Here's to Your Health (Cont.)

The Affordable Care Act (or Obamacare, or As You Like It, or What You Will) has once again survived the Supreme Court.  The Court has ruled in favor of the Obama administration in a case that many people (including many supporters of the ACA) felt might prove the undoing of the healthcare act.

At issue was whether people could receive subsidies to purchase insurance from a federal insurance exchange if they lived in states that had decided not to set up their own state-run health insurance exchanges.  The ruling hinged on a single phrase in the ACA, which stated that people could only receive subsidies for buying insurance on “an exchange established by the state.”  Opponents of Obamacare seized on this loophole in their ever-more desperate attempts to find some way--any way--to eliminate a law they found abhorrent, after losing consistently at the ballot box and, overwhelmingly, in the court of public opinion.

Common sense would suggest that the law's intent was always clear.  Common sense would further dictate that, if the offending phrase really DID create confusion, the simplest remedy would be to revise the text of the law to eliminate ambiguity, e.g., "an exchange established by an individual state or the federal government, you nitpicking pedants."  OK, maybe I'm embellishing.  But of course common sense plays little role where politics are concerned, and a Republican-dominated Congress would certainly balk at putting forth even minimal effort to salvage a law that had provided health insurance to hundreds of thousands of previously uninsured and/or uninsurable citizens because. . . Well, because that's how they roll.  Furthermore, if the phrase was, in fact, found to forbid subsidies to people receiving federal health insurance, that would effectively destroy the law, as people in states without exchanges of their own--millions of people--would suddenly find themselves once again unable to afford insurance.  The fate of Obamacare, in other words, rested in the hands of a largely conservative Supreme Court.

Thankfully, the majority of SCOTUS acted conservatively--in the truest sense of the word--and opted not to eviscerate a law that has, overall, helped millions of people and, despite semantics, is functioning pretty much exactly as Congress intended.  In the decision, Chief Justice John Roberts wrote that, “In this instance, the context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”  And while I celebrate the ruling, I cannot help but feel that the whole "controversy" over the phrase has been overblown.  Indeed, a close reading of the phrase suggests that, in fact, subsidies for federal exchanges were always kosher.

For what does "the state" refer to in a piece of federal legislation?  Sure, it can refer to any of the 50 states, but it can also clearly refer to the United States of America as a whole, in much the same way that the State Department--the "Department of STATE"--refers to an entity that represents the country as a whole.  Now, if the relevant phrase had said, "an exchange set up by the stateS" or "an exchange set up by A state," the plaintiffs might have had a more plausible case.  But, to this erstwhile English instructor at least, both the law's intent and phrasing were abundantly clear.  Let's be thankful the Supreme Court saw it the same way.

Here's to Your Health: So Much for Bipartisanship

The Supreme Court has agreed to hear yet another challenge to the Affordable Care Act.  I'm sure the fact the Supremes agreed to hear this case a mere three days after an election that will return the Senate to Republican control is the purest of coincidence.  The fact that this time, if the justices rule against the ACA, there will be not the slightest shred of a chance that Congress will agree to tweak the legislation to conform to any judicial ruling has, I'm sure, nothing whatsoever to do with their decision to hear the case.  That would indicate crass political calculation, well below the dignity of such an august body of judges.

Bastards.

In case you're interested, at issue as far as I can tell are the semantics of the word "state."  A group of highly indignant folks has taken umbrage with the federal government for providing subsidies to people who cannot afford insurance, when those people live in states that have refused to set up state-run health insurance exchanges.  The dispute revolves around language in the ACA that restricts federal subsidies to those participating in "an exchange established by the state."  The IRS has issued regulations codifying the idea that people may receive subsidies for participating in a health insurance exchange whether that exchange is run by a state or by the federal government, which is running its own exchanges--for the admittedly nefarious purpose of providing health insurance to those whose state governors are only trying to protect them from. . . having health insurance.

One group of federal appeals judges have declared the language in the original legislation ambiguous, and have consequently ruled that the IRS made a reasonable interpretation in establishing its regulations.  Another appeals court has "reluctantly" determined that the law as written does, in fact, forbid the federal government from providing subsidies.  As a liberal, I want to agree with the former, but as a writer, I fear that the second court might actually be correct--or at least is not clearly wrong.  And the larger point is that, while the ambiguity of the phrasing does, in fact, probably give the IRS the right to do what it did, I fear that this same ambiguity will provide the conservative majority on the Supreme Court the political cover it will need to achieve its presumed desire of destroying the Affordable Care Act.  Not that the Court takes into account such crass political calculations.

What everyone should bear in mind is that this law has so far provided millions of people the ability to receive healthcare to which they previously had no access.  Presumably, people are alive today--or at any rate healthier today--because of this legislation.  And for all the talk of gloom and doom and apocalyptic rises in the cost of coverage, nobody seems to be suffering much as a result of the ACA.  Make no mistake, this lawsuit is nothing but the latest mean-spirited attempt to gut a piece of legislation that has as its goal nothing more than to help people, largely out of spite and continued irrational hatred of the man who championed the legislation in the first place.  I just hope the millions of people who lose their coverage if/when the Supreme Court and their Republican enablers have their way will remember this in the next election.

Of course, the GOP will find a way to blame Obama for that, too.

Amtrak Officials Object to Use of "Train Wreck" Metaphor to Describe Obamacare

WASHINGTON--At a news conference Friday, an Amtrak spokesman explained that numerous railroad employees, including both senior management and rank-and-file staff, took offense at the continuing usage of the metaphor "train wreck" to describe the failings of the Affordable Care Act (ACA) website.

"Look," said Amtrak spokesman David Walcott, "we here at Amtrak know a thing or two about train wrecks.  And using that term to describe the ACA website is just insulting to Amtrak.  Even our worst disasters pale in comparison to the complete debacle that is the Obamacare internet portal."

Engineer Mick Gessel, 57, concurred.  "I've been with Amtrak for over twenty-five years, so believe me, I'm no stranger to railway catastrophes.  I've even helped picked up toes at a couple of crash sites.  But none of that can hold a candle to what is happening with healthcare.gov."

Obama administration officials, too, derided the use of the "train wreck" metaphor.  "We don't feel that the website rollout is a train wreck, at all," said White House spokesman Jay Carney.  Carney, however, declined to answer when asked what lethally catastrophic failure--space shuttle explosion, nuclear plant meltdown, avalanche--could serve as a more apt description of Obamacare.

In other news, an Amtrak Obamacare outside Pittsburgh claimed the lives of 37 people early Saturday morning.  Toes were strewn over a five mile area.

I Hope President Obama Can Survive the Humiliation. . . .

Our not-so-long national nightmare is finally over!  The House of Representatives just approved a Senate bill to finance the government and raise the debt ceiling, paving the way for the restoration of government services and the return of furloughed workers.  Analysts portray the deal as a complete repudiation of the Republican Party's extremist wing, a political defeat of historic proportions, but this is unfair.

True, the Tea Party faction failed to achieve its primary goal--defunding the Affordable Care Act--but everybody knew they would fail.  Saying the Republicans lost that battle is like saying the New York Mets lost this year's World Series: They were never in it to begin with. 

And, sure, right now the Republican "brand" is about as popular as anal herpes, but given the American electorate's attention span, they have every possibility of bouncing back by next year's elections--unless they are stupid enough to pick this kind of battle again next October.  With Michele Bachmann retiring, though, the collective IQ of the GOP congressional caucus will probably rise just enough to allow them to avoid that debacle.  Too bad.

But amidst all the bad news for the GOP, let's not overlook the silver lining, the major concession they managed to wring from recalcitrant Democrats: a "slight tightening of income verification rules for Americans accessing new health insurance exchanges created by the Affordable Care Act."

I know you probably think that doesn't sound like much, but that's because you don't know what it really means!  The Tea Party scored a major victory here.  (My fellow liberals better brace themselves.)  According to an article in the Los Angeles Times, under the rules approved as part of this budget deal, the Secretary of Health and Human Services must "report to Congress by Jan. 1st on the 'procedures' in place to verify eligibility" for subsidies offered to help people pay for health insurance.  And as if that weren't enough, by July 1st, the Secretary must report on the effectiveness of the verification!

Well, Tea Party, I tip my hat!  You sure showed us!  I hope it was worth it.

Irony and Hypocrisy

Last week, in one of his typically insightful rants, Jon Stewart excoriated the Republicans for--brace yourself!--their hypocrisy in attempting to shift the blame for the continuing governmental shutdown onto President Obama, claiming that it is his unwillingness to negotiate that is unnecessarily prolonging the stalemate. 

 

Essentially, he points out that if Republicans want to claim that they are standing on principle and protecting Americans from what they sincerely believe to be catastrophically misguided legislation (the Affordable Care Act), then that's fine...but they have to "own it"--and willingly accept whatever consequences they suffer in the court of public opinion.  And while I always revel in an explication of GOP hypocrisy, I was struck yesterday by the irony of the Republicans' situation.

Because if the Cruz-controlled GOP hadn't shut down the government over Obamacare, they could right now be making tremendous political hay over the utter SNAFU that has thus far characterized the rollout of the Affordable Care Act.  An article in yesterday's Times catalogued the ongoing technical problems that have plagued the online portal where people could go to get information and ultimately to sign up for the insurance exchanges that are the centerpiece of the ACA.  While administration officials are hopeful that the glitches will be fixed soon, Republicans have cost themselves an opportunity for a "told-you-so" to end all "told-you-so's."  Because even if they could find people in the general public--i.e., those who haven't drunk the Tea-Party brewed Kool Aid--to listen to another one of their strident denunciations of this "existential threat to the nation," all President Obama would have to do is turn around and say that, yes, there are technical problems with the ACA website, but these problems could be fixed a lot faster if, y'know, THE REPUBLICANS HADN'T SHUT DOWN THE FEDERAL GOVERNMENT!

The modern Republican Party: Hoist on their own petard since 2009!

Best Thing I Read All Day

Unsurprisingly, the Republican House majority passed a budget bill that includes no funding to implement the provisions of the Affordable Care Act.  So, unable to prevent passage of the bill, unable to overturn the bill legislatively or at the ballot box, the GOP has now decided to drive the country over a financial cliff in a fit of sore-losership unequaled since Mike Tyson took a bite out of Evander Holyfield's ear.  Because the bill has about as much chance of making it through the Senate and receiving President Obama's signature as. . .well, as Mike Tyson had of beating Evander Holyfield.  And if the spending bill is not approved, then the federal government will shut down for the first time since 1996--and the GOP firebrands are perfectly OK with that.

Now, are you ready for the best part?  See, while shutting down the government will inconvenience a lot of people--families wanting to visit national parks, Medicare providers who may not be paid in a timely manner, low-level members of the federal bureaucracy who will find themselves furloughed--the essential business of the nation will continue.  The United States will, for example, still have an army.  (Don't get any funny ideas, Canada!)  This is because, even if the federal government comes to a general standstill, agencies charged with upholding "the safety of human life or the protection of property" would still be allowed--required--to function.

And--get ready for it--President Obama could unilaterally declare the provisions of the Affordable Care Act vital to protect human life!  In other words, by shutting down the government over a refusal to fund Obamacare, the House Republicans may actually expedite Obamacare's implementation!

Whatever you may think of President Obama, you have to envy him the utter stupidity of his adversaries.

Seriously, Why Am I Even Surprised?

So John Boehner has finally (finally?) caved to the Tea Party lunatic fringe.  As the country heads for a federal government shutdown and another ludicrous showdown over its borrowing limit, the Speaker of the House has decided to cast his lot with the most extreme members of his party.  Rather than try to work with Democrats and the less insane members of the GOP to craft a political solution to these impending train wrecks, Boehner has decided to accept a Tea-Party strategy of vowing to pass needed financial legislation if and only if the budget includes no funding to implement the Affordable Care Act (i.e., Obamacare).

Not content with holding meaningless votes to repeal the ACA, Congressional Republicans have now decided to hold the economic fate of the nation hostage, rather than fund a piece of legislation (passed, we should remember, by a majority of duly elected representatives) that they don't like.  We could, perhaps, excuse this band of rabble-rousers, who, let's face it, represent the back end of the IQ Bell Curve (their caucus includes that diplomatic dream-team of Michele "Spells Her Name with One 'L' 'Cause the First Lady Spells Hers with Two" Bachmann, Louie "Don't Cast Aspersions on my Asparagus" Gohmert, and Steve "La Raza" King).  But what's Boehner's excuse? 

Whatever you may think of John Boehner, you know that he knows this is a terrible idea: Even if he believes in the cause--which I'm not at all sure he does--he knows that, politically, this is a disaster: The Senate won't back any bill that calls for defunding the ACA, and even if it did, Obama wouldn't sign it.  I guess he's assuming that, somehow, when the government gets shut down, the public will blame the Democrats, but he should ask Newt "Moonbase Alpha" Gingrich how well that strategy tends to work.

But what could Boehner do, you ask?  Well, how about show some leadership?  How about he goes up to these Tea Party "rebels" and says something like, "Look, you may think you're standing on principle, but you're also going to destroy the country and probably take the Republican Party with it.  So here's the deal: You can say whatever you want, but when it comes time to do the business of the country, you toe the line.  And if you insist on this kamikaze shit, I will make it my mission in life to see that you end up just like those kamikaze pilots: You will be stripped of all committee assignments.  You will get no support from the Republican Congressional Committee when you run for re-election; and your district can forget about receiving anything in the way of federal spending as long as you are its representative."

Maybe that would work.  Then again, these are people who just slashed billions of dollars from the food stamps program--a program, incidentally, that puts a huge amount of money in the pockets of Tea Party constituents.  So appeals to reason--or even threats--would likely fall on deaf ears.

Here's to Your Health, Again

The other day, I posted about the latest Republican attempts to thwart implementation of Obamacare.  A friend of mine, who has made no secret of her disdain for this particular piece of legislation, reiterated her opposition to it.  Fair enough, although that did not address the basic point of my piece, which was the insane level of obstructionism of various GOP politicians: In this case, going so far as to block provisions of the Affordable Care Act (the law of the land, mind you, duly passed by legitimately elected representatives) that would make it easier for the desperately poor to gain access to health care and that would literally cost them and their states ABSOLUTELY NOTHING for the first three years.

What occurred to me today, as I pondered once again this friend's ongoing dislike of Obamacare, is the fact that--for all the opposition's sound and fury and gnashing of teeth and cries of "Tyranny!"--the law hasn't even gone into effect yet!  And if early reports from states like California are any indication, many of the dreaded repercussions feared by Obamacare opponents--such as higher insurance premiums--will not come to pass.  So, here's my modest suggestion: Why don't people just relax and wait and see what actually happens with the ACA, instead of prophesying the imminent fall of the Republic if and when it is enacted?

Of course, that's not going to happen.  The GOP will continue to scream and wail and convene nonsensical votes to repeal Obamacare--a repeal they all know is never, ever going to happen--because what else have they got?  They certainly have shown no interest in proposing better legislation--or worse legislation--or any legislation.  And the more they scream, the more a sensible observer must recognize how benign--if not downright helpful--Obamacare will turn out to be. 

If the GOP truly thinks the law is a disaster--really believes the vast majority of the country would be harmed by it--then the smartest thing they could do, from a political perspective, is to shut up, sit back, and wait for the law to take effect.  If people truly end up hurt by the law--well, then, the Republicans will solidify a Congressional majority for many years to come.  Lest anyone think otherwise, let's be perfectly clear: Republicans are not afraid of the potential harm the Affordable Care Act might cause; they are, however, completely terrified at the thought that it will work.

Here's to Your Health

A provision of the Affordable Care Act (Obamacare) sought to extend insurance coverage to the uninsured through an expansion of the Medicaid program, the generally successful program that, for over forty years, has ensured that the poorest of the poor have some access to healthcare.  Seemed like a good idea at the time.  The Supreme Court, however, ruled that, since Medicaid is administered at the state level, individual states had the right to choose whether or not to allow such Medicaid expansion.  Now, as the ACA nears implementation, a number of states are balking at an extension of Medicaid, which means that, ironically, a number of uninsured people will find themselves too poor to receive financial assistance to pay for healthcare.

Now, the fact that the states planning to reject Medicaid expansion are all under Republican leadership should in no way suggest that the rejection is a political ploy to make Obamacare look bad.  This is purely about fiscal rectitude!  After all, the states reasonably point out that their own budgets are stretched already.  How can they afford to take on an unfunded mandate like Medicaid expansion?

Well, OK, it's not completely unfunded: For the first three years, in fact, the federal government will pick up 100% of the new costs.  But, still, what about when those three years are up?  Then--THEN--the states will find themselves stuck with all the costs for all those people who have become accustomed to not going bankrupt when they need to see a doctor!

Well, OK, they won't be stuck for all the costs, but the federal contribution to the state's coffers will shrink dramatically from 100%--all the way down to 90%!!!

OK, yeah, it's a political ploy to make Obamacare look bad.  Why do I even bother to be indignant?

News Notes

An article in today's Times reports that a substantial portion of the investor class is cashing out stocks earlier than they might otherwise have done because they worry what will happen when President Obama and congressional Republicans reach an agreement on increasing taxes.  (Yeah, I said that with a straight face.)  Large investors can reap millions in extra profits if they sell stock or other assets now, before higher rates kick in.

This behavior is, or course, eminently rational.  It may even redound to the benefit of the economy: True, the government will collect less revenue than if the assets were sold after taxes were raised; at the same time, though, there is no guarantee that taxes WILL be raised or that the assets would have been sold if they were subject to higher tax.  In other words, this mild market panic may result in a short-term windfall to the public coffers.

Two things struck me about the article.  First, a quote from John Moorin, an investor who recently sold approximately $650,000 worth of stock: "I love these companies [whose stock I'm selling], but I’m so scared that now all of the sudden I’m going to get taxed at such a rate with them that they won’t be worth anything."

The current capital gains tax rate is 15%.  Now, I'm no accountant, but I think that means--assuming the $650,000 was ALL profit (which is not, mathematically speaking, possible)--that Moorin would "net" a little over $550,000 after taxes.  Next year, under one proposed change to the tax code, the capital gains tax rate could increase to 20%, meaning Moorin would "only" net $520,000 after taxes.  Sure, $30,000 is nothing to sneeze at, but I think the fact that an apparently seasoned investor considers $520,000 to be "nothing" says something about warped values.

Another thing: Not once but tTwice the article referred to the fact that capital gains taxes may be raised to help pay for "President Obama's health care law" (emphasis added).

A note to the Times' editors: It is NOT "the President's" health care law: It is a law that was proposed by the President, and then debated, revised, and ultimately passed by Congress.  References to the Affordable Care Act as "the President's" law are the kind of thing I'd expect to hear on Fox News, where the editorial staff takes the position that President Obama is the dictatorial love-child of Vladimir Lenin and Hitler.  The New York Times should know better.

It's On

Have you heard about the "job creators" who, in a fit of toddler-esque spite, are laying off workers in the wake of President Obama's re-election.  Ostensibly. they can "no longer afford" these workers due to the onerous taxes that the Obama administration has not actually imposed, to say nothing of the mandates of the Affordable Care Act.  Papa John's CEO John Schnatter, for example, ominously warned that, once Obamacare is enacted, customers may have to pay up to 14 cents more for a pizza. . . .

I'm sorry, that doesn't quite capture things:

UP TO 14 CENTS MORE PER PIZZA!!!!!

There, that's better.

Anyway, Schnatter has now said he will reduce workers' hours so as to avoid having to provide them with health insurance (a requirement that kicks in when employees work more than 30 hours a week).  To put it another way, Schnatter will charge you more for pizza AND force you to pay for his employees' health care when they show up at emergency rooms and/or sign up for taxpayer-sponsored insurance policies.

Mr. Schnatter, I personally have no problem paying an extra 14 cents for pizza if it means people get healthcare.  In fact, I'm willing to pay up to--oh, I don't know, an extra 28 cents!  Maybe even 43!  But guess what?  I--and I suspect many other like-minded folks--will not spend a DIME on your pizza if this is your attitude toward the public good.

By the way, to whatever audience I have: Please pass along any information about companies that are responding with similar petulance to the thought of having to, y'know, contribute to society.  Not so much to ME--rather to Facebook and any other outlets that have a wider reach.  If these folks don't like the cost of doing business, let's try to make sure they have considerably less business to do.

A Fate Worse than Death Panels

During the debate over healthcare reform, Republican legislators and their cohorts in the punditocracy warned darkly that a vote for Obamacare would lead inevitably to the formation of "death panels": bureaucratic troikas that would determine whether the elderly or infirm retained enough societal value to justify their continued existence; those deemed to have outlived their usefulness would be swiftly euthanized.  How we all enjoyed the spectacle of a sitting US President forced to assure the public that he had no grand plan to authorize the wholesale slaughter of the nation's grandmas.

Consider this: An article in today's Times explained that millions of low (and even not so low) income people depend on Medicaid for long-term care.  Since only a small number of people have insurance to cover them if they become incapacitated due to age or injury, millions must deplete their life savings--as well as those of their families--before ending up in nursing homes paid for by Medicaid.  If the Romney-Ryan budget is enacted, however, Medicaid will face massive cuts.

What, then, will happen to people like Rena Lull, 92, who has exhausted her savings to pay for  nursing-home care, and who now must turn over "all but $50 a month of her $969 income from social security and a pension toward the Medicaid cost of her shared room"?  What will happen to people like Elaine James, 76, who suffers from dementia and whose daughter has struggled to provide some minimum level of care?  Republicans have no good answer for that.

Railing against phantasmagorical "death panels" may make for good--or let's say effective--politics.  The GOP's positions on the realities of things like Medicaid and Medicare, though, seem far more likely to destroy our grandmas' quality of life.

Here's to Your Health (Continued)

In hindsight, it makes perfect sense that the Supreme Court upheld the Affordable Care Act. As (ahem) someone pointed out not long ago, the controversial insurance mandate at the heart of the case was effectively nothing more than tax policy, and therefore well within the purview of Congress to legislate.  Kudos to Chief Justice John Roberts for applying my reasoning in his majority opinion. I look forward to receiving a thank-you note from him soon.  Perhaps a fruit basket.

This doesn't mean the political back-and-forth over healthcare reform is over, of course.  Indeed, now things get interesting.  If, as Republicans insist, Obamacare is a wildly and widely unpopular law, then the Supreme Court has done Mitt Romney a huge favor: Passionate Teabaggers now thwarted by the judicial branch will stream into voting booths to pull the lever for the man who has promised to repeal this repugnant law, based largely on a law he championed as governor of Massachusetts.  On the other hand, President Obama will surely campaign on the idea that healthcare reform provides or will provide significant benefits to the uninsured and to the American population as a whole--but that this now-definitively constitutional law will likely be undone if Republicans recapture the White House and/or both houses of Congress.  This election thus becomes largely a referendum on Obamacare, and the American people will rightly have the opportunity to express their preference.

The other interesting aspect of the court's decision was that it was Chief Justice Roberts and not Seesaw Kennedy who provided the deciding vote.  Most conservatives assumed Roberts was one of them.  Indeed, I think Roberts may have proven today that he IS a conservative--a REAL conservative--a judge who feels that the judiciary should largely defer to the legislature, as long as the legislature is reasonably acting within its boundaries.  It almost makes one optimistic that the Roberts Court won't be as retrograde as we had long feared.  Almost.

Here's to Your Health (Continued)

Somehow, the debate over the constitutionality of the Affordable Care Act (Obamacare) has become a dispute about broccoli. During arguments before the Supreme Court, Justice Antonin Scalia asked semi-rhetorically whether a broad interpretation of the Constitution’s interstate commerce clause, which Obamacare supporters rely on to defend Congress’s right to impose an individual mandate to purchase health insurance, could also be used to support legislation requiring all Americans to eat broccoli. Scalia’s reductio ad absurdum point is that, if Congress can require individuals to purchase health insurance, then in effect it could require virtually anything, including the individual consumption of broccoli.

Well, actually, Justice Scalia, I think the answer is, “Yes.” Yes, Congress COULD mandate the consumption--or, at least, the purchase--of broccoli. And what’s your point?

Look, I’m no lawyer, and I’m sure that a law stating explicitly that all Americans must purchase X number of pounds of broccoli per year would probably face all manner of scrutiny. It would probably be declared unconstitutional. But that doesn’t mean it couldn’t be done.

Suppose, for example, instead of the aforementioned mandate, Congress passed a tax measure--one that, say, offered people a tax credit for purchasing broccoli. People would simply hold on to their grocery store receipts and turn those in along with their tax returns. Similarly, Congress could impose a tax penalty for broccoli evasion. The tax code has always been used to influence behavior--note the ubiquity of taxes on tobacco products. In effect, people would have a free choice: Buy broccoli or incur a penalty; if people deemed the penalty less onerous than the purchase of broccoli, they would be free to pay the tax and be done with it. This, by the way, is essentially the choice that the Affordable Care Act offers.

Still, you might say that this is unfair. Why should people be forced either to purchase a product they don’t want (broccoli, health insurance) or to pay a penalty to support those who do want the product?

Well, that’s what a society IS.

People who don’t have children pay taxes to support public education for those who do. People who own cars pay taxes to support public transportation for those who don’t. And, yes, people who can afford health insurance on their own--or who feel they have no need for health insurance--pay taxes to support those who can’t. In this latter case, indeed, universal taxation makes even more sense: As much as someone feels he needs no government-supported healthcare, he cannot be sure. Someday, we ALL will need to see a doctor, and there’s no telling what our financial situation will be when this day comes: A government-supported system allows everyone a modicum of, ahem, insurance for a time of need.

Frankly, if people want to talk about unfair government mandates, let’s discuss the mandate that all Americans must buy homes. In case you’re unfamiliar with this mandate, it’s the part of the tax code that rewards homeowners with mortgage-interest deductions. As a lifelong renter, I’ve always considered that to be a tax penalty for not owning or being able to afford to buy a home. So how come nobody is up in arms about the unfair tax burden placed on me and others like me--a tax burden by which I subsidize homeowners (who are, as a group, probably financially better off than I am)? And unlike healthcare, I receive NO benefits from this subsidy I provide.

Do I digress? Maybe. On the whole, though, given the choices brought up in this essay, I’d rather see either Obamacare upheld or the mortgage interest deduction repealed--hell, if it’ll help, I’ll even buy broccoli.

Here's to Your Health (Continued)

"The lawyer, Edwin S. Kneedler, said the court should not strike down the mandate. If it does and decides to engage in judicial editing, he said, only two other provisions — one forbidding insurers from turning away applicants and the other barring them from taking account of pre-existing conditions — would also have to fall." (On Day 3, Justices Weigh What-Ifs of Health Ruling)

Many commentators say that, if the Supreme Court does find the individual mandate unconstitutional but does NOT strike down the entire healthcare reform law, then it must at least invalidate the provision requiring insurers to cover anyone without regard to pre-existing conditions.

My question: Why?

Just musing here, but what would happen if the justices DON'T eliminate those requirements?  The short answer, I suppose, is that Congress would tweak the law; if Republicans win the White House and/or Senate, they will try to repeal the whole law, anyway.  But let's just imagine that the provisions requiring insurers to cover anyone somehow remain, despite the elimination of the mandate.

The reason, of course, that everyone says those provisions would have to be struck down is that, if there is no requirement for everyone--including the relatively healthy--to buy into the pool,  then insuring everyone--particularly those expensive folks with chronic illnesses--would become prohibitively expensive.  As a result, insurers would presumably raise their rates and premiums to the point that they rise beyond the reach of any but the most affluent customer.  Employers that provide insurance coverage would raise their rates and copays or just eliminate that perq altogether.  As more and more people are priced out of the market for health insurance, I imagine that the big insurance companies would ultimately start to lose money as well

How long would it be before big insurers, joined by their fellow corporate titans who can no longer afford to offer insurance to their employees, begin clamoring for Congress to help them out--perhaps by devising some sort of. . .  individual mandate?  If the Chamber of Commerce Republicans truly want to look out for their own interests, shouldn't this be a no-brainer?

Just a thought.

Here's to Your Health--Update

Let's simplify the debate currently before the Supreme Court over whether or not the individual health insurance mandate included as part of "Obamacare" is unconstitutional.  Essentially, those on the right claim the mandate violates the Constitution by requiring people to participate in economic activity (i.e., buy health insurance) whether they want to or not.  Many legal scholars find this argument  flawed, but, given the current right-leaning make-up of the Supreme Court, the individual mandate might indeed be struck down and, along with it, the entire edifice of healthcare reform: If people are not required to purchase health insurance, then the economics of the rest of the legislation--such as a requirement that insurers cover everyone regardless of pre-existing conditions--fall apart.

While I don't agree with their principles, I acknowledge that libertarian types who claim the individual mandate is unconstitutional might have a point.  When put in highly emotional terms--"The government is forcing you to buy something whether you want it or not"--the argument resonates.  But let's ask another question: Should people who cannot afford or choose not to buy health insurance be turned away from hospitals--even in case of emergency--because of an inability to pay?  If an old lady collapses on the sidewalk from a heart attack, should she be whisked to the nearest ER and treated, or should EMTs and other medical professionals withhold treatment until it can be determined that she has the means to pay for any necessary treatment?

All but the most extreme libertarians will agree that the woman should be treated.  I suspect that, if asked, a solid majority of people would be in favor of retaining current laws that require hospitals to treat everyone.  But if the law requires hospitals to treat everyone, then it seems eminently reasonable to require "everyone" to pay for these services.  In effect, "everyone" already does, whether through taxes or simply through higher co-pays or other costs for medical services.  All the individual mandate does is simplify this payment plan and spread it out among as many people as possible.

In short, unless you are the most passionate Tea Partier, you already support socialized medicine--at least in terms of the provision of services.  The individual mandate simply socializes the cost.

HEALTHCARE SOLVED!!!!

WASHINGTON--In an historic decision that will likely end once and for all the healthcare crisis in the United States, congressional leaders and the White House today announced that they had reached an agreement on a single-payer system.  That single payer is Mr. Randall McMurtry of Clark Fork, Idaho.

Mr. McMurtry, 48, a forklift operator at a sardine plant, expressed shock and dismay when told that he would be responsible for some $2 trillion per year to ensure basic healthcare for every man, woman, and child in the United States.  He continued spluttering even after receiving assurances that administrative savings generated by the single-payer system would likely lower actual costs to something closer to $1.5 trillion.  Congressional proposals to exempt Mr. McMurtry from responsibility for Wyoming and Delaware may lower the final bill even more.

Mitt Romney immediately attacked the proposal as just another example of Obamanamian socialism run amok, and Newt Gingrich bit the head off of a kitten.

Here's to Your Health (Continued)

The Supreme Court has agreed to hear an appeal of the Affordable Care Act (i.e., "Obamacare").  The main issue under debate concerns whether Congress overstepped its authority by requiring to purchase health insurance under the law.  As an article in the Times put it, "If the federal government can require people to purchase health insurance, what else can it force them to do? More to the point, what can’t the government compel citizens to do?" (Health Law Puts Focus on Limits of Federal Power)  It's an interesting question.  Honestly, as much as I support the idea of healthcare reform, I'm not sure I have a great answer.

The obvious comparison is to automobile insurance (leave aside for the moment that automobile insurance is regulated at a state, as opposed to a federal, level).  If people can be required to buy automobile insurance, why can't they be required to buy health insurance?  The Obamacare critics' response is that, technically, the government does not require people buy auto insurance: It simply makes such insurance a legal prerequisite for car ownership.  Since no one is required to buy a car, no one is required to buy car insurance.  On the other hand, no one can "choose" whether to remain healthy--which is too bad really, as that would solve a lot of problems--so the health insurance mandate becomes a charge incurred simply for existing as a citizen of the United States.  That is to say, it becomes a "tax," which Congress does have the authority to implement, but calling the requirement to buy health insurance a tax would have been politically unpalatable, so it was not done that way, which is why the case has made it to the Supreme Court.

The problem with the current case before the Court is that, if the insurance mandate is declared unconstitutional, then the whole Affordable Care Act probably falls apart. Healthy people will choose not to purchase health insurance, figuring they don't need it.  The majority of people buying insurance will be the elderly, the infirm, or the hypochondriacal, forcing insurers to raise rates if they hope to take in more money than they pay out in claims.  Since insurers will not be able to deny clients due to pre-existing conditions, all these folks will be able to buy insurance, but they will not all be able to afford it, which will put the country right back where it's been for many years now: an incredibly wealthy nation with an ever-increasing number of citizens unable to afford basic healthcare.

Ultimately, this speaks to the absurdity of our healthcare system.  As a nation, we seem to have lost sight of the fact that there is a fundamental difference between health insurance and healthcare.  Whenever we hear statistics about our nation's healthcare shortcomings, it's always put in terms of the number of people who lack health insurance: "45 million people lack health insurance"; "the ranks of the uninsured continue to rise"; etc.  Technically, no one in the United States lacks access to healthcare: If you have a medical emergency, hospitals have to treat you, regardless of whether you have health insurance or not.

The tragedy would not be a finding that Obamacare is unconstitutional.  The tragedy is that our politicians are so beholden to corporate interests that it is inconceivable that they would pass legislation that actually addresses the problems of healthcare in this country.  If Congress mandated that every American is entitled to receive a certain basic level of healthcare, and paid for it through the tax system ("Medicare for all," anyone?), they could cut out the profit-minded middlemen of the insurance industry.  They would run afoul of no constitutional issues, and they would go a long way towards making the United States a bit more civilized.

But that'll never happen.  People will scream "Socialism!" and scare away anyone interested in a sensible solution to an intractable issue.  Like I said, tragic.

Win-Win?

The Obama administration has asked the Supreme Court to hear arguments about the constitutionality of the Affordable Care Act (i.e., healthcare reform).  The law has come under judicial scrutiny in different federal courts, and the results have been mixed: Most appeals courts have found the law constitutional, but the 11th Circuit Court of Appeals in Atlanta found one of the law's central requirements--that all individuals have health insurance--unconstitutional.  If that portion of the ACA is disallowed, the whole plan falls apart, so the White House is understandably eager to have the question resolved.

Some have questioned the wisdom of the Administration requesting this review at this time.  If the Court hears the case now, a ruling will likely be issued next spring, in the midst of the presidential election campaign.  For Obama, though, this makes a great deal of sense.  If the law is upheld, the President can claim a substantial victory.  If the law is ruled unconstitutional--especially if the justices rule according to their perceived ideological biases--this will likely motivate the Democratic base to come out in force.

As much as the Republican Party would like to convince us otherwise, a majority of the American public wants healthcare reform.  The constant cries of "creeping socialism" are wholly unconvincing.  If anything, most people probably feel the ACA didn't go far enough--especially in light of news that Big Insurance is seeking enormous rate increases during a time of financial crisis for most Americans.  The Court will either validate Obama's vision or validate the belief--growing exponentially since the Citizens United decision--that a highly politicized right-wing mini-majority does nothing but carry water for corporate masters.  The backlash could be inspiring.

The Daily Outrage

Well-wishes have poured in from around the blogosphere in response to the 1,000th installment of "The Solipsist."  I received very few actual gifts.  Don't feel bad, though, folks; I'm still accepting presents.  Besides, what I got from Pat Robertson will tide me over for some time: On Tuesday, the Right Reverend Voldemort counseled one of his followers on "The 700 Club" that divorce--while generally frowned upon by self-righteous rightists like him--is perfectly OK . . . if your spouse has Alzheimer's.

Context: Robertson was responding to a caller who was asking about a friend (yeah, a "friend") who had started seeing another woman after his wife was diagnosed with Alzheimer's.  Robertson, predictably, frowned on the adultery and counseled that the husband "should divorce [his wife], and start all over again."

Now, I know what you're thinking, "What kind of scumbag is this douche?" Or, perhaps, "What kind of douchebag is this scum?"  Or, simply, "What the fuck?!?"  We hasten to point out, though, that Robertson only advocates spousal abandonment if the "friend" first "make[s] sure [his wife] has custodial care and someone looking after her."

Custodial care, of course, costs more than a little money.  Still, assuming the husband's insured, this shouldn't be a major problem.  Oh, wait, the wife will lose the husband's coverage after he, y'know, divorces her.  But THAT must be why Robertson so vocally supported President Obama's healthcare reform package. I mean, he RAVED about how healthcare reform would be part of some "socialist colossus"!  Oh. . . he didn't mean that in a good way, did he?  Well, his followers support it, anyway: That's why they've gone to court to say that it. . .uh. . . it. . .it violates the Constitution.

This isn't looking so good, is it?

Robertson justifies his matrimonial advice on the basis that spousal abandonment of an Alzheimer's sufferer is compatible with the whole "'Til death do us part" of the wedding vow because Alzheimer's is "a kind of death."  Well that solves everything, doesn't it? The poor, addled, soon-to-be-discarded former love-of-someone's life doesn't need health-care! SHE'S DEAD ALREADY, DUDE!  KICK HER TO THE CURB!

We should point out that this advice applies only to heterosexual couples.  If you're in one of them queer marriages, then the Alzheimer's is just God's way of saying "Told ya so," and you have to stick with each other to the bitter end.  But at least you'll have insurance.