There is no free lunch in health care or firefighting

The GOP’s attack on Obamacare has taken on a new tactic  since the Supreme Court ruled it constitutional.  They no longer could make the argument that the Affordable Care Act should be repealed on constitutional grounds. They now have a new one. “ It is a tax increase.  Yes, Obamacare in its entirety is a tax.  Taxes are evil. Therefore it should be overturned.”

Come on, GOP. Stop spinning.  Consumers have a choice: they can pay the penalty for not having health insurance or they can get health insurance, made affordable by Obamacare The sick-deniers  who believe in their own immortality and their ability to turn up at an emergency room if things get really bad are the only  ones who will pay the mandate tax if they persist in being irresponsible.. The tax is a penalty, but it is also a way to get slackers to pay for services.  It is those seeking  a free lunch that the GOP wants to protect.

   Yes, the GOP will now make the case that it is wrong to tax free riders and free loaders who cost us all money by going naked with insurance on some misplaced faith that they will never get sick, be in an accident, or die in a way that would put them in a hospital.  We are already paying for those slackers who refuse to take individual responsibility.  We are also paying for those who cannot afford to buy health insurance because they do not have enough income. The medical  costs of the free loaders and the near poor costs are passed onto insured families in higher premiums, higher copay and less coverage to the tune of $10000.   

The medical free loaders  are not the only free loaders in this country.  Look in your mirror; you may be one of those  who  want the services but do not want to pay for them in taxes or fees in the future. Colorado Springs cut their 2012 firefighting budget and  the deeply GOP El Paso County sends those to Congress who are sworn to a budget that would cut non discretionary spending that includes cutting federal money for  firefighting and disaster funding.  Post the Waldo Canyon  fire there, I wonder  what they do with their budget next year. I wonder, too, if their Congressman sees any connection.

George W Bush knew this.  That is why he launched two wars and gave seniors a welcome relief in drug care benefits, and  got a large reduction in taxes for the rich  without paying for it in taxes or any other measure.  That is why he busted a balanced budget and ran up the deficit.  He was under some assumptions that tax cuts would stimulate the economy enough to create tax revenue to offset this.  How wrong he was.  Even before the Great Recession of the last years of his administration, the assumption was faulty and the economy had not been stimulated and unemployed was already ticking up.  The crash of 2008 made recovery based on increased revenue to the treasury a laugh, and 40% of the current deficit is the result of the loss to tax revenue because of the recession that reduced taxpayers incomes and profits.

Polls show that overwhelmingly numbers of voters want their pre-existing conditions to be covered, to be able to afford insurance if their employer does not provide it, or  the insurance plan they are on cannot  kick you off if you are sick, or expenses surpass the lifetime limit,  or if they are laid off or even fired.  They do want their college age kids to be on their   insurance policies.  They just did not want the package plan of Obamacare that figured a way to get these benefits paid for with a some more  taxes on the rich,,  and making uninsured take responsibility for getting insurance and paying into the system as much as their income level would allow.  

So, GOP, now is the time to show your payfors for  the benefits consumers your own supporters want and need. You should know by now there is no such thing as a free lunch..

Mitt Romney...he made me sick

There is an ad running in Colorado on behalf of Pres. Obama’s reelection that is  an  opportunity to make a point it besides the one it intended. It underscores the fear that loss of a job means loss of health care and the lesson is that health care reform would eliminate that fear.  The ad features an older woman with Parkinson’s like symptoms who said that when Bain capital (Mitt Romney’s firm) bought the profitable company for which she had worked for many years, she lost her health insurance and pension, even though she was 2 and a half years from retiring.  The punch line: “Mitt Romney…….he made me sick”. The point: Romney did not care about the damage his brand of capitalism caused to human beings. As we wait for the Supreme Court’s decision on the Affordable Health Care Act (“Obamacare” to the disaffected),  we should also  understand that if the woman had lost her employer provided health insurance and income, she could have received health care she could afford even if she had a pre-existing condition if ‘obamacare’ were in effect.  That fear…loss of job means loss of health care.. is  a fundamental dread  to those who face a job loss or change and that advantage of health care reform is rarely highlighted or understood.  

Christmas Market, Free Market

Version of my original column submitted to the paper; skyhidaily news(skyhidailynews.com)   printed an edited version Dec.21, 2011

So many of our Christmas traditions come from Europe, some coming sooner and others later.  One that is only now catching on lately is a Christmas Market.  In the old country, especially in German speaking regions,  the village town square is filled with stalls selling hand made tree ornaments and goodies and toys and items to give at gifts when Christmas eve comes.  I treasure the tree ornaments my junior year abroad children brought to me so many years ago from Austria. Those markets are like our crafts fairs and farmers markets with a Christmas theme .  It is old fashioned, free market capitalism for which so many yearn.

Being nostalgic  for the free market olden days has also become an unstated litmus test of the GOP presidential contenders and their media spokespersons .  It is  held up as a standard of economic good, and it will cure what ails us including high health care costs and Wall Street busts.  The sound bite of the month is that the President Obama Is an enemy of the free market because  he supports more regulation of Wall Street   and his health care reform law  is a government  take over the health care market.

  I love the free market too, when it is truly free, fair, safe, and competitive. Following my European sister in law around  the huge farmers market in Zagreb, Croatia, this summer I saw the free market at its best.  She went to her favorite vendors who usually had the best quality and turned over the tomatoes to see if there was a rotten spot or a worm hole. She picked and poked and then bought.  There must have had twenty different tomato vendors  there.

Neither the health care insurance industry nor Wall Street meet standards of being  free, fair ,safe  or  competitive.  It is not Obama who is the enemy of the free market system;  it is some of the participants in that market who do it the most harm.  The financial sector has utilized  modern technology and shell game techniques to fool their customers, both unsophisticated  consumers and the experienced investors.   The old “liars can figure and figures can lie” approach  permeated the securities markets pre the 2008 crash may possible by unregulated financial instruments such as  derivatives   and hedge funds  and unwise lending practices.  Dodd/Frank  Wall Street Reform  brings  tougher  regulation and new scrutiny to those worst practices, to the howl of protest by the GOP and bankers.  .

  Major contributors  to the bubble that burst in 2008 were  practices that were unfair to consumers and  undermined  free market choices. The least able to shop wisely  in the credit  market were   everyday consumers, who assumed that they could afford the house if the bank told them they could and   were incapable of finding the worm hole in the shiny pages and fine print of documents shoved under their faces at closing.  Credit card companies found imaginative ways to soak their customers. There was no place to go for a consumer to complain or someone to make lenders behave  fairly .   

 The Consumer Protection   Bureau was established in the Wall Street reform legislation to provide a solution.  The GOP and Wall Street lobbyists are stonewalling appointments to the agency, hoping to eventually sabotage it by putting more banker-foxes  in charge of the hen/house  of consumer protection….all in the name of free market economics.

“Let competition of health insurance companies  cross state lines  and we can lower health care costs”, say the GOP, offering that as the alternative to Obamacare.   Bad news:  There is no free market .  A few nationwide health insurance companies and their subsidiaries control the market, free to collude on prices , restrict  offerings and divvy up customers because they are freed  from anti trust laws.  That is why Obamacare establishes  an open, affordable market of  exchanges  providing a choice of competing for profit and non profit private insurers, offering  coverage fairer to consumers.

What we can learn from recent votes on issues; swinging pendulums rest in the middle

My column in the Sky Hi News today:
As the Republican Party tries to read the tea leaf residue of the votes on issues recently, Democrats were taking comfort that there was hope voters had not swallowed entire cups of Tea Party brew.

It may be too soon for either side to conclude much, but there may be justification for the Tea salesmen to be a little worried and the Democrats to feel encouraged. The coming 2012 election battle will not be for the hearts and minds of either ideological extremes, but the victory will belong to whichever side appeals to the more moderate middle. The middle made its voice known in these early November contests.

Ohio voters overturned the law passed by the GOP-dominated legislature and their governor, John Kasich, to prohibit collective bargaining by public employees. Gov. Scott Walker in Wisconsin, who was the object of sit-in protests over similar legislation, was probably having a few turns in his tummy digesting the news.

Mississippi voters rejected the personhood amendment that would have elevated a fertilized egg to human being status in the eyes of the law. This pro-life overreach was more than voters there could stomach, too.

I often wonder how my traditional rock-ribbed Republican parents would have voted if they had not departed this earth in the late 1980s or had lived in either one of those two states. Dad was staunchly anti-union and later anti-New Deal, and both were pro choice. Both looked warily at any extremes that rocked the boat.

I do not remember my father complaining about taxes, but just wanting them to be spent honestly and efficiently and not to benefit the slackers of this world. My mother observed often that wild political pendulum swings would always come to rest in the middle. If change came, it had to come slowly and be absolutely necessary.

They were true conservatives in the political science definition of the word, but they would not have qualified for that definition given the litmus tests every single candidate seeking GOP support to run for president has to pass these days. Nor did they fit the definition of reactionaries, yearning for the good ol' days of Hoover, either. They had voted for FDR for his first two terms.

The GOP, however, found one spot of cheer … a vote in Ohio against Obamacare mandates, the part of the health care reform law that required everyone to buy into the system according to their income levels. The mandate issue is chock full of irony.

Karl Rove, the GOP political strategist, wrote in the Wall Street Journal that this was a significant vote. In a sense, he was being self-congratulatory since he played such a significant role in turning Obamacare into a dirty word. Ironically, the same week an appellate court upheld the constitutionality of the mandate clause and followed the pattern of other conservative judge's rulings on the subject. Other courts had ruled otherwise. The Ohio vote was effectively symbolic since the constitutionality question will be decided by the U.S. Supreme Court in the spring.

While I can guess my parents would have stood with the two governors on the collective bargaining issue and opposed personhood laws, they would have struggled with the health care mandate issue. They hated freeloaders of any social welfare system … those who took taxpayer money and did not make an honest effort to do their share. In fact, mandates were the brainchild of conservative think tanks for that reason . 

I could see the irony played out in the GOP candidate debate that took place the same week. While all pledged to overturn Obamacare, Michele Bachmann got a roar of approval for proposing that the poor pay their share of taxes, even if it added up to a couple of hamburgers. Freeloaders able but unwilling to pay into the health care system were fine, but the poor should not to be let off the tax hook, it appears.

Obama needs to counter GOP issues immediately

My column in the Sky Hi News today; also linked by the Wall Street Journal in onespot.wsj.com/taxes

The 2012 Presidential campaign is in full throttle with the GOP trying to sell us their pitch that small government, low taxes will cure the Great Recession and any other problem that even indirectly relates to it.

President Obama, on the other hand, has hit the road in defense of his jobs plan, revving up friendly crowds in pep rally style. That approach is not enough if he wants to become more credible to the less friendlies who still have an open mind. He needs to do a better job of countering the GOP's substantive arguments as they arise and not wait for a year.

In the past three years, the GOP has repeated untruths until the untruths have been accepted as fact, even after such assertions got shot down by impressive numbers of independent experts. Instead of calling the GOP out immediately, the administration has often remained silent, allowing the Republicans to turn fiction into common wisdom and making it harder for Obama to persuade voters later.

Now we hear that the president is waiting until the GOP settles on a candidate to paint a contrast between himself and the other guy. Why wait? There are platforms held in common by all of the GOP presidential hopefuls and the president can begin at least countering those now and save other attacks specific to the GOP nominee for later.

To a person, the GOP candidates are firing salvos against health care reform and the president's jobs act. They are a Greek chorus of “kill them both.” The president has not returned substantive fire other than lobbing back fairness issues. This may rally an already sympathetic base, but he needs more substance to woo the skeptical middle. It is not enough to have a day or two of rebuttals by experts on talk media, either. The president himself needs to draw more on credible evidence and logic than he has been doing. His challenge is indeed couching complex argumentation in effective sound bites.

The GOP attack line has been “kill the jobs plan; it won't work. We need long term solutions instead.” That last phrase is the GOP's Achilles heel because the voters need help today, not years from now. Credit Obama for repeating ad nauseam, “pass this bill NOW.” He has not countered the “won't work” argument, though. The rating agency Moody's and the poll by Bloomberg News of leading economists conclude that Obama's job plan will save us from a double dip recession, improve the GDP growth, and increase employment somewhat. Obama should shout out these evaluations and accuse the GOP of hurting job creation and risking a double dip recession by holding short term measures hostage to the long term. Both are needed and complement each other.

Obama's failure to make a case for health care reform has allowed “Obamacare” to enter our vernacular as a dirty word. Both the Simpson/ Bowles report and the Congressional Budget Office say it will save the deficit billions. The president is making a mistake if he is waiting for the Supreme Court to rule in the spring on the laws' constitutionality to begin his counter-attack, because no matter what the Court's ruling, there will still be finger-pointing and threats of new legislation throughout the 2012 campaign.

Polls show that two provisions already in effect in advance of the 2014  full health law implementation are popular: allowing young adults to stay on their parents' insurance and requiring coverage of pre-existing conditions. Is that what the GOP wants to kill? The GOP has never had a plan to provide affordable coverage for the 30 million uninsured other than to let them continue to burden the inadequate ERs, rely on hospital charity that passes their cost on to the paying public, or palm the solutions onto the states who cannot even pay their teachers and firefighters. Obama should call them on it sooner than later.

Raising Cain on "obamacare"

Herman Cain just won the Florida GOP straw poll.  In the Orlando debate this week, he also made one of the silliest statements  I heard…Not only were his allegations geared to fear,  based only on some speculation that there would be long waits for tests if we had “obamacare”,  he showed just how out of touch the GOP is. Cain’s comments need raising, even though most still do not consider him a winner in the long run, but  they are much like other Tea Party panderings made by other candidates.
 His comments  got cheers from the crowd.. Those are the same kind of crowds that roared  cheers that so many had been executed in Texas, that those without health insurance should die, cheers that a gay marine ought to be booted out with restoration of Don’t Ask Don’t Tell.  Cain said he was a colon cancer survivor because he had early detection and claimed if we had “obamacare”, he would have died waiting for tests.  Sheer speculation; sheer fear mongering, not based on any fact or study .  That was bad enough, but what he neglected to say is that there are 30 million uninsured in this country who do not get or cannot afford such tests and checkups and they will have that access to preventative medicine when “obamacare” is implemented in 2014.  Lucky Cain; he could afford insurance and tests;  many others cannot.

GOP/CNN/TEA PARTY DEBATE...FLYING IN THE FACE OF REALITY

I watched the Tea Party/CNN sponsored debate of the GOP presidential hopefuls last night and something profound may have happened.  Political theory and Tea Party character came face to face with real life.  Wolfe Blitzer posed a question to Ron Paul, the libertarian, in the context of the “obamacare” mandate requiring all to carry health insurance. “What should be the policy if a 30 year old male, who thought he was healthy and would not need insurance, and was allowed to opt out of insurance, had a serious health problem and was in a coma for 6 months in a hospital”? Paul, true to the libertarian view, said that individuals should take responsibility for their own health care and have insurance. The follow up question: what then should we do, let him die?
The most telling response from many more than a few in the audience was a shouted chorus of “let him die”.
Even Paul, a physician, was taken back and he responded,” no, when he practiced medicine back in the 60’s at a faith based hospital, the church took care of the expenses.” 
Aside from Paul’s living in the wrong century, where hospital stays cost far more than it did in the 1960’s and most charitable care hospitals have been bought out  by for profit large administration systems because they could not afford to provide charity care or raise enough money to do so, everyone there missed the most important point:
30 million people are left out of the system now and area unable to take responsibility for their own care if they wanted to because  they cannot afford the cost of insurance on their own that is as more as $12,000 per year for a family of 4.
There is indeed charity care.  That young man is not left to die today. However, his cost of care is passed on to consumers who already get health insurance and take responsibility and the expense  is then reflected in health insurance costs which are estimated to cost that family $1000 per year.  This is ER medicine and charity care which now provides everything from treatment of the flu to the long term hospitalization of the lingering coma patients for those who either do not have insurance or now have the ability to opt out of the responsibility of carrying it. We do not feel the cost if we have insurance, because of the matching from our employers or the deductions from pay checks or we have Medicare.  We just pay the deductible and assume that is the cost.  The result is a very inefficient system that costs two and a half times per person more than anyone else in the industrialized world and gives us outcome that ranks us near the bottom when the average is taken between those fortunately to have insurance and those who do not. The cost is buried where we do not feel the cost and we are fooling ourselves.
The universal litany, parroted by all of the GOP candidates is” kill Obamacare”.  Only they do not provide any other solution than, let the private sector be free to deal with it.  What? Isn’t that is the system we have had for the past one hundred years?  Let the private sector compete?  There is no competition in the private sector. Two or three for profit insurance companies control costs across all states and they are exempted by law from antitrust action, free to set prices and divvy up markets.  That is the reality.
Or the old and oft repeated myth that tort reform, which means keeping patients from making a frivolous lawsuits for mal practice (one person’s frivolity may be someone else’s dire situation) has been scored by the Congressional Budget Office as having a minor effect on the entire cost of health care and almost 2/3 of the states have already enacted caps on pain and suffering so bringing along the other one third would not do much.
What was astounding about the “let the patient die” folks in the audience, is that this is coming from the same group of Tea Party seniors who waived their signs in 2009 chanting,” do not let Obama take my Medicare away from me (before they realized it was a government program)” and railed in fear that death panels would decide their care. It is a description of their values that as long as they get their Medicare, others can die if they do not have insurance.  I am speaking as a person on Medicare and I find that view morally abhorrent.
The other oft parroted GOP slogan is that Obama care has stolen billions from Medicare to fund “obamacare”.  That is mostly Michele Bachmann’s shtick.  However, the $500 billion was taken from the useless subsidy of private insurers to administer a program called Advantage that provided an advantage to no one in improving their health outcome.  Instead, the measures taken by “obamacare” extend the life of Medicare by another 8 years, according to CBO.  Perhaps if Bachmann keeps repeating that mantra of hers enough, it will take on a truth that soars above the reality, or perhaps that has already happened.
Two other exchanges reached the level of repeating something when it is false until some take it as truth: Gov. Perry’s assertion that the original 2009 stimulus created no jobs.  CNN’s post reporting “fact check” again cited the CBO which it stated a range of over a million to nearly three million jobs were saved or created by the stimulus, which by the way, contained the GOP preferred many, many tax breaks. 
The other mantra, if repeated enough, could take on the aura of truth, even though reality is quite something else. It was couched is terms that only Tea Party members would catch and the general public would not.  The reform of Wall Street, to help us avoid another bubble crash based upon fraud and banks too big to fail, and obscure and false representation of investments passed on to other institutions, was called by all on the stage:  the Dodd Frank legislation. That piece of legislation is Wall Street Reform passed by Congress.   Just unleash Wall Street to do their thing was the agreement on stage.  What? To do again what brought on the first crash?

Mandates and recent lower court rulings

Below is a posting I did on the Muftic Forum Facebook profile Dec. 13, 2010. In addition to the comments in the posting are some more thoughts.  Besides expanding the size of the pool, the other advantage of requiring all to carry health insurance is that everyone is paying something they can afford into the system...which helps pay for health care reform. Before healthcare reform, 30 million paid nothing in premiums; with Obamacare, all but the very poor of them will pay something if not all toward their premiums. Only the very poor get off with not paying something toward their insurance; everyone else pays in with premiums based upon their ability to pay taking in consideration family size and income level.  For those not able to afford health insurance, if they buy insurance in the exchange, they will be discounted (subsidized) to the level they can afford. Everyone else who does not get any subsidy will still benefit from the stiff competition of the private insurers who compete within the exchange for their business..  That gives consumers a competitive market from which to choose. 
"About the recent Federal judge ruling on insurance mandates: While the judge ruled one way, two other federal judges have ruled another way, 18 more cases are still in various courts.  This pretty well makes sure that the issue will go before the Supreme Court.
I will not second guess the legal arguments, but I will comment on the fall out if the mandates are thrown out:
Above all, freeloaders will run up the cost making it nearly impossible to insure those with pre-existing conditions and the entire cost of the health care system will be impacted.
 The reason is that healthy and well as unhealthy must be included in a big pool to make the odds work and spread the risk around.  Freeloaders who choose not to participate will get sick, go to the ER, and, as we know, use of the ER now is extremely expensive medicine. Patients who go there are usually already very sick, prevention is not included in ER treatment, and abusing the ER as primary care doctor is expensive in itself. This is one reason health care costs twice as much per capita as it does in other industrialized nations.
The other cost is in covering those with pre-existing conditions. It will not happen without a large infusions of tax payer money or some other method of funding. One way to do it would be to establish high risk pools and subsidize them, segregating those expensive to insure from the others.  Republicans have proposed covering their cost by reforming mal practice or increasing cross state competition, which I support...in any case, but whether it could raise enough money and how it would do it is a very big question that has not been resolved or have projections been made by the Congressional advisers (Congressional Budget Office)  or independent sources, that I know of.
Otherwise, the state by state exchanges, the other provisions to ensure the uninsured who did not have pre-existing conditions, extending coverage to those up to 26 years old, and the consumer protections which are not conditioned upon pre-existing conditions would continue.  The state exchanges would exclude those with pre-existing conditions and bump them into some kind of high risk pool covered by tax dollars.However, others may enjoy the lower prices provided by the pools which give the private sector a level field to provide choices that meet certain standards in an above board competitive system.   Those not insured by their employers who are able to qualify for insurance may still find policies that are affordable in the exchanges.
 What I find angering is the glee many express at the possibility of the freeloading ruling succeeding.  It appears to me that they want health care costs to rise and those with pre-existing conditions to cost us more than Obamacare. They will not kill health care reform; just cut out the savings and make it more costly than it needs to be.
The only ones winning if the Supreme Court rules against the mandates are those who intend to freeload the system.  The rest of us will have gotten screwed."