Tag Archives: ACA

When Elected Officials Don’t Get It, We All Pay the Price

Indiana Governor Mike Pence is adamantly opposed to the expansion of Medicaid in Indiana, despite the fact that his opposition will cost Hoosiers a lot of money–not to mention lives.

I have previously explained why our stubborn refusal to participate in this particular aspect of the Affordable Care Act is irresponsible, inhumane and costly.

When Pence announced his negotiated one-year “deal” with the federal government to continue “Healthy Indiana” in lieu of expanding Medicare (a “deal” that leaves some 400,000 Hoosiers without healthcare), he insisted that “Consumer driven healthcare is the path to the future.”

Sorry, Mike–but if that’s the case,  the future is pretty damn bleak.

Here’s the problem: markets work incredibly well when buyers and sellers operate on a level playing field. They work especially well when consumers are looking for widely-available goods and services, and can compare prices and quality and shop around for the best deal. Economists define a market transaction as one involving a willing buyer and willing seller, both of whom are in possession of all relevant information.

That description does not remotely apply to medical care.

The “consumer” who needs a hernia operation is highly unlikely to be in a position to shop around. He’s much more likely to need immediate care, and be locked into using a particular provider by his insurance company. And he is highly unlikely to know as much about the procedure as his doctor.

For that matter, this “consumer transaction” isn’t going to be negotiated by the patient and his doctor. The real parties to this transaction are the doctor and the health insurance company–and as recent news reports have reminded us, the needs of the patient are rarely front and center. (The Star recently reported on a lawsuit brought by the widow of a man who needed a pacemaker–despite the urging of his own doctor and another doctor who was consulted for a required “second opinion,” the insurer delayed its approval, and the man died. The doctor insists that, had his patient had a timely procedure, he’d be alive today.)

There is no market in health care. There never will be. Hernias and heart attacks aren’t widgets and mousetraps; there is not and cannot be a level playing field where consumers have as much information and power as their providers–or where their providers have as much power as the insurers. Other countries have figured that out. And in those other countries, amazing as it may seem, big bad evil government has turned out to be more protective of patient needs than for-profit insurance companies beholden to their shareholders.

To suggest that “consumer-driven” healthcare is the future is to display profound ignorance of market economics.

I think it’s interesting how many “free market” ideologues like our governor have no idea how markets really work.



What Is WRONG With These People? Rerun Edition

The Atlanta Journal-Constitution recently ran a story that left me banging my head on my desk.

“Let me tell you what we’re doing (about ObamaCare),” Georgia Insurance Commissioner Ralph Hudgens bragged to a crowd of fellow Republicans in Floyd County earlier this month: “Everything in our power to be an obstructionist.”

After pausing to let applause roll over him, a grinning Hudgens went on to give an example of that obstructionist behavior, this one involving so-called “navigators” who are being hired to guide customers through the process of buying health insurance on marketplaces, or exchanges, set up under the federal program.

“We have passed a law that says that a navigator, which is a position in that exchange, has to be licensed by our Department of Insurance,” Hudgens said. “The ObamaCare law says that we cannot require them to be an insurance agent, so we said fine, we’ll just require them to be a licensed navigator. So we’re going to make up the test, and basically you take the insurance agent test, you erase the name, you write ‘navigator test’ on it.”

As the article points out, Georgia is not the only state where Republicans are in charge and are doing everything in their power to insure that people don’t get healthcare.

Think about that. No matter what your policy differences with the President, no matter what concerns you might have about the ACA’s approach, what sort of human being deliberately–indeed, gleefully–takes steps to insure that other people will continue to suffer?

How much do you have to hate the President that you are willing to let thousands of people go bankrupt and/or die if that’s what it takes to deny him a policy victory?

The Atlanta reporter asked the obvious questions:

Why would you take pride in making it harder for Georgians with pre-existing conditions to get the insurance coverage that had previously been denied to them, and that might save them from potential bankruptcy or even death? Why would you block the federal government from offering Medicaid coverage to more than 600,000 lower-income Georgia citizens, coverage that would allow them to compensate hospitals and doctors now forced to treat them for free? Why refuse to educate uninsured Georgians on the fact that they will soon be eligible for subsidies to help them pay for health insurance, as other states are doing?

I’d ask how low these people can go, but I’m afraid I’ll find out.


Texas Republicans Have a Great Idea

Republicans in the Texas Legislature want Wendy Davis to pay for the second special session called by Governor Rick Perry. Their logic is irrefutable: her 11-hour filibuster prevented them from passing their pet anti-choice policy.  That forced Governor Perry to call a  separate session so they could complete their culture-war agenda. Since it was her fault, she should pay.

I think the Texas GOP’s idea is well worth applying to another legislative body–the one that meets in Washington, D.C.

Why shouldn’t We the People require repayment, not just for the GOPs incessant filibusters ( conducted by weenies who don’t even have to match Wendy Davis’ marathon performance–who just have to intone “you don’t have 60 votes”), but for all the other childish antics done solely to prevent Congress from getting the people’s business done. (I think we’re up to 40 votes to repeal Obamacare now…The Congressional Research Service calculates that it costs $24 million to run the House for a week, so the first 33 votes cost taxpayers approximately $48 million. It breaks down to around $1.45 million per vote.)

At the very least, the Party of No should have to pay salaries, utilities and other overhead costs of keeping the Capitol Building open  week after unproductive week.

Wendy Davis was trying to prevent a bad bill from becoming law. These childish Congresscritters are not only taking votes they know to be utterly meaningless,  they are refusing to do their duty to vote on nominees to fill judicial and administrative vacancies.

When my children were toddlers, and they threw tantrums, they lost privileges. Pretty soon, they stopped throwing tantrums. I see no reason why we shouldn’t take the same approach when Congress misbehaves.

Want to argue the merits of a bill? Fine. That’s why you’re there. No penalty.

Want to stamp your foot and refuse to allow the grown-ups to do the nation’s business? That’s a no-no. Here’s a bill for what it will cost you.

Yes, indeed…those assholes in Texas may accidentally be on to something….


How Far It Has Gone….

As Maddowblog has noted,” this has simply never happened before. There is no precedent in American history for Congress approving a massive new public benefit, a president signing it into law, the Supreme Court endorsing the benefit’s legality, and then having an entire political party actively and shamelessly working to sabotage the law.”

The law, of course, is the Affordable Care Act, aka “Obamacare.”

It isn’t only the 39 votes to repeal the ACA–votes for repeal that GOP Congressmen know are entirely symbolic and will die in the Senate.  As several media sources have reported, Republican Congressmen are now refusing to help constituents who call their offices with questions. “We know how to forward a phone call,” said Rep. Jason Chaffetz (R-Utah). He added, “[A]ll we can do is pass them back to the Obama administration. The ball’s in their court. They’re responsible for it.”

Then there are the Governors, like Indiana’s own Mike Pence, who are refusing to participate in Medicaid expansion, even though such refusal costs their state millions of federal dollars it would otherwise receive. (I won’t even dignify the Pence Administration’s recent bald-face lies about projected costs of individual health insurance policies.)

My question is: why?

The GOP has no alternative plan to offer, possibly because the ACA was the GOP’s approach, back when the party was composed of adults focused upon solving real problems. They don’t even pretend to have a different solution to a healthcare crisis that threatened to destroy  the American economy while leaving fifty million Americans uninsured.

They don’t want to solve the  problem. They just want to undo the solution that was cobbled together by that black guy in the White House and ushered through the process by the woman who was briefly Speaker–the solution that was acceptable to the insurance companies and pharmaceutical companies that had to be placated if anything was to be done.

I have real problems with Obamacare as policy, but I recognize that it is infinitely better than nothing. I also recognize that it is the best we could do politically. I am absolutely incapable of understanding what motivates these people who simply want to repeal it, without putting anything in its place. They clearly don’t give a rat’s you-know-what about the people who had no access to healthcare before the ACA. They don’t care about the small businesses that couldn’t compete for good employees because they couldn’t afford to offer healthcare. They don’t care about the fact that 50% of the personal bankruptcies that cost businesses dearly and are a drag on the economy are a result of medical costs incurred by uninsured and underinsured Americans. They don’t care that before the ACA, America was spending 2 1/2 times more than the next most expensive country for a system ranked 37th in the world.

All they seem to care about is beating that guy in the White House. If people have to suffer or die as a consequence, that’s tough. If the economy has to take a hit, so be it. Nothing, evidently, is as important as thwarting Barack Obama.

That’s how far it has gone.



Our Political Charade

I’ve reluctantly concluded that self-government doesn’t work. Voters respond to vacuous platitudes and bumper-sticker slogans, and candidates are perfectly willing to pander to their uninformed biases while evading the complexities of policy.

Case in point, an egregious but certainly not the only available example: Mike Pence.

Yesterday, in the “candidate conversation” hosted by the Public Policy Institute at IUPUI, Pence said he wants Indiana to have more control over how federal dollars are spent in the state. His campaign literature features a promise to create a new state agency to “reject” federal regulations, and (an unrealistic and ridiculous) promise to return federal dollars to Washington.

A couple of days ago, he declared he would not create a state- based health insurance exchange.  (The Affordable Care Act authorizes states to set up these new, competitive marketplaces to allow individuals and small businesses to choose among an array of affordable, comprehensive health insurance plans.) The ACA provides for these exchanges to be established at the state level, but if a state refuses to do so, authorizes the U.S. Department of Health and Human Services to come into the state to establish that state’s exchange.

It is obviously in Indiana’s best interests to control our own Exchange. The ACA gives states considerable flexibility to tailor these mechanisms to the needs of the people living in that state, and a locally-run Exchange is likely to be more responsive to the concerns of our elected officials and the professionals and nonprofits who serve the constituency using the Exchange. Refusing to allow the state to create an Exchange doesn’t keep the dreaded “Obamacare” from being implemented; it simply assures that it will be controlled by Washington–something Pence claims he opposes.

This pastiche of inconsistent positions makes no sense as policy. But that really isn’t the point–at least, it isn’t the point for Pence. The point is to tell voters what they want to hear–that they can get services without paying for them, that (despite substantial evidence to the contrary) further reducing taxes will create jobs, that a program to increase access to healthcare is an assault on their freedom (Pence’s website really does say that), that Indiana should control its own destiny –except where we refuse to do so and thereby hand control over to the federal government. It’s all ludicrous and incoherent, and it has kept Pence ahead in the polls.

It’s been said that we get the government we deserve.

That’s the problem.