What a Concerned Person Might Do

It’s Monday afternoon and the resistance is heating up. There’s going to be a big demonstration in Washington on Wednesday. A human chain around the Capitol Building has been mentioned.

Meanwhile:

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calls

Senators love hearing from people who live in their states. They also love hearing from nice people who claim to live in their states. Such people could try calling Senators through the main Senate switchboard at (202) 224-2131. But it’s often easier to get through to a Senator’s local office, in states like, for instance, Maine, Arkansas and Ohio (see list above).

Emails don’t have as much impact, but Senators also love getting them, especially from people who live in their states (or claim to). You can tell because their contact pages usually refer to the Senators by their first names. So it’s “Contact Jeff” or “Contact Susan”.

If a person wanted to send a nice but not quite accurate email to a Senator, despite not living in the Senator’s state, a person could:

Find a city in that state.

Bring up the map for that city.

Look for a part of town where affluent people probably live (usually somewhere on the outskirts where the streets are curvy or there are lakes or a country club nearby).

Identify a pleasant street name.

Use Zillow to find a nice house on that street. (Zillow will provide the Zip Code too!)

Look for a local business, school or church and save the phone number.

Find the Senator’s contact page. (They all look like Jeff’s.)

Then a person could enter some personal data, specifying a name of their choice, an address on that nice street with a street number of their choice, the Zip Code that Zillow provided, and maybe a phone number with the relevant area code and prefix.

Unfortunately, a person would also have to enter an email address, possibly twice, so it’s good if a person has  an innocuous email address that can be used to receive garbage emails. (I have one; maybe a person should have one too.)

After that, all a person would have to do is maybe select a topic (something like “Health”), possibly type in a subject (like “Senate Health Care Bill”) and then enter a polite plea to vote No on an upcoming piece of abominable legislation that relates to health insurance.

Perhaps something like this, but using a person’s own words: 

Dear Sen. XXX: Please vote No on the Senate Health Care Bill. You know in your heart that it’s a bad bill. It will harm the people of <XXX’s state>. Reporters say that moderate Republicans always give in to the GOP leadership at the last moment. Don’t let that happen, no matter what they promise. We are counting on you. Sincerely yours, <the name that a person chose to use>

I’m not recommending this, of course, because, as President Nixon famously pointed out, “it would be wrong”. But given the stakes (many people will unnecessarily suffer and die if this legislation passes), a concerned person might do it anyway.

 

What People Need to Know About Medicaid

Please share this 20-minute video, even with Americans who hate politics. It might reach people in Alaska, Arizona, Colorado, Louisiana, Maine, Nevada, Ohio or West Virginia who will call their relatively sane Republican Senators and demand that they vote No on the Better Healthcare Reconciliation Act, also known as the Senate healthcare bill or Trumpcare. We need to stop this abomination now.

If Only His Words Meant a Damn Thing

I wrote about the Republican healthcare bill earlier today:

Assuming logic and morality don’t win the day, and simple majorities pass the bill in both houses, it will go to the President. If that sleazeball cares what’s in the bill, he’ll veto it, since it won’t be anything like the health care bill he promised. But we know how much we can count on him.

What he’s promised:

No one will lose coverage. There will be insurance for everybody. Healthcare will be a “lot less expensive” for everyone — the government, consumers, providers….

“We’re going to have insurance for everybody,” Trump said in an interview with The Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”…

As his run for president took shape, candidate Trump boasted via Twitter, “I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid”

Of course, a few weeks ago he celebrated the passage in the House of the AHCA (or Trumpcare), the legislation that would break all those promises!

So it was interesting to see this report later in the afternoon:

WASHINGTON (AP) — President Donald Trump told Republican senators Tuesday that the House-passed health care bill is “mean” and urged them to craft a version that is “more generous,” congressional sources said.

The president’s comments, at a White House lunch with 15 GOP senators, came as Senate Republican leaders’ attempts to write their own health care package have been slowed by disagreements between their party’s conservatives and moderates [i.e. the radicals and conservatives].

Trump’s remarks were a surprising critique of a Republican-written House measure whose passage he lobbied for and praised. At a Rose Garden ceremony minutes after the bill’s narrow House passage, Trump called it “a great plan.”

His comments also seemed to undercut efforts by Senate conservatives radicals to include restrictions in their chamber’s bill, such as cutting the Medicaid health care program for the poor and limiting the services insurers must cover. Moderate Conservative GOP senators have been pushing to ease those efforts.

The sources say the president did not specify what aspects of the bill he was characterizing….

One source said Trump called the House bill “mean, mean, mean” and said, “We need to be more generous, more kind”. The other source said Trump used a vulgar phrase to describe the House bill and told the senators, “We need to be more generous.”

It’s extremely unlikely that DT will know or care what’s in the bill he’s given to sign, and even less likely that he would veto it.

If we’ve learned nothing else since the election, it’s that his words don’t mean a damn thing. The Executive Branch of our government is being run by someone you wouldn’t trust to feed your cat or water your lawn.

What’s Their Deal With Health Insurance Anyway?

It feels odd to write about anything else now that a senseless, malevolent being has taken control of the White House, but here goes anyway:

Four years ago, Dr. Ben Carson, who is expected to be the U.S. Secretary of Housing and Urban Development in the new administration, compared the Affordable Care Act to slavery:

“You know, Obamacare is really I think the worst thing that has happened in this nation since slavery,” Carson … said … in remarks at the Values Voter Summit in Washington. “And it is in a way, it is slavery in a way, because it is making all of us subservient to the government, and it was never about health care. It was about control…”

“And why did [the Obama administration] want to pass it so badly? Well, as I said the other night on television, Vladimir Lenin … said that socialized medicine is the keystone to the establishment of a socialist state.”

As we might expect, there is no evidence that Lenin said any such thing. The “socialized medicine” quote attributed to him by Carson and others was fabricated for a 1949 brochure issued by the American Medical Association. That’s back when the AMA was fighting President Truman’s proposal for national health insurance (and years before they opposed Medicare). But Carson telling that tall tale helps explain why the Republican Party is so opposed to the Affordable Care Act.

The ACA requires individuals to have health insurance (or pay more income tax) and employers of a certain size to offer health insurance to their employees (or pay more income tax). It also requires that health insurance plans meet specific requirements in order to qualify as health insurance for purposes of the law. So that’s one reason Republicans want to repeal the ACA. The law requires that we do something for our own benefit or for the benefit of others. It limits our freedom to do whatever the hell we want. That makes it a prime example of government overreach, or what the right-wing calls the “Nanny State”.

But since Republicans are forced to buy insurance for their houses and cars without making a fuss (let alone bringing up slavery or Nazi Germany), being forced to buy insurance for their bodies (or their employees’ bodies) can’t be the only reason they’re against the ACA.

A second reason is simply political. After decades of trying, a Democratic President finally got a bill passed that takes us closer to universal health insurance. But whatever Obama was for, the Republicans were against. They immediately labeled the ACA as “Obamacare” to help convince right-wingers to oppose the law, even if they didn’t know what the law did (and even if the law would improve their own lives). 

That’s despite the fact that the ACA adopted the conservative approach to universal healthcare that Republicans had been advocating since the 1970s. It’s pretty amazing. A letter to the editor in The Chicago Tribune tells the disheartening story:

Obamacare is virtually the same privatized mandate plan [the Republican Party] pushed since President Richard Nixon first proposed the National Health Strategy in 1971, then again in 1974. Then the GOP revived its privatized mandate plan again in 1993 with … the [HEART] act … an alternative to the [Clinton] single-payer plan… 

Obama — as a compromise to have basic health reform passed — used this same GOP blueprint with one significant change: adding a public option alongside the GOP’s privatized mandate plan … 

Eventually the public option was stripped out of the 2010 ACA bill as a further compromise to attract bipartisan support for the bill, leaving in its place the very plan that the GOP wanted and pushed for decades. Unfortunately, the ACA did not receive a single vote from the Republican Party that created the plan’s primary concepts as an alternative to a single-payer — “Medicare for all” — type of system.

No wonder the Republicans have had so much trouble coming up with a replacement for “Obamacare”. The law they’re so against is the law they used to be for.

A third reason the Republicans oppose the ACA is that it’s the kind of Robin Hood economic redistribution Republicans hate. It takes from the rich and gives to the poor. Paul Krugman explains in a blog post called “Health Care Fundamentals”:

Providing health care to those previously denied it is, necessarily, a matter of redistributing from the lucky to the unlucky. And, of course, reversing a policy that expanded health care is redistribution in reverse. You can’t make this reality go away.

Left to its own devices, a market economy won’t care for the sick unless they can pay for it; insurance can help up to a point, but insurance companies have no interest in covering people they suspect will get sick. So unfettered markets mean that health care goes only to those who are wealthy and/or healthy enough that they won’t need it often, and hence can get insurance….

The thing is, however, that guaranteeing health care comes with a cost. You can tell insurance companies that they can’t discriminate based on medical history, but that means higher premiums for the healthy — and you also create an incentive to stay uninsured until … you get sick, which pushes premiums even higher. So you have to regulate individuals as well as insurers, requiring that everyone sign up — the mandate. And since some people won’t be able to obey such a mandate, you need subsidies, which must be paid for out of taxes…

What [the Republicans] are left with is … voodoo: they’ll invoke the magic of the market to somehow provide insurance so cheap that everyone will be able to afford it whatever their income and medical status. This is obvious nonsense [but] it’s all they’ve got.

The redistribution is related to a fourth reason they’re against the ACA and it might be their biggest reason of all. Not only did the ACA impose fines in the form of tax increases on taxpayers who wouldn’t buy health insurance, it included a separate, relatively large tax increase on the richest Americans. As everyone knows, that‘s anathema to Republican politicians. Repealing the ACA, therefore, would mean a big tax cut for the Republicans’ favorite people. From Slate:

One of the core, very simple things [the ACA] did was raise taxes on the wealthy in order to fund subsidized health care for more Americans. Couples earning more than $250,000 saw a 0.9 percent increase in their top Medicare tax rate, as well as a new, 3.8 percent Medicare surtax on investment income.

If Republicans have their way and successfully repeal the Affordable Care Act, those two taxes will be toast—which will mean a substantial break for some of the country’s wealthiest families. The liberal Center on Budget and Policy Priorities estimates that millionaires would see 80 percent of the benefits from those tax reductions. Based on the most recent IRS data, the think tank roughly projects that the 400 highest income households—which earned an average of more than $300 million each in 2014—would see a $2.8 billion annual tax cut, worth about $7 million on average per filer.

So that’s at least four reasons why Republicans want to scrap the Affordable Care Act:

1) It’s what they call the “Nanny State” in action. 

2) It was an important Obama accomplishment.

3) It’s the kind of redistribution Robin Hood was for and the bad guys were against.

4) It raised taxes, especially for the rich.

In conclusion, Republicans don’t necessarily want millions of Americans suffering and dying without medical treatment. Being concerned about that kind of thing is simply low on their list of priorities.

I Wish I’d Said It This Well

Paul Waldman writes for The Washington Post. His new column echoes much of what I posted yesterday with the title “On the Bright Side, ACA-Wise”.

Only Mr. Waldman writes for a living and has an editor, so you might want to take a look. His piece is somewhat optimistically called “Donald T___ may have just destroyed the Republican effort to repeal Obamacare”. Please don’t tell him or his paper that most of it is available here. I’m going to have enough trouble because of this:

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Quoting Mr. Waldman:

When even the most committed Republicans came around to support Donald T___ in 2016, they made a kind of bet. It wouldn’t matter much that T___ had no apparent fealty to conservative ideology or that he was a complete ignoramus about policy, because he’d be leaving all that boring stuff to them. The Republican Congress would pass its agenda, he’d sign whatever they put in front of him, and they’d all live happily ever after.

But now it’s not looking so simple. In fact, T___ just dealt a huge blow to their top priority: repealing the Affordable Care Act. Accomplishing repeal without causing the GOP a political calamity is an extremely delicate enterprise, and the last thing they want is to have him popping off at the mouth and promising things they can’t deliver. Which is what he just did:

President-elect Donald T___ said in a weekend interview that he is nearing completion of a plan to replace President Obama’s signature health-care law with the goal of “insurance for everybody”….

“We’re going to have insurance for everybody,” T___ said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better”.

We should begin with the assumption that nothing T___ says can be taken at face value; the “plan” that he claims is being devised could be no more real than the secret plan to defeat the Islamic State he used to claim that he had formulated. But that’s not the point. What matters is this: Donald T___ just emphatically promised universal health coverage. That’s an absolutely gigantic promise, and it’s one that Republicans have no intention of keeping.

But now they’re stuck with it. Democrats will be saying, “President T___ promised that everyone would be covered!” every day for as long as this debate goes on. Every time a congressional Republican is interviewed on this topic, they’ll be asked, “President T___ said that everyone would be covered. Does your plan do that?”, and they’ll have to bob and weave as they try to avoid admitting the truth.

That’s because the Republican plan, in whatever final form it takes, will absolutely, positively not cover everyone. Universal coverage isn’t even one of their goals. Republicans believe it’s much more important to get government as far away from health care as possible. In place of the ACA’s expansion of Medicaid and subsidies for the purchase of insurance that have extended coverage to 20 million more people…, they’ll be offering some tax credits and health savings accounts, which would be very good for the healthy and wealthy, but not so great for other people.

They call this “universal access,” which is meant to sound like “universal coverage” but is actually nothing of the sort. The truth is that there are really only two ways you can achieve universal coverage: by having the government cover everyone in some form of single-payer, or with a set of extremely coercive mandates to carry coverage, much more coercive than the ones in the ACA. Republicans would rather pluck out their own eyes than agree to either one of those. So the trick is to make the public think they won’t take away coverage from tens of millions of people, while doing just that.

That requires some rhetorical subtlety, which is something T___ is just not capable of…. T___ says whatever comes into his head, and whatever seems like it might be popular. People hate out-of-pocket costs, so he promises low deductibles. People don’t like the idea of tens of millions losing their coverage, so he promises that everyone will be covered.

And now, congressional Republicans are going to have to answer for breaking a promise they didn’t even make. At a moment when opposition to the repeal of the ACA is gathering strength, this was the last thing they needed.

I don’t know if it will be so hard for Republicans to admit they’re not offering universal healthcare or “insurance for everybody”. Making stuff up is part of T___’s act and they can always say he “misspoke”. In addition, they’ll claim that their plan will insure almost everyone through the miracle of untrammeled competition (sure, competition between giant corporations that avoid price competition if at all possible). And T___ will keep saying he’s solved the healthcare problem even though it’s obvious he hasn’t.

But it still seems like a good thing that he keeps saying he wants what we want and what sleazeballs like Sen. Mitch McConnell and Speaker Paul Ryan don’t. In parlous times, we must thank the Lord for small favors.

On the Bright Side, ACA-Wise

There is only one sure thing when it comes to predicting what President Donnie will do. He’ll always do what he thinks will serve his interests. It might not actually serve his interests, but he will believe it does. Otherwise he wouldn’t do it. That’s because he doesn’t have an altruistic gene or self-sacrificing neural pathway in his body. Not one. He is 100% self-centered and selfish. 

The possibly good news is that Donnie has promised not to cut Medicare and Medicaid (and Social Security):

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Plus, there’s this:

…T***p told the Wall Street Journal he would consider keeping two of [the ACA’s] most popular provisions — one that allows adult children to stay on their parents’ health insurance plans, and another that would forbid insurance companies from refusing to cover “pre-existing conditions.”

“I like those very much,” the newspaper quoted Trump as saying [on Nov. 11th].

Furthermore, although he has parroted the standard Republican line about quickly repealing the Affordable Care Act, he’s said it should immediately be replaced with something “terrific”. In his case, of course, “terrific” usually means either expensive or fraudulent, but let’s assume he wants the ACA replacement to be popular. It’s true that he’s so mendacious, ignorant and/or stupid that he recently said it will take about a week to design and approve a terrific replacement, but put that aside too. Perhaps he sees an opportunity to feed his narcissism by doing something that will make most of America admire him (as unlikely as that will ever be). 

It shouldn’t have been a surprise, therefore, that Donnie told “The Washington Post” yesterday that he will shortly unveil a plan that offers “insurance for everybody”!

(By the way, before I forget, whoever is responsible for childishly defacing that picture up there from Donnie’s Twitter account is going to be in big, big trouble on January 20th.)

Of course, given that the President-elect’s entire career outside reality TV has been based on telling suckers what they want to hear, his promises are less than worthless. But at least we know that protecting Medicare and Medicaid; limiting the ruthlessness of insurance companies; and making sure we all have health insurance are ideas he’s heard of.

There are a few other reasons for a tiny bit of extremely cautious optimism:

(1) Most of us don’t want the ACA repealed and nobody wants to lose what they already have, so there has been a huge negative response to the Republican “plans”, with websites like Faces of the ACA , articles like “Without Obamacare, I’ll Get Sicker, Faster, Until I Die” and “Here’s What One Cancer Survivor Wants You To Know About Obamacare” and constant reminders that it’s “Time to Turn Up the Heat: Senate Staffers Are Complaining About the Avalanche of Angry Calls”. The anti-ACA repeal movement is also getting support (some of it lukewarm) from unlikely sources, including Republican governors, hospital administrators, insurance companies and the American Medical Association. 

(2) The House of Representatives almost always follows its leader, the odious Paul Ryan, but the Senate is much less predictable. Even in the House, the most reactionary Republicans sometimes vote against their leader because a proposed piece of legislation doesn’t harm enough people. In fact, recent history shows that Republicans find it much easier to agree on what they’re against than on what they’re for. On top of that, nobody knows how  Pres. Donnie will react to legislation that doesn’t obviously satisfy his greed or narcissism. For a helpful summary of the procedural hurdles Congressional Republicans are up against, see “Everything Republicans Will Have To Do To Actually Repeal and Replace Obamacare” (subtitle: “It Won’t Be Easy”). 

(3) It’s been reported that there is more opposition to “Obamacare” than to the Affordable Care Act. The more people learn what the ACA actually does, the more they like it. So, once President Obama becomes a fond memory, and despite well-funded Republican efforts to confuse the issue, it’s possible that support for the ACA will increase. Andy Slavitt, the acting administrator of the Centers for Medicare and Medicaid Services, prepared a list of everyone who will be negatively affected by repeal of the ACA (without, of course, a terrific replacement):

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And let’s not forget this bit of good news:

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Will spreading the good news about the ACA and bad news about its repeal have an effect on the right-wing ideologues in Congress and the orange person in the White House? We don’t know, but it’s worth a try.

One last thought for now. One of the phrases that comes up in arguments about our healthcare system is “socialized medicine”. It’s used to attack the idea that the government should control or bear responsibility for healthcare. When you think about it, however, it’s clear that healthcare does have a very strong social aspect. If we don’t want poor people dying in the streets or dread diseases spreading through the population, we need society, including the government, to make sure people get medical treatment. This is why people who arrive at emergency rooms at the edge of death get medical treatment, even if they don’t have a health insurance card or a suitcase full of cash.

The idea that healthcare is a social good fits nicely with the standard Democratic view that “we are all in this together”. Most of us don’t want to live in a dog eat dog world. 

Republicans, however, lean toward the “every man for himself” or “not my brother’s keeper” model. That’s not all bad. Almost everyone puts themselves, their family and their friends ahead of strangers. But in the Republicans’ case, that fundamental attitude easily translates into less for the poor and sick and more for the rich and healthy. That’s the underlying message behind Paul Ryan’s recent statement that he favors “high risk pools” for people with “pre-existing conditions”. He was answering a question from a cancer patient whose life was saved by the ACA:

So we, obviously, want to have a system where they can get affordable coverage without going bankrupt because they get sick. But, we can do that without destroying the rest of the healthcare system for everybody else. That’s the point I’m trying to make. What we should have done was fix what was broken in health care without breaking what was working in healthcare, and that’s what, unfortunately, Obamacare did. So, by financing state high-risk pools to guarantee people get affordable coverage when they have a pre-existing condition, like yourself, what you’re doing is, you’re dramatically lowering the price of insurance for everybody else [PoliticsUSA].

Doing this won’t work, of course, unless those unlucky sick people are wealthy enough to pay sky-high premiums, the government (meaning the rest of us) pays their bills or they simply give up, drop out of the insurance market and take their chances. That’s how “high risk pools”, also known as “insurance ghettos”, have always worked, i.e. failed, in the past.

A closing comment from the PoliticsUSA site:

… Ryan thinks cancer patients and other pre-existing conditions are ruining healthcare for everyone else…The true evil in [Ryan’s] plan is that by separating out the high-risk patients from everyone else, Ryan … can keep costs down by underfunding the pool for people who need healthcare the most…

That’s the attitude we’re up against. The news isn’t all bad, but it’s not going to be easy.