From Esquire.com It was a Biblical beatdown. Getty BY CHARLES P. PIERCE AUG 22, 2017 While the president* was fastening on his Serious World Leader face Monday night, Speaker Paul Ryan, the zombie-eyed granny-starver from the state of Wisconsin, was facing a carefully tailored audience at a CNN “town hall” in Racine. Because Ryan is […]
Category Archives: Health
Yesterday I asked how low can he go? It seems the answer is a lot further. Trump’s latest jaw-dropping act is to pressure Republicans to repeal the Affordable Care Act immediately. He wants the replacement “very quickly or simultaneously, very shortly thereafter.”
Republicans have been unable to come up with a viable replacement for the ACA in the seven years since it became law. They still cannot agree on a plan that will ensure affordable health insurance to many of the 20 million people that had no insurance before. the ACA. Does Trump not know that? Impossible.
His supporters don’t know it. They voted for Trump because they liked other campaign promises he made; they didn’t believe he was serious about repealing Obamacare. Sarah Kiff of Vox interviewed Trump voters in Kentucky who were enrolled in the ACA. In Whitley County, the uninsured rate dropped 60 percent with Obamacare, yet 82 percent voted for Trump. They thought Trump would work to lower the premiums and deductibles that had become too expensive. Debbie Mills explained :
“I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many peoples lives, I mean, what are you to do then if you cannot pay for insurance?”
Where is the president-elect’s concern for the working poor who elected him?
The Senate is incapable of moving quickly, but Trump doesn’t seem to know that either. Bills have to be written and then added to an extensive agenda. Of course, on rare occasions like the current 2-hour confirmation hearings, the Senate seems to be pushing through cabinet confirmations in record time, even though the nominees have not disclosed their financials or been thoroughly vetted. Trump has evidently convinced the senators that such investigation is not necessary with his nominees, unlike all the others that came before. His power grows ominously as he approaches the Oval Office.
Before the ACA, also known as Obamacare, women were at a distinct disadvantage. Most health insurance plans required women to pay higher premiums than men did. In addition, people were not covered for pre-existing conditions that often made them ineligible for health insurance. For women these included pregnancy, a previous Caesarean section, and even conditions stemming from sexual assault. Many plans excluded maternity coverage. As a result, women paid approximately $1 billion more per year than men did for health care and some women could not afford any health insurance at all.
Obamacare changed all that. Women are now demonstrably better off.
Continue reading Obamacare Scores Big for Women but Stops Short of the Goal
At last! the decision that all Americans — for different reasons — have been waiting for. The Supreme Court has kept the Affordable Care Act viable, at least until the next assault. Justices Kennedy and Roberts joined the progressives on the Court in the 6-3 decision. The ruling affirmed that subsidies for eligible poor and middle-class individuals are legal in federal exchanges. It is estimated that as many as 9.6 million people would have lost their coverage if the Court had upheld the challenge to the ACA, although the Court could not take that effect into account in its analysis of the wording of the law. Mother Jones has a clear and succinct summary of how the ACA works, the case against it and the ruling that saves it.
The argument against the healthcare law was based on six words (“an Exchange established by the State”) that would rule out federal subsidies in states (34 as of now) that didn’t establish their own exchanges (insurance marketplaces that enable consumers to price and compare plans).
Does it make sense that those six words out of 235,000 in 906 pages of legal text were deliberately written with the purpose of invalidating the entire act? Republicans think so. Sen. Rand Paul, presidential hopeful from Kentucky, said, “This decision turns both the rule of law and common sense on its head.”
Justice Antonin Scalia, author of the dissent, characterized the majority opinion as “”interpretive jiggery-pokery,” a “defense of the indefensible,” “pure applesauce,” and “interpretive somersaults.”
Chief Justice Roberts, enraging conservatives by rescuing the ACA for a second time, did not agree with his conservative colleagues. He crystallized the logical underpinning of the majority opinion:
Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.
The Republican reaction? Knowing that while Obama is president he will never sign a law that undermines or repeals one of his signature achievements; and that Democrats, though in the minority, would not help them to override Obama’s hypothetical veto, Republicans have a simple strategy for overturning the SCOTUS decision: elect a Republican president and maintain the congressional Republican majority to repeal Obamacare.
Sen. John Barrasso (R-WY) of Wyoming, the Republican tasked to head the Senate’s response to the ruling: “We will continue to try to pull parts of the law down, but we need a willing partner in the White House to accomplish these things.”
Jeb Bush: “disappointed … but not the end of the fight against Obamacare…”
Marco Rubio: “ObamaCare is still a bad law that is having a negative impact on our country and on millions of Americans. I remain committed to repealing this bad law and replacing it…”
Republican presidential candidates have a ready-made issue: Obamacare is bad; elect me and I’ll repeal it or replace it. They no longer have to contend with the Democratic argument that they will deny healthcare to millions of people.
Today’s favorable decision on Obamacare was critical, but it’s obvious that the ACA is not necessarily here to stay. It is on firm ground until the next president takes the oath of office in a year and a half. If Republicans were to give up their idée fixe of dismantling the ACA or nullifying it completely and instead collaborated with Democrats to improve it … Ah, well. In another life.
Sad to say, the optimism in a post I wrote a month ago was misplaced. “Don’t look now, but we’re actually governing!” was quite misleading. While it’s true that the bipartisan legislation passed with overwhelming support from both parties and it solved the “doc fix” dilemma that had been frustrating doctors and legislators for years, it does so at a significant cost (surprise, surprise!).
The physicians were being paid successively less each year, and many were threatening to leave Medicare while others had already left. The new legislation will give them a guaranteed 0.5 percent pay hike for the next five years. While the doctors win, wealthier seniors (earning $133,500 to $214,000 yearly) will pay more for their medical insurance and prescription drug coverage.
Somebody has to pay, not just seniors. Medicare’s budget will be cut by billions of dollars. Spending for long-term care (hospice, home health services, nursing homes) will also be reduced. A reason to cheer, though, is the two-year extension of CHIP, the Children’s Health Care Program.
Pres. Obama is extremely happy to sign the second most significant health care bill after the Affordable Care Act, popularly known as Obamacare. The Tea Party of course isn’t happy. Senators Ted Cruz (R-TX) and Marco Rubio (R-FL) denounced the bill because it will add to the deficit. (These presidential contenders seem to be going out of their way to antagonize significant sectors of the electorate with their stances on immigration, gay marriage, and now seniors.)
But I just don’t believe you kill 149 strangers because you want to kill yourself.
The medical records of the co-pilot who deliberately crashed a plane into a mountain, killing 149 people in addition to himself, are being examined. We now know that Andreas Lubitz suffered from depression and had suicidal tendencies. We also know that he had always loved to fly — he joined a flight club when he was 14. Add to this picture that he had problems with his vision.
So, given what we know, let’s hypothesize a worst-case scenario: the likable young man who made a living doing what he loved best was diagnosed with an illness that would soon result in blindness. This knowledge made him depressed or increased his already existent depression, especially because it would mean the end of his flying. So he began to think about suicide, as blindness meant he would have to live without his life’s purpose. Even if you don’t agree that suicide is a solution, it’s not hard to understand his state of mind and follow that logic. No one would be shocked if he killed himself.
Up to here, the narrative is reasonable. BUT there is a huge gulf between pointing a loaded pistol at your own head versus killing yourself and at the same time murdering 149 people who had put their lives in your capable hands. How could an apparently non-psychopathic person deliberately allow a plane to practically glide into a mountain? There is something very big missing here. Other than terrorism, anger at the cruel world and other severely anti-social motives, why did Lubitz do what he did? There must be a lot more than meets the eye.
So said Rep. Renee Elmers, Republican of North Carolina. She was celebrating the achievement of House Republicans and Democrats, who accomplished the seemingly impossible. Speaker John Boehner (R-OH) and Democratic Leader Nancy Pelosi (D-CA) found a way to reduce Medicare costs while improving medical care and then sold the deal to their caucuses. The parties actually negotiated and came to a bipartisan agreement on how to fix Medicare’s financial woes and other health-related problems. In today’s polarized government, this was nothing short of a miracle.
The sweeping change to Medicare is to reward doctors based on successful outcomes rather than fee-for-service. Until now, doctors were paid for every test and procedure they ordered or performed, regardless of the outcome. “Now,” said Marilyn Moon, a health economist and former trustee of the Medicare program, “doctors get paid more if they do more. In the future, they will be paid more if they do it better — and may be paid more for doing less.”
Some of the cost will be offset by higher premiums for the wealthiest Medicare beneficiaries. Without this bill, physicians with Medicare patients would face a 21-percent reduction in their fees on April 1. Many doctors would consequently feel compelled to drop out of Medicare, leaving seniors scrambling for access to many fewer doctors. Republicans also agreed to extend CHIP, the government-funded health insurance for needy children. Democrats wanted a four-year extension, but settled for two years in the hope of a longer extension in the future.
What remains is for the Senate to vote its approval. Passage of the bill in Senate is all but certain, given the overwhelming majority in the House, which passed the bill by a vote of 392 to 37. Pelosi corralled all but four Democrats to vote in favor, while Boehner lost only 33 of the most conservative Republicans.
Was this an amazing fluke, or are the people we elected to govern actually learning to play well together? Stay tuned.
Photo by KAZ Vorpal