Monday, July 24, 2017

To defend the ACA, please contact your friends in NV, WV, AK, OH and AZ!

Please contact your friends in Nevada, West Virginia, Alaska, Ohio, and Arizona and ask them to call or write their Senator's health staffer. You can find your friends in those states by typing “friends in [Nevada]” in the Facebook search bar. 
You can tell your friends:
It’s do-or-die time for repeal of the Affordable Care Act. Voting starts tomorrow.
If repeal of the Affordable Care Act passes, 22 million Americans will lose their health insurance and most of us will face higher premiums and/or deductibles (especially if we are old or sick, or will someday get old or sick). 
Please call the health staffers of the following undecided Republican Senators and tell them that you oppose repeal of the ACA. If you have a personal story, that would be great too.
Contact Info
Murkowski (AK), (202) 224-6665, Morgan Griffin, Morgan_Griffin@murkowski.senate.gov
Capito (WV), (202) 224-6472, Dana Richter, dana_richter@capito.senate.gov
Portman (OH), (202) 224-3353, Sarah Schmidt, sarah_schmidt@portman.senate.gov
Heller, (NV), (202) 224-6244, Rachel Green, rachel_green@heller.senate.gov

McCain (AZ), 202-224-2235, David Bennet, david_bennett@mccain.senate.gov
Flake (AZ), 202-224-4521, Helen Heiden, helen_heiden@flake.senate.gov

Friday, April 28, 2017

Loss of protections for people with pre-existing conditions would disproportionately hurt states won by Trump


Before the ACA, insurance companies either denied coverage to people with pre-existing conditions or charged them more than other people for their coverage (this was only true in the individual market, not the employer-provided market). As a result, millions of Americans were unable to find affordable coverage. The ACA outlawed this practice, but the new Republican health care proposal will allow it again in most states. 

Insurers will still be required to cover everyone who can afford coverage, but they will be able to charge any price and decide which treatments to cover. (The new proposal eliminates the ACA's requirement that insurers provide ten "essential health benefits"). This will effectively end protections for people with pre-existing conditions. The Republicans claim that states will be free to choose whether they allow this, but because the the proposal will no longer require healthy people to buy insurance, most states will be forced to reinstate the practice in order to avoid unaffordable increases in insurance premiums for most of their residents. 

Kaiser Family Foundation conducted an analysis in 2016 of the percentage of people in each state who have excludable pre-existing conditions under the pre-ACA rules. I've taken that analysis and broken it down by which candidate won the presidential election in each state. As the table shows, the new rules will disproportionately effect Trump states. Of the 17 states with an above-average percentage of people with excludable conditions, 15 voted for Trump. 

Yesterday, Trump reportedly decided to keep NAFTA because his agriculture and commerce secretaries  brought him a map showing that its elimination would disproportionately hurt Trump country.  How I wish the President read this blog and also that I was better at making maps. 

By the way, GOP cuts and changes to ACA subsidies would also disproportionately hurt voters in Trump counties (mainly rural)

Percent of Non-Elderly Population with Excludable Pre-existing Conditions under pre-ACA insurance Rules* by 2016 Presidential Winner
West Virginia
36%
Trump
Mississippi
34%
Trump
Kentucky
33%
Trump
Alabama
33%
Trump
Arkansas
32%
Trump
Tennessee
32%
Trump
Oklahoma
31%
Trump
Kansas
30%
Trump
Louisiana
30%
Trump
Missouri
30%
Trump
Indiana
30%
Trump
Georgia
29%
Trump
Delaware
29%
Clinton
Maine**
29%
Clinton
South Carolina
28%
Trump
Michigan
28%
Trump
Ohio
28%
Trump
United States
27%



*Gary ClaxtonCynthia Cox, Anthony Damico, Larry Levitt, and Karen Pollitz. 2016. “Pre-existing Conditions and Medical Underwriting in the Individual Insurance Market Prior to the ACA,” Kaiser Family Foundation Issue Brief, Dec 12. <http://kff.org/health-reform/issue-brief/pre-existing-conditions-and-medical-underwriting-in-the-individual-insurance-market-prior-to-the-aca/>


**Clinton received 3 electoral votes in Maine and Trump received 1.

Thursday, November 17, 2016

Trump is a disaster for the United States

Trump's election is a disaster for the country.

His campaign featured insults and policy positions that targeted and incited hatred for wide variety of groups, in particular immigrants (especially from Mexico and Syria), women, Muslims, and African-Americans.

He showed contempt for democracy and constitutional rights (such as freedom of speech, freedom of the press, the right of assembly, and the right of privacy).  He claimed that the election was "rigged" and threatened to reject its results.  He threatened to jail his political opponent. He threatened to investigate and reporters and media outlets that wrote negative stories about him.  He encouraged violence against protestors and encouraged his supporters to intimidate voters of color. Meanwhile, his party used a plethora of strategies to suppress voting by people of color.  

He bragged about groping and kissing women without their consent and spying on underage beauty pageant contestants while they showered. A dozen women have accused him of such acts. 

His policy proposals are wildly inconsistent and ever-changing. Jane Timm of NBC News provides a fascinating list of his evolving positions.  Some of his worst proposals were to build a wall at the southern border, deport 11 million undocumented immigrants, prohibit Muslim immigration, launch a first-strike nuclear attack, encourage the spread of nuclear weapons, authorize torture, criminally prosecute women who have abortions, and utilize stop-and-frisk policing techniques. Many of these were later modified in the face of criticism and at this point, it is impossible to know what Trump intends to do. Paul Ryan and the Republican party have many deplorable plans of their own, but again it is impossible to know at this point which of these Trump will embrace or prioritize.

In another post, I'll talk about his plans (if we can call them that) for Obamacare. 

I've no doubt missed many things in this bill of particulars.  James Fallows has compiled a daily list of 152 Trump outrages.  Feel free to add more in the comments. 


After-dinner Critic is Back!


After-dinner critic has been on a four-year hiatus, but recently some stuff happened (you may have heard about it) that required a resurrection.  I'm back baby!






Friday, August 29, 2014

Myra Marx Ferree on Doctors and Demonstrators: How Political Institutions Shape Abortion Law in the United States, Britain and Canada,

A couple of weeks ago, the Collective Behavior and Social Movements section of the American Sociological Association held an Author Meets Critics session on the two most recent winners of the Charles Tilly Best Book Award, my book, Doctors and Demonstrators and Kathleen Blee's Democracy in the Making.  My critics were Myra Marx Ferree and Annulla Linder.  Myra's comments, below, echoed her earlier review in the American Journal of Sociology:

Doctors and Demonstrators: How Political Institutions Shape Abortion Law in the United States, Britain and Canada, by Drew Halfmann

Myra Marx Ferree, American Journal of Sociology, Vol. 118, No. 4 (January 2013), pp. 1112-1114

Everyone knows that abortion is a highly polarizing, violently contested, ideologically central issue in U.S. politics. Understanding why this is so, and why it was not always this way, has spawned a huge literature, both scholarly and journalistic, scrutinizing the role of public opinion, social movement mobilizations, state and federal political competition, and the balance of judicial and legislative power. There is also a smaller but still substantial literature drawing comparisons between the highly contentious politics of abortion in the United States and more measured debates in other countries. Drew Halfmann’s own earlier work expanded this explanation by bringing in a consideration of the role of the medical profession and the financing of health care, and drawing a useful comparison between the way the United States organizes health systems and pays for medical procedures and how this is done in two other countries, Britain and Canada, that share our largely liberal view of government.

In Doctors and Demonstrators, Halfmann has greatly expanded his argument about the role of the medical establishment by placing its activities in a wider comparative institutionalist framework—one that now gives even more weight to the political institutions of each of these three countries. The title may still hark back to his original focus on how health care is managed, but along with more attention to social movements and their mobilizations, the new book actually gives more attention to the nature of political institutions in general. The apparent similarities of the United States, Britain, and Canada in terms of language, political culture, and religious mix of Protestant and Catholic, turn out to be dwarfed by vast differences in how parties and movements relate, how governments can or cannot control legislative agendas, how judicial decisions are framed, and again, centrally how health care is institutionalized, funded, and politically understood in these three countries.

The crux of Halfmann’s argument now is that political institutions— including the degree to which social movements can gain access to being part of a political party’s core constituency, the extent to which health care was institutionalized as a central government responsibility, and the ability of elected officials to control the political agenda—have had a huge effect in defining what kind of issue abortion is thought to be in the public mind, moving political parties toward or away from embracing it as an opportunity for electoral gain, and giving other institutional actors a stake in resolving it or keeping it as a burning issue. Health care is still central to his story. While the move to liberalize access to abortion in the “long 1960s” was a global phenomenon, the specific nature of the reforms implemented had much to do with doctors’ concerns about protecting their autonomy in different health-care systems and with the courts’ willingness to define health- care provision as a right of citizens. But Halfmann adds an emphasis on the specific ways that political parties are organized, candidates selected, and campaigns funded, and on how bills are introduced, debated, amended, and either allowed to die or not. In sum, Halfmann’s attention to the interplay between politics and political institutions is now expanded beyond the politics around health care, and the book is thus a much more generalizable and significant contribution.

As Halfmann shows convincingly, abortion is not necessarily defined as a critical issue of conscience and religion, even the Roman Catholic Church is less mobilized around it in the United Kingdom and Canada, nor is “taxpayer funding” always framed as a matter of deep religious significance. He offers carefully documented accounts of how U.S. religious actors were particularly motivated to engage the issue at a critical moment of party realignment as “amnesty, abortion, and acid” became, with race, the issues Nixon’s “Southern strategy” exploited and got the power they did from the opportunities that realignment offered. Halfmann also gives a clear and comprehensive account of how abortion moved in the United States from being an issue that divided the parties and from which politicians fled, which it remained in Canada and Britain, to one that small groups of highly committed actors on both sides could use to select, fund, and ultimately discipline candidates until parties fell into line. In short, the abortion issue offers Halfmann the opportunity to account for many of the ills that the U.S. system is manifesting across many other issues, and thus provides not only a comprehensive political history of the path the abortion issue followed but good indications of the sources of the havoc wreaked on U.S. decisions on other issues from climate change to tax policy.

Overall, the book offer a refreshingly unpolemic counter both to the tendency to see all political collapse as a matter of the global spread of neoliberalism and all abortion politics as a struggle between the forces of good and evil in the world. Halfmann uses his impressive command of the literature to offer a detailed and nuanced story of constrained change, where the institutional opportunities that vary across countries matter a great deal, but choices and strategies of individual actors—from Harry Blackmun to Nixon strategist Kevin Phillips to Tony Blair—give a sometimes decisive push in particular directions. The writing is clear and uncluttered, and advanced undergraduates should have no difficulty following the argument.

There are, of course, some omissions, the institutional structure of the media itself is ignored and racial impacts of both political campaigns and policy outcomes are slighted, and some flaws, the U.S. Affordable Care Act is treated as if it were actually being implemented rather than held up in the courts; the variation in actual abortion access in Canada is not conveyed, but on the whole this is a convincing account both of why U.S. women have lost much of the right to reproductive control that they thought they had won, and why British and Canadian women have gained more access and affordability over time and are now in a much better position relative to the United States than anyone would have imagined in the 1970s.

Anullla Linders on Doctors and Demonstrators: How Political Institutions Shape Abortion Law in the United States, Britain and Canada

A couple of weeks ago, the Collective Behavior and Social Movements section of the American Sociological Association held an Author Meets Critics session on the two most recent winners of the Charles Tilly Best Book Award, my book, Doctors and Demonstrators and Kathleen Blee's Democracy in the Making.  My critics were Myra Marx Ferree and Annulla Linder.  Here are Annulla's comments: 


Annulla Linders

CBSM 2014 Author-meets-critic session on Doctors and Demonstrators

Had this been an author-meets-fan session, my task would have been a lot easier. It’s a great book – ambitious, well-written, and deeply engaging – and a model of what comparative work can accomplish. In so many ways, this is a book I wish I had written myself.

The explanation he gives us of the differences and similarities among these three nations is complex and layered. There is no single variable that magically accounts for the dizzying array of sociopolitical action that has surrounded abortion – at least in the US – for the past 50 years. And yet, by focusing on institutional processes, at the precise intersection of social action and political systems, he nonetheless manages to deliver a clean and uncluttered explanation that is wholly satisfying to the reader.  

But since I am recruited to be a critic, I will do my best to live up to the expectations of that role. With the critic’s prerogative, I take some liberties with my comments, sometimes veering off the path Drew has laid out for us and occasionally moving into territories that may better belong in another book.

I focus the discussion on three issues: The first – I call it the boggle line - is linked to abortion as a sociological issue; the second – this one I call cliff hangers – relates to the volatility of abortion politics; the third, to quote one of my former colleagues, deals with the squuishi stuff, that is, meanings, values, interpretations, and the softer side of sociology. These issues are obviously much larger than this particular work, but Drew provides useful insights into all of them…It hardly counts as criticism to say he hasn’t provided the final word on any of them (if he had, what would the rest of us do J?)

The Boggle Line
If you read the opinion piece by anthropologist T. M. Luhrmann a few weeks ago in the New York Times, you may remember his reference to the “boggle line.” The boggle line captures the point at which things no longer make sense – the brain simply won’t compute it, it boggles us. We all have our individual boggle lines and cultures too have boggle lines beyond the noise of social variations and disagreements. And I think sociology also has its boggle lines.

When I came to the US some 30 years ago I was clearly boggled by the abortion mess I encountered. It wasn’t policy—abortion was legal after all. But the mess was seemingly everywhere: in the legislatures, the courts, the doctors’ offices, and on the streets. Why wasn’t it settled? Why was it so volatile, and why only in the US, and not in my native Sweden? It boggled me. And there was the beginning of my dissertation, a historical comparison of abortion politics in Sweden and the US (I threw capital punishment into the mix too, but that’s a different story).

Judging from the size of the literature addressing abortion in the US, I am clearly not the only one boggled. That is, for many of us, it is the US that consistently falls on the other side of the boggle line. And I think that’s how Drew sees it too. It’s not so that abortion is a non-problematic issue in other nations, but rather that abortion politics in the US is so much crazier. I cringe a bit myself when I say that – after all, I keep telling my students that they must treat both sides of an issue as sociological mysteries in need of explanation – and I tried hard as I was reading the book to turn the table and make Canada and Britain the cases that were boggling. But it’s a difficult exercise and, although Drew’s analysis is as evenhanded as may be possible, it is still an account that is designed primarily to explain abortion politics in the US.  

I don’t mean this as a criticism, on the contrary, but as sociologists it should give us pause. Obviously there is a long tradition in social science of approaching the US as an exceptional case, that is, a case that does not quite follow the logic of its western European siblings and hence needs different theories. Although Drew identifies a number of ways that abortion politics is different in the US, he still does not approach the US as a wholesale exception, and rightly so. And yet, it is the boggling US that drives the analysis, and it is to our understanding of abortion in the United States that Drew contributes the most.

Cliff Hangers
Social cliff hangers. Here I am thinking of close votes, last minute vetoes, judicial surprises, unstable and cross cutting coalitions. I also include the kinds of social minutia that invariably come to light when we start digging into the complex historical layers of sociopolitical issues (serendipity, coincidences, unique personal trajectories, and the like). Drew provides several different instances of such cliff hangers and historical minutia, which enrich the account and pull the reader into the volatile unfolding of events. Analytically speaking, though, it is not entirely clear what to do with such cliff hangers. Are they evidence that things could always have gone the other way? Do they signal that much of social life is a series of historical accidents? In short, what do we do with social cliffhangers?

Most commonly and in the big scheme of things, we often ignore—or gloss over – such minutia and instead focus on the larger trend, as if there were inexorable forces pushing social life in certain directions and moving it away from others. And I think most of us think of abortion in this way: it can really only go in one direction. Hence we find our puzzles where it stops, veers off its path, or even go in reverse direction.

Another way is to move away from explanations that emphasize the predictable character of social life and instead approach social life us fundamentally open-ended and unpredictable– it always could have happened another way.

Yet another way – and this is what Drew is doing in this book, and very nicely too – is to embrace them and try to account for them in ways that support his overall account.  Take the US Supreme Court, for example, which has delivered several abortion rulings over the years that qualify as cliff hangers. Pointing to factors that simultaneously infuse the judiciary with politics (political appointments) and dilute immediate political interests (lifetime appointments), Drew lays bare the process whereby the justices arrive at their decisions, including very surprising ones, like Roe v. Wade.

But it makes me wonder if there is yet another way we could approach cliffhangers, to think of them as social things in themselves, both in terms of form and trajectory. Although this is not where Drew’s analysis lingers, he nonetheless points us in a few directions that can help. For one, his analysis confirms the oft-cited observation that the US political system, because it is so porous, invites continuous conflict where other political systems more effectively close the door on conflict. For another, he shows how the timing and pace at which different social actors enter the debate can have profound impacts on the unfolding of social issues in the political process.

But I keep wondering if it could also be a feature of a particular set of issues that, for one reason or another, generate moral conflict, that is, pit one moral absolute against another. I don’t mean to suggest that some issues are inherently moral, but instead that the moralization of issues is a normal part of the democratic political process (even if more or less). And if so, as this book demonstrates very nicely, the passionate and volatile politics that surround them cannot be relegated to the edges of political analyses where they otherwise often reside. Rather, they are a particular and recurrent form of normal politics.

The Squuishi Stuff
Finally, what about the squuishi stuff? I am using this as an umbrella for things very loosely described as cultural. This is not a book about the culture of abortion politics, and Drew doesn’t claim that it is. Still, one of the great advantages of this book is that Drew does not ignore the importance of the cultural realm. This is so especially in his analysis of the medical profession in the three nations. He very effectively challenges theories of interest groups that link their interests to their objective social position and their success in the political market place to size and other measures of strengths. Instead, he insists, we need to be receptive to all the ways in which the larger social, political, and cultural context shapes how interest groups construct and prioritize their interests. There are times when I wished he had approached the interests of other political actors with the same analytical dexterity—feminist interests, for example, are not subject to the same kind of scrutiny—but the issue I want to address here refers to the  relationship between institutional processes and the interpretive realm, especially in comparative work.

I think of it as a challenge akin to translation. Whenever I am working on a paper involving a comparison of Sweden and the US I sit with a dictionary in my lap, trying to determine how to best translate key passages that capture the essence of what political actors claim. It is a difficult process not only for linguistic reasons, but also for reasons having to do with meaning. Things can mean different things, even when the words are the same.

What I am trying to get at here is not simply that “culture matters” – many of us here, including Drew, would obviously agree with that – but instead that comparisons that take culture seriously always face a translational dilemma not just in relation to the words that political actors use but also the larger sociocultural context that surrounds and penetrates institutional processes and practices. Even something as simple as “abortion on demand” does not mean exactly the same everywhere and certainly – as Drew clearly shows – does not give rise to the same institutional practices when it comes to delivery.

Although this is not the problem Drew set out to resolve, he still has given us some ideas for how to proceed. For example, in his discussion of the limitations of explanations of cross-national differences in terms of “national values” he observes that one the main contributions of the American creed to abortion policy “was the institutions that the founders left behind” (46). This suggests that institutions and the social processes they engender are saturated with meanings; that is, the cultural elements are not simply meat on the bone, so to speak, but part of the very bone structure itself. This observation should serve as a caution when we try to explain cross-national differences with the help of isolated structural or institutional features as if they were easily abstractable, if that’s a word, and hence comparable.  Drew also observes that although “values” “do not determine the content of policies” they do “provide a set of cultural resources for political actors” (45). This is a good reminder that even though we cannot predict with any certainty how political actors will use which of the cultural resources available to them, we know that they will always use some. It is an almost ridiculously simple point to end on, but I’ll do it anyway, since I think it is an important one: political actors cannot make claims, and policy makers not laws, unless they are culturally embedded in recognizable constellations of meaning.