The Closer You Look, The Meaner It Is

If your eyes glaze over at the prospect of getting down “in the weeds” of the Senate healthcare bill, Josh Marshall’s summary really tells you everything you need to know:

It has always been crystal clear for numerous reasons that the Senate health care repeal bill would be the like the House bill, both versions, just as it will be like the final bill that emerges from a conference committee. McConnell and Ryan knew that ball hiding about scores and legislative language would prevent reporters from saying this: Around 24 million Americans will lose their coverage, everyone will go back to the era of pre-existing conditions restrictions and lifetime limits. The freed up money will go to a big tax cut for the very wealthy. You didn’t need to see the legislative language to know this. It’s been a failure of journalism to pretend otherwise.

If, however, you want several specific compelling reasons to oppose this travesty, there are any number of reports and commentaries that can help. For example, we learn about several “buried” provisions from an article in the LA Times, in a column that describes the bill as a “poorly-disguised massive tax cut for the wealthy, paid for by cutting Medicaid — which serves the middle class and the poor — to the bone.” Then there’s this:

States will have more authority to reimpose lifetime and annual benefit caps and eliminate essential health benefits. This may be the most insidious provision of the repeal bill, and certainly is the most deeply hidden.

As several Governors–including Republican Governors– have noted, this grant of authority to the states will almost certainly be used, because the deep cuts in Medicaid and other federal funding will leave the states no choice.

The Affordable Care Act also had state waivers designed to allow for innovations, especially in state Medicaid programs. But under the ACA, those waivers could not  lead to fewer people being insured, or to the imposition of higher out-of-pocket expenses. The Senate bill repeals those limitations.

Under the measure, the secretary “must” approve a waiver request as long as it won’t increase the federal deficit. As a result, states would be able to eliminate the essential health benefits that all health plans must provide under the ACA — including hospitalization, prescription coverage, maternity care and substance abuse and mental health treatment. Since only essential health benefits are subject to the ban on lifetime and annual benefit limits, high-cost patients such as cancer victims and sufferers from chronic diseases could permanently lose their benefits in the course of their treatment.

And then there’s pre-existing conditions. As the Times reports,

Protection for people with preexisting conditions is destroyed. Senate Republicans claim in their talking points that the measure protects people with preexisting conditions from being denied coverage or priced out of the market. Don’t believe them…The Senate bill will open the door to states forcing people with preexisting conditions into segregated markets that will lead them to pay far, far higher costs than everyone else….This bill will bring the country back to a system in which insurance only works for the healthy, and the sick can’t afford the coverage they need.

There’s lots more. Older Americans will get hosed; under this bill as currently drafted, older Americans could be charged five times what younger, healthier Americans will pay. Meanwhile, the biggest tax cut for the rich is retroactive; a millionaire who already had booked a $1-million gain on a stock sale, for example, would collect a $38,000 benefit.(Even the Wall Street Journal was aghast at that one.)

And most despicable of all:

In fact, all the measure’s tax cuts taken together, valued at about $700 billion over 10 years, would be almost entirely paid for by the bill’s elimination of Medicaid expansion in the 30 states and the District of Columbia that accepted it.

The bill defunds Planned Parenthood. It cuts Medicaid so drastically that hundreds of thousands of elderly Americans will no longer be able to go to nursing homes, and rural hospitals that depend upon Medicaid will close. It will strip coverage from more than twenty million people, and take us back to the days when people had no choice but to use emergency rooms for primary care. The medical cost curve, which had been coming down under the ACA will once again rise more rapidly than the rate of inflation.

And why? To further enrich the already wealthy–and not so incidentally, to destroy the legacy of America’s first black President.

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Another Year

How does that old song go? “Another year older and deeper in debt”? That could be our new national anthem, since it captures both our moral and fiscal deficits.

As I write this, Senate Republicans have refused to allow a vote on repealing “Don’t Ask, Don’t Tell,” and prospects for bringing it back to the floor before the conclusion of the lame-duck session are iffy, at best. This intransigence has persisted despite the fact that the Secretary of Defense and most of the highest-ranking military officials have testified in favor of repeal, and despite the fact that polls show a sizeable majority of Americans in favor of allowing gays and lesbians to serve openly.

Before you shake your head about the persistence of homophobia, however, let me remind you that the gay community hasn’t been singled out. Senate Republicans have also refused, once again, to fund medical care for the brave men and women who were first responders on 9/11. I don’t use the word “hero” very often, but that’s what these firefighters, police officers and medics were. They braved the inferno that was the Twin Towers in order to rescue those inside, and they are now suffering from injuries and illnesses caused by that rescue operation.

The refusal to repeal DADT is excused by mumbling “unit cohesion.” The refusal to provide desperately-needed medical care to first responders has been justified by several Senators on the basis that the expense would add to the deficit.  They have cited the same excuse for their refusal to extend unemployment benefits for the millions of Americans who still cannot find work.

The elephant in this room filled with elephants is tax breaks for American families earning over 250,000 a year. As Obama correctly noted in a press conference where he tried to explain his capitulation on the issue, the Senate GOP was holding these measures—and many others—hostage to their insistence that the richest 2% of Americans retain the favorable tax rates they received from George W. Bush.

It is true that helping first responders and unemployed people would cost money. But extending the Bush tax cuts for the wealthy will add billions more to the deficit than those measures would. Furthermore, unemployment benefits put dollars in the hands of people who immediately spend those dollars, and thus stimulate the economy. (People defend our historically low tax rates for the rich by claiming those dollars will be spent to create jobs; however, the evidence shows otherwise.)

So here we are, ending the first decade of the 21st century facing moral and fiscal bankruptcy.

Our government is broken; it now takes sixty votes to get any measure through the U.S. Senate, making a mockery of democracy and majority rule, and allowing a cohesive and determined minority to hold the nation hostage to the demands of the greedy and privileged. The income gap between rich and poor is wider than it has been since the gilded age, and the strain that gap places on our civic fabric is immense.

This is the environment within which we enter the New Year, and this is the environment within which gay citizens must work to achieve equal rights. It isn’t just DADT repeal—history has plenty of examples of what happens to minority groups during periods of national upheaval and fiscal distress. When times are tough, people look around for someone to blame.  In Germany, before WWII, it was the Jews. In the U.S. today, it is gays and immigrants.

People have asked me, over the years, why I advocate for equal rights for gays and lesbians. My answer has always been the same: I’m selfish. I want equality for myself, and I understand that only in a country where everyone is equal can anyone be equal. But the flip side of that is equally true. Gays and lesbians cannot achieve equality in an unequal and inequitable system. We are all in this together.

Happy New Year. I guess.