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 FactCheck.org 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 FactCheck.org? Fine. Let’s go to the roster of fact checkers:

Politifact.com: “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

NashvilleBroadcastingHistory.com

NashvilleBroadcastingHistory.com

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.


Hero or Traitor? Or Something in Between?

snowdenThe sensational new documentary on Edward Snowden, CITIZENFOUR, opens here in Nashville at the Belcourt Theater next week. I reviewed the film for the Nashville Scene in this week’s issue. A snippet:

The film’s center, dramatically and chronologically, is the middle hour focusing on the fateful encounter of Snowden, the Guardian’s Glenn Greenwald, and documentarian Poitras (behind her camera, occasionally heard but never seen) in a Hong Kong hotel room for eight days in June 2013. Poitras’ camera was rolling from the start, giving us a front-row (bedside?) seat as history unfolds. Columbia Journalism School dean Steve Coll likens it to having footage of Bob Woodward’s first parking-garage meeting with Deep Throat.

From this seemingly mundane procedural footage, we learn that extended sequences of a few people talking in a hotel room, working on laptops, watching television, munching on room service and taking an occasional phone call can be downright spellbinding.

For anyone who cares about civil liberties in a free society, unmissable.


Who Are These Folks Moving Here?

We know that Nashville’s hot, and that as a result people want to move here. And we know from Census Bureau data that they are moving here, the numbers putting Nashville among the fastest growing large metro areas both in the last few years and since 2000. That’s great … we love newcomers, right? But who are these mooks relocating here?

Demographers don’t call it relocating; they call it migration, and The Atlantic‘s CityLab project is out with a nifty new analysis of migration in and out of U.S. cities — specifically, a look at the education level of people coming and going. So are we attracting smart, educated humans to Nashville? Can’t really speak to “smart,” but here’s what the analysis says about the education level for domestic migration to Nashville (which means it excludes immigrants):

citylab_nashville_500x282

It’s data from a single year, so just a snapshot, but that snapshot suggests that Nashville is losing its most educated residents, with the inflow of newcomers looking like a balanced mix of college educated and non-college folks. How does this compare with other cities, especially those with whom we like to compare ourselves?

Here are two sets of comparison cities. The first is a set of three sunbelt metro areas we often either compare Nashville to or benchmark against:

cityset1

These pictures show two big things that separate Austin and Charlotte from us. First, those cities are attracting more highly educated migrants — large net inflows of people with bachelor’s and postgraduate degrees. And second, although those two metro areas are similar in size to Nashville, look at how much bigger their raw numbers are: Charlotte’s net domestic migration is three times Nashville’s, and Austin’s almost four times. Atlanta, by contrast, is attracting a markedly less educated influx of new residents than Nashville, and is actually may be having problems holding on to its educated workforce.

The second set of comparison cities are tech-centric metro areas out west:

cityset2

These comparisons show just how far out of the big leagues Nashville remains in attracting the kind of very educated talent influx that some cities are enjoying. Putting together the two sets of comparison cities, we can see that Austin and Charlotte are approaching this level of well-educated migration; Nashville isn’t.

A prior CityLab post broke down flows of population in and out of metro areas in 2013 into their international (inflow of immigrants) and domestic components. Nashville, like most cities, showed net inflows in both categories. The exceptions were the largest cities: net migration was negative — more people leaving than coming — in New York, L.A., Chicago, Philadelphia, and Miami.

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


The Ring of Neurofire

JC_and_RMN2From the world of medicine, and specifically the academic journal Frontiers in Behavioral Neuroscience, comes news that a successful neurological treatment for severe obsessive-compulsive disorder can trigger a curious side effect of the Nashville kind. From the published paper’s abstract:

Recently, neuroscientists have discovered that music influences the reward circuit of the nucleus accumbens (NAcc), even when no explicit reward is present. In this clinical case study, we describe a 60-year old patient who developed a sudden and distinct musical preference for Johnny Cash following deep brain stimulation (DBS) targeted at the NAcc.

The patient, identified as “Mr. B,” is said by the team of Dutch neuroscientists who published the paper to have had broad musical tastes before the treatment, “covering Dutch-language songs, the Beatles and the Rolling Stones.” After making no progress with conventional treatment, he was treated with deep brain stimulation, which is known for its use with Parkinson’s patients. Months after the DBS procedure Mr. B. happened to hear “Ring of Fire” on the radio and that’s when the man in black made neuroscience history:

Mr. B. reported that he felt good following treatment with DBS and that the songs of Johnny Cash made him feel even better. From this moment on, Mr. B. kept listening simply and solely to Johnny Cash and bought all his CD’s and DVD’s. When listening to his favorite songs he walks back and forth through the room and feels like he finds himself in a movie in which he plays the hero’s part. He reports that there is a Johnny Cash song for every emotion and every situation, feeling happy or feeling sad and although Mr. B. played almost simply and solely Johnny Cash songs for the following years, the music never starts to annoy him.

Okay, maybe a little lingering OCD there. Side benefit for the docs who wrote the case up: best academic journal article title ever — A case of musical preference for Johnny Cash following deep brain stimulation of the nucleus accumbens.

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


Scalia Watch: Which Nino Will Show Up for Hobby Lobby?

ninoscaliaThe U.S. Supreme Court hears arguments Tuesday in Sebelius v. Hobby Lobby, a case about whether for-profit businesses can on religious grounds avoid a legal requirement that employer-provided health insurance include full contraceptive care. The owners of the privately-held corporations that brought the suit are, to be sure, religious people who run their businesses in part on religious principles. But this case isn’t about their individual beliefs so much as whether the entity they own and operate can itself as a corporation claim a First Amendment right to religious free exercise, and in doing so avoid complying with generally applicable law having secular intent. This case made it to the Supreme Court after a mix of rulings in different federal appeals courts, and where the high court will go with this one is seriously open to question.

With that in mind, it will be entertaining to see how Justice Antonin Scalia plays this one out. On one hand, it’s hard to imagine a scenario in which Hobby Lobby wins without Scalia in its corner. On the other hand, Scalia did write the majority opinion in the important 1990 case Employment Division vs. Smith, ruling against a couple of guys in Oregon who sought exemption from a particular application of drug laws on religious grounds after ingesting peyote as a sacramental ritual at their Native American Church. In Hobby Lobby, one of the issues the court will ponder is whether the contraception requirement, which as a regulation has no religious character or intent, substantially burdens religious exercise to an extent that would justify letting some evade the law.

So what does Scalia think about situations in which public policy created through a democratic process collides with individual claims to a right to religious free exercise? It is instructive to read some of the things he had to say in 1990 in the Oregon case:

“The government’s ability to enforce generally applicable prohibitions of socially harmful conduct, like its ability to carry out other aspects of public policy, cannot depend on measuring the effects of a governmental action on a religious objector’s spiritual development.”

“Respondents urge us to hold, quite simply, that when otherwise prohibitable conduct is accompanied by religious convictions, not only the convictions but the conduct itself must be free from governmental regulation. We have never held that, and decline to do so now.”

“Our cases do not at their farthest reach support the proposition that a stance of conscientious opposition relieves an objector from any colliding duty fixed by a democratic government.”

“It is horrible to contemplate that federal judges will regularly balance against the importance of general laws the significance of religious practice.”

Quoting with approval a 19th century case: “‘Laws…are made for the government of actions, and while they cannot interfere with mere religious belief and opinions, they may with practices…Can a man excuse his practices to the contrary because of his religious belief? To permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself.'”

Which Scalia will show up today for Sebelius v. Hobby Lobby? The one from 1990 who understood the proper balance between democratic government and religious freedom? Or the twenty-first century version who just seems to make it up as he goes to suit his ideological whims?

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


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