30 Governors Open Health Care Ghettos: October 1, 2013

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The governors from over half of the 50 states have or are considering refusing to establish Health Care Exchanges and to participate in Medicaid as provided for by the Affordable Care Act, (ACA) cynically known as “Obamacare.”  My assessment is that the consequences of this decision by the Chief Elected Officers of these states is going to in actuality create a third-tier, low quality health care environment.  Simply put, those states that offer to their residents full participation in the rights and privileges provided by the ACA, which is the law of the land, will develop in a few short years, into first-tier, high quality health care systems.  The states  that don’t, however, will within a similar number of a years see their health care, both private and public, degenerate into a ghetto of medical inferiority.

I call it…Read More

Mitt Romney is Four Years Old

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I am sitting on my couch listening to Mitt Romney give his acceptance speech as the Republican nominee for President the United States.  What strikes me (as it has with other speeches I have listened to from the Republican National Convention) is that unlike scientific creationists who at least believe that the universe is a scant 6000 years old, Mitt Romney and the Republicans believe the universe is four years old.  Four years old.

Nothing in the universe existed before 2008 (shouldn’t that be year 0004?) in the GOP cosmos.  No universe, no galaxy, no solar system, no earth, no America.  It all spontaneously came into existence the moment President Barack Obama took office.

In the Republican cosmos according to Mitt Romney, nothing came into existence until Barack Obama became President of the United States. Four years ago.

That’s it.  In their cosmology all the ills America is facing are the directly the result of four short years.  Since nothing existed before that time, the Republicans and Mitt Romney believe there is nothing for which they have to take responsibility.

There is only one conclusion I can draw from Mitt Romney’s speech: The GOP is only four years old, therefore Mitt Romney is only four years old.

As a progressive and a Democrat I have news for them.  We live in a universe that is nearly thirteen billion years old, the solar system is four and a half billion years old, America is 236 years old, and four years ago when Barack Obama took office, the economy he inherited had been worn threadbare and emaciated by years of Republican living high on the hog, passing bills and conducting wars with unfunded mandates.  They are the ones who drove our economy into the ground, not President Obama.

And don’t the Democrats bear responsibility for their version of bad legislation in the past?  Of course they do.  What they don’t claim, however, is that the universe began with George W. Bush.  FDR, maybe, but not Dubya. (For the satire-challenged, that was it.)

Mr. Romney, since you are only four years old, you do not meet the Constitutional minimum age of 35 to be President of the United States.  Neither are your Republican toddler companions.  That goes for your running mate, Rep. Paul Ryan–a disciple of Ayn Rand, an atheist objectivist–along with Rep. John Boehner, so-called Speaker of the House who has raised obstructionist political shenanigans to the highest levels ever seen in the history of the Republic, and finally Mitch McConnell, minority leader of the Senate, who for the past four years–again that toddler age–has not one day done his job as a senator to govern but has dedicated is every breath to the defeat of the President.

America needs a mature adult in the White House.  That adult is Barack Obama.  He lives in the real world with a clear sense of history, both the good and bad.  And without a clear sense of history, there can be no clear sense of the future.  That is America–true Americans have never wavered from that clarity!

ACA Aftermath: Three Little Pigs & the Big Bad Wolf

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Three Little Pigs. Silly Symphony Original Release Poster, 1933. Courtesy Walt Disney Company.

Remember the story of the Three Little Pigs?  You know, one pig built a house out of straw and a second built a house out of sticks, while the third built a house out of bricks.  The antagonist is the iconic “Big Bad Wolf” whose ravenous appetite for pork knew no bounds.  Endowed with an impressive lung capacity he goes to each of the little pig’s houses and, as the story goes, “He huffed and he puffed and he blew the house down!”  (It’s more fun if you say it out loud with all the enthusiasm and glee a four year old would put into it.) The house of straw immediately collapses under this pneumatic assault, and the one made of sticks fares no better.  Their plump porcine owners scramble to find shelter in the house made of brick, which as we all know, survived the wolf’s hurricane-force winds, unscathed.  It is, of course a morality tale about being wise to the ways of the world and “building” the various parts of one’s life out of material that can withstand its big bad wolves, or storms, be they actual or virtual.  Either that or a clever publicity story concocted by the bricklayers union, but I prefer the former.

Now that the Affordable Care Act (ACA) has been declared constitutional by the Supreme Court of the United States (SCOTUS) there has been non-stop huffing and puffing by the Republican opponents of the law, who thought they were going to be rewarded with a Health Care house that was made out of straw, or at the worst, of wood.  SCOTUS, they reasoned, would strike down all or part of it so that they could legislatively “huff and puff” and finish blowing the house down.

Big Bad Wolf: “I’ll huff and I’ll puff and I’ll blow your house down!” Three Little Pigs, 1933. Courtesy Walt Disney Company.

But it turns out that the Court took the position of the third little pig and, in declaring the law constitutional, revealed a house made of bricks.  It’s rather like that moment on the television show, Extreme Makeover (Huh, something familiar about that…), where at the moment of climax as the family stands in nervous anticipation, the crowd yells in unison, “Driver, move that bus!”  Only in this scenario, the Republicans and their conservative wolf pack are not overcome with emotion at the fabulous new home standing before them, but rather are stunned, being confronted with an edifice made out of material largely impervious to their huffing and puffing.

Here’s the thing.  The story ends with the wolf leaving in abject defeat, his hunger unsated.  Conservatives, however, apparently lack the capacity to see they have lost this fight and therefore continue to huff and puff, launching into tirades to any convenient warm body holding a mic and a TV camera, insisting that they have actually won and it’s only a matter of four months until the General Election to prove that point.  Already, they have coined a new term to try to recapture their bluster: Obamatax.

We will be subjected in coming months to their incessantly chanting this new mantra as the justification for their huffing and puffing, but they fail to realize the American people just aren’t that stupid and soon it will become distracting background noise.  In fact, it already is.  Yes, the Supreme Court changed the word “penalty” to “tax” but despite the conservative’s vitriolic demonstrations of outrage and consternation over the ACA being declared “constitutional” there is nothing new here.  Nothing.

It is completely dishonest to claim that on June 28, 2012, President Obama imposed a new tax on Americans.  Completely dishonest.  And it only piles a huge mound of disingenuous, uh, bovine excrement, on top of that dishonesty to claim that President Obama lied to the country by promising there would be no new tax.  There wasn’t and isn’t.  Chief Justice Roberts bears the responsibility for substituting the words in his ruling.  The wailing and gnashing of teeth on the part of the GOP and the hyper-cons is all for show, political theater at its most profane.  Over-played and badly acted, at that.

The inconvenient truth for the Republicans is that the statue of their graven idol, Antitaxus Ultimatum, has feet of clay.  The Supreme Court just took a sledge hammer to it.  It now teeters, susceptible to collapse from the tiniest puff of air from a butterfly’s wings.  Or a poorly aimed huff from one of their own, say, perhaps one Mitt Romney?

I see two important lessons that Democrats should learn (and avoid at all costs) from the Republicans: If you lie to the American public long enough on the theory that the one who shouts the loudest is telling the truth, it does not take long for you to start believing your own lies.  Second, once you begin believing your own lies, you lose all perspective regarding the reality that ultimately the Big Bad Wolf failed.  He could not blow down the house made of bricks. Ever.

Why?  The answer springs forth in the words of the man who neither succumbed to the lie nor lost his perspective of what it means to be an American:

“…that this nation under God shall have a new birth of freedom, and that government of the people, by the people, for the people shall not perish from the earth.”

Abraham Lincoln, November 19, 1863. The Gettysburg Address.

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VINDICATED! Today a New Dawn Rose for a Healthier America

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CONSTITUTIONAL!

It is a day that even I wondered would ever come.  I began Extreme Thinkover with posts on the topic of comprehensive health care for all Americans.  I wrote in September of 2008:

The typical arguments for or against universal health care always focus on what the government will have to spend, what taxes will have to be raised to finance it at any level, or providing health care to consumers, i.e., virtually the whole population, has been, from my perspective, approached from the wrong frame of reference.

I put forth the argument on numerous occasions.  The Affordable Care Act, from my perspective, is a just solution to a miserably broken health care non-system.  It is just in the sense that this law creates a new level of access to medical assistance that Americans have never enjoyed, but that virtually every other First World country (and a number of smaller nations) has offered its citizens for decades.

The Affordable Care Act is the cornerstone of an inalienable right that makes possible in a tangible manner the chance for every person in the country to be healthier, and consequently enjoy the Blessings of Liberty. Yes, I can imagine the eyes rolling over that assertion.  But though it will take a generation, maybe more, to make that difference, doing nothing, that is, to go back to the pre-ACA situation, Americans would continue to be less healthy, costing perhaps trillions of dollars in avoidable care.  Now, at least we have a law, a system, that can turn that trend around.

Having worked in a hospital for over a decade and a half with daily patient contact, I can attest to the misery and personal suffering that those who have no insurance are forced to bear.  Add to that, my hospital is Catholic, with a mission to serve the poor and uninsured, and I have seen the incredible stress this very broken way of providing medical care has placed on my organization, restricting our capacity to plan for the future because tens of millions of dollars annually are required to subsidize those with no insurance.

I fully realize that the success of this change depends on individuals taking personal responsibility for their health.  I would contend, however, based on my experience with chronically ill patients who are poor or unemployed, they are caught in a vicious circle that all too often results in their getting the short end of the stick economically, for which access to medical care for wellness simply does not exist.

I could also put it this way, with the Supreme Court’s decision today, health care in America has finally stepped into the 20th Century.  The challenge now to us living in the 21st Century is fend off those who would overturn the law and plant us firmly back into the 19th Century.

People.  Real, live people with real live medical needs.  That is what the ACA is really about.  That is why for nearly four years, I’ve objected to the argument put forth by the law’s opponents that it was all about money and government.  I rejected that argument on both moral and ethical grounds.  Those who grouse that they are only paying for others bad habits are short-sighted, and in my opinion, fundamentally selfish.  To me, that argument is both highly ironic and paradoxical, because my experience with my neighbors has uniformly been that Americans possess a natural selflessness and generosity to help anyone in need.  But somehow getting the connection tied between to the two has been an uphill battle and continues to be.

For example, I have no doubt that if Sen. Mitch McConnell, Rep. John Boehner, Rep. Michelle Bachmann, or Sarah Palin were in a setting in which total strangers were injured and needed immediate emergency medical care, that every one of them would step up and wade in to help.  But all of them today condemned this law, despite the fact it acts on their behalf as well, so that their fellow citizens will receive that care as a matter of course.  And those patients won’t be nearly as likely to end up bankrupt as a result of seeking out that care.

Simply put, I don’t get it why they don’t get it. (I’ve got a pretty good notion why they think they don’t want to get it, however). Because of that great contradiction, conservatives like those mentioned above still want to overturn it legislatively.  I will continue to write to defend it.

(Yee-haw!)

Is Health Care a Constitutional Right?

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A Constitutional Right to Health Care?

The assertion that we have a right to medical care is one of the pillars supporting the Affordable Care Act.  Not the sole pillar, but one of them.

Photo Courtesy Blue Ridge Community College, NC

As with all of our rights, it has to be built up from some source that is part of the foundation of the national edifice.  Being a democratic republic, as I understand it, we in the United States have two sources.  One is the Constitution, and the other is the statutory authority given the various levels of government both federal and state by the Constitution.

Do we have the Constitutional right to medical care?  Read More…

The Supreme Court and the ACA: The Ultimate Death Panel?

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I started Extreme Thinkover in the fall of 2008.  The presidential race was in full swing.  Universal health care was one of the major topics that the candidates, media, and the public were debating.  One of my primary motivations for creating the blog was to have a forum in which to express my ideas about the health care debate.

I’ve worked in the health care industry for nearly 16 years and have daily contact with patients and families in the hospital.  I hear their stories, good and bad, about what these hospitalizations are doing to their lives.  Yes, what the hospitalization is doing to their lives.

Here in America, going to the hospital is not just about getting medical treatment; it’s also about entering a very broken and extremely expensive system. It nevertheless tries to limp along: In all fairness to the medical professionals who work very hard on behalf of their patients, in most cases, if you find yourself hospitalized, you get reasonably good medical care.

However, in the middle of this is an ongoing battle with the major health care players (hospital systems, health insurance, pharmaceuticals, medical equipment providers, etc.) all wanting to maximize their profits in an economic power race that too often is at the expense of the quality of care delivered to the patients who pay for their services, as well as forcing ever-increasing demands on their care givers to do more with less.  Admittedly, it doesn’t happen everywhere, but it is far too pervasive in Rube Goldberg “system” that passes for health care in America.

I wrote in fall 2008:

Here’s the question: What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?

That perhaps is not the question you expected to hear. The national conversation has focused on how much will it cost to provide all Americans with health insurance, how will the spiraling costs of health care be brought under control, will taxes have to be raised to pay for it, what will the roles of the health insurance industry, and the medical industries, and most of all the federal government be? Tough questions all around.

That question, “What kind of treatment and medical care is needed so that all Americans can be healthy, or as healthy as possible?” remains the key to a successful national health care program.  It also remains almost totally ignored by politicians, lobbyists, and, sadly the American public, none of whom have yet realized that without answering this question first, in my opinion, the debate about the cost cannot be resolved.  I contend this is why the health care law polls low for national support.

The current law, the Patient Protection and Affordable Care Act, passed in 2010, nibbles at the edges of what I think is essential, but it, also, is far too focused on trying to control medical costs.  And in case you are wondering, yes, I’ve read the law cover to cover.

Beginning Monday, March 26, the Supreme Court of the United States is going to hear arguments for and against the PPACA.  The primary question before the Court is whether Congress overstepped its authority regarding the interstate commerce clause of the U.S. Constitution by mandating all Americans (sort of) be required to purchase health insurance.  The debate is guaranteed to be rancorous, even in the sedate and forcibly polite setting of the Supreme Court.  The debate, though, once again is all about the money.  A healthy America will likely never even come up. The pundits will have a field day with this, without question, but I doubt any will see the fundamental flaw in all the arguments, based on my point of view.

Will the justices see past the smoke screen of political ideology, special interest group pressure, and inflammatory rhetoric that is fueling these proceedings?  If they do, and declare the law constitutional, there is hope that the ACA can continue to be refined, actually moving toward being a mechanism to support a healthier America.  If they don’t, by striking down all or parts of it, the Supreme Court will, for all intents and purposes, become the Ultimate Death Panel, condemning tens of millions of Americans to poor health, premature, and in some cases, an agonizing death because they will have been denied the right to even the most basic level of health care.  And that, tragically, just months before a law already on the books would have given them the care snatched away by the Supreme Court Death Panel.

Now we wait to see how this court rules on the fate of Americans’ health for generations to come.

The Thinkover:  When Patrick Henry uttered those iconic words, “Give me liberty or give me death!”  he wasn’t suggesting that death was preferred outcome of that stand for patriotism.  So far, the opponents of the ACA have been clueless to this obvious distinction in demanding “liberty” from the ACA mandate.

Dumbing Down the POTUS

This post is not about George W. Bush.  Really.  Although he had a role in my thesis.  This post is about our current president, Barack Obama.  I don’t want there to be any confusion about that.

It finally struck me yesterday what the GOP is up to regarding the November elections, after four events, three of which were unusual, filled the majority of my day.

They were, in this order:

  1. I watched two hours of Fox News shows at the behest of my friend, Dr. John Bogen, who is politically as conservatively moderate as I am liberally moderate.  Many of the themes I discuss below were the primary topics of those shows.  (If you are a regular reader of Extreme Thinkover, you will remember John’s very fine posts last fall on the H1N1 Pandemic, both regarding vaccinations and his advice how to understand H2N1 H1N1 (thanks, John!).
  2. I read an article about how the White House allowed President Obama’s passport–yes the President’s passport–to be photographed to counter the ongoing idiocy of the so-called “birthers” who obstinately cling to the totally false accusation that Obama was not born in the United States.  The issue of people believing the President is a Muslim is so far off the scale of absurdity it doesn’t even get its own separate number.
  3. While wandering around a big box electronics store I started experiencing chest pains and deciding to err on the side of caution and went to my hospital’s urgent care.  All my tests came out negative, fortunately, but with my family’s history of cardiac artery disease I’ve earned a ticket to be the main attraction in my second stress test.  Thinking about one’s mortality is a sobering moment for anyone.  I also have health insurance.
  4. After I got home, I got to watch my favorite NASCAR driver, Kyle Busch, set a NASCAR record at Bristol Motor Speedway in Tennessee by sweeping the three races of weekend.

It was during the race it hit me what the conservatives are doing to try to defeat the Democrats this fall and to discredit not only the president but the presidency in every way possible for their advantage. Why during the race?  Maybe it had to do with the vagaries of a car race, the strategies, and the ever-present reality that each driver and his car only has so much control over what is happening to them.  Someone else makes the smallest of mistakes and you can be out of the race with your car a pile of scrap metal in a fraction of a second.  Or maybe it was just dumb luck.

You will remember, quite painfully if you are a person with any capacity to carry on a civil conversation with someone you disagree with, the Cirque de Chaos we had to endure during the Congressional recess town hall meetings last August over the Tea Party and health care and carrying guns around in public like it was the Showdown in the O.K. Corral.  This year, there’s hardly been a whimper over this.  That’s because the new strategy is much more subtle and the Far Right learned one lesson: viewer fatigue.  By the end of August last year, the “scream at your politician” gambit had backfired; most Americans get fed up with toddler-type tantrums very quickly.  Simply put, the Far Right overplayed its hand.

The plan this summer is to make the president look dumb.  Also incompetent, if possible, but definitely dumb.

Why?  Because Barack Obama is probably one of the smartest presidents in the history of the nation in terms of sheer intellect.   So the way to attack him is to create, in this case, two exceptionally dumb fabrications about him: he wasn’t born in Hawaii, and he is Muslim, and then keep feeding those very stupid lies by constantly just hinting about them or have pundits “debate” the issue on TV and radio.

Dumbing Down the POTUS. Image Courtesy Motifake: http://www.motifake.com

http://www.motifake.com

This strategy works because there is no rational way to defend against it.  You can’t “put this one to bed” because there is no effective counter-strategy.  So the Republican leadership, now held hostage by the Far Right Wingnuts, can just keep the topic alive by continuing to feed their constituents who have bought into it.  And the way you do that is very simple: whenever the question is asked, you deny it, but ambiguously.

Last year, the Far Right tried shouting and threats of revolution.  It fell flat on its face.  This year they are trying lies and innuendo.  It’s a big gamble for the GOP because the Tea Party and other Far Right groups are much like a political multi-headed Hydra each with its own idea of who should be in control and what the outcomes should be.  But the Republicans lack a Hercules to control this beast.  Rep. John Boehner, Sen. Mitch McConnell, and RNCC Chair Michael Steele to a person lack the ability or imagination to keep these groups under control.  I suspect Rush Limbaugh and Glenn Beck are hoping they can throw meat at the monster without getting eaten themselves.

The question is can the Democrats find their equivalent of a Hercules to cut off the heads, politically speaking, of the Right’s Hydra?  President Obama, in my opinion, is more than capable, as we saw him campaign for the office, but now as Leader of the Free World, his focus should be on his job, not slaying dragons.  The same goes for Vice President Joe Biden.  Sen. Harry Reid, in addition to being in the fight of his career to keep his senate seat, is the epitome of milquetoast.  Rep. Nancy Pelosi has the fire, but in addition to being speaker of the House, is in her own campaign.  The DNC’s chair, Tom Kaine, is an excellent administrator, but has wisely kept out of the spotlight.

I’ve heard more than one pundit and politician say the Democrats are disorganized and not responding effectively to the attacks from the right.  That may or may not be true.  It may be the Democratic strategy is to let the Far Right, with all their fractures run their course, and when they begin to collapse, pounce with the equivalent with a sledge hammer against a glass window pane.  In reality it would not take much for the Republican Party to implode upon itself.  The GOP’s structure is much more precarious than they are letting on.

In the meantime they are going to attempt to make the president look dumb, out of touch, incompetent, a threat to the American Way of Life.  He is none of those things, so eventually the truth will out.  I continue to read the polls with a huge grain of salt.  Now I know what I’m looking for, I’ll be able to tell more clearly what is happening below the surface.  November 2, 2010 is still going to be a very interesting election day.