Category: Health Insurance

BEWARE OF UNWISE MEN BEARING SIMPLISTIC IDEAS

A long time ago, in what now seems like a galaxy far, far away, conservatives possessed an intellectual rigor that drove their vision of laissez-faire government, individual liberty and a free market economy. Although not my cup of tea, this political philosophy reflected an honest, rational and structured approach to governance.   That’s all gone now, replaced by the impulses of angry, feeble thinkers whose approach to leadership is vastly inferior to that of a gaggle of drunken sailors.  

Surely conservative giants like Barry Goldwater, William Buckley and Milton Friedman are spinning in their graves – to the right of course – as their movement devolves into a frantic rush toward foolish, simplistic and jingoistic responses to complicated problems. Whether it’s Brexit in Europe or Trump’s wall at the Mexican border, we are living in an age of political thoughtlessness.  It’s as if that crazy uncle who delights in listing the inane things he’d do if only he were king, was suddenly wearing a crown.  

Yes, conventional conservatives like Paul Ryan and Mitch McConnell, rank high on the nuisance scale with their trickle-down shell games and burning desire to raid Social Security.  But at least they had the cognitive wherewithal to come up with specific, detailed plans that would further their objectives, as onerous as they be to many of us.  This new breed of right wing populism seems to be propelled by non-ideas.  Instead of concrete plans, we get metaphoric images that whip up the base but offer not the slightest hint of an actual solution.

Donald Trump was jubilant this week over a federal judge’s decision striking down the entire Affordable Care Act, also known – particularly  by Trump rally fans – as  Obamacare.  If the ruling survives appellate review, the president insisted there will be “great healthcare results for Americans!”  The Donald and his disciples have been railing, ranting and raging over Obamacare since the Republican primaries nearly three years ago.  Not once – during the primaries, the general election campaign or his first two years as president – has Trump ever offered the slightest hint of what he thinks “great healthcare” would consist of.  He has never had anything resembling a constructive thought about healthcare. It was all about capturing the adulation of the Obama-haters, with no regard to what happens to people who lose their insurance.  To Trump and his minions, “Abolish Obamacare” was as void of meaning as “Lock Her Up”. The juices of anger flowed, but there wasn’t a single policy thought to be had.

This is the same kind of thought-deprived leadership that has thrown the United Kingdom into a perpetual state of crisis. Just as America-first Trumpism was gaining steam in 2016, conservative populism roared through the UK, emotionally propelled by the simplistic notion that life could be made great again with a one-word plan: LEAVE.  By a 52 percent margin, the Brits voted in a national referendum to secede from the European Union.  Zero thought was given to the practical policy implications of secession, and Parliament, after two painful years of trying to come up with a divorce decree, is nowhere close to an agreement.  That means the separation may well occur in March without a single plan on how to handle such details as trade, taxes, financial payments and immigration policy. The Bank of England has warned of a “deep and damaging recession with worse consequences for the UK economy than the 2008 financial crisis.”  LEAVE made for a powerful chant, but it was completely content-free, void of any details about how the breakup would affect people’s lives.

Back home, Trump has threatened to end the week with a partial government shutdown over another of his one-word campaigns. Like a toddler pleading for a favorite toy, the president has been yammering for his WALL, his “big, beautiful” wall, a magical wall that will restore America’s greatness by keeping people with brown skin out of the country.  

There are few public policy issues more complex and involved than immigration, which is one reason Congress has been unable to tackle the issue in a satisfactory manner for more than 30 years.  And then along comes Trump and his one-word fix.  “Build the WALL”, is at or near the top of the charts for his campaign rally chants. As if architecture could solve one of the world’s thorniest problems.  

As of last year, nearly 60 million people have been forced by violence and conflict to flee their homes. More than half of all refugees are under 18.  According to the United Nations, if all those asylum-seekers and refugees were a country, it would be the twenty-first most populous nation in the world. In the U.N.’s view this crisis is the worst it has been since World War II and will steadily become worse as violent conflicts grow and climate change wreaks havoc. Yet, the alleged leader of the free world directs none of the vast resources at his disposal to find meaningful responses to these problems. Instead, he yaps incessantly about his wall as the magical cure for a broken immigration system.  And on climate change, he offers a rake.

The only upside to the right’s cataclysmic populism, is that it is difficult to envision a scenario where it has staying power. By definition, simplistic solutions to complicated problems fail. The essence of their brief life span lies in the visceral illusion of workability.  Cracks are already bringing to show. Polls track a steady approval increase for the elements of the Affordable Care Act, even among those who disliked Obama.  They don’t want to lose their insurance.  Faced with potentially severe consequences of leaving the E.U., many Brexit supporters have expressed buyers’ remorse. That’s not to say there won’t be serious fallout from this politics of mindlessness. It is merely a reminder of the governing principle that you can’t fool all of the people all of the time.

LAST RUSH TO REPEAL OBAMACARE IS AN ENDGAME ONLY BECKETT COULD LOVE

Samuel Beckett, theatre of the absurd playwright extraordinaire, would have been absolutely enchanted with the U.S. Congress and its over-the-top obsession to repeal Obamacare. Mindlessly repeating actions, completely unattached to any rational or meaningful result, is the heart and soul of absurdist theatre. In one of his early writings, Beckett captured the utter despair and pointlessness of his character’s life with this line: “If there is one question I dread, to which I have never been able to invent a satisfactory reply, it is the question of what am I doing.” Beginning to see the connection to this Congress?

Then, in his critically acclaimed play, “Endgame”, Beckett constructs a dialogue reeling with hopelessness between two characters as they shuffle through repetitive actions totally void of meaning. As they talk, a rat scurries across the floor. Clov says to Hamm, “If I don’t kill the rat, he’ll die.” And Hamm says, “That’s right.” Republicans insist that Obamacare is either dead or is dying, but they are rushing to kill it because, if they don’t, it just might live. Worse yet: it could grow into single payer healthcare. No, it doesn’t make sense. It’s not supposed to. Welcome to Government of the Absurd.

Senate Republicans are just a couple votes away from passing a health care bill most of them don’t like nor fully understand. It is, most analysts say, far more Draconian than the one voted down in July. It will leave tens of millions of Americans without insurance, drastically reduce Medicaid benefits, and remove protections for those with pre-existing conditions. And the list goes on. Republican senators who earlier voted against less egregious versions are either supporting or thinking of supporting this monstrosity. Why? It’s the “last train” available to Obamacare repeal. That’s what a high ranking GOP Senate staffer told Vox this week. Under Senate rules, between now and September 30, Republicans need 51 votes to move that train. Come October 1, it will need 60 votes. With 52 Republicans in the Senate, and a united Democratic opposition, the train isn’t going anywhere after next Saturday.

Sen. Pat Roberts (R-KS) used a different transportation metaphor to describe the party’s dilemma: “Look, we’re in the back seat of a convertible being driven by Thelma and Louise, and we’re headed toward the canyon. . . So we have to get out of the car, and you have to have a car to get into, and this is the only car there is.” Neither of the analogists said a word about what the bill would do for people who need healthcare. That’s because, to Republicans, unlike the motivational posters, it’s all about the destination, not the journey. The destination is Obamacare’s death.

Sen. Charles Grassley (R-IA) said he could come up with at least 10 reasons why the bill is bad and should never be considered. Yet, he’s a yes vote. His ringing endorsement is right out of a Beckett script: “. . . Republicans campaigned on this (Obamacare repeal) so often that you have a responsibility to carry out what you said in the campaign.”

Look, Congress has taken its share of slings and arrows over the years. Legislating is a messy process and most outcomes leave something to be desired. But this is a whole new height of absurdity. Senators like Roberts and Grassley freely admit that this legislation, this massive thrashing of our healthcare system, sucks. But they are on board – whether by way of the last train or the only car – because the party has been mindlessly chanting “Obamacare Repeal” for seven years.

The Washington Post’s Paul Kane suggested this week that Senate Republicans made a calculated decision that it was better to fail once more in trying to repeal Obamacare than not to even give it a shot. According to Kane, the August recess was really tough for Senate Republicans, given their narrow healthcare bill defeat in July. They faced, he said, “an unrelenting barrage of confrontations with some of their closest supporters, donors and friends,” all pounding them for not making good on their Obamacare repeal promise. Those flames were fanned, of course, by regular tweets (here, here and here) from President Trump on how disgusted he was with Senate Majority Leader Mitch McConnell for not delivering the votes on repeal. A Republican donor in Virginia even filed suit against the GOP on grounds that it repeatedly solicited funds for an Obamacare repeal it couldn’t produce. The suit alleges fraud and racketeering. So the party clings to an obsolete goal.

That kind of bizarre thinking is the result of intellectual inertia. From a Republican standpoint, Obamacare repeal made sense in 2010. For all its faults, it was the most progressive national insurance legislation passed in 50 years. Conservatives understandably wanted to attack it and try to undo it. But that window doesn’t remain open indefinitely. Republicans used it effectively for several years, even leveraged it to take control of Congress. Meanwhile, millions of people were added to the health insurance rolls. There was no discrimination for pre-existing conditions. Adult children were covered by their parents’ policies. For the past year, a growing majority of Americans say they like Obamacare and don’t want to lose it. The Republican establishment, however, has not changed gears. It just keeps forging down the same archaic path, mindlessly committed to repealing a program that people now want.

The best outcome for Republicans at this juncture is that their repeal efforts fail once again. A bruised ego ought to be preferred over the wrath of voters stinging from the loss of their healthcare. It’s a result, however, that can’t be taken for granted. Best to call those Republican senators now and urge a no vote. When they answer, ask them just what it is they think they are doing. See if they are honest enough to offer a Beckett answer: “I have no idea.”

GOP’S NO HEALTHCARE CUT LEFT BEHIND BILL IS PARTICULARLY CRUEL TO WOMEN

If Republicans have their way, women with reproductive health issues will soon be sent to dentists, food banks or nursing homes for help. That’s why the horrifically misnamed Better Care Reconciliation Act may one day be more accurately known as the Population Growth Act of 2017. This is what happens when 13 male senators draft a health care bill in secret.

Apparently, it was not enough for the GOP to simply take insurance away from 22 million people and jack up premiums for those least able to pay. It’s not every day a political party gets to make a real difference in social policy. So the Senate bill, quietly and secretly crafted by that body’s majority leader, Mitch McConnell, and a dozen of his closest bros, went all out and cut off federal funding for Planned Parenthood, the nonprofit organization that provides vital health care services for millions of low income patients, mostly – but not exclusively – women.

Despite its role as a lightning rod for the anti-abortion crowd, Planned Parenthood outlets offer the gamut of health services, including birth control, cancer screenings and STD testing and treatment. Abortion accounts for only 3% of its services and is not even available at many clinics. Yet, as if this consensus-free healthcare debate was not divisive enough, conservatives tossed in their long dreamed of plot to defund Planned Parenthood.

The Senate legislation cuts off all federal funding for Planned Parenthood for only one year. Why just a year? A compromise with those who support the program? Alas, the maneuver is far more conniving and diabolical. The nonpartisan Congressional Budget Office costs out every change in the healthcare bill, and that math plays a huge role in rounding up votes, both for and against. According to the CBO, the cost of not funding Planned Parenthood carries a ten-year price tag of $130 million. That’s how much budget crunchers say it will cost Medicaid for the obstetrical care of women unable to get contraceptive assistance through Planned Parenthood. So the Gang of 13 Senate guys came up a smoke-and-mirrors workaround: cut the funding for just one year, win a better overall CBO score and then come back, once the limelight of healthcare battles has faded, and make the cutoff permanent.

The bill’s Republican sponsors insist that there are many other federally qualified health providers offering family planning services and that the legislation would transfer funding from Planned Parenthood to those other facilities. The CBO, however, noted that one in five counties served by Planned Parenthood have no federally qualified clinics offering contraceptive services. The New York Times took a look at those alleged Planned Parenthood alternatives cited by the Republicans. The list included, inexplicably, hundreds of ophthalmologists, nursing homes, dentists, cosmetic surgeons, audiologists, addiction treatment centers and food
banks. Pity the poor woman who goes looking for contraceptive services at a dentist office or a food bank, and walks away with a cheap toothbrush and a box of Cheerios.

Anyone suggesting that the CBO’s projected population expansion is crude guesswork should check out a paper published by the New England Journal of Medicine. That research focused on Texas where the state cut off Planned Parenthood funding in 2013. Medicaid pregnancies increased by 27% in the first 18 months. Alina Salganicoff is the Kaiser Family Foundation’s director of women’s health. She told CBS news recently that the burden of this funding cutoff “disproportionately impacts the young and low income, or people who want to get confidential care.” “For a lot of women,” she said, “Planned Parenthood is their only source of care.”

Sadly, complete and utter disregard for women’s health, has been at the heart of the political battle over abortion since Roe v Wade was decided in 1973. Poor women have been denied Medicaid assistance for abortions since the passage of the Hyde Amendment in 1976. Yet, this legalized economic discrimination, renewed by Congress every year since 1976, has never been enough for the anti-abortion forces. They know that Planned Parenthood performs 35% of the abortions that occur in this country, even though the procedure represents only a small part of its medical practice. They want them shut down completely, even if doing so will prevent Planned Parenthood’s low income patients from getting family planning assistance or being screened and treated for diseases. When it comes to their never-ending war on abortion, women without money are always fair game for collateral damage.

However, their leverage this time around, while not great, is better than it was during the Hyde Amendment days of 1976. The Senate had no female members then. There was no need for a select male cabal to secretly legislate away women’s rights; the entire Senate was a male cabal. Today there are 22 women in the U.S. Senate, and two of them – Susan Collins of Maine and Lisa Murkowski of Alaska – both Republicans, are opposed to the Planned Parenthood defunding. Majority Leader McConnell can afford to lose only two Republican votes, and he has a growing list of senators who are shaky over various other aspects of the legislation.

It takes a lot of chutzpa and cynicism to call this bill the “Better Care Reconciliation Act of 2017”. There is absolutely no “better care” in this act for anybody. And the only thing being reconciled is a tax cut for the rich, on the backs of less fortunate Americans who will lose access to critical health services. If the Republican leadership wants genuine reconciliation, it will deep-six this monstrosity and work with Democrats to pass meaningful legislation that makes “better care” a reality for everyone.

OBAMACARE REPEAL PROMISE SHOWS ITS AGE, AND IT’S NOT PRETTY

For one brief shining moment, the left and the right have come together in a chorus of Kumbaya. All it took was a singularly pernicious piece of legislation that simultaneously offended all of their principles. You’ve got to hand it to Republican congressional leaders: they came up with a health care bill that almost anyone can hate. Who could have imagined such a collection of odd couples – Planned Parenthood and the Koch brothers, MoveOn.org and the Tea Party, Sens. Bernie Sanders and Ted Cruz – all locking arms in battle?

Yet, even with depleted and exhausted troops, these determined generals – Senate Majority Leader Mitch McConnell and House Speaker Paul Ryan – keep trying to climb that seemingly unscalable mountain in order to pound a stake through the heart of Obamacare. It’s a seven-year-old elusive dream that has not aged well. This bizarre mission is draped in a misplaced notion of integrity, of promises to keep. “We’re keeping our word,” Ryan told ABC news. “That’s very important.” Our promise, McConnell has repeatedly insisted, is to “repeal Obamacare root and branch.” The repeal mantra worked for Republicans back in the day. But political slogans need to change with the times. Even George Wallace knew that his 1963 “segregation now, segregation tomorrow, segregation forever” line wouldn’t play in the 1980s. Too much had changed. The health care swing was less dramatic but just as real.

The frenzy to pass this legislation is all about a promise that is no longer operative. It served conservative political interests a few years back, when the new health insurance system was confusing, unsettling and, thanks to Republican demagoguery, unpopular. However, people have gotten used to it, including the estimated 17-20 million who now have insurance for the first time. Suddenly, polls show that a majority of Americans like Obamacare. Meanwhile, NPR/Marist polling on the Republican health bill this week gave it a 17% approval rating. In that same survey, 63% of the respondents favored either leaving Obamacare unchanged or strengthening it.

From a pure standpoint of self-interest, the GOP’s health care strategy makes no sense. Politicians have two constituencies: voters and campaign contributors. So far, every health care permutation Republicans have come up with alienates both groups. If anything resembling their current bills pass, between 22 and 23 million Americans will lose insurance. Lower income families and the elderly will see premiums rise by 280%. Taking benefits away from people – or overcharging for them – is not an effective way to win votes. Republican governors get that, which is why many of them oppose their party’s mindless drive to repeal and replace. It’s a promise that has lost its predicate.

And now come the financial heavies, the real power behind the anti-Obamacare movement, all angrily insisting that the Republican bills aren’t a repeal at all. The repeal promise, of course, was not born out of a desire to create a better health care system. It was all about appeasing the Koch brothers and other titans of the corporate right. Americans for Prosperity, the Koch network’s political arm, and a number of similar groups, poured hundreds of millions of dollars into the campaign coffers of candidates committed to a total dismantling of Obamacare. They are all thoroughly disgusted with the House and Senate bills that upend insurance for millions and slash Medicaid spending. It’s not enough for them, not nearly enough. AFP leader Tim Phillips called the Republican legislation “a slight nip and tuck”, according to the Associated Press. He said it was “Obamacare-lite” and that AFP is poised to go after Republicans who support it. In other words, the only way McConnell and Ryan can satisfy their financial benefactors is to cut much deeper, leaving millions more without insurance, and passing their subsidies on to the rich in the form of tax cuts.

The Washington Post reported today that McConnell was gingerly rearranging pieces of his Senate bill in an attempt to address objections launched from every possible direction. Reportedly, this would involve scaling back tax cuts for the rich in favor of helping lower income people get insurance. That might appease some moderates but will further frustrate the right. To compensate, says The Post, he may strike some Obamacare coverage mandates from the bill. Meanwhile, the nonpartisan Congressional Budget Office reported that the bill’s reduction in Medicaid coverage would be significantly higher than originally calculated. Bottom line: the bill is not headed toward a Palm Sunday reception.

McConnell and Ryan are not in this promise trap by themselves. President Trump spent his campaign promising to slay Obamacare on day one. Of course, the president could cram everything he knows about health care and the legislative process into a single tweet, and have 140 characters left over. He says he wants a Senate bill that is not as “mean” as the House version. Yet, Trump threw a Rose Garden celebration for passage of that “mean” House bill, calling it “very, very, incredibly well-crafted . . .a great plan.” Unlike the president, McConnell and Ryan know what they are doing. They just made a huge stumble.

There is a certain nobility attached to fulfilling a promise, but nobility can quickly turn into dung when the underlying conditions behind the promise change. This is one more example of Republicans ignoring science at their peril. Remember the uncertainty principle from physics class? You can determine a particle’s position or its momentum, but you can’t accurately measure both at the same time. That’s because positions and momentum change. The Republican leadership built their repeal strategy on 2010 measurements. Once people who never had health insurance got it, the public’s position on the particle called Obamacare started to change. It’s been moving ever since, but the Senate majority leader and House speaker are just now taking stock of its momentum.