30 Governors Open Health Care Ghettos: October 1, 2013

Featured

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

ACA Aftermath: Three Little Pigs & the Big Bad Wolf

Featured

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.

.

.

.

.

.

.

.

ALERT: You may have received this post with an advertisement embedded below.  These ads are automatically placed by WordPress and have not been approved by Extreme Thinkover.  It should not be construed to in any manner be part of the post or an endorsement of the company or its products.  If the advertisement violates the standards for Civil Discourse required by this blog, it is solely the fault of the company.  Please contact me if you find an embedded ad offensive and I will file a complaint with WordPress.

VINDICATED! Today a New Dawn Rose for a Healthier America

Featured

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?

Featured

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…

Landing the Health Care Reform Bill: It Feels Like Apollo 11 Redux

The voyage of the legislation to create a Health Care Reform Bill has all the

Sen. Harry Reid Launches Health Care Reform in U.S. Senate. Photo credit: C-Span

emotional elements of landing Apollo 11 on the Moon in July 1969.  Health Care reform has been a long, complex mission with an uncertain outcome.  Is it an overstatement to say that landing on the Moon and returning to Earth was an easier and safer endeavor than getting the Health Care Reform Bills passed, conferenced and onto the President’s desk for signature?

At this moment, it seems almost to be the case.

When Neil Armstrong took manual control of the lunar lander to find a safe spot to set down, a thousand different things could have gone wrong.  In fact, alarms were going off in the cockpit.

As the Eagle’s landing radar acquired the surface, several computer error alarms appeared. The first was a code 1202 alarm and even with their extensive training Armstrong or Aldrin were not aware of what this code meant. However, they promptly received word from CAPCOM in Houston that the alarms were not a concern. The 1202 and 1201 alarms were caused by a processing overflow in the lunar module computer. As described by Buzz Aldrin in the documentary In the Shadow of the Moon, the overflow condition was caused by his own counter-checklist choice of leaving the docking radar on during the landing process. Aldrin stated that he did so with the objective of facilitating re-docking with the CM should an abort become necessary, not realizing that it would cause the overflow condition.  Source: Wikipedia

Eagle Lunar Lander just seconds after separation, Apollo 11, July 1969, Photo: NASA

It’s one thing to read about it.  As we close this 40th Anniversary of the Apollo 11 Landing, it really is much more satisfying to watch it.  This video is one continuous shot of approximately the final 10 minutes of the descent and landing, viewed from the right window of the LEM.  The audio is quite good, as well.  Watching it still stirs in me that sense of excitement I felt as a 16 year old kid glued to the TV set with my family.

[For a similar, but NASA produced video, click HERE.  This is the final approach, and included is an inset window that tracks the Lander’s progress crater by crater.  It provides a sense of perspective for the approach.]

Regarding the impending passage of the Senate bill and then the conference process, if you tend more toward the pessimistic side, you probably agree with Jonathan Cohn of The New Republic:

If your standard for comparison is your ideal health care reform, then of course this will be disappointing. Like every bill that’s moved through Congress, this one would leave millions uninsured even after full implementation–and leave millions with coverage facing substantial, although generally not crippling, financial burdens. It would introduce some reforms to the delivery system and, according to the official cost estimates, generate budget surpluses over time. But it’s not going to radically turn American health care into a paragon of cost efficiency.

If you tend more to the optimistic side, you probably agree with Paul Krugman of The New York Times:

Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable.

So how anyone can call a plan to spend $200 billion a year on Americans in need a defeat for progressives is a mystery.

I wish there were a public option in there; I wish there were broader access to the exchanges; I wish the subsidies were even bigger. There’s lots of work to be done, work that may eventually culminate in a true, not simulated, single payer system. But even in this form, we’re looking at something that will make America a more just, more secure nation.

If you are a Republican or Tea Party Advocate, you are most likely hoping and praying the Health Care Reform bill will suffer the fate of the Soviet Luna 15 Lunar Lander Probe that was launched three days before Apollo 11:

Luna 15, launched only three days before the historic Apollo 11 mission to the Moon, was the third Soviet attempt to recover and bring lunar soil back to Earth. The spacecraft was capable of studying circumlunar space, the lunar gravitational field, and the chemical composition of lunar rocks… After completing 86 communications sessions and 52 orbits of the Moon at various inclinations and altitudes it began its descent. Astronauts Armstrong and Aldrin had already set foot on the Moon when Luna 15 fired its main retrorocket engine to initiate descent to the surface at 15:47 UT on 21 July 1969. Unfortunately, transmissions ceased only 4 minutes after deorbit at a calculated altitude of 3 kilometers. The spacecraft impacted the lunar surface on July 21, 1969. The spacecraft had probably crashed onto the side of a mountain.   Source: Wikipedia.

Launched 3 days before Apollo 11, the USSR's unmanned Luna 15 crashed onto the Moon's surface just hours after the Eagle had safely landed with Armstrong & Aldrin on board.

I’ll give House Minority Leader, Rep. John Boehner (R-OH) the final word…

Photo courtesy Politico.com & BlueStateDigital.com

No, I think I’ll give this Tea Party protester the final word.  Just like the rest of us loyal and patriotic Amurricans, life without spell-check is worse than…oh, wait, he spelled the word right.  In high school he clearly decided to protest which sections of Mrs. Dewey’s English classes were not patriotic enough, because he was getting this way-too-liberal education paid for through public taxation.  And those unacceptable sections happened to include homonyms and writing complete sentences.  I think his pointy hat needs to be cone not a tri-corner.

A Tea Party Protester: The Epitome of the Well-Educated American. Photo: ImageShack