A Few Links to Dispel Conservative Myths Part Nine: Syrian Refugees and the Conflict in the Middle East

America is a nation of immigrants. We have always held that American freedom will attract the best and the brightest from all over the world.

Sometimes we have lost our way. Between 1924 and 1965, an immigration quota system was in force that overwhelmingly favored people from northern Europe. Now-whites were kept out almost entirely. The United States did not officially allow refugees from war-torn nations into the country until after World War II. Although thousands of Jews fleeing Hitler's Europe reached the U.S. by 1941 under the relatively generous immigration quota for Germans and Austrians, many more would have come had they been allowed.

Why were boatloads of refugees turned away from American ports? Why did the U.S make it more, rather than less difficult for them to come to America as the war dragged on? One reason was pure prejudice. There was widespread bigotry in America towards Jews. A 1939 poll showed that most Americans were against allowing even a modest number of Jewish refugees into the country.

The U.S. government also had groundless fears that Jewish refugees posed a security risk, and raised an increasing number of barriers to Jewish immigration. Otto Frank, father of world-famous diarist Anne Frank sought her entry to the U.S. in 1941. Had he succeeded, Anne Frank might be a 77-year old writer living in Massachusetts today. But that was not to be. From Patricia Cohen of the New York Times,

"By June 1941, no one with close relatives still in Germany was allowed into the United States because of suspicions that the Nazis could use them to blackmail refugees into clandestine cooperation. That development ended the possibility of getting the Frank girls out through a children's rescue agency."

To date, the U.S. has accepted fewer than 2,000 refugees from the civil war in Syria. In September, President Obama announced plans to resettle 10,000 refugees in the country in 2016. In the wake of the recent attacks on Paris and other cities, the President's plan has created a firestorm of anger, bigotry and lies among Republicans and conservative leaders who believe the refugees represent a threat to America. Those who have forgotten the mistakes of the past are, as always, doomed to repeat them.

For the record, the current refugee vetting process is incredibly thorough. From Stephanie Condon of CBS News:

"The process for any refugee begins with the processing of biographic information (such as an applicant's name and date of birth) and biometric information (such as fingerprints). The information is checked against databases in several different U.S. agencies including the FBI, the State Department and the Department of Homeland Security (DHS).

If an applicant has applied for an overseas visa in the past, their biometric information should be on record. It can be used to ensure that the applicant has had a consistent story about the circumstances that prompted them to seek asylum. 

After that, applicants go through a lengthy, in-person interview process overseas. The interviews are conducted by specially-trained DHS officers who spend at least eight weeks learning skills like how to question applicants and test their credibility. These adjudicators receive special training for interviewing refugees from Iraq or Syria."

And with that dose of reality, let's move on to fantasy with:

Part Nine: Syrian Refugees and the Conflict in the Middle East

Myth: Congressional Republicans have cited gaps in the screening process for Syrian immigrants. The bill recently passed by the House halts the President's refugee program until those gaps are closed.
Fact: Asked to cite the dangerous gaps in question, Republicans have nothing to say. From Jennifer Steinhauer and Emmarie Huetteman of the New York Times:

"When pressed, most Republicans could not specify which aspects of the rigorous refugee vetting program that they found inadequate. Mr. Ryan’s staff members cited a Bloomberg poll of 1,002 adults released on Wednesday, conducted by Selzer & Company, that found that 53 percent of those surveyed said the resettlement program should be halted."

"The bill, which received the full support of Speaker Paul D. Ryan, would require that the director of the Federal Bureau of Investigation, the secretary of the Department of Homeland Security and the director of national intelligence confirm that each applicant from Syria and Iraq poses no threat. The bill did not go into specific measures; rather, it said that officials "shall take all actions necessary" for a "thorough" background check."

FBI Chief James Comey has condemned the House bill, while endorsing the current refugee vetting process. From Evan Perez of CNN:

"Comey has told administration and congressional officials that the legislation would make it impossible to allow any refugees into the U.S., and could even affect the ability of travelers from about three dozen countries that are allowed easier travel to the U.S. under the visa waiver program, the officials say.

There are always risks in allowing any foreigners into the U.S., Comey told the officials, adding that the FBI believes it has an effective process with intelligence and other agencies to conduct vetting of refugees."

Myth: Refugees represent a serious, demonstrable threat to American security.
Fact: Of the nearly 750,000 refugees admitted to the U.S. since 9/11, the number arrested on domestic terrorism charges is zero.

Myth: "Opposition to Jewish refugees (during WWII) was “racial”; opposition to Syrian refugees is based on security concerns." - Joel E. Pollak, Breitbart.com

Fact: The core of opposition to Syrian refugee is bigotry against Muslims. Senator Ted Cruz has said that America should welcome Christian Syrians while banning Muslims. Jeb Bush has also said our "focus" should be on Christian refugees above others. Louisiana Governor Bobby Jindal would like to exclude Muslims from immigrating to the U.S. based on a test of their political beliefs. Outside the realm of (relatively) mainstream political leaders, bigotry is even more widespread. Influential Christian evangelist Franklin Graham would like to ban all Muslim immigration, as would Daniel Horowitz, Senior Editor of the Conservative Review.

Myth: "At least one Syrian refugee who had recently entered Europe was among the seven terrorists who carried out the deadliest attacks in France since World War II, according to authorities." - Yaron Steinbuch, the New York Post, 11/15/15, in an article regarding the Paris bombings.

Fact: All the attackers identified so far in the Paris bombings were European nationals. It is true that a fake Syrian passport was found near the body of one unidentified attacker. If that document did in fact belong to the attacker in question, records show he arrived in Greece from Turkey on October 3, posing as a visiting Syrian national loyal to the Assad regime. There is no indication that the man was in fact Syrian, and he was not posing as a refugee.

Myth: 77 percent of the refugees who have gone to Europe are young men, and "The director of national intelligence has said that among those refugees coming into Europe are no doubt ISIS terrorists." - Senator Ted Cruz. The majority of Syrian refugees are, "young males." - Presidential candidate Ben Carson.
Fact: Republicans would like you to believe that most Syrian refugees are actually Muslim jihadists or young men who are otherwise dangerous. Some facts: Among Syrian refugees, women outnumber men, and children 11 years old and younger account for 38.5 percent. Furthermore, U.S. National Intelligence Director James Clapper has never said that the refugees are "no doubt ISIS terrorists." Instead, Clapper said that it’s a, "huge concern" that ISIS could attempt to infiltrate the refugees, but he's expressed confidence in the government’s ability to screen the refugee applicants. 

Myth: Young Syrian men, "have left their wives, young children and elderly relatives in the face of the ISIS threat." The media portray them as refugees, "when they are more accurately described as economic migrants." - Donna Rachel Edmunds, Breitbart.com
Fact: The refugees are undoubtedly seeking better lives. But many young men are fleeing Syria in order to avoid being drafted into the fighting by dictatorial regimes that they do not support. For example, the PYD, a Kurdish nationalist party that has assumed power in parts of Syria with the tacit consent of the al-Assad regime, is prohibiting men over the age of 18 from leaving the country so that they can be drafted into the fighting.

Myth: On November 16, eight Syrian illegal aliens were apprehended attempting to enter Texas from Mexico.
Fact: From ABC News, KTXS 12: "DHS confirms that on Tuesday, members of two Syrian families, two men, two women and four children, presented themselves at a port of entry in Laredo.  They were taken into custody by CBP and turned over to ICE for further processing." In other words, the families simply traveled to the U.S. border and asked for asylum. They were not apprehended as illegal aliens. Donald Trump of course immediately jumped on the false report and tweeted, "WE NEED A BIG & BEAUTIFUL WALL!" and Ben Carson from stated, "our worst nightmare may be unfolding before our eyes." (For the record, there is no illegal immigration crisis at our border with Mexico. See part three in this series.) 

Myth: President Obama plans to bring 100,000 or 200,000 or 250,000 refugees from Syria to the United States, according to, respectively, Carly Fiorinia, Ben Carson and Donald Trump.
Fact: The President has no such plan. Current law allows the U.S. to accept up to 70,000 refugees from around the world in 2015. The U.S. State Department has suggested this number will increase to 100,000 by 2017. However, only 30% of refugees coming to the U.S. are from the Middle East, and most of these are from Iraq. The President has asked only that at least 10,000 be accepted from Syria in 2016.

Myth: Saudi Arabia has refused to accept Syrian refugees.
Fact: Saudi Arabia has given residency to 100,000 Syrian refugees.

Myth: TV news reports showed "thousand and thousands" of Muslims in New Jersey cheering the terrorist attacks on 9/11. "It did happen. I saw it. It was on television. I saw it. There were people that were cheering on the other side of New Jersey, where you have large Arab populations. They were cheering as the World Trade Center came down." - Donald Trump, 11/22/15
Fact: This simply did not happen. Trump's delusion appears to stem from old, debunked newspaper reports of Muslims in New Jersey celebrating the attacks.

Myth: President Obama gives Muslim refugees priority over homeless military veterans.
Fact: I see this one a lot. It's an easy excuse for Islamophobes, "Hey, as long as there are vets in need, we shouldn't spend money on anything else." That is not the worst idea. However, when conservatives are given the chance to help veterans, they consistently refuse to do so. In 2014, Senate Republicans stopped Democrats from advancing a bill that would have expanded healthcare and education programs for veterans. Between 2009 and 2012, those same Senate Republicans blocked seven different bills that would have provided jobs for veterans and assistance to homeless veterans. Meanwhile President Obama has actually done a great deal for homeless vets. His Opening Doors plan has reduced homelessness among veterans by 50% over the past four years.

Myth: The torture of detainees during the war in Iraq yielded valuable intelligence, including information leading to the capture of Osama bin Laden.
Fact: Donald Trump can't wait to bring back waterboarding. The idea that torture yielded information that led to the capture of bin Laden is a favorite of former Vice President Dick Cheney. In fact, the vital intelligence leading to bin Laden was obtained without torture, and torture did not provide good intelligence during the war. Experienced interrogators have said that torture actually prolonged the hunt for bin Laden. An exhaustive five-year Senate investigation of the CIA’s secret interrogations of terrorism suspects was released in 2014. That report’s central conclusion was that harsh interrogation measures, deemed torture by program critics including President Obama, did not work. Khalid Sheik Mohammed was waterboarded  a staggering 183 times. The torture of Khalid Sheik Mohammed produced only false and misleading information, while the best intelligence gained from a CIA detainee, information describing Abu Ahmed al-Kuwaiti’s real role in al-Qaeda and his true relationship to bin Laden, was obtained through standard, noncoercive means. In 2014, 17 former top CIA, FBI and military intelligence officials to signed a public statement denouncing harsh interrogation techniques as morally reprehensible and ineffective.

Myth: The invasion of Iraq in 2003 was justified, as the stockpiles of weapons of mass destruction cited by the Bush administration were eventually found.
Fact: No they weren't. First let's recall the Bush administration's case for invasion, which we can summarize entirely through quotes of Vice President Dick Cheney: "We do know, with absolute certainty, that he is using his procurement system to acquire the equipment he needs in order to enrich uranium to build a nuclear weapon," "Hussein is reconstituting his biological, chemical, and nuclear weapons programs," and from Secretary of Defense Donald Rumsfeld: "(Saddam) has amassed large, clandestine stockpiles of chemical weapons, including VX, sarin, and mustard gas." All of this was a pack of lies of course; the administration's own intelligence showed no evidence of WMD.

While it's true that America troops in Iraq discovered what had been  roughly 5,000 chemical warheads, shells or aviation bombs in the scrapyards of Iraq, this stuff was a lot of rusty junk, not WMD. From C.V. Chivers of the New York Times:

"All had been manufactured before 1991, participants said. Filthy, rusty or corroded, a large fraction of them could not be readily identified as chemical weapons at all. Some were empty, though many of them still contained potent mustard agent or residual sarin. Most could not have been used as designed, and when they ruptured dispersed the chemical agents over a limited area, according to those who collected the majority of them.

In case after case, participants said, analysis of these warheads and shells reaffirmed intelligence failures. First, the American government did not find what it had been looking for at the war’s outset, then it failed to prepare its troops and medical corps for the aged weapons it did find." 

Myth: As a U.S. Senator, Hillary Clinton voted for the disastrous war in Iraq.
Fact: There was never a vote, "for the war." There was a vote to give President Bush the authority to go to war in Iraq, an authority Bush lied that he needed, "to keep the peace." Clinton talked pretty tough regarding Saddam Hussein, but she never endorsed the Iraq invasion. On October 10, 2002, she said, "My vote is not, however, a vote for any new doctrine of preemption, "I support this resolution as being in the best interests of our Nation. A vote for it is not a vote to rush to war; it is a vote that puts awesome responsibility in the hands of our President. And we say to him: Use these powers wisely and as a last resort."

-----

Final Thought: President Barack Obama urged Americans to show generosity to Syrian refugees in a Thanksgiving message on Thursday, reminding them that the Pilgrims who came to America in 1620 were themselves fleeing persecution.

Tweet

A Few Links to Dispel Conservative Myths Part Eight: Republican Round-Robin

"How can I help but see what is in front of my eyes? Two and two are four."

"Sometimes, Winston. Sometimes they are five. Sometimes they are three. Sometimes they are all of them at once. You must try harder. It is not easy to become sane." - George Orwell's Nineteen Eighty-Four

In this passage of the novel, The Inner Party interrogator of thought-criminals, O'Brien, says of the mathematically false statement that control over physical reality is unimportant; so long as one controls one's own perceptions to what the Party wills, then any corporeal act is possible. (Thanks Wikipedia.) Republican Presidential candidate Jeb Bush recently did an interview  regarding his tax plan with Chris Wallace of Fox News which mimicked the famous dialogue between Winston Smith and O'Brien.

WALLACE: (Regarding the Bush Plan), The Tax Foundation says the middle class would see after-tax income increase 2.9 percent. But the top 1 percent would get a boost of 11.6 percent.

BUSH: Look, the benefit of this goes disproportionately to the middle class. If you look at what the middle class pays today compared to what they would pay in our tax plan —

WALLACE: But they get a 2.9 percent increase in after tax income —

BUSH: Because higher income people pay more taxes right now and proportionally, everybody will get a benefit. But proportionally, they’ll pay more in with my plan than what they pay today.

WALLACE: Well, I mean forgive me, sir, but — but 2.9 seems like it’s less than 11.6.

What's going on here? It's simple. Jeb Bush is lying, and demanding that everyone believe his lie. And this typifies the campaign for the Republican Presidential nomination. The candidates are lying. Constantly. They lie about the facts. They lie about their personal backgrounds. They lie about their plans for the Presidency. When they're caught lying, they tell an even bigger lie. And, most interestingly, they sometimes try to reshape perception of history and reality to make their lies appear true.

Returning to Nineteen Eighty Four, the protagonist Winston Smith has an important job. He alters old issues of the newspaper in order to make history more closely align with current Party propaganda. Carly Fiorina, another Republican Presidential candidate, is doing the same thing. As I discussed in the last edition of this series, Fiorina claims that secretly recorded video recorded by the anti-choice group called the Center for Medical Progress (CMP) shows Planned Parenthood selling the body parts of aborted fetuses and otherwise breaking the law. The accusations against Planned Parenthood are false.

Called to account for this (from Ana Marie Cox of the Daily Beast),

"Fiorina didn’t just repeat that she had seen something that does not exist, she accused the organization of something that the "sting" video’s makers hadn’t: "Planned Parenthood is aborting fetuses alive to harvest their brains and other body parts. That is a fact." To be clear, with this statement, Fiorina isn’t just repeating a mischaracterization she already told (that Planned Parenthood "harvests" organs that are intact after an abortion). Rather, she is saying that Planned Parenthood aborts fetuses alive, for the purpose of harvesting their intact organs. She added, "Planned Parenthood will not and cannot deny this because it is happening."

That last bit is a hoary nugget of rhetorical flim-flammery on par with "When did you stop beating your wife?" It tries to reinvent lack of engagement as admission of guilt. Except Planned Parenthood has denied allegations of illegally “harvesting” organs—and six different state investigations (Pennsylvania, Georgia, Indiana, Massachusetts, South Dakota, and now Missouri) have backed up those denials.

Instructively, what’s disturbing about Fiorina’s falsehoods isn’t that she lied, or even that she seems to believe her own lies. It’s not even, really, that her lies get bigger every time.

No, what should give you pause is that by sheer force of articulated will she has fabricated her own reality, to the point that her Super PAC spliced together a different video to illustrate just what it is she said she saw. Think about it: If Fiorina had stuck to some kind of emotionally-charged but non-specific description of the video, there would be no second round of debate. As it is, Fiorina didn’t just lie—she created a storyboard."

Well, I have to give Fiorina one thing. At least she cares enough about accusations that she is lying that she at least tries to alter the past so that her lies become truth. As we'll see, some of the 2016 Republican Presidential candidates can't even be bothered to do that.

Part Eight. Republican Presidential Candidate Round-Robin

Myth: Dr. Ben Carson's remarkable personal story includes overcoming a history of violent conflict with his peers as a youth, turning down an offer to attend West Point, and a harrowing tale of how he sheltered his white classmates during Detroit race riots.
Fact: These incidents, as described in Carson's memoir, Gifted Hands are not true. More information here. Carson's response to these controversies has been bizarre. First he admitted to Politico that he had not received an offer to attend West Point. Then when Politico reported this admission, Carson claimed Politico was lying. When confronted with some of Carson's other fabrications, his campaign replied, "Why would anyone cooperate with your obvious witch hunt? No comment and moving on…… Happy Halloween!!!!!" Carson also held a recent press conference where he attempted to address the falsehoods in Gifted Hands by launching into an angry tirade against the media in the form of long-debunked President Obama conspiracy theories. Pretty strange stuff from a candidate who claims to believe that honesty is more important than political experience.

Myth: Senator Marco Rubio's tax plan, which cuts taxes for businesses and individuals at all levels of income, would create a budget surplus within ten years.
Fact: Numerous independent estimates have found that Rubio's plan would actually increase the national debt by roughly $5 trillion dollars according to some sources, or as much as $12 trillion according to Citizens for Tax Justice. The idea that the economy would be so stimulated by the tax cuts that revenue would actually skyrocket comes from "The Tax Foundation." From Ezra Klein reporting on Vox (with another interesting allusion to Orwell):

"(W)hat Rubio is saying is that his massive tax cut is actually going to mean more tax revenue for the government — that two minus one will equal four."

"The Tax Foundation is an amalgam of anti-tax advocacy group and tax policy think tank: It produces research, churns out charts and tables, and scores tax plans, but it's motivated by an anti-tax agenda."

"Its assessments of tax cuts are, as you might expect, considered rather rosy by more mainstream economists."

"Indeed, it's so optimistic that when New York Times's Josh Barro ran the results by "10 public finance economists ranging across the ideological spectrum," none of them would endorse the Tax Foundation's conclusions."

Myths: "When Mexico sends its people, they're not sending their best," "They're sending people that have lots of problems...they're bringing drugs, they're bringing crime. They're rapists." - Donald Trump, 6/16/15
"The Mexican government ... they send the bad ones over." - Donald Trump, 8/6/15
Fact: Donald Trump. Where to begin? From the day Trump announced his candidacy, the Washington Post called him, "a fact checker’s dream … and nightmare," and devoted a lengthy article to debunking all the lies and myths just in his announcement speech. To date, Politifact.com has fact checked 67 of Trump's statements and rated zero of them "true" while rating three-quarters of them, "mostly false," "false" or "pants on fire."

And hoo boy, does Trump hate Mexicans and other Latino immigrants. He wants to create a "massive deportation force" which apparently would push the entire undocumented immigrant population of eleven million south of the border. It's also possible that Trump means more than eleven million folks however, as he also believes that children born in the United States to undocumented immigrants are not citizens.

Regarding the myths in the above Trump quotes:
*There is no evidence that any Mexican policy pushes anyone, criminal or non-criminal, into the United States.
*Regarding the rapists Trump alleges are crossing the border, Jake Miller of CBS News notes,
"Asked why he used the term "rapists" to characterize Mexican immigrants, Trump pointed to recent reports that as many as 80 percent of the female immigrants crossing the U.S.-Mexico border are sexually assaulted during the trip. CNN's Don Lemon then pointed out that those reports document immigrants being raped during their journey across the border - not the immigrants raping people after they get here."
*Regarding the link that Trump alleges between immigration and crime, he actually has it backwards. Both immigrants and first-generation immigrants have a lower rate of criminality than other Americans.

Myth: "The last president we had was Ronald Reagan that said we’re going to dramatically cut tax rates. And guess what? More revenue came in, but tens of millions of jobs were created." - Senator Rand Paul
Fact: Republicans really, really want you to believe that tax cuts create economic growth. Study after study after study demonstrates that they do not. Regarding Rand Paul's remarks, Conor Lynch of Salon has a good summary of the real Reagan record:

"First of all, fewer jobs were created per year under Reagan than under either Clinton — who increased income taxes — or Jimmy Carter. (Two million jobs were added per year under Reagan, compared to 2.6 million under Carter.) Second, revenue did not increase with Reagan’s tax cuts, but with his four subsequent tax increases (passed in 1982, 1983, 1984 and 1987). The first major income tax cut came in 1981, which slashed the top rate from 70 to 50 percent, and reduced — yes, reduced — revenue by $208 billion in its first four years. And, of course, the federal debt just about tripled under Reagan, who increased spending (especially on defense) while revenue decreased overall (when measured to the GDP)."

Myth: "Virtually every person across this country has seen premiums going up and up and up," due to Obamacare. - Senator Ted Cruz, 10/16/13
Fact: This quote predates the Presidential campaign, but the candidates are still saying this same thing, in one form or another. Long story short, on average, premiums have risen by about 5.8 percent per year since Obama took office, compared to 13.2 percent in the nine years before Obama.

Myths: "America’s gun-related homicide rate … would be about the same as Belgium’s if you left out California, Illinois, D.C. and New Jersey, places with some of the strictest gun control laws in the U.S." - former Arkansas Governor Mike Huckabee, 8/20/13
"(T)he jurisdictions with the strictest gun control laws, almost without exception … have the highest crime rates and the highest murder rates." - Senator Ted Cruz, 1/7/13
"(I)n state after state after state with some of the most stringent gun control laws in the nation (there exists) the highest gun crime rates in the nation. Chicago would be an example." - Carly Fiorina, 10/24/15
Fact: I hear this nonsense from pro-gun friends sometimes; the idea that places in the US with more gun control have more gun violence. First of all, Huckabee, Cruz  and Fiorina are both wrong. Politifact rates Huckabee's claim as "pants on fire," saying, "removing the four states from the equation, as Huckabee did, doesn’t really budge the firearm-related homicide rate for the nation as a whole." Regarding the Cruz and Fiorina claims, at the state level, there is absolutely no doubt that states with the strongest gun control laws have the lowest gun death rates per capita, while those with the loosest gun laws have the highest gun death rates per capita. At the metropolitan level, for 2009-2010, the top gun murder rate areas were, in order: New Orleans, Memphis, Detroit, Birmingham and St. Louis. All five of those cities are in states that are dominated by Republicans and thus have comparatively loose gun laws.

Myth: The 2015 world power agreement to curb Iran's nuclear capacity, "doesn’t send international inspectors. This deal trusts the Iranians to inspect themselves." - Senator Ted Cruz, 9/1/15
Fact: The agreement requires Iran, (from Eric Bradner of CNN), "to provide inspectors from the International Atomic Energy Agency, the U.N.'s nuclear watchdog, access to all of its declared facilities so that the agency can ensure there is no potential for military-related developments."
Furthermore, the agreement is working as designed: Iran has begun shutting down uranium enrichment centrifuges. Republicans were in more or less complete agreement last summer that the nuclear deal would, "pave the way for a nuclear armed Iran." Don't they feel silly now?

How best to summarize the 2016 Republican Presidential candidates? Easy. From Nineteen Eight-Four, one more time:

"And if all others accepted the lie which the Party imposed – if all records told the same tale – then the lie passed into history and became truth. "Who controls the past," ran the Party slogan, "controls the future: who controls the present controls the past." And yet the past, though of its nature alterable, never had been altered. Whatever was true now was true from everlasting to everlasting. It was quite simple. All that was needed was an unending series of victories over your own memory. "Reality control," they called it: in Newspeak, "doublethink.""

Tweet

A Few Links to Dispel Conservative Myths Part Seven: Reproductive Rights

Former Secretary of State Hillary Clinton was questioned for eleven hours on October 19 by a congressional committee in a farcical hearing the likes of which has not been seen in America since the days of Senator Joe McCarthy. The House of Representatives Select Committee on the attack on the U.S. compound in Benghazi, which Republican House majority leader Kevin McCarthy admits was created to damage Hillary Clinton in her run for President, succeeded however only in making Hillary Clinton look more like Presidential material and in making congressional Republicans look like the blithering idiots they are. (Additional note: congressman Kevin McCarthy is not related to the late Senator Joe McCarthy except in spirit.)

I mention the Clinton hearing because congressman McCarthy wants to take the valuable witch-hunting experience that the current Republican congress has gained through the Benghazi committee debacle and apply it to harassing Planned Parenthood and undermining reproductive rights in America.

"When you look at the poll numbers of Hillary Clinton, they’ve dropped, unfavorables pretty high," McCarthy said. "If we really want to be able to show what this Planned Parenthood has done — you see a few videos, so there’s real question — have the select committee get all the information, all the hearings, so the public can see that."

Jennifer Bendery of the Huffington Post explains, "House Republicans created a special committee on Wednesday (October 7) to investigate abortions, fetal tissue procurement and the use of federal funds at Planned Parenthood."

"Its stated mission, among other things, is to examine "medical procedures and business practices used by entities involved in fetal tissue procurement" and "federal funding and support for abortion providers."

"The special committee comes a few months after anti-abortion activists released a series of heavily edited undercover videos that purported to show the family planning provider breaking the law by selling fetal tissue after abortions. Multiple state investigations and a federal investigation by the Energy and Commerce Committee have so far been unable to find any facts to support that claim. Planned Parenthood, which legally accepts money to cover the costs of transporting donated fetal tissue to medical researchers, has slammed the videos as "deceptively edited" and denies any wrongdoing."

Will the committee attacking Planned Parenthood backfire and merely embarrass itself and, ironically, see Planned Parenthood actually become more well-liked, just as the Benghazi committee did for Hillary Clinton? One can only hope so, because reproductive rights in America are under siege and getting weaker every day.

One in three American women have an abortion at some point during their lifetimes. But with Republicans dominating control of state governments, the landscape for women to exercise their constitutional right to terminate a pregnancy cannot be exercised in most of the country. Eighty-nine percent of all U.S. counties lacked an abortion clinic in 2011; 38% of women live in those counties. There are six states with only one abortion clinic. Between 2011 and 2014, states adopted 231 new abortion restrictions. And the clear goal of the new congressional committee is to convince Congress to strip Planned Parenthood, the most important provider of reproductive health services in America, of its public funding. And on that note, let's move on to:

Part Seven. Reproductive Rights Myths

Myth: Secretly recorded video recorded by the anti-choice group called the Center for Medical Progress (CMP) shows Planned Parenthood selling the body parts of aborted fetuses and otherwise breaking the law.
Fact: From Rachel Larris of Media Matters' for America, "even the longer version of the video and the transcript released by CMP, which they claim is unedited and accurate, undermines their sensationalist claim, showing at least three crucial edits that reveal that (Senior Director of Medical Services Dr. Deborah) Nucatola was actually discussing reimbursement costs for consensual, legal tissue donations. The CMP-released transcript includes remarks made by Nucatola not included in the shorter edited video explaining that "nobody should be selling tissue, that's just not the goal here." The shorter video cuts nearly eight minutes out in the middle of a conversation about money where Nucatola makes clear that PPFA only accepts payment to cover legal reimbursement costs for what she repeatedly characterized as "tissue donation" in the transcript." Note the reimbursement costs in question were money clinics legally received money to cover the cost of procuring, storing and transporting tissue. Thanks to recent harassment over the issue, Planed Parenthood will no longer accept the reimbursements.

Myth: Another secretly recorded video shows an abortion at Planned Parenthood, and shows, according to Republican Presidential candidate Carly Fiorina, "a fully formed fetus on the table, its heart beating, its legs kicking, while someone says, "We have to keep it alive to harvest its brain.""
Fact: According to medial experts, the event is a miscarriage and it occurred in a hospital, not in an abortion clinic. Furthermore, the video in question has no sound; no one says, "We have to keep it alive to harvest its brain," or anything else.

(There are actually a whole bunch of these deceptively-edited videos used to attack Planned Parenthood. A Comprehensive Guide is found here.)

Myth: Obtaining fetal tissue from abortions is not important for medical and scientific research. "There’s nothing that can’t be done without fetal tissue,"  "[I]t’s been over-promised what the benefits of fetal research would be. And very much under-delivered." - Republican Presidential candidate Dr. Ben Carson
Fact: Scientists use fetal cells in research because they divide quickly and adapt more easily than adult cells to new environments. Human fetal cells obtained from two abortions in the early 1960s are still growing in labs and are used as incubators to replicate viruses for the production of vaccines against chickenpox, rubella, shingles, rabies and hepatitis A. Scientists who developed the polio vaccine used cultures from fetal kidney cells. Stem cells extracted from fetal tissue are being used to treat Parkinson's disease. Fetal tissue research has helped medical providers diagnose genetic diseases before birth. Note also that Dr. Carson is a hypocrite on this issue: A 1992 study published by Carson and three of his colleagues at John Hopkins University used tissue from the fetal brain and nasal cavity to better understand the development of chambers in the brain. More information on the Carson study can be found here and here.

Myth: "Almost 95 percent of all (Planned Parenthood's) pregnancy services were abortions." - Fox Business reporter Sandra Smith
Fact: So what does Planned Parenthood do, anyway? From Politifact.com: "Testing and treatment for sexually transmitted disease and infection, both for men and women, accounts for the largest share of services provided by Planned Parenthood at more than 4.47 million. Contraception, which includes birth control, emergency contraception kits, and sterilization and vasectomy procedures, accounts for more than 3.58 million services. Different types of cancer screening and prevention, including breast exams, account for 935,573 services." "(T)here were also more than 1.1 million pregnancy tests, 47,2000 urinary tract infection treatments, or 65,500 "family practice services." Over the course of 2013-14, Planned Parenthood performed more than 10.5 million services. Sometimes patients are double-counted because they receive multiple services. Put another way. Planned Parenthood clinics saw 2.7 million individual patients that year. Of all services, abortions account for 3 percent of services performed, said Erica Sackin, a Planned Parenthood spokeswoman." (emphasis mine).

Myth: If Planned Parenthood is defunded, folks will have no problem getting care elsewhere. "(T)here are 10 times the number of community health centers out here, and if you talk to anybody out here on the street right now, particularly women, they would tell you, "Oh, if you get rid of Planned Parenthood, women will never get care." That's just not true. The numbers don't support that." - Gerri Willis, Fox Business Network
Fact: There's already plenty evidence that defunding Planned Parenthood results in women being denied health services. Sarah Kliff of Vox.com recently wrote a very thorough and incisive article on this subject.

"Historically, researchers have found that when Planned Parenthood clinics close, other clinics do not step up to fill the gap. Meanwhile, when there are fewer reproductive health clinics available, women get less reproductive health care — from birth control to cancer screenings to STD testing and treatment. Unintended pregnancies would likely increase, too."

"(T)here are 103 counties in the United States where Planned Parenthood is the only provider of publicly funded contraceptives. In an additional 229 counties, Planned Parenthood serves the majority of women who are low-income and qualify for government help paying for birth control."

"When Texas defunded Planned Parenthood, there was a lot of talk that it will be easy to fill the gaps and no one would lose services," says Leighton Ku, a public health researcher at George Washington University. "We called other clinics and asked them, 'If Planned Parenthood couldn't do this anymore, are you prepared to step up to the plate?' The answer, in the short run, was they couldn't do it. They just had limited capacity."

Louisiana is currently attempting to defund Planned Parenthood at the state level. This resulted in some very dark comedy when state's attorneys attempted to convince a court, as reported by Molly Redden of Mother Jones,

"that there are 2,000 family planning providers ready to accommodate new patients. A federal judge, reviewing the list in an early September court hearing, found hundreds of entries for specialists such as ophthalmologists; nursing homes caregivers; dentists; ear, nose, and throat doctors; and even cosmetic surgeons. 

"It strikes me as extremely odd that you have a dermatologist, an audiologist, a dentist who are billing for family planning services," said the judge, John deGravelles, who will determine in the next week whether it is legal for the state to end Planned Parenthood's Medicaid contracts. "But that is what you're representing to the court? You're telling me that they can provide family planning and related services?""

One additional note: It's very strange to hear so many conservatives say they think they live in a country where everyone has access to publicly-funded health care. In reality, for every patient served by a community health center today, nearly three residents of low-income communities remain without access to primary health care.

Myth: Abortion is dangerous to womens' health.
Fact: There is plenty of misinformation on the Internet regarding abortion. For example, AbortionFacts.com claims, "The risk of breast cancer almost doubles after one abortion, and rises even further with two or more abortions." In reality, induced abortion is not associated with an increase in breast cancer risk, according to the National Cancer Institute at the NIH. Less than one-quarter of 1 percent of abortions performed in the United States lead to major health complications. Abortion is 40 times safer than a colonoscopy.

Myth: Women frequently regret abortion.

Fact: Various studies show that 95% to 99% of women feel having an abortion was the right choice. Sources claiming otherwise are generally like the site I've linked in Myth above: they simply dismiss studies on the subject and rely on anecdotal evidence.

Myth: It is dangerous to perform abortions in clinics that do not meet the same standards as ambulatory surgical clinics.
Fact: Requiring clinics to meet these standards and (in some states) requiring clinic doctors to have admitting privileges at local hospitals are gimmicks designed to close as many clinics as possible. Doctors' groups say the laws do little to improve patient safety.

Myth: Although most abortion clinics in Texas have been forced by new laws to close in the last three years, this has not been an obstacle to women receiving the services they seek. Or, as Texas state attorneys put it when defending the new regulations, "Receiving optimal care is not an undue burden. It would be safer for patients to drive further to receive an abortion at a surgical facility with a credentialed and privileged physician than to seek an abortion at a nearby, substandard clinic."
Fact: The closing of clinics in Texas has resulted in the return of the back-alley abortion: women are now crossing the border to obtain services and pharmaceuticals in Mexico. From Laura Bassett of The Huffington Post:

"Indeed, the lack of abortion access in Texas is already pushing pregnant women back across the border. At Mexican pharmacies, they can purchase misoprostol, a drug with the labeled use of preventing gastric ulcers -- but which can also induce abortions."

"American women are learning that if they don't have access to an abortion provider, they can obtain misoprostol illegally and take a high dose of it on its own to end a pregnancy."

Myth: Support for abortion rights is falling. "In terms of polling, the pro-choice (support) is going down a little bit" - Republican Presidential candidate Donald Trump, 6/2015
Fact: From Politifact.com: "The most recent polling we could find comes out of Gallup. In May of this year, the polling group found 50 percent of Americans identify as pro-choice, compared to 44 percent of Americans who identify as pro-life. That's actually up, not down. The gap is outside the margin of error, the first time the pro-choice position has a statistically significant edge since 2008. If anything, the pro-choice position is gaining ground, not losing it in recent years."

According to Pew Research, "55 percent of adults say abortion should be legal in all or most cases, while with 40 percent say it should be illegal all or most of the time. In both cases, these figures have remained relatively stable for at least two decades."

(Apparent) Myth: Outlawing abortion will reduce the number of abortions.
Fact: I say this myth is "apparent" because, while so many Americans are fighting to outlaw abortion or at least make it virtually unobtainable, I can't find anyone saying point-blank that making abortion illegal will actually reduce the number of abortions. The idea that it would is not mentioned in lifenews.com's Three Legal Reasons Why Abortion Should be Banned, or in listland.com's 10 Reasons Abortion Should be Illegal. I did find an old statement by George W. Bush that, "by not spending taxpayers’ money on abortions that we can reduce abortions in America." That is a direct statement, more or less, that making abortion more difficult to obtain in a legal way will result in fewer abortions.

In any case, it's not true. In 2007, as reported by Elisabeth Rosenthal of the New York Times, "A comprehensive global study of abortion has concluded that abortion rates are similar in countries where it is legal and those where it is not, suggesting that outlawing the procedure does little to deter women seeking it." A survey by the Guttmacher Institute in 2009 also found that, (as reported by BBC News), "Restricting the availability of legal abortion does not appear to reduce the number of women trying to end unwanted pregnancies." There is every indication that the number of illegal abortions per capita was far higher before Roe v. Wade than the number of legal and illegal abortions today. See this article in  by Katha Pollitt in the Atlantic and this estimate by the Guttmacher Institute.

So what's the best way to reduce the number of abortions in America? Here's a good summary from Jessica Arons and Shira Saperstein of the Center for American Progress:

"Making abortion less necessary is by far the better approach. The first way to do so is to reduce the incidence of unintended pregnancy. Half of all pregnancies in this country are unintended, and, of those, half end in abortion. Unintended pregnancy could be reduced significantly if we showed true commitment to: 1) comprehensive sexuality education that includes medically accurate information about abstinence and contraception; 2) insurance coverage of and public funding for family planning services; 3) greater access to emergency contraception (which prevents pregnancy and does not cause abortion); and 4) programs that curb domestic violence and sexual abuse. Clearly, women who are able to avoid unintended pregnancy do not have to make the difficult decision of whether to have an abortion."

In other words, as Hillary Clinton has said, with the right approaches to people and health care, abortion can be safe, legal, and rare.

Tweet

The Wall Street Journal Lies About Seattle's Minimum Wage Increase

American conservatives endlessly recycle a lot of rhetoric that has no application in the real world. For example, Republican Presidential candidate Jeb Bush is currently pushing a plan that would dramatically reduce taxes for the rich. Won't that mean significantly lower revenues, and thus a greatly increased federal deficit? Don't worry about that says the Bush team, lower rates will unleash tremendous economic growth. There just one problem with this talking point: It's demonstrably false. And by, "demonstrably," I mean it's been proven over and over and over again that tax cuts for the wealthy do not significantly spur economic growth.

Similarly, conservatives want Americans to believe that increasing the minimum wage is a bad thing. Most especially, the executive leadership of America's fast-food corporations want everyone to believe that increasing the minimum wage will cost jobs, because those corporations like to pay employees poverty wages. So that executive leadership isn't too happy with my hometown of Seattle, WA. Washington already has the nation's highest state minimum wage; $9.47 as of January, 2015. Separately, the city of Seattle increased minimum wage for large businesses to $11.00 in April, and all business will be required to pay $15.00 within seven years.

Seattle is America's fastest growing city, so it's difficult to find any negative impact to the recent increase in minimum wage. So difficult in fact, that the Wall Street Journal is prepared to simply lie. Recently the Journal welcomed an opinion piece written by Andy Pudzer, the CEO of CKE Restaurants. CKE owns Hardee's, Carl's Jr. and other fast-food chains. The article is hidden behind the Journal's paywall, but there's easy ways around that. According to Mr. Pudzer,

"It’s still early to know how the hikes are affecting the job market, but the preliminary data aren’t good. Mark Perry of the American Enterprise Institute, Adam Ozimek of Moody’s Analytics and Stephen Bronars of Edgewood Economics reported last month that the restaurant and hotel industries have lost jobs in all three cities. Mr. Bronars crunched the numbers and discovered that the “first wave of minimum wage increases appears to have led to the loss of over 1,100 food service jobs in the Seattle metro division and over 2,500 restaurant jobs in the San Francisco metro division.” That is a conservative estimate, he notes, as the data include areas outside city limits, where the minimum wage didn’t increase."

The loss of 1,100 restaurant jobs in Seattle area would be significant. And I have to emphasize, "would be," because Mr. Pudzer is lying. Let's have a look at what Mr. Bonars found when he analyzed the numbers from the Bureau of Labor Statistics. Bonars notes that growth in restaurant employment in the Seattle metro area significantly outpaced the national average between 2011 and early 2014. Between early 2014 and early 2015 however, restaurant employment in Seattle grew by 2.42% while the balance of the country saw growth of 3.52%. The difference of 1.10% apparently translates into at least 1,100 jobs.

So to summarize,
*Seattle continued to add restaurant jobs despite the minimum wage increase, yet Mr. Pudzer refers to a "loss" of jobs because he's prepared to assume that more jobs might have been created under different circumstances.
*He's also prepared to assume that the minimum wage increase is driving the loss or gain of jobs, despite the fact that three out of four jobs in the Seattle metro area are outside the city limits and not affected by the minimum wage increase.
*He's further prepared to assume that there are no other variables in the equation. Consider for example that for years the growth of restaurants in the Seattle area outpaced the rest of the country, so that the city now has more eateries per capita than any city except San Francisco. So it's just possible that our restaurant infrastructure is now over-built, and the pace of new hiring is now bound to slow down.
*As already noted, growth of restaurant employment in Seattle significantly outpaced the nation average between 2011 and the end of 2014, a time during which Washington state also increase minimum wage from $8.67 to $9.42. One wonders how that could happen if the impact of increasing wages is as great as Mr. Pudzer claims.

The right-wing American Enterprise Institute also decided to get in on this game, although this article by Mark J. Perry is a little more cautious in its conclusions. He notes that according to the BLS, the Seattle metro did in fact lose 1,000 restaurant jobs in April, the same month is which the minimum wage increase went into effect. so in Mr. Perry's opinion, "it looks like the Seattle minimum wage hike is getting off to a pretty bad start."

This opinion is already moot. Although the Seattle metro saw an decrease of 2,000 restaurant jobs between January and May of this year, the months June, July and August saw an increase of 1,900 jobs.

So what's the actual effect of increasing minimum wage? I'll leave the answer to economist Paul Krugman:

"Now, you might argue that even if the current minimum wage seems low, raising it would cost jobs. But there’s evidence on that question — lots and lots of evidence, because the minimum wage is one of the most studied issues in all of economics. U.S. experience, it turns out, offers many “natural experiments” here, in which one state raises its minimum wage while others do not. And while there are dissenters, as there always are, the great preponderance of the evidence from these natural experiments points to little if any negative effect of minimum wage increases on employment.

Why is this true? That’s a subject of continuing research, but one theme in all the explanations is that workers aren’t bushels of wheat or even Manhattan apartments; they’re human beings, and the human relationships involved in hiring and firing are inevitably more complex than markets for mere commodities. And one byproduct of this human complexity seems to be that modest increases in wages for the least-paid don’t necessarily reduce the number of jobs.

What this means, in turn, is that the main effect of a rise in minimum wages is a rise in the incomes of hard-working but low-paid Americans — which is, of course, what we’re trying to accomplish."

Tweet

(Somewhat) Legitimate Criticism of Obamacare, Part Two

I've had a great deal to say about conservative myths regarding the highly successful Affordable Care Act, otherwise known as Obamacare. In my last post, I commented on the fact that although it's true that some of the newly insured are using emergency rooms at public expense, those folks are also healthier, more likely to have access to preventitive care, and less likely to stick emergency rooms with expenses for which hospitals will find it difficult to get reimbursed.

This time I'll tie off the last of the partially-true criticisms of Obamare.

Criticism Two: Obamacare is driving insurance companies out of business.

True, Assurant Health of Wisconsin is closing its doors. And it's pretty clear that Assurant struggled with complying with Obamacare's new rules, such as forbidding higher premiums based on medical history and age. However, just because Assurant couldn't make it under the new rules doesn't mean that the industry in general is hurting. On the contrary. From Daniel Jennings of Seeking Alpha:

"UnitedHealth, Cigna, Aetna, and WellPoint have shown significant TTM revenue growth in the last year." "TTM revenue figures indicate that the changes to the health insurance market in the past year are having a positive impact on those companies."

Last September, Daniel Mangan of CNBC also pointed out:

"The number of insurers set to sell health plans on Obamacare exchanges in the upcoming open-enrollment period is 25 percent higher than for 2014, as 77 issuers jump into that market."

Finally, some states saw few insurers ready to operate on the exchanges in Obamacare's early days. Now choice of plans is growing. From blogger demoinesdem at bleedingheartland.com:

"The Iowa Insurance Division announced today that "seven companies have applied to offer Iowans health insurance through the federal health insurance marketplace" for 2016. This year, Coventry was the sole provider selling through the exchange, following the collapse of CoOportunity Health. Although Iowa's dominant insurance provider, Wellmark Blue Cross/Blue Shield, is staying off the exchange for another year, Coventry and Minnesota-based Medica want to sell individual plans statewide, and United Healthcare wants to sell in 76 of Iowa's 99 counties."

Criticism Three: "Giving people Medicaid insurance is almost like giving them nothing, because you can't find a doctor that will see Medicaid patients." - Republican house majority leader John Boehner

As I discussed in my last post, there's some truth to the claim that folks newly insured with Medicaid are having trouble seeing clinicians, and busy clinics are instead referring them to emergency rooms for care. This problem however is fairly limited. From Jason Millman of the Washington Post:

"The Commonwealth Fund, a health research foundation supportive of the health-care law, is out with a new survey this morning examining the experiences of the newly insured under the Affordable Care Act. The survey, conducted by SSRS between April and June, found that 60 percent of people with new coverage, either through Medicaid or a private health plan, said they had already visited a health-care provider or filled a prescription.

Just about one in five of those with new coverage, though, said they tried to find a primary care doctor — but of those, 75 percent said their search was somewhat easy or very easy. And once they found a primary care doctor, most new enrollees said they were able to make an appointment within two weeks."

 According to a study just released by the peer-reviewed journal Health Affairs, primary care has actually improved for Michigan Medicaid patients under Obamacare. The authors conclude:

"It is noteworthy that Medicaid appointment availability in Michigan increased rather than decreased during a period when approximately 350,000 adults entered the Medicaid system and the number of primary care providers likely remained stable." and that, "appointment availability increased 6 percentage points for new Medicaid patients."

Conservative cyberspace has also been circulating the claim that, "214,000 doctors refuse to take patients with insurance bought on marketplaces." Long story short, Politifact.com rates this claim as, "False."

Criticism Four: The President said, "If you like your plan you can keep it." That wasn't altogether true.

Yes, but it was about 99.8% true. At one time, we heard claims that millions had seen their policies cancelled. Here's an update on the facts, as summarized by of Forbes:

"About 2.2% of Americans who purchased coverage on their own, or 400,000 people, had individual policies cancelled, according a new analysis from the nonpartisan Urban Institute. And just 0.3% of  Americans with coverage through their employer, or 500,000 people, had their health insurance policies cancelled in 2014, the Institute said. Authors of the issue brief, funded by the Robert Wood Johnson Foundation, said there was no evidence of a significant number of policy cancellations in either the self-insured or small group markets."

And even among this group, we have to ask how many really lost policies they liked and planned to keep. As I've pointed out before, while it's true that certain health care plans are no longer available due to changes in the law, many of these were not insurance at all, but junk plans that didn't offer real coverage.  Furthermore, Obamacare is not the reason why most of the folks who changed plans did so. On the individual health insurance market, plans typically are sold with one-year contracts that change prices and/or benefits year-to-year. Even before Obamacare, only 17 percent of consumers in this market kept the same plan for two years or more. Fewer than one million people who previously had individual market insurance transitioned to being uninsured. And insurers were given the option of continuing even the junkiest plans for one year after Obamacare went into effect.

So, did anybody lose a real insurance plan they liked? A few did. Some folks were getting cheap insurance because their plans didn't accept anyone with preexisting conditions. Those plans are no longer allowed. Sorry folks.

Criticism Five: The President said his plan would, "cut the cost of a typical family's premium by up to $2,500 a year." That wasn't true.

This last one is hard to spin. What the President said is not true. His statement was prompted by a report that estimated the total savings of everything Obamacare would do, then divideded that figure by the number of households in the country. The problem is the President used the word "premium." While Obamacare has reduced the annual year over year increase of health care costs, it certainly has not reduced insurance premiums by a couple of hundred bucks a month.

Good night, and good luck.

Tweet

(Somewhat) Legitimate Criticism of Obamacare, Part One

Last week, the Supreme Court upheld the Affordable Care Act's federal subsidies in the case of King v. Burwell. Obamacare is here to stay. Obamacare works. The number of uninsured is at an all-time low. Obamacare greatly reduces the federal deficit. It improves solvency of the Medicare Trust. It reduces health care cost inflation. It creates jobs. It's helping the population become healthier. People who have Obamacare policies like their policies. And criticism of Obamcare by conservatives is almost entirely a pack of lies.

Now, "almost entirely a pack of lies," is not the same as, "entirely a pack of lies." Fair is fair, it's time for some thought on the criticism of Obamacare that actually has some legitimacy.

Criticism One: Obamacare was designed to reduce expensive emergency room visits. But some people with Obamacare are actually using emergency services more rather than less frequently.

According to acasignups.net, 14 million of the 32.7 million Americans who have signed up for Obamacare are lower-income folks eligible for policies under Obamacare's Medicaid expansion. These folks can now receive preventative clinical care instead of higher-priced care in emergency rooms at public expense. Reducing emergency room traffic is a specific goal of Obamacare. In 2009, President Obama said,

"One of the areas where we can potentially see some saving is a lot of those patients are being seen in the emergency room anyway, and if we are increasing prevention, if we are increasing wellness programs, we're reducing the amount of emergency room care, then that frees up doctors and resources to provide the kind of primary care that will keep people healthier, but also allow them to see more patients and hopefully give more time to patients, as well."

Unfortunately, as Ray Fisman of Slate.com explains, that's not what happening:

"The clear and compelling evidence that ER usage increases with Medicaid coverage is the latest finding to come out of the landmark Oregon Health Insurance Experiment, which randomly selected low-income uninsured adults in Oregon to receive health insurance through the state’s expansion of Medicaid."

Why are new Medicaid enrollees using the emergency room more? Fisman notes:

(1) Rather than try to see a doctor, "the uninsured typically try self-medicating first, or just wait and hope the chest pain is heartburn and not cardiac arrest."
(2) "Patients aren’t, in fact, substituting primary care for the ER to the extent that many insurance advocates have hoped they would," because a busy clinical practice may be, "booked up with regular, predictable appointments, which doesn’t leave much slack to handle these urgent (but nonemergency) cases." Overbooked clinics may then refer patients they don't have time to treat to the emergency rooms.

Also significant is a recent poll released by the American College of Emergency Physicians, in which 28% of doctors surveyed nationally saw large increases in patient volume, while 47% saw slight increases.

So does this mean the President was wrong to state that health care reform would reduce emergency room visits, and the corresponding cost to taxpayers? Not necessarily. A 2014 study in California by UCLA’s Center for Health Policy Research found that ER use was higher among new enrollees in California’s Low Income Health Program, the state's Medicaid-like program, but also found that the spike was temporary. From Olga Khazan of The Atlantic,

"In fact, after two years in the program, the enrollees used hospitals at roughly the same rate as people who had already been insured. The study authors said a likely reason for the eventual decline was that the LIHP program offered preventative care and treatment for chronic illnesses. Over time, LIHP patients were able to see regular doctors for their lingering medical issues, and they used hospitals less as a result."

A temporary increase in emergency room visits, followed by a significant decline was also observed in Massachusetts following that state's 2006 health care reform program, which was a model for Obamacare. In other words, health care reform is working as designed: people who were formerly uninsured are now getting preventative care which is keeping them healthier and out of hospitals, including emergency services.

Some other points in defense of Obamacare:

(1) Clearly some new Medicaid patients are pushing new costs onto taxpayers through hospital visits. But remember, as Ray Fisman pointed out in the Slate article linked above, "the uninsured typically try self-medicating first, or just wait and hope the chest pain is heartburn and not cardiac arrest." One of the health care reform's biggest goals is to stop people dying simply from lack of medical care in the richest country in the world. And while someone who visits the ER may cost taxpayers more than someone who just dies, and (to paraphrase Ebeneezer Scrooge), "decreases the surplus population," that investment in health care usually means another productive American citizen who can pay into the system more than they take out in entitlements. (I would just say that it's wrong to let people die from lack of health care, but I always try to make the economic argument.)

(2) The US saw steady growth in emergency room visits during the two decades before Obamacare was implemented. The pace of that growth has actually slowed in some places since Obamcare went into effect including Los Angeles County, California (which happens to be America's most populous county). From Soumya Karlamangla and Doug Smith of the L.A Times,

"During the first three months of expanded health insurance coverage required by the federal Affordable Care Act, emergency room visits by patients who didn't require hospitalization increased 1.7% in the county compared with the same period last year, a Los Angeles Times analysis of data from 75 hospitals shows. Annual ER visits in the county had increased 3% last year and 5% in 2011 and 2012."

A recent study in the peer-reviewed Journal Health Affairs also concluded that the Affordable Care Act is reducing ER visits among young adults.

(3) Some Republican-dominated states have refused to expand Medicaid. There are many negative consequences to this decision, not the least of which is withholding health insurance from people who need it. But refusal to expand Medicaid can also have negative consequences for ER service availability. As of Joshua Holland of Moyers & Company noted last year,

"These states aren’t just rejecting an opportunity to expand coverage; Obamacare assumed that expanding Medicaid would dramatically reduce the number of uninsured patients showing up at emergency rooms for treatment they couldn’t afford, so it cut funding for hospitals that treat large numbers of these patients. Without those federal dollars coming in, a number of hospitals that serve low-income populations in refusing states have already been shuttered. According to the Urban Institute study, "these 24 states are also slated to lose a $167.8 billion (31 percent) boost in Medicaid funding that was originally intended to offset major cuts to their Medicare and Medicaid reimbursement.""

Obviously, if some emergency rooms close thanks to these Republican shenanigans, a greater burden will fall on those that remain open. How grim is the situation? This past March, Guy Gugliotta of the Washington Post reported that,

"48 rural hospitals have closed since 2010, the majority in Southern states, and 283 others are in trouble." He cites, "declining federal reimbursements for hospitals under the Affordable Care Act as the principal reasons for the recent closures. Besides cutting back on Medicare, the law reduced payments to hospitals for the uninsured, a decision based on the assumption that states would expand their Medicaid programs. However, almost two dozen states have refused to do so."

Florida Governor Rick Scott's refusal to expand Medicaid has crippled that state with a hospital funding crisis and a budget crisis. Governor Scott still wants federal dollars of course. He's actually demanding a return to the old, grossly inefficient system whereby millions were uninsured, went to emergency rooms for all their care, and the federal government wrote checks to hospitals to keep them in business.

(4) While some emergency rooms may be seeing more patients, those in states that have expanded Medicaid are seeing fewer who have no insurance. The LA Times article linked above noted that in Los Angeles County, emergency room patients without coverage and responsible for their own medical bills dropped from 18% to 16%. A decline in uninsured patients seeking uncompensated care increases revenue for health providers.

(5) Yes, it costs the taxpayers money to insure the uninsured who cannot pay for coverage themselves. However, from a financial standpoint, the smart thing to do is to provide very poor Americans with comprehensive services including health insurance, housing and income support. From Chris Zeigler of cracked.com:

"Boston Health Care for the Homeless tracked 119 chronically homeless people for five years. In that time, those 119 people racked up an astounding 18,834 emergency room visits, despite the fact that 33 of them died and seven were placed in a nursing home during that time. In Washington in 2002, 198 individuals generated 9,000 emergency room visits, or a little under one a week. At a minimum of $1,000 a visit, that's a heck of a medical bill that those hospitals are trying to collect from a homeless person. Unless they have a really good day panhandling, that money is coming out of your pocket.

Add in the annual cost of $24,000 if they take advantage of a shelter, plus the cost of the police to arrest and process those who misbehave (plus the round-the-clock housing, feeding and guarding they get once they're in jail), and it all adds up to a tidy sum for taxpayers to handle. Experts say it really would be cheaper just to house them and treat them.

For instance, a San Diego program found that "When patients were connected with housing, income benefits, health insurance and a primary care home, a 61 percent decrease in emergency department visits and a 62 percent decrease in inpatient days occurred over two years." Statistically, a person just doesn't get as sick, and doesn't get into as much trouble, once they have a roof over their head."

Good night, and good luck.

Tweet