The Ironic Cherry Reads... An American Sickness

An American Sickness:

How Healthcare Became Big Business

and

How You Can Take it Back

by

Elisabeth Rosenthal

It takes a lot of hands to mess up healthcare as badly as we have done in this country.  And Elisabeth Rosenthal has described pretty nearly all of those interested parties and how they have affected us and our health care in this book.  She has done it in a way that makes each aspect of the healthcare disaster personal to each of us.

Rosenthal is a writer and non-practicing physician who now writes for Kaiser Health News.  Not only is the book well-researched, but she does have her finger on the pulse of American healthcare.  In the book, she documents chapter by chapter the different pieces of the healthcare puzzle, with personal stories about wrestling with the massive and systemic incompetence and corruption.  These personal stories come from people not in the field, but also other physicians, and Rosenthal herself.  Importantly, the people whose experiences she describes are not anonymous.  They have all come forward to tell their story in order to help change this awful system.  And then she details practical ways we can effect both political change and fight personal battles over things like drugs and hospital bills.

I would like to run down all the most important details, but it seems that I would have to basically transcribe the entire book.  There is critical information on every page.  And it is information that could affect any of us.  Rosenthal has broken the book down into chapters about each aspect, from insurance, hospitals and doctors, to pharmaceuticals, medical appliances and research.

Each of those facets of health care, since the sixties, has contributed to changing the goal from improving health to increasing profit.

Blue Cross Blue Shield was once a true non-profit which goal was to make health care affordable, but when for-profit companies like Cigna stepped in, the competition forced Blue Cross to make profit a goal in order to survive.  Money was increasingly spent more on advertising and executive salaries than on health care, to the point that the Affordable Care Act now requires that the industry spend at least 80% of premiums on health care.

The initial function of hospitals was charitable.  These days many of those hospitals have become an important way to bring in money to the Catholic Church.  Again, executive pay and advertising run up the bill.  Hospitals compete by offering the services that will increase profit rather than those that are most needed.  Part of their business model is that they must continually get larger, swallowing up smaller hospitals or forcing them to close.  Hospital administrators now tend to have business backgrounds rather than medical experience.  And those administrators work hard for their big paychecks, by figuring out ways to increase profit.  Unnecessary tests and extended hospital stays, $10 aspirin, contracting out rather than having in-house doctors -- just a drop in the bucket of creative ways to jack up hospital profit, with little to no accountability.

Likewise, physicians were increasingly likely to run their practices with an eye to profit rather than the needs of their patients or community.  The doctor that stops by your bed to see how you are doing is billing you for it.  "Physician extenders" can step in and do the work of the specialist without the qualifications; double billing; coding for a more costly procedure; out-of-network physicians who are contracted by a hospital without your knowledge, leaving you with a huge out-of-pocket bill.  And you may never see the doctor who quickly scans your treatment from an office miles away, yet bills you as though he has actually provided treatment.

If you are wondering why our drugs cost so incredibly much more than those sold in any other country, the culprit is a for-profit system with a pharaceutical industry that pays lobbyists a fortune to keep government regulations at bay.  The tricks they play to keep the prices sky-high are mind boggling.  There are actual legally accepted methods that can keep a generic off the market for years after the patent should have expired.  Competitors actually make deals with companies that have big-name drugs, agreeing to keep their drug off the market for a price.

Remember Martin Shkreli, the cocky, immoral narcissist who bought the rights to a cheap generic and raised the price from $13.50 to $750 a pill?  The thing about Shkreli is not so much what he did, but that he did it so publicly and shamelessly.  In fact, that kind of abuse goes on all the time, at every available opportunity.  The government is unwilling to step in and regulate.  The drug companies make billions from our suffering.  Marketing new, expensive drugs that are less effective than older generics, extending a patent by adding a new coating to a pill, fishy FDA rules that allow drug approval with inadequate testing... again, I could go on and on.

Medical devices are another area of creative price gouging, one that is buried in other bills.  The device manufacturers' lobby has been so successful that as some members of the Senate are attempting to work together on fixing the ACA, thus far the only item that has been altered is eliminating the 2.3% medical device tax, which is actually closer to 1.5% after deductions.  20,000 jobs were not lost as a result of the tax.  The tax is not on consumer devices, like eye glasses, but only on "non-retail medical devices," like MRI's and pacemakers.  And like the $4,000 screws used in some back operations.  The prices from hospital to hospital vary like crazy; there is no rhyme or reason to the pricing.

One of my favorite boondoggle stories is a personal one.  A few years ago, while I was working at a branch of the Charleston County Public Library, each branch had installed a defibrillator.  It was a great source of wonder and comic relief for the staff.  As a library assistant, high school degree required, the assumption was that one of us would be required, with no training, to operate the defibrillator on a patron suffering a heart attack.  One of us thought that it should only be used if the patron was unconscious.  We hadn't even been given an emergency phone number.  In a very cynical way, it cracked me up.  But wasn't it a damn clever idea to sell those things to zillions of local governments across the country? With little proof of effectiveness of defibs in public places, no funds for training, and a pretty good-sized price tag for governments that, in the 2000's were bearing the weight of huge budget cuts.  Hate the government?  Blame the corporations that prey on them.

Medical tests are overpriced and overused; in-house testing creates greater profit for doctors and hospitals and sometimes ridiculously higher bills for patients.  Ambulances are now in many areas contracted out, and the costs non-negotiable, and often, not covered by insurance.  Physical therapy used to be an affordable service but is now big business.

Medical coding, rather than being a language that makes it easier for professionals to know a patient's medical status, is now an opportunity for obfuscation and profit.  Consultants are hired to find a way to pad the bill by entering a more highly reimbursed procedure code.

And then there is research.  Research is the excuse given by pharmaceuticals and device manufacturers for their exorbitant prices and insistence on longer patent times.  But "new" items too often these days merely replicate old, tried and true -- and less expensive --  drugs or devices, research is oftentimes not as rigorous as seems to be required.  And results and follow-ups, well, they just aren't cost effective when it comes to the bottom line, so when the regulators aren't paying attention, they too often are minimized or don't happen.

Medicare and the Affordable Care Act have both attempted to improve medical outcomes and curb costs, but those who stand to profit work tirelessly to get around those efforts to provide affordable quality care.  And lobbyists ensure that our lawmakers don't do much to get in the way of the industry.  Al Franken, Amy Klobuchar and -- my god -- Elizabeth Warren, all worked across the aisle to support REPEAL of the medical device tax, which had been intended to finance Obamacare.  Why?  Because Minnesota and Massachusetts are home base for three of the largest device manufacturers.

On that sobering note, the author goes on to itemize by category our $3 trillion health care bill.  And then, in a short but important section, she gives practical instructions for combating the health care behemoth in our own lives, as, for example, when you get an unexplained charge on a hospital bill.

It would be in your own interest to read this book.  But we don't all have the time.  But I urge you to check it out of the library, glimpse through it, and pick a chapter that calls out to you.  Fifteen minutes of your time (if you can put the book down) will give you an idea of why it has taken so long to get to Obamacare and why there has been so much energy, and so many dollars, put into dismantling it.  And why it is so important to take down this massive waste of money and lives.

Playing at the Town Hall

One thing you can say about our own Lindsey Graham is that he is having a good ole time.  I watched all I could tolerate of his performance at his town hall on April 1, about a half hour.  Of the two of us, he was the only one really enjoying himself.

He knew he was being televised, and he had a full house, in a way a captive audience at his mercy.  Which I must say was a pretty clever turnaround after all the legislators who have been caught as though running red-handed from a crime scene.  Which they pretty much were, given the horrendous acts they had committed on their constituents over the past years.

Anyway, the thing about Lindsey is that he does a smooth transition, back and forth, from a level headed, rational person to a rabid right wingnut.  Likewise, his strut across the stage and his ready laugh go from charming to a bit maniacal.

What he did on Saturday was maintain control even in the face of a furious, fed up audience.  They were actually constituents, but he sure made it feel like they were an audience.

He started off with Russia.  Russia was easy.  I could tell he knew he nailed it with the audience, because we all know that Russia is the bad guy.  Trump was another easy one, because by now we all have shorthand for what we think of him, and we knew he agreed.  And that even though he hoped the Senate could do a sound investigation, the most important thing was not to get in the way of the FBI.

Once he got us all warmed up he tossed the bucket of cold water at us.  Gorsuch.  He’s been playing that tune since the nomination.  Lindsey Graham LOVES Neil Gorsuch.  How could he not?  Gorsuch is as slick as they come – as I learned to say in the South, he cleans up real good.  But underneath that well-dressed white haired dignified suit of armor is an angry, mean control freak.  Gorsuch is going to act out every damn thing Graham can only dream of.  He will consistently rule for corporations, which I don’t even think is the most important issue for Graham.  More important, he will take down women, dashing any hope for reproductive rights, worker rights, and basically, self-determination here in the 21^st century.

Because Lindsey truly has a thing about women.  He could be reasonable about Obama, but when it comes to Hillary, his hatred is visceral.  And lately, you can see it in his eyes when he talks about Susan Rice.  Women in power.  Competent women.

So when those types of issues come up, that’s when we see crazy Lindsey.  That’s when facts fly out the window.  I believe this is why his defense of Gorsuch on Saturday was so shrill.  As though he had no idea that the nominee was even more right-wing than Scalia, he told the group that if they couldn’t see how qualified Gorsuch is then “you are blinded by your own partisanship.”  And that our problem with Gorsuch was entirely to do with Trump (and not Merrick Garland):  “You want to set the election aside because you can’t accept the results – that’s your problem,” adding, inevitably, that Trump is being investigated by the FBI, big deal, “so was Hillary Clinton.”  And of course, bringing up the made-up “Biden rule,” as though he has so much respect for Biden’s philosophy that he would follow him anywhere.

After that things went downhill.

There was the usual “Obamacare is failing,” followed by the very strange accusation that the ACA “was not designed to get us health care but to get single payer through the back door.”  A truly through-the-looking-glass moment as I recalled progressives’ anger at Obama, who had not just omitted the possibility of single-payer altogether, but also did away with a “public option” at the polite request of the insurance industry.

When that idiocy brought about some loud boos, he laughed and said, “Good fun!  This is better than going to the Flower Show.”  And proceeded to tell folks that if they like single payer, well, Canada has it.  And if we want his insurance we can join the military, apparently believing that his stint in the military is what makes him deserving of government health care, and not just being an American.  Adding that the VA system is a failure not because it does not have the funding to streamline and have more doctors, but because it is a monopoly.  Ending with a fantastical suggestion for improving health care with a combination of managed care for people of high risk (anybody remember the abomination known as managed care?), tax credits, and allowing sales across state lines.  Done and done.  Everybody insured.

About Betsy DeVos:  “She has spent most of her life working on alternatives to failing schools.”  The alternative being taking money out of public schools to profit private schools.

Around about that time, Graham had a brief attack of sanity.  Regarding social security and medicare, he offered that those with high incomes, like himself, should pay more, take less.  But then came the trade-off:  We should all be willing to raise the retirement and Medicare ages.

Now this has been a bee in Lindsey's bonnet for a very long time.  Way back in 2011, I made an ad for the Progressive Change Campaign Committee pleading with Lindsey not to change the social security retirement age.  It was actually featured on Keith Olbermann's Countdown; it was my fifteen minutes of fame and a truly proud moment.

Point being, that Lindsey is so out of touch with his constituents that he has no clue how many of us finally retire with aches and pains and actual disabilities at age 62, or force ourselves to work to age 66.  He has dismissed us whiners by saying we can just apply for disability, as though his gang of criminals has made it real easy for people who are hurting to cash in.  He has no idea how, thanks to folks on his side of the aisle, Medicare has been chipped and hacked at until it requires costly private supplements, another boon for the insurance industry.  I don't know how people survived before the pharmaceutical boondoggle known as Medicare Part D, but the way it stands now, with the drug plan, we are all in a position where cutting meds in half or living without them -- or not -- is a real option.

And then there is Planned Parenthood, where Lindsey has his final split from reality.  Again, a woman thing.  He doesn't much care about facts at this point, saying that the debate about funding "is about providing abortion services."

Lindsey is not an idiot.  He knows the government does not pay for abortion services -- although they damn well should -- yet he contends that this is the crux of the issue.  And this sometimes rational legislator is willing to not just vote for, but support cutting a truly essential source of women's reproductive health care because they also do abortions.  Like his blind spot with Hillary, the thought of women making their own choices about their bodies brings him to near Trump-level irrationality.

And I am just sick to death of having these unmarried old white guys obsessing over control of women's bodies.

But we are indeed left with crazy Uncle Lindsey.  He might toss you a quarter, but then you have to listen to him rant about Hillary and abortion if you want to keep it.  Unlike the other unmarried right wingnut who "represents" South Carolina in the Senate, at least Lindsey's head clears every once in awhile.  Is it good enough?

Graham has fought off challenges from the right.  He has lately blown away what the state Democratic Party seemed to think was its best chance, a challenger with the all the right stands on the issues, but one who was outmatched in the ability to take center stage.

Invincible?  I'm afraid it would take lots of money and a candidate brimming with personality and chutzpah, who could talk to the folks as though they were having barbecue and beer, and damned, knew what they were going through with that dad-gum gub'mint and was shore gonna fix it.  Somebody who could make even a thick-headed southerner admit that they didn't want their nutty next-door neighbor carrying a gun, or their teenage daughter having to have a baby when that nasty boy she was with got her knocked up.

That would surely do it.  And there's somebody out there just dying to step up. 

Tim Scott's Health Care Fantasy

I was going to write about the Supremes today.  But then I got an email from Tim Scott weaving his usual out-of-touch right-wing imaginings.  Of course, these aren't his own ideas; he has no more ability to think on his own than his president does.  He is just passing on the Word of his true constituents, the ones that line his pockets and assure his re-election.

Tim Scott appreciated my input on the ACA as well as the opportunity to share "his" thoughts with me.  Basically, it was the same talking points we have been hearing as all republicans are speaking with one mouthpiece as they cheer on the death of Obamacare.

Premiums and deductibles have gone up (soared is the word they are required to use).  Choice has gone down as we all know:  insurers are opting to leave the marketplace.  If you have lots of time you may want to dig into why this happened.  It could be that insurers were planning the hike before the election in order to butter their bread on the side that will ensure them the most profit.  We know (but forget) that premiums "soared" pretty much consistently before the ACA, and slowed dramatically afterwards, and let's assume that, as in the past, the insurance industry will take every opportunity to hike premiums when they can.  And by the way, much was made of Aetna dropping out of the exchange because of cost.  Turns out, it was a move to increase the likelihood of the courts approving their merger with Humana.  Who knew an industry giant would mislead the public to advance their own cause? 

Of course, republicans, like their president, don't care to do actual research and find actual facts, so talking points will do.  They all have similarly apocalyptic language, like Scott's:

"It increased taxes, stifled job creation, and created an entirely new classes of the uninsured: those who pay penalties because they cannot afford the mandated plans, and those who buy plans with high premiums and deductibles, which keeps them from actually using their coverage. The regulatory burden and mandates that the PPACA places on providers, businesses and families serves to increase costs and reduce access to care." 

Those of us who live in a fact-based world, and actually walk around outside of the bubble know that taxes were increased on the wealthy, Scott's true constituency.  We know from jobs reports that unemployment has actually gone down in the Obama years, and despite republican obstruction, wages actually began to go up.

Ignoring the grammatical error, there are indeed uninsured who pay penalties under the ACA; Scott makes the great leap that they do this because they cannot afford the mandated plans.  Let me just say:  bullshit.  If they could not afford the mandated plans, they would be entitled to the government subsidy, just as I was for the 1 1/2 years I was on Obamacare, before I became eligible for Medicare.  And I would like to add that my plan (one of the dreaded Blue Cross plans) was not just the most affordable but had the absolutely best benefits I have ever had under one plan.  Now, they may have chosen not to enroll in the ACA because they had the money but didn't want to spend it on healthcare, kind of like Jason Chaffetz' fantasy that we working poor are spending our money on those nice new iPhones instead of health insurance.  And with the help of the Supremes and right-wing Congress critters like Scott, the penalty for non-compliance ended up being minimal enough to be worth paying it rather than jump in and get health insurance.

The regulatory "burden" and mandates placed on providers include requiring most of the premiums paid to go back into actual health care payouts rather than things like advertising dollars.  Regulations include requiring quality health care, including preventative coverage, caps on raising premiums and deductibles, removing the lifetime cap on coverage, requiring coverage for those with pre-existing conditions.  You know, all that nasty fine-print insurance companies have been getting away with for decades, with the blessing of people like Tim Scott.

Scott goes on to say that one of his priorities is denying patients the ability to sue doctors for malpractice, or as he calls it, "medical tort reform."  Reform has a pleasant, positive sound, and a lot of people don't even know what a tort is, although it sounds yummy, so the whole thing just sounds like a good idea.  He then goes on to say that he wants everybody to have the same "great success" as they have had with tort reform in Texas.

Call me a cynic, but when somebody suggests that we should be more like Texas, I tend to want to look into that.  In fact, other than those with employer based insurance and us older folks on Medicare, statistics compiled by the Texas Medical Association pretty much show Texas insuring far fewer individuals than the U.S. average (2014):

Comparison of Texas Uninsured Population to U.S. Uninsured Population

Uninsured total population
Texas Uninsured: 16%
U.S. Uninsured: 9%

Uninsured children
Texas Uninsured: 9% 
U.S. Uninsured: 5%  

All adults uninsured, 19-64 years of age
Texas Uninsured: 22%
U.S. Uninsured: 13%

Uninsured women 19-64 
Texas Uninsured: 21%
U.S. Uninsured: 11%

Uninsured men 19-64
Texas Uninsured: 22%
U.S. Uninsured: 14%

Nonelderly uninsured- at least one full-time worker
Texas Uninsured: 76%
U.S. Uninsured: 74%

Enough with statistics.  Scott then goes on in his email to sing the praises of the AHCA, or Trumpcare.

"This legislation aims to lower the cost of health care coverage and improve patients' choice by repealing the PPACA taxes, eliminating the individual and employer mandates penalties, expanding Health Savings Accounts (HSAs), and providing a monthly tax credit for individuals and families who don't receive insurance through work or a government program."

The only way health care coverage is going to be lowered is by offering -- lots -- fewer benefits.  You know, those pre-ACA era plans that were cheap enough to afford, and then when you got sick you found out why.  As far as "choice" goes we should all know by now that the word "choice" coming from a republican has the same oxymoronic meaning as the word "freedom."  We get to choose our health plan if we have lots of money to pay for it.  Period.

On the plus side, for people like Scott, Ryan, and Trump that is, is that the taxes that would have been paid by the wealthy to pay for the health care for the rest of us is repealed.  And if you decide you just don't want to play, you don't have to pay those pesky penalties.  Both of which serve the additional function of strangling any health care benefits to those with lower incomes that remain.

Speaking of which, let's end on a laugh.  Health Savings Accounts mean that if your income is high enough for you to actually live comfortably, and not paycheck to paycheck, you can put money aside for future illness.  If you work at McDonald's, let's assume that doesn't work for you.

In that case, you might have a chuckle over the other option:  tax credits.  This means that if, at the end of the year, when you pay your taxes, if you owe $4,000 or more, the government will give you back $4,000 toward your health care costs.  Of course, if you are one of those freeloaders who is trying to support your family on, say, $25,000, and you don't pay any taxes, well, you're on your own paying those premiums.

So in conclusion, I would just like to thank Tim Scott for sharing his perspective with me.  Just as when I communicate my thoughts to him, his thoughts have absolutely nothing to do with my life in the real world, so there is as little chance of me changing my perspective as of him changing his.  At least he gets paid to maintain his warped view of what Americans need.

On the bright side, though, I am writing to you all knowing that you understand what the real world is like, and will help spread the word about what that nice Tim Scott really plans on doing to our health care.

The Thing About Health Care

First of all, let me just say that “health care” and “health insurance” are two different things.  But somewhere along the way, we have started to call health insurance, health care.

I remember the days when a health insurance plan did not necessarily provide a person with health care.  There were abominable deductibles and co-pays, and lots and lots of health care that just wasn’t covered.  Remember that?  It wasn’t so long ago.

And then, to republicans’ great consternation, Obamacare required minimum standards that were actually standards and not rip-offs.  The complaint from the right-wing was not at all about quality of care, it was about… freedom of choice.  That’s right.  The government was telling you that you would no longer be allowed to buy a sub-standard health insurance plan.

Shortly after the ACA became a real thing, I heard a guy at the optometrist’s office complaining to the receptionist about his Obamacare.  “I do get more stuff covered,” he admitted, grudgingly.

But now the good old days are coming back.  We consumers will once again have freedom of choice, by which I mean freedom to choose health insurance that you can afford even if it doesn’t really provide adequate health care, and even the freedom to be uninsured.  "Boy howdy!" as Rachel Maddow would exclaim.

And then there is the current big debate among the majority lawmakers over tax credits.  What tax credits mean is that when you pay your taxes, you will get a credit for a certain amount to go towards payment for health insurance.  So, if your health insurance costs $3,000 a year, you would have to pay $3,000 less in taxes.  Sounds good, right?

But suppose your income is so low that you only owe $1,000 in taxes?  What happens to that other $2,000 of health insurance cost?  That, friend, is what our lawmakers are bickering about.  The less evil among them believe the government should pick up the other $2,000, while the Ted Cruzes and Paul Ryans -- we know who you are -- believe we should just go suck eggs.

Until the ACA came along, Medicaid covered low-income seniors, children and the disabled.  If you were an adult working, say, at McDonald's, and you were most likely not earning a living wage, you most likely couldn't afford health insurance and you did not qualify for Medicaid.  For much of the country, Obama's Medicaid expansion changed that, providing federal dollars to cover those whose earnings put them somewhere between a rock and a hard place.

Republicans saw the injustice in providing health insurance to the working poor, however, and got the Supremes to agree that governors could decide whether or not they would take the free money.  And some of those anti-tax governors just could not go along with taking tax dollars, especially if they weren't going to benefit big corporations.  Here in South Carolina, where Nikki Haley refused to accept the Medicaid expansion, that meant you qualified if you earned less than $12,000 a year, and had less than $7,300 in savings.  So I am thinking (and this whole thing is about as clear as earwax) that if you are a low-income worker in SC, the good news is you may be no worse off after Congress and Trump get done with health insurance.

Sadly, that will be true for a whole lot more Americans.  And for those of us whose income qualified them for health insurance through the ACA, tax credits will mean a lot more of us will be falling through the cracks.  The good news about this, though, is that those fools will probably also repeal the mandate, so if you can't afford health insurance, you won't get fined for not being able to buy it.

The republican congress did not show up much in the eight years of Obama's presidency.  Mostly they were there to block any proposals made by the president and congressional Democrats.  That meant filling their time with lots of votes to repeal Obamacare.  These days I have heard more than once that they are like the dog that caught the car.  And I am really proud to say that, beginning with the Woman's March on January 21, we have been a big part of their problem.

We have shown up at town halls, made phone calls, protested, marched, written letters to the editor, and pretty much kept legislators awake nights wondering how they can sneak this travesty by us while we are watching their every move.

Apparently, even the Americans who voted R have finally woken up to see that something they need badly is being snatched out of their hands.

There is a lot of crap flying these days.  We are trying to fight as much of it as we can.  There are bad things that will happen.  For awhile, corporations will be having a big party, overindulging and then throwing up all over our country.  The rich will get richer and the poor will get poorer, until those of us who have been buying the stuff that make the plutocrats fat can't afford it anymore.  It happened in 2008.

But this time we anticipated it, and we didn't just let it get reported in the news.  We took to the streets, and we are fighting it.  I don't know if the republicans are going to be able to turn health care into the tragedy it was before the ACA, or if they will just mangle it beyond recognition.  I do know that their decision will take them down.

And then we get to build it again.

Make America Sick Again

When Paul Ryan was a teen, he fell in love with Ayn Rand.  It appealed to his narcissism, as it did mine at that age.  The difference between us is that I grew up and recognized the reality of the world around me.  Paul Ryan still obsessively believes that if you got it, you deserve it.  And if you don't, it's your own fault.

That spunky can do attitude defies the reality of living in capitalist America, where if you got it, you get more, and if you don't, it has gotten increasingly less likely that you ever will.

But Ryan is surrounded by like-minded haves, and like so many of our current members of Congress, just doesn't have any patience with the whiners and the takers who think they deserve things like housing and health care.  To that end, he is determined to prove that what we all need is tough love, forcing us to choose whether we are going to survive.  That philosophy has been echoed "bigly" by our incoming moron-in-chief, who believes he made it on his own, by virtue of his big brain and not his wealthy father and Vladimir Putin.

Republicans in the House have been chomping at the bit to get rid of Obamacare, and since they have been back in session they have shown a greater work ethic than they have for some years.  They have detailed plans on how they can do away with the Affordable Care Act, in conjunction with the Senate and the Orange-Haired Idiot, who babbled at his press conference about how the bill would be repeal and replace, at the same time, maybe within a month, maybe within a week, maybe within the hour, maybe time traveling to 2010, you get the gist.

Way back in 2009, at the end of the last era in which Americans hung their hopes on an idiot with a clever and duplicitous campaign, the state of health care was shameful.  To the point where Keith Olbermann, on MSNBC, had been highlighting and fundraising for Free Health Care Clinics.  I recall my horror that so many were uninsured that -- in America -- they waited in hours-long lines to see a doctor.  That so many diseases that could have been easily treated were left to fester, so many people made sicker and even left to die out of the greed and neglect that the wealthy and the corporate powers exercised.

A couple of weeks ago, I heard some privileged cretin (a republican member of Congress) talk about how we were just spoiled by being able to get health care whenever we needed it, because we never had to face the cost.  He told the harrowing tale of his son falling and hurting his arm, and he and his wife deciding they would just ice the injury and wait a day to see if they needed to bring him to a doctor.  What a guy.

A guy who has never had to watch a loved one get sicker, hoping that the tide will turn and they will get well without the exorbitant costs of medical care.  A guy who is pretty damned out of touch with the extent of out of pocket costs involved with health care today.  A guy who could get really fine medical care the next day if he chooses to wait to get his son looked at.

For that matter, there is a myth regarding all of us great mass of unwashed Americans that says that we demand to see a doctor whenever we feel a windchill.  That we have nothing we would love to do more than wait in a waiting room at a doctor's office or a hospital, so we can suck up medical expenses.  That it is our self-indulgence, and not the greed of the pharmaceutical industry, the mismanagement of our hospitals, the fact that many of us are forced to wait until a common condition becomes an expensive medical emergency, that has caused health care costs to skyrocket.

And people like Paul Ryan have swallowed the lies and distortions in order to continue to live in the pockets of their corporate donors.

Meanwhile, as Ryan and the right wingnuts work to take away health care from millions of Americans, they continue to carry the best taxpayer funded health insurance the country has to offer.

So why not insist that members of Congress be forced to accept whatever plan they chisel out of their rigid dogmatic principles?  Of all of us, they can certainly better afford it.  It may be a challenge to their fact-free ideology, and it might be tough for them to be living in the trenches having to make some of the same decisions the rest of us live with on a daily basis.  But getting in touch with the unbearably high cost of private insurance just might convince them that the "r" word they are looking for is not "repeal" but "regulate."

If you have Obamacare, or insurance from the health care exchange, or from the Affordable Care Act, you may not know that they are all the same.  This was one of many of those sleights of hand that republicans managed to pull off, while Democrats thought getting the work done for the people would be enough.  I will assume that if you are reading my blog, you know these are all the same thing.  But there are an awful lot of people out there who do not.  And they will be tragically surprised to learn that the guys they voted for have taken away their health care.  Right now, one of our tasks is simply to spread the word that whatever they call it, they are going to lose their affordable health insurance.  Unless they speak up.  And those rate hikes that incredibly happened just before the election?  Democrats never let them know that it was a much smaller increase than we have seen before the ACA.  Ooops.

In fact, this could be a great time to let people know how much better and cheaper single payer health insurance would be.  If the Democrats would only.  Because as long as the republicans are offering "repeal and replace" the thing to do is to offer Americans a "replace" that would work.  Of course, it won't happen while the party of profit and destruction is running things, but if they heard some enthusiasm building up for a single payer plan, maybe backing off on the "repeal" wouldn't seem like such a bad idea.

Supreme's Greatest Hits

The Supreme Court seems to have ended its session and begun summer vacation with a bang.  Three major decisions over the past several days have reflected what I heard one commentator refer to as the most "liberal" court in decades.

To which I did a double take.  But when I thought about it, we did have some really significant wins.

The surprise decision was the one that supported the Fair Housing Act of 1968.  Surprising in light of the demolition of the Voting Rights Act, which gave states the right the do whatever damn thing they wanted to keep selected groups from voting, and which they wasted no time following through.  Chief Justice John Roberts, with his Pollyanna smile, declared there was no need for voting rights protection because racism was dead.  Leaving me wondering what rationalizations he made to justify the red-state rush to legalize voter discrimination immediately after the decision.

Not one to ever learn from his mistakes, Roberts was one of the four who voted against supporting the Fair Housing Act.  But he did weigh in with us liberals on the case that had my heart beating fast.  The state health care exchanges, with federal subsidies, remained intact, leaving a lot of folks like me with our Obamacare.  The vote was 6-3, with the core group of idiots, Scalia, Thomas and Alito holding down the right wing-nut opinion.

For those of you who are thinking Roberts may be sliding to the left, his opinion had nothing to do with the rights of Americans to have affordable health care.  His decision, just like the one in favor of Obamacare three years ago, was purely pro-business.  If you recall back then Roberts' opinion had pretty much everybody's head spinning, including his own.  He twisted and corkscrewed the law, arguing not the obvious one that was in question regarding the Commerce Clause, but that the individual mandate was a tax, and the feds were within their constitutional right to levy that tax.

So.  I'm thinking Roberts knew quite well that the insurance industry would take a crippling blow if it lost all us customers that could no longer afford health insurance without the federal subsidies.  And there are quite a lot of us.

Scalia, on the other hand, and despite his contention that his decisions are based purely on constitutional originalism, consistently bases his decision on what feels good to him.  This is the guy, after all, who believes that the devil is a real person.  So let's assume logic doesn't have as much to do with his thinking process as he would like us to believe.

Along with his imaginings of the devil and what the founding fathers believed we should be doing all these years later, Scalia has the kind of rigid and fragile psyche that just can't take much confrontation.  And so when he writes his dissents (which Chris Hayes noted are extremely wonderful and entertaining, especially because they are dissents) he tends not to sound all that educated, or intelligent, or even rational.

In his dissenting opinion on the Obamacare decision he calls the majority opinion "interpretive jiggery-pokery" and "pure applesauce," legal terms that no doubt go back to the founding fathers.  He snipes that since the Court has backed Obamacare in two major decisions, "we should start calling this law SCOTUScare."  And in an overwrought, pubescent and melodramatic fit, he sums it up by saying, "Words no longer have meaning...."

Roberts predictably let his right-wing flag fly in the marriage equality decision.  No surprise there.  It was purely a human rights case, and human rights will not sway our Chief Justice.  And I was not at all surprised that Kennedy was the deciding vote in favor of marriage equality, as he has voted in favor of gay rights before.


I'm thinking that a couple of things are happening with the Supremes.  Justice Kennedy retains his position as the swing vote.  I believe that he is a romantic, and he likes to feel like he is being wooed.  It also seems to me that he is easily influenced by the new guys on the block.  It happened when Roberts and Alito took up the cause of the right a decade ago, and now we have the left-leaning Kagan and Sotomayor.

Roberts is going to vote pro-business and against human rights.  The only individual he is going to support is the individual corporation.

The most fun these days is watching the narcissistic Scalia as he comes apart at the seams.  And even better, the more that happens, the less likely Kennedy is likely to want to be seen siding with him, leaving him sitting alone at the cafeteria table with Clarence Thomas and Sammy Alito.

Without taking away from these important victories, though, I am concerned about one group of decisions, those affecting women's privacy and health care rights.  Hobby Lobby, which has never blinked about paying for insurance that covers vasectomies, won the right to deny women contraceptive coverage.  Even Kagan and Sotomayor voted against a woman's right to be safe from harassment at an abortion clinic, refusing to support a state's right to determine an appropriate buffer zone from protesters.

At this point, with state and federal legislators pushing ever more extreme anti-abortion bills into law, pro-choice groups are afraid to take a case to this Supreme Court, fearing the complete overturn of Roe v. Wade.  This could happen, but we need to take our cue from the fearlessness and persistence of the LGBT community.  We need to continue to take cases to the Supremes, and we need to find new arguments, just as Burwell did with Obamacare.  We can't stop fighting, and we can't let our worry about the bias of all those Catholics on the bench slow us down or even cause us to hesitate.  As disappointed as I have been in the women's reproductive health care decisions, it is only by showing our strength that they will eventually be swayed.

So have a good summer vacation, Supremes.  We are counting on you to keep us entertained next time around. 

Killing Obamacare

I am outraged by assaults by the republicans on abortion rights and voting rights, but these are issues that are not personally going to affect me.  What I am personally concerned about these days is all the efforts that are going into killing Obamacare, still.  The latest assaults could well succeed.

Antonin Scalia, narcissist extraordinaire and the mouthpiece most damaging to the honor and credibility of the Supreme Court, is the most likely nail in the coffin of the Affordable Care Act.  He believes that in looking at legislation, intent should not be considered, even if it is verifiable.  The only consideration should be the exact words in the law.  Unless, that is, it goes against his own belief of what the law should be.

In this case, the whole of Obamacare is resting in the four words, "established by the state."  Despite the fact that no one involved in the debate or writing of the law believes that the intent was to exclude those states who refused to create an insurance exchange, Scalia will hold forth with the claim that those words are in the bill and must be followed.

Now that the ACA is the law of the land, and people have become very happy with having affordable insurance, the republican party is being a bit more sneaky about killing it.  They have already come up with an alternative that would continue the ACA until 2017, but only if the individual and employer mandates are discontinued.  Those extremists who believe tax subsidies should only go to wealthy corporations are proposing tax credits rather than subsidies.  So basically, if your income is so low you pay no taxes, voila, no tax credit.

Because I turn 65 in 2016, and it seems even the rabid republicans can't kill Medicare in that short a time, I let go a sigh of relief to hear that I could still have insurance even if Scalia gets his way.  But that doesn't make the problem a lesser one.  Killing the mandate kills the funding for the ACA.  What the republicans understand is that Obamacare only works if everyone participates.  And what they also understand is that most voters are mostly concerned with what affects them immediately.  They will be angry if they lose their insurance coverage.  But if the republicans can blame Obama and the Democrats, which they have done successfully for some time now, it is a win-win for them.  They can continue to be the anti-tax party and the freedom party.

What they understand all too well is that people don't care about health insurance until it affects them.  That is why forcing insurance companies to offer better plans only matters to those who had inadequate insurance that they needed.  Those who didn't need it are quite loud and angry about having to pay more for what amounts to better insurance.  And some that are quite stupid will yell about paying more even when they use that better coverage.

I worry about what the Supremes will decide in June.  As should we all.  Because I might be okay till I turn 65, but my kids might not.  They might end up having the same vulnerability to illness that too many of us Americans experienced up until Obamacare was passed.  It was a terrifying time, and the republicans, frankly, don't give a damn.  They can turn our fear and tragedy to votes.

What we can do at this point, is be educated about this.  And inform others.  Keep an eye on the Supremes, and be willing and ready to fight our South Carolina legislators, both state and federal, to preserve affordable health care.

To Legislators: If You Won't Stop the Assault, Then Pay for It

The twenty-week abortion ban, H 3114, which we have all heard far too much about, is making its way back to the House to approve the bill with the Senate amendment which would make exceptions for rape, incest, fetal abnormality or the health of the woman.  Some few are expected to vote no because they balk at the exceptions -- women should carry a pregnancy to term under any circumstances, the more gruesome the better.  But it is very possible that this bill will pass, making the rare 20-week abortion illegal in South Carolina, and imposing hardship on the pregnant woman.  It will also impose draconian regulations, reporting, and burdensome proof upon the physician, with exorbitant penalties for non-compliance.

I wonder who in our government is going to be responsible for this surveillance.  It will entail data collection and monitoring, as well as law enforcement.

This is a bunch that continually repels background checks on gun purchases as a violation of our liberty.  They promoted an anti-Obamacare campaign based on the myth that the ACA would invade our privacy:

These are the people who continue to waste the state's time and money to push through bills that would do exactly what those false Obamacare ads claimed.

So this is my proposal.

If you are going to vote for bills that will add both emotional cost and financial cost to a woman and her family, than let's insist on amendments to that bill that would require the government to pay all costs.  Costs for additional health care for the pregnant woman, and guarantee health care costs for mother and child after the baby is born.  Costs for any emotional hardship to the woman and her family, as well as any financial losses she must endure because she has been forced to remain pregnant.  It goes without saying that any costs to maintain a healthy pregnancy, including nutrition, should be borne by the government.

And don't forget the burden on the physician, requiring extensive paperwork to justify their recommendations, and by-the-way, requiring them to give up medical data that has up to now been considered a private trust between woman and doctor.  The state, with its strong beliefs about protecting small business owners, should certainly be willing to give tax breaks to any doctor who is forced to comply with these onerous new regulations.

I think Lee Bright is onto something when he and his fellow cretins flood the Statehouse with variations on the same bill, and insist that time and money be spent to address these bills.  Proponents of healthy families and the rights of doctors to practice unimpeded should have no trouble coming up with amendments to all these bills, as well as new bills that guarantee a woman each individual right that is being threatened by the anti-abortion gang.

Seriously.  Isn't it time our pro-choice, pro-women, pro-family legislators became pro-active rather than continue to try to play whack-a-mole with each piece of outrageous anti-abortion legislation that are thrown at them?

We need to adopt for our own the tagline of those creepy Obamacare ads:

Don't let government play doctor.