Take two: Employers want to provide health insurance

Perhaps I buried my lede a bit yesterday in a post about the ACA's employer mandate. So let me try a carve-out.

Josh Barro, taking at face value some bitching about the requirement that employers with more than 50 full-time employees offer health insurance to their employees, recently charged that the mandate is a mistake and that health reform should have pushed health insurance away from the employer-employee relationship.

Defensible as that diagnosis may be in the abstract, voters at large were not the only constituency resistant to weakening the employer-healthcare bond.  Big businesses, and a not inconsiderable number of small businesses, values their role as health insurer, seeing that role as an important part of their bond with employees, as a competitive advantage, and increasingly, as an opportunity to make their workforce more productive  -- not to mention as font of a tax-free form of compensation.

Call them crazy, as Matt Miller did in October 2009 when the National Coalition on Benefits, an association purporting to represent the interests of employers covering 130 million Americans in the health reform process, helped to shoot down Senator Ron Wyden's Free Choice Amendment, which would have enabled all employees to opt out of their employer's health care plan and buy insurance on the insurance exchanges established by what later became the Affordable Care Act. The group's motto: Don't Erode What Works to Fix What's Broken. *

U.S. employers want to provide health insurance

The Wall Street Journal has a good article today, by small business reporters Emily Maltby and Sarah Needleman, about three smallish businesses grappling with the the Affordable Care Act's employer mandate, which charges employers with more than 50 employees $2,000 per employee (excluding the first 30) if they don't offer coverage.  None of the business owners opt not to offer coverage. Here's the head of a small pizza chain with 90 hourly workers:

Next year, Mr. Stark intends to offer a health-insurance plan for the first time to comply with the law. "At the end of the day, if we take care of our team members, they will take care of the guests," he says. "I philosophically believe people having health care, regardless of age, is positive."

A consultant with 93 employees adds:

Love the sin, hate the sinner or whatever

Forty five-odd years ago, a popular poster, sweatshirt etc. showed the Peanuts character Linus (blanket in tow), protesting loudly, "I love mankind -- it's people I can't stand."

That flashed back to me last week when I read Marco Rubio's justification for a fresh round of budget terrorism:

“I have tremendous respect for this institution,” Mr. Rubio said in an interview on Friday. “But I’m not all that interested in the way things have always been done around here.” 

"The way things have always been done" in this case means reconciling House and Senate budgets without tying those negotiations to a threat of national default.

The Times editorial board reminded me of that flashback this morning. Their take on Rubio's comment: it exemplifies the mindset of the latest crop of high profile Republicans, who "want to dismantle government, using whatever crowbar happens to be handy, and they don’t particularly care what traditions of mutual respect get smashed at the same time."

As Peanuts characters used to say from time to time: I'd be foolish to deny it.

Hobson's choices in Syria

Re Syria, the FT's Gideon Rachman is at his best -- teasing out the geopolitical crosscurrents tugging at those countries that fancy themselves able or compelled to try to influence events, and noting the extent to which appearances may be deceptive:

As the world edges towards a peace conference on Syria, three ideas about the west’s role in the conflict are widely accepted. First, that the longer the conflict goes on, the greater the chances of direct or indirect western military intervention. Second, that there is a deep and bitter division between the US and Russia that is making progress much harder. Third, that the Syrian civil war is dominating western thinking on the Middle East. Few people publicly dispute these propositions. And yet they are all distinctly questionable (my emphasis).

Western inhibitions about intervention are driven not just by the debacle in Iraq but by the "success" in Libya:

Hire this woman

I'd have a lot more blog traffic If I could quote myself as enticingly on Twitter as The American Prospect's Jaime Fuller quotes everyone else. Based on my sampling of one, she has a click-through rate of over 50%. Her best tweets are all quote.  A sampling from the last few days (and last few minutes):

"'We’ve come for the poem about the duck,' the cop would say, as I pumped a shell into the chamber." oxfordamerican.org/articles/2013/…
— Jaime Fuller (@j_fuller) May 21, 2013

"A man with a camera mounted on the handlebars of his bicycle lifted up the bike in order to film Weiner walking." capitalnewyork.com/article/politi…
— Jaime Fuller (@j_fuller) May 23, 2013

Another rung down for "Afghan good enough"

If it's possible to define success in Afghanistan down any further, Obama may have done so in his speech seeking an end to perpetual war yesterday:

In Afghanistan, we will complete our transition to Afghan responsibility for that country’s security.  Our troops will come home.  Our combat mission will come to an end.  And we will work with the Afghan government to train security forces, and sustain a counterterrorism force, which ensures that al Qaeda can never again establish a safe haven to launch attacks against us or our allies.

Not, "we'll work with the Afghan government to train security forces to support and sustain a democratic government that serves its people." Not even a force to fend off the Taliban. Keeping al Qaeda out is thesole goal. [5/28 update: I believe I misread this a bit, helped by an ambiguous pronoun. It's the U.S. counterterrorism force that "ensures that al Qaeda can never again establish a safe have." Not clear what the Afghan security forces will "ensure," if anything.]

That went along with a retroactive redefinition of the U.S. mission in Afghanistan in the Obama years:

Obama on counterterrorism: will "redefines" become "unwinds"?

It is true, as Matt Welch avers, that Obama could amend much of what is wrong with the current U.S. response to terror by executive order, without the help of Congress. Also true, by extension, is that much of what is wrong -- excessive use of targeted killings, failure to release those Guantanamo prisoners cleared for release, disproportionate punishment of leakers -- is his responsibility [Update, 5/25: See Joe Nocera today on Obama's responsibility for the continuing hell of Guantanamo].  Also, that while yesterday Obama articulated important intentions -- paring back and ultimately repealing AUMF, closing Guantanamo, finding a way out of the indefinite detention trap -- he was lighter on announced action -- though paring back the drone campaign and transferring it to the military (which he didn't mention, but has signaled clearly through other channels) is certainly significant, as is getting the ball rolling with Yemeni detainees.

And yet, we should not under-emphasize the import -- or the courage required -- in redefining the conflict for the American people, taking us back to the future in our response to terrorism, and warning -- as pointedly as Eisenhower did about the military-industrial complex -- about the dangers of perpetual war.  And in this regard, my response to Obama's rhetoric in his speech redefining U.S. response to the terror threat is, once again, almost Pavlovian. He is so analytical, so precise, so nuanced, and so clear in laying out the threats we face, and the need to balance threats to security and freedom, that I can't help but feel renewed faith in his judgment, and to suspect, with one caveat I'll get to later, that he's balanced his responsibility for U.S. security and for the preservation of our civil liberties and standing in the world reasonably well -- constrained by our divided government, the hysterical existing terms of our national security discourse, an intellectually corrupt opposition, and the institutional machinery of the Pentagon and the security state .

Note the blend of analysis, classification and narrative below, the refusal of triumphalism, the parsing of threats -- Pre-, post- and post-post 9/11; regional vs. U.S.-aimed, terror generally vs. jihad, overseas vs. homegrown:

Kevin Drum's dangerous indulgence

Kevin Drum gave in to temptation this afternoon (and I gather it's kind of Obama's fault):

A couple of hours ago I had a choice to make: spend the next hour writing a reaction to President Obama's big national security speech, or go to lunch. I went to lunch.

Such lapses can put us in danger. So claims Screwtape, C.S. Lewis' devil and master tempter (in Lewis' imagining, each of us is assigned a guardian devil, so to speak, as well as a guardian angel, and they battle it out moment by moment until we die). Read and tremble, midday indulgers:

I once had a patient, a sound atheist, who used to read in the British Museum. One day, as he sat reading, I saw a train of thought in his mind beginning to go the wrong way. The Enemy, of course, was at his elbow in a moment. Before I knew where I was I saw my twenty years' work beginning to totter. If I had lost my head and begun to attempt a defence by argument, I should have been undone. But I was not such a fool. I struck instantly at the part of the man which I had best under my control, and suggested that it was just about time he had some lunch. The Enemy presumably made the counter-suggestion (you know how one can never quite overhear what He says to them?) that this was more important than lunch. At least I think that must have been His line, for when I said, "Quite. In fact much too important to tackle at the end of a morning," the patient brightened up considerably; and by the time I had added "Much better come back after lunch and go into it with a fresh mind," he was already halfway to the door.

Where Obama's Green Lantern lies

Sean Trende offers up a kind of excuse for pundits and centrists who indulge in what political scientist Brendan Nyhan calls Green Lanternism. --lambasting Obama for failures of ill-defined "leadership," i.e., for failing to charm the Republicans out of their scorched-earth opposition or to overcome the extreme constraints the Constitution imposes on presidential power in domestic affairs.   According to Trende, the expectation that Obama would exert magical powers to overcome opposition derives from the campaign Obama ran in 2008:

Many of the president’s supporters thought they were voting for the Green Lantern in 2008.

Remember, the actual policy differences between Obama, Hillary Clinton, and John Edwards were pretty limited. To help distinguish himself from the pack, and to attack Clinton indirectly, Obama all but dressed up in green tights, claiming that his candidacy would enable us to put old arguments behind us, bring people together, and transform the country.

There is an element of truth to this, as there was an element of malarkey in Obama's promise to usher in "a different kind of politics."  But only an element, on both sides of that equation. Obama's core pitch and promise in 2008 was more realistic and tough-minded than "I can melt the opposition."

Does Obama subject African Americans to "targeted scorn"?

Yesterday I put up some thoughts about Obama's commencement speech at Morehouse College, in blithe and admittedly self-imposed ignorance of what others had said about it (I plead lack of time, fatigue and eagerness to get my thoughts down -- and will also cop to not wanting to complicate that quick-stream).  I thought it was an awesome speech, in the pre-colloquial sense of awesome, as in awe-inspiring.

Ta-Nehisi Coates, however, greets the speech (and a parallel commencement address by Michelle) with a powerful indictment. In response to a passage in which Obama admonishes the Morehouse Men, "there's no longer any room for excuses" -- e.g., being held back by racism, Coates writes:

This clearly is a message that only a particular president can offer. Perhaps not the "president of black America," but certainly a president who sees holding African Americans to a standard of individual responsibility as part of his job. This is not a role Barack Obama undertakes with other communities.

Taking the full measure of the Obama presidency thus far, it is hard to avoid the conclusion that this White House has one way of addressing the social ills that afflict black people -- and particularly black youth -- and another way of addressing everyone else. I would have a hard time imagining the president telling the women of Barnard that "there's no longer room for any excuses" -- as though they were in the business of making them. Barack Obama is, indeed, the president of "all America," but he also is singularly the scold of "black America."

There is undoubtedly a lot of truth to this. As Fallows notes in response, though, Obama has to walk a razor-thin tightrope when addressing African Americans directly or matters of race generally -- or, better, as Fallows put it, "a tiny, little rope suspended across a Grand Canyon." By way of additional mitigation, Fallows notes,  "We all take a different tone in setting expectations for "our own."

I would add three further mitigating thoughts. First, in his admonishments throughout the speech, Obama was channeling the historic messages of Morehouse itself -- including in the passage Coates focused on:

Obama gets personal at Morehouse

I have read or listened to several Obama commencement addresses over the years, and his address at Morehouse College yesterday struck me as something of a departure in several ways. While I may have missed or forgotten prior iterations of the parts that struck me, let me set down what I thought was singular.

First off: Morehouse is a men's school, and so Obama addressed men, which gave the talk a retro feel.  He talked about what it means to be a man, rather than simply a responsible adult, and what it means to be a black man in particular.

Addressing black men meant walking a fine line -- as Obama always does when he addresses African American audiences -- between the particular and the universal (in this case, particulars of gender as well as ethnicity).  Obama acknowledged as much in a rather meta moment:

Two takes on Obama from Fallows

In the long hot political summer of 2011, as Obama was sliding down the precipice toward the Budget Control Act (that wonderful deed that gave us the sequester), I was struck by a balance struck between admiration and anxiety about Obama in a note from James Fallows:

"We will hope that the qualities we admire in Obama outweigh the ones that make us nervous."

Today, in a view-from-China at our three scandals, Fallows concentrates on the one that troubles him -- the leak investigation -- and by the way expresses a similar toggle-switch assessment of the president's strengths and weaknesses (in an exception to the long-term rule):

It is one of the rare times I question not his effectiveness or tactics but his judgment. 

Housekeeping note*

A busy work week and a long graduation weekend have put xpostfactoid on unexpected semi-pause for a week. Back soon! - maybe even on the weekend.

We're coming back with this booty -- Sir Walter of the South. Yippee! Painted toenails not included.

* Is "housekeeping note" Bernstein's coinage, or in general bloggy parlance. Apologies to JB if the former.

Are "liberals" learning to love the sequester?

A while back, as the sequester took hold and Obama unfurled his budget, Greg Sargent framed up what he presented as a tough choice for Democrats (on the dubious chance that they would have any choice at all): Stand pat with the sequester in place, Medicare and Social Security left essentially untouched, and no new revenues beyond the $600 billion over ten years enacted in January -- or sign on to a grand bargain that would include entitlement cuts proposed in Obama's 2014 budget, e.g.,  chained-CPI and higher Medicare premiums for wealthier seniors, along with more targeted and gradual discretionary spending cuts than those mandated by the sequester, and some new revenue.

As of today, Sargent seems to have made his choice, or assumed a collective one for "liberals":

The Monica Lewinsky scandal may have helped save Social Security in the late 1990s. Now the scandal fever currently gripping Washington — IRS, Benghazi, Associated Press phone records — may save Social Security and Medicare two decades later.

Liberals who are dreading the scandal-mania that is taking hold should note that it contains a potential upside: It could make a Grand Bargain that includes cuts to Medicare and Social Security benefits even less likely than it already is.

Save Social Security? From Obama's chained-CPI proposal, which by slowing cost-of-living increases would reduce payments from the current baseline by about 0.3% per year, with offsets for the very elderly? Save Medicare? From Obama's $400 billion/10 year grab bag of nips and tucks, little different from those proposed in his 2013 budget, the most notable difference being larger (but still quite incremental) premium hikes for wealthy seniors than those proposed in 2013?

Eloquent omission, Damian Paletta

I approve this messaging from the WSJ reporter on federal budgeting matters:

And while the short-term deficit is shrinking, both parties know it is projected to widen dramatically in coming decades as the U.S. population ages unless changes are made to curb the growth of programs like Medicare.

Conspicuous in its absence from this long-term budget snapshot: Social Security.  Again, later in the article:

Many Democrats have called for a broad budget deal that would reduce the deficit over many years by raising taxes and curbing the growth of Medicare and other entitlement spending.

I get nervous when I read sentences like this, cont.

from Greg Sargent:

And so, in the days ahead, you’ll hear top Democrats continue to amplify the case that the so-called “Boehner Rule” — in which Republicans insist on dollar-for-dollar spending cuts in exchange for the debt limit hike — is a dead letter. You’ll hear them continue to call on Republicans to stop allowing Tea Party intransigence to exert total control over budget strategy. You’ll hear them demand an end to chaos governing. But we’re probably stuck with chaos governing for the foreseeable future. Anyone see any way out of this?

As I've noted before, anticipations by Sargent, Beutler and other progressive close watchers of the budget battles that Democrats won't cave on a particular upcoming sticking point are pretty good indicators that Democrats will, in fact, cave on that particular point. In this case, Sargent does leave the outcome open, merely relaying what we'll hear from Democrats. And it's hard for me, too, to imagine Democrats making any new spending concessions without further tax increases. But still...

Picking at the healthcare Gordian knot

It's no secret that there's a grotesque hierarchy in U.S. healthcare pricing. Medicaid pays the lowest prices, followed by Medicare, then by private insurers.. and then, at the bottom of the totem pole, by uninsured individuals, who, as Steven Brill documented in grotesque detail, may pay three or ten or fifteen times what Medicare pays for a given procedure.

This system is not only grossly unfair, it's the chief reason Americans pay more than twice the OECD average per capita for healthcare than people in other developed countries. Notwithstanding a wide variety of payment systems, countries with universal health insurance -- that is, every other wealthy country in the world -- almost universally empower government to impose uniform pricing. In Japan, for example, where most people get health insurance through private, nonprofit plans provided by their employers (generally with a 30% patient co-pay), the government publishes a uniform price schedule. T.R. Reid, in The Healing of America, describes it:

[the medical price schedule is] published in a thick book--about the size of the Tokyo telephone directory--that anybody can buy. This hefty volume, the Shinryo Tensu Hyakumihyo ("Quick Reference Guide to Medical Treatment Points"), sets forth exactly what a doctor, therapist or hospital will be paid for any treatment or medication. There are tens of thousands of different treatments in the book: "throat swab,", "application of plaster cast, ankle," "sutures, outer arm," "X-ray, simple, neck region, rear," etc., etc. For almost all of these, the price is extremely low...(p. 91).

Vietnam as glimpsed from Camelot

When I was about four or five years old, I was sitting with my mother in our car outside the "Neighborhood House" community center in Riverdale in the Bronx, NY when I must have said something about war.

My mother said, "There are no more wars."  Then she thought about it for a moment and added (as I remember it), "well, there's a little war going on right now. It's not a real war."

I tried to picture a "not real" war. The visual backdrop of our lives was the Palisades, a long run of pristine blue flat-topped cliffs across the mile-wide Hudson River, which our apartment overlooked.*  I imagined Indians falling dead along the cliff line, then getting up again, like kids in a game, because it wasn't a real war.

This evening, as I came across the passage below in Stephen Ambrose's Rise to Globalism, I allowed myself to think that that remembered conversation took place in 1963 (it might have been 1964, but never mind):

Precedent Eisenhower

When justifying his major foreign policy decisions, Obama cites Eisenhower more than any other predecessor -- e.g., in his December 2009 speech announcing his time-limited Afghan surge:

As President, I refuse to set goals that go beyond our responsibility, our means, or our interests. And I must weigh all of the challenges that our nation faces. I don't have the luxury of committing to just one. Indeed, I'm mindful of the words of President Eisenhower, who -- in discussing our national security -- said, "Each proposal must be weighed in the light of a broader consideration: the need to maintain balance in and among national programs."

As calls mount for U.S. intervention in Syria, with exhortations to Obama to uphold U.S. "credibility," I find this summation by Stephen Ambrose in Rise to Globalism*  of Eisenhower's second term instructive:

THE OVERWHELMING FIRST IMPRESSION OF AMERICAN FOREIGN POLICY from 1956 to 1961 was one of unrelieved failure. America’s inability to do anything at all to aid Hungary’s rebels made a mockery of the Republican calls for liberation. Eisenhower and Dulles were unable to contain the Russians, who succeeded in their centuries-old dream of establishing themselves in the Mediterranean and the Middle East. Spectacular Soviet successes in rocketry, beginning with Sputnik, sent the United States into a deep emotional depression. Russia seemed to have won the arms race, and in 1959 it was Khrushchev who played at brinksmanship from a position of strength. After the Suez crisis, the French, British, and Americans could never fully trust each other. In Southeast Asia, Communist guerrillas in South Vietnam and Laos threatened to upset the delicate balance there in favor of the Communists. In Latin America, the Eisenhower administration was helpless in the face of a revolution in Cuba, which soon allowed the Russians to extend their influence to within ninety miles of the United States. 

Surface appearances, however, reveal only surface truths. Eisenhower’s outstanding achievement was to avoid war. However irresponsible Republican emotional appeals to the anti-Communist vote may have been, and despite the Russian shift to the offensive in the Cold War, Eisenhower refused to engage American troops in armed conflict. He was not immune to intervention, nor to provocative rhetoric, nor to nuclear testing, nor to the arms race (within strict limits), but he did set his face against war. It became the Democrats’ turn to complain that the United States was not “going forward,” that it was not “doing enough,” that America was “losing the Cold War.”

Kierkegaard, Julian, Obama

Who knows what governs how a moderately engaged undergraduate makes sense of abstruse philosophic texts? As a sophomore, my mind settled on a basic dichotomy: Hegel bad, Kierkegaard good. This was probably what you might call a gendered thought. Hegel's basic How-Things-Work was to my mind aggressive, imperialist, male: thesis absorbs antithesis in new synthesis. Man slays dragon, eats its heart, becomes (relative) superman. Kierkegaard, by contrast, kept apparently irreconcilable opposites in eternal balance, on an eternal toggle switch whereby they could be seen alternately as part of a unity and eternally distinct.

I can't tell you at this distance whether my abstract caricature is accurate, but it has stayed with me all my life, and I tend to class thinkers on one side or the other of this divide. In retrospect, I'm sure that I placed the subject of my dissertation, the medieval mystic Julian of Norwich (an achoress, i.e. a nun in self-imposed solitary confinement) on the Kierkeaardian side of the ledger, though I never zoomed up the centuries to probe the association. *
 
Julian had a brilliant trick of subordinating the harsh elements of Catholic dogma that she didn't like (the damned are damned forever) to those that she felt by force of direct revelation to be true (all will be well, and all will be well, and all manner of things will be well).  Her basic dynamic was that God-as-man maintains two "cheres," or points of view: the human, limited one, whereby we must see and condemn our own sin, and the "inward, more ghostly" and more strictly divine one, whereby no one does anything except by God's will, and God is delighted with all, and sin is merely an instrument of human self-education.

Intransigence got them the win. Intransigence keeps them from taking it.

Brian Beutler has an intricate and well-sourced account of how the Obama administration scopes out the task of creating a "permission structure" for Republicans to compromise on a budgetary grand bargain. Broadly, it's Gang of Six II, a new attempt to jump off the presidential shadow by staying in the shadows, averting what Ezra Klein called the paradox of power: "If you take a strong position, the other side will immediately take the opposite position."

So once again, as Beutler puts it, "Obama’s putative absence is key to creating the political space Senate Republicans need to negotiate in good faith." But the master hurdle is in the House, where the GOP majority is way more recalcitrant than the five-odd GOP senators who would be needed to get a bill through the Senate.  And there, Beutler's framing caught my eye, because it illustrates a second paradox:

Of consumer cathedrals and Catholic capitalists

Can you love capitalism and hate the forms of commerce that the world's most capitalist economy creates? You can if you're Catholic and acculturated to cathedrals. Like Andrew Sullivan:

The striking paintings of Wal-Marts we featured this morning are not alone. Michelle Muldrow targets, among other supermarkets, Target. She calls these photographs paintings “Cathedrals of Desire.” Cathedrals used to function as a way to transcend desire into love, the worldly into the unworldly. Now these new consumer cathedrals make the worldly sacred and turn desire into a virtue.

I have to say that Target in particular engenders in me an instant version of what some hyper-lefty Germans called Konsumterrorismus: a total panic caused by the option of limitless shopping. (The definition is not undisputed). In my case, this phobia is compounded by the lighting – especially in Target. Aaron took me there once and I could not really get past the doorway. It was just horrifying. If I go to Hell, I will not have my ankles licked by fire. And I will not be lit from below. I will be subjected to giant, constant, overhead fluorescent lighting – what Michael Cunningham once called less lighting than the “banishment of all darkness.”

That gets it right, I think. All darkness must be banished to promote and encourage the purchase of things. This is what a huge amount of our culture now rests upon: the purchase of things. I guess you have to banish the literal darkness to disguise the shallow yet impenetrable darkness our shopping civilization represents.

Serendipity!  Yesterday, Andrew linked to an excellent review (by John Gray) of what sounds like an excellent biography of Karl Marx (by Jonathan Sperber). While unsparing about the harm wrought by Marx's "incoherent mishmash of idealist philosophy, dubious evolutionary speculation, and a positivistic view of history," Gray also credits Marx with an insight into the dynamics of capitalism to which the right is generally blind: