Category Archives: Republicans

Voters Tuning Out of Health Care Debates

Axios reported yesterday that American voters are tuning out of the health care debates dominating Washington, the presidential campaign, and the politically active talking about Medicare for All and other proposals, according to an article by Drew Altman.

Axios conducted six focus groups in three states, Texas, Florida and Pennsylvania. It was facilitated by the Kaiser Family Foundation’s director of Polling and Survey Research. The focus groups consisted of independent, Republican, and Democratic voters in several swing states and districts.

They were only aware of candidates’ and elected officials’ proposals on health care, but they did not see them as relevant to their struggles to pay medical bills or navigating the health care system.

Each of the six focus groups had between 8 and 10 people who are regular voters and said that health care will be an important issue for them in the 2020 election for President.

Here are the takeaways from the focus groups:

  • These voters are not tuned into the details — or even the broad outlines — of the health policy debates going on in Washington and the campaign, even though they say health care will be at least somewhat important to their vote.
  • Many had never heard the term “Medicare for all,” and very few had heard about Medicare or Medicaid buy-in proposals, or Medicaid and Affordable Care Act state block grant plans like the one included in President Trump’s proposed budget.
  • When asked what they knew about Medicare for all, few offered any description beyond “everyone gets Medicare,” and almost no one associated the term with a single-payer system or national health plan.
  • When asked about ACA repeal, participants almost universally felt that Republicans did not have a plan to replace the law.
  • When voters in the groups were read even basic descriptions of some proposals to expand government coverage, many thought they sounded complicated and like a lot of red tape.
  • They also worried about how such plans might strain the current system and threaten their own ability to keep seeing providers they like and trust.

Most of the voters in these groups did not see any of the current proposals from either side of the aisle as solutions to their top problems: namely paying for care or navigating the insurance system and red tape.

The debates on health care have gotten too far into the weeds and are too complex and complicated for the average voter to understand, let alone follow at this early stage of the presidential campaign.

The debate will become more meaningful, the article contends, when they see stark differences between the health plan of the Democratic nominee and Trump. This way, they will be able to focus more on what those differences mean for themselves and the country.

Here is the comment posted in response by Don McCanne:

Although we should be cautious about trying to draw Great Truths from half a dozen focus groups, we should be concerned about what these groups revealed about their understanding of the basis of the problems that they experience with our health care system.

They see problems with navigating the health care system and with paying their medical bills. But when offered solutions for these problems they show little understanding of even basic health policy, and they seem to be influenced more by political memes expressing a distrust of government, complexity of public solutions, and government interference with their interactions with the health care system.

A particularly important example of this is, “When asked what they knew about Medicare for all… almost no one associated the term with a single-payer system or national health plan.”

This lack of sophistication leaves them unaware that the government Medicare program is far more deserving of our trust than the private insurers (“surprise medical bills” anyone?), that a government program that includes everyone though a publicly funded universal risk pool is far less complex than a multitude of private insurers with various complex rules for accessing and paying for care, and that a single payer system interferes less since the patient has free choices in health care whereas the private plans are more restrictive of benefits while limiting coverage to their contracted provider lists (a minute fraction of the physicians and hospitals available throughout the nation).

Health policy is complicated, but the message for single payer Medicare for All need not be: enrollment for life, free choice of physicians and hospitals and other health care professionals and institutions, and automatic payment by our own public program. The focus groups already understand that the Republicans do not have a replacement plan, but what they do not understand is that only the single payer model of Medicare for All meets these goals whereas the ACA/public option Medicare for Some often leaves them exposed to the access and affordability issues they already face.

Again, single payer Medicare for All means:

  • Never have to change insurers
  • Free choice always of doctors and hospitals
  • No medical bills since care has been prepaid through our taxes.

None of these are features of either the Republican proposals or the Democratic ACA/public option proposals. It’s a simple message. Let’s do our best to see that the American voter understands it.

Florida lawmakers pass bill for Canadian drug importation – Sun Sentinel

From the Overnight News Desk:

Richard’s Note: My late mother worked for a local company that imported drugs for seniors from Canada, the UK, and Israel. The seniors would bring the prescription from the doctor to their office, the employees would fax the prescription and any other documents to the pharmacies in those countries, who would then ship the medications directly to the seniors, without the drugs ever going to the company’s office.

As the two articles cited below state, this would be a departure from Republican orthodoxy on prescription drugs, and could be a model for other states to pursue to bring down the cost of drugs, at least as far as senior citizens are concerned.

I post these articles to honor my mother for her work to help fellow seniors to get less expensive versions of their medications.

Here are the two articles:

Floridians could eventually gain access to cheaper Canadian prescription drugs under legislation the state House has sent to Gov. Ron DeSantis.

Source: Florida lawmakers pass bill for Canadian drug importation – Sun Sentinel

Source: Florida Gov. Ron DeSantis defies GOP orthodoxy with drug importation plan

Medicare for All and Its Rivals | Annals of Internal Medicine | American College of Physicians

Richard’s Note: A shout-out to Don McCanne for posting this today from the Annals of Internal Medicine, which is providing the full article for free. The authors, Steffie Woolhandler and David Himmelstein, both MDs, should be familiar to readers as two of the authors I covered in my review of the Waitzkin, et al. book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health. In the spirit of the AIM, I am posting the entire article below with link to the original. It is that important.

Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

The leading option for health reform in the United States would leave 36.2 million persons
uninsured in 2027 while costs would balloon to nearly $6 trillion (1). That option is called the
status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life
expectancy, the widening mortality gap between the rich and the poor, and rising deductibles
and drug prices. Even insured persons fear medical bills, commercial pressures permeate
examination rooms, and physicians are burning out.
In response to these health policy failures, many Democrats now advocate single-payer,
Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of
frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans
or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump
administration seeks to turbocharge market forces through deregulation and funneling more
government funds through private insurers. Here, we highlight the probable effects of these
proposals on how many persons would be covered, the comprehensiveness of coverage, and
national health expenditures (Table).

Table. Characteristics of Major Health Reform Proposals as of March 2019

Medicare for All

Medicare-for-All proposals are descendents of the 1948 Wagner–Murray–Dingell national health
insurance bill and Edward Kennedy and Martha Griffiths’ 1971 single-payer plan (2). They would
replace the current welter of public and private plans with a single, tax-funded insurer covering
all U.S. residents. The benefit package would be comprehensive, providing first-dollar coverage
for all medically necessary care and medications. The single-payer plan would use its
purchasing power to negotiate for lower drug prices and pay hospitals lump-sum global
operating budgets (similar to how fire departments are funded). Physicians would be paid
according to a simplified fee schedule or receive salaries from hospitals or group practices.
Similar payment strategies in Canada and other nations have made universal coverage
affordable even as physicians’ incomes have risen. These countries have realized savings in
national health expenditures by dramatically reducing insurers’ overhead and providers’ billing-
related documentation and transaction costs, which currently consume nearly one third of U.S.
health care spending (3). The payment schemes in the House of Representatives’ Medicare-for-
All bill closely resemble those in Canada. The companion Senate bill incorporates some of
Medicare’s current value-based payment mechanisms, which would attenuate administrative
savings. Most analysts, including some who are critical of Medicare for All, project that such a
reform would garner hundreds of billions of dollars in administrative and drug savings (4) that
would counterbalance the costs of utilization increases from expanded and upgraded coverage.
Reductions in premiums and out-of-pocket costs would fully offset the expense of new taxes
implemented to fund the reform.

 

“Medicare-for-More” Public Options

Public-option proposals, which would allow some persons to buy in to a public insurance plan,
might be labeled “Medicare for More.” Republicans Senator Jacob Javits and Representative John
Lindsay first advanced similar proposals in the early 1960s as rivals to a proposed fully public
Medicare program for seniors. This approach resurfaced during the early 1970s as Javits’
universal coverage alternative to Kennedy’s single-payer plan and gained favor with some
Democrats during the 2009 ACA debate.
Policymakers are floating several public-option variants, most of which would offer a public plan
alongside private plans on the ACA’s insurance exchanges. Although a few of these variants
would allow persons to buy in to Medicaid, most envision a new plan that would pay Medicare
rates and use providers who participate in Medicare. Positive features of these reforms include
offering additional insurance choices and minimizing the need for new taxes because enrollees
would pay premiums to cover the new costs. However, these plans would cover only a fraction
of uninsured persons, few of whom could afford the premiums (5); do little to improve the
comprehensiveness of existing coverage; and modestly increase national health expenditures.
The Medicaid public-option variant, which many states might reject, would probably dilute
these effects.
Medicare for America, the strongest version of a public-option plan, would automatically enroll
anyone not covered by their employer (including current Medicare, Medicaid, and Children’s
Health Insurance Program enrollees) in a new Medicare Part E plan. It would upgrade
Medicare’s benefits, although copayments and deductibles (capped at $3500) would remain.
The program would subsidize premiums for those whose income is up to 600% of the poverty
level, and employers could enroll employees in the program by paying 8% of their annual
payroll. The new plan would use Medicare’s payment strategies and include private Medicare
Advantage (MA) plans (which inflate Medicare’s costs [6]) and accountable care organizations.
Medicare for America would greatly expand coverage and upgrade its comprehensiveness but
at considerable cost. As with other public-options reforms, it would retain multiple payers and
therefore sacrifice much of the administrative savings available under single-payer plans.
Physicians and hospitals would have to maintain the expensive bureaucracies needed to
attribute costs and charges to individual patients, bill insurers, and collect copayments. Savings
on insurers’ overhead would also be less than those under single-payer plans. Overhead is only
2% in traditional Medicare (and 1.6% in Canada’s single-payer program [7]) but averages 13.7%
in MA plans (8) and would continue to do so under public-option proposals. Furthermore, as in
the MA program, private insurers would inflate taxpayers’ costs by upcoding as well as cherry-
picking and enacting network restrictions that shunt unprofitable patients to the public-option
plan. This strategy would turn the latter plan into a de facto high-risk pool.

The Trump Administration White Paper and Budget Proposal

Unlike these proposals, reforms under the Trump administration have moved to shrink the
government’s role in health care by relaxing ACA insurance regulations; green-lighting states’
Medicaid cuts; redirecting U.S. Department of Veterans Affairs funds to private care; and
strengthening the hand of private MA plans by easing network-adequacy standards, increasing
Medicare’s payments to these plans, and marketing to seniors on behalf of MA plans. A recent
administration white paper (9) presents the administration’s plan going forward: Spur the
growth of high-deductible coverage, eliminate coverage mandates, open the border to foreign
medical graduates, and override states’ “any-willing-provider” regulations and certificate-of-
need laws that constrain hospital expansion. The president’s recently released budget proposal
calls for cuts of $1.5 trillion in Medicaid funding and $818 billion in Medicare provider payments
over the next 10 years.
Thus far, the effects of the president’s actions—withdrawing coverage from some Medicaid
enrollees and downgrading the comprehensiveness of some private insurance—have been
modest. His plans would probably swell the ranks of uninsured persons and hollow out
coverage for many who retain coverage, shifting costs from the government and employers to
individual patients. The effect on overall national health expenditures is unclear: Cuts to
Medicaid, Medicare, and the comprehensiveness of insurance might decrease expenditures;
however, deregulating providers and insurers would probably increase them.
In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and
persistent problems with access and quality triggered a roiling debate over single-payer plans.
As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative,
1 of several proposals promising broadened coverage on terms friendlier to private insurers.
Kennedy derided these proposals by stating, “It calms down the flame, but it really doesn’t meet
the need” (10). President Nixon’s pro market HMO strategy—a close analogue of the modern-
day accountable care strategy—ultimately won out, although his proposals for coverage
mandates, insurance exchanges, and premium subsidies for low-income persons did not reach
fruition until passage of the ACA.
Five years into the ACA era, there is consensus that the health care status quo spawned by
Nixon’s vision is unsustainable. President Trump would veer further down the market path.
Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-
for-All proponents aspire to decouple care from commerce.

Another reason Single Payer is inevitable – Managed Care Matters

Once again, Joe Paduda has broken down why single payer is inevitable, and what will happen to millions if repeal of the ACA happens.

I won’t go over the reality of what the landscape would look like, because we have heard about it before, and does not bear repeating. However, what does need to be said is, repeal will lead to single payer, no matter what the medical-industrial complex says or does to stop it, and those who advocate an incremental approach, such as fixing ACA, or some other half Medicare measure, will eventually lose ground politically, especially those running for president.

And those of you who advocate for more competition and a truly free market in health care should pay attention to what Joe say about that.

Finally, check out the infographic at the bottom of the text. It is funny.

Here is Joe’s post:

Earlier this week President Trump called for the GOP to become “the Party of Great Healthcare.” He wants three Senators to come up with a “terrific, beautiful” healthcare plan. What Trump is actually doing is accelerating the day when Single … Continue reading Another reason Single Payer is inevitable

Source: Another reason Single Payer is inevitable – Managed Care Matters

Why Are Republicans So Mean? – An Exploration

Revelations this week that the Orangutan Administration is going ahead with plans to repeal the ACA, as reported by myself and Joe Paduda, as well as the announcement by Education Secretary Betsy (I have ten yachts) DeVos, that her budget calls for cutting $18 million from Special Olympics, raises the question, “why are Republicans so mean?” and why do they hate the poor and those not like them?

This article will explore this question from an economic, ideological, political and sociological perspective, citing several previously published articles asking the same question as the title above. It is certainly not definitive, but does suggest some possible explanations.

To begin with, a little history. The Republican Party was formed due to the inability of the Whig Party to deal with the question of slavery and the disappointment many Northern Democrats had with their Southern brethren over this issue, one that occupied a central focus in the second quarter of the first half of the 19th century.

While that twenty-five year period ended in 1850, it is important to note that the GOP was founded in 1854, which is still in the range of the time frame.

After the Civil War, the Republican Party was made up of two wings: the Radical Republicans who favored Reconstruction and harsh treatment of former Southern Confederates (this will have a bearing on our discussion later) and the conservatives who were aligned with the Eastern bankers and industrialists.

In fact, it was the conservatives who, as pointed out in the Spielberg motion picture, “Lincoln”, that made it possible for the passage of the 13th Amendment when they were assured by the President that there were no Southern negotiators in Washington (They were on a riverboat in Virginia being guarded by African-American Union soldiers).

However, after the election of 1876, when Rutherford Hayes became President by promising the South to end Reconstruction, the Radical Republicans were slowly replaced by more conservative Northern Republicans loyal to the industrialists who would dominate the second quarter of the second half of the 19th century, and thus lead to future calls for reform and addressing of the effects industrialization had on the working class.

So as their wealth increased, so too did the misery and poverty of the working class, and this led to the rise within the GOP of a progressive movement, and a likewise movement among the rural population in the Midwest in the form of populism.

With the ascendancy of Theodore Roosevelt to the Presidency in 1901, progressivism took off, and many Republicans led the way for political, economic, and social reform. A brief return to the past in the 1920s under three successive Republican Presidents was followed by the election of FDR and the Democrats controlling Congress for decades to come, making more reform possible, and creating the largest middle class in history.

By the mid-20th century , the Republican Party had three wings: conservatives, moderates, and liberals. Barry Goldwater’s run in 1964, and Robert Taft’s in 1952 sort to change the dynamics in favor of the conservatives, but only meant they lost the battle, but won the war.

Then came Reagan, the first celebrity President. He brought victory to the conservatives and into government. Remember, he said that government was not the solution, government was the problem, and thus, that is how the GOP would operate when they took over.

Turning to the economic aspect of why Republicans are mean, let us look at something written a hundred years ago, Max Weber’s essay, The Protestant Ethic and the Spirit of Capitalism.

According to Wikipedia,

“capitalism in Northern Europe evolved when the Protestant (particularly Calvinist) ethic influenced large numbers of people to engage in work in the secular world, developing their own enterprises and engaging in trade and the accumulation of wealth for investment. In other words, the Protestant work ethic was an important force behind the unplanned and uncoordinated emergence of modern capitalism.

So in this context, Protestantism, or rather its Calvinist form, which influenced the Puritans of New England, formed the moral and ethical basis for the rise of modern capitalism, and while the descendants of the Puritans today in New England are decidedly more liberal than in the past, due to evangelical missionaries in the late 18th and throughout the 19th centuries, in what historians call the Great Awakenings, these values were transmitted to people in the South and Midwest, or were carried with them during western expansion.

As for the South, as mentioned earlier, the debate over slavery has some bearing on why many of today’s Republican leaders in Congress are Southerners, and what that means for the country’s direction these past thirty years or so.

Sara Robinson’s article in Salon.com, attempts to answer why this is so, and sheds light on the difference between North and South. To begin with, despite the rise of Capitalism from Calvinist Protestantism, seen originally among the Puritan settlers, Robinson states that,

For most of our history, American economics, culture and politics have been dominated by a New England-based Yankee aristocracy that was rooted in Puritan communitarian values, educated at the Ivies and marinated in an ethic of noblesse oblige (the conviction that those who possess wealth and power are morally bound to use it for the betterment of society).”

On the other hand, Robinson relates that the New England-based aristocracy is opposed by,

…the plantation aristocracy of the lowland South, which has been notable throughout its 400-year history for its utter lack of civic interest, its hostility to the very ideas of democracy and human rights, its love of hierarchy, its fear of technology and progress, its reliance on brutality and violence to maintain “order,” and its outright celebration of inequality as an order divinely ordained by God.

Robinson cites David Hackett Fisher who,

described just how deeply undemocratic the Southern aristocracy was, and still is. He documents how these elites have always feared and opposed universal literacy, public schools and libraries, and a free press.

In addition, Robinson cites Colin Woodward, who wrote that,

…From the outset, Deep Southern culture was based on radical disparities in wealth and power, with a tiny elite commanding total obedience and enforcing it with state-sponsored terror. Its expansionist ambitions would put it on a collision course with its Yankee rivals, triggering military, social, and political conflicts that continue to plague the United States to this day.

However, Robinson writes that the most destructive aspect of the Southern’s worldview,

is the extremely anti-democratic way it defined the very idea of liberty. In Yankee Puritan culture, both liberty and authority resided mostly with the community, and not so much with individuals. Communities had both the freedom and the duty to govern themselves as they wished (through town meetings and so on), to invest in their collective good, and to favor or punish individuals whose behavior enhanced or threatened the whole (historically, through community rewards such as elevation to positions of public authority and trust; or community punishments like shaming, shunning or banishing).”

Robinson continues,

Individuals were expected to balance their personal needs and desires against the greater good of the collective — and, occasionally, to make sacrifices for the betterment of everyone. (This is why the Puritan wealthy tended to dutifully pay their taxes, tithe in their churches and donate generously to create hospitals, parks and universities.) In return, the community had a solemn and inescapable moral duty to care for its sick, educate its young and provide for its needy — the kind of support that maximizes each person’s liberty to live in dignity and achieve his or her potential. A Yankee community that failed to provide such support brought shame upon itself. To this day, our progressive politics are deeply informed by this Puritan view of ordered liberty.”

Conversely, Robinson states,

In the old South, on the other hand, the degree of liberty you enjoyed was a direct function of your God-given place in the social hierarchy. The higher your status, the more authority you had, and the more “liberty” you could exercise — which meant, in practical terms, that you had the right to take more “liberties” with the lives, rights and property of other people.”

Anytime a Southern conservative talks about “losing his liberty”, Robinson follows with, the loss of this absolute domination over the people and property under his control — and, worse, the loss of status and the resulting risk of being held accountable for laws that he was once exempt from — is what he’s really talking about. In this view, freedom is a zero-sum game. Anything that gives more freedom and rights to lower-status people can’t help but put serious limits on the freedom of the upper classes to use those people as they please. It cannot be any other way. So they find Yankee-style rights expansions absolutely intolerable, to the point where they’re willing to fight and die to preserve their divine right to rule.”

This would appear to not only apply to the justification for the South’s secession from the Union in the 19th century, but for the way Southern politicians, both Democrats (remember, many were Southerners who were promised committee chairmanships by FDR to get the New Deal passed) and Republicans after passage of the Civil Rights Act in 1964 led to Southerners fleeing the Democratic Party for what LBJ said would be for a generation, have acted towards any legislation that would cause them to lose their liberty. Today, we call that White Privilege.

For an ideological perspective, Marc-William Palen, in Foreign Policy in Focus, provides us with a clear understanding that the Republican Party is not merely a party of classical liberalism, but something different from what it was when it was founded.

According to Palen,

From its mid-nineteenth-century founding, the Republican Party was the party of big government, high tariffs, and government-subsidized internal improvements. The exceptions to this rule were the Gilded Age Liberal Republicans. In their vocal calls for laissez faire principles, these Liberal Republicans quickly became the independent thorns in the side of the Republican elephant throughout the first decades following the Civil War. When the big-government Republican majority continued to prove intractable, these Liberal Republicans became known as the “Mugwumps” when they ultimately switched their support to the Democrats in 1884.

Palen writes that classical liberalism was founded on moral sentiments, and that these moral sentiments, “are almost non-existent within the Republican rank and file, especially since the ultra-nationalist party draped itself in the red, white, and blue following 9-11, and led the jingoistic charge into Afghanistan and Iraq.

Nor is morality to be found amid the incessant Republican demands to cut social spending,” he says, pointing out what Grover Norquist, the driving force behind the GOP’s anti-tax, small government ideology when he said in 2001,  he wanted to

shrink government to the point where he “could drag it into the bathroom and drown it in the bathtub.

Palen suggests that if the Republicans current ideology is not found in classical liberalism, then where does it come from? Palen says, Ayn Rand’s pronounced atheism and intellectual elitism certainly does not align with the ideological outlook of most Republicans. And, he says, there is perhaps an element of a Social Darwinian “survival of the fittest” ethos—although no Republican politician is likely to admit to subscribing to anything associated with the theory of evolution.

So where does it come from?

…a large part of Republican ideological inspiration stems from fear. In particular, it is a reactionary ideological response to the turbulent upheavals inherent in an increasingly globalizing world. Such fears—let’s call it “globaphobia”—are frequently expressed on issues such as immigration, global terrorism, global warming, and American participation in international institutions like the United Nations. The massive federal intervention in the so-called free market following the global financial meltdown invariably exacerbated Republican fears that government intrusion in the market— and Keynesian economics more generally—would eventually undermine American individualism, citing Douglas LaBier.

However, Palen says it is not entirely satisfactory. According to Palen,

their fear-driven ideological inspiration dovetails with the philosophy of Thomas Hobbes, who predated Adam Smith by a century and who expounded on an amoral philosophy of self-interested individualism, counterbalanced by acquiescence to authoritarianism. Hobbes believed that a strong state prevented “war of every man against every man,” a chaotic type of warfare that Republicans believe is contained within al-Qaeda’s radical philosophy.

As we have seen, there is no one answer to why Republicans are mean. It seems to be a combination of factors all valid and relevant to today’s political climate in Washington and in the nation at large.

But nothing ever is just as simple as being mean. since we are dealing with human beings and not machines.

For our purposes, health care is just one more “liberty” conservatives are afraid of losing, so therefore, they will deny it to others, so that they can have more of it. Any discussion of universal coverage in a single payer health care system is a threat to their liberty, and therefore must be opposed. Add to that, the economic loss of profit and gain by those in the medical-industrial complex, and you get a clearer picture of the problem.

But to answer the question raised at the beginning, why are the Republicans so mean? It’s because it is in their DNA passed on from one generation of conservatives to another like our genes are passed down from our parents, grandparents, and so on.

Now the question is, what to do about it?

 

Trump Regime to Repeal ACA

From the Overnight News Desk:

Both CNN and The Washington Post reported yesterday that the Justice Department will back a full repeal of the Affordable Care Act (ACA), after a federal judge in Texas ruled the law unconstitutional in December.

If this repeal takes effect, millions of Americans will lose their healthcare. Those of you employed in the medical-industrial complex, and related industries, must face the fact, that if the Republicans succeed in their long-held promise to destroy healthcare for Americans who could never afford it before, or had limited coverage, there will be no other alternative left to provide healthcare than to have an Improved Medicare for All/Single Payer system.

There are those who believe that Medicaid for All is a better option, but given that many states that expanded Medicaid elected GOP governors and legislatures, or could in the future, Medicaid in those states could also be taken away from those who receive expanded coverage.

Many of you are employed by the very same insurance companies, pharmaceutical companies, device manufacturers, and other businesses that are allied with the healthcare system, and it is these companies that are gearing up to fight passage of any Medicare for All/Single Payer health care bill.

Do you really want your fellow Americans to die because they cannot generate huge profits for your employers and for Wall Street investors and shareholders?

if the Orangutan gets his way, that is what will happen. Also, our hospital ERs will once again be clogged with patients who need immediate medical attention, and the quality of health care will deteriorate even further.

The only logical solution is Medicare for All/Single Payer, because the only option left will be Medicare for All/Single Payer.

ACA Declared Unconstitutional: Now What?


In another example of how cruel and inhumane the radical Conservative/Libertarian Republican Party has been regarding health care, a Federal judge in Texas late Friday, struck down the Affordable Care Act as unconstitutional.

The judge, Reed O’Connor, appointed by George W. Bush, struck down the law on the grounds that its mandates requiring people to buy health insurance is unconstitutional and the rest of the law cannot stand without it, as reported yesterday in the New York Times.

According to the Times article, the ruling was over a lawsuit filed earlier this year by a group of Republican governors and state attorneys general. States led by Democrats promised to appeal the decision, which will not have immediate effect.

However, the Times reports, it will make its way to the Supreme Court, where the survival of the law and the health of millions of Americans will be in doubt.
Judge O’Connor said, the Times quoted, that the individual mandate requiring people to have health insurance “can no longer be sustained as an exercise of Congress’s tax power.” In addition, the judge said, “the individual mandate is unconstitutional” and that the remaining provisions of the ACA are invalid.

The main issue, pointed out in the Times piece, was whether the law’s mandate still compelled people to buy coverage after Congress zeroed out the penalty as part of the tax overhaul this year.

20 states, led by Texas, argued that with the penalty zeroed out, the mandate had become unconstitutional, and that the rest of the law could not be severed from it, the Times wrote.

The Justice Department under former Attorney General Sessions, declined not to defend just the individual mandate, but the pre-existing conditions provision as well.

A spokesman for California attorney general Xavier Becerra said that California, and other defendant states, would challenge the ruling with an appeal in the US Court of Appeals for the Fifth Circuit in New Orleans.

Becerra’s statement, reported by the Times, said the following, “ Today’s ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the ACA’s consumer protections for health care, on America’s faithful progress towards affordable health care for all Americans…The ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Supreme Court.”

The chief plaintiff in the case, Texas attorney general Ken Paxton, applauded the decision, and was quoted in the Times in a statement, “Today’s ruling enjoining Obamacare halts an unconstitutional exertion of federal power over the American health care system.”

Meaning that the American “health care system” can only be a private insurance-based system that allows companies to profit off some people’s health, or lack thereof. He is upholding the “right” of insurance companies, drug companies, medical device manufacturers, and others to profit at our expense and to play with the lives of millions of Americans who will lose what coverage the ACA gave them.

This also means, that any attempt to enact Medicare for All/single payer health care will result, at some future date, to a judge or court striking it down as unconstitutional.

Simply put, Conservative jurisprudence believes that the Constitution enshrines free-market health care.

The Times added that Paxton also said, “Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the ‘failed’ [quotes added] social experiment with a plan that ensures Texans and all Americans will again have greater choice (to be ripped off and overcharged) about what health coverage they need and who will be their doctor.”

In other words, Mr. Paxton wants the American health care system to stay where it is, so long as companies can make money from it.

Here are a few takeaways from the rest of the Times’ article:

• If the judge’s decision stands, about 17 million Americans will lose their health insurance, according to the Urban Institute. This includes millions who gained coverage through Medicaid expansion, and millions more who receive subsidized private insurance through the ACA marketplaces.
• Insurers will also no longer have to cover young adults up to age 26 under their parents’ plans
• Annual and lifetime limits on coverage will again be permitted
• And there will be no cap on out-of-pocket costs
• Also gone will be the law’s popular protections for people with pre-existing conditions

This last takeaway was front and center of the Democrats midterm campaigns, and while most Republicans insisted that they did not want to withdraw those protections, the article reported that most were silent after the ruling.

Without those protections, insurers could deny coverage to such people or charge them more; they could also return to charging them based on age, gender or profession, according to the Times.

The Kaiser Family Foundation, the Times noted, estimated that 53 million adults from 18 to 64 — 27 percent of that population would be rejected for coverage under practices in effect before the ACA.

Larry Levitt, senior vice president of the Kaiser Family Foundation wrote on Twitter, “If this Texas decision on the ACA is upheld, it would throw the individual insurance market and the whole health care system into complete chaos…But the case still has a long legal road to travel before that’s an immediate threat,” the Times quoted.

Democrats attacked the decision as absurd. Incoming House Speaker Nancy Pelosi said that when the party took control of the House next month, it would “move swiftly to formally intervene in the appeals process to uphold the lifesaving protections for people with pre-existing conditions and reject Republicans’ effort to destroy the Affordable Care Act.”

Healthcare Dive.com, in reporting Friday about the decision, wrote that a decision had been waiting in the wings since September, when the Justice Department asked Judge O’Connor to wait until the individual market’s open enrollment period ended, which was also a convenient time for Republicans running in the midterms.

Healthcare Dive.com also stated that the decision would be appealed to the conservative Fifth Circuit, and possibly to the Supreme Court, where advocates worry that it will be struck down.
Providers such as the American Hospital Association (AHA) and American Medical Association (AMA) urged a stay until a higher court could take it up.

One state not a part of the defendants was Maryland, according to Healthcare Dive.com. Maryland’s Democratic Attorney General, Brian Frosh, brought its own case seeking a reaffirmation of the ACA’s constitutionality.

Attorney General Frosh argued that Maryland residents who became insured under the ACA would be harmed if the law was unconstitutional or eliminated. About 150,000 people in Maryland gained insurance through the ACA marketplace in 2018, and more than 300,000 are insured through the state’s expanded Medicaid program.

The Maryland case is still ongoing.

So now what?

In the short-term, nothing will change, as mentioned in the two articles above. However, in the long-term, there will be serious consequences, just as Larry Levitt said on Twitter Friday.

But more importantly than chaos in the insurance market and health care system, millions of Americans will once again be at the mercy of insurance companies, be denied coverage for pre-existing conditions, including pregnancy, cancer, and a whole host of illnesses, be denied life-saving drugs, or rejected for surgeries, etc.

And among those millions, many will die needlessly because of the greed of the insurance companies and the actions of a Cowboy judge.

What does this mean?

Allow me to put on a different hat here and offer an opinion as to what may transpire in the future, since none of us are clairvoyant. As someone who studied both American history and American government and politics, in my opinion, we will not see universal health care in this country unless and until, to use a medical metaphor, this Conservative/Economic Libertarian virus is eradicated from the American political system, or at least is brought under control.

I do not say this lightly, nor am I being flippant here. Let’s face facts. The Republican Party stands in the way of the adoption of rational, universal health care for all Americans because they are the defenders of a rapacious, greedy Capitalist health care system that demands that investors, shareholders, insurers, manufacturers, and service providers and consultants, be allowed to profit by the health and welfare of the American people.

However, as also reported in the New York Times on Sunday, the ACA could be hard to knock down, despite the judge’s ruling, according to legal scholars quoted in the article.

Yet as Ezra Klein writes in Vox.com, Republicans have refocused Democrats on building what they failed to build in 2010: a universal health care system simple enough and popular enough that it is safe from constant political and legal assault. And that means some version of Medicare-for-all. Democrats are promising swift action once they take over the House in a few weeks, so we wait and see how that will turn out.

But on the other hand, as I have pointed out in previous posts, both those penned by myself, and those that I reposted from other sources, the medical-industrial complex is pushing back hard against any move to alter this broken system.

Two recent posts, Healthcare Lobbying Group Double-Crossing Democratic Voters and Establishment looks to crush liberals on Medicare for All – POLITICO highlights the attempt by the health care industry to keep the status quo, or at least to convince Democratic politicians who might be opposed to full single payer health care, to offer alternatives that will allow the insurance companies to profit from providing coverage to only those who are not sick, which is called adverse selection.

There are some people in this country who argue that what we need is not less competition in health care, but more. However, this misses the point. Whether or not there is more or less competition is not the reason why our health care system is broken. The reason why it is broken is because there is competition in the first place. No other Western country has this problem, and they all have some form of universal, single payer health care.

So, the prognosis for the future of universal health care is cloudy, if not downright gloomy. Advocates for single payer, improved Medicare for All must take a sober hard look at reality and formulate a strategy to meet this new and regrettable challenge. And they must do so with a clear eye and mind on the realities of the political landscape, and not be lulled into thinking that just because polls indicate approval by voters, that enacting Medicare for All will be easy or accomplished quickly. We have enemies, and one of them is Reed O’Connor.

Additional Reading:

Judge Rules Obamacare unconstitutional, endangering coverage for 20 million
Obamacare ruling delivers new shock to health system