Tag Archives: health care

Lies, etc.

The airwaves are thick with heated commentary on how President Obama overstated the simplicity of his signature health insurance legislation, popularly known as Obamacare. “If you like your health care plan, you can keep it,” was how the refrain went throughout his first term. It was an unqualified statement and, indeed, an emotionally potent oversimplification of the type we see in political rhetoric, I don’t know … how about all the time?

Right, so, he lied in the sense that what he said was not accurate for 100% of the people who have health insurance, 100% of the time. It is, however, accurate for about 95% of the people 100% of the time, and for the other 5%, only some of the time. If you have a super crappy individual health insurance plan with an enormous deductible and you signed onto Who lied about Obamacare? Seriously?it before implementation of the Affordable Care Act, sure, you can keep that dog – it’s grandfathered in. The insurance companies simply can’t continue selling those policies now that the law is in effect because – and this is important – THEY SUCK TOO BADLY, and because of that, they do not comply with the law.

To hear t.v. commentators of nearly every stripe talk about this, you would think individual life insurance is some kind of Eden from which subscribers are being exiled by pitchfork-wielding devils. Let me tell you, I spent many years in the private insurance market. I had a plan with Mutual of Omaha and one with Excellus BlueCross BlueShield. Mutual of Omaha paid for exactly nothing; the money went one way, from me to them. BCBS was mostly BS – I had a high deductible, as did my wife. I remember once going to my doctor because of a persistent cough, having to get some blood work, and being declared well. That cost me $500 (in 2005). My wife had an emergency room visit that came to $2,000. (She was fine, also.)

My point? Jon Stewart made it best. The people who are yelling “liar!” the loudest are the same ones that have been telling ridiculous lies about the ACA since its passage. In the liars hall of fame, Obama’s “never” clause ranks far behind “death panels” and not even in the same league as “Saddam Hussein has weapons of mass destruction.”

luv u,

jp

Over the edge.

The fiscal cliff is just ahead. Be afraid, be afraid! Are you afraid yet? Well, you’re supposed to be. Going over the “fiscal cliff” is the worst thing that can possibly happen – worse even than … I don’t know … losing your Social Security, Medicare, Medicaid, etc.

Friends, this is the oldest trick in the book. Our leaders have done their best to bankrupt the government over the last decade and a half, coupling undeclared wars with massive tax cuts, crashing the economy through their vaunted hands-off approach to the financial sector, etc. Now when it comes time to pay the tab, guess who’s picking it up? Not a big surprise that they’re running out on the check. They only do it every freaking time.

Listening to the series of Republican interviews that is NPR the other day, I heard some talk of raising the Medicare eligibility age as one means of covering their failed fiscal policy decisions. That has to take the prize as the stupidest idea ever proposed. Sure, take the youngest people out of the Medicare system – the people who need the least care! That’s a surefire way to bankrupt the program, which I’m sure is their ultimate aim. The G.O.P. has always hated Medicare, almost as much as they hate Social Security, despite their claims to the contrary. If they were truly serious about saving money, they would be expanding Medicare to include younger, healthier people, not the other way around.

The thing we have to watch like the proverbial hawk is our election year friends, the Democratic Party. We need to remind them who gave them victory a few weeks ago. We need to encourage them to challenge the Republicans on their fealty to the same failed policies Milton Friedman advocated decades ago, on their determination to protect the private tyranny that is the health insurance industry. We need to encourage them to do the right thing, no less.

That is what we should be focusing on, not irrational fear.

luv u,

jp

Resolved.

You’ve heard enough about the debate, I know. Now hear it from me. I will dispense with my usual grouse about these not being actual debates – no proposition advanced or opposed, no rules of order, etc. Let us concede that they are essentially dueling press conferences. The salient fact is, I tuned in to watch a debate between President Obama and Mitt Romney, and neither of those two men showed up. Obama was taciturn and seemingly unaware that he was in front of a national television audience of 68 million, his head featured in an inset box practically the whole ninety minutes. (I felt like yelling, “He’s over there, Barry! Stop doing your homework!”)

And Romney. Has a man ever run farther or faster from his own proposals? Can conservatives truly celebrate the candidate they saw on Wednesday night? Just a few small points:

Romney: “I don’t want to cut our commitment to education”

Okay, aside from funding for the Corporation for Public Broadcasting, I didn’t hear Romney advocate cutting anything. So… if he’s going to cut the federal deficit without raising revenue – in other words, reforming the tax code in a “revenue neutral” fashion – where are those cuts coming from? Not from defense – he’s adding many billions to that as he’s boasted many times. Apparently not from education. His intimations about Medicaid spending sounded like cheap sleight of hand; how does the federal government save money by block granting programs like Medicaid? You’re still spending the money, only without the knowledge that it’s being spent on what it’s intended for.

Romney: OK, what are the various ways we could bring down deductions, for instance? One way, for instance, would be to have a single number. Make up a number — 25,000 (dollars), $50,000. Anybody can have deductions up to that amount. And then that number disappears for high-income people.

This counts as kind of a bidding war with himself. Romney’s people have been floating this notion of a $17,000 deduction cap on individual income tax. Wednesday night he worked that up to $25 – 50K. Do I hear $75K? Wait another week. Once again, caught advocating for a deeply unpopular policy of ending major deductions like mortgage interest, Romney is cycling backwards at lightning speed. We still have no information on where “loopholes” and deductions could be found to make up for $5 trillion in tax cuts – 20% across the board, which he has endorsed.

Romney: It’s — it’s — it’s a lengthy description, but number one, pre-existing conditions are covered under my [health care] plan. Number two, young people are able to stay on their family plan. That’s already offered in the private marketplace; you don’t have — have the government mandate that for that to occur.

Say what? Since the hell when? A week ago, Romney’s plan was for sick poor people to go to the emergency room – that’s what he told David Gregory, anyway. And if keeping your kids on your “family plan” is common in the marketplace, it’s news to working people.

Then there’s the look. The patient, condescending smile while Obama is talking. It’s actually the same look Romney uses when people are saying nice things about him. Fact is, he uses that all the time when he’s waiting to speak. I call it his screen saver.

Barry: Here’s a free line for the next debate. “Hey, Mitt – glad to see you’ve finally come around to my positions on health care, education, and taxes. I’m thinking about asking you to join my administration.”

luv u,

jp

Next round.

Sure, I’m surprised that the Affordable Care Act survived this past Thursday. I thought the mainstream media was going to talk it to death, frankly. Talk about wind-ups … by the time 10:00 a.m. rolled around, I was too bleeping sick of the issue to even care, and let me tell you – that’s quite a distance for me. It’s just that the horserace coverage of every political issue gets under my skin in the worst way. The merits of a given issue are never deeply examined; it’s always he said this, she said that. No way to work out which is closer to the truth.

They did this with health care, pretty much all day. After the decision was handed down, NPR had some guy from Cato and a policy wonk from the administration. Basically just put them in a room and watch them spar. Of course, Cato guy is much further to the right than the Obama person is to the left, so it’s kind of a straw man argument at best. How is this news? They pulled the same thing with the “Fast and Furious” faux-scandal. Even though Fortune Magazine blogger Katherine Eban blew a hole in the standard story about this a full day before, NPR, NBC, and other mainstream outlets were still framing the argument the same way – the GOP want documents, Holder and Obama say no. He said, they said.

What about the merits of the Affordable Care Act? I was never a big fan. It is, of course, a conservative idea, like cap and trade – market-based policy designed to head off something saner and more effective. Basically profit insurance in its purest form. Nevertheless, it establishes the concept of national health insurance for the first time, so that’s a minor step forward. The mandate requirement includes a penalty that the Supreme Court has called a tax; there’s a shocker. I wrote about this herein a few times, I think, most recently in March. Arguably any cost the government imposes can be described as a tax. I would go so far as to say that the failure to provide affordable universal coverage is a kind of tax, since everyone ends up paying through the nose as a result of its absence.

The G.O.P. is crowing because it thinks it has a tax issue for the coming election. All I can say is that, for all their bluster, they are responsible for the single largest tax hike I have ever had – their refusal to renew the “Making Work Pay” tax credit cost me $800 last year, as it did millions of other Americans. Where’s your tax issue now, boys?

luv u,

jp

Life and death.

This was a week when national health insurance was equated with cruciferous vegetables; when purveyors of deadly gun violence played the victim and had the law on their side. What a week, eh?

First, the Affordable Care Act being considered by the gang of nine (robes division). There are a great many things that might be said of the judicial theater we were all treated to this week, but from my perspective – a limited one, to be sure – they boil down to the following points:

Health Care: Still Not A Vegetable. This is one of those vacuous, tea-party type arguments that has been thrown around since the Affordable Care Act (ACA) was considered by Congress. Jesus freaking christ on a bike, Justice Scalia … no, health care is not the same as freaking broccoli. You can live your whole miserable life without eating a single floret of broccoli, but god damn it you will certainly end up in a hospital at some point, and someone is going to pay for it. And no, it’s not a cell phone either, damn it. Some people have never used one; my 85-year-old mother for one. Neither cell phones nor broccoli are essential or inevitable like medical care in America.

Pick Your Constitutional Overreach. Justice Kennedy – a.k.a. he who will decide whether millions can see a doctor or not – appears to think that the ACA fundamentally changes the relationship between the government and the people. Many take this as confirmation that it is constitutional overreach. But even if it were, why pick that out of the crowd? We have undeclared wars that last ten years and more. We have routine violations of fourth amendment rights. Our government kills, detains, and spies on people at will without any discernible limit. Why aren’t these same people attacking those excesses? Or is it just that they are attacking the ACA because they disagree with it politically? Thought so.

Where’s Thomas? I’ve heard the audio from these sessions, mostly on NPR, and I have heard comments from every justice but Thomas. Every single one had something noteworthy to say except Thomas. Has someone tried shaking him or poking him with a stick lately? I’m not sure he’s responsive at this point. Strange, strange justice.

The outcome of this life or death question could take any of a number of shapes, but my money is on their striking it down, mostly because conservatives (i.e. reactionary statists) are in the majority, thanks to George W. Bush and the ignorant people who re-elected him. They showed their impartiality with Bush v. Gore and Citizen’s United … and it doesn’t bear close scrutiny.

Re: Trayvon Martin. The police video shows that Zimmerman is not only an extreme exaggerator, but also a good deal more athletic than we’d been led to imagine. But the real perps here are the Florida legislature, former governor Bush, ALEC (the American Legislative Exchange Council), and the NRA – authors of the “Stand Your Ground” legislation that has made such slaughter legal. Time to shoot the law, Florida. It’s a question of self defense.

luv u,

jp

To health in a handbasket.

The Affordable Care Act (what Republicans contemptuously refer to as “Obamacare”) goes before our brilliant Supreme Court this week. Given that the law does yeoman service to preserving the private health insurance industry in America and is therefore a friend to the almighty Corporation, one might expect them to turn back the constitutional challenges on that basis alone. There are, of course, stronger constitutional arguments in favor of the plan – David Cole runs through them in The Nation much more fluently than I could ever attempt to do. I think, though, that we have to see these challenges for what they are, not for an effort to secure something called “economic freedom” which G.O.P. presidential candidates regularly invoke but fail to define.

The challenges are, of course, a cynical delaying tactic and an effort to procure through other means what the Republicans failed to achieve through the legislative process. They have attempted to put a log in the spokes of this effort from the very beginning, despite the fact that the legislation we ended up with is precisely the kind of health reform their party has been advocating for decades. Aside from a slight expansion of those covered by Medicaid, under this legislation health insurance remains in the private sector. Outside of Medicare, Medicaid, and the VA, no one will have government health insurance unless they’re covered by a state plan. So the Republicans’ charge of a “government takeover of health care” is a transparent lie.

I don’t think the AFA is the best solution. I think we should have Medicare for all, expanded sufficiently to eliminate the need for so-called “Medigap” coverage. It would work better, be more efficient, bring better outcomes, and likely cost a great deal less than what we have now. Nevertheless, the AFA has some virtues; it has helped some people keep their coverage. Perhaps most importantly, it establishes the principle of national health insurance – one that we can hopefully build upon in the years to come.

The attack on the personal mandate is laughable, frankly. I’m starting to think that Americans – even though we live in the land of a billion insurance policies – simply do not understand the basic concept of insurance. “I don’t see why I should pay the medical bills of some drunk who sits around watching T.V. all day,” a neighbor of mine once griped. (He’s on Medicare.) Thing is, we already do pay for that guy. If he has no coverage and ends up in the hospital – as pretty much all of us eventually do – ultimately the bill goes to us. It’s a question of how we cover these costs.

People bridle at the notion of government forcing us to purchase something. But (like it or not), government has the right to tax us, correct? The health mandate says, buy a policy; if you can’t afford it, we’ll subsidize you. If you can afford it and refuse, you pay a tax. The fact is, the government is basically taxing everyone to provide universal coverage. Buy a policy and you get out of paying the tax. That’s not forcing you to do anything: you don’t have to buy insurance. But if you want the tax break, that’s what you’ve got to do. What’s unconstitutional about that?

Republicans say they have an alternative, and indeed they do: absolutely nothing. If there’s one thing you can say unequivocally about the AFA, it’s that it is better than nothing.

luv u,

jp

Issues and non-answers.

A little more off the top of my head. One of these weeks I’m going to take some pains over this posting, but… not this time.

Don’t worry, Kyoto. Canada’s pulling out of the Kyoto Protocol (can you say “tar sands”?) and Durban was a bust. What’s it going to take, people? We had massive tornadic storms this past year. We don’t have the luxury of another decade of inaction and ignorance.  

See you in health. One of the issues that comes up in our perennial presidential campaign is that of health insurance, mostly in the context of so-called “Obama Care”. What doesn’t get discussed so much is, well, the only possible positive solution to the current situation, which is bankrupting individuals, bleeding businesses dry, and threatening to drown the government in red ink. The only constituency the current health insurance system benefits is private health insurers. Seems like we, as a nation, sacrifice a great deal to preserve their profitability. That has got to end. We need a national health insurance system – basically universal Medicare with some enhancements – that covers everybody.

When GOP strategist Ed Gillespie was on the Daily Show the other day, he seemed to suggest that he didn’t have a problem with the notion of insurance exchanges or the idea that veterans, for instance, should have government coverage because they deserve the best. And yet his – and I think most Republicans’ – solution to the ongoing health crisis is to throw everyone into the private market. I can tell you from experience – that is not a good place to be unless you’re very young, very healthy, and can afford very steep premiums. And the employer based system isn’t working either, partly because it’s based on the pool of employees covered by the plan. If there are a lot of illnesses in a given year, that sends the premiums through the roof. The only way to control costs is to a) get everyone in the freaking country into the same pool, and b) cut the profit out of it entirely so that, as with Medicare, practically all of the money goes to patient care. 

Private, employer-based health insurance is an anachronism that should go the way of the typewriter. It was designed for an age of close to full employment, when companies needed to incentivize people to come to work for them. If the GOP wants to reduce “uncertainty” for their friends in business, they might consider making it possible for them to get out of the health insurance business altogether. The only reasonable way to do that is through a national health plan administered by the federal government.

War’s end. The Iraq war is coming to a close, at least with respect to American troops (though many contractors remain). Of course, there are those amongst us who consider withdrawal a mistake, such as Cheney, McCain, and nearly all of the GOP presidential candidates. I know – who cares what Cheney thinks, right? Has a man ever been more consistently wrong (or despised) than he? Still, I don’t think we should be too dismissive of their views. If Cheney, McCain, Lindsey Graham, Michelle Bachman, and other foreign policy super-geniuses want us to stay in Iraq, we should ship them over there. Good place for them. And they can stay as long as they want.

Of course, we could never really allow that to happen. I mean, haven’t the Iraqi people have suffered enough?

luv u,

jp

Weeks away.

Just a few hurried comments on the events of the day. (The events of the day are keeping me from the events of the day. Shall I say that a second time?)

Cain Mutiny. Presidential candidate Herman Cain has some more difficulties maintaining his myth of marital bliss, and this may be a game stopper for him. Naturally the death knell may come about over something that doesn’t matter a damn. Aside from his family, who the hell cares who he sleeps with, so long as it’s consensual and doesn’t involve minors, animals, etc.? Somehow this seems to bother people (and the mass media) more than the fact that the man has given zero thought to anything having to do with public affairs. He must be the first presidential candidate I’ve ever seen fail to give an opinion when someone asks him about something like the Libya intervention. He had to ask the interviewer what side Obama (i.e. the United States) was on. What the … ? Has the man been living in a pizza box? He is running for the G.O.P. nomination and apparently has no concept of what the pro-life and pro-choice positions actually mean.

Why the hell does this man want to be president? He smells to me like a cut-out for the Koch brothers, but what he says is that God encouraged him to run. Personally, I think God may have just been trying to order a pizza.

Deficit of Imagination. They’re sparring over the payroll tax cut – otherwise known as The Only Tax Cut That Needs To Be Paid For. With the Occupy movement receiving eviction notices from coast to coast, Congress is managing to turn the conversation back to debt with a good bit of help from the major news organizations. I heard Joe Scarborough sparring with Sherrod Brown about Medicare costs and showing “courage” by acknowledging that those costs were tantamount to a cancer on the body politic. His solution? Cut, cut, cut. Which is basically shift the burden onto the elderly, the ill, etc.

I didn’t hear Brown say this (he may have), but the courageous position to my mind would be to advocate expanding Medicare to cover everybody. The reason we have deficit Medicare spending projected for the next few decades is simple – we are subsidizing the profitability of private health insurers, who get to cover the least costly consumers while the government covers the most costly ones (i.e. the ones private insurers don’t want). The courageous thing to do would be to say, we can’t afford this model any longer.

I’m waiting to hear that from someone. Anyone?

luv u,

jp

Medigap.

My first thought at a Democrat winning the 26th district congressional race in upstate New York was one of deja vu. Didn’t this happen two years ago, with that seat up near Watertown, when McHugh was appointed Army Secretary? Bill Owens won, then won again last fall – the only Democrat in my little backwater region of upstate to manage reelection, as it turned out. Dems and liberal commentators tried to read that race as a bellwether, too, but it didn’t turn out to be predictive at all of the 2010 election. What matters is what the party does in between. If the Dems sit on their asses and wait for the check to arrive, they’ll be sorely disappointed.

There’s no denying, though, that this speaks to a strong undercurrent of distrust in the Medicare “reform” cooked up by Paul Ryan and company. As much as they try to dress up their voucher / privatization program, it’s still just a pig with way too much lipstick, and any fool can see it.  I am a bit heartened that their attempt to buy off the elderly by saying their privatization scheme would only affect people under 55 (i.e. me) has thus far failed miserably. Perhaps they neglected to consider that eighty-year-olds might have fifty-year-old children. In the midst of all their yak about family values, they apparently forgot about families. Nice try, mothers!

This should be a gift to Democrats, but if they keep participating in the GOP narrative about deficit reduction, any political benefit will evaporate. Democrats have to overcome the generalized distrust people tend to have for all politicians, and they won’t do that by agreeing to choke off the sick, poor, and elderly person’s lifeline a little bit more gradually than their colleagues across the aisle. If they’re truly on the side of ordinary people, they should say to the Republicans: Want to cut the deficit? Bring tax rates on the wealthy at least back to where they were prior to 2001… or wherever they need to be. Shut down the wars, shutter the overseas bases, and cancel the over-the-top weapons programs. And join the rest of the developed world in building a single payer health care system for everyone, not just the oldest, poorest, and sickest people in the country. And by the way – insist that everything the U.S. government purchases is made in America.  

Do all that, and if there’s still a massive long-term deficit, I’ll eat my shoes. (I don’t have a hat.)

luv u,

jp

Health and taxes.

There’s a t.v. ad that runs almost constantly in my area featuring a “regular-guy” type grocery store owner (not many of those left) complaining about the proposed soft drink tax in New York State. At some point in the ad he says, “Taxes never made anyone healthy.” Interesting statement. I guess he’s never heard of Medicare, Medicaid, Social Security, various Health and Human Services programs, and any number of other government services, from OSHA to the FDA, that in some respect help us stay healthier as a result of tax revenues. Yeah, I know the ad is about a “sin” tax, but you can also see how taxes on cigarettes and alcohol have had a positive effect health-wise. In a sense, it’s just a way of having the price of something reflect the true cost. Sure, we want people to be healthier. But we also want to recover some of the cost of their NOT being healthy, like emergency care costs for people who sugar themselves into heart disease, stroke, diabetes, and the like. Don’t we?

I’ve probably been on this rant before, but this is such a fundamental problem in our society that it cannot be said often enough. Nobody likes paying taxes. Nobody likes taking their medicine, either (well, most people don’t), or eating their oatmeal, or washing behind their ears, or doing their homework, etc. But at some point we must put childish ways behind us (1 Corinthians 13:11 – got your bible right here, kids!) and face up to the simple fact that, yes friends, we get what we pay for… and only that. If we want to have a modern society, we have to pony up some cash to pay for it. I think that should be done in the most equitable way possible – those more able to pay pay more, those less able to pay pay less, those not able to pay pay nothing. The usual method. But taking a “taxation is bad” philosophy to its most absurd extreme is just… well… childish and short-sighted.

And yet the philosophy continues to command respect. Somehow people like Grover Norquist and his ilk are still listened to, still asked for guidance. Meanwhile, the nation’s infrastructure is falling apart, our last major investments (beyond maintenance) in roads, bridges, tunnels, rail lines, etc., now decades old. A stiff wind storm knocks out power to whole states. Instead of investing in the future of this country, we’re putting band-aids over compound fractures. The most striking irony is that these programs are being starved by the kind of deficit hawks who constantly claim that they are doing this for our children and our grandchildren, i.e. not leaving them a huge debt. Fine. There’s a solution. Get people to understand that we need to pay for things, and that civilization is not free. That’s the central point of health reform, lackluster as it may be.

It’s just that we’ve reached the point, particularly in places like California, where people want all these services, but they won’t let their representatives raise the revenues to pay for them. Sorry… that will never work for long.

luv u,

jp