My Wife Joins the Fray on Obamacare

My cousin, now living in Israel where I believe there is a national health care system, is a conservative, anti-Obama, and especially opposed to Obamacare. Which I can understand if he was, like my wife and me, in favor of a single payer system -- Medicare for all. I mean, we are pissed too at Obama for allowing the insurance companies to run health care and take their pound of flesh. But he's a critic from the right. Much closer to a tea party libertarian point of view -- he does come from the business world.

My wife has some serious expertise in this area, having spent much of her career working in a major hospital handing insurance health issues and dealing with every insurance company and the medicare people -- who she found the most effective.

So when my cousin sent this video link about the Affordable Coffee Act to his list today with this comment ----

Clever no matter where you come down on the real ACA. (And less than 4 minutes long.)

http://www.realclearpolitics.com/video/2013/11/28/coffeecare_the_affordable_coffee_act.html



---my wife responded:

Health insurance isn't a luxury, like coffee, that you really don't need to buy.  It's a necessity that at some point almost everyone will need. You can either pay for it now, often with the help of government subsidies, or pay for it later when you become ill and have no insurance and have to bankrupt yourself to obtain care. Just the fact that people with preexisting conditions can now obtain coverage is a huge step forward.

The ACA has faults and yes, you shouldn't have to pay for maternity care if you're menopausal or a man, but in lieu of universal coverage, it's better than the nothing that existed before the law was passed.  Also, although it's a government mandate, it's not the government that will reap windfall profits from the paltry penalty tax that individuals who fail to buy insurance must pay.  The big insurance companies will become even more obscenely rich than they are now by selling all of these policies.

Despite the fact that she was complaining that she had to spend a half hour of thinking time crafting this response, thus taking time away from playing with the cats, I think I'll offer that gal a regular health coverage beat on ed notes -- which she'll turn down of course. Playing with the cats and taking care of a feeble-minded husband takes priority.

UPDATE:
My cousin responded with:

Thanks for sharing your thoughts. First, I know many people who would argue as to which is more important - their cup of coffee or almost anything else when they feel coffee-deprived.

The biggest problem for me is the "we know what is best for you attitude" that I feel has permeated the pro-ACA position. And the fact that the powers who pushed it through 3 years ago knew the truth and lied. Like the "little people" do not know what is good for them and, to quote the famous movie line, "can't handle the truth."

I believe the good elements of the law as you point them out could have been achieved other ways. But this was and is, pure and simply, a power grab by those that know better than the rest of us what is good for us.

Also, I find it is very easy for people who have the means to pay for something to think others, who have less means, should also.

I guess you and I will have to agree to disagree about which path is the most "righteous" (as in has the most "justice" in it) one to take. 

 So I get into this with this response:

We appreciate the debate on this. I am having the same one with my dentist who agrees with you and makes the points about a power grab. But a power grab by whom is what I ask?
He says by Obama -- the big govt- big brother argument.
We critics on the left say it is a typical crony capitalistic profit-making power grab by many elements in the health industry - some will gain a lot and others will lose out -- but generally the corporations will make out fine.
When I point to medicare and basically other than the all too high fraud that could be managed with better oversight, works out pretty well. Imagine medicare for all? Do you have such a health care system in Israel? If so do you consider that a power grab?

I find some hypocrisy in the "nanny state" argument given there are no complaints about so many areas --  required car insurance. Or the costs of so-called "security" and the costs of the military industrial complex which are never opened up to scrutiny.
How about those farm subsidies to millionaire mega-farmers?
There is so much cronyism in a government under the control of special interests that to abstract the idea of an uncoupled government from those interests makes this an ideological not an economic or political argument.
The complexities and failures of Obamacare are due to the needs to satisfy the profit motive of special interests.
People on your side of the fence are not offering those strong alternatives you claim are out there to cover people with pre-existing conditions. If we say let the government just offer them a plan that would work we would hear massive squawks. So basically, you guys have restricted the options and forced people to come up with some kind of plan that satisfies the special interests -- basically the very same plan Republicans were pushing before Obama became president - as in Massachusetts.
So it is interesting how the people against single payer -- who often love medicare - argue out of so many different sides of their mouths.

 I'm waiting for my wife to respond - if she stops playing with those damn cats. And tomorrow morning I have an appointment with my dentist to fix a broken tooth where I will attempt to make my points before he shoves instruments in my mouth.

Revisiting ObamaCare IT: Race to the Top - of Incompetence

I'm listening to Brian Lehrer on NPR talk about the Obama roll-out disaster and the corporate disaster speak we are hearing -- exact tone we hear from Bloomberg/Walcott on that kid who is missing for 2 weeks.

For the record, I posted ObamaCare IT: Race to the Top - of Incompetence on Oct. 10 where I pointed out that it was not overload on the web site but the design/architecture of the system which I pointed out my old pals in the Computer Science Dept at Brooklyn College could have done a better job of doing.

I challenged that Obamacare people would be able to fix this since I know from my work on computers that fixing architecture on the fly leads to worse disasters. I pointed out that in building systems you need to start at the simplest stage, test it to make it foolproof and move up the ladder of complexity.*

I believe that in months or even a year it won't be working and they may have to start from scratch. And good programers know to test it out -- and they could have rolled it out one step at a time. For instance -- open the site for info without having to register. Then open it for registration only and stagger the states. Next step allow some data entry. Test and close down at night to fix.

Then last night I hear Robert Gibbs, Obama's former press secretary lambaste them for this can call for Kathleen Sibelius' resignation. Me thinks he should look to his former boss who after all is where the buck stops. Gibbs must have read Ed Notes -- he says the fault is the architecture of the system.

The guy on Lehrer is points to massive management failure all the way to the top.

And how much to Republicans feel like idiots? As Brian said, it they had just shut up the attention on the failures would have given them enormous fodder. So today is day 1 and watch them shift gears and focus on the roll-out disaster. And well they should.

We in education know the outrage of the impact of White House decision-making as all their ed deform initiatives begin to go down in flames. Makes many of us sympathetic to some of the tea party points of view about government run by arrogant idiots who think they're geniuses.

Afterburn
*Simplicity was the lesson I learned from the late Jim Scoma, a NYC math teacher who was the best programmer I ever met. He was hired by our pal Ira Goldfine, another former teacher who headed the ATS Programming unit which had professional consultants working there who scratched their heads when a junior high school teacher was working beside them. Jim was like a dog with a bone who wouldn't let go -- he never gave up and looked at solutions from every angle. This is what makes programming fun - and exasperating. I miss it but it is so time consuming.

ObamaCare IT: Race to the Top - of Incompetence

Reagan: Government is not the solution.Government is the problem.
Obama: My administration is doing everything possible to prove President Reagan was right.

Really, some of those tea party people are beginning to make sense. Almost. People involved in information technology know full well it never works right. Except the amateurs who designed the Obamacare system. 

They make the creators of ARIS look good.

Do you mean to tell me there was no way to test that sucker in a rigorous manner?

How about rationing? Stated beginning with A-L go odd numbered days - former confederate states don't bother. Like the gas rationing that ended the post Sandy crisis here after idiot Cuomo finally did what Christie did in Jersey? (If I had a choice of these guys for president it would not be Cuomo.)

Information Technology people know what a mess things can turn into. So for the people they put in charge of this mess to mess up so badly is almost inconceivable -- unless you've lived through the Obama/Duncan ed deform even bigger mess - and then it all makes sense. They have no clue because it is all so top down. 

Interviews with the IT people making excuse after excuse (we thought the biggest rush would be in November) makes one thing we need a Danielson rubric for how to run things for the Obama administration.

Let's call this ITTT - Incompetence to the Top.

Afterburn
In the midst of my teaching career, from 1984-1987, I earned an MA in computer science at Brooklyn College, an educational experience so different from my previous academic work -- actually it was almost trade school like but with some computer science theory. So I actually know - or knew- a little bit about that stuff. Ok, so it was before the web was invented by Al Gore, but I understand computer coding - or at least some rudimentary aspects.

I taught beginning programming at Brooklyn College in undergrad and grad school in the late 80s. In the first class I told them, "if your assignment is due on Tuesday burn this into your mind: get it done on Sunday because you may need days to get rid of the bugs. And so it was true. I learned that myself because in my entire history of schooling I was a last minute guy - day of or hour of it being due. Suddenly in my computer science classes due dates turned into something else entirely.

The late Jim Scoma, a junior high math teacher in Brooklyn and my programming pal who helped get me through so many of my classes, is the type of person needed to tackle this stuff. When I used to look at his coding I thought it would be complex. But in fact it was very simple -- he made sure it worked from the ground up. Build your system that way.

It's a good lesson. I hear rumors the architecture of the Obama care web is a mess and you can't just fix that easily, especially under the pressure they are feeling - thus put quick fixes. And imagine what this is costing.

Maybe I'll brew some tea.

Still Fighting for Single Payer: National Nurses United Press Release

Obama can't beat me in a debate arguing single payer on health care. But he never seemed interested in trying.

In my blog last night (Why Is Being Mandated to Pay Auto Insurance Not a Tax?) I mentioned that I had 2 debates in the gym with anti-Obamacare(ites) (one of them a para in the UFT) and left them thinking. In fact just about anytime I have this debate I feel points in favor of single payer win out. [Check out this web site for the full SP case].

So people on the left are pissed at Obama for not using his bully pulpit to argue more strongly the benefits of SP, instead using his pulpit to go after teachers. How ironic that the US ranks 37th in the world in health care but all we hear from Obama/Duncan is how low we supposedly rank in education.

I do understand the political realities -- as expressed in the NY Times Week Review section yesterday by Ross Douthat arguing that Obama had to make deals with the insurance and drug industries to keep them from throwing their power against Obamacare -- and it worked. Both got their pound of flesh. Douthat argued that both FDR and LBJ did the same thing.

I beg to differ. Yes, LBJ and FDR ultimately did deals but they did use their bully pulpit to argue the strong case and then used that as a starting point rather than surrendering at the first sight of opposition. Obama could have made powerful arguments (certainly more than me) for single payer and then offer compromises off that.

And where are the unions on this? Here, National Nurses United makes a strong statement for single payer and calls on labor to keep up the fight. Don't forget that the long-term effects of Obamacare will reduce the Cadillac plans many union members have to dust and reduce medicare too. So as you will read below, the fight is just beginning.

Court Ruling Does Not End Healthcare Crisis Or the Need to Continue the
Campaign for Reform

The Supreme Court decision should not be seen as the end of the efforts by health care activists for a permanent fix of our broken healthcare system, said the nation’s largest union and professional association of registered nurses today.

To achieve that end, the 175,000-member National Nurses United pledged to step up a campaign for a reform that is not based on extending the grip of a failed private insurance system, but “on a universal program based on patient need, not on profits or ability to pay. That’s Medicare for all,” said NNU Co-President Jean Ross, RN. “It is not time to stop, but a reminder to begin that effort anew.”

“Nurses experience the crisis our patients continue to endure every day. That’s the reason we will continue to work for reform that is universal, that doesn’t bankrupt families or leave patients in the often cruel hands of merciless insurance companies,” said NNU Co-president Karen Higgins, RN. Stepping up the fight for Medicare for all is even more critical in the
midst of the still persistent economic crisis,” added NNU Co-president Deborah Burger, RN, noting that nurses have seen broad declines in health status among patients related to loss of jobs, homes, and health coverage. NNU has been holding free health screenings and hosting town halls on the ongoing healthcare crisis over the past two weeks – and hearing daily
reminders of the ongoing plight of many patients.

In addition, NNU will be joining with Michael Moore to host a national town hall later this summer. “The continuing fiscal crisis at all levels of government and the anemic economic recovery remind us that rising healthcare costs and shifting costs to workers burden our society, cause much of these fiscal problems, and limit the opportunities for working people. Only real cost control through a national health program can solve this crisis. Improved Medicare meets that challenge,” said Ross.

“Medicare is far more effective than the broken private system in controlling costs and the waste that goes to insurance paperwork and profits, and it is universally popular, even among those who bitterly opposed the Obama law,” said Higgins. “Let’s open it up to everyone, no one should have to wait to be 65 to be guaranteed healthcare.”

The Affordable Care Act still leaves some 27 million people without health coverage, does little to constrain rising out of pocket health care costs, or to stop the all too routine denials of needed medical care by insurance companies because they don’t want to pay for it.
* * * * *
Excerpts from Paul Krugman's "The Real Winners"
New York Times
Published: June 28, 2012

So the law that the Supreme Court upheld is an act of human decency that is also fiscally responsible. It’s not perfect, by a long shot — it is, after all, originally a Republican plan, devised long ago as a way to forestall the obvious alternative of extending _Medicare_
(http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier) to cover everyone. As a result, it’s an awkward hybrid
of public and private insurance that isn’t the way anyone would have designed a system from scratch. And there will be a long struggle to make it better, just as there was for _Social Security_
(http://topics.nytimes.com/top/reference/timestopics/subjects/s/social_security_us/index.html?inline=nyt-classifier) . (Bring back the public option!) But it’s still a big step
toward a better — and by that I mean morally better — society.

The full Krugman piece is here.
* * * * *

LABOR CAMPAIGN FOR SINGLE PAYER HEALTHCARE STATEMENT ON SUPREME COURT RULING'

Excerpts
(reprinted from Campaign's website)

The jury is still out on what effect this decision will have on the actual healthcare that Americans will receive under the ACA as well as its effects on the long-term prospects of the fight to make healthcare a right for everyone in America. Certainly, a more sober assessment of the healthcare realities faced by most working Americans and their families would show that we are a long way from President Obama’s aspirational vision.

Coming at the end of a Supreme Court session that was especially cruel to the labor movement, it is perhaps to be expected that there would be some celebration at what was widely seen as a defeat of labor's worst enemies. But this must not detract us from the urgency to prepare for a renewed assault on employer-provided healthcare benefits.

At a recent strategy meeting of the LCSP Steering Committee and Advisory Board, we heard from union leaders from around the country who are seeing the writing on the wall. Public employee benefits are under the gun in nearly every jurisdiction. Union Benefit Funds, often the gold standard in employer-funded healthcare, are facing threats to their very survival as ACA regulations impose new mandates while new state insurance exchanges potentially draw off their youngest and healthiest participants. And the 2018
"Cadillac Tax" is beginning to look more and more like a "Chevy Tax" as continued
healthcare inflation will trigger this penalty on the hard won benefits of millions more union members than originally predicted.

What Happens Next?

The Affordable Care Act is now indisputably the law of the land. This will create new conditions and new challenges. Many millions will undoubtedly benefit from increased access to healthcare and regulation of the private insurance industry.

Many millions more will find out that the right to buy health insurance is not the same thing as the right to healthcare. States will be required to set up healthcare exchanges by 2014 and state-level innovation—including state single-payer reforms—will be barred until at least 2017 (although President Obama did re-affirm his support for efforts to move that date up to
2014).

Certain things won't change, however. Healthcare will still be treated as a commodity and a profit center rather than as a human right. Millions will continue to be denied access to basic healthcare. Costs will continue to rise two, three, even four times faster than our wages while quality deteriorates. Employer provided healthcare will continue to go the way of defined benefit pensions and healthcare fights will continue to be the biggest cause of strikes, lockouts and union busting.

The labor movement has no choice but to fight on for healthcare justice. And we in the Labor Campaign for Single Payer vow to re-dedicate ourselves to this fight to remove healthcare from the bargaining table and make it a right for everyone in America. We believe that it is labor's historic responsibility to lead this effort and we will not rest until it fulfills this mission.
* * * * *

The Price of Health Care
By ROSS DOUTHAT

Why Is Being Mandated to Pay Auto Insurance Not a Tax?

When both the left and the right think the Supreme Court was wrong on Obamacare I don't know whether I'm coming or going ------

I line up with Reality-Based Educator in most ways. Certainly on the single payer -- extend Medicare to all position on health care (See his comment below this post at NYC Educator.)

Before going on, your homework is to check this LINK: http://www.counterpunch.org/20...
 
I have been most influenced by my wife who spent 35 years working in hospitals on the admin/billing end. She dealt with all the blood-sucking insurance companies and had the most respect for the government people at Medicare who were the most responsive and competent and caring to try to do the right thing. OK, so it's just anecdotal but don't expect me to bother doing any real research other than talk to her.

Anyway, she has been a confirmed single-payer advocate. But as she pointed out when I sent her RBE's comments, we weren't getting that so she was rooting for SCOTUS to back Obamacare. In fact, I've rarely seen her so engaged in a political outcome as this one. (I was fairly ho-hum in comparison.)

I am caught between RBE and my wife but as a hard head lean toward RBE -- except that coming down as anti-Obamacare lines me up with Republican slime.

Then at the gym yesterday I got into 2 discussions with anti-Obamacare people, one a UFT member and the other a right leaning businessman who hates Obama with a passion -- he opened the discussion by saying, "I hear Obama is moving to Egypt to join his brothers." In both discussions I brought up the car insurance issue - I know the response is that it is states not feds -- but the concept is sure the same as a mandate.

Apparently the UFT member didn't know that at 65 he will be tossed out of his health care program and MANDATED into medicare, a truism since, oh, the mid-60s. So why not just extend that to all? Expensive -- yes. But as my wife points out less expensive than the other options. And as my wife always says, if they got the fraud out of the system it would be real manageable. Imagine if hey hired people like my wife who knows the system inside and out to be bounty hunters -- offer them a % for finding fraud. I could buy that pink Cadillac.

I asked the right winger who is in his 70s if he was unhappy with medicare. Not. Then I brought up the deals about keeping us from buying drugs in Canada. Know what he said? Exactly what the UFT member said to me a few minutes before --- Canada doesn't regulate their drugs as effectively as the FDA -- you know, that awful fed govt agency. He read an article. I asked if he checked to see if any of the drug companies were behind that article (bet they were.). He smiled and wandered off --- finding it easier to work out than argue with me.

Here is RBE's comment followed by a response by NYC Educator:

Yesterday's SCOTUS ruling was a loss, in my opinion.  The federal gov't now has the legal right to force everybody to buy crappy private insurance - no matter how little money you have or whether you'll actually be able to use it once you pay for the premiums.  You don't buy the crappy, expensive insurance, you get penalized via the IRS.  Yesterday's ruling also enshrines the private insurance monopoly.  Say goodbye to ever getting single payer. And finally, those of us with health insurance provided by our employers will soon be dropped from these plans, as the Obama plan rewards companies that drop employer-provided health insurance and penalizes companies that do provide it.

Here's a good quote on Obamacare:

"What this bill does is not only permit the commercial insurance industry to remain in place, but it actually expands and cements their position as the lynchpin of health care reform. And these companies they profit by denying health care, not providing health care. And they will be able to charge whatever they like. So if they're regulated in some way and it cuts into their profits, all they have to do is just raise their premiums. And they'll do that. Not only does it keep them in place, but it pours about 500 billion dollars of public money into these companies over 10 years. And it mandates that people buy these companies' products for whatever they charge. Now that's a recipe for the growth in health care costs, not only to continue, but to skyrocket, to grow even faster. "

Marcia Angell, Harvard Medical School, editor-in-chief of the New England Journal of Medicine

And here's another:
"The real losers in the latest Supreme Court decision, however, are the people of the United States. Not those who will be  required to go out and buy some over-priced, minimal coverage, rip-off insurance plan offered by the private insurance industry, or to pay a  “tax” to the IRS for not doing so, but everyone. This is because the  Affordable Health Care Act is not affordable. It does little or nothing to control health care costs, which are destined
to continue to gobble up an ever increasing amount of the total US Gross Domestic Product as well as of corporate profits and families’ incomes.

The new federal version of Romneycare simply prolongs the day when the US finally does what it should have done decades ago, should have  done during the first Clinton administration, and should have done at the start of the Obama administration: namely expanding Medicare to  cover all Americans.

Instead of going for this option when he had broad and enthusiastic support as the newly elected president, Obama deliberately shut out all discussion of the Canadian-style approach to national health coverage — a national program of government insurance for all, with doctors’ rates and hospital charges negotiated by the government — and instead devised a
scheme that leaves the whole payment system in the hands of the private insurance industry, and effectively lets doctors and hospitals charge what they can get away with.
Obama did this because he was a huge recipient of money from all sectors of the health care industry — the insurance companies, the hospital companies, the American Medical Association, the big pharmaceutical firms, and the medical supply firms.

ObamaRomneyCare is at its core an enrichment scheme for nearly all elements of the Medical Industrial Complex, with the possible exception of the lowly family practice physician, nurses, and hospital workers."


LINK: http://www.counterpunch.org/20...

NYC Educator

It also insures my daughter and all children of insured families to age 26, and I have read it provides subsidies for some. Tax is minimal, like one percent, and I believe a program like this can be improved. I agree with much of what you wrote, however. Much of the negativity presented already exists, so you're right, that does not represent improvement.