Up in the Air

The New Yorker ran an especially good cartoon recently: a man standing up in coach on a plane–and others evidently cheering him on–saying something like “Who else is fed up with the smug attitudes of the so-called pilots who fly this plane? Who else would prefer that I fly it?”

The parallels to our Presidential election are too obvious to require added discussion.

I thought about that cartoon when I read another airplane analogy, this time in connection with the Republicans’ hell-bent-for-leather determination to repeal the Affordable Care Act–aka “Obamacare”–without having the slightest idea what they will replace it with, without any evident concern for the more than twenty million people who will lose coverage, and without any concern for the financial chaos that even their allies have warned will ensue.

As Josh Marshall at Talking Points Memo put it:

“The AMA, which has been rather comically pro-Trump to date, came out today and told Republicans that they shouldn’t repeal Obamacare without a clear replacement. Notably, even two of the most conservative health care economists at AEI, came out yesterday and said that ‘repeal and delay’ would be a disaster. The truth is that ‘repeal and delay’ is the policy equivalent of taking off from JFK to Heathrow with 2,000 miles worth of gas and saying you’re going to figure it out en route. No one who knows anything about health care economics, even people who are staunch free marketeers and hate Obamacare, think that makes any sense.”

From time to time on this blog I have referred to my cousin, an eminent cardiologist (and former Republican). I consult him when addressing issues that require medical expertise that I lack. He has shared with me the following statements on the proposed repeal from both the AMA and the American College of Physicians:

Chicago, IL, January 3, 2017––The American Medical Association (AMA) released the following letter today to congressional leadership from Chief Executive Officer and Executive Vice President James L. Madara, MD, concerning legislative efforts to reform the health care system.

Dear Majority Leader McConnell, Leader Schumer, Speaker Ryan and Leader Pelosi:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing regarding our ongoing commitment to reform of the health care system and potential legislative actions during the first months of the 115th Congress.

The AMA has long advocated for health insurance coverage for all Americans, as well as pluralism, freedom of choice, freedom of practice, and universal access for patients. These policy positions are guided by the actions of the AMA House of Delegates, composed of representatives of more than 190 state and national specialty medical associations, and they form the basis for AMA consideration of reforms to our health care system.

Health system reform is an ongoing quest for improvement. The AMA supported passage of the Affordable Care Act (ACA) because it was a significant improvement on the status quo at that time. We continue to embrace the primary goal of that law—to make high quality, affordable health care coverage accessible to all Americans. We also recognize that the ACA is imperfect and there a number of issues that need to be addressed. As such, we welcome proposals, consistent with the policies of our House of Delegates, to make coverage more affordable, provide greater choice, and increase the number of those insured.

In considering opportunities to make coverage more affordable and accessible to all Americans, it is essential that gains in the number of Americans with health insurance coverage be maintained.

Consistent with this core principle, we believe that before any action is taken through reconciliation or other means that would potentially alter coverage, policymakers should lay out for the American people, in reasonable detail, what will replace current policies. Patients and other stakeholders should be able to clearly compare current policy to new proposals so they can make informed decisions about whether it represents a step forward in the ongoing process of health reform.

We stand ready to work with you to continue the process of improving our health care system and ensuring that all Americans have access to high quality, affordable health care coverage.

Sincerely, James L. Madara, MD

Washington, DC, January 3, 2017––In a letter sent today to leaders in the Senate, the American College of Physicians (ACP) implored them to vote no on a budget resolution that would start the process of repealing the Affordable Care Act (ACA). The College cautioned that this process could destabilize coverage, resulting in tens of millions of Americans losing coverage, benefits and protections established by current law.

The letter expressed concern that the pathway established by the resolution, which will lead to a subsequent vote on a budget reconciliation bill to repeal major elements of the ACA, with the effective date of such repeal being delayed while Congress attempts to develop an acceptable replacement plan, is unworkable and disruptive.

“Independent and non–partisan analyses show that enactment of such a ‘repeal, delay and replace’ bill, especially without an alternative being offered now that could be thoroughly evaluated based on its impact on quality, access, and coverage, would create chaos in insurance markets, causing plans to pull out of the markets with more than 7 million losing coverage in 2017 alone,” said Nitin S. Damle, MD, MS, MACP, president of ACP in the letter. “Full repeal could result in nearly 60 million people becoming uninsured.”

ACP noted that the College welcomed the opportunity to make improvements in the law. Specifically ACP welcomes discussion of ways to stabilize insurance markets by bringing more young people into them without disadvantaging older and sicker patients; to expand consumer choice of insurance products and of physician and hospitals; to ensure network adequacy; to support state innovation including in Medicaid provided that current eligibility, benefits, and protections for current and future enrollees are not undermined, to reduce administrative burdens on physicians and their patients, and to support the critical role played by primary care physicians in providing accessible, high quality and cost–effective care to all types of patients.

“While we acknowledge that the ACA is not perfect (and no law is) and improvements to it can and should be made, our continued support for the ACA is grounded in the fact that it has reduced the uninsured rate to the lowest ever, a major stride toward providing affordable coverage to all Americans,” said Dr. Damle. “We encourage Congress to first put forward ideas for improvements rather than committing to a process that would repeal the ACA’s coverage and protections for many millions of people.”

But what do pilots know about flying planes…?


  1. Thank you for posting the letters of the second most important people in the healthcare industry. Sadly, there is no professional organization of patients commensurate with them. If there were, we wouldn’t have to be fighting this battle again.

  2. In recent years I have considered dropping my Medicare supplemental and relying on Medicare alone; due to primary physicians not being allowed to practice medicine, but merely read the nurse’s results of taking our vitals, writing a expensive prescription if needed and referring us to expensive specialists – not always needed. The percentage paid by my supplemental is low; without it, my co-pay would raise but…it would stop the supplemental coverage from billing Medicare thousands of dollars in unnecessary specialist and test charges.

    I am giving that idea second, third and fourth thoughts at this time due to the strong possibility of losing Medicare. My health care coverage has nothing to do with ACA; those with health care providers they have maintained for years and those through the state health care systems recently have nothing to do with ACA. Yet their monthly premiums and annual deductibles have soared for years…since long before ACA was a target to blame. We, the patients, complained but the government didn’t notice our outcry. The GOP ignores the obvious regarding all issues pertaining to the ACA – calling it “Obamacare” as in insult to our biracial president as if the color of his skin has caused these medicare care exorbitant cost problems. More than 60 attempts to repeal the ACA is also ignored by those who have spent years and millions of our tax dollars trying to repeal a health care law; much of which was written by them under Bush.

    We are looking at a new and frightening future on all levels of existence in this country; medical care by any name is but one of the issues of our survival but it is the primary issue regarding actual life or death.

  3. Steve,

    “Sadly, there is no professional organization of patients commensurate with them. If there were, we wouldn’t have to be fighting this battle again.”

    Maybe ACTIVISM ENGINE is one of the answers to that type of DILEMMA.

  4. It is pretty much a given Drumpf won’t pay attention to “experts” he didn’t appoint. I can see him tweeting how these “experts” begged him to save Obamacare but he is like, a smart person, and knows better.

  5. The ACA wouldn’t be any where near as problematic as it is if the Republicans had worked with Democrats to fix those things that need fixing. Instead, they sued to gut parts of the bill to insure that it wouldn’t work as intended.

    Why haven’t they been able to come up with a plan in the 7 years they’ve been swearing they will? The short answer is that the ACA WAS the Republican plan. It was developed to stop Hillary’s universal health care plan in the 90s.

    What should be most evident from this time in history is that Republicans don’t know how to develop NEW ideas. With their idea stolen from them, all they can do is dither.

  6. As “patients” seek a voice regarding ACA- everyone 50 and over should join AARP.

  7. As a Veteran I have V.A. Coverage. Plus I have Medicare, the Medicare Supplement and Medicare Pharmacy.

    The Republicans have spent how many years trying to repeal Obama-Care or ACA??? You would think by this time the Republicans given their hostility to ACA over the years would have a plan ready to go to replace it. No, the Republicans do not have plan, which simply confirms their mindless, dog whistle politics.

    So OK, the Republicans want to scrap ACA. The Democrats if there are any with backbones should propose replacing ACA with a Federal Single Payer Health Care Program. The last time around Single Payer could not receive a hearing. If the Republicans are so hell bent on repealing ACA, the Democrat Counter weight could be, let’s put Single Payer on the table as a potential replacement.

  8. Here is an organization working for reasonable drug pricing, “Prescription Justice Action Group,” pgag.org. Its segment in healthcare rationality is for consumers who feel drug prices are out-of-control

  9. After checking the price of coverage in Obamacare in AZ, I think I might forego insurance and hope for the best. I know I’ll have to pay a fine at tax time but it will be much less than the premiums of 700 a month with a 4600 deductible and 8400 out of pocket maximum. A 3-4% tax increase on all of us for single payer is absolutely cheaper and we can kiss insurance companies good-bye for good. Well, not the private insurance for those rich people that want it. Think of how much administrative cost savings we’ll have too. Our files will be on a network and if we have allergies to drugs, every doctor in every ER nationwide will know about it. Why can’t we do this?

    Because the ACA is the republican plan and Obama stole it so we’re all going to pay that price for their b.s. repeal. Even in “expensive for everything Switzerland,” my health care is cheaper. A head a broccoli is 5-6 bucks here but I can drive 6 miles to Germany or France and pay 99 cents to 1.50. So don’t tell me we can’t do affordable healthcare. We can. It’s just that no one is going to get rich off of the sick anymore.

    See the problem is that I have a thyroid disease and I have a competent doctor in AZ who is a MD and Naturopath and she also has this disease. So she knows how to treat it, what to check and even visits her elderly patients at home. You know, old school doctor despite her mid-40s age. The problem with her is that she doesn’t take insurance. So I have to pay in cash. She used to send me to the lab my insurance company approved of and have my meds delivered through the mail order pharmacy my insurance approved of and after paying my deductible, even covered 80% of her fees. But with this Obamacare from AZ, she wouldn’t be covered, none of my labs would be covered and none of the meds either. (The thyroid med I take is 21 bucks here for 100 pills. In the states it’s 290 bucks for a 30 day supply because they are made right here in Switzerland. Too bad I can’t steal a years supply before I go). Why bother? I give up.

  10. I’m sure that you are correct, Mike. However, it ‘s the Republicans on the Hill that hold our fates on this issue. Thank you, Sheila for publishing the letter. I am a ‘retired’ teacher who is not old enough to collect Social Security. They keep pushing it out of my grasp. My husband has been severely brain injured for the past 4 years and gets disability pay and Medicare. As you can imagine, I am concerned about many of the issues this year! Any one of them has the ability to rip our lives apart. We all have to stay mobilized to be able to respond to constant threats to our way of life. Many of my friends have already given up because of depression and their mental health. They would rather not know. Those of us that are stronger (or have more to lose) must take up the watch.

  11. When the Social Security Act was passed in the middle 1930s it, like all acts designed to serve a mass market in new legislative territory, was imperfect in its application and was over the years thereafter altered to meet challenges to its purpose. It was and is the greatest piece of social legislation ever passed – so far. The ACA, like the Social Security Act, was imperfect in its original design, and like Social Security, needed time to see how it was working and in order to fix quirks and meet challenges to its intent based on what happens when the rubber meets the road but, unlike the middle Thirties, comes now the HMO-funded ideologues who rightly point out insufficiencies in the act but wrongly determine to throw the baby out with the bath water rather than try to fix things. If such thinking had been around in the middle Thirties and enough Republicans had been around to pull it off, we would have no Social Security but would rather be back to the old township trustee-poor house days, where the poor and aged are nothing more than social orphans, a holdover from the days of Charles Dickens’s stories of maltreated youth during the latter days of the Industrial Revolution.
    Our problem is ideology based upon greed, as in the days of Charles Dickens. We know in gruesome detail what the problem is but money stands between us and its solution fueled by an ideology that demands that all human activities public or private be privatized subject to the whim and caprice (and securitization) of the corporate moneychangers on Wall Street.
    There is an answer to all of this, and it wouldn’t take years to perfect. It is single payer, a well and long-tested plan that most civilized Western countries have long since had in effect. I therefore agree that the ACA needs amendment if we are to continue to play this game of giving the HMOs their pound of flesh, but like some ideologues on the right, I am in favor of repealing the ACA, but only if and when it is supplanted by a single payer system. Let’s quit messing around and solve this problem in one fell swoop (even though a single payer system may from time to time require find-tuning to meet new challenges to its intent as we go along). It’s time, and has been for a long time. Perhaps, in keeping with the idea of Social Security, we could name the legislation adopting single payer as the Medical Security Act.

  12. Wingnuts don’t have a problem with the ACA, the problem they have is the Black guy in their White House. ACA is relatively successful, but it will go down as an accomplishment for the hated Negro and that is what wingnuts are mad about. They are, as a whole, every bit as spoiled and petulant as the mangled apricot hell beast elect. Tantrums will rule the day. This from Jobs Anger-


  13. Affordable healthcare insurance coverage and access is the one subject that I am very passionate about. The tea party and other extreme conservatives were against the ACA from the very beginning because they saw it as another entitlement program.

    Their propaganda claims about death panels simply amazed me – just more lies. We have had death panels in existance for decades. It was known as “no coverage for pre-existing conditions” and “lifetime limits”. Those death panels have been removed.

    Pence fought incessantly against expanding Medicaid in Indiana. In the end, he was backed into a corner by the hospital CEOs who said they could not keep treating uninsured patients in emergency rooms and that if Medicaid wasn’t expanded that hospitals would start closing. He finally realized that this would be much worse than expanding coverage. However, being the hard-headed asshole that he is, he spent a ridiculous amount of time in demanding that CMS accept a plan on HIS terms through a waiver. The expansion that was put into place does not provide the same level of coverage that regular Medicaid does, but it is sure a whole lot better than people not being covered at all. What he did was carve out some of the benefits and put limits on other benefits that regular Medicaid insurance covers.

    The only way that our country will ever obtain anything close to adequate and fair coverage is to have Medicare for all or single payer insurance and demand that we can negotiate prices for everything. This would include pharmaceuticals, DME, joint implants, etc.

    Unfortunately, our country has decided that private corporate profits at the expense of access to affordable health care is more important. The insurance and pharmaceutical industries have spent millions and millions of dollars over the past couple decades to protect their profits. Their money has purchased an amazing amount of power in both DC and in the states.

    Ryan, pence and their cohorts never intended to replace the ACA. Their intention all along was to just eliminate and throw people to the wolves. They see these people as expendable and less than human. Let them suffer and die. They will be less of a drag on society. I was sickened every time I heard pence proudly claim to be a Christian. There is nothing Christian about that man. He is a cold hearted bastard!

  14. I think i read a commentary in the Indy Star that used the same cartoon to shame those who are protesting the pres-elect. His spin was that it only angers the beast and makes things worse. It’s interesting how some can ignore the basic constitutional freedoms when it creates discord in their inner world.
    I wonder if someone among the republican congress has the balls to point out the obvious to colleagues and if there is a few of those who are smart and politically saavy enough to connect the dots. At this point that seems unlikely so I look for a meltdown of the healthcare system followed by the endless blaming of Obama for causing it. They know it always w the clueless voters

  15. AgingLGirl –

    Re your statment “So don’t tell me we can’t do affordable healthcare. We can. It’s just that no one is going to get rich off of the sick anymore.”

    EXACTLY !!!

  16. Medicaid for all ensures that the patient never sees the bull. Medicare for all means patients are on the hook for the 20% Medicare doesn’t cover. I am on Medicare and SS, but can’t afford the supplemental insurance which runs 3X more than Medicare per month. Fortunately for me, the nearest hospital gladly accepts whatever amount of money you can afford to give them each month as long as you work to lower the bill. Not every hospital will do that.

    Health savings accounts are a dumb idea, imho, since many of us have no extra money to put into savings of any kind, Too many wingnuts ignore this reality. They really want a lump sum for Medicaid/Medicare so they can use the money to give taxbreaks to the koch bros- my metaphor for the 1%.

  17. Mike,

    “They really want a lump sum for Medicaid/Medicare so they can use the money to give taxbreaks to the koch bros- my metaphor for the 1%.”

    It’s a shame the Occupy Movement didn’t see it your way. They operated much like the Nazis in that they targeted the banking interests as the metaphor for the 1% instead of the corporate “powerhouses” like the Koch Brothers. They did a fantastic job of “skirting” the real issue.

  18. Pete,

    After taking Garrison Keillor’s advice, what do you think will be left at the end of Trump’s reign?

    Is the stock market just going to forget about all of this mess?

  19. The problem with wingnuts running the government is- sometime in the very near future Dems will be called upon to clean up another yooooge mess and this next one might not be clean upable.

  20. It used to be that employers needed health care insurance benefits to be competitive in hiring good employees.

    The administration of Bush II eliminated that expense through massive unemployment. The supply of qualified workers went up, the demand down, problem solved.

    ACA saved many who otherwise had no choice but to try to live off the insurance of others by skipping out on hospital and Dr bills. They had no choice, no money.

    Of course while this was going on the real problem was growing out of control. We couldn’t and can’t afford our health care which is 2X our competitions. To be competitive we can only offer health care to the wealthiest half of us and hope that the poor half will go to work sick.

    The problem that Republicans have in Congress today is how to stop the uncovered half from whining without disturbing those getting wealthy in the health care business.

    Dr Carson who is very familiar with how much money can be made by providing health care so he will help figure that out.

    The question is will those being required to live without health care riot in the streets?

    I hope so.

  21. I hope so too Pete that’s why I’m moving back. If there isn’t a protest march scheduled, I’m going to create one, organize it and lead the way down the street when it happens.

  22. Mike,

    Thanks for clarifying my point.

    This stinking mess all started out in the 60’s by a small “inner circle” of Texans to destroy the future of social democracy i.e. civil rights movement. When their plans failed to materialize in the early 90’s they continued on despite violating all the rules of game theory: Once you screw up, at least don’t keep playing the same game.

    But the Bush Family has never given a damn about things like that, so they continued on with their political mechanizations inside the Republican Party even after losing the fight in Dallas and NOW have, not only, risked the future of our democracy, but also, the future of our Planet.

  23. Aging Girl, glad to hear that you are moving back. It takes courage to face down a problem rather than keep your distance.

    Keep reading the first three paragraphs of the Declaration of Independence and declare your independence.

  24. Pete,
    I don’t often click those links, but the mere mention of Garrison Keillor sent my finger right to ‘click’. The piece is beautiful! I had read it before, but it is so worth reading again. Thanks for sending the link.

    I am lost without Keillor, and I’m not feeling it at all with A Prairie Home Companion since he’s retired from the show. I have written to tell them that. They don’t care. Will catch Keillor ‘live at the Orpheum soon, and that’s the best I can hope for right now.

    Rough ride, folks, beginning January 20, 2017, and I am hopeful that it’s for only four years…”only” will seem like an eternity. Marv’s right: This may be it for all of us!

  25. My bad-that was supposed to be Madison Capital Times. I hit the site every couple of days for the opinions.

  26. Thanks, Mike from Iowa! A Prairie Home Companion with Garrison Keillor was such a joy! He will be missed! I can appreciate hearing loss, as I swam, taught swimming, and life-guarded for more than 30 years. I experienced a lot of earaches along the way, and now I have some hearing loss. Thanks for the tip about the Madison Capital Times. I shall check on one of my all-time favorite spoken word artists and writers, Garrison Keillor!

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