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Does Lying Make Healthcare Simpler?

July 1, 2017 Leave a comment

Earlier this year, the President admitted that healthcare and healthcare reform are complicated.

The House of Representatives passed the American Health Care Act in May as its repeal and replace Obamacare offering to America. The Congressional print of the Affordable Care Act when finally passed as amended was over 900 pages; the AHCA came in at 130 pages — certainly, an attempt at a simpler healthcare environment.  The President described the AHCA as a “mean” and “cold-hearted” “son of a bitch.”

The Senate GOP leadership then proposed in June its Better Care Reconciliation Act of 2017.  If the number of pages makes a difference, the Senate’s bill, at 145 pages, is a little less simple than the House’s AHCA, but still much simpler than Obamacare.  The additional pages used in the Senate proposal, unfortunately, did not make the Better Care Act less mean — actually, the consensus is that the Better Care Act is “meaner” than the AHCA. The national negative reaction, along with a number of GOP Senators being unable to vote for the bill, resulted in the vote being postponed until later in July.

After the Senate vote was delayed, the President met with the GOP Senators at the White House for a pep talk of sorts, telling them that “This will be great if we get it done and if we don’t get it done it’s going to be something that we’re not going to like and that’s OK and I can understand that.” According to the President, “We have given ourselves a little bit more time to make it perfect.”

Then, in the hours that followed, the President forgot about healthcare’s complexity and focused his efforts on misinformation and misdirection.  When congratulating the Cubs  on their World Series victory, the President told reporters that “We’re going to have a big surprise. … We’re going to have a great, great surprise.”  The next day the President posted the following Tweet at 3:37 a.m., which I suppose was the surprise: “If Republican Senators are unable to pass what they are working on now, they should immediately REPEAL, and then REPLACE at a later date!”

Repealing Obamacare is extraordinarily complicated and would hurt many people — is the Senate, whose GOP members can’t muster 50 votes to pass an arguably harsh repeal and replace bill, able to get enough votes to pass a much harsher repeal bill?  Will Senators agree to repeal all protections for people with pre-existing conditions, and take away the right of adult children to stay on their parents’ insurance until they are 26, and terminate accountable care organizations, and rollback all Medicaid expansion and marketplace health plans, and stop all subsidies to people, and on and on?  Yes, repeal would attract the more conservative Senators, like Paul and Cruz, who want Obamacare and its regulations repealed, but would be opposed by many moderate Senators, like Collins, Capito, and Heller, who remain concerned about the negative impact on their states if Obamacare is drastically changed.

Statements by the President and GOP Senators and House members about the death of Obamacare, its imminent collapse and implosion, are the lies that have fueled the rush to repeal and replace.  These lies have been debunked by the CBO.  The challenges faced by Obamacare are largely because the GOP has refused to help fix the problems because  it and its members’ supporters (i.e., the insurance companies and the pharmaceutical industry) would rather go back to the ways things were by repealing Obamacare.

It is lie is that Obamacare is bad and must be repealed because of the collapsing insurance markets and the increasing premium costs.  Despite its flaws, Obamacare extended coverage, made sure that the sickest segments of our population would still be able to get affordable insurance, forced the insurance companies to actually spend their premium dollars on the health of their insureds, and required that all policies provide certaIn basic benefits so that the insureds actually had coverage after paying premiums.  If Obamacare had been allowed to work the way it was supposed, the individual and employer mandates would have made the pool of insureds bigger and reduced the rate of increase of premium costs.

It is a lie that the insurance markets are collapsing.  Insurers are dropping out of the markets because of their losses (i.e., reduced profits).  For years insurers have enjoyed artificially inflated profits by unilaterally reducing payments to physicians, hospitals, and other healthcare providers, by shifting the risk of insurance to the providers, and by denying benefits to insureds.  Obamacare required these insurers for the first time in a long to actually provide insurance, pay claims, and accept the risk of covering their sick insureds whose money they took for so long.  Insurers should never have been allowed to withdraw from the markets or a public option should have been provided — in any event, the struggle of the markets was orchestrated by insurance companies themselves, aided and abetted by the a GOP who refused to make necessary changes to Obamacare to address these problems.

A related lie is that things will be fine once we allow capitalism and the free market to work.  Who believes this?  Obamacare was the result of an out of control insurance industry abusing its customers in the manner described above.

The Wall Street Journal supports the Senate bill. In an editorial last week, the WSJ said “Repairing the failing individual insurance market, putting Medicaid on budget for the first time in the entitlement’s history, and passing an enormous pro-growth tax cut are historic opportunities.”  Do not ignore the fact that “putting Medicaid on a budget” means less or no care for people getting healthcare now or who will need it in the future.  If rationing healthcare is the goal, then state it plainly and let Americans decide if they ate prepared to have someone decide whose child goes without vaccines, whose grandmother is thrown out of the nursing home, and whose spouse with breast cancer goes untreated.  And this is the underpinning of another lie — the GOP has been telling us that its repeal and replace bills will improve healthcare for Americans.  However, the bills have nothing to do with healthcare other than to reduce its availability and affordability.

The biggest lie of the President and the GOP is that their proposals are what the people want and what they promised when they ran for election.  The great unpopularity of the GOP’s bills demonstrates that those bills are not what people who need health insurance want.  More important, the disconnect between the popular election rhetoric of repeal and replace and the dissatisfaction that voters express when presented with the effects of the GOP’s efforts at repealing and replacing shows that most Americans’ knowledge of Obamacare is still based on the 8 years of lies that the GOP has been telling about it — and continues to tell.

So, even though all of us know that healthcare is complicated, the President appears  convinced that lying will make it simpler and make it easier to tell the Trump core that another promise has been kept.  Making healthcare better should be about more than checking boxes on a list.

 

 

 

Interpreting Fiorina’s Comments on Vaccination Law

August 16, 2015 Leave a comment

The King Case and the Reach of State Legislatures

September 21, 2014 Leave a comment

On September 11, 2014, the Third Circuit Court of Appeals decided the case of King v. Governor of the State of New Jersey.

The King case deals with a New Jersey statute that prohibits licensed counselors from “sexual orientation change efforts” with clients under the age of 18.  The plaintiff-appellants, who provide licensed Christian-based counseling to minor clients seeking to reduce or eliminate same-sex attractions, challenged the N.J. statute as improperly violating their First Amendment freedoms of speech and religion.

The court affirmed the lower court’s upholding of the statute but on the basis of a much more conservative/protective analysis of the First Amendment rights.

The 3rd Circuit’s holding is in line with recent holdings from the 4th, 9th, and 11th Circuits that establish special rules for the regulation of speech that occurs pursuant to the practice of a licensed profession. (The 11th Circuit case dealt with the Florida gun-gag law on doctors.)

Though, unlike the other Circuits, the 3rd Circuit in King held that the statute must be subjected to “intermediate scrutiny” (as opposed to a more deferential review or no review) in order to “adequately protect the First Amendment interests inherent in professional speech.”

The take away here for me is that the reach of state legislatures has gotten bigger.  State legislatures are enacting laws that challenge/support the influence of religious groups (challenge, as in the King case) or political groups like the NRA (support, as in the Florida gun-gag case).  The Constitution has been a shield upholding intrusive laws that support very specific political agendas (e.g., pro-gay, pro-gun).  The politics of a state’s legislators, and the views of their supporters, will likely continue to trickle down to impact on what may be said to patients/clients by their counselors and by any other regulated professions.  I suspect that legislators will explore new ways to intrude on matters of individual choice and conscience that should be outside their interest or concern.

Race and the Health of America

August 30, 2014 Leave a comment

Jon Stewart on Race

This doesn’t have much to do about health law, but it does have to do with the long-term health of America.

I like to think that I am a caring and tolerant human being. I am also a White Anglo Saxon Protestant male. I have no ethnic background worthy of opinion one way or the other. I am plain white toast with margarine. I cannot comprehend what it is to live a life filled with fear and danger when simply going about activities of normal daily living. That is inexcusable in America, and it only can change by our being constantly reminded that the problem of prejudice is real and is affecting real people.

Racism is a virus.  Our health as a nation requires that virus to be obliterated.  The obliteration only happens when we as a nation refuse to tolerate racism — it does not matter how the racism shows itself.  Racial oriented jokes are more insidious sometimes than overt racist behavior.  People of good character must be willing to say enough is enough.  No more excuses and explanations about whether the person who was abused because of his race is somehow responsible the abuse.

It’s time for America to get healthy.

State Health Insurance Exchanges vs. the Immorality of Politics

August 17, 2014 Leave a comment

So, we have two decisions from two different U.S. Circuit Courts of Appeal, Halbig v. Burwell and King v. Burwell, and  coming to two different conclusions as to whether it is permissible to provide financial subsidies to residents of states which refused to establish their own health insurance exchanges.

Here is some background of the two cases (from the Daily Kos, 7/27/14, “The Halbig Case: or, the banality of conservative evil“):

[T]he Affordable Care Act expands access to health care by allowing states to create insurances exchanges on which private companies can sell insurance plans that meet federal standards. To help ensure affordability, the ACA subsidizes a certain portion of the premium on a sliding scale based on income. If a state either cannot or will not set up an exchange, there are also plans available on a federal exchange.

So far so good, right? Wrong. Because of the fervent opposition to the law, most states with Republican-controlled statehouses opted not to participate by building their own exchanges, and instead watched passively as their citizens became eligible for plans subsidized under the federal exchange. Just one problem, though: the authors of the Affordable Care Act did not seem to anticipate that states would refuse to establish exchanges out of political spite. Consequently, the provision of the Affordable Care Act authorizing the payment of subsidies refers specifically to plans under state-based exchanges, but does not explicitly authorize subsidies to help cover plans sold by the federal exchanges. The IRS issued a regulation that federal exchanges were eligible for premium subsidies. But a group of anti-Obamacare plaintiffs, headed by an attorney from the Federalist Society, argued that because Congress had not expressly mentioned subsidies to plans under the federal exchange, those subsidies were unlawful. And that argument won the first round in the DC Circuit Court, whose panel ruled that regardless of whether Congress intended the subsidies to also be available to plans under the federal exchange, a strict reading of the legislation said otherwise.

Let’s be honest.  These cases are not about the stated Constitutional challenge that the President and the IRS have gone beyond the statutory authority of the Affordable Care Act.  They are about politics and the continuing attacks on the President through the rant against Obamacare.

There is no concern about law or justice — and the political maneuvering is more insidious because it hides behind black robes.

If we start with the assumption that politics and politicians should have the goal of helping their constituents, under what theory does one bring these cases when the desired result will deprive millions of Americans of the health insurance that they have purchased?  How have so many lost so much perspective and purpose?

The “class war” that the President is often accused of promoting is really being fueled by a conservative myopic minority. Their willingness to hurt innocent citizens of less means who are seeking health insurance and rely on the subsidies provided is just bullying aimed at achieving some political end and helping no one.  Isn’t it time this immorality stopped?

Happy 68th Birthday, President Clinton! | Clinton Foundation

August 17, 2014 Leave a comment

embday1

Happy 68th Birthday, President Clinton! | Clinton Foundation.

For fans of the former President and fans of House of Cards!

Categories: Politics

Another Hole in the Halbig Verdict | Bill of Health

August 16, 2014 Leave a comment

Another Hole in the Halbig Verdict | Bill of Health.

Here is my view — Of the contradicting decisions, one is clearly right, and the other wrong.  Getting to the right result, however, is really only politics hiding under black robes.

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