Category Archives: Affordable Care Act

I Was an Eighth Grade Communist (and Other Reasons to Vote for Bernie Sanders)

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This really happened. In the eighth grade, prodded by Ms. Spiver, an enthusiastic teacher with an enlightened vision for an open classroom, I had the opportunity to research different governing systems.  I chose communism because the name sounded cool and appeared to frighten everyone. I read about Marx and Lenin and the proletariat of the state and the main idea which I glommed  was to ensure everyone’s basic needs were met. This seemed grand, generous and even beautiful. I quoted the Encyclopedia Britannica at length, and with a flourish, scribbled out three pages in long hand, ending the paper with a makeshift version of the iconic hammer and sickle.

I thought Ms. Spiver would be proud.

The next day I was called into a parent/teachers conference.  This was in Raleigh, North Carolina circa 1976 when the rabid anti-communist Senator Jesse Helms graced the Channel six news editorial spot which my father listened to every. single. night.

Ms. Spiver was all ‘tender mercies!’ and ‘Lord child!’ and ‘where did you get such ideas?’ and I wasn’t sure if she was as concerned about my paper and my education as the possibility that Mr. Creigh, who  substituted as an insurance agent on days when he wasn’t playing the principal, might take serious offense. But I explained, and even defended as best I could the idea of equality, and everyone getting what they needed, these all seemed like fine goals. What was the problem?  Ms. Spiver, to her credit, did not try to correct my initial interpretation, but merely advised that my opinion on the matter was somewhat out of step with the adult population of Raleigh, North Carolina circa 1976. Mom and dad ushered me home, silent in their Buick. Dad finally parked the car in the lot and turned and proceeded to give me the low down. “Communists are bad because they represent a totalitarian system. They don’t allow freedom.  You understand?”

I nodded my head.

“Okay?”

“Okay.”  That sounded like something to avoid. And the tone in my father’s voice was enough for me to forget my flirtation with alternate political systems until high school when we began looking at the social democratic governments, and I found myself once again intrigued by the idea that a government would be based on people getting what they absolutely needed; regardless of their jobs, social stations or life situations.

Denmark, Finland, Sweden, England, to a lesser extent, Germany and Spain. If all these countries pursued such programs, why didn’t we?

My father, with the patience of Job, once again explained what he thought should have been obvious.

“What if I just gave you a dollar every week instead of letting you earn a dollar by mowing the lawn? Hmmmm?”

“I’d have a dollar but I wouldn’t have to mow the lawn.”

Yes, he conceded, okay, but that’s not the point. The point is if you give people something for nothing they’ll take advantage of it. Like all those welfare queens.

By this time, Ronald Reagan was running for high office and was denouncing shady welfare queens that rode around in Cadillacs and bought caviar with tax payer’s money. This activity rankled the hell out of Jesse Helms who never missed an opportunity to denounce the welfare moochers.

Do you want to be a welfare queen?

I decidedly did not want to be a welfare queen. I gathered from my father’s tone that I was not supposed to like the idea of riding around in a Cadillac, eating caviar at the tax payers’ expense, no matter how much fun it might appear.

By the time I entered college, Reagan was in his second term. Taxes had been slashed and the poorer residents of mental homes were dumped onto the city streets.  Despite the loss of tax revenue, billions were being funneled into such patently absurd pursuits as an armed space shield; a so called ‘star wars’  shield that would provide cover for the Western Hemisphere by shooting down missiles aimed to blow up our cities. Since there were none and since billions were being funneled into a useless and unworkable program while the homeless and mentally handicapped were left to fend for themselves, (many times I stood in line with them at the local 7-Eleven), I wrote a few college paper editorials suggesting this kind of activity was ill-advised. I proudly signed my name.

My college Spanish teacher, a middle aged Cuban exile, caught up with me one day.

“I have read what you have written,” she whispered, “You are part of this nuclear freeze movement, too, no?”

“Yes.” I said. Sure I was. Who wouldn’t  be opposed to nuclear weapons lying around waiting to obliterate the world 200 times over?

“Are you a communista?”

Of course I wasn’t a communista! What had that to do with the nuclear freeze movement? But, for her, the nuclear freeze movement was loaded with fellow travelers and communist sympathizers and what not. I tried to ease her mind by telling her I wasn’t a communist, closer to a  democratic socialist, really. This did not appear to help matters.

“You know I come from Cuba. There, when Castro came to power, he forced my family into exile. We had a mansion and servants in Cuba, but when I came to this land, I had to cut my hair and sell it, just to survive. Can you imagine?”

I really couldn’t. “So you were very rich,” I said, “That must have been nice.”

“They stole everything!”

“Right. But now Cuba has much better infant mortality and death rates. It has one of the best medical systems even by Western standards. Cuban doctors help poor people all over the world.”

“So you are a communista!”

“No, I’m not. If I’m anything, I’m a social democrat, like in Finland.”

“It’s the same.”

“No, they’re really different.”

And so I went on to explain to her that one could be a social democrat without falling in lockstep with state run economies like in Cuba or the Soviet Union.  In fact, one of the best examples of social democracy operates as the capitalist heart of Europe: Germany. “They have what they like to refer to as a social market economy. They try to combine the virtues of a market system with the virtues of a social welfare system. You can get a free education, even free higher education, free healthcare and free retirement. Some of your basic essentials are guaranteed by the government, but other stuff, like where you work or what you make is dictated by a private sector economy. Of course, you pay taxes for these things, but the government operates to redistribute the money so it benefits everyone. That is social democracy in a nutshell.”

“It will never work,” she advised me, predicting Germany’s downfall by the end of the decade.

That was 1987. Germany’s still around. It’s 2015. Germany still provides free healthcare, free retirement and free higher education and it is still one of the strongest economies in Europe.  Our economy, conversely, is dogged by huge gaps of inequality, a dysfunctional healthcare system moderately improved by the ACA, insanely expensive higher education costs, and a retirement system whose paltry offerings are even now threatened by reactionary politicians. Our incarceration rate is the highest in the world. Our homicide rate is one of the highest. Our infant mortality rate is higher than Cuba’s and is comparable to Serbia. You read that right, Serbia. None of these things are natural or necessary. They are by design because we refuse to grow up like the rest of the civilized Western world and insist on the fairy tale version of capitalism that doesn’t require any funding for public infrastructure or social services beyond the absolute bare essentials. The only thing we want to pour money into is our vastly over sized military which has caused many more problems in the last few decades than it has solved.

The  majority of the Western industrialized world embraces some form of socialized democracy. In our own country the most successful government programs are inherently socialized: Medicare, Social Security. And, of course, our own Defense Department is an almost entirely socialized bureaucracy.  We have patches of socialism all over the place, but the rightwing has done an excellent job demonizing the term. In fact, the last time someone claiming to be a socialist ran for President was nearly a 100 years ago.   His name was Eugene V. Debs. He famously said when he was convicted of violating the Sedition Act in 1918, that “while there is a lower class, I am in it; while there is a criminal element, I am of it; while there is a soul in prison, I am not free.” Ringing words that beautifully encapsulate a social democrat’s world view.

It’s become increasingly obvious that a strictly free market agenda is disastrous for a people and an economy. One only need look at Kansas under Brownback’s ideological leadership. The state’s surplus has been turned into a catastrophic black hole of debt through a combination of tax cuts for the wealthiest and slashing of public funds. One could see the same disastrous pile up under George W. Bush’s leadership.

The Spanish teacher who accused me of being a communist told me that I needed to ‘grow up.’ The nice thing about Bernie Sanders candidacy is that it  is already grown up.  It assumes responsibility for everyone in the nation, not just those that manage to make the cover of Forbes.  He has tirelessly advocated for the poor and the underclass and, unlike the vast majority of American politicians, assumes it’s okay to travel coach class.  But don’t take it from me that Sanders knows what he’s talking about or that social democracy is a mature governing principle. Take it from that flagship of capitalism, the Economist. In a 2013 article, that magazine declared the social democratic Scandinavian countries, “probably the best governed in the world.”

So there’s no need to carry on with this charade that the ‘socialist’ option cannot win.  We can. Actually, in many areas, we already have. Si, se puede, baby. The only real question is, how soon before the rest of us grow up?

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The Latest in Virginia Politics or… a Layman’s Guide to Hell

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Dante Alighieri had a tough life. Exiled from Florence because of political machinations and with no timely news network to convey his fury, he decided to seek his revenge by penning what is arguably the greatest poem in world literature: The Divine Comedy. The poem provides a road map to heaven, purgatory and most importantly hell, where Dante, with suitable venom, positioned the political hacks of his day on various rings. Each ring was characterized by moral deficiencies in the human temperament. There was lust, greed, gluttony, pride, hypocrisy and so forth. Not unsurprisingly these faults are still with us today, and so are the politicians who — with great disregard for the quality of their souls, much less their constituency – still manage to provide food for the devil’s banquet.

Let’s begin with the low hanging fruit right here in Virginia, Senator Phillip Puckett, a nominal Democrat. A week or so ago he decided to resign his position as state senator for a number of reasons, none of which are especially edifying: to allow his daughter to be confirmed as a judge and to potentially receive a lucrative position as deputy director of the Virginia Tobacco Commission. Whether this is legal remains to be seen, the FBI is sniffing around, and Puckett appears to have turned down the deputy position out of concern for his ‘legacy’ and the negative publicity it has garnered, at least for the short-term.

But the problem isn’t so simple. Puckett might get away with a stint in purgatory for that bit of venality, but the context in which he resigned points to a much larger ethical failure. For the last five months, Governor McAuliffe and state Democrats have been fighting to expand Medicaid through the budget process. Despite its even split of 20 Democrats and 20 Republicans, the Senate made its move, passing a budget with the Medicaid expansion earlier this year. But, with its large Republican majority, the House of Delegates refused to budge, and has passed a budget without the expansion.

By resigning, Puckett gave control of the Senate to Republicans, who have now passed a budget without the Medicaid expansion. This in turn forces Governor McAuliffe’s hand. He can sign the budget and break his campaign promise, or he can preside over the first shutdown in Virginia’s history.

In either case, the prospect for Medicaid expansion has become incredibly dim. An estimated 400,000 Virginians will likely not get health insurance or access to needed health services like check-ups, medicines, surgeries, and cancer treatments. Worse than what Puckett has done to his party, is what he has done to his own constituency. He represented the 38th District, which draws from 10 counties in southwestern Virginia: Tazewell, Pulaski, Russell, Buchanan, Dickenson, Wise, Radford, Bland, Smyth, and Norton. According to Jamelle Bouie writing in Slate, “This is one of the poorest corners of the state. The poverty rate in Russell County, for instance, is 20.4 percent, compared to 11 percent for the state writ large. Even worse is Buchanan County, where 25 percent of residents live below the poverty line. Not only is it one of the poorest counties in Virginia, it’s one of the most impoverished in the entire United States. And according to a recent analysis from the Commonwealth Institute, it contains a chunk of the estimated 20,170 uninsured adults in Puckett’s district who are eligible for coverage under the Medicaid expansion.”

Puckett didn’t just sell out his Democratic colleagues, he sold out the lives and well-being of thousands of his constituents for what amounts to a bag full of silver and a nepotistic arrangement. Dante, who did not fool around, would probably not assign him to the fourth circle of hell, the ring reserved for those who hoard and squander wealth, so involved in their acquisitive cycles they lose their identities. No, Dante would assign him an honored position in the ninth circle of his inferno, the one reserved for those who betray a special relationship of some kind—like the relationship between a politician and those who vote for him, hoping he represents their interests. Dante used the word treachery to describe this particular circle of hell. The punishment that is meted is especially convincing. Traitors are immersed in ice up to their chin for eternity. In Dante’s ninth circle, it’s always a cold day in hell.

Puckett, of course, didn’t act alone. Working in concert with him are the state Republicans, pretty much en toto, although there are a few Republicans who manage to stand out even in this bleak landscape.

At the point when Medicaid expansion was still in play, three state Republican senators, Emmett Hanger, Walter Stosch and John Watkins, nominally supported Medicaid expansion. Up until the primary results were in for another Virginia Republican—majority whip Eric Cantor, in the US House of Representatives. As everyone knows by now, Cantor lost his primary bid to newcomer Libertarian and Tea Party acolyte, David Brat who won 56 percent of the vote, compared with 44 percent for Cantor. “Political earthquake” is the cliché making the rounds for Brat’s victory. As of last week, when Medicaid expansion received its death-blow, the conventional wisdom was Brat won because of an overwhelming tide of tea partiers coming to the polls and shoving through their agenda—an agenda that included a rabid denunciation of Obamacare, of course. That conventional wisdom likely shocked the three state Republican senators and turned tepid support for Medicaid expansion to outright denial.

Unfortunately, the ‘conventional’ wisdom may very well be wrong. Approximately 18,000 more votes were cast in Tuesday’s primary than in 2012, when Cantor easily defeated another Tea Party-backed challenger, Floyd Bayne. Some of those votes look to have come from precincts that were Democratic leaning. Why does that matter? Because not only were Republicans voting in the primary which defeated Cantor, so were Democrats. The open primary law allowed this, and Democratic operatives like Brian Umana had been working for years to put a coalition together to defeat Cantor: a coalition of Democratics and populist Tea Party Republicans disaffected with the Cantor brand.

Said Umana, “Anyone But Cantor” mentality was beginning to take hold in central Virginia and the Richmond suburbs. In this heavily Republican district, many Democrats and Republicans told me in conversations that they saw Cantor as a disingenuous political insider looking out for his own self-interest above the interests of his constituents. …. Put succinctly by one journalist on the scene, “Cantor lost because he was a ‘dick’.”

After the election results were in, the campaign strategist for Brat, Tammy Parada, emailed Umana, writing: “This was the direct result of active participants working together across party lines. An unpopular but honest truth in [the] VA7 victory: Mr. Umana and Mr. Stevens, even as their political ideology is far left of conservative, were important players, offering strong analytics behind ‘the numbers’ that eventually led to Cantor’s defeat.”

So it looks like the state Republican senators flipped their votes based on the fear of a Tea Party ‘tide’ that is more speculative than real. They were willing to prevent 400,000 Virginians from receiving decent healthcare rather than risk a few votes at the polls—votes that may never be cast in any case. According to Dante, such cowards dither at the gates of hell, neither aligned with the demons or the saints, their punishment is to eternally pursue a banner of self-interest while stung by wasps and hornets; the sting of conscience. One last, vivid note. To illustrate their stagnant moral state, maggots drink their blood and tears.

Of course we would never wish such a fate on anyone, and Dante’s writing was speculative in the extreme. But the fate of 400,000 Virginians without medical care is all too real.

Defusing the Bomb in Obamacare


I remember reading this Forbes article in December 2011:

The Bomb Buried In Obamacare Explodes Today – Hallelujah!

Personally, I’m a single-payer gal and look forward to a universal plan for Americans, but the article sounded like exciting good news for the Affordable Care Act. At the same time, I wondered how long it would take for “the medical loss ratio rule” to be attacked. It didn’t take long.

The Medical Loss Ratio Rule:
The MLR rule provides unprecedented accountability of health insurance companies. It will provide protection and value to approximately 74.8 million insured Americans. Estimates from last year indicate that, starting in 2012, up to 9 million Americans could receive rebates worth from $0.6 to $1.4 billion. However, the existence of the MLR requirement may have improved the pricing patterns of plans; some reports indicate that premium increases were tempered by the prospect of having to pay rebates.  The rule, unchanged from the earlier publication, also allows insurers to include payments recovered through fraud reduction efforts in their calculation of incurred claims (up to the amount of fraudulent claims recovered), thereby encouraging plans to fight fraud. The final rule streamlines reporting and rebate requirements, and reduces the administrative burden on issuers and employers, while continuing to ensure that consumers receive maximum value for their health care dollar.

Also, consumers don’t have to pay taxes on the rebates they get from insurance companies that violate the spending rules. It’s free money.

ProPublica has been following this issue. In Senate Bill Could Roll Back Consumers’ Health Insurance Savings, it looks like the bills designed to render the rule ineffective are well under way and worth a call or visit to your representatives.

“Insurance companies have supported the two bills, claiming that the rebate rule, as it stands now, stifles jobs and actually drives up insurance premiums.”

However, a “2011 government report found that most insurance companies were, in fact, lowering their premiums to meet the requirements, as the administration had hoped.”

The bills are:

  • S. 2068: Access to Independent Health Insurance Advisors Act of 2012 (Sen. Mary L. Landrieu, D-La., Sen. Johnny Isakson, R-Ga., Sen. Lisa Murkowski, R-Alaska, Ben Nelson, D-Neb.)
  • H.R. 1206: Access to Professional Health Insurance Advisors Act of 2011 (Rep. Mike Rogers, 6th term Republican from Michigan 8th District)

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As usual, the corporations want to socialize their overhead and have the people pay the commissions they owe to agents and brokers – clearly an administrative cost of doing business. The MLR doesn’t threaten anybody or anything other than fraudulent business practices and the drive to maximize industry profits. It’s a regulation that protects the people and provides that only a reasonable amount of our premiums will be spent on non-medical related administrative costs like advertising.

Here’s how these insurer-supported bills are being framed and pushed by our “servants” on both sides of the aisle to accommodate their corporate buddies:

Landrieu, Isakson Introduce Bill to Protect Small Insurance Agents, Consumers
This legislation addresses a provision of the Affordable Care Act known as the medical loss ratio (MLR) that has had dramatic, unintended consequences for nearly a half million licensed independent agents and brokers, and their employees. Due to the Department of Health and Human Services’ (HHS) interpretation of the MLR provisions in the health reform law, health insurance carriers are required to treat agent and broker commissions as part of their administrative costs. This threatens the ability of independent agents and brokers to stay in business and serve the public.

It does nothing of the sort! The MLR rule merely places the burden of paying these commissions and other administrative costs on the insurance companies rather than the people, and it may be our best hope for adequate control over cost shifting and other typical abuses.

These bills are designed to chip away at the only thing that slipped passed the industry lobbyists who helped write the Affordable Care Act. If the bills go through, the bomb in Obamacare will be a big bang for corporate profits and those wonderful bonuses that their CEO’s manage to wrangle up every year.

Funneling the people’s money up to the top is what neoliberals are good at, and it’s exactly what they’re doing, here.

Paul Krugman has more on the lies being spread by our “servants” about the Affordable Care Act: Hurray for Health Reform
“For now, however, most of the disinformation involves claims about costs. Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.”

DCKennedy

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