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.

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.

Why I Talk about Money

A few days ago, I wrote a blog post about my frustrating efforts to get information in anticipation of my upcoming switch to Medicare.  In that post I talked dollars and cents regarding the costs of Medicare Part B, and specifically the way our Congress has increased the cost to new recipients, while avoiding the shitstorm they might have had if people already enrolled could see how much the premium and deductible had gone up.

My purpose in writing the blog was not just to describe how difficult it is to maneuver the complexities of Medicare, or even to expose all the unconscionable costs that seniors are now expected to pay for health insurance.  I really wanted to leave readers with the awareness that this is very likely to be the future of Obamacare, which is currently affordable and comprehensive.

Since I wrote the blog, I have had a number of conversations with people where we have actually talked in dollars and cents.  It is amazing how many intelligent and aware people do not know or understand all the various components of their health insurance, who just pay what they are billed and are thankful that they are covered.  Which is just the way Congress and the health care industry want it.

I have found, in my life, that we are more comfortable talking about our sex lives than about money.  I was told when I was in my twenties, by a far more sophisticated friend, that it is impolite to talk about money.  We don't want to brag and we sure don't want to beg.  We don't want sympathy, and we don't want scorn.

So we don't talk about our income.  If we were more comfortable sharing information about money, Lilly Ledbetter might not have been in the dark about being subject to wage discrimination.  We might all learn about bad financial deals and all those scams like car buying and loans.  We might exchange good information about tax breaks and government programs to which we are entitled.  We would be far more aware of how the republican right has worked with corporations and billionaires to manipulate our incomes and expenses.

Actually, not talking about money makes about as much sense to me as not talking about age.  It makes a big secret out of something that should be merely a sharing of information.  Really, who cares that I am 64?  It doesn't mean I'm going to die sooner, or look younger.  I believe people will judge me on far more than my age, and knowing how old I am is just a small piece of information that I provide.

Talking about costs is important to me, not because I need for people to know how much I personally live on, but because we all need to know more about how we all survive in this really bad plutocracy.  Absence of information makes us all vulnerable.  That is why corporations fight so hard to hide financial data; that is also why they are working so hard to collect data from all of us.

Here is another thing.  Since the Post and Courier published an article about serious problems with well water on Wadmalaw Island, a number of concerned people asked me how I was faring.  Fact is, I live in a relatively new development, the well is only about 25 years old, and there are people living with wells that were drilled in the 60's and 70's.  But, I add, there is a low income grant that qualifies me for a new well, so I am fortunate on that account as well.

Most people, I think, are uncomfortable learning that I qualify for a new well based on my income.  None of us really want to know that our friends are struggling financially, do we?  And then there are probably those who get their backs up just a bit over their tax dollars paying for my well.  If I end up with a new well and I am not obviously struggling, isn't that wrong?  After all, it wasn't long ago that the right-wingnuts in Congress were saying that you weren't poor if you had a refrigerator.

It's okay for tax dollars to pay for Boeing's success, and it's okay for corporate farms and pharmaceuticals to get huge subsidies from the government.  I recently heard a building contractor, when asked what he thought about Trump, reply, "If he becomes president, I'll be right there putting in a bid to build that wall."  There are acceptable ways to take government money and having a low income just isn't one of them.

I wrestled with agreeing to have that new well built.  I knew there were people far worse off than me.  But I was also told that if something happened to my current system, it would cost $6,000 to drill that new well.  So I agreed.

A businessman getting offered a good deal by the government would hardly turn it down.  But we individuals are made to feel like beggars and sponges if we accept a good deal.  Many, many people do not apply for financial assistance or food stamps because of the stigma, which our right-wing government is all too happy to magnify, by adding regulations from more frequent income checks to required proof of job-seeking to drug tests.

When the housing market collapsed not too long ago, hard working middle class people who believed in our capitalist system were thrown out on the street.  Congress fought over whether people who were unsuccessful looking for jobs should have their unemployment benefits extended.

There is an enormous myth that persists that if you work hard you will not need to turn to the government for help.  And yet those who are in government and trying to cut the benefits we deserve and depend upon are all to happy to take what the government gives them.  Our right-wing majority in Congress, and in too many of our statehouses, insist that people should work two jobs, mothers should work rather than stay home with children.  Meanwhile, members of the US House of Representatives, with full pay and benefits, are scheduled to work 111 days this year.

So let's not be polite about money.  We may think we don't know anyone who is struggling, or we may just think we don't know anyone who is struggling as much as we are.  Fact is, too many of us are in that same shaky boat, while the Koch brothers are in the yacht that is making all the waves. 

Keep an Eye on Obamacare

When my husband died a year and a few months ago, I was surprised and relieved to find that the health insurance of the Affordable Care Act really was affordable.  I figured I might just keep it as my private insurance when I became eligible for Medicare.

Wrong.

When you become age-eligible for Medicare, I have since found out, you cannot keep your Obamacare.  Your options become dizzying, and not in a good way.

I turn 65 in July, so for the past few months I have poured over Medicare books and stared at my computer screen for hours before becoming discouraged and just quitting for the day.  When I take it up again, the bad news starts to sink in, but it doesn't get any better.

But I am not here to whine.  I am here to bitch about the politics of health care for seniors.

I have had a hard time finding out what was available even a few years ago before Part D -- the prescription drug plan -- was enacted into law, so I can't tell you how much better Medicare was in years past.  But my guess is that the republicans -- with some Democratic compliance -- have been chipping away at Medicare for decades now.  Their preference, of course, is to privatize it entirely, but they are content -- as much as such a bunch of malcontents can be -- with destroying it one step at a time.

Let's start with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  It may be that there was no drug coverage before 2003 (I can't even get that info on Wikipedia, so if any of you out there can enlighten us as to what people did for prescription drugs before W came into town and got his hands all over it I would be very appreciative.).  From 2003, the drug component -- Part D -- of Medicare proved to be a real boon -- for the pharmaceutical companies.  And there was a sadistic element to the bill that one has to admire.

First of all, it is purchased from private pharmaceutical companies, with the government subsidizing some of the cost.  But you are not required to buy this coverage.  HOWEVER, each year that you do not buy Part D coverage, your cost for when you do decide you need it goes up.  Each year.  It is called a "late enrollment penalty," and this is the way Medicare explains it:

 Medicare calculates the penalty by multiplying 1% of the "national base beneficiary premium" ($34.10 in 2016) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium.

I imagine the drug companies were tickled at those terms.  But wait!  There's more.

You may have heard of the "donut hole," which Medicare more civilly refers to as "the coverage gap."  Not civil either way you look at it.  This bizarre rule means that -- while you continue to pay your monthly premiums, and after your deductible and copays -- if your pharmaceutical needs are so great that your drug cost reaches $3,310 in 2016, your coverage stops  Then you pay out-of-pocket until you have paid $4,850, when your "catastrophic coverage" kicks in.  By that time, your life if not your health can truly be considered catastrophic, so at least that is aptly named.

I still have to stop and let my mouth drop open when I consider those two key provisions of this totally shitful law.

 After you have contemplated Medicare Part D for a few minutes, we can move on to the truly brilliant way the republican Congress has managed to screw up Medicare with barely a ripple of outrage.

Effective for new Medicare recipients, beginning this year, the monthly premium has gone up from $104.90 per month to the astounding $121.80.  And the deductible has gone up for new recipients from $147 to $166.  This is despite the fact that in 2016 there was no corresponding cost-of-living adjustment to social security benefits.  And there was no COLA because Congress determined that the cost of living had not gone up because gas prices went down.  And then proceeded to raise the cost of living by significantly raising Medicare costs.

Slipping this change in for new enrollees means that most of us just pay what we are told, without realizing just how much the cost has gone up.  By not requiring people already enrolled to pay the increase they manage to stem what would probably have been a shitstorm.

Here's something else to consider.  Our less-than-esteemed members of Congress don't have to deal with this at all.  In one of a very few exceptions, they are allowed to keep their government subsidized health care after they retire.  Pretty cool, isn't it?  As Fred Astaire said, "Nice work if you can get it."

I could go on about Medicare, but I really want to end with some thoughts about Obamacare.

I imagine that we are not allowed to keep Obamacare after we hit 65 because it is, so far, a truly affordable and comprehensive health insurance program.  The government pays steeply for this, but the savings are also tremendous and -- hey -- it actually keeps more people healthy.

Those republicans, fat and happy and with their own pretty damned good government health insurance, will lose sleep over the fact that the government is paying for other people to get good, affordable health care.  They will not rest until they have chipped away at Obamacare the way they have done with Medicare.  Over the years to come, as long as we let them, they will increase out of pocket costs and cut the government subsidy until, just as with Medicare, those who are living on a tight budget, will just have to go without needed health care while they pay mandated costs.

And even at that point our elected officials will resent the fact that we are at all able to continue to breathe their air.

So, forewarned, keep an eye on our Obamacare, and let's not let the right wingnuts put this over on us.  Again.

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.

When the Right Word Just Isn't Enough

A few days ago, I sent out an email suggesting everybody take a deep, calming breath, and get ready for the SC Senate round of "Let's Pass this Awful Anti-Abortion Bill."  The one that I was referring to was Wendy Nanney's pet, the 20-week abortion ban, that didn't make it through last season.  Wendy can't sleep till this bill gets passed, in spite of her contention that people have been just plain mean to her because of it.  Poor Wendy.  You might almost think that she is the one whose welfare is being threatened by the provisions of the bill.

Anyway, no time to take a breath, because that bastion of freedom for old white men, Kevin Bryant, has just sponsored S 531, a bill to ban "dismemberment abortions."  Or as those gentle folk at "Life News" would say, "Bill to Ban Dismemberment Abortions Tearing Babies Limb from Limb."

They may be barely literate, but they make up for it with hysteria.

As you may recall, fanning the flames of hysteria with misinformation and outright lies was a rousing success in the misnamed "partial birth abortion" battle.  This was thrilling for those whose grasp of science is conveniently misplaced but whose imaginations run to the wildly gruesome.  Personhood may not be as successful because it is too extreme, or it may just be that it doesn't raise the hackles as do phrases like "fetal pain" and the more objective sounding yet nonsensical "pain capable."  Giant paintings on the sides of buses, trucks and billboards may not actually represent scientific accuracy, but they certainly can produce Heironymous Bosch chills up one's spine.

In fact, the obsession with the gruesome, in spite of the professed concern for life, pretty much describes the anti-abortion battle.  Much like those so opposed to gays co-existing in their world that baking a wedding cake sends them into frenzies because of the portent of gay sex, the anti-abortion fanatic can't seem to stop seeing dead things.  Tiny dead things.

In this country, theoretically at least, self-appointed messengers of God are still unable to force people to their will based on warped ideas about religion.  So they are forced to resort to gumming up the works with the pretense of science, gussied up with horrid images.

And it works.

I believe it's time we fight hyperbole with hyperbole.  We need our legislators to get out there and write some bills that really, really stand out.

For example, for some inexplicable reason, domestic violence just doesn't have an emotional impact in our red state.  So, to take a cue from those far more adept at inflaming the masses, how about we call it the "Punching and Gunning Down Women Prevention Bill?"

Or the "Don't Starve Our Toddlers Act" in support of expanding food stamps (can also be used for minimum wage).

If that is too coarse for legislators on our side of the aisle, how about a "Prevention of Medical Surveillance" bill to counter the anti-abortion bills?  After all, we here in SC fear being spied upon almost as much as having our guns taken away.  "Death panels" was so effective in revving up fear of Obamacare that perhaps it could be taken out of mothballs and brought back for a bill to actually regulate insurance companies when the Supremes kill the ACA.  Or it can be used here at home against opponents of Medicaid expansion.

I do think we are too timid, and that is why we are constantly in the position of defending ourselves from the onslaught of rabid verbiage that takes center stage in a battle for our civil liberties and safety.  Until we are able to flood Congress and the State Legislature with equally dramatic bills full of fighting words, we will be at a disadvantage.  Thus far, the twenty-first century has not been the time for a reasoned approach.  To anything. 

...and If You Hate Obamacare...

I am one of those South Carolinians waiting with bated breath for the U.S. less-than-Supreme Court to rule on the Affordable Care Act.  It infuriates me that in this country, so many who are fortunate enough to have health care security will continue to rant and obstruct the program that has given so many of the rest of us the same.  The what's-in-it-for-me crowd is so blinded by greed and rage that they are unable to see how, in fact, making health care a right instead of a privilege has been a major factor in the dramatic upswing in our economy.

We have gone in a short time from an economy crippled by high unemployment, in which the younger job-seekers were shut out because we older folk had to hang on till we were eligible for Medicare.  We stayed with jobs we hated, jobs that hurt our aging bodies, jobs that often did not pay a living wage, so that we could cling to that health insurance that each year cost more and covered less.  Employers called the shots because they knew they had something we needed -- and it wasn't that barely living wage.

The health insurance industry, with a strong house advantage, never lost the insurance gamble.  They took in the young and healthy and priced out of the game anyone who actually might cause them to have to pay out.  The cost of people growing sicker and dying because of lack of adequate health care never showed up on the health insurance industry bottom line.

It is true that the health insurance industry made sure to take care of its own when reform became inevitable.  They made promises in exchange for the ability to make even more money.  They did this by allowing our government to subsidize those fat premiums.  And their lobbyists made sure the public saw the government as the enemy and not the industry itself.

So for pretty much the entirety of President Obama's terms in office, we have been listening to the uninformed parroting the vitriol against health care reform.  I've heard people complain about Obamacare in the same breath that they admitted they were now paying less for coverage.  They rage against "Obamacare" as though it is responsible for the global warming they deny and pretty much everything else (Melissa McCarthy as Tammy:  "Four dollars a gallon.  Thanks, Obamacare.").

It is also true that the ACA has only slowed the rise of health care costs.  Well, if Democrats had spines and Republicans had consciences, we just might be able to tackle the greed of the insurance industry.  I'll bet they could have enough profit without raping the all-too-willing government.  It might even be that regulation of the industry would result in a better product.

But we were left with the worst of capitalism, that bit that decries government involvement, unless of course, it is writing the checks.  If you look closely at your "affordable" health insurance, you will see that the government is picking up the tab for most of what continues to be a ginormous premium.  And yet you still have to pay all those cleverly named additional amounts when you actually need health care.

Yet people like me do have affordable health insurance.  For now.  Because even though all those idiotic votes to repeal in the US House, and despite states with governors with Tea Party dreams like ours, the federal government passed a law that has stood up.  Democracy, right?

But now that libertarian Koch darling, the Cato Institute (support with "the Gift of Stock") is leading the challenge to the ACA in the Supreme Court.  And the hook this time is four words in the law, which may eliminate federal exchanges in states like South Carolina, where we insist that the best way to help people without health insurance is to deny them health insurance.

I only just today learned that argument will be heard on Wednesday.  Most of us, happily insured, are totally uninformed on this fight for our very health and well-being.  I worry that while we look away, we will lose our health care security once again.  And ironically, a lot of those who are going to lose are the Obamacare haters.  Imagine that.

Not Too Bright, But Busy

Arlo Guthrie once said about Ronald Reagan that he doesn't mind our President nodding off because, "The more he sleeps, the safer we are."

These days I am wishing that folks like South Carolina state senator Lee Bright would take a few naps.  He has been using his pent-up anger and frustration at being passed over for Congress (in favor of the ultra-liberal Lindsey Graham) by redoubling his efforts to fill the state dockets with the same worthless bills he failed to get through in the last legislative session.  In fact, he has thus far already sponsored some forty bills.

Why this self-aggrandizing good Christian can't take a break for the Christmas holiday just defeats me.  He sure could stand to say a few prayers for guidance.

The bills he has sponsored (and co-sponsored with fellow idiot Larry Grooms) are mostly anti-abortion and pro-gun bills, with a smattering of anti-Obama.  Not too bright, and no new ideas, but enough vitriol to keep all his right-wingnut supporters happy -- well, actually, to keep them angry.  Maybe if he can raise the level of ugly just a little tiny bit more he'll be able to oust Graham in six more years.

Lee Bright's dream for South Carolina is a state where the fed'ral gub-mint keeps its hands off our weapons, and the state is free to stick its business in women's private parts, if you know what I mean.  Don't need the feds to help make sure the women -- and the girls -- stay pregnant and stay home; South Carolina has been fighting hard to maintain that status quo all by its own self.

No new ideas from Lee Bright

Here is what I want to know:  why do our reasonable legislators (and we really do have some) always seem to be in the position of chasing after the nutcases?  People like Lee Bright clog our legislature with destructive bills, bills that attack freedom of religion, right to privacy, the right of licensed medical professionals to provide the best care without government interference, the right to be safe from people of poor judgment carrying weapons, the right to vote.  We could wallpaper the State House with bills that seek to prevent the state of South Carolina from having to follow federal laws.

I would like to see our reasonable legislators (have I mentioned that we do have some?) pre-filing bills that would enforce federal health care laws and force the governor to accept Medicaid funding, assure voting rights to all, bills that would require that the government not invade the privacy of women in their doctors' offices, and that medical professionals are allowed to practice freely and without fear of government intervention.  How about bills that keep guns out of public places?  And bills that require additional police training in use of physical force and weapons so that citizens no longer risk getting shot by a panicked officer as they reach for their license and registration.

We don't need to always be finding ourselves on the defensive.  Our legislators need to be as passionate about protecting the rights of South Carolinians as are idiots like Lee Bright about taking away those rights.

So sharpen your pencils and get out the paperwork.  Maybe while Lee Bright is at Christmas mass schmoozing with the holy rollers we can get some good bills filed, and give him and his buddies something to keep him so busy he won't have time to file another stupid bill.

Praying for a good idea

Just as Silly

I'm having flashbacks to the Republican loss in 2012.  Remember when, immediately after the election, they were all talking about what they'd done wrong, that they must not have been reaching the American people, and then they came out the other end with the idea that it must be that they had to change, not the message, but the way they sold that message.  Say what???

So let's move forward to 2014.  Here are the Democrats, all demoralized, wondering what they did wrong.  All talking to each other having meetings and forming committees, trying to figure out why people didn't come out to vote for them.  It seemed like they almost nearly just about had it figured out.  Maybe it was because they hadn't represented the issues that Democrats were supposed to stand up for.  Maybe they were trying too hard to soften the message, to distance themselves from the President.  Maybe they had failed to talk to the voters about all the successes the Democrats had, in spite of Republican obstruction.

In fact, I'm hearing one Republican strategist say he can't understand why the Dems ran away from their successes, were afraid to talk about all the people that were now insured, the low unemployment rate, the declining deficit.  And Rachel Maddow is pointing out how the Dems that won in this really bad year were the ones that actually ran on Obamacare, the environment, saving Social Security, you know, Democratic issues.

So here we are a week and a couple days later, and I hear that Mary Landrieu who is in a runoff race for her Senate seat, is trying to push her opponent's bill to approve the XL pipeline before the end of the session.  Huh???

And here's a Harry Reid story:  apparently he is reluctant to get all those Obama judicial appointments -- and that all-important attorney general appointment -- through the Senate while the Democrats still hold the majority.

So what have we really learned from this year's midterm disaster?  Well, President Obama has figured out that if he plans on enacting all those things he promised in his two election campaigns, he's going to have to do it without the help of his party.  And the Republicans have learned to keep doing what they are doing, because it really scares the Dems and keeps their base happy.  The Democrats who didn't get it to begin with seem to have learned nothing.

With people voting to approve gun control measures, and legal marijuana, and gay marriage, the only big success stories from the candidates were those who ran a campaign on solidly progressive issues, like Al Franken.  Even the two guys who were beaten in an NRA-sponsored recall election in 2013  in Colorado for their gun control legislation had their day.  The voters re-elected them to the seats they had lost such a short time ago.  And Colorado Governor John Hickenlooper who promoted that gun control legislation has also won his re-election.  And my goodness, in the Arizona town where the school board voted to remove pages from an honors level science textbook that discussed abortion, the electorate sent those recently elected idiots back to their caves and elected candidates who actually approved of educating students.

Maybe voters aren't really paying attention to what the candidates stand for.  So when the candidates are afraid to be outspoken and challenge their opponents, all we have to go on is the rumor, scandalous headlines and idiotic ads.  No wonder then that voters are often able to vote smart on issues, but just pull that big "R" when it comes to candidates.

I just don't think that Wendy Davis or Alison Lundergan Grimes understand that where they fell short was where they backed off from being a Democrat.  And it seems that Mary Landrieu will learn too late that pushing the pipeline isn't what will make people head to the polls to support her in the runoff.

Silly times, tragic consequences.