Beacon Center v. Reality

In the wake of this morning’s King v. Burwell ruling, in this corner we have those health care denialists at the Beacon Center of Tennessee, quoted by The Tennessean:

“Obamacare has been proven to be unaffordable, unworkable, and unfair. We should not invite further consequences of this already failing law into our state by expanding Medicaid”

And in this corner, courtesy of data aggregated by the Urban Institute’s Health Policy Center, we have reality:


The winner … you make the call.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.

Is Academic Freedom a License to Provoke Without Consequences?

Does academic freedom entitle university professors to be as provocative as they wish when expressing their views on issues of the day? This question has come alive with three recent cases involving professors making politically charged – some would say incendiary – statements on controversial issues.

The first case involves Steven Salaita, whose offer of a tenured appointment at the University of Illinois was rescinded because of charged comments he made on Twitter last year about Israel and its actions in Gaza.

Second is the case of Saida Grundy, a new professor of sociology and African-American studies at Boston University, who has been called out for contentious tweets about race.

Third is the matter of Jerry Hough, a chaired political science professor at Duke who penned what many saw as a racist diatribe in the comments section of a New York Times editorial about happenings in Baltimore.

The details of these situations differ, but there are common threads.

Each features a professor in hot water for speech delivered outside the confines of academic employment. Each involves expression that, while being objectionable to some, is constitutionally protected speech. Each has aroused the ire of stakeholders, such as students, colleagues, alumni and other interest groups. And as a result, each has forced university leaders to wrestle with a three-way collision involving academic freedom, free expression and institutional reputation.

These professors – like all of us in tenure-track academic appointments – are employees with jobs at universities that pay their salaries. So, one way to view these cases is through the lens of employment.

Within the larger landscape of worker rights in a free society, the tension between our right to speak as citizens and obligation to our employers as job holders is contested terrain – an issue I explore at length in my book on the legal, ethical and managerial dimensions of free speech in and around the American workplace.

The legal aspects of this subject are complex. The employment-at-will system of labor law in the US, which in the absence of a contract lets employers and workers terminate the arrangement at any time for any reason, means that private sector workers have virtually no free speech protections against employer wrath.

If your boss doesn’t like your off-work speech, even if it has nothing to do with your job or your employer’s business, you can be fired for it. For instance, consider the Alabama woman who lost her job in 2004 for having a John Kerry bumper sticker on her car in the factory parking lot.

Workers in public sector jobs have greater protections. In situations involving government rather than a private entity as the employer, Supreme Court rulings over several decades have upheld workers’ rights to speak on matters of public concern without risking their jobs.

A handful of states give workers in the private sector some of the free speech protection that government workers have through what are known as “lifestyle discrimination” statutes. These are laws that bar employers from punishing workers for off-work activity, including speech, that is legal and poses no significant threat to an employer’s business.

But these protections for government workers (and private sector workers in a few states) are enforced only up to a point. When someone fired for his or her speech files a lawsuit, the court weighs the worker’s right to speak against the employer’s right to a functional and efficient workplace. Analyses of case law indicate that courts are inclined to tilt the balance in favor of employers.

The public-private distinction is relevant to our three recent cases of professorial provocation. This is because one of the three – Salaita at Illinois – involves a public university.

After having his job offer rescinded, Salaita filed a federal lawsuit claiming that his rights to free speech and due process had been violated; a judge’s ruling on whether Salaita’s lawsuit can go forward is expected any day.

That kind of constitutionally based lawsuit isn’t available to Grundy at Boston University or to Hough at Duke since their appointments are at private institutions. Although Grundy and Hough cannot claim a constitutional infringement on their rights, they can appeal to the principle of academic freedom.

This is what distinguishes the occupation of professor from other kinds of employment: universities pledge (in the form of an implied contract) to respect professors’ free speech rights beyond what typical private sector job holders can expect, when they make academic freedom a foundational principle. And while happy to ordain and celebrate the lofty ideals of academic freedom, universities are also quick to couple them with cautionary caveats.

At Duke (where Hough is), the faculty handbook cedes to professors the right “to speak in his or her capacity as a citizen without institutional censorship or discipline.” Duke warns, however, that the right to “espouse an unpopular cause” carries with it “a responsibility not to involve the university.”

Making a similar pledge, the handbook at Boston University (where Grundy is) adds that a professor’s right to speak as a citizen carries “special obligations” to be accurate, exercise restraint and respect others’ opinions.

With reasonable-sounding but rather vague conditions like these, universities (both public and private) have reserved the ability to impose boundaries on outrageous expression that the professor might assume is protected by academic freedom.

Having crafted faculty employment policies as manifestos of mutual obligation, universities coping with professors who speak scandalously find themselves in the role of an arbiter of the boundary between freedom and responsibility.
And so it was that in blocking Salaita’s appointment, the University of Illinois Board of Trustees decided that he lacks the requisite “professional fitness to serve on the faculty.”

The trustees probably figure they can fend off Salaita’s lawsuit – a not unreasonable expectation, to judge by a new legal analysis showing that courts tend to side with university claims that a professor’s speech disrupts its academic mission.

Weighing the balance differently, Duke asserted that Hough’s comments are “noxious, offensive and have no place in civil discourse” but saw the remedy as encouraging others in the community to speak out when the university’s “ideals are challenged or undermined.”

Boston University acted similarly, respecting the professor’s “right to hold and express personal opinions” while adding “we’re offended by such statements.”

The question of when a professor’s provocation becomes actionable cause for termination is a hornet’s nest of subjectivity around the meaning of words like “offensive” or “bigoted” or “harmful” or “restraint.” A university that chooses to act against the professor – as Illinois did against Salaita – puts itself in the uncomfortable position of having to explain what these terms mean and where lines are drawn.

Instead of appeasing offended stakeholders by drawing lines in shifting sand, a more enlightened approach prioritizes a free exchange of ideas over the dubious judgment of a free-speaking professor. That’s the path Duke and Boston University are following: condemn the objectionable remarks while preserving the professor’s freedom to make them, leaving a verdict to the court of public opinion.

This article was originally published on The Conversation. Read the original article.

Death, Distinctively

The good folks at the Centers for Disease Control and Prevention have rounded up some nifty state-by-state statistics on “distinct” causes of death in each state, defined as “the cause of death in each state that stands out most relative to its national average.” So what do you imagine is Tennessee’s distinct cause of death? As shown in a map legend included in a Washington Post story on the CDC report, here are the choices:

Source: CDC via Washington Post

Source: CDC via Washington Post

…and the winner is…

Accidental discharge of firearms! Shocking. The map does suggest some handy travel tips: Stay away from hospitals in New Jersey, avoid unprotected sex in Louisiana, and don’t spend too much time with attorneys in Oregon.

Source: CDC via Washington Post

Source: CDC via Washington Post

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.

Baldfaced Lies at the Legislature

I realize I’m becoming a bit of a broken record documenting the shameless lies and propaganda that dominate the Beacon Center of Tennessee’s messaging on “Insure Tennessee.” But since our state lawmakers insist on giving Beacon a platform to spread their nonsense, someone has to call bullshit. Consider it called.

At this morning’s Senate Health and Welfare Committee hearing on Insure Tennessee, committee members were shown this slide by the Beacon Center’s Justin Owen, who was appearing before the committee to describe the various forms of apocalypse that will ensue if the legislature approves Medicaid expansion.


Owen wants to argue that Medicaid expansion puts stresses on the system that end up harming the most vulnerable individuals already covered, and the slide was an attempt to suggest there there is evidence for this alarming prediction in the experiences other states that have expanded Medicaid. There’s just one problem with the slide: Every claim it makes is factually incorrect.

You see five claims in that slide. Let’s take ’em one by one.

Arizona – dropped coverage for transplants? It is true that Arizona made some drastic cuts that included reducing Medicaid coverage for some transplants, but this occurred in 2010, before Obamacare took effect and a full three years before Arizona actually approved Medicaid expansion in 2013. And oh by the way, Beacon doesn’t want you to know that Arizona restored funding for those organ transplants for Medicaid patients in 2011.

Arkansas – denied drugs for cystic fibrosis patients? It is the case that Arkansas’ Medicaid program last year decided to deny access to the drug Kalydeco, which costs around $300,000 per year, triggering a patient lawsuit. What the Beacon Center conveniently omits adding, however, is that a few months later a state review board comprised of doctors and pharmarcists recommended that restrictions on the use of Kalydeco be eliminated, a recommendation that the Arkansas Department of Human Services has said it intends to adopt.

Oregon – stopped coverage for cancer treatments? This claim has its roots in a bogus chain email that made the rounds in 2013. PolitiFact Oregon has thoroughly vetted this and rates it a “pants-on-fire” lie: “Older patients diagnosed with cancer need not worry that treatment will be rationed or denied under the Affordable Care Act. The claim is based on an inaccurate reading of a bill that went nowhere.”

Maine – stopped treating brain injury patients? It is preposterous to attribute any change in coverage in Maine to Medicaid expansion given the basic reality that Maine is not participating in Medicaid expansion. It’s governor Paul LePage has been an unyielding advocate of shrinking Medicaid, not expanding it.

Rhode Island – implemented premium for disabled children? This refers to a proposal floated by Rhode Island’s governor early last year that would charge a $250/month premium to parents with kids in the state’s Katie Beckett program for severely disabled children. What the Beacon Center conveniently neglects to mention is that state lawmakers scoffed, the premium proposal was scrapped, and if you visit the Rhode Island Katie Beckett eligibility page you learn that “There is no cost to families.”

That Beacon slide on display for Tennessee lawmakers this morning had no title. It need one: “Things in other states that didn’t happen but if I can fool you into thinking they did maybe I can scare you into opposing health insurance for the working poor.”

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.

Can Alarmist Propaganda Derail Insure Tennessee?

On the eve of the Tennessee legislature’s special session on Medicaid expansion, The Wall Street Journal over the weekend gave the Beacon Center of Tennessee an opportunity to expand its alarmist anti-Insure-Tennessee propaganda to a national audience. In a piece coauthored with Christie Herrera of the Foundation for Government Accountability (another libertarian think rant tank), Beacon CEO Justin Owen characterized Gov. Haslam’s plan as a “bad deal for the public” that will “hurt the neediest patients,” is financed with a “sketchy” funding scheme, and will bloat the national debt. Owen and Herrera summed up the coming week’s doings in melodramatic terms:

Tennessee lawmakers must decide if they are going to burden more state residents—and American taxpayers—with ObamaCare’s broken promises, failed schemes and unsustainable policies, or whether their state will lead the march toward more freedom, greater access, and better health outcomes.

Obamacare is, to be sure, complicated and a work in progress. But “broken promises, failed schemes and unsustainable policies” seems like a pretty harsh verdict (and by “harsh” I mean “delusional”) for a set of policies that can be demonstratably associated with…

…increased access to health insurance: In the one year period from Sept. 2013 to Sept. 2014, the uninsurance rate (percentage of adults lacking health insurance) dropped by 30% nationally. The drop is 36% in states doing the Medicaid expansion thing, 24% in those not. (Source: Urban Institute Health Policy Center.)

…a drop in growth of systemic health spending: Health inflation measured as a growth in national health expenditures in 2013 was at its lowest level since the statistic originated in the 1980s. (Source: Centers for Medicare and Medicaid Services.) Brookings sums it up this way: “Growth in health spending over the past four years has been the slowest rate on record in approximately 50 years.”

…the same or lower cost for most people in the individual market: For those with individual policies who had to change insurance because their old plans didn’t comply with minimum standards set by Obamacare or otherwise went away, 46% end up paying less, 39% more, and 15% the same. (Source: Kaiser Family Foundation.)

…some wins in quality of care: Obamacare changes to payment systems intended to stimulate cost savings were designed in part to improve outcomes as well, and there’s evidence that hospital-acquired infections and hospital readmission rates are significantly down. (Source: Dept. of Health and Human Services.)

…high levels of satisfaction: Survey data show that 78% of adults added to the ranks of those covered in 2014 are satisfied with their new health insurance. Also, 58% of those who have gained access to health care (either through exchanges or Medicaid expansion) say they are better off than before&#8212a number that rises to 70% for those who have actually used their coverage in some way. (Source: The Commonwealth Fund)

It is true, as Obamacare critics contend, that the expansion of coverage puts strains on the system. Many in the individual market may have narrower provider networks than before, and expanded Medicaid isn’t all that expanded if docs won’t take new Medicaid patients. These issues can add up to legitimate questions about whether increased access to insurance translates into increased access to care. A fair-minded person can also question whether some of the favorable trends and outcomes are merely coincident with Obamacare rather than caused by it. Odds are it’s some of both.

But to try to take down Insure Tennessee by tarring Obamacare as a package of “broken promises, failed schemes and unsustainable policies” is to live in a world of policy hallucination. If more people insured at lower cost with high satisfaction and some gains in quality translates into “failed schemes” then color me pro-failure.

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.

A Shopworn Lie

One of the louder voices opposing Gov. Haslam’s Medicaid expansion plan is the libertarian Beacon Center of Tennessee, which has just launched a new radio ad running in the Knoxville media market. The ad, framed as a conversation between a senior citizen and her daughter, resurrects one of the right’s most dubious (but nonetheless durable) canards on this issue:

DAUGHTER: “In fact, the Medicaid expansion will be paid in part by $716 billion in cuts to seniors’ Medicare benefits.”

MOM: “To give health insurance to able bodied adults?”

DAUGHTER: “You got it.”

It’s always good practice to begin a factually debunked assertion with the words “in fact.” This claim has been fact-checked so many times it should take up residence in the fact-checking hall of fame. But since Beacon thinks the way to build opposition to health insurance for the working poor is to recycle a lie, let’s go at it once more, with feeling.

The origin of that $716 billion number is an analysis by the Congressional Budget Office back in 2012 in response to a request from House Speaker John Boehner for an estimate of the cost of repealing Obamacare. On page 13 of its 22 page analysis, the CBO said that “Spending for Medicare would increase by an estimated $716 billion over the 2013-2022 period.”

Does that sentence mean, as the Beacon ad claims, that Medicaid expansion will be paid for by $716 billion in cuts to Medicare benefits? As the highly respected Annenberg Public Policy Center’s has noted, the $716 billion is an estimate of the decline in future growth of Medicare spending owing to reductions in growth of payments to hospitals and providers, diminished subsidies for Medicare Advantage plans, and savings anticipated as a result of reimbursement system changes. The claim that projected declines in future spending growth represent cuts of Medicare benefits to seniors, they conclude, is “misleading and shameful.”

Don’t like the pinkos at Annenberg’s Fine. Let’s go to the roster of fact checkers: “Obamacare does not literally cut funding from the Medicare budget, but tries to bring down future health care costs in the program….There is reduction in spending to Medicare outlays, but it’s fueled by finding savings in the program, a move that Republicans actually supported in the Ryan budget. Medicare spending still increases in the coming years.”

Los Angeles Times Fact Check: “The president’s healthcare law does reduce future spending on Medicare, but those savings are obtained by reducing federal payments to insurance companies, hospitals and other providers, and do not affect benefits for people in the Medicare program.”

Washington Post Fact Check: “While it is correct that anticipated savings from Medicare were used to help offset some of the anticipated costs of expanding health care for all Americans, it does not affect the Medicare trust fund….Spending does not decrease in Medicare year after year; the reduction is from anticipated levels of spending in future years. Moreover, the “cuts” did not come at the expense of seniors.”

TIME Fact Check: “As for the cuts, they come from eliminating a massive subsidy to private insurers and gradually reducing the rate of growth in payments to some providers….The idea, however, that the Affordable Care Act struck a dangerous blow to Medicare that will change the program in fundamental ways is untrue.”

Beacon describes itself (humbly) as an organization that “empowers Tennesseans to reclaim control of their lives, so that they can freely pursue their version of the American Dream.” Reclaim control of their lives? Or of their lies?

A version of this post appears on the Nashville Scene‘s Pith in the Wind blog.

And I Mean the Left

This post appears at the Nashville Scene’s Pith in the Wind blog along with those of others who appeared on “The Round Table,” the long-time radio enterprise hosted by the great Teddy Bart, who passed away a few days ago.

Growing up in New York I fed an early nerdy talk-radio addiction using a bedside clock radio to catch the pompous erudition of the great Barry Farber, the offbeat weirdness of Long John Nebel, and even occasionally (yes I’ll admit it) the original semi-unhinged conservative radio mouthpiece Bob Grant. Whatever the politics and eccentricities of a particular host, the appeal was (mostly) civilized conversation about ideas with smart people for a loyal radio audience.

Each place I’ve lived after leaving the northeast for college always brought me in short order to cruising the radio dial for good local talk — surely I can find a version of this conversation almost anywhere. Landing on planet Nashville in the early 1990s I happened upon this Teddy Bart guy and his morning Round Table of … what, exactly? It felt like an odd mix: one minute serious journalists are kicking around city and state politics, the next minute Teddy is tickling the ivories of an electric piano in the studio and pivoting into sports and weather. So this is Nashville, I thought: You get a talk show only if you can play an instrument and sing.

Once I’d been spewing opinions in outlets like the Nashville Scene for a while, Teddy invited me to be on the Round Table from time to time as a panelist “on the left” (“and I mean the left,” he would always add with a smile). It was great fun, as it would be for any card-carrying political junkie, to chew the fat on issues of the day with other smart humans of diverse viewpoints. But it was serious fun: it was a great privilege to be part of conversations that were informed and constructive, that mattered (without taking themselves too seriously), and that were heard.

The show in its later years may have aired on obscure AM radio stations with obscure cable-access replay — hard to find unless you were looking for it, but it turns out a lot of people were looking for it. Almost nobody turned down an invitation to be on the show, and nine years after it ended I still run into people who recall my minor involvement and lament that Nashville has had no similar outlet for regular meaningful civic dialogue ever since.

He was plenty good with that keyboard, but thoughtful, civilized discourse turned out to be the instrument Teddy Bart played virtuoso.


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