No Time for Celebrations

If you read the last post on this blog, you know that I was glum at the prospect of Mitch McConnell’s preparations to announce that he had finally succeeded in repealing (most of) the Affordable Care Act (Obamacare).  Secret drafting of a “replacement” bill that was actually a huge tax cut for the truly wealthy, and equally secret rehearsals by Republican Senators for their bravura performance–great drama over their sensitivity toward the elderly and the sick, or the opioid-addicted, etc., followed by McConnell’s moves to direct funds to the states where those Senators come from–would end with relatively fast passage of his bill.  Obamacare would be (mostly) dead and the USA would once again be safe for huge profits by pharmaceutical companies and health insurance company executives!  USA!  USA!

An odd thing has taken place in Washington, though.  In a Senate where two Republicans could have voted against McConnell’s bill in order to save face with enraged constituents, then tut-tutted when it passed, for some reason, more than two of them said they would not support the bill.  And they did not follow the script I spoke of, at least not right away.  All this week I have waited for all but two Republican dissenters to return to the fold and announce their support.  But it has not happened.  At least not yet.

There are rumblings behind the scenes and even some out front that the legislation was no good.  Notably, Ohio’s Governor John Kasich forthrightly condemned it as nothing more than a tax cut for the rich while the less fortunate would lose.  The Republican tandem in Nevada of Republican Governor Sandoval and Senator Dean Heller have not wavered publicly in expressing doubt at the intent and effect of the bill.  You will not be surprised to learn that Heller is up for re-election next year, and that this office has been besieged by calls urging him not to support it.

Have some high-ranking Republicans acquired a conscience?  Or perhaps they have considered what civic duty entails?  More likely there are some few of them who worry that casting a vote in favor of this legislation might do grievous harm to their re-election chances, and, further, that it is fruitless to think that President Trump will somehow “have their back” down the line.  In fact, none other than Senator Lindsay Graham of South Carolina has been quoted as saying (out loud!) quite the opposite.  Trump, in other words, has shown himself to be concerned mostly with Trump.  Further, many party elders may be more concerned that the Donald may not last even one term as president, and thus will not be able to stand behind anyone among Republicans in any meaningful way.  (How many Republicans were elected to the Senate, House, or State House in 1976 with the support of Richard Nixon?)

So, is the McConnell bill dead?  I doubt it.  Donors to his many campaigns, on one hand, and Political Action Committees funded by the Koch Brothers and others are not happy at this turn of events, and they are not going to give up. I still think we will see passage, but perhaps with some more rounding off of the roughest edges than we might have otherwise seen.

One interesting sidelight, though, to this whole piece of performance art is that other voices are being raised, not least of which is that of Bernie Sanders, the Independent Senator from Vermont, whom I heard voice some thoughts just yesterday on the current impasse.  Sanders, though known to favor a single payer “Medicare for all” solution to health insurance, said that perhaps a gradualist approach would be timely, specifically, lowering the Medicare eligibility age from the current 65 to 55.  This would have the effect of creating a larger, comparatively healthier pool of  those insured by Medicare.  Looking, as always, at whose ox would be gored, you will see health insurance companies at the front of the line, as many not-quite-golden-agers would opt for Medicare at reduced rates (even with perhaps higher deductibles) than they pay now.  The CEO’s of Blue Cross/ Blue Shield and their colleagues with other insurers will howl against the idea for years to come, and, of course, their donations flow not only to Republicans.  Don’t look for this to happen any time soon.  But hearing it injected into the discussion is a beginning.

Further, if the idea of health care/insurance reform is for real at all, costs must be reduced.  How? Start with the cost of prescription drugs.  Sanders (again) points out that Americans pay the highest prescription drug costs in the world.  Canadian drugs, virtually identical to the versions sold on this side of the border, are often one-half to one-third the cost of their American counterparts.  Why is that?  And Medicare itself, the largest buyer of prescription drugs in the country, is currently prohibited from negotiating drug discounts with any suppliers.  Or importing many drugs from Canada or anywhere else.

Politicians who talk long and loudly about the virtues of cost reduction in government, where are you?  Many have acted hypocritically, refusing to change current regulations on procuring medicine, citing risks to American consumers from medicines manufactured by other than American companies.  (Cory Booker, I’m looking at you…)  OK, but–Canada?  We can’t trust Canada’s controls?  Give me a break.

There will be a lot of strutting, preening, and citing danger to Americans if any changes are made to monopolistic practices in procurement and delivery of health care.  It still will probably not end well.  Don’t count McConnell’s vision out yet.  And don’t give up, on the other hand, on improving a system that is failing many while making a few rich.  Er, richer.

 

USA! We’re the Best! Even When We’re Not.

First, if you haven’t already done so, you will need to follow this link to a Slate magazine article:

http://www.slate.com/articles/news_and_politics/politics/2017/06/trumpcare_is_right_where_republicans_want_it.html.

Now, if you’ve read the article, what I’m going to talk about will make more sense, but, if you haven’t, in capsule form, what it says is that the coming “debate” over Trumpcare in the Senate will have all the suspense of a pro wrestling event, and perhaps all the drama as well.  Jim Newell, a staff writer for Slate, has done the analysis to show that the current hand-wringing by a few Republican Senators over “Trumpcare,”  designed to overturn (for the most part) the Affordable Care Act, is all scripted, and that Mitch McConnell has reserved a few bones to throw to selected Senate colleagues (after an appropriate interlude, of course) so as to guarantee at least 50 Republican votes for the measure, and thus, its passage as soon as next week.  One or two Republicans can opt out, for the sake of optics, but the outcome is foreordained.

Is Newell right?  We’ll all know in a short time, but as I read his scenario, I could not help but hear the depressing ring of truth.  The Congressional Budget Office markup of the House-passed version of this has forecast that 24,000,000 Americans will lose healthcare insurance and that Medicaid funding will drop over the next decade by billions; those of us who have insurance now and will continue to carry it even after all this will probably see our rates rise because, well, that’s what they do.  We’re used to it, aren’t we?

I have Medicare, since I am over 65 years of age.  Contrary to a common belief, it is not free.  It costs me somewhere over $200 per month, as a deduction from my Social Security annuity.  Also, contrary to a common belief, Social Security is not “welfare for seniors,” and should not be derided as an “entitlement.”  I and millions of others who receive Social Security do so because we paid into the program for many years.  And, primarily because I continue to pay for the group private health insurance that I had for upwards of 40 years during my careers, I keep that, too, both to maintain a secondary insurer, since Medicare only pays part of my own medical expenses, and because there are family members who can be covered under my membership.  In all, I pay several thousand dollars per year for the privilege of handing a doctor or hospital a card to show that they will be paid if I need their help.

So, some ask, why would I care about the fate of the Affordable Care Act?  It won’t affect me personally.  And that attitude always causes me to shake my head, even if only mentally.  You see, the whole idea of “civics,” which Wikipedia defines as ” …the study of the theoretical and practical aspects of citizenship, its rights and duties; the duties of citizens to each other as members of a political body and to the government,” is the give and take of those rights and duties among the citizens of an organized nation, whether it is a republic, a monarchy, a dictatorship, or any other type of governance you can think of.  Suppose, in December of 1941, President Roosevelt had responded to the Pearl Harbor attack by noting that Hawaii was, at the time, only a territory of the United States, not a state, and that the 48 states (at the time) of the United States were not affected?

Get away from the keyboard–I know that hypothetical is ludicrous; I’m not stupid.  Usually not, anyway.  And anyway, citizens of the US and property were lost at Pearl Harbor.  All citizens were called on to defend the wrong done to the civic body.

But I find it equally ludicrous that in the 21st century, the United States as a nation is choosing repeatedly to protect the privileged and the wealthy to the detriment of the weak and the poor.  It’s nothing new; it’s been going on for nearly four decades now.  One of our two principal political parties stands openly and proudly for that position, and the other lacks the unity and the moral standing to make a strong moral case against it.

It has been often said that where one stands on any issue can be told by determining whose ox is being gored.  This particular issue–the American health care system, its ability to heal the sick, and maintain the public health, is being steered by interests rather than by principles.  Paul Ryan, Mitch McConnell, and other figures on the Republican side of it endlessly spout their credo that this country has the best health care in the world, but when pressed for why, in every important measure of how healthy Americans are, it is demonstrably not true that we have the best, they can not rebut the facts.  We do not rank among those countries whose health is being well-maintained by that health care system.  In one metric after another, be it infant mortality, average lifespan, maternal mortality, etc., we are outranked by other nations.  The apologists have resorted to assertions that, well, those statistics fail to take into account that the average American has access to this or that medical specialty or facility.

Having access to something is not the same as having it.  If your house is struck by a hurricane, and you must rebuild, and if your homeowner’s insurance retreats behind claims of “acts of God,” the facts are that the labor and the materials to rebuild your house probably exist in your community, but your access to that labor and those materials then are absolutely defined by the money that is available to you.  If you are someone who has put aside enough to make a new construction fall within your means, then you will be able to rebuild.  If not, you are reliant on the indemnification your insurance provides.  No money, no insurance=homelessness.

Equally, the citizen who is struck by catastrophic disease will survive and prosper only if he has resources or if he is protected by insurance.  But the consequences are not homelessness: they are death or perhaps disability.

Thus, my somewhat extreme analogy.  The exercise of civic duty in every other developed nation in the world has led to the establishment of a base of public health freely (and truly) available to every citizen.  The quality of that care may vary, but it is accepted by the populace that all should find the access to needed health care available as a common right of all citizens.

Getting back to the ox’s being gored, look at who stands to benefit by a return to an every man for himself, “survival of the fittest” system.  Money flows from consumers of health care to its providers and its facilities, but also to another class: the insurers, and the purveyors of patented drugs.  Corporations and executives of those corporations give no shots, bathe no infants, and dispense no medications, but they do donate to politicians.  Into the millions of dollars.

And so, the senior Senator from Kentucky, who has been the beneficiary of a goodly share of those insurance millions (as well as pharmaceutical companies’ millions) should be able to look at his handiwork some day soon and tell his real masters that he has made the world safe again for enormous profits in insurance and pharmaceuticals.

And, just think, that same Senator, who proclaimed in 2008 that his priority would be to ensure that Barack Obama would be a one-term president, will also get his revenge by working so hard to undo Obama’s most famous legislative achievement.  Mitch McConnell, you are a hateful old man who has used your office to glorify the pursuit of profit over the health of children and over the sincere efforts of a political opponent to protect the well-being of those children.  Sleep well.  You, too, are mortal.