Health Care, Obamacare

A TEST OF PURITY

Back in the day, there used to be a commercial that proclaimed that Ivory soap was about 99 and a half percent “pure.” (The other half of one percent was presumably alien DNA.) That commercial rang a bell in my mind as I watched the fiasco of the proposed Republican legislation in Congress to repeal and replace Obamacare go down in flames last week. It seems that for a hardcore of about 30 looney-tunes GOP right wing representatives in the House that call themselves the “Freedom Caucus,” the replace part of the proposed bill was still far too generous. Why some poor soul, somewhere in the country, who was desperately sick and couldn’t afford health insurance, might actually receive a bit of medical treatment on the government’s dime under the Republican plan. Can’t have that. How does that kind of scenario benefit the rich? So, despite extensive lobbying by Trump and his consiglieri’s, this hardcore band of 30 right-wing whackos would not budge in their opposition to House Speaker Paul Ryan’s proposed bill because it still contained some minimal benefits to assist the unfortunate. Only total repeal would meet their objections. In the end, Ryan had to pull the bill  off the House floor in order to avoid an embarrassing defeat. Obamacare, as muddled as it is, still remains in place.

First a few rather obvious observations. Trump, who, essentially believes in nothing but the enhancement of his own ego, couldn’t care less about the details of the proposed legislation. During the recently concluded campaign, at one point he promised “health care for everyone.” That promise quickly dissolved with the morning mist as Republican insiders and contributors to his campaign reminded him that such action sounded an awful lot like universal health care, which has been a Democrat initiative over many decades. So Trump, in the end, was willing to settle for repealing Obamacare, which he had described as “absolutely horrible,” and perhaps replacing it with some inexpensive token gesture. Ryan and his Republican cohorts would have gone along with that, but the problem was, that there is also about 30 so-called “moderate” Republicans from competitive districts who would have faced daunting re-election prospects in 2018 if the Republican plan didn’t contain at least some substance in the replace part of “repeal and replace.” In the end, the two Republican factions could not reconcile their differences, and legislative disaster loomed ahead like the massive iceberg appearing before the Titanic.

Make no mistake- the Ryan plan was still all about removing the poor from government health care subsidies. About 20 million previously uninsured poor have been allowed to sign up for Medicaid in 31 states since Obamacare took hold. (The other 19 states, all hardcore Republican in the South and Mid-West, essentially gave the middle-finger to those unable to afford health insurance. Their philosophy is that if you’re too poor to afford to be covered, and you become seriously ill, just quietly curl up in a ball somewhere and die. But please don’t bother us good, God-fearing folk that can afford insurance.) In any event, the Ryan plan would have put the kibosh on any further expansion of Medicaid, even in states willing to do so, and slowly begin whittling down the number of newer enrollments. There would have been a total reduction in government health care subsidies to the poor, along with a reduction of taxes on the rich. Hey, one needs to get his or her priorities in proper sequence. But even these cut backs were not enough for the so-called “Freedom Caucus” who still feared that someone somewhere would be receiving a government handout.

As I discussed in a recent piece, the only legislation that would provide universal health care to all would be a single payer system run by the government. Every civilized country in the world provides its citizens with such blanket coverage. Even tyrannical, despotic governments such as Cuba or N.Korea provide universal health care. In France, its system is so extensive that a nurse comes to a woman’s house for up to five days after she’s given birth to a newborn child. Yet, somehow, we can’t afford that level of coverage for all Americans. Many years ago, I personally knew a man that moved to Canada so as to take advantage of its state provided  medical system. Although he was only middle-aged, he had a number of serious life-threatening, health-related issues, and could not afford insurance or related doctor’s bills. In Canada, at that time, one had to be a resident for 18 months before they qualified for the state-sponsered system. He sweated it out for 18 months, receiving barely minimal medical treatments for his conditions, that he could hardly pay for; but he did survive and was finally able to receive the necessary care for his ailments, free of charge. Under whose moral value code is it necessary for an American to move to Canada in order to attempt to save his life.

I lay the blame for opposition to something as sane and rational as universal health care in this country, to the poison that’s been pouring out of electronic media for the last 30 years, by crypto-fascists such as Rush Limbaugh, Sean Hannity, Ann Coulter, Laura Ingraham, and a host of other, similar, far right, looney-tooners. Americans have been sold a bill of goods over the last 30 years that everything that’s governmentally sponsored is inherently evil. It wasn’t always thus. In the 1970s, Republican president Richard Nixon proposed a form of universal health care to Congress, and that time it was the Democrats that fucked it all up because they felt it wasn’t extensive enough. So much for politics in this country.

In any event, a band of Republican far right-wingers in the House was enough to sink a very bad piece of legislation to begin with, and deprive Trump of the victory his ego so voraciously craved. The bill just wasn’t pure enough for the “Freedom Caucus” to support. It certainly wasn’t as pure as Ivory soap.

 

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THE HEALTH CARE DEBACLE

So, a professional sky-diver is in the plane, thousands of feet in the air, and is told by the crew that it’s time for his jump. Wait a minute, he replies, where is my parachute. Oh, we’ll design that for you after you exit the plane, says the crewman. Think he would be inclined to  make that jump? But that’s been pretty much the GOP position on getting rid of the despised Obamacare health insurance plan and replacing it with a Republican brand on the label. For 7 years, since passage of the Affordable Health Care legislation in Congress in 2010, Republicans have been desperately trying to repeal and supposedly “replace” it with something better. Except that for these past 7 years the GOP hasn’t been able to put forth a feasible and rational plan for replacement. Until this week, when House Speaker Paul Ryan issued something resembling replacement in his proposed legislation to repeal and replace Obamacare, that no one is happy with, including a large segment of his own Republican Party.

Just to be clear, I was never a big fan of Obamacare. The legislation was way too long, detailed and cumbersome. It consumed over 2000 pages in written length from the start, which can never be a good thing.While the intent of the Affordable Care Act was admirable, i.e., to provide universal health care so that even the poor could receive quality medical treatment when sick, the methods devised under Obamacare were just too bureaucratic and crushing to function smoothly. Too many hoops had to be jumped through to make it work. The most rational method of providing medical treatment to all Americans regardless of their financial circumstances, would have been to establish what’s called a single payer system, run by the government. A system that every first world country on the planet already employs. Except us, of course.

Under single-payer, if you get sick, you visit the doctor or hospital of your choice. Same thing if you need a medical check-up. If you have a toothache or need a cleaning you make an appointment with your dentist. No insurance to buy, no forms to fill out. The hospital, doctor or dentist would then submit the bill to the government for services rendered. The government would then turn those bills over to designated insurance organizations who would reimburse the health professionals performing the services in question. No fuss, no muss. A system, as I’ve said, used in Canada, and throughout almost all of Europe and Asia. But how would we pay for all of this without levying harsh new tax burdens, you might ask. Again, not a problem.

The way its done in those countries embracing universal health care is to establish about a 5-10% value-added tax, which is like a sales tax on manufactured goods, usually at each step of the manufacturing process. Won’t this add significantly to the cost of purchasing such products? No, not really. While the actual cost of manufacture may increase, these costs would be more than off-set by U.S. companies not being required to offer health insurance for their employees. The savings to companies in no longer providing health coverage for their workers would be dramatic and probably exceed the increased costs of manufacture. That’s why, for example, Japanese auto companies such as Toyota and Nissan can often out-compete their American counterparts such as G.M., Ford and Chrysler. They incur no health insurance costs.Today about 190 million Americans receive their health insurance from the companies they work for. That huge burden on U.S. commerce would be lifted under a single-payer system.

But, of course, legislating such a simple health care system would be far too rational for the U.S. political arena to cope with. Instead, the Ryan plan’s replace part of “repeal and replace” mumbles something about providing “tax credits” to those too poor to afford health insurance premiums. Never mind that nearly half the country pays no income tax. I suppose that some sort of negative tax system would have to be established, similar to the Earned Income Tax benefits that now go to low income wage earners. And even these would phase out in about 2 or 3 years. The very heart of Obamacare that has had the Republican establishment so upset all these years, is that it provides the poor with cash subsidies that enable them to purchase health insurance. As flawed as the law is, about 20 million people who previously had no health plan,  have signed on to Obamacare since its enactment, many through Medicaid. But a large part of the GOP establishment is dead set against health care subsidies and enhanced Medicaid enrollments. A group of about 50 GOP hardcore right-wingers in the House are calling the Ryan plan “Obamacare Lite” and  are refusing to support it, because it provides some minimal subsidies. Some Republicans in the Senate are also unhappy. After all, they reason, the poor are used to getting the short end of the stick anyhow. What harm would there be with another poke in the eye. The fun just never ends.

One other thing. Our esteemed President Trump, (that phrase still claws at the very fabric of the universe) made some comment the other day that he didn’t know that health care could be so complicated. Who knew? Who knew that water insists on running downhill instead of uphill? Who knew that the sky was blue instead of orange. Who knew that standing in the rain without an umbrella will get you wet? Who could know such things?

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