Nobamacare

Don't count on conservative "opponents" to torpedo the Ryan plan for ending Obamacare.  The Freedom Caucus is making noise, but at the heart of the current proposal is a goal dear to the far right: the destruction of Medicaid.

Most Americans who have health insurance enjoy it as an employee benefit, and are entirely indifferent to the cost of purchasing their own.  Nevertheless, the insurance exchanges got most of the attention in debates over the ACA — even though it was the law's expansion of Medicaid that was most significant in bringing health care to millions who lacked it.  The Republican "Patient's Choice Act" will not merely eliminate Medicaid for those enrolled in the expansion, but create a system of block grants to the states that will destroy the program entirely.

The single most important goal of the Obamacare repeal, like virtually every other piece of Republican legislation since Reagan, is to cut taxes on the rich.  Finding the money to do that inevitably involves reducing benefits for everybody else.  Ending Medicaid — which pays for half the babies born in the United States and half the elderly in nursing homes — uses a lot of money that otherwise might be lining rich people's pockets.  Sad.

The Patient's "Choice" Act will give poor patients a "choice" between medicine and food.  The chief hope for its failure is defections by Republican senators from states where Medicaid was expanded under the ACA, and where its elimination may do some real political damage.  Those senators now are working hard to figure out just how much damage might be done, and how well that damage might be offset by the gratitude of wealthy donors.

Economic Outlook

Although the Times still is publishing an extra section to cover election "news," and a lot of young people in urban centers haven't figured out that you're supposed to organize and get active before bad things happen, the dust is beginning to settle.

Somebody seems to have assured Wall Street that our next president will not be starting any trade wars, so the markets have stabilized.  Given Tr*mp's anti-regulatory instincts and the promise of even more tax advantages for the rich, a bit of a bull market certainly isn't out of the question.  Economically, it looks like Republican-as-usual on the horizon.

The narrow Republican majority in the Senate means that Obamacare, such as it is, will be safe for a while — although steady defunding seems inevitable.  In a way, it's a shame: the total elimination of Obamacare could pave the way for genuine national health insurance down the line.  The biggest beneficiaries of the ACA were those newly qualified for Medicaid, and it's pretty clear that letting market forces determine health spending continues to be unworkable.

I wonder how successful Tr*mp can be in moving expensive infrastructure projects past the deficit hawks.  They even might balk at a substantial expansion of border controls.  Forget the "wall" altogether: if there is any real progress towards seizing remittances to Mexico, invest in virtual currency exchanges — or, perhaps, organized crime cartels.

The biggest damage will be done to the fight against climate change — but even there, it seems to be too late to save the coal industry.  Hopefully, though, the industry's last gasps won't be a prelude to our own.

Noteworthy

Yemen
Saudi Arabia's war on Doctors Without Borders, along with its many other war crimes in Yemen, has not discouraged the Obama administration from providing aid and support to the monarchy.  Some say it's a matter of "making up for" the nuclear deal with Iran, but the influence of lobbyists for the arms manufacturers may be more important.  There's an effort underway in Congress to stop an impending sale of tanks and armored vehicles to the Kingdom — more as a signal of disapproval than as a means of slowing the war effort — but that would miff arms merchant General Dynamics, so don't count on it.

Obamacare
Aetna got all pissy because the Justice Department is suing to prevent the insurance giant's acquisition of fellow insurance giant Humana, and will cease operations over most of the Federal Exchange.  It's conceivable that some in government will finally concede that there has to be a public option, at least, available on every exchange — but don't expect Hillary to come out for National Health Care while she's pandering to Wall Street.

alt-Right
Stephen K. Bannon of Breitbart News is now in charge of the Tr*mp campaign, signalling total abandonment of establishment Republicanism and complete embrace of the racist, white nationalist extreme of the Republican Party.  Having alienated everybody else, Tr*mp hopes there are enough proto-fascists in the USofA to give him a victory.  Failing that, he is looking for an investment opportunity in some "news" outlet where he can continue to indulge his narcissism.

Demarcating Dems

Last night's debate might have had a real impact on undecided Democratic voters had any of them been watching it.  Somehow, though, I suspect the audience was comprised primarily of persons already committed to either Bernie or Hillary.  Might any of them been swayed towards the other side?  Maybe.  Probably not.

Partisan towards Bernie, I thought my candidate did an excellent job of casting Hillary in the role of toady to the rich, with special emphasis on big banks and big pharma.  Hillary did well portraying Bernie as soft on the NRA; but gun control is far down the list of important issues to most Democrats.  Martin O'Malley (whom I do not believe is angling for a vice-presidential spot) joined in on both attacks, and will be a man to watch in 2020 or 2024.

Is Hillary being honest when she says Bernie wants to "destroy Obamacare?"  No.  He'd like to replace it with a far superior single payer system, but nobody in her right mind could think he wants to first cancel the Affordable Care Act and only then work towards "Medicare for all."  Would Bernie be able to get his ideal single payer system if he were elected?  No, but if nobody even is willing to talk about single payer, it will never become a real possibility.

Bernie stands against kleptocratic plutocracy, which pulls the strings of our alleged "government by the people," and has been with us roughly forever.  Okay, maybe it is inevitable, but that doesn't mean we have to like it, nor just roll over and accept it.

Hillary is a better option than some others — pick any of the Republicans — but she should not go into the election thinking of herself as the ideal Democrat.  (O'Malley is working hard to win that title.  Yes, definitely keep him in mind for the future.)  Personally, I think Bernie actually could win the presidency if matched against many of the Republican contenders.  Maybe he would have a very frustrating one-term presidency, but it would signal an historic shift in American consciousness.

Now that the Republicans are tearing themselves apart, why should the Democrats step in to take on the role of defenders of corporate dominion?  (Answer: so Democratic politicians can dig their hands deeper into the corporate goody bag.)

Catching up

Stuff has been happening, and I've been either too busy or too lazy to blog: hence, some quickies.

Domestic Terrorism
Speaking of catch-up, yesterday the New York Times caught up with my previous post about the greater terrorist threat in the USofA, albeit citing a new source.  Check it out.

Greece
Greece's creditors continue to demand more austerity in exchange for keeping Greece out of default.  Accepting such demands will exacerbate Greece's already drastic economic problems.  Do the creditors really continue to believe in austerity, or are they trying to monkey-wrench the Syriza government?  The latter seems increasingly likely.

Racist Symbology
Symbols are important in the context of human psychology, so it is not surprising that racist Southerners cling to their Confederate banners, statues of John C. Calhoun, and similar bric-a-brac.  Also, it is not surprising that most black Americans want to see the last of such gewgaws.  Still, the First Amendment protects even the most hateful expression, so cowardly Republicans saying "the states should work it out on their own" unwittingly have a point.  (On the other hand, Confederate symbols represent not only racism, but treason against the government of the USofA.  Are the "Sons of the Confederacy" really endorsing treason?)

(Tweet: #ConfederateTakeDown - Replace #SouthCarolina #BattleFlag with WHITE flag! They DID surrender! Hooray for #heritage and #SouthernPride!)

Obamacare
Well, the Supremes said we still can have it, and it's better than nothing — but we still must do better.  I don't see any opportunity for a real national health insurance system at any time in the near future, but then I would have said the same, not that many years ago, about...

Same Sex Marriage
Congratulations to the LGBT community!  Granted, the "T"s still need a lot more public acceptance, but the right to marry won't be one of their problems now.

Legal Insanity
Let's face it — none of us can claim to be a paragon of "mental health."  James Holmes is nuts, and so is Dylann Roof, and the same is or was true of Dzokhar Tsarnaev, Nidal Malik Hasan, Eric Harris and Dylan Klebold, Adam Lanza, Josef Stalin, Idi Amin, and a bunch of other mass murderers.  Just the same, you can't convince me that any of them were unaware that what they were doing was wrong.  I don't approve of the death penalty, but just the same, a person has to be totally delusional before he meets the criteria for legal insanity, and that's as it should be.  Behavior must have consequences.

The Affordable Care Act

The worst thing about Obamacare is not that the website doesn't work, nor that women (and men) in their fifties are required to buy policies with maternity and pediatric coverage, nor that the President out and out lied about how people could "keep" their coverage if they "like" it.

The worst thing about Obamacare is that private insurance companies are in charge, which, in many markets, means there is essentially, no competition.  If only one or two companies want to get into a market (and why they're allowed to do it by county instead of by state is beyond me), premiums necessarily will be high.  This is the state of affairs in many rural areas.

When Obama punked out on the public option, thinking he might get some "bipartisan" support (he didn't), he blew a hole in the side of "health care for all."  If the Affordable Care Act is his "signature" achievement (along with strenuous persecution of whistleblowers), he's been a pretty crappy President.

It's unlikely the Democrats can take back the House in 2014, no matter how crazy the Tea Party has been and may be.  Districts are too well gerrymandered.  Even if they do, though, I don't think single payer would stand a chance.  Robert Rubin Democrats will stand in its way.

Assorted Stuff for October

That Unfortunate Website

Well, the federal ACA website has bombed big-time.  The O is taking the heat, but we should remember he's not personally responsible for everything.  On the other hand, his people did sign the contracts with the private sector contractors who screwed it all up.

Unfortunately, we no longer are allowed to create federal agencies to take care of such major efforts.  We have to divvy up the money to be made on such projects among private sector contractors, probably because the public sector doesn't have enough lobbyists.

Holderman v. Dimon

It appears that J.P.Morgan-Chase will be paying 13 billion bucks to resolve most of its liabilities from the mortgage crisis.  Maybe it's not entirely fair, because Dimon's bank didn't own WaMu or Morgan-Stanley when they racked up lots of the losses.

What the hell.  J.P.Morgan-Chase picked up WaMu and Morgan-Stanley at bargain basement prices.  Dimon didn't have to be goosed along too hard, and at the moment, it seems that his farts still don't stink.

The whole thing is making Holderman look better than usual — to wit, he's doing something other than chasing down leakers.  Is 13 billion enough?  Who knows?

Afghanistan

As in Iraq, we're having problems leaving troops behind after the scheduled "withdrawal," because we want our troops to be immune from local and national law.  Murder?  Rape?  Really, we'd rather try them back home.

Personally, I don't see the problem.  Afghanistan is so corrupt, it should be fairly inexpensive to bail the naughty boys out of their trouble, not that I necessarily approve.  On the other hand, some Special Forces asshole could wind up being a political asset for whoever happens to replace Karzai.

If we don't leave any troops behind, it is quite likely that Congress will decide to stop financing the Afghan military.  That's okay by me.  They hate us and our imperialism pretty much all over the world, so Afghanistan should not be especially "special."

The "Train Wreck"

John Boehner really, really, really wants to keep his job as Speaker.  He's not stupid, and I'm sure he doesn't want to shut down the government, but he had to go along with the radical crazies in his caucus for fear of losing his job.  That's why he supported the House bill to defund Obamacare, referring to the ACA as a "train wreck."

The real train wreck will come at the end of the month, when government shuts down.  Unlike the catastrophic Congress Clinton had to deal with back in the nineties, which had enacted a fair number of appropriations bills before digging in its heels, the current Congress had not passed any appropriations bills at all.

Not long after, of course, we come up against the debt ceiling.  Will the crazies carry through on their threat to let the USofA default on its debts?  Are they really that crazy?

I guess all we can do is wait and see.

The Big Surprise

We've become so accustomed to Justice Kennedy being the swing vote on the Supreme Court that just about everybody waiting for the ruling on Obamacare (ACA) was going crazy trying to figure out what he might do.  Personally, I didn't have much confidence that he would uphold the individual mandate — and I turned out to be right.  He didn't.

The real surprise was that the swing vote, this time, came from Chief Justice Roberts.  Mind you, he didn't uphold the mandate based on the Commerce Clause, as the four liberal justices did.  Roberts construed the mandate as a form of a tax, and hence within the powers of Congress to enact.

Actually, it seems only reasonable that one of the conservative justices, at least, would find it possible to approve a plan designed by the Heritage Foundation.  It may be that Roberts, while ideologically conservative, is less political than Thomas, Alito, and Scalia.  It may also be that he wanted to find a way to approve the ACA for the sake of the nation's health.

We know that the Republicans in Congress will try to overturn the law, but as long as there are 41 Democrats in the Senate, it won't happen.  In the meanwhile, some states my try experimenting with public options, which have to bring down insurance costs because they would be non-profit and require no advertising.  We'll see.

To your health...

The weather's been especially windy this month, and so have I. What the hell — here comes post #11 for March.

As we have seen in the past week (if we hadn't noticed it earlier), the Supreme Court is thoroughly politicized. Now there is no branch of government in which the American people can place its faith.

The first mistake of the Obama administration was deciding to go with a health care plan designed by the Heritage Foundation. Did Our President think a plan designed by a right wing think tank would lead to bipartisan support for universal coverage? Probably not. For a smart man, he's more than a little naive, but he couldn't have been that innocent. Even though he never actually joined the DLC, he's been a fellow traveler — and he certainly didn't want to offend the deep-pocketed insurance industry.

I don't know whether the individual mandate is or isn't constitutional, and I don't suppose it especially matters — unless Chief Justice Roberts, perhaps, figures out he no longer is beholden to the plutocrats, or Kennedy hits the Jameson's a little harder than usual. (Our affirmative action Justice, as usual, said nothing — but we all know how he'll vote.)

What I do know is that if the Democrats had some organization, some discipline, and some guts, we might even have single payer on the horizon instead of a jumbled mishmash of questionable legislation which will do nothing to lower health care costs. (Okay, that was just wishful thinking — too many goddamned DINOs were standing in the way. There may have been sixty Democrats in the Senate, but there were a hell of a lot fewer liberals.)

I can't fault Sandra Day O'Conner for leaving the court — I am not one to begrudge anybody's retirement — but I still wish she had stayed. I don't know how she would have voted, but I'm sure her vote would have been based on her understanding of the law rather than on ideology.

Okay. That should do it for March.

Burning down health care — the "free rider" principle

By this time, everybody's heard about that incident a few months back when Tennessee firefighters stood by and watched a family's home burn down because the family had neglected to pay its $75 annual subscription fee for fire protection. As reported by the Times, this led to a bit of a dispute in the conservative wing of the Republican Party, and an interesting dispute it was!

Mr. Cranick, the owner of the home, offered to pay for his subscription — which he had paid in previous years — if only the firefighters would come over and save his house, but it was too late. The fee was due when it was due, and that was that. They came to protect a fee paying neighbor's house, but Mr. Cranick was on his own.

More recently, Fourth District Court Judge Henry Hudson ruled the Obamacare mandate that individuals purchase health insurance unconstitutional — an overbroad interpretation of the Commerce Clause. I am inclined to agree with Judge Hudson. I was unhappy with the mandate when it was first announced. I don't see why, for the sake of my health, I should be required to buy, for example, a gym membership; nor, for the sake of my moral health, a copy of Why Good People Do Bad Things.

The root of the problem, of course, was Obama's typical bargaining strategy — start out by giving the opposition half of what it wants, and then "compromise" by giving it most of the rest. What could be better for private health insurers than forcing young, healthy people to pay them? Since the only way to make private insurance affordable for sick people is to enroll healthy people, the mandate is the linchpin of the whole, complex, schizophrenic policy.

So let's get back to the Tennessee firefighters, who refused to "treat the uninsured." Unlike the vast majority of public hospital emergency rooms, they were allowed to do that. Because of the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA), any hospital that accepts Medicare has to provide treatment to every patient, regardless of ability to pay. Offering free treatment to the uninsured guarantees free-ridership — people who take advantage of the "fares" paid by others to benefit themselves.

If the Supreme Court upholds the decision of Judge Hudson, it makes perfect sense to repeal EMTALA. Is your leg broken, otherwise healthy young man? Set it yourself, or pay the hospital, say, $17,000. Need a liver transplant, oh rugged, self-sufficient libertarian? That will be $329,ooo please.

I would hope that children whose parents failed to buy them a heavily subsidized CHIP insurance plan would receive treatment at public expense, but their parents should be charged with gross neglect, lose custody, and spend a little time in jail. I can't see why that would be unconstitutional.

Of course, the real answer is a single payer system funded through taxation. I can't see any court ruling that one need not pay taxes for goods or services one does not want. Hell, I don't want the taxes I pay to fund the war in Afghanistan, farm price supports, faith based initiatives, and scores of other things they pay for now — but I still have to pay.

The truth is, Obamacare won't put nearly as big a dent in our health care spending as is needed, even if the Supreme Court upholds the Administration's point of view. We have to start viewing health care as a public good — something government should provide for everybody — and strip the profit motive out of our health insurance.