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You are here: Home / Anderson On Health Insurance / The ACA at 10

Reader Interactions

43Comments

  1. 1.

    Mary G

    Those were happy times. It’s been harder for them to kill than old Moscow Mitch thought it was. Most of the people in the picture besides Chuck and Nancy are no longer in Congress.

  3. 3.

    cain

    Thank you for this – it saved my ass last year.

    I hope that the next time we get all 2 houses that we have a shit ton of bills that we can all work together on and get them going as quickly as possible. Specifically, national vote by mail – get our underrepresented minorities voting without bullshit poll closings and the like.

  4. 4.

    Yutsano

    The death by a thousand cuts still hasn’t killed it. There are definite massive improvements to be made (Mayhew we can talk about the Excess Advanced Premium Tax Credit some time) but it has insured millions. And the remaining state holdouts on Medicaid expansion will give in eventually. We could jump from here to Swiss style controls or even beyond because we have a framework. That framework will get built upon.

    Unless the Conservative 5 kill it next year.

  5. 5.

    joel hanes

    Mister, we could use a man like Henry Waxman again.

    Mind you, I’m not complaining about Schiff or Lieu, but Waxman was a good ‘un.

  6. 6.

    Mary G

    OT but Dr. Fauci spoke with Science Mag today and I’m calling dibs on fired or overcome with exhaustion by 8 a.m. Thursday.

    Q: The first question everyone has is how are you?

    A: Well, I’m sort of exhausted. But other than that, I’m good. I mean, I’m not, to my knowledge, coronavirus infected. To my knowledge, I haven’t been fired. [Laughs.]

    Q: How are you managing to not get fired?

    A: Well, that’s pretty interesting because to his [President Trump’s] credit, even though we disagree on some things, he listens. He goes his own way. He has his own style.  But on substantive issues, he does listen to what I say.

    Q: You’ve been in press conferences where things are happening that you disagree with, is that fair to say?

    A: Well, I don’t disagree in the substance. It is expressed in a way that I would not express it, because it could lead to some misunderstanding about what the facts are about a given subject.

    Q. You stood nearby while President Trump was in the Rose Garden shaking hands with people. You’re a doctor. You must have had a reaction like, Sir, please don’t do that.

    A: Yes, I say that to the task force. I say that to the staff.  We should not be doing that. Not only that–we should be physically separating a bit more on those press conferences. To his credit, the Vice President [Mike Pence] is really pushing for physical separation of the task force [during meetings]. He keeps people out of the room–as soon as the room gets like more than 10 people or so, it’s ‘Out, everybody else out, go to a different room.’ So with regard to the task force, the Vice President is really a bear in making sure that we don’t crowd 30 people into the Situation Room, which is always crowded. So he’s definitely adhering to that. The situation on stage [for the press briefings] is a bit more problematic. I keep saying, is there any way we can get a virtual press conference. Thus far, no. But when you’re dealing with the White House, sometimes you have to say things 1,2,3,4 times, and then it happens. So I’m going to keep pushing.

    Q: You’re standing there saying nobody should gather with more than 10 people and there are almost 10 people with you on the stage. And there are certainly more than 10 journalists in the audience.

    A: I know that. I’m trying my best. I cannot do the impossible.

    Q: What about the travel restrictions? President Trump keeps saying that the travel ban for China, which began 2 February, had a big impact [on slowing the spread of the virus to the United States] and that he wishes China would have told us three to four months earlier and that they were “very secretive.” [China did not immediately reveal the discovery of a new coronavirus in late December, but by 10 January, Chinese researchers made the sequence of the virus public.]  It just doesn’t comport with facts.

    A:  I know, but what do you want me to do? I mean, seriously Jon, let’s get real, what do you want me to do?

    Q: Most everyone thinks that you’re doing a remarkable job, but you’re standing there as the representative of truth and facts but things are being said that aren’t true and aren’t factual.

    A: The way it happened is that after he made that statement [suggesting China could have revealed the discovery of a new coronavirus three to four months earlier], I told the appropriate people, it doesn’t comport,  because two or three months earlier would have been September. The next time they sit down with him and talk about what he’s going to say, they will say, by the way, Mr. President, be careful about this and don’t say that. But I can’t jump in front of the microphone and push him down. OK, he said it. Let’s try and get it corrected for the next time.

    Q: You have not said China virus. [Trump frequently calls the cause of the spreading illness, known as coronavirus disease 2019 (COVID-19)  a “China virus” or a “Chinese virus.”]

    A: Ever.

    Q. And you never will, will you?

    A: No.

    Q: I’m curious about some things that aren’t happening on a national scale. One is, why are shelter in place orders happening state by state? Why are we doing this sequentially? Is that a mistake?

    A: No, I don’t think we could say it’s a mistake or not a mistake. There is a discussion and a delicate balance about what’s the overall impact of shutting everything down completely for an indefinite period of time. So there’s a compromise. If you knock down the economy completely and disrupt infrastructure, you may be causing health issues, unintended consequences, for people who need to be able to get to places and can’t. You do the best you can. I’ve emphasized very emphatically at every press conference, that everybody in the country, at a minimum, should be following the fundamental guidelines. Elderly, stay out of society in self isolation. Don’t go to work if you don’t have to. Yada yada yada. No bars, no restaurants, no nothing. Only essential services. When you get a place like New York or Washington or California, you have got to ratchet it up. But it is felt–and it isn’t me only speaking, it’s a bunch of people who make the decisions—that if you lock down everything now, you’re going to crash the whole society. So you do what you can do, as best as you can. Do as much physical separation as you can and ratchet it up at the places you know are at highest risk.

    Q:  But I heard a guy say, if you think you’re doing too much, you’re probably doing the right amount.

    A: That’s me.

    Q: I know it’s you. The “15 Days to Slow the Spread” campaign doesn’t mention religious gatherings. I know Pence mentioned them yesterday. But why aren’t they on the 15 Days recommendations? All these other places are mentioned.

    A: It was implied in no crowds of more than 10 people. But you’re right, crowds in church are important and every time I get a chance to say it, I mention it. I can’t really criticize them strongly for that at all. When you say less than 10, it makes common sense that it involves the church. I say it publicly and even the vice president has said it publicly.

    Q: What happens before each press conference? What do you do as a group?

    A: We’re in the task force. We sit down for an hour and a half, go over all the issues on the agenda. And then we proceed from there to an ante room right in front of the Oval Office to talk about what are going to be the messages, what are the kind of things we’re going to want to emphasize? Then we go in to see the president, we present [our consensus] to him and somebody writes a speech. Then he gets up and ad libs on his speech. And then we’re up there to try and answer questions.

    Q: At Friday’s press conference, you put your hands over your face when President Trump referred to the “deep State Department,” [a popular conspiracy theory]. It’s even become an internet meme. Have you been criticized for what you did?

    A: No comment.

    Q: We’ve seen creative ideas about how to respond in other countries that we aren’t adopting. China uses thermometers at supermarkets before letting people in. Should we be considering that?

    A: Yes, of course. I think the logistics of that have to be worked out. That was discussed. All these things are discussed. Not all of them are implemented. This is something that should be considered. I will bring it up at the next task force meeting and see whether there’s some sort of a logistical, bureaucratic reason why it can’t be done. The rationale for doing it is at least worth serious consideration.

    Q:  Big Picture. We’ve had all this pandemic preparedness. Why did this fail? What went wrong?

    A: I think we’ll have to wait until it is over and we look back before we can answer that. It’s almost like the fog of war. After the war is over, you then look back and say, wow, this plan, as great as it was, didn’t quite work once they started throwing hand grenades at us. It really is similar to that. Obviously, testing [for the new coronavirus] is one clear issue that needs to be relooked at. Why were we not able to mobilize on a broader scale? But I don’t think we can do that right now. I think it’s premature. We really need to look forward.

    Q: Right now, why do we have a travel ban on visitors from China when there are few cases in China other than imported cases? What’s the logic?

    A: I’m sorry. I was just looking at two text messages, one from a governor and one from the White House. I gotta get off.

     

  7. 7.

    Goku (aka Amerikan Baka)

    @Yutsano:

    Unless the Conservative 5 kill it next year.

    I would hope Roberts would stick with his previous rulings and care about his legacy

  9. 9.

    MisterForkbeard

    @Mary G: Wow, parts of that article are really negative. Some of them boil down to:

    Interviewer: The president is lying about all these things and telling people disinformation. What can you do about it?

    Fauci: What do you expect me to do about it? He does it, I can’t stop him.

  10. 10.

    Eolirin

    @Goku (aka Amerikan Baka): Hopefully it’s only the current 5 conservative justices next year. That can change between now and then. Hell, if something happened to Roberts, and Trump decided on a replacement, all bets would be off.

  11. 11.

    Eolirin

    @Mary G: Why do you think he’d suddenly change his mind? And do you think he’s as much of an idiot as some of the others? If the court strikes the ACA down, at this point, it will destroy the GOP. It’d mean sudden stoppage for millions of people’s health care, and there’s no way that a republican controlled senate would get anything even half as good as it through. 2018 would look like a mild blip compared to the wave election that’d happen in 2022.

    The only opportunity he had to kill it was the first decision, before people were actually benefiting from it, and he didn’t do it then. It’s far too late to do it now.

  13. 13.

    Brachiator

    A few years ago, I had to have a medical procedure done. At some point they had me on a gurney and had wheeled me to some station to wait on a nurse to check a few things. There were other patients in other areas separated by curtains.

    But I overheard one guy who was in the film industry talking to a medical staffer, and say outright, “If it wasn’t for Obamacare, I wouldn’t be able to get this done at all.”

    Short and sweet. The ACA may not be perfect, but it has made a tremendous difference in the lives of many people.

    ETA: The Democrats have a powerful weapon simply defending the ACA and promising to improve it. They don’t need to get into a fight about M4A. They just have to bring the fight to the GOP. How are you going to get affordable health care to more people? How are you going to insure that coverage for pre-existing conditions is maintained?

  15. 15.

    Brachiator

    @Eolirin:

    And do you think he’s as much of an idiot as some of the others?

    Yes.

    If the court strikes the ACA down, at this point, it will destroy the GOP.

    The Republicans don’t care. They are set on this course and believe that Fox News will cover them, and that their plutocrat donors will be able to help them survive ripping health care away from millions.

    Continuing to back Trump may destroy the GOP. But despite Trump’s increasingly corrupt and incompetent decisions, they continue to praise him as the best president ever.

    It’d mean sudden stoppage for millions of people’s health care, and there’s no way that a republican controlled senate would get anything even half as good as it through.

    GOP Congressional leaders have, for example, consistently lied about protecting coverage for pre-existing conditions while putting forth legislation that would let insurers strip coverage from people.

    They have never offered a credible alternative to the ACA, and hide from their own constituents when confronted about their failures.

    This is a GOP blind spot. They have been committed to getting rid of the ACA from the moment it was first proposed. They are stuck. They don’t know how to back down. And there are even a core of the GOP base who are just as misguided. Worse, there are those who don’t realize that the medical plans they have actually are Obamacare, and who foolishly encourage Republican efforts to kill it.

  18. 18.

    tokyokie

    @Mary G

    Those were happy times. It’s been harder for them to kill than old Moscow Mitch thought it was. Most of the people in the picture besides Chuck and Nancy are no longer in Congress.

    Hell, at least a couple of them, John Glenn, seated to the right of the desk, and John Conyers, who’s next to Glenn, are dead.

  20. 20.

    Mary G

    @tokyokie: Partly why they got the votes; not everybody wanted to be reelected as much as today’s Rs do.

    Also, too, Ted Kennedy was dying and wanted it.

  21. 21.

    Chetan Murthy

    @Mary G:

    not everybody wanted to be reelected as much as today’s Rs do.

    Tom Perriello.  He took one for all of us.

  22. 22.

    LeftCoastYankee

    I’ve always thought of the ACA as the BCS (college football reference) of healthcare: a monstrously complex and inadequate compromise, which if taken on face value pretty much sucks.  But taken in the context of breaking the half century stalemate of inaction before it is a great achievement.  If we can finish what we started….

    Onward progress!

  24. 24.

    NotMax

    @Mary G

    what are going to be the messages, what are the kind of things we’re going to want to emphasize? Then we go in to see the president, we present [our consensus] to him and somebody writes a speech. Then he gets up and ad libs on his speech.

    Face/towel/palm.

    I know, but what do you want me to do?

    Perhaps a not so subtle hint at those pre-event gatherings that your plate is kind of full and being stood on stage as validation for half-truths, outright lies, uninformed and vacillating speculation, vilification and misinformation which can kill people isn’t in your job description. Perhaps inserting into every interview, repeatedly, one prefatory sentence, “The president has his opinions on that, here are the facts.”

  25. 25.

    Hob

    @Mary G: I winced when I read Fauci’s line about how Trump is a smart guy. I don’t know what the expression was on his face when he formed those words, but I imagine he was thinking something like “Well, I can’t get fired just yet. I can still get some work done. FUCK THAT FUCKING IDIOT TO HELL no cool it, don’t get fired yet.”

  28. 28.

    Mary G

    @Hob: That’s why I think he’s toast. He was just too honest. Guessing he knows and likes the reporter, is exhausted and just blurted some stuff out.

  32. 32.

    Mai naem mobile

    I remember reading that when the USSC decision came down Obama for some reason initially(momentarily) thought  the mandate had been struck down so he went from being extremely disappointed to being elated within a minute. I still cannot believe we went from Obama to this buffoon.

  34. 34.

    Chyron HR

    @Mary G:

    Q: Millions of Americans are going to die because of the President’s incompetence. How can you enable him?

    A: I’m sorry. I was playing “Candy Crush”.

  36. 36.

    WereBear

    @JPL: So do both the humans at Casa WereBear.

    I vividly remember the child he had at his side: they both lost their mothers to breast cancer and I am tearing up as he declared, for both of them, that it shouldn’t happen that way moving forward.

    Can we declare the Republican party a travesty, YET? And their enablers traitors, YET?

  38. 38.

    SFAW

    @Mary G:

    I hope you both are right.

    I do, too, but experience/history indicates Roberts will probably give them (and us) a sad. That Federalist traitor is the new permanent swing vote, and I am less than sanguine regarding his ability to “rise above partisan politics” at this point. I hope I am wrong about him.

  39. 39.

    SFAW

    @WereBear:

    Can we declare the Republican party a travesty, YET? And their enablers traitors, YET?

    Based on the attitude of the smug, evil pricks in that caucus and the White House, I’d guess they view that as a feature, not a bug. Of course, they don’t refer to it that way — “No traitor! NO Traitor!! YOU’RE the TRAITOR!” — but it’s always projection with them. And their moron voters love it.

  40. 40.

    Ohio Mom

    David, if you are still here, one thing I am wondering about is the eventual effect foregoing routine care and the monitoring of chronic conditions is going to have on a macro level.

    Obviously this can’t be helped; doctors don’t want to, shouldn’t take the risk of seeing patients they don’t need to.

    But for example, if someone who had an annual exam scheduled for this week has been rescheduled for, pick a month, December. So their blood tests showing they have crossed the line into diabetes, the Tdap they were overdue for, the colonoscopy they needed to be reminded to schedule, that funny black thing on their back they are completely unaware of but should be biopsied, whatever, isn’t done/found in time to have made treating whatever easier, more effective and possibly complication-free.

    I suppose this is analogous to the time before the ACA, when many more people suffered from preventable and treatable conditions.

    I don’t remember exactly what my question was. Maybe: Is this something that is expected and will be researched? I’m guessing yes.

  41. 41.

    David Anderson

    @Ohio Mom: Damn good question.  And the short answer is — not really sure.

    A lot of  researchers are getting ready to poke at this collection of questions — what happens when routine care gets pushed off by X months on a population basis.  The big challenge from a methodological standpoint is figuring out the control groups.  There a ton of confounders going on right now.  For instance, with most workplaces closing down, eating patterns are shifting dramatically.  Eating at home is often far healthier than eating lunch at a restaurant.  So if A1C goes down, is that attributed to the low value of routine care OR the shift in eating patterns

    Far better researchers than I will have creative ways of answering those questions, but it is not a facially easy question to get solid causal inference on.

  43. 43.

    Ohio Mom

    Thanks, I see that this issue is more complicated than I expected.

    The not eating-out-as-much example is certainly true in this household and I have the messy and dirty kitchen to prove it.

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