Month: July 2012

It would seem that people are waking up to the fact that the possibility of states opting out of the Medicaid expansion might put a crimp in the fabulous achievement of Obamacare and, not incidentally, leave millions of people uninsured.

Wonkblog is featuring a story about it this morning, with some charts that spell out very clearly who’s going to get hurt:

Now why would people want to deny health care to people at the lowest end of the spectrum, the ones who can least afford it? I think this little dispatch from North Carolina explains it quite well:

Greenville News 07/01/2012

Sense of entitlement is likely to metastasize

Obamacare has been ruled constitutional by the Supreme Court, those esteemed individuals we consider sages when they agree with us and tyrants when they don’t.

The decision has rendered supporters of the law posi­tivelyapoplectic, even raptur­ous.

Detractors have been lying in fetal positions taking antac­ids and trying to figure out how it all happened. Either way, for now it’s a done deal.

The politics of the matter remain to be seen.

While not a supporter of the legislation, I am man enough to concede and say that I hope it works. I admit that there are a couple of provisions that are (at least temporarily) merci­ful in its pages. Among them, coverage for pre-existing conditions; a thing that could be very useful for my diabetic teen as he grows older.

In addition, there’s the abil­ity to keep children on their parents’ insurance until age 26. With unemployment soar­ing even among undergradu­ate and graduate degree hold­ers, mom and dad may have the only insurance available for the kids as they ply their advanced degrees and theses by serving fries and burgers.

The problem I have with the Affordable Care Act (well, one of the problems I have) is that it presumes a certain amount of responsibility among the populace and due vigilance in the government (Not particularly common on either part.) What I mean is, the Afford­able Care Act requires that individuals purchase health insurance or face a fine. The same goes for businesses.

Of course, businesses are easy to fine. But individuals?

Less so. And really, if the gov­ernment is unwilling to deport illegal aliens in custody for crimes, or imprison multiple offender drunk drivers with suspended licenses, do we really think they’ll take a per­son to the mat if they neither purchase insurance nor pay the penalty for failing to do so? Seems unlikely to me.

Thus, individuals will not add to the fund from which they’ll draw deeply when they are sick themselves, and final­ly get insurance (like a death­bed baptism).

The other problem is not about fines or rules, but about lifestyles and attitudes. Hospi­tals have all too many patients with no sense of accountabil­ity, who “take” as a way of life. Not a majority, mind you, but a powerful minority has de­veloped an incredible alacrity for navigating hand-outs, programs, criminal courts, government checks and as­sorted entitlement programs.

This isn’t a screed against the poor, but a shot at the ma­nipulative. All too often they come to hospitals only for pain or anxiety medicine or work excuses. Or for manufactured drama on weekend nights.

Frequently, they come to add weight to their somewhat spurious disability applica­tions for things like “I can’t keep a job,” and “I get angry a lot.” (Yes, we actually heard those from healthy young men seeking disability checks.) These persons, soon to be eligible for insurance, are superb at obtaining food, medicine, money, drugs and influence at the expense of others.

They understand how to use state and federal pro­grams with maximal effi­ciency. And they know that speaking loudly, calling out for “patient care representa­tives” and filling out negative satisfaction surveys will gen­really, in most large facilities, get them their snacks, drinks, pain medicine and excuses.

The amount of money hos­pitals spend tracking down frankly false complaints, for pain prescriptions alone, is staggering.

To understand the depth of this problem, just “ask a nurse,” and you’ll get an ear­ful about the awful treatment they endure, the way nurses and other care providers struggle to care for their own kids and make ends meet only to be told by a fully capable adult, “I need you to give me my prescription, since I don’t have any money.” This as their iPhone and cigarettes spill out of their pockets, and their drug screen lights up for marijuana, cocaine, opioid pain medications and the now ubiquitous Methamphet­amine. (All of which they can magically afford).

Here’s my point. If anyone thinks that providing a means to insurance for everyone will make all people better or healthier, they’re wrong.

While it will likely benefit many, the patients I’m dis­cussing won’t work on their diets, smoking, drinking, Meth use or their serial pa­ternity.

All they’ll understand is that there’s one more way to get things they want without contributing to the solution.

Ironically, in this way the ACA might inadvertently cause entitlement to metasta­size even more widely than it already has. I hope I’m wrong. But experience, in the real world, with real human be­ings, suggests I’m not. I sup­pose only time will tell.

I can’t imagine who he’s talking about.

[W]e have to remember that this is an ideological and even a moral issue to conservatives, who view dependence on any form of public assistance as eroding the “moral fiber” of the poor (as Paul Ryan likes to put it), and as corrupting the country through empowerment of big government as a redistributor of wealth from virtuous taxpayers to parasites who will perpetually vote themselves more of other people’s money. This line of “reasoning,” of course, would justify the abolition of Medicaid, not just a failure to expand it, but conservatives are careful (and smart) to disguise that ultimate goal and simply suggest we have reached some sort of welfare-state tipping point beyond which we become Greece.

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Profits equals liberty in our corporate democracy

by digby

Just remember, corporations are people too and have exactly the same rights you and I do:

Verizon believes that even if Congress had authorized network neutrality regulations, those regulations would be unconstitutional under the First Amendment. “Broadband networks are the modern-day microphone by which their owners [e.g. Verizon] engage in First Amendment speech,” Verizon writes.

Verizon believes that it’s entitled to the same kind of control over the content that flows through its network as newspaper editors exercise over what appears in their papers. That includes the right to prioritize its own content, or those of its partners, over other Internet traffic.

“Although broadband providers have generally exercised their discretion to allow all content in an undifferentiated manner, they nonetheless possess discretion that these rules preclude them from exercising,” Verizon writes. “The FCC’s concern that broadband providers will differentiate among various content presumes that they will exercise editorial discretion.”

Verizon points to a 1994 case in which the Supreme Court ruled that regulations requiring cable television providers to carry broadcast television channels triggered First Amendment scrutiny. By the same token, Verizon says, network neutrality rules trigger First Amendment concerns by restricting broadband providers’ rights to allocate more bandwidth to some content than to others.

That’s not all. Verizon also believes the FCC’s rules violate the Fifth Amendment’s protections for private property rights. Verizon argues that the rules amount to “government compulsion to turn over [network owners’] private property for use by others without compensation.”

The Fifth Amendment prohibits the taking of private property without compensation. According to Verizon, network neutrality rules are “the equivalent of a permanent easement on private broadband networks for the use of others without just compensation.”

Indeed, quoting a recent law review article, Verizon argues that network neutrality rules allow third parties to “physically invade broadband networks with their electronic signals and permanently occupy portions of network capacity.”

Well hell. If I didn’t know better I might think they are tailoring their argument just for this Supreme Court.

So, what do you think? Are we seriously going to say that the bill of rights applies to corporations? Was that the sacred founders’ dream?

I doubt it. In yet another in the July 4th series of leftist quotes from the founding fathers, via Jonathan Schwartz:

[P]ower always follows property. This I believe to be as infallible a maxim in politics, as that action and reaction are equal is in mechanics. Nay, I believe we may advance one step farther, and affirm that the balance of power in a society accompanies the balance of property in land. The only possible way, then, of preserving the balance of power on the side of equal liberty and public virtue is to make the acquisition of land easy to every member of society; to make a division of the land into small quantities, so that the multitude may be possessed of landed estates. If the multitude is possessed of the balance of real estate, the multitude will have the balance of power, and in that case the multitude will take care of the liberty, virtue, and interest of the multitude in all acts of government.

I have heard a whole lot of “big ideas” come along in the wake of Citizens United, as normal people struggle to figure out how to save our democracy from this corporate coup. Many are great ideas, but one that might be promising is the idea of a constitutional amendment declaring that corporations are not people. Obviously it would cause a revolution in the law since corporate personhood has been around for a long time. But maybe that’s a good thing.

Of course, if it were up to me and some utility-like corporation like Verizon, which provides a necessary lifeline that makes the entire economy work, tried something like this: I’d nationalize the damned thing. But that’s just me.

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It doesn’t matter if they call it a tax or a penalty

by David Atkins

The last few days have seen Mitt Romney argue with himself, to much general hilarity, over whether to call the Affordable Care Act’s mandate provision a “penalty” or a “tax.” The larger conservative establishment would obviously love to call it a tax, since John Roberts gave the mandate his grand seal of Constitutional approval by declaring it to fall within Congress’ powers of taxation. Mitt Romney has trouble with that, since he himself called the mandate a “penalty” when he instituted a healthcare mandate in Massachusetts. So the Republicans are doing backflips trying to find their rhetorical footing on the subject and failing amusingly.

But on a larger level it doesn’t even matter what they call it because people who know anything about the issue at all already understand the basics pretty well, and people who don’t understand the issue at all after the last two years aren’t likely to be persuadable because of what a politician says about it now.

It’s fairly obvious what the mandate does: once the government makes health insurance affordable (in theory), people who don’t pay for it will be penalized in order to prevent moral hazard, and to prevent people from not buying insurance until the minute they feel they might have a medical problem. Call it a tax, call it a penalty, call it whatever one wants: the concept is clear enough.

That doesn’t make it popular, of course. Conservatives hate it because it gives government another power over what people do with their money, and because it means that human suffering won’t be as wholly dependent on how much money people happen to have–and as we all know, punishing people with misery and death for daring to not have enough money is a core moral principle for conservatives. Progressives tend to hate the mandate because it entails the government forcing people to buy insurance from bloodsucking private corporations that cannot and will not provide care or coverage as inexpensively or as effectively as a single-payer system could.

But both camps are fairly clear about the basics, as will anyone be who looks at the issue for more than 10 seconds.

So the Republicans can spin their wheels trying to frame the mandate as a tax in spite of having nominated the grand architect of the original private healthcare mandate system. It won’t work. People understand that taxes are levied on purchases. Fines are levied on people who don’t do what the government says they must, including making appropriate purchases. Calling the mandate a “tax” doesn’t actually make much sense, given how most people understand the concept of taxation.

But more importantly, the larger voting public generally understands what the mandate is. What Republicans call it won’t make much of a difference.

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Oh, and to hell with pre-existing conditions ban too

by digby

I’ve been hearing a lot of people suggesting that Mitch McConnell has seen the writing on the wall and will not fight the ACA in the Senate. Maybe so. But he sure has a funny way of putting it:

The senior senator from Kentucky, who himself enjoyes government-subsidized insurance as a federal employee, toldthe National Review on Tuesday that the party would do little to help the 129 million people who could be denied insurance because they suffer from a pre-existing condition should the law be repealed. “I’m not convinced that issue needs to be addressed at the federal level,” he said, before praising Republican governors for refusing to implement a provision of the law that expands health coverage to lower-income residents through the Medicaid program.

During the interview, McConnell also confirmed that he planned to repeal Obamacare’s main provisions — like the individual mandate — through reconciliation, a process that allows the Senate can pass budget-related bills with a majority vote

He also said this:

Is there anything more specific on Medicare and Medicaid?

I’m hoping that the states will advantage of the option not to add massive numbers of new people to the Medicaid rolls. I’ve had a couple of town-hall meetings in hospitals this week and I’ve had a number of them over the past year. In Kentucky, we can’t handle the Medicaid patients we already have. Our health-care providers are completely distraught at the notion that, in my state for example, 400,000 people would be added to the Medicaid rolls, with 30 percent of Kentuckians receiving free health care. They can’t handle it. They can’t handle the Medicaid they have now and they certainly can’t handle this. I don’t know what our state government will decide to do, but some governors are saying “thanks, but no thanks,” now that they have the option.

On a final note, what’s your message to conservatives and tea-party activists who are suspicious of Republican leaders and their commitment to repeal?

Boy, I don’t know how they could be suspicious on this issue. Every single Republican in the House and Senate voted against Obamacare. I must have made 125 speeches about it on the floor. If there is any area where I don’t think conservatives of any stripe should be concerned, it would be this one. We’ve been clear and unambiguous about Obamacare from the beginning to the end — all of it. And I led the fight in the Senate, so I know what I’m talking about.

Again, that’s a funny way of saying that they aren’t going to repeal it if they can.

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The luckiest man in world

by digby

Here’s an excellent question. How does one get a hundred million in their IRA?

He may have generated a return of of 30% a year to reach $100 million. Or, in a possibility Kleinbard calls troubling, Romney may have rigged the system. “Complete disclosure would clairfy it,” Kleinbard says. One possibility is that Romney put the money into funds he controlled, then sold them at prices he set. “The question is, did he set the prices at an honest, fair market value? Or did he lowball the prices?”

You have to love the idea of Mitt even having an IRA. It was designed for middle and upper middle class types to save money for retirement not for vulture capitalists worth hundreds of millions to defer taxes — and possibly rig their returns. But hey, whatever works right?

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The Rwandan example

by David Atkins

Tina Rosenberg in the New York Times has another reminder about the dramatic benefits of universal health insurance, this time in post-massacre Rwanda:

Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.

One key reason that Rwandans are so much healthier today is the spread of health insurance. In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them. In response, the Health Ministry began a pilot project of health insurance in three districts. In 2004, the program began to spread across the nation. Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.

Mutuelle is a community system — premiums go into a local risk pool and are administered by communities. Until last year, Mutuelle’s premiums were about two dollars a year. This system turned out to be untenable — even two dollars a year was too much for a lot of people. (If you are a rural farmer with an income of some $150 a year, you have to spend every penny on food.)

Last year Mutuelle adopted a sliding scale. For the wealthiest, premiums essentially quadrupled, to about $8 a year. Each visit to a clinic has a co-pay of about 33 cents. If you need to go to the hospital, you pay a tenth of your hospital bill…

But now the poorest — as judged by their communities — pay nothing. The Health Ministry says that the poorest 25 percent of Rwandans get free care.

One of the marks of a truly great country is to heed the experience of others, and to learn by example when others have success. Like truly great people, a truly great nation never stops learning and attempting to improve itself.

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A New Declaration of Independence

by digby

This is one for our time:

The unanimous Declaration of the world’s Normal People (we know who we are),

When in the Course of human events, it becomes necessary for the Normal People of this Planet to dissolve the political bands which have connected them with their Leaders, and to give getting along without Leaders a real Shot, courtesy requires that we should declare the causes of this long-overdue separation, just so we’re all on the same page.

read on …

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As American as apple pie

by digby

Following on David’s founders quotes below, it’s appropriate to also point out that “leftism” and criticism of capitalism is as deeply woven into the fabric of American culture as chauvinism and Jesus.

With the celebration this month of the 100th anniversary of Woody Guthrie’s birth, festivals, academic symposia and new collections of his music are bringing renewed attention to “This Land Is Your Land,” one of the U.S.’s unofficial anthems. And it is becoming more widely recognized that some versions of the song featured lyrics not normally associated with patriotism — words reflecting Guthrie’s communist beliefs.

What may not be so well-known is that “This Land Is Your Land” belongs to an American tradition of patriotic pieces made by critics of capitalism. The authors of the Pledge of Allegiance and “America the Beautiful” also took a distinctly leftist view of the U.S. economic system.

I hate to tell you wingnuts, but we are Americans too.

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Everything he does makes me nervous

by digby

Watch out:

I would have thought that was a cute picture if I weren’t convinced that old Mitt was about to shove that ice cream in the kids face as one of his “practical jokes.”

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Trevor Thomas is in “Vogue” in Michigan

by digby

Hmmm. It looks as though one of the good guys might be pulling ahead. From Gaius Publius at Americablog:

You read the headline correctly. Trevor Thomas, real progressive and candidate for western Michigan’s 3th-district House seat, may easily have a substantial lead over anti-woman Dem candidate Steve Pestka.

(Yes, in this year of Dem fundraising on the “War Against Woman” theme, Pestka is blatantly anti-woman — click to see why.)

Mlive.com has the Trevor–Pestka polls story (h/t Towleroad):

A leading national pollster says underdog Democrat Trevor Thomas can move into a substantial lead in his primary showdown against Steve Pestka, if Thomas can raise the money to spread his message in the district.

Mark Mellman’s firm says a recent 400-person survey of registered Democrats shows Thomas with lower name recognition and overall favorability rating than Pestka.

But when presented with what the firm and the Thomas camp say is a fairly worded description of both men, Thomas surges to a 22-point lead from a 21-16 point deficit.

“Trevor Thomas has a fantastic opportunity to defeat Steve Pestka in Michigan’s 3rd Congressional District in what begins as a close race with a huge number of undecided voters,” Mellman wrote in a memo to the Thomas campaign. “Our poll confirms Thomas has a powerful set of messages at his disposal if he can raise the funds to get that message out.”

Thomas is a great candidate and would be a major addition to the progressive caucus.

As you may know, to help him raise the funds needed Howie has generously donated his own signed Madonna “Vogue” gold platinum record to the cause. [Update: you cannot buy one of these anywhere.] (She’s a Michigan homegirl, you know…) Tomorrow is the day when one lucky Blue America contributor to Trevor’s campaign will win it.

It’s not too late to jump in. The winner will be chosen randomly, it doesn’t matter if you donate a dollar or a hundred dollars. (And anything you can do to help Trevor win his race is already “winning.”)

Donate here for a good cause (and if you’re a Madonna fan,to win a signed gold record.)

Much more on Trevor, here.

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