Tag: obamacare

Medicare for All

12 comments

nhs_0_108664While our most dysfunctional Congress continues to debate whether we should repeal Obamacare or not, every single other industrialized nation in the contemporary, modern world goes about its merry way having long ago settled the question, “should all our citizens have access to quality health care on demand, regardless of ability to pay?” The American inability or unwillingness to answer that question in the affirmative with some semblance of unanimity is a failure. 

Obamacare is by no means perfect – neither ideal nor, perhaps, even wanted. But it is the great liberal compromise, adopting a conservative way to health insurance reform as its own. Indeed, it seems to be the only way Democrats seem to win lately on national issues – adopt the conservative thinking, and wait for the conservatives to pounce with furious indignation disguised as opposition. 

The very poor and children receive health insurance through Medicaid. The old receive health insurance through the wildly efficient and popular Medicare program. The rest of us, the ones in the middle, are seeing coverage dwindle and cost go up, and we’re told by smugRepublicans that it’s Obamacare’s fault despite it being a year away from full implementation. 

CNN looked at the perpetual American political crisis over healthcare and one conclusion is that we manage disease instead of preventing it. But suggest that people should eat healthier, and you’ll be denigrated as the soda police, as New York Mayor Bloomberg has. 

The issues are cost and access. Medicare is extremely efficient and popular. It is a single-payer health insurance scheme that one pays into throughout their work life and is an “entitlement” insofar as you’ve paid for it, like Social Security. Expansion of Medicare to all Americans is the easiest, most rational way to ensure universal coverage for not only managing disease, but also preventing it. Canadians have liberty, too – liberty from medical bills for routine health care, and the myths that Canadians die while queueing up for services are just that – myths. Canada’s systemis not perfect, either, but it is more perfect than what we have. The British system would be less of a political headache, because it allows for private physician and clinic alternatives – something Canada forbids. 

So, given that every industrialized pluralist democracy in the world offers its citizens some form of universal health care access – as many different models as there are nation-states – why is it that we as Americans move in baby-steps into some sort of conservative plan involving health insurers and mandates? Why not just expand Medicare to all persons of every age, and make health insurance become something truly private and competitive, where you can buy enhanced coverage of some sort on an open market? In other words, if you need cancer treatments that would otherwise cost millions of dollars, you’ll never see a bill. If you want your hospital room to have a spa in it, you can pay extra for that. 

Our revolution was fought to replace a colonial feudalism with bourgeois meritocracy. Expanding health care to all Americans, including the middle class, is something we’ve discussed as a country since the end of World War II. People still, however, go bankrupt from medical bills in what is billed as the greatest superpower in Christendom. It is that – not the notion of “socialized medicine” – which is the disgrace. 

 

Things for Thursday

6 comments

A few things I found online in the last few days: 

1. Remember a few weeks ago, when NRA CEO and infamous goon Wayne LaPierre blamed everything but guns on the massacre of teachers and first graders at the Sandy Hook Elementary School in Newtown, CT? LaPierre didn’t just stumble on being a hateful lunatic – this is something that is apparently part of his job qualifications. Back in 1995, after the Oklahoma City bombing perpetrated by WNY native Timothy McVeigh, LaPierre said things so horrible and conscious-shocking that former President George H.W. Bush publicly rebuked him and resigned his NRA membership. Bush wrote, 

I was outraged when, even in the wake of the Oklahoma City tragedy, Mr. Wayne LaPierre, executive vice president of N.R.A., defended his attack on federal agents as “jack-booted thugs.” To attack Secret Service agents or A.T.F. people or any government law enforcement people as “wearing Nazi bucket helmets and black storm trooper uniforms” wanting to “attack law abiding citizens” is a vicious slander on good people.

Al Whicher, who served on my [ United States Secret Service ] detail when I was Vice President and President, was killed in Oklahoma City. He was no Nazi. He was a kind man, a loving parent, a man dedicated to serving his country — and serve it well he did.

In 1993, I attended the wake for A.T.F. agent Steve Willis, another dedicated officer who did his duty. I can assure you that this honorable man, killed by weird cultists, was no Nazi.

We can have a debate and discussion about guns, gun rights, and limitations on both – but calling people Nazis isn’t part of it. 

2. When it came to slavery, Thomas Jefferson was kind of a jerk. He was kind to some (especially if there were rapes to be had), and particularly cruel to others. He was happy to take out mortgages against his slaves, to have them flogged, and even refused to carry out a request contained in Polish General Kosciusco’s will, wherein money was set aside for Jefferson to buy out and free his slaves.  

The critical turning point in Jefferson’s thinking may well have come in 1792. As Jefferson was counting up the agricultural profits and losses of his plantation in a letter to President Washington that year, it occurred to him that there was a phenomenon he had perceived at Monticello but never actually measured. He proceeded to calculate it in a barely legible, scribbled note in the middle of a page, enclosed in brackets. What Jefferson set out clearly for the first time was that he was making a 4 percent profit every year on the birth of black children. The enslaved were yielding him a bonanza, a perpetual human dividend at compound interest. Jefferson wrote, “I allow nothing for losses by death, but, on the contrary, shall presently take credit four per cent. per annum, for their increase over and above keeping up their own numbers.” His plantation was producing inexhaustible human assets. The percentage was predictable.

In another communication from the early 1790s, Jefferson takes the 4 percent formula further and quite bluntly advances the notion that slavery presented an investment strategy for the future. He writes that an acquaintance who had suffered financial reverses “should have been invested in negroes.” He advises that if the friend’s family had any cash left, “every farthing of it [should be] laid out in land and negroes, which besides a present support bring a silent profit of from 5. to 10. per cent in

this country by the increase in their value.”

The irony is that Jefferson sent his 4 percent formula to George Washington, who freed his slaves, precisely because slavery had made human beings into money, like “Cattle in the market,” and this disgusted him. Yet Jefferson was right, prescient, about the investment value of slaves. A startling statistic emerged in the 1970s, when economists taking a hardheaded look at slavery found that on the eve of the Civil War, enslaved black people, in the aggregate, formed the second most valuable capital asset in the United States. David Brion Davis sums up their findings: “In 1860, the value of Southern slaves was about three times the amount invested in manufacturing or railroads nationwide.” The only asset more valuable than the black people was the land itself. The formula Jefferson had stumbled upon became the engine not only of Monticello but of the entire slaveholding South and the Northern industries, shippers, banks, insurers and investors who weighed risk against returns and bet on slavery. The words Jefferson used—“their increase”—became magic words.

Jefferson’s 4 percent theorem threatens the comforting notion that he had no real awareness of what he was doing, that he was “stuck” with or “trapped” in slavery, an obsolete, unprofitable, burdensome legacy. The date of Jefferson’s calculation aligns with the waning of his emancipationist fervor. Jefferson began to back away from antislavery just around the time he computed the silent profit of the “peculiar institution.”

And this world was crueler than we have been led to believe. A letter has recently come to light describing how Monticello’s young black boys, “the small ones,” age 10, 11 or 12, were whipped to get them to work in Jefferson’s nail factory, whose profits paid the mansion’s grocery bills.

Much of the information in this Smithsonian story has been carefully excised from our Jefferson hagiography because 150 years later, we still can’t come to terms as a country with our history of slavery and racial animus and discrimination. 

3. Just because you employ someone doesn’t mean you have the right to inject your own opinions on their healthcare decisions. Hobby Lobby, which has two outlets in western New York, has gone to the Supreme Court to seek injunctive relief so that it would not have to provide health insurance coverage for contraception for its employees under Obamacare. Why their employees’ sex lives are any of Hobby Lobby’s business is a mystery for sure, but Obamacare doesn’t force Hobby Lobby to hand out the morning after pill with every paycheck – it merely requires the health insurers to offer contraceptive coverage. Aside from the fact that the employees affected work for Hobby Lobby, the company has no further mandate set upon it. If it doesn’t agree with contraception, it is free to hold that belief, but should not be free to impose it on its employees, or to have its employees’ rights become less than those of workers elsewhere. Justice Sotomayor rejected Hobby Lobby’s request for injunctive relief. As a shopper for crafty things and toys for grownups, you may choose to use this information to direct your hobby dollars accordingly. 

 

The 47% and Irony

26 comments

Let’s personalize Mitt Romney’s denigration of the 47%. 

Cindy Nerger went to her local Kroger’s to pick up groceries for her family. She paid using her food stamps, but the cashier and then the store manager said that she still owed $10. Ms. Nerger replied that this was not possible, because she knew that food stamps covered everything she had bought. To this, the store manager replied, “Okay, just give it to her.” Nerger said, “see, I told you it was covered by food stamps,” to which the manager replied, “excuse me for working for a living and not relying on food stamps!'”

Granted, it was likely one of the few times the manager of a Kroger’s in the middle of Georgia was able to lord it over anyone else, but still.

When the manager insulted her in that way, Nerger turned and saw the other people in line, felt humiliated, and left the store in tears. 

Moocher. 

But here’s the thing. 

Nerger said she started receiving food stamps, formally known as the Supplemental Nutrition Assistance Program, when she became eligible for Medicare and Social Security Supplemental Income because of kidney failure in 2008. While she waits for a kidney transplant, she cannot work because of daily 12-hour dialysis treatments. Her husband runs a carpentry business. “If he doesn’t get a call [for a job] we don’t have any extra money for the month,” she said.

Food stamps have been a hot issue in the presidential campaign, with Republicans labeling President Barack Obama the “Food Stamp President” and charging that Obama has deliberately increased dependency on government. The Great Recession and its aftermath have pushed SNAP enrollment to 46.6 million, up from 34 million at the same time in 2009.

Heartbreaking, right? Well, here’s the other thing:

However much the campaign issues might resonate in her personal life, Nerger said she doesn’t have cable and hasn’t been following politics or the presidential election. Still, she doesn’t think much of either Obama or his Republican opponent, Mitt Romney.

“They’re all gonna kill us,” she said. “Most of the people that we have to choose from — Obama with his spending and his health care reform, and then Mitt Romney, he just wants to let poor people die, so either way we’re doomed. So I don’t see any point in voting.”

Scroll back up to the part where she’s a Medicare recipient. She is a beneficiary of a federally run single-payer health insurance program and denigrates Obamacare and “spending”.

WTF, people. 

Chris Collins: Repeal Consumer Protections

5 comments

This morning, on my way to work, I caught a WBFO interview with Republican candidate for Congress, Chris Collins. The lies and misinformation reveal that Collins is either misinformed, trying to dupe his prospective constituents, or both. 

Collins suggested that the Affordable Care Act, or Obamacare, is exactly like the Canadian single-payer Medicare system. While Obamacare is many things, many of which are open to debate and criticism, one thing it decidedly is not is anything resembling what Canadians enjoy*. 

*Yes, enjoy. 82.5% of Canadians in a recent poll indicated that they were “very satisfied” or “somewhat satisfied” with their health care system. 86% of them wanted the current system strengthened through public initiative, rather than privatized. American politicians can denigrate a Canadian system that is wildly popular with Canadians.  By contrast, a 2007 Gallup poll found that only 57% of Americans were satisfied with whatever private or public insurance they had.  By contrast, our own domestic single-payer Medicare plan, available only to seniors,  Whereas in 2007 45% of people with expensive private coverage reported problems with access to care, and 35% reported problems with billing, only 18% of Medicare recipients reported access problems, and only 14% reported any billing issues.  A 2010 Suffolk University poll revealed that 94% of American Medicare recipients are satisfied with their socialist, Canadian-style, single-payer plan. 

He went on to say that he hopes that Romney becomes President, and that that Republicans maintain their House majority, and add three Senate seats so that they can “completely” dismantle and repeal Obamacare. In its place, Collins suggested insurer competition across state lines, and minimizing injured patients’ access to the courts to seek redress for medical malpractice. Both of these “solutions” would hardly put a ding in the overwhelming cost of health care in this country, and would do absolutely nothing to guarantee universal coverage, or to shut the emergency room-as-primary care payment budget hole that our taxes fill. 

But the question that wasn’t asked is, what would result from an immediate repeal of Obamacare? Here are the provisions that have already become active: 

  • Expand the FDA’s ability to approve more generic drugs (making for more competition in the market to drive down prices) ( Citation: An entire section of the bill, called Title VII, is devoted to this, starting on page 766 )

  • An increase in the rebates on drugs people get through Medicare (so drugs cost less) ( Citation: Page 235, sec. 2501 )

  • Established a non-profit group, that the government doesn’t directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. ( Citation: Page 684, sec. 1181)

  • Requires chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. ( Citation: Page 518, sec. 4205 )

  • Creates a “high-risk pool” for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of “pre-existing conditions” altogether. For now, people who already have health issues that would be considered “pre-existing conditions” can still get insurance, but at different rates than people without them. ( Citation: Page 49, sec. 1101, Page 64, sec. 2704, and Page 65, sec. 2702 )

  • Forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that) ( Citation: Page 66, sec. 2705 )

  • Renews some old policies, and calls for the appointment of various positions.

  • Creates a new 10% tax on indoor tanning booths. ( Citation: Page 942, sec. 5000B )

  • Forbids health insurance companies from telling customers that they won’t get any more coverage because they have hit a “lifetime limit”. Basically, if someone has paid for health insurance, that company can’t tell that person that he’s used that insurance too much throughout his life so they won’t cover him any more. They can’t do this for lifetime spending, and they’re limited in how much they can do this for yearly spending. ( Citation: Page 33, sec. 2711 )

  • Allows children to continue to be covered by their parents’ health insurance until they’re 26. ( Citation: Page 34, sec. 2714 )

  • Eliminates “pre-existing conditions” exclusions for kids under the age of 19. ( Citation: Page 64, sec. 2704 and Page 76, sec. 1255 )

  • Limits insurers’ ability to change the amount customers have to pay for their plans. ( Citation: Page 66, sec. 2794 )

  • Helps close the “Medicare Gap” by paying rebates to make up for the extra money they would otherwise have to spend. ( Citation: Page 398, sec. 3301 )

  • Prohibits insurers from dropping customers once they get sick. ( Citation: Page 33, sec. 2712 )

  • Requires insurers to be transparent about fees. (Instead of just “administrative fee”, they have to be more specific).

  • Requires insurers to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they’re turned down. ( Citation: Page 42, sec. 2719 )

  • Increases anti-fraud funding, and new ways to stop fraud are created. ( Citation: Page 718, sec. 6402 )

  • Medicare extends to smaller hospitals. ( Citation: Starting on page 363, the entire section “Part II” seems to deal with this )

  • Medicare patients with chronic illnesses must be monitored more thoroughly.

  • Reduces the costs for some companies that handle benefits for the elderly. ( Citation: Page 511, sec. 4202 )

  • A new website is made to give people insurance and health information. (http://www.healthcare.gov/ ). ( Citation: Page 55, sec. 1103 )

  • A credit program is made that will make it easier for business to invest in new ways to treat illness by paying half the cost of the investment. (Note – this program was temporary. It already ended) ( Citation: Page 849, sec. 9023 )

  • A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they’re not price-gouging customers. (Citation: Page 41, sec. 1101 )

  • A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn’t paying for the Aspirin you bought for that hangover. ( Citation: Page 819, sec. 9003 )

  • Employers need to list the benefits they provided to employees on their tax forms. ( Citation: Page 819, sec. 9002 )

  • Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge. ( Citation: Page 33, sec. 2713 )

What the ACA really amounts to is a consumer protection act. While Collins and his ilk will call this a job-killing tax on the middle class, or something, it really amounts to a prohibition against insurance companies from engaging in predatory practices against its ratepayers. It provides better protections for consumers.  

The question is – why does Chris Collins want to repeal all of the consumer protections that have gone into effect? 

Collins also suggested that an extension of the Bush-era tax cuts should be extended to all Americans, including him and those like him with millions in income. The Obama plan would extend those tax cuts only to the middle class, and revert back to Clinton-era, pre-9/11 rates for those making more than $250,000 per year. 

Under Bill Clinton, unemployment dropped steadily from over 7% in 1993 to 4.4% by the late 90s. To suggest, therefore, that reverting tax rates to what we had in the 90s would stymie employment growth versus the situation we have now – with anemic jobs growth and the Bush tax cuts in place – strains credulity. 

Collins suggested that reverting to the Clinton-era tax rates for those making over $250,000 per year would be a “wet blanket” on job growth. However, only 3.5% of small businesses – mostly professionals like doctors and lawyers – would be affected by this change. An op/ed in the Washington Post goes into more detail here. 

Chris Collins opens his mouth and finds himself wrong again. Almost like it’s a pattern or something. 

Independence Week: Roundup

9 comments

Obamacare Roundup

1. Here’s a story from those leftist pinkos at Forbes, explaining that Obamacare is not a huge tax on the middle class, at all. In fact, it goes as far as to call that narrative a “lie”. 

2. In the wake of the Supreme Court holding that Obamacare is constitutional, support for the law has jumped.  Significantly, support among independents went up from 27% to 38% in just the past week. It was just a week ago that Mitt Romney was explaining that Romneycare (the conservative Heritage Foundation’s health insurance scheme on which Obamacare is largely based) was great for Massachusetts, but that its expansion to all 50 states was an improper usurpation of federal power. However, the Supreme Court just held otherwise. Oopsy. By the same token, people who dislike the law are somewhat energized now. 

3. It wasn’t too long ago – at least as far back as the debate over HillaryCare in the early 90s – that universal health care coverage was a bipartisan goal, we just disagreed on how to get there. Now that we have a constitutional statute that gets us about as close to universality as we’re likely to get, the Republicans are signaling that they no longer consider universal coverage as a policy aim. Senator Mitch McConnell (R-KY) says, in essence, that the 30 million people whom Obamacare would cover, and who would not be covered were the law to be repealed, can go to hell.  

4. Mitt Romney and congressional Republicans all pledge to repeal Obamacare. Did you know that 30 votes have been held in Congress since 2010 to repeal Obamacare? What’s one more going to accomplish? How many jobs will that create? And pay close attention to what Republicans say when asked, “with what would you replace Obamacare?” The answer is – nothing. They’d just maintain the pre-2010 status quo, with 40 million uninsured, skyrocketing costs, substandard care, and an untenable hodgepodge of private for-profit bureaucracies keeping people from their doctors and needed treatment, and separating them from their money – oftentimes rendering them insolvent. 

5. Paul Ryan, Republican Chairman of the House Budget Committee shat the following from his mouth: 

“I think this at the end of the day is a big philosophy difference. We disagree with the notion that our rights come from government, that the government can now grant us and define our rights. Those are ours, they come from nature and God, according to the Declaration of Independence – a huge difference in philosophy.”

The right to have access to health care is, at its core, a pro-life notion, isn’t it? Any politician who turns to Jesus or God, (and uses the Declaration of Independence, a document that has no legal effect in 2012), as justification to essentially leave millions of Americans with a choice between death or bankruptcy, shouldn’t pontificate about what God would and wouldn’t do. 

Carl Emails, WNY Yawns

6. Did you get emails from Carl Paladino threatening to “expose” former Senator Al D’Amato for being a “predator” because he’s aligned with people like Mark Grisanti and Joel Giambra, and because he supposedly helped Cuomo pass same sex marriage? So did I. I deleted them. Seriously, who cares what that person says? 

Fast & Furious: NRA Flip & Hochul Votes for Contempt

7. Last week, Congress held a vote to hold Attorney General Eric Holder in contempt of Congress. Of course, about 88% of Americans hold Congress in contempt, but that’s beside the point.  Many Democrats walked out during the vote, charging that it was just a witch hunt. Among the few Democrats who not only stayed, but voted in favor of the contempt order was Kathy Hochul (NY-26). I think the Fast & Furious inquiry is a load of nonsense, and a purely political stunt designed to harm the administration; politics as usual. What follows in blockquote below is what Hochul released to explain her vote, but answer me this: a lot of gun enthusiasts link Fast and Furious to 2nd Amendment rights. I don’t really get why, and since I’m not a gun fetishist I don’t particularly care. But the first thing an NRA type will tell someone who is in favor of gun control is that, “guns don’t kill people, people kill people.” Yet, the entire focus of the Fast & Furious inquiry is about the guns that ended up in the possession of Mexican drug cartel members who then used one to murder a Border Patrol Agent in Arizona. A horrible crime, to be sure – but it was committed by a criminal. Is the NRA now standing “guns don’t kill people” on its head because it suits their political aim of attacking Obama? Shall we add an asterisk, “guns don’t kill people, people kill people* [*except in cases where the gun was purchased by the Justice Department in furtherance of an investigation into where Mexican drug cartels get their weapons, and one of those weapons disappears and is used in a particularly horrible crime, in which case the gun killed the agent, not the narco-killer].”

 “We can all agree that the Fast and Furious operation was ill-conceived and the death of U.S. Border Patrol Agent Brian Terry was an avoidable tragedy. Now, our objective must be to evaluate the facts and work to prevent such an event from ever happening again,” said Hochul. 

“At a time when our country is facing significant economic challenges, it’s disappointing that both parties have, yet again, become distracted by Washington politics.  The people of Western New York deserve a transparent government, regardless of which party is in control.  Congress has a constitutional responsibility to exercise appropriate oversight, and I believe Attorney General Eric Holder should fully disclose the documents requested and allow this issue to be resolved.”

What I see is a conservative Democrat staving off any accusation that she’s weak on the 2nd Amendment – an issue about which her opponent in November has proven himself to be somewhat weak. I also see a Republican congress that continues its singular mission of harming the President at all costs, even if it collaterally does harm to average Americans or the country in general. 

ECDC: GOOD PR, BAD PR

8. On Friday, the Erie County Democratic Committee sent out two press releases. One likened the execrable Chuck Swanick, who is incredibly running to return to elected office, to Mitt Romney, calling the two “peas in a pod”. Swanick’s a lot of things – most of them negative – but he’s nothing like Romney, even remotely. The second release was much, much better. Remember how Chris Collins ran for County Executive re-election by touting how, under his “leadership”, he’d extricated the county from the hospital business? Yeah, about that – 

In 2011, Collins campaigned on the promise that Erie County was out of the hospital business, but clearly he was mistaken. The troubling news that Erie County Medical Center will cost nearly $39 million this year alone, more than double the “fixed” cost that Chris Collins promised taxpayers in 2009, raises serious questions about Collins’ ability as a manager and executive.Erie County deserves a full explanation from Chris Collins over the creation of a deal that has come back to bite taxpayers to the tune of more than $38 million over three years.

That’s 39 million reasons why the county isn’t out of the hospital business, no thanks to the guy now running against Kathy Hochul to essentially gain what passes for a noble title in America, and also to obtain subsidized federal health benefits while denying them to his constituents, and to supplement his already ample income with taxpayer dollars in the form of salary, fringe benefits, and other legacy costs. Conservative!

 

Obamacare: The Mandate And the Taxing Power

33 comments

Oftentimes, the federal government finds itself wanting to promote a certain behavior as part of a national program, but without the direct power to do so. By way of example, in the 1980s, the Reagan Administration decided that it wanted the drinking age to be raised from 18 to 21 nationwide. But the drinking age isn’t a federal, but a state statute. In order to persuade states to raise the drinking age, the federal government passed an incentive plan. If a state failed to raise its drinking age to 21, it would find itself with a diminution in federal highway funding. 

“The power to tax involves the power to destroy”, wrote Chief Justice John Marshall in 1819. With respect to the Affordable Care Act, or “Obamacare”, the power to tax also involves the power to build something. Under the law, beginning in 2014, Congress will require most Americans to obtain health insurance, or – if you don’t, you pay a fine to the government. The mandate was, ironically, a precondition set by the insurance industry, without which they would not be able to economically justify offering insurance to people with pre-existing conditions at no penalty.

The key part of Chief Justice Roberts’ opinion yesterday reviewed the constitutional justification for that mandate to purchase health insurance.  Congress’ powers are specifically limited and enumerated in Article 1 of the Constitution. 

Roberts turned first to the Commerce Clause (Article 1, Section 8), whereby Congress has the power to “regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes.”  Roberts rejected the argument that the government could regulate the absence of commerce; you cannot regulate that which does not exist.  His analysis seems somewhat limited, however. After all, there is not a personal alive who isn’t engaged in the health care market now, or inevitably. Even if you’re not seeking medical care, you’re paying for others’. 

Right now, you and I (and everybody) are taxed to help pay for uninsured people’s emergency room visits. ERs can’t turn people away, and oftentimes the poor and uninsured use them for primary care.  Those hospitals seek reimbursement for the cost of providing those services through two Federal Programs, Disproportionate Share Hospital (DSH) and Upper Payment Limit (UPL)–that require a 50% local share match. So…instead of forcing the cost of health care provision onto the people who don’t have insurance, you (a taxpayer, or a person with insurance) are paying for them to get health care with both your federal and county tax dollars. 

Secondly, Roberts turned briefly to the “Necessary and Proper” Clause, also in Article 1, Section 8, it reads, “The Congress shall have Power – To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof.”  Roberts declined to go along with this, reasoning that…

Each of our prior cases upholding laws under that Clause involved exercises of authority derivative of, and in service to, a granted power. For example, we have upheld provisions permitting continued confinement of those already in federal custody when they could not be safely released…[t]he individual mandate, by contrast, vests Congress with the extraordinary ability to create the necessary predicate to the exercise of an enumerated power.

And so, the last resort – the “in the alternative” argument – was most persuasive to the 5 members of the Court who voted to maintain the ACA mandate. The very first Congressional power enumerated at Article 1, section 8 involves the power to tax and spend. Roberts wrote that Congress’ mandate isn’t the issue – it’s the “penalty” imposed on people who refuse to purchase insurance. While the dissent argued that the government is semantically blocked from calling the “penalty” a “tax”, Roberts argued that the word “penalty” assumes some sort of fine for illegality. Yet the refusal to purchase insurance isn’t illegal – it isn’t a crime. It is merely a choice, and a person’s choice to opt to pay a tax instead of buying insurance is one that government can regulate under its taxing power. 

…the Government asks us to read the mandate not as ordering individuals to buy insurance, but rather as imposing a tax on those who do not buy that product…

…None of this is to say that the payment is not intended to affect individual conduct. Although the payment will raise considerable revenue, it is plainly designed to expand health insurance coverage. But taxes that seek to influence conduct are nothing new. Some of our earliest federal taxes sought to deter the purchase of imported manufactured goods in order to foster the growth of domestic industry

Because Roberts invoked the taxing power, dumber pundits and lazy politicians have pivoted to calling it all – the whole law – a “huge tax”.  Perhaps they should read the law, and then read the Court’s opinion. It’s not a “huge tax”. It’s a mandate that you have health insurance. Chances are, you already have it – it’s not like you’re being forced to buy super-more health insurance on top of what you may already have. And if you don’t have it, you’ll have much easier and cheaper access to health insurance. And if you choose not to have any at all, then you’ll be assessed a fine, a tax, whatever you want to call it. 

The ACA’s “shared responsibility payment”  is a tax only on people who choose not to hold insurance. Anyone who says otherwise is ignorant, mistaken, and/or lying. 

With the mandate in place, no longer will the person without health care get away with not paying hospital bills, and no longer will taxpayers be “mandated” to subsidize those choices. Instead, the person making the choice to avoid insuring himself will be assessed a tax in the eventuality that he becomes ill and can’t afford to pay his bill. Do you want the person without health care to be taxed, or do you want to continue to be taxed because they don’t have health care?

In the olden days, “personal responsibility” was a conservative talking point.  Now, we’re essentially codifying it through Obamacare – you’re responsible to get coverage, or for the consequences if you don’t. Now? 

The remaining portions of the decision dealt with (a) the Court’s analysis of whether the issue was ripe for decision (it is); (b) whether striking the mandate meant invalidating the whole law (they didn’t have to reach it); and (c) a provision dealing with the expansion of Medicaid, holding that States can reject federal funding and therefore not comply with the new rules. 

The misinformation and disinformation being spread over the last 24 hours has been simply mind-blowing. For instance, here’s a fundraising email that Republican congressional candidate Chris Collins (who, incidentally, never, ever has to worry about not being able to afford anything, ever, including health care) sent yesterday: 

Dear friend,

The Supreme Court has confirmed what we already knew – ObamaCare is nothing more than a massive tax increase that will hurt hardworking families and continue to act as a wet blanket on economic growth and job creation.

Today, I’m asking for your donation of $27 dollars to protect the residents of the 27th Congressional District from this massive tax hike and help end ObamaCare.

I need your help to stop Kathy Hochul and Barack Obama from raising taxes on thousands of Western New York and Finger Lakes families. 

$27. 

$27 is how we can protect our families in the 27th Congressional District from massive tax increases.

When I go to Congress, my first order of business will be to lead the fight to repeal ObamaCare and replace it with common sense solutions that protect seniors and don’t crush small businesses and cost us jobs.

$27 can get us there.

Whether it’s $27, or $5, $10, $50 or $100 – anything you can do to help us stop Barack Obama and Kathy Hochul from raising taxes and cutting Medicare by $500 billion is so important.  Will you consider donating today?

There’s so much at stake, and I need your help.

Sincerely,

CHRIS COLLINS

Congressional Candidate, NY-27

No, it’s not one side or another that won or lost – everybody won. Everybody will benefit from the implementation of Obamacare. It isn’t at all a huge tax increase, and the only reason Medicare funding goes down is because the ACA picks up the slack. Obamacare isn’t a “huge tax increase”, indeed it will help families by reducing the most common type of bankruptcy – ones brought about through medical expenses. Is this law a boon to insurers? Yes. That’s why many progressives didn’t like it much, and that’s why the law is something of a Frankenstein’s monster. But Obamacare, like its progenitor, Romneycare, is a fundamentally conservative idea. Because it’s been adopted by a Democratic President whom the Republicans are determined to ruin, it is now characterized as something it’s not. 

And make no mistake – the Republican drive to ruin Obama is so concentrated and driven, that it doesn’t matter what collateral damage there is to average Americans, or the economy. 

It’s not surprising to see a politician lie, but when mere puffery, (“I’m the best”), turns into brazen lying, (“I poop rainbows and spit unicorns”), you have to wonder what the politician thinks of the people who are going to vote for him. I heard some of our right-wing omniphobe media personalities liken the United States under the ACA to North Korea. There was heavy emphasis on “Hussein” yesterday, because “Hussein” is a foreign, Muslim name, and because somehow that correlates with socialism. Or something. I wish I was a professional psychologist so I could better analyze what was taking place.  Even Mitt Romney noted that the Court didn’t hold that Obamacare was a “good policy”. That’s jaw-droppingly dumb – Palin dumb. 

Requiring Americans to buy private health insurance from private corporations is socialist? Spreading the risk across most Americans so that health insurers can’t refuse to insure people with pre-existing conditions is like living in a Stalinist dictatorship with no market, no freedom, no food, no money, closed borders, and extensive gulags? How dumb. Almost as dumb as the many people who took to Twitter to decry the loss of America’s freedom and announce that they’d move to Canada, which has true single-payer socialized medicine. 

Set aside the crazies and the liars – Americans won today. The ACA – Obamacare – isn’t a perfect solution. No solution is perfect, after all. But it will make our health insurance in this country more affordable, with better coverage, and no longer will you live at the mercy of health insurance companies, fearing arbitrary rate hikes, lifetime payout maximums, or being barred from buying insurance due to a pre-existing condition if you change your job. This is good for people. 

[youtube http://www.youtube.com/watch?v=b5zU1y_0Geo]

ObamaThread: MANDATE UPHELD UPDATE

13 comments

If you haven’t already read about how Bain Capital’s buy ’em, gut ’em, and outsource ’em M.O. destroyed a healthy, longstanding WNY business, and you haven’t already been informed about how Mitt Romney made his millions by doing that repeatedly, over and over again, then you should go and do that. 

In the meantime, the big news today will be what the politicized, partisan, conservative-activist Supreme Court will do with the Obamacare mandate to buy health insurance. Will it be ruled unconstitutional? If so, will it render the whole law a nullity, or will it be severed from the remainder of the law? If severed, will the law be able to be maintained? 

The fundamental brokenness of our idiotic, inefficient, Balkanized way of paying for health care that isn’t even the best in the world is one of the big failures of the post-WW2 era. As postwar Europe built its social safety nets, the US couldn’t get out of its own way to do the same. The 1964 law creating Medicare and Medicaid was originally supposed to provide all Americans with universal health care. It never happened. Soshulizm. 

So, instead, we operate under a largely for-profit form of privatized socialism. (Yes, insurance is socialism – it’s the redistribution to claimants of wealth earned from premiums). 

The United States, as we all know, is the last remaining western pluralist democratic capitalist country that does not guarantee free health care to all of its citizens. Obamacare taught us a lot. It taught us that a mixed-race Democratic President can propose a fundamentally conservative health care reform bill, manipulate changes to it to try and obtain buy-in from people who had very recently proposed it, and still the Republicans would vote against it uniformly because it would do political harm to said President.

It highlighted that politics trumps policy; that obstruction trumps governing.

Maybe – just maybe – the failure of the Frankencompromise of Obamacare will lead to a massive push to abolish Medicaid and expand Medicare to all Americans. 

Medicare for all Americans. A program that is uniquely popular, has very low overhead, and would be voluntary. People like Mitt Romney and Chris Collins could continue to buy health insurance from private companies and be Lear-Jetted to gold-encrusted, faraway clinics, if they wish. But taking away the average American’s expenses for health care would do wonders for the economy. Taking away businesses’ responsibility to provide elaborately complicated and ridiculously expensive private health care options would also be able to increase efficiency, productivity, and profitability. 

It would be a single-payer system for those who want it. For those who don’t, buy something different – not dissimilar from the English model, rather than the far less flexible Canadian model. You know, Canada, which has a really good economy, little corruption, no bank collapse, and more or less the same freedoms we enjoy. 

This is a SCOTUS Obamacare ruling open thread. Enjoy your Thursday. 

UPDATE: The individual mandate, and Obamacare, is upheld as a constitutional use of congressional taxing power with respect to the penalty for not buying health insurance. 

Hochul: 

“Today’s Supreme Court ruling provides much needed clarity in an important national debate on the appropriate role of the federal government in the delivery of healthcare. While I was not in Congress to vote on the Affordable Care Act, I have always believed, and continue to believe, that the law is far from perfect, and I remain concerned about the high cost of implementing the law.  That is why I have worked to roll back many of its most troubling provisions, including the financially unsustainable CLASS Act, the Medical Device tax, and the Independent Payment Advisory Board, which could result in the rationing of Medicare.

 “I am hopeful that today’s ruling will help to focus our country on the need for more effective policies that drive down the cost of care and ensure that all Americans—especially children, seniors and veterans—have access to quality and affordable health care.  I stand ready to work with my colleagues on both sides of the aisle to continue to improve the law and find appropriate solutions to the rising cost of health care in this country.”

Higgins: 

“Today the Supreme Court, in an opinion authored by Chief Justice John Roberts, held that the Affordable Care Act is constitutional. Under the law, this year over 3 million New Yorkers have begun receiving free preventative care, over 3,000 New Yorkers with pre-existing conditions are no longer denied health insurance coverage, 160,000 young adults in New York State are now receive health coverage through their parents’ plan, and 254,083 New York State seniors on Medicare are saving an average of $655 on their prescription medications.

“The old way of doing business was unaffordable, unacceptable and unsustainable for taxpayers and patients alike. Despite exorbitant expense, according to the World Health Organization, the United States is 37th of 192 countries in terms of overall healthcare quality.

“The Western New York health community is already leading the way on health reform. They have embraced electronic medical records and the formation of comprehensive care organizations. This law gives Western New York the tools we need to go farther and it gives the rest of the country the opportunity to follow our lead.

“Much of the Affordable Care Act was modeled on the Cleveland Clinic standard, care Western New Yorkers frequently travel to receive.  Cleveland Clinic quality care is the health care I want for my family, my community and my nation.”

Slaughter:

Congresswoman Louise Slaughter (NY-28) today applauded the Supreme Court’s decision which upheld the life-saving provisions of the Affordable Care Act. Slaughter, one of the leading supporters of the ACA, has been in the forefront of the effort to improve access and quality of health care for American families.

 “I am very pleased that the Supreme Court has upheld the landmark Affordable Care Act,” said Slaughter. “I was proud to bring this bill to the floor of the House of Representatives as Chairwoman of the Rules Committee in 2009, and I continue to be proud of the ways in which the law has improved health care access for millions of Americans. We worked long and hard to protect Medicare’s guarantee of quality health care for our seniors and to make health care more affordable for American families. The ACA also ensures that being a woman is no longer a pre-existing condition and a justification for higher premiums.

 “This groundbreaking legislation was never about politics – it was about saving lives and safeguarding the health and wellbeing of American families. I know that much work remains to be done but I am gratified to know that we are a step closer to ensuring that no American will live in fear of losing their home and everything they own because they or a member of their family is stricken by illness.”

 Because of the provisions of the Affordable Care Act, Americans are already seeing lower costs and better coverage: 

  •          54 million Americans in private plans have received one or more free preventive services.
  •          In addition, in 2011, 32.5 million seniors received one or more free preventive services.  So far in 2012, 14 million seniors have already received these services.
  •         105 million Americans no longer have a lifetime limit on their coverage.
  •         Up to 17 million children with pre-existing conditions can no longer be denied coverage by insurers.
  •         6.6 million young adults up to age 26 have taken advantage of the law to obtain health insurance through their parents’ plan, of whom 3.1 million would be uninsured without this coverage.

     

  •         5.1 million seniors in the ‘donut hole’ have saved $3.2 billion on their prescription drugs, an average of $635 per senior.

     

  •         In 2011, 2.3 million seniors had a free Annual Wellness Visit under Medicare.  So far in 2012, 1.1 million seniors have already had this free visit.
  •          In 2011, 360,000 small employers used the Small Business Health Care Tax Credit to help them afford health insurance for 2 million workers.

 Slaughter is a champion of the life-saving changes that have been implemented as a result of the Patient Protection and Affordable Care Act.  Thanks to these lifesaving provisions, children can stay on their parents’ insurance until the age of 26, insurance companies can no longer deny a person health insurance, and millions of seniors now have free access to life saving health care- all while reducing the federal deficit by billions of dollars.

 Thanks to the Affordable Care Act, in New York’s 28th district:

·         5,500 young adults in the district now have health insurance. 

·         10,400 seniors in the district received prescription drug discounts worth $6.7 million, an average discount of $640 per senior. 

·         70,000 seniors in the district received Medicare preventive services without paying any co-pays, coinsurance, or deductibles. 

·         22,000 children and 100,000 adults now have health insurance that covers preventive services without paying any co-pays, coinsurance, or deductibles. 

·         430 small businesses in the district received tax credits to help maintain or expand health care coverage for their employees. 

·         $10.9 million in public health grants have been given to community health centers, hospitals, doctors, and other healthcare providers in the district to improve the community’s health. 

·         7,000 to 32,000 children with preexisting health conditions can no longer be denied coverage by health insurers.

CNN, the Buffalo News, Channel 2 all reported incorrectly that the mandate had been stricken.

 

 

WBEN texted people that the mandate had been stricken and didn’t fix the error for over an hour.

Happy Birthday, Romneycare!

2 comments

Six years ago, Massachusetts’ then-Governor Mitt Romney signed the Commonwealth’s universal health insurance act into law. Try as Romney might, there is no doubt whatsoever that Obamacare directly descends from Romneycare – it is the Massachusetts plan writ large and federalized. Six years is the half-life, apparently, where a conservative path towards universal coverage becomes socialism. 

But Romneycare has resulted in an almost 100% coverage rate in Massachusetts, and though not perfect, has been dubbed a success story. 

Yet the 2012 model of Mitt Romney has nothing whatsoever to say about Romneycare on its sixth anniversary in the middle of a Presidential campaign. It’s his most significant and marketable achievement, and he’s painted himself into a rhetorical corner to avoid drawing attention to the similarities between Romneycare and Obamacare.  They’re almost identical. 

Romney’s argument in 2012 is that he’s proud of Romneycare, but disagrees with the notion that every state be required to follow one particular model. It’s the cowardly Republican’s disingenuous argument – when in doubt, go with state’s rights. The problem is that the crisis – really the shame – of uninsurance and underinsurance is a national one, one that requires a national response. The problems of medical bankruptcies (handled exclusively in federal courts), and of the uninsured using emergency rooms for primary care, the cost of which is then shunted onto taxpayers are national, federal issues. 

If Mr. Romney even believes these things to be problems needing solving, he should present a plan to fix them. If he wants to be true to his supposed 10th Amendment feelings, the federal government could simply mandate that states reach universal health insurance coverage, and let them each come up with their own ways to do so. 

I eagerly await President Obama to call Mr. Romney on this particular bluff. 

Well, Happy Birthday, Romneycare. Thanks for setting up the system that the federal government modified to apply to the entire country!

 

[youtube http://www.youtube.com/watch?v=WxZK0spa1yI]

1 2 3