Tag Archives: Obamacare

The Morning After (Part 2)

16 March 2015

The Health Care Plan Republicans Always Wanted-Until They Got It

J.S. Chavez

As Robert Reich noted (link below) Obamacare is almost exactly the sort of health care reform that Republicans have said they always wanted, going all the way back to President Nixon. (Yes, that Nixon and yes, the situation is really that bad.) Reich points out that it is Republicans who have always insisted on private insurers rather than a Medicare-Social Security based system. 

It was Republicans who came up with the idea of an individual mandate, which Mitt Romney successfully carried through in Massachusetts. Reich concluded by noting that since Democrats had to pass the ACA without Republican support they could have held out for a single-payer, Medicare-based system that would have actually worked.  Possibly. But Republicans would surely be apoplectic over any health care plan that Obama (or any other Democrat) came up with. And there’s the problem, for both the Republican party and the people of the US.

Just about everyone you ask, Democrats and Republicans alike, will tell you that universal health care should be a right. 

So, if the ACA is essentially the plan Republicans would have come up with if they had to come up with a plan, how come they’ve lined up against it as though it were the anti-Christ? Follow the money: Health care in the US is a business—a very good business.  Average per capita spending on health care in the US is over $8,000 per year. Republicans don’t want health care reform, many even claim it isn’t needed.  They also claim that if market forces are given free reign then competition will drive costs down.

Medical care in the US is basically a cartel.

Insurance companies, not patients, are the consumers. And they’re part of the cartel.  They don’t care if Big Medicine charges exorbitant prices.  They can just raise their premiums.  Their cut comes off the top so they always get paid.

Try calling up a hospital and getting a price for a surgical procedure.  Ask about something  simple, like a hernia operation.  They won’t tell you because the real answer is “it depends.” (See the “possible exception to the rule” link.) Mostly, it depends on your insurance (like whether you even have insurance). If they were to be honest with you (they won’t be) they would tell you that the price is “as much as we can get.” In other words, it’s a negotiation—but not with you, because you aren’t the consumer. 

The negotiation is with your insurance company. Your insurance company decides what your co-pay will be.  Your insurance company decides which hospital you can use.  This is based on the deal the insurance company worked out with the hospital. You have no say in the matter, even though you’re paying for it.  There is no other business arrangement in the world where this would be tolerated.  Would you hire an electrician to rewire your house if the price he quoted was “it depends?”

There is a critical point that most people do not seem to understand:

Insurance companies are not in the business of paying for health care.  Insurance companies are in the business of collecting premiums.

Insurance companies are the consumers of medical care.   The insured (you) are the consumers of insurance.   All the money that goes into the pockets of insurance companies comes from you, whether you pay them directly or your employer pays a share. 

And about that; any insurance provided by your employer is part of your compensation as an employee.  It is not a gift provided out of the goodness of your employer’s heart.  When Hobby Lobby claims that they shouldn’t have to pay for contraceptives because it runs contrary to their religious beliefs, what they’re really trying to do is foist their religious beliefs onto you, forcing you to adhere to their religious principles as a condition of your employment. 

That’s the conservative version of religious freedom. You, as an employee, are free to adopt the religious beliefs of your employer.  Conservatives complain about the nanny state but they’re fine with the fundamentalist feudal state.

It’s pretty simple: Republicans hate Obamacare, mostly because Obama, a black Democrat, got it passed. The Affordable Care Act is deeply flawed, precisely because it is more of a Republican plan than a Democratic one—but it’s a start—an essential start. Republicans don’t want to talk about any kind of health care reform because they know that the only one that makes sense (based on our own experiences and those of just about all the OECD countries) is a single-payer system. 

Medicare, our Medicare, (the so-called “entitlement program” that we pay into all of our working lives) is way more efficient than private insurers, doing a much better job of containing costs.

Just prior to the implementation of the ACA, our “system” of health care was financially unsustainable.  And Republicans couldn’t have cared less.  They’re happy to ride us all into the ground and bleed us of every last dime.  That’s the Republican version of health care reform.

The fact is Republicans offer nothing.  Nothing. They are the party of “No.” The party of No obstructs, obfuscates, obliterates and offends.  The party of No does not solve problems.

The party of No is the problem.

So, why does health care in the US cost so much?  The graph below tells a big part of the story. Mid-life and end of life (EOL) care costs are far higher in the US than anywhere else.  In 2011, 28% of Medicare spending was for care in the last 6 months of life. Just what are we getting for these insane expenditures? Has anyone ever gotten out of this life alive?

Health-care-costs-by-age-and-country.png

(Source: Forbes.com)

Do you suppose that these huge EOL expenditures buy us more time and better quality of life?  It doesn’t appear so.   The US ranks about 33rd in life expectancy in the world (not far behind Costa Rica and Cuba). Average life expectancy in the US is 78 years.  Average per capita health care spending in Cuba is about 1/20 what it is in the US. Most Americans say they would prefer to die at home but 75% of us die in hospitals or nursing homes.

  Source Links and More Information: 

Robert Reich  Obamacare is a Republican Plan / Robert Reich Blog /  Kaiser Health Care / Co$t of Dying / Bloomberg / Rand /NIH /Bitter Pill /Exception to the Rule?

The Morning After (Part 1)

9 March 2015

Credit where Credit is Due: Senator Ted Cruz Saved Obamacare

By J. S. Chavez

The Affordable Care Act (ACA), a.k.a. Obamacare, website was in shambles in November of 2013 as technicians worked 24/7 to fix the hardware and spinmeisters in the West wing worked 24/7 to shore up its image. Millions of dollars intended to fund an advertising blitz to drive people to the Healthcare.gov website were (understandably) on hold.  Secretary of Health and Human Services,  Kathleen Sebelius, took a well deserved drubbing from Congress for her part in the debacle and the site continued to limp along, harassed by higher-than-expected traffic and inadequate administrative and technical support. It was ugly, but they muddled through, and somewhere along the way Obamacare arrived. Still, this is not how you treat the signature legislation of a two-term presidency. You don’t leave your first new car, the one you bought with the money you scrimped and saved by working three part time jobs, forgoing parties, forsaking friends, and denying yourself a single new outfit for a whole year, parked in the street next to the crack den on Saturday night with the doors unlocked and the keys in the ignition. You wouldn’t do that, right? You’d pamper that car.  You’d drive five miles per hour under the speed limit, avoiding potholed streets and fresh asphalt. You’d lovingly scratch the squashed bugs off the windshield with your own self-manicured fingernails. You’d wash it everyday, with warm water and mild soap and carefully chamois the water off. You’d be sure to keep the tires properly inflated and you’d park it in the shade so as not to fade the interior or age the paint.   

YOU WOULDN’T TAKE ANY CHANCES THAT SOMETHING BAD WOULD HAPPEN TO RUIN WHAT YOU WORKED SO LONG AND HARD FOR! Right?

President Obama, Kathleen Sebelius, the Centers for Medicare and Medicaid Services and the rest of the hapless hacks whose job it was to launch the Affordable Care Act (ACA) should be lining up to give Senator Ted Cruz a big, sloppy wet kiss. That the Obamacare team should find itself in bed with Cruz after the collapse of the Obamacare site is one thing but that they should be grateful for his company would have been impossible to predict when they hooked up in October of 20113. They should take pictures of themselves screwing the ACA pooch while Cruz looks on. I’m not sure this would rise to the definition of bestiality but it works as evidence. Ponder the alternate political reality we would all be living had Cruz not put his own self interest ahead of that of his party and his country, and had Speaker John Boehner actually led the House rather that pandering to it’s basest elements. Right, too far-fetched but, suppose, just suppose, that Republican House members had agreed to a reasonable budget in time to avoid a shutdown. The Healthcare.gov site would have imploded anyway and Republicans, instead of doing the walk of shame, would look like the reasonable, responsible legislators they so often pretend to be. Given how difficult it is for them to “effectively connect with voters” (see 16 Days in October, Part 4) they are not likely to get another opportunity like that for, well, ever.  I mean, what the hell was the administration thinking? The White House spent weeks dodging, weaving, spinning, vacillating between mea culpas and passing the buck, but generally having to acknowledge that they screwed up, if not quite owning the screw up. Seldom have we seen so much freely given political capital (the shutdown) dissipated so quickly, wantonly, and extravagantly. And so it went as one of the most profound unforced errors in the history of American social policy staggered through its painful, incompetent debut. 

However, the Obama administration seems to have gotten away with it, as a practical matter.  ACA enrollments are ahead of predictions, premiums are being paid, costs of premiums are not going through the roof, enough young people are signing up to ensure the viability of the program, and a healthy majority of people who have taken part, including those who identify themselves as Republicans, have been satisfied with their coverage.

As a political matter, it seems unlikely that the Right  will move on from here.  On the other hand, few seem to believe that the ACA is likely to be undone, even at this early stage.  By 2016, the prospect  of going back to the way things were is not likely to be any more tenable. Still, the Tea Party is alive, if not entirely well, and still flexing their muscle. 

One day soon, the passage and implementation of the ACA may go down as one of the greatest political achievements of all time. And we have Ted Cruz to thank for that.

16 Days in October (Part 1)

12 January 2015

The Dodo is Extinct…The Wacko Bird is Alive and Well

“You do not take a hostage you are not going to for sure shoot, and we will not for sure shoot this hostage.”

Senator Tom Coburn (R-OK)

Another national election season is upon us and the field of potential Republican presidential candidates is as thick as locusts. Given Republicans’ approach to problem solving (remember the government shutdown?) does the GOP candidate exist who would not alienate the vast majority of the electorate?

There used to be a saying in national politics: Democrats fall in love; Republicans fall in line.  The first part is probably still true. Democrats are less likely to vote for a candidate purely because he/she is their party’s nominee if the candidate does not inspire passion. Republicans, on the other hand could always be counted on to turn out the vote, weather be damned, no matter who their nominee was, because theirs was a top-down organization. This disciplined approach to electioneering served the party well for decades and that, coupled with their fund-raising advantage and superior knack for appealing to the everyman, made them a force to be reckoned with.

Something has changed. These days the Republican party looks a lot like the maniacal melange of characters gleefully portrayed by Tony Collett, whose protagonist, Tara, suffers from dissociative identity disorder (DID) in Showtime’s “The United States of Tara.” The title of the show is ironic but, then, so is the GOP, self-identified as the party of fiscal responsibility.

So, how did the party that could be counted on never to air its dirty laundry in public become the disfunctional family whose internal disagreements spill into the street and wake up the neighbors?

Dog Day Afternoon

In August of 2013, 80 House Republicans sent a letter to House Speaker John Boehner suggesting that he use the threat of a government shutdown to defund the Affordable Care Act (Obamacare).  (Charles Krauthammer dubbed them the “Suicide Caucus.”) The Suicide Caucus was largely composed of Representatives of southern and upper midwestern, (mostly) red states. None of these states are on the West coast or in the major population centers of the East coast and New England. These 80 House districts represented just 18% of the US population – though the US population they represent is not representative of the US.  These districts are whiter, more rural, and far more Republican than the country as a whole.  Despite widespread criticism of the tactic from the more moderate wing of the party, the Suicide Caucus, egged on by fellow “wacko bird” Senator Ted Cruz, took the US Government and the world economy hostage. Standard and Poors estimated that the shutdown cost the US economy $24 billion and substantially reduced fourth quarter GDP. True to it’s nickname, the Suicide Caucus went down in flames, though its demise was not nearly as dramatic, nor as noble, as they wanted it to be.

“We’re not going to be disrespected”
Representative Marlin Stutzman (R-Ind) to The Washington Examiner.

(He was wrong.)

The Suicide Caucus’s initial demand to defund Obamacare as a condition for agreeing to a budget was quickly abandoned as unobtainable, and the ensuing drama devolved into a deluge of disfunctional demands which decreased in relevance and legitimacy as the fiasco wore on.

The ransom note(s): (Courtesy of Rachel Maddow. The comments are mine.)

  • Defund Obamacare
  • Delay Obamacare
  • Delay the Individual Mandate
  • Deny Coverage for the President
  • Deny coverage for the cabinet
  • Deny coverage to congressional staffers
  • Deny birth control coverage
  • Means testing for Medicare (Actually, a good idea. How did that get in there?)
  • Change federal employee pensions
  • Approve the Keystone pipeline
  • Expand oil drilling 
  • Block net neutrality
  • Tort reform
  • Weaken regs for coal-fired power plants
  • Tax code changes (Also a good idea but not the way they intended)
  • Thwart EPA coal-ash regulations
  • Repeal the medical device tax
  • Change rules on debt ceiling

The GOP has long been the party of fiscal and social conservatism.  This, even though social conservatives, who tend to be religious, often don’t have a clue as to what fiscal conservatism is all about. And many country club Republicans only pay lip service to conservative social values, for the sake of party unity. Mainstream fiscal conservatives are more likely to live on one of the coasts rather than in the rural bible belt, the domain of social conservatives. Monied Republicans are only loosely tied to rural conservatives by a shared dread of change. Change is bad for your bottom line—or it might be.  (Why take the chance?) If you are socially conservative you don’t want change because things are the way God intended (else, why would they be this way?) and you are bound to follow God’s will.

The issue of gay marriage may be the quintessential example of the divide between the two factions. Does anyone suppose that the cause of gay marriage (which is near to becoming the law of the land) would have made the gains it has in the last few years without the support of many mainstream Republicans?  Fiscal conservatives, business people, have gone public, first with tepid expressions of tolerance of gay unions but, increasingly, with full-fledged endorsements of gay marriage.  Why? The short answer is that gay marriage is good for the economy.

Listening to the rantings of the Know Nothing Suicide Caucus one was struck by the other worldliness of their point of view.  The “keep the government’s hands off my Medicare” ignorance of Tea Party constituents would be amusing if it weren’t also echoed by their elected representatives—at least when it serves their purpose.   Mainstream Republicans are no better. After all, they don’t necessarily disagree with the Know Nothings’ point of view, only their tactics. Their insistence that Obamacare is a “train wreck” that is “doomed to fail,” that it will “bankrupt the country” and is “causing thousands of people to lose their jobs” before it was implemented, mind you, borders on delusional.  The plain fact is that the state of health care in the US was a “train wreck” that was bankrupting the country and causing thousands of people to lose their jobs.  Not to mention that it isn’t any better than health care elsewhere that costs a third as much.