The Great Debate

When even a key architect of Obamacare says the law’s implementation will resemble a “train wreck,” it is clear that its biggest remaining supporters need to finally level with the American people about what’s in store — starting with President Barack Obama.

The president must step into the breach and explain to the public that skyrocketing premiums and a raft of new taxes, penalties and fees are coming their way.

It may not be easy, but the president has a responsibility to explain as frankly as possible what this law will mean — before its major components take effect. He could start by delivering a major address, just as he did to push the law’s passage, laying out exactly what Americans can expect. He should also instruct his Cabinet secretaries to explain what this could mean as well. Families and businesses across America need time to prepare — and that means they need to know the facts.

Here are just a few we already know:

For many families and individuals, especially younger Americans, the law will lead to increased health insurance premiums. These have already gone up $2,370 per family since Obama took office, not down by $2,500 as he promised. And this is before most of Obamacare’s most costly mandates have even taken effect.

For many business owners, Obamacare will mean a crushing tower of red tape, demonstrated by the nearly 20,000 pages of regulations already issued. Employers have already planned layoffs due to uncertainty surrounding this law, according to the Federal Reserve. Obamacare could result in up to 800,000 fewer jobs, according to some estimates.

President Barack Obama must like the view from 1600 Pennsylvania Avenue right now. Politically speaking, the sky is clear, and the few clouds on the horizon have silver linings.

Because where things now stand with Congress, if he wins – he wins. And if he loses – he wins.

Getting Republicans to bend to his will on any of the banner issues this year – whether immigration reform, gun control or deficit reduction – will help enshrine him as a president of real achievement. If he fails, however, these same issues can be used as bludgeons to pound Republicans as heartless, even racist, knuckle-draggers who only want to service their rich masters.

President Barack Obama made the middle class the focus of his State of the Union address on Tuesday. He was lauded by some as fighting for jobs and opportunity, and even for launching a “war on inequality” equivalent to President Lyndon B. Johnson’s 1960s War on Poverty. He was assailed by others for showing his true colors as a man of big government and wealth redistribution.

Yet the initiatives Obama proposed are striking not for their sweep but for their limited scope. That reflects both pragmatism and realism: Not only is the age of big government really over, so is the age of government as the transformative force in American society. And that is all for the best.

Wait a minute, you might reasonably object: What about healthcare? What about the proposals for minimum -wage increases, for expanded preschool, for innovation centers, for $50 billion in spending on roads and infrastructure? Surely those are big government and aim, effectively or not, for transformation?

--Jocalyn Clark (@jocalynclark) is Senior Editor at PLOS Medicine. The opinions expressed are the organisation's own.--

While coverage of health care has increased considerably since the international community defined its millennium development goals to improve health around the world, health gains remain stubbornly elusive, especially in developing countries, and poor quality of care may be the reason why.

These are the conclusions of leading maternal health scholar Dr. Wendy Graham and her colleagues as they reflect on the global progress in women’s and children’s health in preparation for the global maternal health conference in Arusha, Tanzania this week that brings together 700 delegates and political leaders from around the world.

Now that the Supreme Court has provided legal certainty on the recent healthcare reform law, the nation must turn its attention to affordability. While the law expands coverage to millions of Americans, a goal health plans have long supported, major provisions of the law need to be changed to avoid significant cost increases for consumers and employers.

Healthcare affordability is an issue that touches every part of our nation: single parents struggling to make ends meet; two-income families trying to get ahead in challenging times; and retirees trying to stretch their budgets. Equally important, rising medical costs crowd out government spending on other priorities, such as education and infrastructure, and put our nation’s businesses at a competitive disadvantage in a global economy.

The first priority is to address a number of the reforms taking effect in 2014 that will make healthcare coverage more expensive.

Last week’s ruling by Chief Justice John Roberts that the Affordable Care Act is constitutional has thrown conservatives into consternation. Rick Santorum says he is “very disappointed … It was a folly of a mistake.” Conservative radio host Michael Savage suggests Roberts must be on mind-altering medication. Even those, like John Boehner, who said they respected his jurisprudence disagreed with his decision.

Roberts now finds himself in the same bad standing with conservatives as Fed Chairman Ben Bernanke. Bernanke’s credentials as the heir to Milton Friedman, Ronald Reagan’s monetarist guru, have not been enough to save him from abuse either. When good conservatives like Roberts and Bernanke are traduced by their own side for being closet liberals, letting Barack Obama introduce European social democracy through the back door, something strange is afoot in the conservative universe.

The definition of a conservative used to be someone who values institutions above all as the bulwark against tyranny. That is the lesson left by the father of conservatism, Edmund Burke. But America’s most valued institutions, and those who operate them, are under attack from the very people who at one time would have been their stoutest defenders. People who like to call themselves conservatives, and set themselves up as arbiters of who is a true conservative, now despise the very institutions that safeguard our fragile freedoms from tyranny.

Editor’s note: This post is republished from the author’s blog.

The Weight of the Nation is a four-part series on obesity in America by HBO Films and the Institute of Medicine, with assistance from the Centers for Disease Control (CDC) and the National Institutes of Health (NIH). It’s been showing on HBO and can be viewed online. Each of the four parts is well done and informative.

Obesity is defined as having a body mass index (BMI) of 30 or more. For a person 6 feet tall, that means a weight of more than 220 pounds. For someone 5’6″, the threshold is 185 pounds. People who are obese tend to earn less and are more likely to be depressed. They are at greater risk of diabetes, heart disease, stroke, and some types of cancer, and they tend to die younger. The CDC estimates the direct and indirect medical care costs of obesity to be $150 billion a year, about 1% of our GDP.

The chart below, which appears several times in The Weight of the Nation, shows the trend in obesity among American adults since 1960, the first year for which we have good data. The data are from the National Health and Nutrition Examination Survey (NHANES). They are collected from actual measurements of people’s height and weight, rather than from phone interviews, so they’re quite reliable. After holding constant at about 15% in the 1960s and 1970s, the adult obesity rate shot up beginning in the 1980s, reaching 35% in the mid-2000s.

Americans believe in second chances. The oral arguments before the Supreme Court last week were a rare opportunity to dispassionately re-examine the divisive healthcare debate of two years ago. What happens if, after the smoke clears, we get a second chance at healthcare reform?

We’ve long known that healthcare will be a central theme in the 2012 presidential contest. The High Court’s deliberations and June decision only reinforce that reality for President Obama and Governor Romney.

Unlike with the Patient Protection and Affordable Care Act (PPACA), the constitutionality of Governor Romney’s Massachusetts law has never been seriously questioned. States, not the federal government, have police powers, allowing them to require purchases (car insurance, taxes and licensure) and to pass wide-ranging public health laws and public safety laws. The Bay State law enjoys broad popular support.

By Amanda Marcotte
The views expressed are her own.

Wednesday morning Health and Human Services Secretary Kathleen Sebelius overruled the FDA’s long-awaited decision taking age restrictions off Plan B emergency contraception. The change would have allowed those 16 and under to buy Plan B, moving it from behind the pharmacist counter and into the shelves alongside aspirin and condoms. But now that won’t happen.

The decision confounded the medical community as well as the women’s rights world. Since no HHS Secretary has ever overruled an FDA decision of this sort before, the widespread assumption, best articulated by Matt Langer at Wonkette, was that Sebelius was working under “marching orders from an administration now fully in re-election mode” and fearful of getting a reputation as somehow “soft” on teen sexual activity.

Sebelius admitted to no political calculation, and instead claimed to be concerned about supposedly inadequate research into the effects on 11- and 12-year-olds who might use the pill. FDA Commissioner Margaret Hamburg, no doubt irate at being told she and her entire team don’t know how to do their job as well as non-medical professional Sebelius, denounced this argument, and defended the extensive research done to assure that Plan B was safe for over-the-counter sales. Taking into account the evidence, and the drawn-out political battle over emergency contraception, it’s safe to say that Sebelius did choose political pandering over women and girls’ best interests.

Now that federal government shutdown has been averted, it's a good time to examine what's at stake for most of America in the crucial next round of budget talks.

Not doing anything to reduce the size of government debt will be catastrophic. Not much quibble there. But acting hastily and cutting the wrong things can be even more costly to social and economic welfare.

Neither the Republican nor the Democrat's budget plans for 2012 will meet the major challenge of sustaining social programs while cutting the most egregious waste.