Whither humanity? Three NYT snapshots

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The front page of today's print New York Times greeted Sunday breakfasters with what feels like a typical trio of world-going-to-hell headlines above the fold:

• Nearly 80 Die As Blast Strikes Somali Capital
• As It Detains parents, China Weans Children From Islam
• Trump Eroding Role Of Science In Government

As antidote, in the op-ed pages Nicholas Kristof offered up his annual reminder that by quantitative material measures the human condition continues to improve; extreme poverty, debilitating disease and child mortality are declining, literacy is growing, hundreds of thousands climb out of extreme poverty daily. 

In the same op-ed section, Ross Douthat leads with a truly arresting take on the last decade:

Ross Douthat and the "expert-fashioned architecture" of the ACA

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Credit where due: Ross Douthat is a creative thinker, capable of carving new conceptual boundaries across familiar landscapes.  Today, claiming that Democratic voters have tired of Clinton- and Obama-style technocracy, he identifies the competing approaches to policy as moral (Bernie Sanders) and transactional (Joe Biden).

On the healthcare front, citing ""widespread left-wing disappointment with what the Obama-era politics of expertise produced," Douthat asserts:

This disappointment has been strongest on health care, where Obamacare’s most popular provision was the simple socialism of the Medicaid expansion rather than the complicated, expert-fashioned architecture of the exchanges.

He's right on the merits.  The Medicaid expansion accounts for probably 75% or more of the net coverage gains achieved by the ACA.  Enrollee satisfaction is far higher in Medicaid, which covers all of enrollees' costs, than in the marketplace, where satisfaction is inversely proportionate to out-of-pocket cost exposure, and at least half of enrollees are subject to high deductibles and out-of-pocket costs.*

Status quo Sunday at the New York Times

I had the oddest sense of deja vu while reading Ross Douthat's column about the Affordable Care Act today immediately after reading Tom Friedman's column about Israel. 

Both were sleight-of-hand defenses of a status quo: an Israel continuously extended on theft of land and a welfare state in statsis that Douthat would not have adapt to mitigate new problems of wealth distribution and risk transfer.

Friedman's column is a mealy-mouthed plug for a book by Haaretz columnist Ari Shavit, which may well be better than Friedman's characterization.  It begins with an even-handedness trope: a plea to view "the real Israel, not the fantasy, do-no-wrong Israel peddled by its most besotted supporters or the do-no-right colonial monster portrayed by its most savage critics." Fair enough. But the column sanitizes the colonial reality, flashing briefly on a bloodless freeze-frame of expelled refugees in 1948 rather than engaging with the continuing and accelerating gobbling of the West Bank.  It then devolves into que sera piety: Palestinians should suck it up and get on with their lives. And by the way, the failure of two-state negotiations is all their fault:

The ACA as a framework for (further) conservative healthcare reform

Austin Frakt does AEI's James Capretta the honor of seriously considering* elements of Capretta's attempt (with Douglas Holtz-Eakin) to fill in the long-empty "replace" blank in Republicans' purported "repeal and replace" program for the Affordable Care Act. After spotlighting various lacunae as well as potentially workable elements in Capretta's "decentralized, market-diven alternative to the PPACA," Frakt comes to a core point, implicitly questioning whether conservative healthcare wonks are acting in good faith:

6...Democrats are well aware of the limitations and problems with the Affordable Care Act. Some are so troubling that the administration is considering some interesting proposals that would require Congress to act. Point being, there is leverage for some negotiation on some aspects of the law. And, crucially, some of the things Capretta has proposed fit within the structure of the ACA, such as allowing Medicaid enrollees to buy exchange plans (see Arkansas), capping the employer-sponsored insurance tax subsidy (see the Cadillac tax), or making exchange plans more catastrophic. But that brings me to …

"What if Obamacare works?" -- What Ross Douthat leaves out

Ross Douthat "fairly fairly" describes the differences between the cheapest health insurance plans available on the ACA exchanges and the cheapest plans currently available on the individual market, most of which will be phased out because they don't comply with ACA minimum coverage requirements.  But he leaves some important facts out.

Douthat acknowledges that the ACA's premium subsidies will offset the price increase for many who buy on the exchanges, and he fairly if too briefly presents the limitations of a cheap plan currently available on the individual market ("a $5,000 deductible, an annual out-of-pocket limit of $12,500, and all kinds of copays and coverage restrictions"). He then frames the ACA's political prospects like this:

With some grandfathered exceptions, Obamacare makes those kinds of plans illegal. The out-of-pocket limit for individuals is capped at $6,500 a year, preventive services are fully covered, and various “essential benefits” as well. 

If we ever get beyond the follies of HealthCare.gov, the politics of the rollout will probably be defined by how (and how vocally) middle-class Americans just above the subsidy threshold react to this “pay more, get more, subsidize other people” deal.

True, perhaps -- though the politics will also be defined by the reactions of those eligible for the subsidies, and those shut out of the current market by preexisting conditions or age (the ACA limits age-related price differentials to 3-to-1; currently they're as high as 6-to-1), or, to a lesser extent, by those newly eligible for Medicaid (who are less likely to be politically vocal and perhaps less likely to recognize that their new benefits are a product of the ACA).

It's Douthat's presentation of the likely long-term consequences of a successful ACA rollout that tilts our view of past and future playing fields:

Conservative debate watchers have a point, but...

On one hand, I am pissed that Republican spin on the last debate is getting some credence in the media -- Politico and ABC both retailed the hypothesis that the debate might strengthen Romney's position, since he came across as credible an unscary -- and the electorate doesn't much care about foreign policy.

On the other hand, I think that the conservative analysis digested by the Dish -- by Douthat, Levin, Lowry and Ponnuru -- has some validity. Lowry summarizes their collective take well:

I think Romney executed what must have been his strategy nearly flawlessly: reassure people that he’s not a bomb-thrower; project strength but not bellicosity; go out of his way to say how many Obama policies he agrees with to create a sense of his reasonableness; focus on the big picture of a world that seems out of control; get it back to the economy as much as possible; and communicate a real passion for the future.

In fact, my own reaction to Romney's performance, taken by itself, was somewhat similar.  I disagree, though, with this from Levin, and in that disagreement lies hope:

Attention, delegate math mavens: it ain't over when it's over

About this time in 2008, shortly after Hillary Clinton won the Texas and Ohio primaries on a night when Obama netted more delegates (March 4) than she did, political insiders were insisting with increasing certainty that Obama had a lock on the nomination. His narrow delegate lead was insurmountable, notwithstanding that Hillary Clinton was a "lead pipe certainty" to win the Pennsylvania primary on April 22, as Al Giordano wrote in early March.  And so it turned out.

Now, cognizati  are rolling their eyes at breathless horse-race coverage of the Republican primary contest.  Ross Douthat scopes out remaining contests, ventures predictions for each, and concludes, "the consequences are eminently predictable: Either Romney will clear the 1,144 delegate threshold in May or early June, or else he’ll fall 50-100 delegates short and need to play a little inside baseball to win some of the uncommitted delegates." For details, he kicks the ball to Michael Brendan Dougherty, who does the math:

Mitt Romney has won almost 1.2 million more votes than Rick Santorum overall. How much did Rick Santorum gain on him last night?

39,119 votes. So in Rick Santorum's "big wins" he erased approximately 1.35 percent of Romney's lead in votes. That's it....Get used to it: Romney is winning.

Quite so. But a few caveats.

Dept. of unpublished letters, cont.

To the Times, on Monday:

In his contrast of marriage, sex and childbirth patterns in red  and blue states, Ross Douthat notes that more liberal states' lower rates of teen and out-of-wedlock birth depend in part on heavier recourse to abortion. 

 

How can blue states retain their more stable marriage and childbirth practices while reducing abortion? One partial answer is universal health care. A study published in the New England Journal of Medicine this March finds that abortion rates declined significantly during the first two years that Massachusetts implemented its comprehensive health insurance plan.  In the same vein, T.R. Reid observed in a Washington Post op-ed that wealthy countries with universal health care all have far lower abortion rates than those prevalent in the U.S. 

In a March 21 column, Douthat grouped Reid's implicit claim that the health reform bill would reduce the U.S. abortion rate with other "liberal" claims about the bill's likely good effects and concluded, "As a conservative, I suspect they're wrong." He did add that as an American he hope that he himself was wrong, since the bill would become law. 

I trust that as an opponent of abortion, Douthat particularly hopes he's wrong about the new health reform law's long-term effects on that front.

Minority retort

Republican Senator Mel Martinez of Florida, former RNC co-chair, warns the party:

The fact of the matter is that Hispanics are going to be a more and more vibrant part of the electorate, and the Republican Party had better figure out how to talk to them. We had a very dramatic shift between what President Bush was able to do with Hispanic voters, where he won 44 percent of them, and what happened to Senator McCain. Senator McCain did not deserve what he got. He was one of those that valiantly fought, fought for immigration reform, but there were voices within our party, frankly, which if they continue with that kind of rhetoric, anti-Hispanic rhetoric, that so much of it was heard, we're going to be relegated to minority status.

The Republican Party, relegated to minority status by minority voters. Now that was a slow train coming. Since one-party rule is good for no one, here's hoping the dead-enders' day ends relatively soon, and the Republicans begin the slow work of reaching out to new voters with new ideas. Time they "dou that..."