In Affordable Care Numbers it’s the Politics not the Policy that Counts

DeadlineNew Orleans    With the official 2014 deadline for much of the enrollment under the Affordable Care Act coming to a close the numbers are now over 6 million plus another 3 ½ million who have signed up for Medicaid in those states that expanded that program for more of the poor.  There will be continued mop-up on the program, which also means that there will be steadily increasing enrollments as well, and the expanded Medicare is open all the time any time. There in fact will be some enrollment over the first two weeks in April for anyone still essentially “in line” when the whistle blew.  Navigators and others are assisting with documentation on all computer problems as well as passing out paper applications which will also be accepted to still qualify people. 

            Nonetheless, we are at the point where normally sane and sober citizens would say that “it’s all over but the shouting.”  The problem is that the shouting has been incessant and will only likely continue to increase over the coming months, and the contention will grow as recognition of penalties increase as well.

            It is worth noting though how the search for the simple is already creating a narrative of confusion around the numbers and hoping that amnesia rather than analysis guides any understanding of what is really happening here.

            First, this whole thing about the numbers needs to be qualified.  The story off the shelf for everyone continues to be that the initial problems on the website is the whole tale.  More recently the revised story seems to be that, hey, the national website was fixed, but look at the mess in some of the states like Oregon.  I wonder if that’s true at all.  Yes, the site was a mess and there has been a recovery, and, maybe the revised enrollment estimate by the feds from 7 million to 6 million says, “Success!”   I wonder though if there isn’t a different reality hidden in these numbers that in fact indicate that real individual enrollment has likely far surpassed even the most optimistic early enrollment estimates by the feds.  My argument would be that the exemptions given by the White House that totally postponed small employer enrollment of their workers coupled with the politically expedient exemption to allow many to keep totally inadequate and crummy insurance policies likely totals considerably more than a million lost enrollees.  And, if those now exempted numbers were part of the original goals, as I believe they were, then the fact that pure and simple individual enrollments have come so close to the original goal means that at the grassroots level Obamacare has been more popular than expected. 

            Secondly, reading the pundits searching for a new narrative, many, including a large number of health professionals and policy folks, keep arguing that the real story is still out there, and it’s not about the numbers at all.  Of course they are partially correct given that there are a lot of uncertainties and outcomes that will still be hugely important to resolve, but where they are missing the boat is that politically it’s not about the policy, or god knows we would be living in another world, and in this world it’s all about the politics.  In the political world that will determine the life and death and expansion of Obamacare in the future, the numbers, right or wrong, and the degree to which they establish the popularity of the program are right now the only thing that is really important.

            We need the number crunchers and the Nate Silvers, the darlings of big data, to take another look at these numbers and see if they don’t establish momentum and movement that could soon be changing this whole debate.  Politicians are not profiles in courage, but they are finger-in-the-wind folks with their ears to the ground listening for the sound of the stampede, and when they finally recognize it’s coming, then we’ll see the opposition finally melt away. 

            And, it may already be happening now!


Middle Class Movement Takes Needs than Wishing and Hoping in India

IMG_1065Mumbai     I’ve been coming to India regularly for over a decade now, several times per year for many years and annually more recently.  There have been visible changes, tall apartment blocks growing like weeds, highways under endless construction finally completed, more people with more money more visible, but all of this in a death grip alongside and frequently oblivious to the same grinding, relentless poverty of even more people.  How does change come to a nation of 1.1 billion people?  Very slowly, very slowly.

            On the eve of coming national elections, the rising of the middle class is an undeniable factor and part of the conversation of change.  Their cry for more transparency, less corruption, and more protection for women in public and private spaces has found not only voice but some political weight in emerging parties.  Nonetheless, their issues will not be what turns this election, and it is not just because of their lack of organization.  They simply don’t have the numbers yet and haven’t done the work to build the bridges to offset their weakness. 

Their strength is in some of the cities, but even there for example internet usage, according to Google, is 37% in urban areas, while the government statistics estimate total internet access at approximately 93 million.  Certainly, these are big, fat numbers, but nationally they are less than 10% of the population.  They are caught in an echo chamber where their own voices are vibrating back to them, louder and louder, but little heard otherwise, and, elsewhere, too much is as it ever was.

Vinod Shetty, ACORN India’s director in Mumbai, and I had a challenging conversation with two dynamic women community organizers trying to find their way to a workable model to engage the new India they sought to activate around modern values and sensibilities.  They had tried and abandoned a model of selecting associates of sorts to train and support in various organizing projects around Mumbai and had applied themselves with great energy and significant resources to the task, but had shifted gears.  Why?  The director stated simply and flatly, “not enough capacity.”  The meaning of the simple phrase was two-fold.  On the one hand a fledgling organization like theirs was ill equipped to chase all over a city of 18 million to realistically support at any effective level more than a half-dozen mini-campaigns chosen somewhat at whim by the trainees themselves.  On the other hand without her fully saying so, it became obvious in their experience that there was no way to simply graft on to their trainees their theory of change unless they could also figure out a way to actually demonstrate and model  what change and organizing would look like.

Their insight might seem obvious, but it is one still missing in Indian society at large, where this emerging middle class is hoping that speaking truth to power can in fact change the way power works.  Reading the editorialists in countless papers, they are frustrated that somehow politicians are adjusting without either embracing change or fundamentally adapting to a different political climate and culture.   The miscalculation of the Common Man party in having won the right to govern in Delhi, but then forfeiting the position in less than two months is a case in point.  Hard questions are facing their candidates around the country on whether they are quitters or “doers.”  In effect people are asking why they should waste their votes on the party, if they are not going to demonstrate the ability to establish through government the changes on the issues they advocated.  Our organizing comrades may be searching for sure footing, but at least they already understand, they are going to have demonstrate what they are advocating, which seems to have been an elementary lesson overlooked by the new middle-class reformers.

Meanwhile according to Google, the most common uses of their searches right now in the run-up to the election are two.  One is what the caste is of Modi, the BJP frontrunner.  The other is whether or not Rahul Gandhi, the emerging spokesperson for the Congress Party, is a Christian.  

As I said, change comes very slowly.