Why (Republican) House Speaker is the Worst Job in Congress

Jonathan Allen in Vox: “God, it sucks to be the Republican speaker of the House.”

“There are a lot of reasons the job of speaker has become less desirable over the years, from fundraising demands to losing power over perks like earmarks and watching the dysfunction of Congress rob the institution of some of its clout. But the real issue is as brutal as the total disrespect rank-and-file Republicans have shown for the office and the institution it represents — and, I would argue, for the American public.”

“Our system of governance only works when our elected leaders are willing to either compromise or find common ground … The idea, hard as it is for some in the House to understand or accept, is that the republic functions when people and parties of disparate views can agree. Sometimes that requires giving up a little bit of ground. But this small band of House Republicans is unwilling to do that. Its members threaten to take down the speaker when he tries to govern.”

“I think the best way to look at it is this: Anyone who wants to be speaker of the House, by definition, should be someone who wants to participate in governing the country. The Freedom Caucus and its ilk are preventing anyone who holds the job from doing that. So what’s the point in being speaker in a Republican House? It sure as hell isn’t to govern responsibly. Thus, no one in the GOP who feels a commitment to that ideal wants it.”

U.S. Spends More on on Healthcare With Worse Results

The Hill: “The United States spends far more per person on healthcare than other wealthy countries, but often has worse health outcomes, according to a new report.”

“The report from the Commonwealth Fund, a health research group, reinforces a critique that reformers have long pointed out about the U.S. health system.”

“The study finds that the U.S. spent $9,086 per person on healthcare in 2013. In a comparison group of 12 other wealthy countries, including the United Kingdom, Canada and France, the next closest country to the U.S. was Switzerland, which spends about $6,325 per person.”

“U.S. healthcare spending is also much larger when measured as a share of the economy. Healthcare spending is 17.1 percent of the U.S. economy, compared to 11.6 percent for France, in second place.”

Squires OECD Exhibit 01

But: “Life expectancy in the U.S., at 78.8 years, is a few years lower than that in all 12 other countries. The U.S. also has by far the highest percentage of people 65 or older with two or more chronic conditions, at 68 percent.”


Where is Physician-Assisted Suicide Legal?

Sarah Kliff in Vox: “California legalized physician-assisted suicide on Monday. Overnight, with that new law, the number of Americans living in states where it is legal for a doctor to prescribe lethal medications to terminal patients tripled.”

“Before California, there were four states — Washington, Oregon, Montana, and Vermont — where doctors could prescribe these lethal drugs. A total of 13.7 million people live in those places. But California is the country’s most populous state, with more than 38 million residents. Now that its new law has passed, there are 52.5 million people — about one in six Americans — who live in places where doctors can help terminally ill patients end their own lives.”

“An additional nine states are currently weighing legislation that would create the right elsewhere.”

It’s a First: Washington Works Together to Amend Obamacare

Huffington Post: “President Barack Obama signed a bill into law Wednesday, which is pretty boring in and of itself. The legislation is kind of boring, too. But what made the moment significant is it’s the first time in four years that Congress has sent the president a bill expressly intended to make Obamacare work better, not ruin it.”

“This time, lawmakers identified a problem and worked together to pass legislation to deal with it, and then the president signed it. Just like they teach in social studies.”

“What gets less notice is that Democrats and Republicans in Congress agree on what some of Obamacare’s real problems are — and sometimes the White House does, too. Obama isn’t only paying lip service when he says he’d be happy to sign things that fix the flaws in his sprawling, complicated health care law.”

“It’s not that the law has gone untouched since 2010. Obama has signed 13 bills that changed the ACA, according to the Congressional Research Service. But only once before, in 2011, has the Republican-led Congress passed a bipartisan measure with the express purpose of improving the functioning of the Obamacare-regulated health insurance market. In the other cases, mostly minor tinkering to the ACA was part of bigger bills with broader aims.”

Where do Americans Sleep Best?

Christopher Ingraham: “New research … finds that the quality of Americans’ sleep has a geographic dimension, too. The data comes from the Centers for Disease Control and Prevention’s 2009 Behavioral Risk Factor Surveillance Survey, which asked 432,000 people the following question: “During the past thirty days, for about how many days have you felt you did not get enough rest or sleep?”

“Researchers separated people into two categories based on how they answered this question: those who reported poor sleep on fewer than 15 days, and those who slept poorly 15 or more days in the previous month … Then they tallied the responses up at the county level and mapped the percent of each county’s residents who reported this persistent poor sleep.”

Screen Shot 2015-10-08 at 8.00.28 AM

“The nation’s biggest cluster of bad sleep ended up in the heart of Appalachia and in a cluster of counties in Ohio, West Virginia, Kentucky, Virginia and Tennessee.”

“The research also identified a number of ‘coldspots’ when it comes to sleep deficiency — places where rates are below average. Wisconsin has a number of these counties, as does Northern Virginia. In many of these counties, rates of sleep difficulty fall below 20 percent.”

“People who were generally younger, poorer and in worse health were more likely to live in places with high rates of bad sleep.”

Uninsured Rate Holds Steady at 11.6%

Gallup: “The uninsured rate among U.S. adults aged 18 and older was 11.6% in the third quarter of 2015, essentially unchanged from 11.4% in the second quarter, and down from 11.9% in the first quarter. The uninsured rate has declined 5.5 percentage points since the fourth quarter of 2013, just before the requirement for Americans to carry health insurance took effect in early 2014.”

Percentage uninsured in the U.S., by quarter

“The steadiness in the uninsured rate in the third quarter is not surprising given that the open enrollment period for 2015 ended in February. Similarly, the uninsured rate also held steady between open enrollment periods last year. Open enrollment through the marketplace exchanges will begin Nov. 1, but coverage for many who sign up during that period will not kick in until January 2016. Therefore, the full effect of the 2016 enrollment period on the uninsured rate may not be evident until the open enrollment period ends on Jan. 31.”

While proponents of the Affordable Care Act are likely encouraged by the reduction in the uninsured rate since late 2013, it is unclear how much further it will decline.


Is the U.S. the Best Place to Die?

Quartz: “The Economist Intelligence Unit (EIU) ranked [Britain] first in its latest quality-of-death index, which uses 20 quantitative and qualitative indicators to measure the effectiveness of end-of-life care in 80 countries. The measures include the the quality of palliative care, affordability, the health care environment, and community engagement.”

“Not surprisingly, rich countries generally did better than poor ones in the rankings. But there are noteworthy variations: the US came in ninth place with a score of 80.8 (out of 100), far below the 93.9 score achieved by Britain, where complaining about health care is as popular as grumbling about the weather:”

“The most striking finding in the report is that Mongolia, a poor country with few provisions for end-of-life care in 2000, now leads the low-income countries with a score of 57.7, which puts it 28th overall, above a host of more advanced economies.”

Washington’s Myopic Focus on Health-Care Costs Doesn’t Add Value

Ezra Klein argues that Democrats and Republicans are wrong when they focus solely on costs as the litmus test for a successful health care system.

“But the problem isn’t that America’s health-care system costs too much. It’s that it delivers too little. Value, not cost, is the problem. And cutting costs may actually be counterproductive.”

“The question in American health care isn’t how much it costs. It’s how much it’s worth. People complain that America spends about a fifth of its GDP on health services. But in isolation, the statistic is meaningless. The question is whether the health services Americans get are a good value at a fifth of GDP.”

“On that, the answer is easy: hell no. Americans spend roughly double what other developed nations spend but get basically the same outcomes. We’re not paying more to get more. We’re paying more and getting ripped off.”

“You can fix that problem by paying less for health care of the same quality, by paying the same — or more — for health care of higher quality, or some combination of the two. But our political discourse focuses simply on cutting costs.”

Can the Court Woo Back Conservatives?

Paul Waldman in The Washington Post: “The Supreme Court’s new term begins … and it brings with it a paradox. On one hand, the Court is poised to deliver conservatives a string of sweeping, consequential victories on issues covering a wide swath of American life. On the other, conservatives are up in arms about how they’ve been betrayed by the Court, and particularly by Chief Justice John Roberts, despite the fact that Roberts has in all but a couple of cases been as reliable a conservative vote as they could have hoped for.”

“To be clear, Republicans are right to focus on the Supreme Court during the campaign, and Democrats ought to as well … There may be no single issue more consequential for America’s future in this election than what will happen to the Supreme Court in the next four or eight years. But Republicans aren’t just arguing that it’s important for them to elect a Republican so they can get friendly justices, they’re arguing that even Republican presidents and Republican-appointed justices can’t be trusted not to turn into judicial Benedict Arnolds.”

“If you’re someone like Ted Cruz, this idea fits in nicely with the rest of your message, at least during the primaries: the real enemy isn’t the Democrats, it’s the feckless and unreliable Republican establishment that has failed to deliver the conservative paradise we were promised.”

Unemployment Dips, But It’s Still a Shaky Job Market

Wall Street Journal: “The number of unemployed Americans dipped below eight million last month for the first time since 2008–but that figure doesn’t entirely reflect job growth.”

“Unemployment dropped to a new low the same month that 350,000 Americans exited the labor force, the Labor Department said Friday. The civilian labor force has shrunk three of the past four months since touching a record high in May.”

“One explanation for the trend is that Americans out of work for an extended period of time are giving up looking for jobs.”

“Why are workers leaving the labor force? It could be because relatively few unemployed are receiving jobless benefits. The number of Americans receiving ongoing unemployment benefits touched a 15-year low last month.”


A Closer Look at Who Doesn’t Pay Taxes

The Hill: “Mitt Romney’s 47 percent is now 45.3 percent.”

“The Tax Policy Center says that’s now the number of households who don’t pay any income taxes, an almost five percentage point increase over the 2013 estimate of 40.4 percent.”

“Romney, the 2012 GOP presidential nominee, took a political hit when he used a previous Tax Policy Center estimate to assert that the 47 percent who didn’t pay income taxes would support President Obama.”

“The Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, says this year’s increase is largely due to more precise projections about who actually pays taxes.”

“In other words, as the Center’s Roberton Williams put it: ‘Those additional non-payers were there all the time — we just failed to count them.'”

Americans: Don’t Repeal Obamacare. Fix Our Soaring Medication Costs.

Wall Street Journal: “Attention has focused lately on new drugs with eye-popping prices and on a few whose price a new owner abruptly raised several-fold. But what many drug companies rely on for sales growth is a pattern of steady increases, year in and year out, on older medicines. Wholesale-price increases for the 30 drugs analyzed by the Journal averaged 76% over the five-year stretch from 2010 through 2014. That was more than eight times general inflation.”

“Pricing power helps some in the pharmaceutical industry to compensate for sluggish demand, new competition or weak product pipelines. ‘Pricing has covered up a multitude of other disappointments over the past 15 years’ in the sector.”

Americans have taken notice. In fact, according to The Hill, a recent poll by the Kaiser Family Foundation found “Americans have a greater concern for medication costs than they do about the Affordable Care Act.”

“The Kaiser poll indicates that, for the public, repealing ObamaCare is much less of a concern: 44 percent of respondents have a favorable view and 41 percent of respondents have a negative view. Only 28 percent of the respondents want outright repeal, but most likely they have real-world concerns with drug prices.”