Watermelon, Meet Hammer

I bet you don’t all agree on how amusing Gallagher is, with his giant, whacking sledgehammer and immobile, squishy vegetable/fruit targets.

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But between the hammer and the watermelon, I bet you agree on which one’s the Republican and which one’s the Democrat. Right? The Republican hammer has been pounding away at the Democratic Affordable Care Act watermelon for the last 6 mos until finally this week, Kathleen Sebelius popped out. Meanwhilst, Democrats—in and out of the White House—have just been sitting in the front row, silently draped in their plastic sheets, somewhat offended by the waste of good food yet strangely attracted to the spectacle.

So what. Sebelius IS a watermelon, right? Botched that website rollout! Give her a whack for me!

Well, any of you ever been involved in a really big, innovative, IT project? And no, I don’t mean changing your FB profile photo or starting a blog. I mean something large that’s never been done before and requiring multiple vendors and multiple years. I didn’t think so. Well I have (certainly not on the scale of the ACA, but still in the multi-million range). So let me remind you the IMPORTANT things that happened with this rollout. The project LAUNCHED ON ITS GO-LIVE DATE in October. And it MET ITS FIRST MAJOR TARGET (7 million registrants by 3/31/14). These are the metrics that matter, not whether there were bugs along the way. Meeting a launch date set over a year in advance and a pre-specified metric in a project this complex is a big deal. And if you think you can do innovative tech (ie, building something that didn’t exist rather than just duplicating current functionality) and NOT have bugs, problems and glitches, well then you don’t know what you’re talking about or have an axe to grind. That is, you’re a Republican.

So why do we insist on being watermelons? Why do we just lie there, taking whack after whack from the Republican hammers being wielded by grinning loons? We reformed health coverage in this country! We made it impossible for insurance companies to deny medical coverage to people who (gasp) actually NEED medical coverage! We made it impossible for them to throw you out once you got sick! We arranged for subsidies to help people who cannot afford the full cost of coverage and expanded access to Medicaid! These are good things. These are great things. What did the Republicans do? Well, they split their seams and shouted themselves hoarse trying to block all this and deny people health care. And most Republican governors are still blocking access by refusing to participate in the Medicaid expansion, which ALONE will cause thousands of otherwise preventable deaths each year (see Paul Krugman in NYT, and the original research article in Health Affairs Blog).

From now on, every time you hear some dunderhead fuming about the “botched” ACA, pull out the hammer:

  • Launched on time
  • Met its targets
  • Why are you killing people?

Capitol Hill is full of fat frogs croaking “Benghazi, Benghazi” who need a good whack and I want to see people in the administration haul off and take a swing for once.

Lies, Damn Lies and Mistakes

A staple of knucklehead-dom is the man who, on being challenged about some inane statement he made like “Obama is a Kenyan-born, Muslim socialist,” “The Apollo moon landings were Hollywood fakes,” or “Sarah Palin would make a fine president, ” blusters the retort, “You callin’ me a liar? Huh, are ya’?” Although the tempting reply is simply a whack on the nose with a rolled up newspaper (something you can’t do with your iPad—more than once, anyway), the rational person instead sighs and points out, “No, I’m not calling you a liar. I’m just saying that you’re mistaken—sadly and deludedly mistaken, but nonetheless simply mistaken. There’s a difference.”

So how is it that so many people on all sides, including the typically rational Bill Maher and Jon Stewart, seem to have bought into the Fox trope that Obama “lied” to us about the ACA. You know, the part where he said “If you like your coverage, you can keep it.” Well, he was certainly wrong. But was he wrong on purpose, that is, was he lying? Was he muttering to himself, “If we tell people their shitty coverage isn’t allowed under the new law, they’ll be really upset and will call Fox News and complain. I know! Let’s tell them that they can keep policies that are specifically banned by the law! Even though it’s written down in the ACA in black and white where everyone can read it, who will know?”  Really? Because that’s the thought process that would have to have been going on for this to be a lie. And that would make it not just a lie, but a really, really stupid lie. I mean, you’ve got a better chance arguing that the shadow angles on the videos prove the moon landings were fake than you do arguing that a law doesn’t require what it specifically says it requires. Now the 15% of the population who would believe absolutely anything bad about the president also have no trouble believing he’d lie like this. As for me, it doesn’t make much sense. Especially when there’s the alternative possibility that he was mistaken.

I think he (mistakenly) meant something else, and I say that mainly because I (mistakenly) thought he meant something else. When I heard him talk about keeping your policy if you liked it, I interpreted that to mean the fairly minor points that if you liked having health insurance, the insurance company couldn’t throw you off for outrageous offenses such as getting sick and costing them money, and that if you were already covered at work, then you wouldn’t be required to drop that plan and sign up on the exchanges—that the ACA didn’t apply to the vast majority of people who had coverage through their company. It was designed to facilitate coverage of people who were unable to get basic health insurance on their own. I (mistakenly) wasn’t thinking about the few percent (and that’s all it is) of people who purchase their own insurance, and purchased a plan that doesn’t meet the basic ACA standards, and don’t want a better one, and don’t qualify for enough subsidies to make one of the ACA plans cheaper. Mistake? Yep. Lie? No way.

I think the president (and I) have done enough mea culpas. Let’s remember what this whole thing is about. We’re trying to make health insurance available to more of the nearly 50 million Americans who do not have it, AND we’re trying to set some pretty minimum standards for what can be offered as “health insurance.” There are standards for what’s in gasoline and how your house plumbing has to be put together, so why not standards for health insurance? And just a reminder, here’s what we’re talking about:

The essential health benefits include at least the following items and services:

  • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
  • Emergency services
  • Hospitalization (such as surgery)
  • Maternity and newborn care (care before and after your baby is born)
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services

In addition, health insurers will be prohibited from imposing lifetime limits on coverage and will be prohibited from rescinding coverage; new health plans will be required to cover certain preventive services with no cost-sharing; increases in health plan premiums will be subject to review; insurers will be required to spend at least 80% of premiums on medical costs; young adults will be allowed to remain on their parent’s insurance up to age 26.

Don’t like that? Maybe you also like water in your gasoline and plumbing made out of cardboard. The rest of us think it should be standard.

The Food was Awful…And the Portions Were So Small!

…Republican restaurant review. I know Krugman just recently used this old joke, but I thought of it weeks ago—really I did. Yeah, so the people who think Obamacare is a socialist plot of the devil are incensed that its website doesn’t work well. You’d think they’d be happy the lines to get into the concentration camp were so long. Naah, the main point is to have something to criticize. Hey kids, let’s have a hanging! Ok, fine with me. Well, Republicans, how about we hang as many people as you were willing to string up for the global financial meltdown that cost the economy (and me personally) a total shitload of money and created a worldwide recession. Oh right, that number was zero. But gosh, launching a buggy computer program is MUCH more serious than international financial disaster.

Not that I’m thinking the rollout was handled well. It was pretty botched. Even for such a complicated system, this was really poor performance (note to Republicans—you are permitted to criticize the administration even when it is your own party). BUT, this system will in fact be fixed and will in fact work. Just not as well as the “Medicare for All” that I’ve been recommending on these pages for 2 years, but it will work. Chill. (I’d like to think the Republicans would help make it work, but since we haven’t legalized pot in PA, I’m not going to have that delusion).

Now what about this “I can’t have my old policy!” whining that is all the rage this week. First of all, this only has to do with people who privately purchased their policy (only 6% of insured people) AND whose privately purchased plan does not meet current ACA requirements (an even lower number). Now it boggles my mind that people want a policy that covers only their left lung and allows them to be dropped (or their rates doubled) the first time they actually cost the insurance company $$ by having the nerve to get sick. But fine, you like your really crappy policy. And you’re mad you have to sign up for something different. How dare Obama make that happen! Well, I guess since you are buying your policy on your own, you’ve never had health coverage through a big company—the model that all Republicans just love (though God knows why). Well let me tell you something. I get my coverage through the Fortune 100 company I work for, AND IT CHANGES EVERY YEAR! And rarely for the better. I don’t get to “keep my coverage if I like it.” I’d love to have my 2014 coverage be the same as 2013, but it won’t be, and not because of Obamacare—our coverage always met the ACA standards—but because it’s cheaper for the company (but not, heh heh, for me). So get over it! And stop citing cost comparisons that don’t take into account the subsidies available to people earning up to 400% of the poverty level.

I want to hear less about this nonsense and more about how there will STILL be 10s of millions of people without coverage. And I want to hear why the Republicans who care so much about the inconvenience of a buggy computer program don’t give a rat’s ass about cutting food assistance for poor people.

Maybe the Republicans Really Mean It?

You know, I’m starting to get the idea that the Republicans actually don’t like Obamacare. You have to admit, the first clues were pretty subtle. I mean, they haven’t even voted 50 times to eliminate it—and that’s over how many years? But they’re starting to leave better hints, like shutting down the government (except for the parts that shoot people and blow stuff up).

So now I get it. And after all, how can you NOT be driven into a mouth-frothing, head-exploding, purple-faced Fox News anchor rage by the thought that more people in the country might get health insurance? Really! Because you know what that would mean, don’t you? That’s right. It would mean that when those people got sick or hurt, they’d be able to pay their medical bills! And what self-respecting doctor, nurse, therapist, ambulance service, pharmacy or hospital would ever want anything like that? No real capitalist (or Republican) could in good conscience support anything that would increase their number of paying customers. More income? How commie is that? And doesn’t it just make you sick to think that all those people will now go to the doctor and get their high blood pressure treated instead of doing their patriotic duty by dying of a heart attack or stroke and thus ridding the country of some more Takers? The whole thing leaves a sour taste in my mouth. Or is that reflux? Maybe I’d better see my doctor—good thing I have medical coverage. Too bad about you, though (ha ha, just kidding—it’s not too bad about you).

All right, maybe I turned the sarcasm dial up to 11, but last night I had a conversation with some Republican friends and relatives who were astounded by the fact that I didn’t think Obamacare was pure socialism. Right. I pointed out that getting lots of people to purchase a product from for-profit companies was kind of the core of capitalism (and the point of every tv commercial). But they countered with the idea that it was the government plan to help some people pay  for it that was the socialist-plot part. Hmm. By those lights, then I guess that when the government pays private companies outright for tanks and planes and bombs that we must be looking at pure Marxism. Or is it only socialism when the government spends money to heal people rather than kill them? Guess so.

Republicans Continue Attempts to Thwart Republican Health Plan

So, the Republicans in Congress continue to strain every fiber of their being and every last cent of the Koch brothers’ carbon-based loot in their valiant effort to fight off—the Republican Health Care Plan. Yes, the evil Obamacare, its nefarious schemes unmasked to all in a Web video recently that showed a leering Uncle Sam preparing to do a pelvic exam, was for the past TWO DECADES—the Republican Health Care Plan. Yes, it’s a Republican baby, paternity confirmed on public record, conceived in response to the Clinton health care plan of 1993, and built on the foundation of an individual mandate to purchase insurance from private insurance companies. A Republican governor (what was his name again?) actually implemented this plan and Republicans continued to advocate for it—right up until the time a Democratic president proposed it in the apparently mistaken belief that Congressional Republicans could at least be persuaded to vote for a Congressional Republican program. “Hah! Consistency? We spit on consistency! Though foolish consistency is the hobgoblin of small minds, and we have small minds, and are foolish, we reject consistency as it is much less important than denying health care to the poor and a victory to the Muslim president whose socialist plan will result in a windfall of profits for private insurance companies and…Never mind! Remember what we said about consistency!”

The history of the Republican plan was described by Ezra Klein in the New Yorker. Briefly, in 1989 the Heritage Foundation published “Assuring Affordable Health Care for All Americans,” which suggested that all individuals be required to purchase health insurance (like they must auto insurance). Then in 1993, as an alternative to the Clinton plan, the Republicans included the individual mandate in their Health Equity and Access Reform Today Act (sponsored by John Chafee, RI and co-sponsored by 18 Republicans). In 2006, Sen. Ron Wyden (D, OR) and Bob Bennett (R, UT) sponsored the Healthy Americans Act (11 R and 9 D co-sponsors). Broad Republican support. No Uncle Sam ob/gyn videos…until president Obama changed his mind in 2009 and used the Republican plan to design the Patient Protection and Affordable Care Act. Then the blue-blooded, rock-ribbed Republican baby morphed into the evil Obamacare.

So what exactly is in Obamacare that inspires such vitriol and hatred from Republicans? What makes Georgia state insurance commissioner, Ralph T. Hudgens, say he will do “everything in our power to be an obstructionist.” Well, Obamacare tries to help poor people, and that ought to be enough right there, don’t you think? But besides that, what’s in the plan? Fasten your seatbelts, folks, and raise the blast shields, because here’s a straight look into the maw of hell that is Obamacare, which proposes to:

  • Prevent insurers from denying coverage or charging higher premiums to those with preexisting conditions, and from rescinding coverage after people have required expensive care
  • Require plans to cover preventive services without cost-sharing (deductibles)
  • Allow children to remain on their parents’ insurance up to age 26
  • Eliminate lifetime limits on coverage
  • Raise Medicaid eligibility to 138% of federal poverty level
  • Create health insurance exchanges in which people without employer or Medicaid coverage can buy insurance (and cost-sharing for some of those who need help paying for it)
  • Require everyone to have health insurance beginning in 2014 (the individual mandate)
  • Require plans to spend at least 80% of premiums on actual medical costs
  • Penalize employers that do not offer affordable coverage to their employees (with exceptions for small employers)

OMG! OMG! Insurers can’t drop you when you get sick or get so sick that you cost too much! They can’t deny you coverage because you had asthma when you were young? They have to spend 80% of the premium money you pay them on actual medical care (note that Medicare spends 96% on medical care)? Help, help! Call the Thought Police!

You know, I’ve looked at more detailed summaries of Obamacare (see this summary from the Kaiser Foundation) and I’m still looking for the evil. The only evil I can come up with is that it’s not Medicare for All—but that’s because it’s a Republican plan, now isn’t it?

Grover’s Gonna Gitcha, Mitt

First, I guess a shout out to Chief Justice John Roberts for his completely out of character decision to step away from the side of the knuckle-dragging apologists for the plutocracy and do the right thing by upholding Obamacare*. And if you disagree that this was uncharacteristic of him, show me a Republican who was not surprised by it. Good on him. Won’t hold my breath waiting for a repeat performance, but I’m willing to be pleasantly surprised. One more like this and maybe Scalia will have an actual seizure, rather than just simulating one in his dissenting opinion.

But given the reasoning behind the court’s decision, to wit, that the individual mandate was constitutional because it is technically a tax (and of course Congress does still retain the power to tax), I’m really wondering about the effect of this on Mitt. Why? Because Mitt established a similar insurance mandate in Massachusetts, and that means he’s in violation of his pledge to Grover Norquist not to raise taxes. Now that evil, ankle-biting gnome is going to have to run honking after his party’s standard bearer like an angry goose, demanding penance (or perhaps one of Mitt’s overseas bank accounts).

Which reminds me. All these Congresspeople who signed Grover’s pledge. How, exactly, does a pledge to a someone who doesn’t even live in your district somehow take priority over your responsibilities to your job? “Oh, I promised!” Oh, right, like your other promises ever meant squat. And what sense does it make to promise to anyone that you’ll never, ever do anything? I mean, I’m about as anti-war and anti-foreign-misadventure as it gets, and I’d certainly like my leaders to promise to try to avoid war, but I wouldn’t for a minute think it was sensible to promise never, ever to go to war no matter what.

Oh, and when Grover drowns the government in his bathtub, if Mitt is president then, will he go swirling down the drain along with Social Security and Medicare? Or will those 2 good programs reject his presence and allow him to float to the surface like water was supposed to reject a witch in medieval times?

*As per a previous post, I think President Obama should get full credit for this very important (but still preliminary) step in reforming American health care. Let his name stay attached so everyone who now has access to health care and wouldn’t’ve before knows exactly who to thank.

Obamacare

So, I read that the hero of the South, Rick Perry, has as one of his main platforms repeal of the Affordable Care Act, which he charitably refers to as “Obamacare.” He and all the other Republicans who bandy this term about seem to think it’s a smart move on their part to link President Obama very tightly to health care reform. That way, all the people who would’ve gotten thrown off their health insurance plan for getting too sick, or who got too sick to work and then couldn’t buy coverage at any price would know who to blame for them still being able to get medical care. Good idea, Republicans. For once I agree with you. Mr. Obama deserves full credit for being the first president in American history to get a majority (barely) of Congress to agree that civilized countries ensure their citizens are cared for when they are hurt or sick, rather than the “survival of the richest” medical plan that is the essence of Republican health care policy. Yes, this is Obama’s care plan and I thank him for it. You will too if you lose your job and then get sick.

 Oh, we can’t afford it? I say we can’t afford foreign wars that attempt to reform the unreformable and a war machine that can fight any country anywhere anytime that we say threatens our “interests”. We can’t afford to have multi-billion dollar corporations pay little or no taxes just so their leaders and owners will donate to right-wing candidates (to be fair, they’d donate to left wing candidates that would also maintain their breaks). Let’s take care of Americans for a while.