's important to bear in mind. If you're only looking at the federal and state budget implications of Obamacare, it's easy to hate.
25% of Americans get their healthcare from the government anyway. Do they get to claim that this is wasteful government spending? I think not, since that would be pretty hypocritical. Yes, the burden on state and federal health care programs will go up, but there is a very real chance that Obamacare will achieve its other goals of improving outcomes and lowering costs. Part of the goal of this legislation was to address the very real skyrocketing costs of healthcare by getting more people preventative care options AND by holding providers responsible for outcomes, and taking insurance companies to task for inflating administrative costs.
The 30% of the country that's not insured through their employers or the government is either uninsured, or falls into one of the 3 categories of "I previously had lousy insurance that is now illegal." Some percentage of the uninsured are now quite happy to sign up for something. There are some compelling stories about this compiled in a nice marketing piece by HHS. Contrary to the Romney narrative, most people in this country do not like handouts and want to provide for themselves and their families. They simply had no good options for affordable care prior to Obamacare. Now that they have options, they're signing up to the tune of 5,000,000 plus.
Remember, just because it's marketing doesn't make it imaginary - these are real people. I also am friends with a number of artists on facebook who write glowing reviews of their experience, in particular some of the New Orleans musicians I miss so much. Oddly enough, when you play on street corners and in bars, those gigs don't offer good health coverage, yet these musicians do want to take better care of themselves and they recognize the risk they have been taking by not having coverage. It was just truly un-affordable to them. There are still some freeloaders out there, but there always will be.
I think the approval rating of the ACA today should be determined by the uninsured who want coverage, and groups #2 and #3 from the "I previously had lousy insurance that is now illegal" crowd. Those are the people for whom the ACA has the greatest short term impact. If you still get coverage from your employer or uncle same, your opinion on the sign up phase is irrelevant. You can weigh in a couple years from now when we have some real evidence as to whether this thing lowers the cost of care and improves patient outcomes. By then we'll know if it's worth the tax burden or not.
It's been a while since my last rant about the stupid model by which Americans get mobile phones and wireless plans. Part of this model is driven by the fact that our wireless carriers here have really strong lobbies in Congress, so they do everything they can to protect their vested interests in NOT having an efficient market. CDMA, LTE, UMTS, HSPA+, EDGE,GSM... I don't even try to keep with all the variations in technologies used in this country, but that's one of the things that locks people into a particular carrier. Technically there are 4 major carriers in the US, but since there are really only two main technologies deployed, what we really have is 2 pairs of carriers, and even within those pairs they've done what they can to make it useless to switch. In Europe and Asia, any phone works on any network. It's wacky.
The other big difference of course is this subsidy/contract model. Americans tend to sign two year contracts for their phones, and part of the monthly fee they pay is actually a subsidy for the handset they use. So they think they're getting an iPhone for $199 instead of the full retail $699, but all they're really doing is signing up for an iron-clad contract where they payoff the other $500 over the course of 2 years. American's don't think about it this way - they think they're getting an iPhone for $199, and that their generous wireless carrier is going to "let" them upgrade two years from now. In point of fact all the carrier is doing is offering them the opportunity to sign away their freedom of choice for two more years when the initial contract expires. What a deal! The result? 33% of Americans now use pre-paid (no-contract) phones.
Three years ago I bought my first phone, a Nexus One. I loved it. I still have it as a backup phone. Google engraved my name on it. I've used it on AT&T, T-Mobile, Tata Wireless, Vodafone, Orange, O2 and KPN. I still take it with me to Europe sometimes. I paid $500 for it. The Nexus is an Android phone, and it got all the updates for 2 years until its hardware became out-dated. After that I bought a Nexus 4, and it's serving me equally well.
Now, 3 years after I adopted this model myself, the major wireless carriers are coming along. T-mobile has lowered its rates and no longer offers contract plans. You literally cannot sign a service contract with them anymore. Bring your own phone, or finance one, but they're not subsidizing it. And they lowered their rates. $50/month gets most users all the data they'd ever need, and my 4G LTE signal here in Lexington is sometimes 3X, even 4X what I get from our cable internet provider. True, T-mobile doesn't have the coverage that the big guys do, but it's improving, thanks largely to the $1 BILLION payout from AT&T when a recent merger attempt failed. So be a smart consumer and at least shop around and know your options before blindly signing up for a contract just to get a phone. There are a lot of pre-paid and virtual network operators now - you can get your phone service at Wal-Mart of Kroger, and it's probably a better deal than what you can get from AT&T or Verizon.
This weekend marks 4 years since the passage of the Affordable Care Act. The GOP re-branded it as "Obamacare," in hopes that those who hate Obama would similarly hate "his" healthcare plan. There are at least 3 flaws with that: 1) he didn't write the bill 2) some Obama haters directly benefit from this plan and 3) the GOP has given the Dems a great marketing tool here: there are now over 10,000,000 people who are fans of Obamacare because it has given them the health insurance they wanted and couldn't get previously. Ask P&G about the marketing power of 10,000,000 consumers who are out there saying "I just bought this product and it's really helping me and my family."
There's not much point reviewing the law and how it's been rolled out, as that is a well-documented and over-analyzed debacle. I find the IT issues particularly embarrassing as I work in that industry and it reads like a classic case of how NOT to run a large IT project. Because I work in that industry though, I'm also aware of how notorious the government is for NOT being able to manage IT contractors, being difficult to work with, and changing requirements on the fly without adjusting timelines or budgets appropriately. This example just happened to get a ton more media attention than others, and rightfully so, but rest assured there are several hundred other IT initiatives that Uncle Sam is screwing up at this very moment. In short though, adoption has been less than expected, a majority of Americans "disapprove" of Obamacare although I'm certain a majority of Americans don't understand it either (who does?), and the true costs of this thing will not be known for years.
Is Obamacare bad for America? I don't know. It's certainly ugly, and poorly executed, but is there a net benefit to it at the end of the day? What's the point of comparison? Obamacare is awful compared to what - doing nothing? Compared to the national health care systems that a VAST majority of advanced industrialized nations have successfully deployed with better outcomes, lower costs, and none of the rationing & death panels the GOP desperately wants you to believe exist? That's the system I want, by the way, and there is overwhelming, conclusive evidence that national health care systems work AMAZINGLY well if the standard of comparison is the health care "system" we had in place before Obamacare. I'd love to see every insurance company put out of business, because I believe they're the root of the problem, and the doctors and hospitals have simply evolved & adapted to maximize their own outcomes because of how they have to deal with the insurance companies. No rational person can look at this system which has:
An annual enrollment process (what's the cost to our economy of the lost productivity when we all have to do that crap each year?)
Denial of coverage to the sick and/or pregnant
The artificial inflation of and wide regional variations in the costs of care due to the absurd relationships between insurers, providers, and hospital systems
Having to get permission from insurance companies before you get treatment
Coverage that is often tied to your employer, which completely skews labor force participation and job mobility...
and say "yes, that's an awesome system, I want that!" I've lived in the UK. I've done long term IT projects in Sweden and France. And I'm here to tell you those systems work well. Are they perfectly efficient and without flaws? Nope. There is bureaucracy, there is corruption, and those things will be true for ANY system that tries to provide healthcare for millions of people - some of the exact problems we see in Medicare here in the US. But I'm here to tell you that the GOP is full of crap when they want you to believe that you get poor quality care or that it's difficult to see a doctor. That's just simply not true. Anyone who gives the "they pay way higher taxes than we do" doesn't understand the big picture either. First off most of us already pay 40% in taxes, we just don't get healthcare thrown in with it. Then consider the insanely higher cost of care in the US, which WE ALL PAY FOR ANYWAY, just not in the form of direct taxes. You cannot analyze the big picture and come to any conclusion other than to say that most national health care systems provide better care at a lower net cost, full stop.
But today I want to talk about elections and call out the GOP for pulling a classic "I hate your idea but I'm not actually proposing a viable alternative" move. You know, the kind that your mom called you out for as a kid, and your colleague calls you out for today. This is yet another dimension of where the GOP has completely alienated its TRUE base - moderates like me. There are literally millions of us, Reagan Republicans who know full well that Reagan wouldn't take the time to spit on John Boehner's shoes, that compromise is not a sign of weakness, it's how you get things done in Washington. Back to my point #1 about why the GOP was stupid to paint Obamacare as Obama's law, this law was written by the Dems in Congress, the GOP had a chance to participate and shape things, but they chose not to. I'll be the first guy to admit that Nancy Pelosi is useless, so why on Earth would anyone let her craft such an important piece of legislation?
The answer is simple politics. The GOP, "led" by Mitch McConnell, openly stated that their goal was for Obamacare to fail, NOT because they had a better plan, but PURELY because if it failed big time that would help them win elections. That motive must be used to frame anything and everything they try to tell us about Obamacare and/or their alternative proposals, if they ever come up with one. They could have collaborated with the Dems in writing this thing, they chose not to.
If you're a true conservative and you want to get rid of government waste and improve our economy, the healthcare sector is a perfect place to start. Our nation spends way too much on it, it's crippling our economy, and it should be a prime target for reform. But today's GOP big shots aren't leaders, they're self-centered jerks who care far more about winning the next election and sticking it to the Dems than actually giving this country what it needs: healthcare reform, entitlement reform, a simplified tax code. They are absolutely owned by big pharma and the big insurance companies & hospitals, the exact organizations that have the most to lose from a more efficient health care system.
The strongest evidence of this is that, four years on, they have yet to propose a viable alternative. They've wasted 50 votes in the House to repeal Obamacare. These jerks can't pass anything meaningful, but the notion that Congress can't pass a bill is nonsense. If they can find time for 50 symbolic votes that get them nothing more than a sound byte for the next election cycle, they could find time for more meaningful debate if they wanted to. They don't. All they care about is being able to say "we tried to repeal it over 50 times, it's the Dems that stopped us so blame them." Well, the reason the Dems stopped you is because they outnumber you, because you guys ran on a "repeal Obamacare" platform in 2012 and that failed to win you the majority you'd need in Congress to actually DO that. My favorite part of this dimension of the story is that many of my GOP friend now deny that the 2012 cycle was a referendum on Obamacare; that instead it's the upcoming 2014 mid-terms that will be the referendum. This is because they figured 2012 would be a landslide for the GOP and it wasn't. They lost 2 seats in the Senate and 6 seats in the house.
So where does this leave the GOP for 2014? I think they're actually in a really bad spot. True, more people disapprove of Obamacare today than 2 years ago, but there's another pesky statistic that I think offsets that: we've now got 10,000,000 Americans who just GOT coverage through Obamacare that didn't have it previously. In states that setup their own exchanges, the participation rates are staggeringly high and the percentage of the population who's uninsured has dropped dramatically. In Kentucky, our uninsured population has dropped by 75% and half of the newly insured are under 35 years old.
One of the GOP's best talking points is that there are a few million people who lost coverage, in particular Obama's failure to deliver on his promise that "if you like your coverage you can keep it." Well, the truth is that a lot of people had terrible coverage that is no longer legal, but this is America and if you want to pay for an insurance product that doesn't even cover basic preventive care, that's your "right." Here's the rub: if your key argument is that Obamacare is bad because people lost coverage from it, you can't repeal it today because you'd be killing coverage for 10,000,000 Americans! All the GOP can feasibly do in terms of reforming it is to further Frankenstein a law that's already ridiculously complex. The GOP knows this, and I'm betting they also know it's not worth the fight this year to try to pass an alternative. Much easier to stick with the current strategy of just throwing stones at it. The smart voters already know that the GOP isn't actually proposing any alternatives, and the dumb voters don't care, they vote based on sound bytes anyway.
Mitch is a politician I love to hate. Sadly, he's also my Senator. He's spent 30 years in the Senate, a career politician by definition, and in that time has done effectively zero to improve the quality of life in one of the poorest states in the nation, Kentucky. He's really good at sending pork barrel projects home though, and that has proven highly effective at getting him re-elected.
This year, he's actually got a legitimate challenger. He's down in the polls. The GOP "brand" has basically got negative equity these days because the only loud voices in the party are the "I think the tea party has got some great ideas here!" types, not the moderates who are actually greater in number. Ten polls that came out in the first week of February all have him trailing her, or have them in a dead heat. It's possible for 1 poll to be off, but not 10. To put this in perspective, he's never, ever been even close to being unseated. From his first re-election campaign until his 5th (yep, he's had 5 of them), it's been a foregone conclusion that he'd just win. And some of these polls show that a full 12% of Kentucky residents say they simply don't know Alison Grimes, his opponent. So if the Dems put some marketing dollars behind her, oh and by the way Bill Clinton thinks unseating McConnell is so important he's agreed to campaign with her here in Kentucky, they could easily tip the scales in her favor. For the record, she's spectacular and she's already got my vote. I'm not the kind of Republican who blindly votes for anyone with an "R" in front of their name, and Mitch McConnell and Rand Paul are to shining examples of why that's the case.
So McConnell started running some ads here on TV a few weeks ago. A guy with a raspy voice tells you he got cancer while working at a government facility vital to our national security, and because he had no health insurance, he was really in trouble. So Mitch McConnell really came through for him by getting him... health coverage. Let's examine some of the details behind this story, because it's a doozy.
The dude worked at the Gaseous diffusion plant in Paducah. This plant makes radioactive Uranium for use in nuclear reactors and nuclear weapons. You remember those infamous "centrifuge" arrays that Iran built which pretty much let the world know they were doing more than just making their own nuclear fuel? Yeah, ours (1812 of them) are in Paducah, and it takes 3,000 megawatts to run them. Fun trick: call your utility company and say you're opening a business that takes 3 gigawatts of power to operate, listen to the reaction from the sales agent. That's like running roughly 6,800 steel mills, simultaneously.
That plant is pretty much the only thing going in Paducah. It offered good paying jobs, and was seen as an alternative to coal mining by many residents. Little did they know that the business of making U-235 is far more hazardous to both them and their community than the coal mining (which is quite dirty and hazardous) so common throughout Western Kentucky.
The plant in question is now a superfund site, because it has contaminated the soil and groundwater in the area. Superfund classifies the site as "under control" because it has since put monitoring in place to minimize the contamination, but let's keep that in perspective: it takes a major environmental threat to get listed as a superfund site in the first place. If they declared your house one, you'd move, not ask "well can you keep the contamination risk under control for me and my kids?"
McConnell has promised Paducah residents throughout his career that he'll work to keep the plant open, and he has, but there are consequences there too. Without that plant, the Paducah economy will take a huge hit. 550 workers got laid off there in January, and another 500 will lose their jobs in April. Oh yeah did I mention it's a massive health hazard to work there? So the longer it has remained open, the more employees who have fallen ill! He fought so hard to keep it open that he opposed sanctions against South Africa's Apartheid regime because they bought Uranium from Paducah. In 1988 he passed an amendment to exempt the plant operators from lawsuits. Talk about a deal with the devil - a company says "yeah, we'll keep that plant open, but we know it's a death trap so we'll only do it if you exempt us from the inevitable lawsuits."
Workers at the plant wrote to McConnell for years, when they were enduring the kinds of conditions that a Washington Post expose revealed back in 1999. Only after the media picked up the story did McConnell show interest.
The Department of Energy, who oversaw plant safety (not OSHA, think about that), was well aware of the contamination problems. They had even put together a plan for how to address them. That plan was killed by the Senate appropriations committee, led by... Mitch McConnell. We can't waste taxpayer dollars cleaning up a mess we made with taxpayer dollars, right?
McConnell hates Obamacare, yet we all sympathize with the plight of the man in the video. He was sick and had no way to get insurance, because prior to Obamacare you could deny insurance to a dude with cancer! How can you hate Obamacare and yet your campaign ad is "I got a sick guy some healthcare because he couldn't get it on his own?!" Oh and by the way, you made him sick, Mitch!
This is McConnell's BEST story?! I have to assume so, since he ran the same story as an ad in his 2008 re-election campaign.
I have a lot of friends who identify themselves as conservatives. I used to call myself a conservative, but that's no longer the case. My views haven't changed, but the definition of conservative has. I stand for smaller government and personal liberty. That means you can marry whomever you want, you can carry whatever kind of gun you want, you can smoke whatever you want to, and we shouldn't be giving handouts to oil companies, farmers, or solar panel hippies. That's not what conservative means today though. In 2014, "conservative" means "I believe in Jesus, and I believe Fox News tells the truth, handouts to farmers are ok but handouts to poor people are shameful, and legalizing pot and gay marriage would ruin the moral fiber of our country. I believe that my religious views should be applied universally, to everyone, regardless of what the constitution says about the separation of church and state."
Today we have the tea party and a rising libertarian movement. These groups are mostly good people, but what they fail to understand is that while they might seem "purist" in their views, they couldn't be further from purists in practice. I don't know a libertarian who supports gay marriage. I don't know a tea partier who thinks we should stop giving tax breaks to farmers, oil companies and the coal industry. These folks are more aligned with the modern definition of conservative than the niche movements where they claim membership. They claim to be Reagan Republicans, but forget that Reagan raised taxes, restricted firearms sales and granted amnesty to over 3 million illegal immigrants.
The US response to the situation in Syria is amusing to me. To be clear, I think that what happened is a very serious situation, and not something that should be taken lightly. What I'm saying is that the manner in which the US is responding (or, at the moment, not responding) is laughable. The same goes for the Brits. I mean seriously, when was the last time the FRENCH were calling for action and it was the limeys and the yankees who couldn't get our act together?
The Syrian government bombed its own people with chemical weapons. This is not in dispute, except in the mind of Vladimir Putin and the Chinese. Really, I don't think even they are questioning what happened privately, they're only questioning it publicly to put on a show. If you think they're more credible than France, then UN, and the US, oh, and the 1429 Syrians who died in the attack, I can't help you. The UN security council can't even agree on the day of the week, so anyone who suggests they should agree on a response is nuts. Don't take my word for it though. Start with Christiane Amanpour, one of the most well respected journalists on the planet. There is no conspiracy here, this was not the work of the rebels, it was not the Israelis, it was a crazy dictator killing his own people in one of the most cruel ways possible.
So why is the US response amusing? Because only the 2013 Congress could turn this into a political battle. And really I'm talking about John Boehner and Mitch McConnell. This is largely the same Congress that blindly approved Bush's war in Iraq based on what we now know was one, lying, informant. Except that our current president is one of a very few Senators who voted against that war. So why the change of heart? Let's compare some key points:
W & Powell contended that Saddam had WMD and might use them - in contrast Kerry & Obama have strong evidence that Assad DID use them, on August 21.
Obama has committed to NOT placing any boots on the ground - W sent half the army, who ended up staying there for 10 years (7 years after he appeared under a "mission accomplished" banner on an aircraft carrier)
So how is it that Bush's war hawks have now turned into peace loving hippies? Is it because they learned their lesson and want to be more cautious? Nope. No rational, logical person can look at the evidence here and question anything about it. It's overwhelming, it's from dozens of sources, and it's simply impossible that it's all been fabricated. So Congress is opposing this for the same reason they oppose everything Obama proposes. Actually it's much like China versus US at the UN Security council - "I oppose things just because you proposed them. I don't care about the lessons of history; that when you allow a crazy dictator to gas his own citizens it tends to result in a holocaust. I care about elections, and me winning them and you losing them." Awesome attitude. Real leadership there. Great role models for the kids!
The only positive note here is that Obama has also forced Congress to own the decision. It's really the closest any President has come to complying with the War Powers Act, if you think about it. He's saying "look, I could act here, but really it's the job of Congress to determine when we go to war." That's true. I agree that's the right thing to do. Somehow, I'll bet they even find a way to blame him for doing exactly what a President is supposed to do in a situation like this: deferring to Congress. They'll say he's not shown leadership (like they did with Obamacare - if he's not shown leadership, why are they calling it Obamacare?), that he's wussing out. Well, if we fail to punish a guy who has gassed his own people, I think we've all wussed out. FYI 79% of Americans support military action here.
Here's what you need to know about Delhi: skip it. I'm going to go out on a limb and say that's true for most major cities in India. After spending 3 days there, I can't see any reason to visit unless you're there on business (like I was) or you're a diplomat (which I guess means you'd be there on business anyway).
Delhi is bigger and "nicer" than Bangalore. By that I mean less trash in the streets, fewer stray dogs and cows, better roads, a metro/subway system, a spectacular airport. These things are all nice, but they don't make for anything particularly impressive in the sight-seeing department. I was able to go see "India Gate" which is apparently a major tourist attraction. It celebrates India's independence. It looks like the Arc du Triomphe in Paris, but it's smaller, less ornate, and surrounded by beggars and a SWAT team who expects a terrorist attack at any moment. They spend so much time posing for photos with tourists, they'd probably miss one if it did happen anyway. India Gate seems to largely be of relevance to Indian citizens, as most of the tourist buses there were full of people from other parts of India.
As a city for business, it's very nice. Many office parks, great hotels, relatively easy to get around town and all that. I met with 5 customers here and participated in a CIO panel discussion one morning for breakfast. All were very interesting, if you're a cloud computing strategist. Rush hour is still terrible, it's still got the extreme contrasts between rich and poor, and I got to watch a guy take a dump in the middle of the street, which was a neat first. Once the initial excitement and curiosity associated with the sensory overload subsides, you're left with just plain sensory overload. I'm referring to the city, not the turd of course.