Why No Health Care "Compromise" Is Possible With The Right

Amidst millions of gallons of ink spilt very few have pointed out that the Senate Healthcare Bill ("Better Care" - so called) never fessed up to its central premise: to cut federal medical benefits to the bone. So no wonder so few citizens are enthused about it, opting to engage in high profile protests (with the disabled in wheelchairs) including at Senators' offices and outside their homes.

Meanwhile, the ideological Right pushes its "free market" (i.e. you're on your own) agenda in op-eds and other forums to get the Reep bill passed, any bill. Alas, that bill resides in limbo as Mitch McConnell waits for John McCain to recover from blood clot surgery to return to D.C. and vote. Of course, McCain - like McConnell-   has a "Cadillac" level of care in what is provided via his Senate health plan. Too many millions of Americans do not.

How bad is what's on offer? Over the past few days we beheld the organization known as AHIP (America's Health Insurance Plans) put the kibosh on the version of the Reepo bill offered (via amendment) by Ted Cruz. To remind readers, Cruz'  proposal (called "mini-Med" by critics ) would let insurers  sell low cost plans with skimpy coverage as long as they also sell policies providing a stringent set of services they're already required to provide under the ACA, aka "Obamacare".  But the AHIP and its sister organizations (e.g. Blue Cross - Blue Shield Association) have asserted this would:

- Be unworkable in any form

- Increase premiums

- Lead to widespread termination of coverage

Bottom line, this gimmick would encourage the healthy to go "lowball" and buy the bare bones policies leaving sicker people (who need comprehensive coverage) confronting unaffordable costs. In fact, two insurance groups assert premiums would skyrocket for those with pre-existing conditions, especially for middle income families who don't qualify for the bill's tax credit (which is pathetic as it is and in no way compare's to the generous ACA subsidies that actually made a difference).

But hey, this is exactly what the Repukes want! A bare bones, mock "health care" bill masquerading as a real one to provide PR cover so they can deliver tax cuts to the rich. Once one grasps that, and that cutting the biggest piece of the health care puzzle (Medicaid) is what the Right is all about, then it becomes evident why no compromise is possible.

Let's start with the delirious Peggy Noonan who recently wrote in a WSJ op -ed  ('On Health Care, A Promise,  Not A Threat', July 1-2, p. A13) that a Democratic Senator ought to come forward to work with the Repubs for a health compromise thereby "showing a little humility and humanity".  According to her "this person would be a hero in the Beltway which prizes compromise and constructiveness".

Adding:

"The Democratic Party made this mess. It's on them to help dig out of it. If they show some humility, Republicans would look pretty poor in not responding with their own olive branch."

I have news for Miss Peggy, the Republicans already look pretty piss poor with their barbaric Senate bill - even after a proposal to remove the tax cuts for the rich. Why the hell should any Dem with more than air between the ears help these fools out of their morass?  Besides, there is simply no way to any such compromise given it would be political suicide for the Dems to go along with gutting Medicaid, which is the core basis of McConnell's bill.

Since the Repukes will not cooperate with the Ds unless Medicaid is cut (some $774 b by 2020)  and the Ds will not cooperate with the 'pukes if they insist on such cutting - then there is absolutely no way to any Noonan-style compromise, whether the Beltway likes it or not.

None of the conservo opinion writers, as I will show,  appear to grasp that the entire state -federal funding system for low income and disabled citizens would be changed to a per capita cap if Medicaid was cut.  Such a move would forever limit federal spending to the states - many of which are already facing huge budget crunches, deficits. What do you then think would happen? Well the disabled and sick would be tossed out to beg for any help they could get.

The 'pukes talk of getting these low income folk into cheaper policies (like Cruz' advocates)  but what they're really advocating is putting them into health care ghettoes: exploitative policies preying on pools of the mostly sick featuring monumental deductibles combined with outrageous premiums and very limited care (e.g. no maternity care, no mental health care, no ER visits).  What sort of  political moron would sign onto that  and have his/her name on the legislation? Certainly no sane Dem!

Thus, Noonan's blather that "the GOP donor class would likely hate a compromise bill as the Democratic Party's nihilist left - which wants no compromise" misses the point because she doesn't grasp the fact that giving away the store to make nice is a losing wicket. Once again, for a million economic reasons, gutting Medicaid to salvage McConnell's bill can't be part of any humane compromise.

The steady, stupid spin of the Right in assorted op-eds and thinktank blather also has antagonized the Democrats. One of the most ignorant and disgusting of all was rendered by Peter Cove in his July 5th WSJ piece ('Get Able-Bodied Americans Off The Couch') depicting those on the Medicaid rolls as deadbeats and latter day welfare queens.  He argued that basically there were millions of "able bodied" - including men- just laying around and grabbing Medicaid without working - when they could work and get health benefits from a company.

One had to wonder what this asshole was drinking or what manner of dope he was smoking.  Other WSJ  letter writers also echoed his babble including that "those in poverty have the luxury of saying 'no' to a job and suffering no consequences when they choose not to work".  Suffer no consequences? What is this dense cretin thinking? How about his kids without enough food, or having his utilities shut down or his home foreclosed?   Added to the earlier drivel,  this other ignorance: "Someone who loses a job loses not one penny of cash assistance nor his food stamp vouchers nor Section 8 housing".  Again, no remote idea that de facto cuts have already been applied to those programs.   For example, in March, 2016 a budget decision by the Repukes  led to up to 1 million in 22 states losing their food assistance (SNAP)  benefits after three months regardless of how hard they were looking for work.

But that's the key characteristic of these Philistines on the Right:  they don't care that people are already working.  If they're not earning enough money it's all on them,  not the economy,  which is geared more to Wall Street than Main Street. (Look at how the DOW has shot past 21,000 yet consumers have cut back on spending the past two months, according to the WSJ , July 16).

No wonder the above sort of comments and Cove's piece elicited furor in the Colorado Medicaid care and recipient community. Moe Keller, a Vice President of Mental Health Colorado noting (Denver Post, July 9, p. 16A):

"There is a shocking ignorance about who these people on Medicaid are. They (op-ed writers, public officials, much of the public) think they're just siting around eating bon-bons and watching TV. They're not. They're working individuals."

Or - they are people who have worked hard, and  are not now in a physical condition to do what they used to.  At least one WSJ letter contributor - an M.D. - did provide the proper perspective. As he wrote in his reply to Cove's piece (July 17):

"Some of my unemployed patients are over 50, have a history of back or similar injury, abuse or previous jail time. Employers don't want to take the risk of employing such an individual as firing them might entail claims of age discrimination, or payment for work-related injuries......A person on Medicaid with significant and costly chronic medical problems who wants to work simply cannot afford to take the chance of losing public health benefits as private insurance with its copays and deductibles are overwhelming at entry level positions"

In other words, the choice not to work (if one's job potential is limited) - for whatever reason  - is a rational one. It is also a rational one to go onto Medicaid if one is already covered by their own insurance but have a child with severe brain damage whose physical needs would not be fully covered by that private insurance.

This is the case of Jennifer and Matthew Fischer highlighted in the Denver Post's extended look at Medicaid recipients in Colorado (op. cit.). Both, as the Post notes, "have health insurance and work full time".  It "covers major medical issues picks up substantial costs for their child's medical care" - though they inevitably hit their maximums in January each year.   But there is much it doesn't provide and that's where Medicaid comes in. That includes: the wheelchair ($25,000), the formula their 11 -year old (Cecilia) which needs to be ingested through a feeding tube. ($500 a month), and the nurse who accompanies their daughter to school and attends to her needs.  As the Post explains:

"All of that is covered through a Medicaid waiver, making Cecilia among the 45 percent of the state's Medicaid recipients who are age 20 or younger."

This insight is critical in skewering the whining of other Right nabobs like WSJ columnist Daniel Henninger who has pissed and moaned  ('The GOP's Fatal Infatuation', July 9):because "Medicaid's original purpose was to ensure medical care for the disabled and poor women and children" i.e.  not middle class people.  So, of course, Henninger like other pro-GOP whiners has complained long and hard about Obamacare's "evil genius" in expanding the program.  Henninger concedes that GOP gubernators in "expansion states" have had no choice than to swallow "the kool aid" and accept it, because their citizens have grown dependent on it..

According to Henninger (ibid.):

"Once the governors took expanded Medicaid payments, they were hooked"


Adding that "Medicaid is already lowest common denominator medicine"

Well, try telling that to the Fischers who have seen their daughter Cecilia reach a level of capacity she wouldn't have otherwise, i.e. without Medicaid.  It's easy for  one percenter nabobs like Henninger to dismiss Medicaid when they reap Cadillac level care via their elite jobs, like at the WSJ. But for those who have it and depend on it, especially to keep sick and disabled kids and family  cared for at home, it's as gold standard as one could want.

Another Rightist letter writer, commenting on the Post's Medicaid story (July 16, Perspective), exceeded all lows for a normal human of any sentience by bellyaching that most Medicaid beneficiaries had "gotten themselves into their economic predicaments by their own choices".  Adding: "Why should I as a taxpayer have to bail them out?"  Well, uh...because you are supposed to be a decent person with some measure of humanity and care for your fellow citizens?

But let's not kid ourselves here. The Right, essentially, has zero interest in providing any kind of viable health care to those who most need it because such quality care costs money - which they may  have to pay for via taxes. So they'd rather engage in PR stunts and obfuscation than come clean to the American people about what they're really doing.  That is, to gut the one program that nearly 76 million depend on and which stands between them and medical catastrophe or bankruptcy and penury.

One of the most spot on observations made by one Medicaid recipient (via the ACA) appeared in the latest TIME (July 24, p. 34):

"The party that would have me crucified for having an abortion now wants to make it impossible for me to keep him alive."

Again, betraying the whopping magnitude of hypocrisy on the Right pertaining to abortion: that all it cares about is life before birth - but not afterward.

There is no way any sober and sane Democrat could ever agree to a compromise with this lot that demands the gutting of Medicaid.

See also:

http://www.smirkingchimp.com/thread/donna-smith/74038/ode-to-the-sicko-decade-and-single-payer-power

Trump Now Demands "Repeal Only" And NO Replace - Why Even His Supporters Are Abandoning The Twit

"I want the whole Obamacare repealed! No replace! Do it!"

Trump, aka Donald Drumpf, can't seem to help burning his whole administration down from the inside out using his own halfwit, impulsive brain. The latest salvo manifesting as friendly fire on his own Repuke Senate (struggling to pass their "Better care" bill) was his demand to just "repeal Obamacare and don't replace".   The very fact this imbecile could offer this shows: a) he doesn't know diddly about the existing R- bill, and b) doesn't know it contradicts all his previous statements committed to NOT doing that, and c) that it would leave 32 million without any health care.

In addition, as per a WSJ article today (p. A4, 'Conservatives Seek Speedy ACA Repeal') "those inside and outside the GOP warned that repealing the ACA without a replacement would create enormous uncertainty, roiling the insurance markets, panicking consumers and making life difficult for businesses."  Not mentioned is the effect it would have on health insurance stock shares, i.e. send them into the toilet.

Above all this Trump tweet demand discloses the guy isn't serious, he's again acting the part of the disrupting clown he really is, only fit to do stand ins as Bozo, or....maybe clean porto-potties in a clown costume. Hell, he isn't even aware of the peril he's now in as word is spreading through more intelligent and savvy former supporters that he's a loser and the carny barker most of us on the Left had always claimed. He's simply the real estate swindler and reality TV "firing" goon he always was.

As a blogger friend, Vietnam-Era vet and Trump voter put it in a recent blog post referencing the falling out:

 --------------

I voted for you but this is embarrassing,” someone else wrote last week, responding to the president’s tweet attacking the department store Nordstrom.

Complaints like these are being logged by a Twitter account called @Trump_Regrets. Since November, the account, managed by Erica Baguma, a 23-year-old Canadian college student, has climbed to more than 220,000 followers by curating some 1,500 messages, mostly from exasperated people who say they voted for Trump.

And…these people are not the only ones’ pulling their support from Trump. There are literally thousands of veterans like myself also ‘waking up’ to his BS! He’s ‘shit’ on and pissed off the wrong people with veterans. Despite Trump being granted FIVE deferments during Vietnam (one medical and four educational deferments), we vets nevertheless voted for him 2-1 over Killary.

The last straw was when he proposed to cut financial support for aging and disabled veterans included in $1.1 trillion federal budget proposal for the estimated 225,000 vets who would have lost the payments, had it not been for the hue and cry from veterans and veterans’ groups, and finally…Shulkin said he would not include the (IU) cuts in the budget proposal.

But, as far as myself and thousands of other vets are concerned…too little – too late! It shouldn’t have even been a consideration!

Some comments from veterans, when they found out it was in the budget proposal were:

“Make that guy in the White House keep his promise to all of us veterans, lest we all fall by the wayside and be left on the battlefield,” said a former Army staff sergeant who served in Vietnam.

“Please don’t do this to us,” said a sailor who served on ships in the Tonkin Gulf during the Vietnam War. “My wife and I already live our later years in constant uncertainty. We thought our VA benefits were fairly safe.”

“I have become aware that President Trump’s VA budget sets to screw Vietnam veterans first in line by eliminating the unemployability benefit for those of us who actually served and sacrificed who have reached the age of Social Security benefits,” said a former Navy lieutenant who flew the EP-3E version of the P-3 Orion surveillance aircraft in Vietnam.

-------------------------------------------------------------

Wow! If trends like this continue, Drumpf's "re-election campaign" will be dead in the water before it even gets to the midterms next year. And these are just the citizens, mainly military, upset about the potential cuts if his budget goes through, and as my blogger pal noted these are mostly "wish lists", most don't go through in entirety. But now add to those the millions of Trump voters who will be adversely affected by his pulling Obamacare without replacing it and it's his (and the GOP's) worst nightmare.

Even Kimberly Strassel in her Op-Ed in the WSJ two days ago, conceded that 77 percent of Americans now accept the minimum for the health care tableaux must include: i) acceptance of pre-existing conditions and  (ii)that kids can stay on their parents' plans until they are 26 years old. She argued the reason the acceptance of these ACA provisions was so widespread  because they were "the simplest part of the ACA to understand".  Maybe, but they are also humane and rationally based, especially not charging ten times more to those suffering from pre-existing conditions!

All Trump is doing now - between his deranged tweets and trying to trump Bitch McConnell in health care policy -  is ensuring disaster for himself, his administration and his party.

For those of us on the Left, it can't happen soon enough that all of these assholes sink, one time if possible, but we'll accept the 'long game' otherwise.

See also:

http://smirkingchimp.com/thread/p-m-carpenter/73742/just-say-it-donald-trump-is-mad

The Wall Street Journal's Misplaced Malarkey On The Senate "Health Care Advance"

These days words and meanings are everything, and are often deployed with special aplomb to distort and divert inquiring minds from truth. I've already - in previous posts  - noted many historical examples, such as the substitution of the vanilla term "scandal" for actual, multi-layered conspiracies such as Watergate and Iran -Contra. The effect being to divert the historically purposive mind from political conspiracy to well, something "scandalous" - like the Clinton- Monica Lewinsky nonsense. Thus are events riven with historical and political gravitas reduced to gossip-style, forgettable one offs.

Similar word twisting perversion occurred with using the term "death taxes" for estate taxes, the better to spare the wealthy from having to pay their fair share in a democratic, supposedly fair society.  Now, the latest addition to this sordid verbal jui jitsu involves the terms used for the atrocity known as the Senate health care bill which demolishes Obamacare and has cynically been named the  'Better Care Reconciliation Act. of 2017.'

The Wall Street Journal added to this perversion in its editorial yesterday ('The Senate Health Care Advance') by first using the term "Senate" when only the Reepo contingent pushed it through, and second, calling it "health care" when in it is all about tax cuts, and third, using the word "advance" when it is in fact a major regression for 75 million fellow citizens.

There are other aspects of the WSJ editorial I also want to call into question and criticize from a historical, economic and political perspective. Why? Because getting at the true nature of this misbegotten piece of "legislation" requires doing so, at least to the same degree as when I take care to classify solar flares by their x-ray output.   Hence, I cannot in good faith conflate an X-1 flare with an X-9 event, like the WSJ does with its ACA and Medicaid "facts".  But WSJ editorials are not known for being factual but circulating  Rupert Murdock propaganda.

For example:

"The legislation replaces Obamacare's subsidies with tax credits for people who buy insurance on the individual market"

The use of "tax credits" betrays the true intent of this bill as a tax plan, as opposed to a health care bill. Tax credits are the standard conservo solution to genuine fiscal holes, but are really useless gestures. After all, they do absolutely nothing for people in  serious medical distress, say to be able to afford actual, meaningful tresatments. They are little better than a useless dollop or dressing, and as one mother of an autistic child put it in a TIME essay last year, would barely cover $1200 of her $30,000 yearly needs.  But they do create the illusion of offering something, I mean look at the term "credit",  after all.  But in terms of health care which I already noted increases inexorably, it is subsidies that pay the freight, not "tax credits!"!

And subsidies would more than be the solution if this country pared back its defense spending to half the GDP proportion, say to what it was before 9/11.  After all, a nation that outspends the next 13 together in defense can't possibly be "on the ropes"! Only a moron would believe so.  Hence, as former defense analyst Chuck Spinney once put it, let's cut the defense share of GDP  back to 2.4 % to 2.2 %. THEN we can make room for providing subsidies via the original ACA which, let us be clear, was the reincarnation of an original REPUBLICAN health care law (also known as "Romney Care")

"Medicaid was originally meant for poor women, children and the disabled - which Obamacare opened to able-bodied, working age adults above the poverty level".

This takes no account whatsoever that health care access (and needs) must expand as a population increases and economic legislation alters over time.  Point of fact, the population of the U.S. was about half what it is today at the time (1965) Medicaid came onstream. In addition, the poverty level has barely changed since then, remaining far too  statistically "lowballed" for the very purpose of limiting access to benefits.

Now add in the economic forces of globalization - globalized labor markets (and destruction of the U.S. manufacturing sector), and mass corporate downsizing in the 90s, and the case can be made that the original intended beneficiary base of Medicaid was simply way too meager, too small, by 2000. To put it another way, most lower middle and working class citizens - even with jobs - were in essentially the same economic position as "poor women and children" in the late 1960s.  Of course, it is in the Journal's best propaganda and spin interests not to process this.

To fix ideas,  consider the Denver Post article ('4 in 5 Adults Face Poverty At Some Point In Lives', July 29, 2013).   According to the article:

"Although ethnic and racial minorities are more likely to live in poverty, race disparities in the poverty rate have narrowed substantially since the 1970s, census data show.

Economic insecurity among whites also is more pervasive than is shown in government data, engulfing more than 76% of white adults by the time they turn 60, according to a new economic gauge to be published next year in the Oxford University Press."

The Post article further notes that "measured across all races" the risk of economic insecurity rises to 79% or nearly 4 in 5. Pardon me, but this indicates a nation of rising inequality and the degradation of most citizens in terms of their economic welfare. Above all, it shows the need for vastly expanded medical benefits given the deplorable economic inequality ensures most can't afford the health care they need- so must depend on a decent federal government to provide it.  An "entitlement"? Perhaps, but how else will our people get the medical treatments they need and deserve?

"The Senate waits four years instead of three but pegs the (block) grants to inflation with no adjuster."

As former Medicaid administrator Andy Slavitts observed last night ('Last Word') this translates on average to a state cut of 25 percent per individual beneficiary.  This portends serious losses of benefits for most of a state's population especially given no adjuster. But again, this exposes this sham law for what it is, a tax cut plan for the rich as opposed to providing for the most medically disabled and adversely affected among us. Unless states trapped in a zero sum budget scenario compensate - say by taking funds from roads or preschool-  thousands of state citizens will be left to scramble.  The very Darwinian nature of the Repuke bill is here exposed, pitting one segment of citizen interests (and citizens) against all others. In other words, a return to the law of the jungle but in economic warfare form.

"The Senate includes about $100 billion for a stability fund .....and could be used by creative Governors to support insurance markets in states like Maine and Alaska"

In other  words, the Reep Senate bill creates a slush fund that can be used to bribe state Governors (especially in high premium states)  to cooperate with the for -profit sharks to set up costlier protection rackets - passed off as health insurance. (See William Rivers Pitt's sterling analogy at the end of yesterday's  post.) By use of creative accounting the state Governors can then make it appear health exchanges are really working - as they would be under a properly redone ACA- when they're only on temporary support from the limited slush fund. When the slush fund is exhausted the premiums across the board will shoot through the literal roof.

"The Senate wouldn't allow states to apply to relax the community ratings regulation which limits how much premiums can vary among individuals with different health risks."

In other words, if instead of being a  70 y/o Medicare beneficiary with prostate cancer, I was ten years younger and lived in a high premium state (e.g. AK) , insurers could charge me up to five times more in premiums (say $5,000 a month instead of $1,000) precisely because my health risk would be recognized as greater from being diagnosed with prostate cancer. It doesn't take a genius to figure out that the end result of this sort of draconian solution would necessarily see fewer men going in for PSA tests, for the very reason they would wish to escape a possible negative diagnosis with adverse consequences to their insurance premiums.  By the same token we'd likely see fewer people going in for colonoscopies as well as skin exams (which I also recently had - with one suspicious mole removed for biopsy).

"Importantly, the Senate bill also repeals all of Obamacare's tax hikes .....including the 3.8 percent surtax on investment income."

Left unsaid is that it was precisely these tax hikes that helped pay for the individual subsidies for the low income citizens with unmet health care needs.  What the Reeps have done is to basically cut out the tax hikes and gut the subsidies, replacing them with "tax credits". So, whereas before a citizen might have had $20,000 to cover the costs of a prostate cancer treatment he will now be lucky to get a chump change $500 tax credit.  This would barely be enough to cover his pain meds and basic tests, far less any kind of real treatment (say focal cryotherapy) Again, all of this exposes the Senate bill as an outright sham, a tax cut bill NOT a health care bill.  For reference  a person with a $1 million annual income would gain $54,000 each year in tax cuts. Almost enough to buy a new Lexus.

The Journal even confirms this tax cut imperative when the editorial states:

"Some Senators pushed to keep the surtax to avoid the tax cuts for the rich label and spend the revenue on something else."

Too late now, assholes, you're busted! We all know this is a damned tax cuts for the rich   Trojan horse being rolled out like a new health plan.  Only a certified halfwit would believe otherwise.

"It's not too much to say that this is a defining moment for whether the GOP can ever reform runaway entitlements. If Republicans, the next stop is single payer."

Then by all means let us hope they fail and miserably!

To summarize, these are the facts not processed in the WSJ's editorial:

1) There are vastly more poor citizens than rich in the U.S. of A.

2) The medical needs of an expanding population with few resources, income to begin with will always grow exponentially in relation to economic budgets for which yearly predictability is sought.

3) At the same time the costs of those medical needs must always expand, never decrease because medical inflation always exceeds other forms.

4) Therefore, by dint of (1)-  (3) it is budget allocations for genuine health care which must always be given priority in a nation that seeks genuine national security. After all, a sick population can never be a secure one, nor - by extension - can the nation they inhabit.

5) Tax cuts even disguised in a health care bill (so called) can never work and have  been proven not to work. They only increase deficits by cutting revenue and make a country less able to come to terms with its long term liabilities. To use economist Paul Krugman's term, they are a "zombie idea" because the Repukes keep bringing them back even after their efficacy has been disproven.

See also:

http://www.smirkingchimp.com/thread/robert-reich/73691/it-s-time-for-medicare-for-all