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The GOP Has Become a Malevolent Force in American Life

The GOP Has Become a Malevolent Force in American Life

Consider these words written in 2012 by non-partisan political scientists Thomas Mann and Norm Ornstein:

The GOP has become an insurgent outlier in American politics. It is ideologically extreme; scornful of compromise; unmoved by conventional understanding of facts, evidence and science; and dismissive of the legitimacy of its political opposition.

Eight years on things have got demonstrably worse. Republicans continue efforts to repeal the Affordable Care Act both legislatively (in 2017, which failed) or in court as GOP states led by Texas pursue a lawsuit currently pending before the Supreme Court that may see the ACA overturned next spring. The consequences to millions of Americans would be devastating.
This in the face of a virulent pandemic with more millions of Americans losing their jobs and their health care who will likely need the ACA. In the current health crisis, the Republicans’ rush to open up the economy before infection rates have decreased or we have adequate testing and contact tracing capabilities promises to cause thousands of unnecessary deaths – particularly among the elderly.

Meanwhile the GOP’s stubborn and obtuse denial of climate change threatens the future of our children and grandchildren. The depressing litany of destructive policies the GOP has embraced over the years whether its unravelling environmental protections and workplace safety regulations, beating up on the poor in America, suppressing voting rights of minorities to name but a handful, do enormous harm to the American people. The reality is of a political party and conservative movement that rejects the worth and role of government to do good and runs it incompetently to prove its point, while doing everything possible to impede the other party from governing effectively.

In this the GOP is robustly supported by its perpetually angry base, and a right-wing media machine that pushes both to the extremes. Negative partisanship is bipartisan but at least most Democrats get their news from reliable mainstream media as opposed to Republicans who are far more likely to be misinformed thanks to conservative media even on something as critical as the coronavirus. The latest conservative conspiracy theory, for example, is that the COVID-19 death rate is vastly exaggerated, a dangerous illusion that promotes a lethal complacency.

In short, Republican governance at every level is severely hazardous to our health and well being. In the present emergency, a GOP administration first weakened the federal government’s ability to combat a theoretical pandemic then thoroughly botched its response to a real one. And while a pragmatic Democratic House has tried gamely to bring some sanity to the government’s response to the economic and health calamities, it’s an uphill struggle against an ideologically driven, boneheaded GOP majority in the Senate. For example, an obvious need to support states with an infusion of federal funding as their economies tank and their revenues plummet is being blocked by a hatefully partisan GOP leadership that sees it as disproportionately (and erroneously) benefitting Democratic states.

When this catastrophe is finally over, Americans need to have a serious conversation on the future of our democracy in light of the bitter divisions that are unlikely to ameliorate even without the vile and divisive presence of either Trump or Senator “Moscow” Mitch McConnell. I don’t pretend to know the answer but I do know that we can never move forward as a country while this extreme polarization, without parallel in any other democratic nation, persists.

Coronavirus Stimulus Bill Sabotaged by Republicans

Coronavirus Stimulus Bill Sabotaged by Republicans

Senate Republicans don’t care about people. They only care about big business, corporate donors, and their extremely wealthy friends. We knew that when a Republican controlled senate passed President Trump’s Tax Cuts and Jobs Act in December 2017. It gave huge tax cuts to corporations and provided a big tax loophole for pass-through income. The bill was advertised as a move that would lower taxes for workers and help businesses expand by providing them with more cash. Most workers saw very small decreases in their taxes and some actually saw their taxes go up a little, but businesses were left with a lot more cash in pocket and they used it to buy back their own stock to line the pockets of their already obscenely rich corporate executives. They did not increase investment any more than they would have otherwise and they did not provide any substantial increases in wages or benefits for workers. Some cities and states saw increases in wages because they mandated higher minimum wages themselves. Republicans in congress refused to increase the minimum wage like they always do.

Trump’s tax-cut was an expensive failure.

So they were fine with their 1.5 Trillion Dollar tax cut for the rich, but they aren’t so fine with a new and much needed coronavirus stimulus bill that will cost somewhere between one to two trillion dollars if most of that money is funneled to the people who really need it – the unemployed workers.

The Democrats focused their efforts on people first, not profits first. They would direct the money to the millions of people in the service industry (restaurants, bars, hotels, ride-share drivers, salon workers, dental hygienists, etc.) who are all out of work. This is a huge sector of our economy. Workers need cash to buy food, pay rent and mortgages, and obtain healthcare – all urgent stuff. The stimulus bill should provide that urgent aid first. A one-time check in the $500 to $1,200 won’t provide the long-term aid they are going to need.

The spending should cover the cost of extending the unemployment insurance for at least a year or two. It should probably force large employers to provide sick pay for as long as is necessary for their workers to recover from COVID-19. The bill should prevent people from losing their jobs because of government-mandated work stoppages. It should make sure that everyone afflicted with the disease gets the healthcare they need regardless of whether or not they have insurance. To put it simply, the stimulus bill can’t be about “creating jobs” right now. It should be all about alleviating hardship and suffering caused by the outbreak, because it can’t help put people back to work until the pandemic is gone, and it looks like that isn’t going to happen for months.

The Republicans’ bill includes $5B for a corporate slush fund. It’s weak on worker retention and has loopholes. It’s treasury lending section is vague. It doesn’t provide provisions to protect people from evictions and foreclosures. It provides zero money for state and local governments. Is that because the states hardest hit are blue states? No additional spending on SNAP when the program will obviously be under extreme pressure. No direct payments for people who did not file tax returns in 2018 or 2019. It offers no help for the uninsured and no help for people with student loans.

What this all adds up to is, as James Martin wrote in The New York Times today, a Moral Evil. That’s suffering caused by the actions of individuals or, in this case, the inaction of individuals. And even worse; the deliberate redirection of resources that should be used to alleviate suffering of the most vulnerable people to the least vulnerable, most wealthy people in our country. That’s right. Who do you think will be the recipients of a slush fund?

Maybe enough Republicans in the Senate will read The Bible tonight and decide to do what Jesus would do (from the James Martin column):

Needless to say, when caring for someone with coronavirus, one should take the necessary precautions in order not to pass on the infection. But for Jesus, the sick or dying person was not the “other,” not one to be blamed, but our brother and sister. When Jesus saw a person in need, the Gospels tell us that his heart was “moved with pity.” He is a model for how we are to care during this crisis: with hearts moved by pity.

I’m not betting on it.

US healthcare system ranks last again. Obamacare will raise its future rankings.

US healthcare system ranks last again. Obamacare will raise its future rankings.

A recent study by the Commonwealth Fund ranking healthcare systems in eleven advanced countries found the United States in last place. And while we languished at the bottom the study, which ranked healthcare delivery on such metrics as quality of care, access, efficiency and healthy outcomes, rated the United Kingdom at number one (take that, Fox News know-nothings). Just to add insult to injury, the UK spends $3,405 per capita on health (second lowest behind New Zealand) while we spend a whopping $8,508, the most of any in the study by a country mile.

Unsurprisingly, we fared poorest in categories associated with access and equity thanks to our lack of universal insurance coverage, and in efficiency where we are burdened with such deficiencies as excessive insurance company administrative overhead, medical duplication and overuse of emergency room treatment.

We also performed the worst in healthy outcomes as measured by infant mortality, healthy life expectancy, and mortality amenable to medical care (i.e. unnecessary or avoidable deaths).

As if this study wasn’t bad enough, we also have the International Federation of Health Plans 2013 Comparative Price Report which annually measures the cost of medical procedures and drugs among selected countries. Guess who regularly emerges as the most expensive? Even Switzerland (where a hamburger meal can cost $50) is way cheaper. As Ezra Klein noted about the iFHP 2012 price report in the Washington Post:

This is the fundamental fact of American health care: We pay much, much more than other countries do for the exact same things. For a detailed explanation of why, see this article. But this post isn’t about the why. It’s about the prices, and the graphs.

One note: Prices in the United States are expressed as a range. There’s a reason for that. In other countries, prices are set centrally and most everyone, no matter their region or insurance arrangement, pays pretty close to the same amount. In the United States, each insurer negotiates its own prices, and different insurers end up paying wildly different amounts.

So the US healthcare system is definitely ailing. But relief may be at hand. In noting the results of the Commonwealth Fund report, a New York Times  editorial states:

The poor results for the United States reflect the high cost of its medical care and the absence of  universal health insurance, a situation being addressed by the Affordable Care Act. The federal law is already increasing the number of Americans with health coverage and will substantially cut the number of uninsured in coming years. Other advanced nations are far ahead in the game because they have long had universal health coverage and promoted strong ties between patients and doctors.

Already the ACA’s beneficial effects on the rate of uninsured are being felt, particularly in states that embraced it wholeheartedly, as this piece about Minnesota from Jonathan Cohn in the New Republic shows.

So, despite the best efforts of Republicans to keep us mired in a rotten system that is inefficient, inequitable, prohibitively expensive, and too often lacking in overall effectiveness, there is hope that the future will be significantly brighter for American healthcare, thanks to Obamacare.

GOP’s selective outrage on display with VA scandal.

GOP’s selective outrage on display with VA scandal.

Over at Vox.com, Ezra Klein puts the current Veterans Administration healthcare scandal into much needed perspective by wondering why there isn’t similar outrage over the 4.8 million Americans who fall into the Medicaid gap because their GOP governors and/or legislatures have refused that program’s expansion under Obamacare – an expansion paid for 100% by the federal government for the first three years and 90% thereafter.

Of that 4.8 million, about 250,000 are poor veterans. Their situation is far more precarious, as Klein points out, than that of veterans caught up in the VA’s care backlog.  However long and outrageous the wait times may be for VA care, those eligible for it at least know that quality care will come eventually.  Veterans not eligible for VA care but eligible under the Medicaid expansion who happen to reside in one of the 24 states which have opted out can expect no relief, no help. For them it is not just a delay in care that is at issue but its complete absence.

So where is the outrage for the almost 5 million souls affected, particularly from those Republicans and conservatives who are practically frothing at the mouth over the VA revelations? We know the answer from the din of silence, and it’s not difficult to figure out why. There’s political mileage to be made out of the VA’s problems even though they’ve been a long time building. But the lack of coverage for those in the Medicaid gap is the GOP’s exclusive shame and the less said about it the better.

No one would argue that our wounded veterans don’t deserve the very best care we can provide. But why stop there? It’s not a zero-sum game, after all? We can show our concern for both vets and the uninsured working poor can’t we?

Klein provides the roll of shame of states which have refused the Medicaid expansion and the total number of people in each who would be eligible, together with a separate figure for vets. It’s nothing short of a disgrace and as a civilized society we should be every bit as outraged over the plight of those in the Medicaid gap as we are over the VA’s deficiencies.

Happy Thanksgiving Cards from the Obama Hating Heritage Foundation

Happy Thanksgiving Cards from the Obama Hating Heritage Foundation

They’ve got some great Thanksgiving cards to celebrate the occasion. Like this one:

Heritage Thanks Gov Reg

Hilarious! Must be aimed at Bloomberg. And how about this one directed at the First Lady?

Heritage Thanks Michelle

Ha Ha Ha ! That is so funny!

Ah the Heritage Foundation,  that delightful conservative think tank that drafted the plans for a universal healthcare system that preserved the private, for-profit, health insurance system we’ve all come to know and love here in the good old U.S.A. Yes, they are the ones that helped a Republican governor of a liberal East Coast state implement their system that prevents insurance companies from rejecting applicants with pre-existing conditions, requires citizens to sign up, and subsidizes the poor with tax credits provided by taxing the wealthy. It worked great for Governor Romney – Massachusetts covers more of its citizens than any other state.

President Obama campaigned for universal healthcare during the 2008 election, and he won. The politics at the time were highly polarized (and still are), so its no surprise that he could not get the more desirable and more efficient single-payer system through congress, so he went with the Heritage Foundation’s plan that has been so successful in Massachusetts. And how does the Heritage Foundation respond this Thanksgiving? With this:

Heritage Thanks Liberals

It’s so crazy I can’t stop laughing! I love how they completely flipped their conservative plan to funnel tens of millions more people into the for-profit insurance system into a liberal “socialist” plan that they’ve now disowned.

What is it that motivates them to mock a system they crafted themselves? Could it be they don’t like Obama? What is it about a right-leaning, centrist president that so displeases them? Could it be they don’t approve of his upbringing by a white woman from Kansas? Or could it be that they don’t approve of his black father from Kenya? Hmmm… I just can’t figure it out, but whatever it is, they sure are funny!

Ugly side of Republican conservatism on display with Obamacare rollout

Ugly side of Republican conservatism on display with Obamacare rollout

A recent Washington Post story tracked the efforts of an Affordable Care Act navigator, Courtney Lively, to help uninsured residents of Breathitt County, Kentucky, enroll in Medicaid now that it has been expanded under the Affordable Care Act, or in a private health insurance plan on the state’s exchange. Kentucky is the only southern state to both establish its own exchange and embrace the Medicaid expansion. Not coincidentally, it has a Democratic governor.

The article shows the ACA working as intended to help those most in need of health insurance. Breathitt County, for example, has a per capita income of just $15,000; 15% of Kentucky’s population or about 640,000 people are uninsured:

Lively, who has been signing people up since the exchanges opened in early October, said one woman cried when she was told she qualified for Medicaid under the new law. She said people have been “pouring in” to her office, an unused exam room in the back of the clinic, where her set-up includes a table, a two-drawer filing cabinet, manila folders, a planner to track her schedule, a notebook to track her numbers and a laptop that connects to the state health-insurance exchange, Kynect.

Here is a sample of the sort of people featured in the piece:

“So, is that Breathitt County?” she asked Woodrow Wilson Noble as she tapped his information into a laptop Thursday morning.

“Yeah, we live on this side of the hill,” said Noble, whose family farm had gone under, who lived on food stamps and what his mother could spare, and who was about to hear whether he would have health insurance for the first time in his 60-year-old life.…. “All right,” she said. “We’ve got you eligible for Medicaid.”

“I got some warts on me I got to take off, some moles,” he said. “I might have that colonoscopy done. My mom had colon cancer twice. I never had money to do it.” He said he was told it could cost at least $2,000.

“I got this pain in my left shoulder,” he said, lifting his arm and rotating it. “Might be arthritis, I guess. I don’t know.”

And another

“All right,” she said to her next client, a 52-year-old disabled master electrician who said his mother, two brothers and two sisters all died from lung cancer. He had been ignoring a spot on his lung discovered during a visit to the emergency room after he had broken his ribs several years ago.

He also vaguely recalled being told at the time he had something called “wedging of the spine.”

“What do I need here?” said Jeff Fletcher, who was being sued for those medical bills. “Proof of income?”

After a few questions

“All right,” Lively said after a while. “You are covered.”

“I’m covered?” Fletcher said. He slapped the table. He clapped twice.

“Woo-hoo! I can go to the doctor now?” he asked Lively. “I’m serious. I need to go.”

And finally Ronald Hudson

…a skinny 35-year-old who worked as an assistant director at the senior center and had just been released from the hospital after a blood-sugar spike.

He’d never had insurance before and said his hospital bills were up to $23,000 at this point.

“Good night,” Lively said, tapping in his information.

Kids: five. Salary: about $14,000 before taxes.

“You’re going to qualify for a medical card,” she told Hudson.

“Well, thank God,” Hudson said, laughing. “I believe I’m going to be a Democrat.”

Lively printed out his papers.

“RONALD’s Health Care Coverage Options,” one of them read.

“Oh, man,” Hudson said.

This is a side of America that most of us don’t see and many of us choose not to; the sort of poverty that shouldn’t exist in a society as rich as this one but does, and to an alarming degree. What follows, however, is a sample of the comments to the article from what I think we can safely say is the conservative side of the American divide:

funowobama1 11/25/2013 10:22 AM PST Is there poverty in the U.S. yes – but giving out free things does not make it better – a woman with 5 kids making 14k – no info on who the father(s) is/are – I have pay for her not being able to cross her legs – please show me the logiic in all of this make her pay something so she can feel the pain.

Skunk at the picnic

11/25/2013 10:12 AM PST

I’ve always wanted to forsake my own financial goals in order to subsidize a bunch of people who smoke, drink, never exercise or eat right or do anything else remotely associated with good health.

dwpm

11/25/2013 10:09 AM PST

There is no such thing as poverty in America. The only people who believe there is poverty in America are the individuals who have never really seen it. Real poverty is no shelter, no food, no education and no healthcare (note I didn’t say “no health insurance”). I have seen real poverty very, very up close and personal and believe me it doesn’t exist anywhere here. Everyone in America (and Europe) has access to shelter, access to food, access to education and access to healthcare (note I didn’t say “access to health insurance”). Poverty in America is all about extracting tax dollars from the working class segment and redistributing it to the dependent class segment to create life long democrat voters. And that is truly evil.

ULikeItUKeepIt

11/25/2013 8:54 AM PST

The title should be edited as follows: “Freebie insurance folks sucking off middle class Americans who were struggling to keep their family afloat and now must pay triple for their family’s insurance to keep Freebie people insured are very happy to screw millions of Americans by playing victim.” Disgusting. Vote liars, Democrat party race-baiters, Constitution haters, and others OUT. Return America to the people who actually love it.

4Runner05

11/23/2013 6:27 PM PST

For Dem/socialists to feel self-righteous and morally superior from these poignant stories, how many people have lost – and will lose – their health insurance? Your socialist wet dream is all about screwing 85% of the people (who have some form of insurance) for the 15%. Destroy the current insurance system and replace it with a “caring, helpful” bureaucracy and you have the real reason behind Obamacare. POWER When the government has power over your health care, you’ll surely vote for the party (Dem/socialist) that has that power. One of the people in the story said it all: “Hudson said, laughing. ‘I believe I’m going to be a Democrat.” If he wants to keep his rationed and mediocre health “care”, then he will. How many of you lefties are “pro-choice”, BTW?

FTC

11/23/2013 7:13 PM PST

So “God fearing people” are responsible for people living in squalor? The poor on the most part make bad life decisions their whole lives and pass those horrible values onto their children, who in this day of birth control and abortion on demand, probably should not of had. The problem with Liberal compassion is that it makes everyone a victim of someone else, and never allows for the dysfunctional to take responsibility for their failures. The taxpayer is responsible for every girl that gets pregnant, the children of every boy or irresponsible man who fathers children with multiple women? Our welfare/entitlement state already is unsustainable, where does it end? As Margaret Thatcher so aptly pointed out “Liberals eventually run out of other peoples money”.

And although congressional Republicans and conservative punditry may not be as openly hostile to the poor, their overall message is still remarkably disdainful. While I doubt anyone can recall the last time they heard a conservative congressman or Fox pundit express any concern for the plight of the uninsured in America, nearly all of whom simply had no viable options for obtaining coverage, they have been apoplectic over the cancellation of policies held by relatively affluent individuals and families who can easily obtain other decent plans under the ACA.

Much of this is politics, no doubt. And some is a woeful and probably willful ignorance of the extent of poverty in America. But most of it is simply a stunning lack of empathy and a willingness to accept myths about the poor and peddle them as facts. As Michael Tomasky says in this piece in The Daily Beast talking about the House GOP’s bill to slash $40 billion in food aid to the poor:

…I think maybe you’ll agree with me that the single worst thing the Obama-era Republicans have done is try to push through a $40 billion cut to the food-stamps program. It’s just unspeakably cruel. They usually say publicly that it’s about saving money. But sometimes someone—one congressman in particular—lets slip the real reason: They want to punish poor people.

… The proposed GOP cut is such a piddling amount of money, in terms of the whole federal budget and especially when spread out over 10 years. But nearly half of it is quite literally taking food out of the mouths of children. What’s the point? The point really is that Tea Party Republicans think these people don’t deserve the help. That’s some fascinating logic. The economy melts down because of something a bunch of crooked bankers do. The people at the bottom quarter of the economy, who’ve been getting jobbed for 30 years anyway and who always suffer the most in a downturn, start getting laid off in huge numbers. They have children to feed. Probably with no small amount of shame, they go in and sign up for food stamps.

And what do they get? Lectures about being lazy. You may have seen the now-infamous video of Tennessee Congressman Steve Fincher, who told a crowd over the summer that “the Bible says ‘If you don’t work, you don’t eat.’” This while Fincher, a cotton farmer, has enjoyed $3.5 million in federal farm subsidies. This year’s House bill ends “direct payments” to farmers whether they grow any crops or not—except for one kind: cotton farmers.

Underlying the actions of congressional Republicans and the words of their base is a pernicious belief that if you’re poor you deserve to be so because you must wish it. Or to put it another way: “Find me a poor person and I’ll show you a lazy bum”.

Ignorance of their own country combined with a singular lack of empathy and a large dose of hypocrisy – this, increasingly, is the only side of the modern American conservative movement that we now see. And it is ugly.

GOP’s deep unseriousness on deficit clearly displayed in Ryan Budget

GOP’s deep unseriousness on deficit clearly displayed in Ryan Budget

The first thing that needs to be understood is that the new budget proposal from Congressman Paul Ryan is not a serious document in any way. Rather, it is a GOP political manifesto, a document that clearly states what today’s GOP stands for and where it wishes to take the country. And it shows how unserious the GOP is about reducing our deficit and the national debt since the plan includes no new revenue and is all about cutting government programs – its real, indeed only priority.

The budget is even more harsh on the poor and middle-class than the last one since its putative purpose is to balance the budget in 10 years. In practice, if enacted it would almost certainly tank the economy and increase America’s poverty rate over its already unacceptably high level, thereby negating any financial benefit from cutting government programs.

The Ryan budget repeals Obamacare, keeps the sequester cuts on discretionary spending which would disproportionately hurt the poor and middle-class, and would actually increase reductions on domestic spending by allowing the defense budget to rise by $500 billion above the caps imposed by sequestration. It would reduce Medicaid by $750 billion over the decade and block grant it to states. It would lower taxes on the wealthy and on businesses.

Ryan’s budget would voucher Medicare but is careful to exclude seniors enjoying its current benefits and those over 55, an act of hypocrisy that is as breathtaking now as when it was first proposed. After all, if giving seniors a voucher is such a great idea from which they will benefit by exposing them to the wonders of the free market in healthcare insurance and save the country money to boot, shouldn’t we start it, like, now? Oh wait! We need to keep all those selfish old white voters in the GOP column come election day and they really don’t want Medicare messed with, at least not for them.

The budget completely ignores the fact that we just had a national election in which Ryan himself along with his ideas played a prominent role. His side lost, big time. But as far as Ryan is concerned it’s: Election? What election?

And the plans for Medicare and Medicaid demonstrate the sort of ignorance and blinkered, ideologically-driven thinking that has become the hallmark of today’s GOP. Despite the preponderance of studies that show both programs are more efficient and cost effective than the private insurance industry, and would be more so if the congressional GOP would allow them to negotiate with the pharmaceutical industry on the price of drugs, the Ryan/GOP budget plan pushes the poor and the future elderly into the vagaries of the private sector. If anyone is in any doubt regarding the lack of cost effectiveness and efficiency of the private health system in this country, they should read Steven Brill’s comprehensive report in Time: “Bitter Pill: Why Medical Bills Are Killing Us”.

The Ryan/GOP budget plan will go nowhere. That’s why Democrats were put on the earth. But it does do two things. It shows to those not yet clued in how far to the extreme right the GOP has moved in the last decade, something that may finally hurt them enough in the next election, even in the heavily gerrymandered House. But it also lays out an initial, albeit, outrageous negotiating position from which they can move left just enough, from uber extreme to merely extreme, to claim the mantle of compromise while still doing immense harm to the country. Obama, whose negotiating skills leave much to be desired since he starts in the middle and then moves further right, could learn a lesson or two.

The people of this nation, despite our differences, will soon need to make a clear choice between two distinct visions of America’s future because we can’t continue to lurch perpetually from one budgetary crisis to the next.

The first believes that while a thriving private market system is essential, so is a supportive and complementary government that regulates and softens the edges of capitalism, provides a firm safety net from its vagaries and provides a boost to the nation’s competitiveness by funding scientific and medical research, and building an infrastructure fit for the 21st century and beyond.

The other sees government as an impediment to, if not an outright enemy of the people and the free market, believes the poor and those struggling to make ends meet should largely fend for themselves, that massive income disparities are a good thing and that unfettered capitalism is the path to prosperity for all, or at least the ones who deserve it.

In a nutshell Democrats believe we should strive to be more like Scandinavia. Republicans aspire to take us back more than a century to a place that doesn’t exist any longer but we’d end up looking a lot like Mississippi today. You choose.

The efficient management of Medicare is the way to save it

The efficient management of Medicare is the way to save it

Medicare is a government program that provides a fee-for-service benefit to cover most of the health care needs of seniors in America. As with health care in general, Medicare costs have increased substantially but, nevertheless, delivers care more efficiently than the private sector insurance industry thanks largely to much lower overhead costs and a slower rate of growth.

The Republicans led by Mitt Romney and Paul Ryan under the pretext of “saving Medicare” propose a plan whereby seniors would be paid a fixed amount which they could use either for the traditional program or private insurance. This they euphemistically call “premium support”. The plan would spare current seniors already receiving Medicare (got to keep those votes in the GOP column!) and is aimed at coming generations of seniors. One may ask why, if the plan is so great, it shouldn’t take effect immediately after the plan is enacted. Maybe we’ll come back to that point.

We all know that Medicare has looming funding problems that threaten the future viability of the program. The GOP’s hated of Medicare is matched only by their fear of messing with an entitlement that happens to be popular across all age groups. Their solution to the conundrum has two steps: the first is to devise a plan that under the guise of saving Medicare effectively ends it in its current form through partial privatization.

The second step is to demonize efforts by Democrats and other supporters of traditional Medicare to find efficiencies within the existing system. How can anyone forget the GOP-Tea Party screams of “death panels” during the Affordable Care Act debate and opposition to such common-sense ideas as the Independent Payment Advisory Board (IPAB), an independent body comprised of medical experts tasked with recommending efficiency changes to Medicare’s payment system.

So the GOP impedes efforts to improve the efficiency of traditional Medicare, and then argues that the only way to reduce the program’s long term costs is to end it as a guaranteed benefit and introduce what they characterize as market efficiencies.

The problem is that, as with any free market approach to health care, the profit motive gets in the way. It’s difficult, after all, to make money from sick people, particularly the chronically ailing. The GOP plan, therefore, is likely to shift some of the costs of their care to many seniors themselves since it is unlikely the price support will keep pace with the rise in health care costs. The GOP trumpets that seniors will have lots more choices than they do now but, in truth, how many seniors are equipped to shop for a health care plan that suits their particular circumstances – and get it right? It’s difficult enough for younger working adults to manage. For an aging and financially vulnerable group like seniors, the risks in getting it wrong are far greater. No wonder the GOP grandfathered in (no pun intended) current seniors to keep the existing system.

The traditional Medicare system remains the best way to go. This is not to say that we can’t find innovative new ways, including the use of financial incentives for the private health care providers that deliver services to seniors, to make Medicare more cost-effective. For example, by adopting a fixed fee-for-care approach that emphasizes outcomes rather than the current fee-for-service system is an idea that deserves serious consideration.

But we need to move beyond sterile accusations of rationing health care. If the system is to survive, rationalization of Medicare services will be essential and unavoidable. We can do it the irrational GOP way which is to let the market decide who gets what services regardless of the health needs of the individual. Or we can keep the existing Medicare system with its guaranteed benefit, and work to make it more efficient and cost effective from within.

I think for most of us, it’s a no-brainer.

America may be Exceptional but not always in a Good Way

America may be Exceptional but not always in a Good Way

Being a naturalized United States citizen, I don’t pretend to understand everything about the Americans. That said, I’ve never really thought of Americans as being particularly inscrutable except when it came to two issues: universal healthcare coverage and the unfettered availability to any Tom, Dick or Harry of guns, about which I confess I have been completely stumped for some 33 years.

When I left the United Kingdom I left behind what many ignorant Americans on the right refer to pejoratively as socialized medicine. In fact, that system provides universal health coverage to all residents; primary and emergency care is first-rate, and while there may be waiting times for non-emergency surgeries these have decreased in the last several years with extra funding. No Brit pays out-of-pocket expenses for medical care (dentistry is a different matter) and statistically health outcomes compare favourably with this country. And all of this is achieved with an expenditure of a bit less than 9% of GDP compared to more than 16% in the US. And among industrialized countries, the UK represents the rule not the exception.

By way of contrast, at any given moment between 40 and 50 million residents of the US are without health care insurance. Thousands die every year of treatable conditions for which they did not seek timely treatment because they lacked insurance. Out-of-pocket medical expenses are the leading cause of personal bankruptcy in America. Under the current system insurance companies can refuse to cover people with pre-existing conditions; many are so underinsured that limits on coverage can be reached quickly in the event of expensive and long-term treatments for conditions such as cancer.

A delightful illustration of why Americans should be ashamed of this state of affairs comes with the news that some of the wounded victims of the Aurora movie theatre shooting lack insurance and will have to depend on the charity of friends and relatives, and perhaps a national whip-round to pay their hospital and rehabilitation bills.

Yet, inexplicably, a plurality of Americans appears to prefer this awful status quo to the first meaningful reform effort to be signed into law: the Patient Care and Affordable Care Act or “Obamacare” as the preferred pejorative label this time from the ignoramuses on the right. While far from perfect (a public option would have been nice) the ACA promises to bring real and substantive benefits to both the insured and uninsured to address the flaws in the current system; but to most Americans it’s the policy equivalent of being forced to take castor oil.

And on the subject of guns, America again has taken a different path from other advanced nations. Unless one is to believe (which I do not) that Americans are inherently more violent than Europeans or Canadians, it is virtually impossible to escape the conclusion that America’s weak gun laws account for its murderously high homicide rate. And I’ve never understood why Americans on the one hand express shock and outrage at events such as the Aurora movie theater shooting-spree when, on the other, they have made such incidents inevitable by their refusal to vote for stronger controls and restrictions on the sale and possession of firearms.

The result, as with the lack of universal healthcare reform, is that thousands more Americans die or suffer grievously every year than would otherwise be the case if ordinary Americans and their political leaders made a different choice.

So is it Americans’ ignorance of the rest of the world which feeds their delusions that no matter their own travails they are better off than everyone else? Or are Americans simply a nation of masochists who suffer to be free or simply want to be free to suffer?

For me it continues to be a mystery and more than a little sad.

Time for Democrats to Defend the Affordable Care Act

Time for Democrats to Defend the Affordable Care Act

Now that the Supreme Court has upheld the Patient Protection and Affordable Care Act (ACA) it would be nice if we could move forward to full implementation in 2014 and give it a chance to work. That’s certainly what President Obama and Democrats would like to be able to do and in a perfect or even a fair world we’d do just that. Let me know when you see those flying pigs.

Republicans clearly have not given up the fight to deprive Americans of the last best chance to enjoy a somewhat coherent and comprehensive system of healthcare insurance that covers, if not all, then at least most of the population. You know like just about every other country in the developed world; like even Rwanda.

The last thing the GOP/Tea Party element of the country wants is another example of government regulation that works. Bad enough we’ve got Medicare and the Veterans Administration system. To see Obamacare implemented is simply unthinkable to these ideologically blinkered scions of the right. No, they will not give up the struggle to head off the ACA before it can demonstrate to Americans that it isn’t simply a huge, amorphous legislative whale that will speed the country into bankruptcy but, rather, a rationale, cost effective plan to bring the United States into the 21st century in terms of providing healthcare security for most of its people.

This time Obama and the Democrats must not shrink from fighting back. They cannot, as they did in 2010, allow the right to set the terms of the debate to distort, misinform and lie about the ACA unchallenged. They are not without weapons. Most Americans like individual elements of the plan and Democrats must hammer home the fact that if the ACA is repealed, those bits will be no more. No matter how hard Romney tries to fudge the question of what he will replace the ACA with once he acts to repeal it, Americans need to understand that the popular parts such as barring insurance companies from excluding individuals with pre-existing conditions will be gone. And they won’t come back.

If anyone was in any doubt about that they only had to watch Minority Leader Mitch McConnell squirm, obfuscate and evade when he was pressed by Chris Wallace on Fox News Sunday to explain the GOP’s plans for healthcare insurance reform following the demise of the ACA. As for the 30 million uninsured Americans that will be newly covered under the ACA, McConnell opined that they were not the issue. Precisely.