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What Obamacare's Successes Should Tell Us About Its Failures

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It’s come to be known as Obamacare. Sometimes it seems more like O-drama-care.

Nearly a decade has passed since Democrats first began promoting the initiative that eventually became the Affordable Care Act. And at no point has their effort to reform America’s dysfunctional health care system gone easily. Passing the law was a struggle, and then implementing it was, too.

Now there are new problems. Many of the nation’s largest insurers say they are losing big money on the policies they sell through the program’s exchanges. Some of these companies have responded by jacking up rates. Others are dropping out of the markets altogether. Consumers who relied on these plans may have to pay more or switch plans next year, and they may not have many alternatives.

But the focus on what’s going wrong with Obamacare makes it easy to lose sight of what’s going right. The law has ended the insurance industry’s most pernicious practices, fostered improvements in the way doctors and hospitals deliver care and brought the number of Americans without coverage to a historic low. Some state markets appear to be working just fine, and at least a few insurers are making money.

The law’s achievements don’t make the problems any less real. But they do put those problems into perspective ― and suggest that fixing them is worthwhile.

Obamacare’s Mounting Problems

One way to make sense of the latest news is to think about two recent reports ― one that spotlights the bad news and one that highlights the good. The first, which the Henry J. Kaiser Family Foundation conducted in conjunction with the Wall Street Journal, examines the exchanges and how many insurers have committed to offering plans through them. The exchanges are where people without access to employer coverage or public programs like Medicare can buy insurance, taking advantage of generous tax subsidies that vary based on income.

According to the Kaiser report, about 19 percent of people buying coverage through exchanges next year will have just one choice of insurer. (The figure could change but is unlikely to do so dramatically.) This is a dramatic increase from last year, when just 2 percent of people buying coverage through the exchanges had could only pick one insurer. The number of people who can choose from only two carriers, rather than more, is also likely to rise next year.

These findings are consistent with other recent analyses, including ones that appeared in Vox and at The New York Times’ The Upshot. And together they paint a worrisome picture.

The big national insurers say they are losing money on Obamacare because the premiums they are collecting aren’t sufficient to cover the medical bills of the people they are enrolling. A big reason for this is that, so far, people in relatively good health ― the ones whose premiums pay for the bills of the sick ― haven’t signed up in the numbers that these carriers expected. Insurers won’t sustain such losses indefinitely, which is one reason why insurers like Aetna are leaving some markets altogether and others are raising premiums, sometimes dramatically.

What’s Going Right?

But in states like California, the markets appear to be functioning well. And although companies like Aetna are taking losses on their Obamacare plans, companies like Florida Blue and Centene are doing well with theirs ― a sign, perhaps, that in some states the insurer shake-out is simply by-product of the leanest competitors prevailing.

Meanwhile, the law has already transformed millions of lives for the better. This is the story of that second report, which Gallup published this past week. It shows that the proportion of Americans without health insurance is down to 10.8 percent of adults, the lowest since Gallup’s tracking began in 2008, when the figure was 14.8 percent. And the proportion of adults who had trouble paying for health care or medicine in the last 12 months has also declined to the lowest figure that Gallup has recorded: 15.5 percent. In 2008, it was 19.7 percent.

Other studies have come to the same conclusion as Gallup. They are a reminder that, while Obamacare consumers in some parts of the country will have fewer choices next year, few choices is still better than no choices ― and that’s what millions of people with pre-existing conditions or low incomes had before the health care law came along.

Meanwhile, predictions that Obamacare would wreck the economy or cause the budget deficit to explode have proven spectacularly wrong. Perhaps the most surprising development is that, nationwide, health care spending is rising at a historically low rate. The health care law may or may not have played a role in this slowdown. But before passage, skeptics of President Barack Obama’s health reform agenda were sure it would have the opposite effect ― and that clearly has not happened.

It’s easy to get carried away with the law’s successes, just as it’s easy to make too much of its failures. Tens of millions still have no insurance and even some of those with coverage still struggle with medical bills. Insurers had to raise premiums once they could no longer deny coverage to people with pre-existing medication conditions, which is why millions of relatively healthy people who don’t benefit from the law’s tax credits are paying more for coverage than they would have otherwise.

What Happens Next?

Exactly how the law will evolve over the next few years is impossible to say right now. The best-case scenario is that enrollment will continue to grow, with healthy people signing up in relatively greater numbers, so that the marketplaces become more attractive to insurers. Premiums could settle, maybe as soon as next year, if this year’s increases represent the equivalent of a market correction ― basically, insurers making up for some early underpricing and setting premiums where they should have been all along.

The worst-case scenario is that insurers continue to flee and premiums continue to rise. The law’s subsidies would probably prevent a true insurance “death spiral,” since they guarantee that lower-income people will continue to find coverage attractive, but it’s easy to imagine a scenario where significant swaths of the country have just one insurance option, with premiums so high that most people ineligible for financial assistance decide it’s not worth the money.

Anything between those extremes is possible, and across the country the story is likely to play out in very different ways. For all discussion of Obamacare as a single program, it actually created 51 different insurance markets, one for each state plus the District of Columbia. The market is also developing in some unpredictable ways, as the most successful plans are increasingly the ones with “narrow networks” of doctors and hospitals. The plans are popular because they are cheap, which is what most people want.

Narrow networks can be a sign of efficiency, because they can mean insurers are coordinating care among small groups of providers (the way plans like Kaiser Permanente do) or demanding steep discounts from doctors and hospitals. But narrow networks can also cause hardship if insurers design them in ways that deny the chronically ill access to speciality care they need ― or lead to high, unexpected charges for seeking care outside networks.

Going forward, politicians face a pretty simple choice. One possibility is to work on improving the system, on the theory that reorganizing health insurance markets was bound to be an ongoing, difficult process. Just this week, the Obama administration proposed changes to the formula for Obamacare’s “risk adjustment” system, in which the plans that attract unusually healthy enrollees subsidize the ones that attract unusually unhealthy ones. It’s the latest in a series of proposals to shore up the markets.

Other fixes, such as boosting financial assistance to make plans more attractive, would require passing new legislation ― something the federal government has done before, with programs like Medicare Advantage, when they ran into trouble. And in a traditional political environment, Democrats and Republicans could easily find a compromise, with reforms that each side favors ― and maybe a little extra money, since the program as a whole has come in well under budget. Next year’s agenda already includes health care legislation, including reauthorization of the Children’s Health Insurance Program and the scheduled restart of a medical device tax, onto which Congress could graft some changes. (Hillary Clinton has already put forth a few ideas, in case she becomes president.)

But a bipartisan deal to shore up the health care law can’t happen when one party, the Republicans, remains committed to repeal altogether. It’s always hard to know what this would mean precisely, since vows to repeal Obamacare usually come with promises to replace it, and Republican leaders can never explain, with any specificity, what that replacement would entail. But the likely result would be lower taxes and less regulation; cheaper insurance options for people in good health ― along with more difficult access for people at risk of getting sick; a proliferation of the junk plans that Obamacare is phasing out of existence and dramatically higher numbers of people struggling with medical bills because they have no coverage at all.

Health care would end up looking a lot like it did before Obamacare came along, undoing the law’s achievements rather than trying to build on them.

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Hillary Needs Collective ADD With This News

Hillary Clinton had better hope that few are paying attention over the long Labor Day weekend and that those who are quickly forget. And that the news flow just moves on to the next things over the week ahead, oblivious to the latest FBI reports and key non-endorsements which have come just before. Because otherwise she has some big new but not so new problems.

First, and of least importance, “Five Thirty Eight” stats expert Nate Silver, who reassured so many nervous Barack Obama supporters during the president’s campaigns, chimed in as the long weekend began pointing out that Hillary’s national lead over neo-fascist bully boy and frequent screw-up Donald Trump was sliding from the mid-single digits. And, even more ominously, that she should not expect her seeming electoral college edge, notably in the form of significant leads in key swing states in which she has spent very heavily and Trump has not, to hold up. That in fact those battleground state leads are already sliding.

While I’ve been pointing that out for awhile, this warning came from one of the originators of the theory of Democratic presidential invincibility. (Who also gave Trump a 2 percent chance of winning the Republican nomination, and so much for the statistical approach to politics.) In any event, when I sent Silver’s assessment around, I received some more polling numbers indicating additional difficulties for Hillary.

But that stuff, though further verifying what I’ve been saying while most of of the media pushed inevitable Hillary (until, you know, now) is far less interesting than the Obama Justice Department’s Friday afternoon document dump. The only good thing about it for Hillary is that Justice obligingly released it just before one of the biggest holiday weekends, and in one of the biggest travel periods of the year.

Because the actual content of the underlying FBI reports on Hillary’s e-mail controversy raise serious questions about veracity and fundamental competence. As longtime readers know, I’ve always been sympathetic to Clinton’s evident desire to short-circuit media gotcha games around her communications. But that is why you carry two devices — one for official business as an office-holder and the other for everything else.

However, given that Hillary had an amazing 13 smartphones at various points during her tenure, and some were lost, it may just be that managing two devices was too much for the heavily-staffed but not computer-savvy Hillary. (Like Trump, she has not used a personal computer.)

Which gets at the most astounding thing about the Friday afternoon revelations. (Even more than her using a concussion as excuse for not knowing if she had received proper security orientation.)

Of course we know that she wants to keep obscure much if not most of her e-mail traffic. Let’s assume, for the sake of argument, that there is nothing nefarious in that. Though the cozy relationship between Clinton Foundation fundraising, access to the State Department, and some foreign decision-making might suggest otherwise. But I’m not so concerned about a politician being accessible to her donors, even if the secretary of state post is historically above such things. In any event, I want to put that issue to the side for this column.

So revelations that there were anymore seemingly relevant e-mails not turned over, or that the Clintons’ tech admin hurriedly tried to delete e-mails as soon as House investigators demanded them, are as unsurprising as they are uninspiring.

What is surprising, and alarming, to my rather jaded sensibility is how ineptly the informational keys to the kingdom were handled by the Clintons.

By which I mean her entire e-mail archive as United States secretary of state, which basically tells an analyst what she did and why and which she so clearly wanted to be kept secret. This archive was compiled by Clinton staff, then handled in the most slipshod manner imaginable.

At one point, it was placed in an account on a web-based e-mail program. Then staffers believed it to have been deleted, after it copied to physical drives, only to be shown wrong by the FBI.

Most astoundingly, this archive, physically contained by a laptop and a thumb drive, was sent by regular mail to Hillary’s new office, but reportedly lost in transit. Or perhaps, lost in the office itself.

Or, quite possibly, the subject of what is called a special collection by an intelligence service. Say, for example, one based in Moscow, which has already made such mischief for the Clintons and many top Democrats.

Why the Clintons did not employ a skilled courier to move such sensitive material is remarkably unclear. And if it ever did arrive, by, er, mail, why it was not immediately secured by her most senior staff is also remarkably unclear.

I was fairly certain before this that the Clinton operation has been penetrated by Russian intelligence. Unless spymaster President Vladimir Putin’s operatives are nowhere near as on the ball as the original KGB — which merely gave birth to the Putin regime itself — it’s hard not to imagine them taking advantage of such stupidity and incompetence.

So it’s likely that the living Republican secretaries of state, whose support Hillary has sought to cement her commander-in-chief credentials against the wildly unqualified Trump, are happy now that they’ve decided against the pro-Clinton move.

George Shultz and Henry Kissinger will issue no endorsement, I’ve learned, instead pushing for “bipartisan” geopolitics.

Colin Powell was already perturbed with Hillary for claiming he had advised her to take this course with her e-mail. The FBI document dump shows that actually warned her against it. James Baker has shown no interest.

And it’s unlikely that Condi Rice would go it alone in backing Hillary.

Happy holiday.

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William Bradley Archive
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Remains Of Minnesota Boy Missing Since 1989 Found

MINNEAPOLIS (Reuters) – The remains of an 11-year-old boy abducted in 1989 while riding his bicycle near his home in central Minnesota have been found and were officially identified on Saturday, authorities said.

Jacob Wetterling, whose parents Patty and Jerry Wetterling became tireless advocates for missing children after his disappearance, was identified by dental records, the Stearns County, Minnesota, sheriff said in a statement.

The statement did not say where or how the remains were located. Authorities expect to be in a position to provide more detailed information early next week, it said, and the sheriff’s office said additional DNA testing will be performed.

Authorities last October named Danny James Heinrich a person-of-interest in the disappearance and suspected homicide of Wetterling and announced separate federal charges of possessing and receiving child pornography.

Heinrich has been in custody since his arrest last year.

“Our family is drawing strength from all your love & support,” Patricia Wetterling said on twitter. “We’re struggling with words at this time. Thank you for your hope.”

FBI Special Agent Richard Thornton in October 2015 said Heinrich was a person-of-interest given the similarities between Wetterling’s abduction, a number of unsolved sexual assaults in central Minnesota dating to the 1980s and the nature of the charges against him.

Wetterling was abducted near his St. Joseph home in October 1989 while riding a bicycle with his brother and a friend.

Authorities looked closely in 1989 and 1990 at Heinrich, who in 1990 submitted his shoes and tires for comparison to tracks and prints left near the abduction scene, Stearns County Sheriff John Sanner said in October 2015.

Investigators reviewing the Wetterling disappearance in the past year took another look at Heinrich and retested DNA from clothing a juvenile male was wearing in January 1989 when he was sexually assaulted by a man about 10 miles from Wetterling’s hometown, Thornton said. They found a match to Heinrich.

U.S. Attorney Andrew Luger said in October 2015 the statute of limitations had run out on the sexual assault and Heinrich had denied any involvement in Wetterling’s disappearance.

Authorities searched Heinrich’s home in July 2015, finding child pornography in three-ring binders and on a computer hard drive. They also found dozens of videotapes Heinrich appeared to have filmed of young boys delivering newspapers, playing or riding bicycles, officials said, but Wetterling’s picture was not among them.

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British Prime Minister Says Brexit Will Wound U.K. Economy

HANGZHOU (Reuters) – Britain’s economy will suffer as a result of the decision to leave the European Union despite signs in recent economic data that the impact has not been as severe as some predicted, Prime Minister Theresa May said on Sunday.

The June decision to leave the 28-country EU sent financial markets into shock in anticipation of a recession as Britain enters a years-long process of tearing itself away from its biggest trading partner and forging a new global economic role.

Sterling surged on Thursday after a stronger-than-expected survey of manufacturers offered the best signal yet that Britain’s economy is performing better than many had initially feared.

Nevertheless, May predicted that the vote would damage the economy and said the government would continue to monitor economic data in the coming months before setting out its fiscal response to protect the economy later this year.

“There will be difficult times ahead,” May told reporters on her way to a G20 summit in Hangzhou, China.

“We’ve seen figures giving some different messages in relation to the economy at the moment. I think the reaction of the economy has been better than some had predicted post- the referendum, but I won’t pretend it’s going to be all plain sailing.”

May was accompanied by Bank of England Governor Mark Carney, who launched a monetary stimulus package last month and forecast the economy would flatline for the rest of the year, and finance minister Philip Hammond, who has signaled a need for fiscal stimulus to protect growth.

Asked for her view on the need for a “fiscal reset” – a phrase used by Hammond on a separate trip to China in July – May said the government’s response was not yet set in stone.

“We will be looking at this issue,” she said. “We have to take all the data into account; by the time of the autumn statement there will be more data available. We’ll have a better picture of what is happening.”

No date has been set for the autumn budget statement, which May said would be when the government laid out its new fiscal position. Hammond is expected to loosen the grip of his predecessor George Osborne on the public purse by pushing back a target to run a budget surplus by 2020.

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To America: Sorry, The Islamic Republic of Iran Will Never Be Your Friend

I was born after the Islamic revolution 1979 in the city of Esfahan, Iran. Unlike many other Iranian-Americans, I lived, studied, and grew up most of life in Iran, including under the presidency of Mahmoud Ahmadinejad and leadership of the Supreme Leader Ali Khamenei. I believe I gained the on the ground, first-hand experience, and witnessed how the political establishment of Iran functions and how the Islamic Republic has its claws in every sector of the society.

It worth noting that one revolutionary value- the anti-Americanism (death to the Great Satan)- is the very existence, raison d’être, and legitimacy of the political establishment, particularly the top gilded circle of Iranian leaders. Whatever one attempts to do, whatever policy a government pursues, and whatever any US administration attempts to do, one can not change this underlying ideological and revolutionary pillar of the system.

Why? Because If you take this revolutionary value 9anti-Americanism) away from the Islamic Republic of Iran, the system will crumble like a house of sand.

That is why whenever leaders think that the US and Iran are getting closer, Iranian top gilded leaders reassert the message that America is the enemy number one; the “Great Satan”.

Since the establishment of the Islamic Republic in 1979, Tehran’s message has been consistent that the Islamic Republic faces existential threats and enemies. We were taught from an early age, through the educational system and books, about the dangerous “America”. The state’s media outlets persistently repeats why one should continue saying “death to America”, and blames America for every socio-economic and geopolitical problem Iran has.

Having this powerful “enemy” serves very well as a social, political, strategic and economic scapegoat for Iranian leaders as well. Without “the Great Satan, the enemy” how can the Iranian leaders justify cracking down on opposition? Without the existential “the Great Satan, the enemy”, how can Khamenei and the IRGC explain the large military budget? If there is no “the Great Satan, the enemy”, how will Iranian leaders take attention away from the day-to-day difficulties that Iranians face? Without the “the Great Satan, the enemy”, how can Iranian leaders distract attention from the accumulation of wealth at the top and the large amount of poverty in Iran? Without the “the Great Satan, the enemy”, from which social base would Khamenei obtain his legitimacy? Having the powerful “Great Satan, the enemy” is also a method to rule by invoking nationalistic sentiments through instigating hatred and fear.

For more details and nuances you can read different versionfull on Here.

_______________________

Dr. Majid Rafizadeh is an American political scientist, business advisor, best-selling author, and the president of the International American Council on the Middle East. Harvard-educated, Rafizadeh serves on the advisory board of Harvard International Review. An American citizen, he is originally from Iran and Syria, lived most of his life in Iran and Syria till recently. He is a board member of several significant and influential international and governmental institutions, and he is native speaker of couple of languages including Arabic and Persian. He also speaks English and Dari, and can converse in French, Hebrew.

You can sign up for Dr. Rafizadeh’s newsletter for the latest news and analyses on HERE.
You can also order his books on HERE.

You can learn more about Dr. Rafizadeh on HERE.

You can contact him at Dr.rafizadeh@post.harvard.edu or follow him at @Dr_Rafizadeh.

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Don't Be Fooled: Donald Trump's Immigration Plans Have Not Changed

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Donald Trump tried almost every strategy possible over the past two weeks to spin his deportation positions. He said he was “softening” and then “hardening” and then “softening again.” He offered subdued remarks in Mexico, then read a fiery speech off a teleprompter in Phoenix, then gave winding, inconsistent comments to the press. He was cordial with Mexican President Enrique Peña Nieto, then reportedly modified a speech just to jab back at him for a tweet he disliked.

The entire period was a dramatic encapsulation of the Trump campaign, which has been characterized by erratic statements, a lack of political clarity and a candidate who resists being controlled or pinned down.

Trump’s immigration policies have been particularly opaque. For more than a year, he’s managed to talk a lot about the issue ― but say very little. This behavior allows others to fill in the blanks, sometimes further obscuring Trump’s position. Or, Trump replies to others’ interpretations by backtracking and pushing a different idea.

That’s how for two weeks, Trump duped everyone into thinking his mass deportation goal may have changed.

In reality, the spin by Trump spokeswoman Katrina Pierson ended up being the most concise explanation. “There’s not a different message,” she said last month on CNN. “He’s using different words to give that message.”

Translation: He’s not changing his plan, and he still wants to expel as many undocumented immigrants as possible ― whether it’s by deporting them or by making their lives so difficult that they leave on their own.

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Trump wants to ramp up deportation of criminals, but also seek out people who overstayed their visas or are otherwise deemed high-priority ― potentially as many as 6.5 million people out of the estimated 11 million undocumented immigrants in the U.S., according to the Washington Post. Anyone remaining would be at constant risk of deportation and without any way to gain legal status unless they left the country, without any guarantee they could return.

So how did Trump actually convince some people he’d changed over the last two weeks? The speculation that Trump was about to flip started when members of his Hispanic Advisory Council told Buzzfeed that they had gotten the impression in a private meeting that the candidate might be more open to legal status for undocumented immigrants than previously believed.

The Trump campaign denied it, but the candidate and his top officials allowed the speculation to continue, and at times encouraged it. Campaign Manager Kellyanne Conway said Trump’s stance on the deportation force he once supported was “to be determined.”

Trump himself launched more speculation by repeatedly going on TV and hinting at a less severe enforcement approach for undocumented immigrants.  

“There certainly can be a softening, because we’re not looking to hurt people,” Trump said on Fox News. Even when he told CNN later that any changes could be considered a “a hardening” of his position, he also said the country “can’t take 11 [million] at one time and just say ‘boom, you’re gone.’”

When he met with Peña Nieto on Wednesday and spoke with him politely, it seemed, again, like Trump was changing. 

Then, the whole illusion fell apart. Peña Nieto said he told Trump that Mexico would never pay for a border wall, and Trump hit back by saying again in a Wednesday evening speech that the country would pay.

Trump was also clearer than ever about his deportation stance, saying there would be no legal status for undocumented immigrants unless they left the country first and that “no one will be immune or exempt from enforcement.”

The speech led to several of Trump’s Hispanic advisers dropping their support.

No one will be immune or exempt from enforcement.

Still, the speculation continued Thursday, when Trump said “there’s really quite a bit of softening.”

“We’ve got a lot of people in this country that you can’t have, and those people we’ll get out,” Trump said on the Laura Ingraham radio show. “And then we’re going to make a decision at a later date once everything is stabilized. I think you’re going to see there’s really quite a bit of softening.”

The spin is working on some people ― MSNBC “Morning Joe” host Joe Scarborough repeatedly said on Friday that Trump’s current immigration policy is the same as President Barack Obama’s or maybe even softer.

This isn’t true. Trump is still advocating his same deportation plans to expel millions. His vague statements about doing something for undocumented immigrants “at a later date” don’t mean much of anything ― he hasn’t even said when he would consider the situation “stabilized” or whether he’d actually support legal status at that point.

This is likely how Trump will continue to play until Election Day, including in an immigration speech reportedly planned for the upcoming week. Trump will keep making statements that people can interpret as pivoting away from deportations, and people will.

But it’s probably best to remember what Pierson said: He’s changing his words, not his message.

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