The Method and Madness of Trumpcare

We should not be surprised that after all the protests, phone calls and town halls, and the first attempt at jamming the AHCA through the House, the bill was resuscitated, bribes were bribed, and it was forced through successfully last week.

We should have known that each and every time a snarky remark was made by a liberal about his failing first 100 days, Trump's determination to win grew.  Much as the truly clever and funny jabs that Obama made in 2011 at the White House Correspondent's Dinner set in concrete Donald's determination to run and win the presidency.

It is said that Donald Trump has no understanding of the complexities of health care... by Donald himself in fact.  And he really does not care, any more than he cares about refugees or American workers.  He wants to be liked, and he wants to win.  He would rather be liked by rich and powerful people than by disgruntled Americans, but if the latter can help him do the bidding of the former, he will say whatever he needs to say to get there.

One of the groups of peons that Trump has courted successfully is the republican Congress.  Don't laugh.  They may be a lot richer than the rest of us, but they aren't in the same league as the Kochs or Vladimir Putin.  They are just rich enough to be insecure about keeping that wealth.  They are just rich enough to know that losing could be just around the corner.  In other words, except for the money, they are a lot like the middle class Trump supporter.

Ryan and McConnell and their cronies want nothing more than to be in the club, and Donald Trump can smell that vulnerability.  When he bused all those senators to the White House for that meeting on North Korea, it had all the makings of a Trump sales pitch.  Inviting a group of powerful people to "his" house is to Trump like inviting the Chinese president to share his delicious chocolate cake at Mar-a-Lago.  It puts the power in his hands.

Imagine his surprise when even republican senators were unimpressed.

Donald Trump is a man of limited intellect but a craving for attention and approval that has created a finely-honed instinct for manipulating others.  Of course, he couldn't have done it without his father's wealth and influence, but what he developed has worked quite well for him in his businesses -- even when he lost he made sure he won, regardless of who he had to throw under the bus to do it.

What looks like erratic behavior is really a pattern of responses that is coming to be fairly predictable:  assumption of success; disbelief followed by rage -- insults and attacks; withdrawing briefly to regroup; followed by approach and flattery; and then the deal.

He has done this with each of his primary opponents, with the media, with foreign leaders, and now with Congress.

But he is finding that he is playing in a different league these days.  Even psycho leaders like Duterte of the Philippines are offering fairly lame excuses to avoid looking like they want to be seen associating with our own psycho leader.  And he was brushed off by the inaptly named Freedom Caucus, the group formerly known as the Tea Party, when he tried to prod them into the original AHCA bill.

Like a rat learning to press the lever to get another rice krispie, however, Trump is a good learner.  He knew how to get Paul Ryan to be his House lapdog, and it didn't take that much more wheeling and dealing to sell the really bad health insurance bill to the people that were actually looking for really bad health insurance to pawn off on the American people.

But that group of people in Congress who are just insecure enough that they will work with Trump to get what they need don't mind throwing him under the bus either.  So what we all tried to call "RyanCare" is now "TrumpCare."  And the republicans who have been at the art of the political dirty deal far longer than Trump, have laid the ground work for laying the blame on him AND gotten their nasty piece of legislation passed.

There are a couple of important factors here, things we need to keep front and center as we watch -- and even try to influence -- the outcome of this struggle.

First of all, we need to stop pretending that the Senate is that much more grown up and responsible than the House.  They are mostly smarter, and definitely shrewder, than their wacky counterparts, but they are still rabid about success, and equally insecure about their futures.  They are in the pockets of the insurance and pharmaceutical industries, but because they can't count on guaranteed gerrymandered districts, they have to pretend to be listening to and working for all their constituents.

We in South Carolina have learned the hard way to never make the mistake of assuming that Lindsey Graham is on our side.  He is on Lindsey Graham's side, the side of the right wing, whether it be religious or corporate.  He was tickled that he could vote Neil Gorsuch onto the Supreme Court, and did whatever mental maneuvers were necessary to defend his desires.  This is true of Mitch McConnell, Tom Cotton, Marco Rubio, and all the other folks that have been bought by corporate money.

And that leads us back to Trumpcare.  It is a truly egregious scheme, a tax cut for the really wealthy that takes health care away from pregnant women, cancer patients and sick children.  But in that, it is not much different than what has been happening to workers and education since the 80's, and what will be happening to our environment.  Every piece of which will make us sicker, less able to care for ourselves and our families, and less able to fight the plutocratic oligarchy that has managed to lie, cheat and steal their way into Washington.

The irony is, you can call it Trumpcare, but Trump doesn't care.  Ryan and the rest of the right-wingnuts are looking for continued wealth and security.  But the joke is on them.  The only ones Trump cares about are Trumps.  And every single damn thing he has done since he came into office has profited the Trumps.  That is the other thing we need to keep remembering to keep our eyes on.

Talk about the art of your deal made in hell.

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.