The Wound That Will Not Heal

It has been eight months since the presidential election, nearly six months since the inauguration and almost two months since I published my post entitled Enoughbut I still wake each morning with emotions ranging from disbelief to disgust to horror.  I shared in that earlier post that my psychological dyspepsia is not purely in response to the rejection of my liberal views by the majority of (electoral college) voters.  It is largely a reaction to the clear and tabulated fact that nearly half of those who voted in the 2016 election knowingly cast their ballot for the human being least capable of being president and that the “winner” continues to demonstrate his ineptitude on a daily basis.  Depending on the day, it is difficult to know if he is channeling Nora Desmond or Ron Burgundy, but all of the days are painful and frightening.

As stated elsewhere in this weblog, Potus is not merely a threat to progressive ideals, he is a threat to the homeland and to the planet.  I know some would argue that we shouldn’t fear his effectiveness, given his inability to focus on anything other than his boyfriend Vladimir Putin and his constant display of hatred toward any media outlet other than Fox News.  Even when he is caught attempting to further the conservative agenda, he often thwarts those efforts by either forgetting which position he is supposed to take (Trump Abandons AHCA), or by completely ignoring his role and instead taking to Twitter to degrade folk who criticize him, which he does with particular zeal if they are women (Attacks on Morning Joe hosts).

Of course, Congress and his White House entourage are more than able to inflict damage while he is sidetracked, but the real threats emanate from the man himself.  The hazards include his ally-enraging reduction of global politics to “The Art of the Deal”, boasting that only agreements which seemingly leave America (read: Potus), on top are acceptable (Withdrawal from Paris Climate Accord and Behavior at Nato National Embarrassment).  There is also his very clear intent to do absolutely nothing with regard to foreign interference in our democracy, as demonstrated by his firing of FBI Director James Comey and his reluctance to keep existing or to add new sanctions against Russia for election meddling (though we must stay tuned to learn his actual motivations for those actions).

While I am unable to include the full name due to my unwillingness to further promote the “Marketer-in-Chief”, there is a Twitter feed called “***** Regrets” (I think my readers can figure out what the asterisks stand for), which purports to follow Potus’ twitter account and then retweet messages sent from his former supporters now expressing their buyer’s remorse.  A random sampling of contributors and their historic tweets certainly suggests that they really may have voted for the man.  The messages contained there, however, are exactly the type of messages that all cognizant citizens—whether they are guilty of placing him in office or not—need to be sending.

As real facts continue to unfold, it is entirely possible that the current “threat to democracy” could be impeached (and/or possibly jailed), but failing that, I still believe that if his electoral “Neilsen Ratings” continue to fall and remain low, the narcissist will concede and return to the business of swindling both real estate investors and building contractors.  I also still believe that those conservative voters who helped create this disaster should not fear that their repudiation of this president will compromise their conservative goals.  Again, the reins will fall to Mike Pence, and though it appears that the “Christian, Conservative and Republican…in that order” may turn out to be one of the most prolific liars of all time (All False Statements…Enabling a Dangerous President, and What Did Mike Pence Know?), his political mission is unambiguous and voters on the right have already proven that veracity is not a required virtue for their leaders.

It is evident, even to some errant voters, that a terrible wrong has been committed, a dangerous force unleashed and a severe wound inflicted…a wound that if not cauterized could be terminal.  Keep resisting bad legislation, but also let your representatives (whether of your political stripe or not), know your opinion of this president.  Remember that the way to an egomaniac’s heart is through his ego.  So tweet and email and march and shout your dissatisfaction while encouraging others to do the same.  You’ve nothing to lose by acting, and everything to lose by just wishing the hurt away.  Contrary to the proverb, time does not heal all wounds.


“Resistance” versus “The Politics of No”

Both arms of Congress and the White House are currently controlled by conservatives (the White House control emanating not from its ideologically-challenged resident, but from the nest of ultra right-ring hooligans who have infested his ear).  Since the presidential surprise of the election (admit it Conservatives, while many of you were hopeful, you were as shocked as everyone else when you awoke on November 9), many liberals have pledged to resist the new administration.  My fear is that resistance will be confused with the politics of no.

resist:  verb  re·sist \ri-ˈzist\   to exert oneself so as to counteract or defeat.

I count myself among those who want to counteract and defeat ignorant, selfish or dangerous propositions championed by any politician.  In fact, isn’t resistance to policies and legislation that are contrary to our political beliefs one of the two main reasons we align ourselves with a political party (the other being the actual promotion of policies and legislation that we support)?  

Our congressional representation currently operates via a multi-party system, which provides additional “checks and balances” within a branch of government already designed to protect us from run-away power.  In theory, ideas supported by the majority of Americans (unless bridled by specific protections otherwise afforded by the Constitution), should be the ideas that are successfully integrated into law.  However, when the electorate is so divided, it can and does result in a gridlock that prevents any progress.  Gridlock is not new and is not always undesirable.  The lack of forward motion can actually be a good thing if the movement would take the country over a cliff.  But for nearly a decade now there has been a serious obstacle to any movement; “the politics of no”.

Just after the 2008 election of Barack Obama, GOP House Whip Eric Cantor made it clear to his caucus that their sole responsibility for the foreseeable future was to make sure that Obama could not point to any bipartisan successes.  And who can forget the  announcement from the Senate minority leader in 2010, No Second Term?

The requests from those two “leaders” were heeded.  While Republicans had just achieved (with Democratic help), a huge Wall Street bailout at the end of George W. Bush’s presidency, they unanimously rejected Obama’s Recovery Act offered within a week of inauguration.  It passed anyway and is considered by many to have saved the U.S. from economic catastrophe, helping both progressives and conservatives alike (see Stimulus Act Was a Success  and  Stimulus Program Was a Smashing Success).

Republicans united to oppose the Affordable Care Act, even though it was largely based on Romney Care in Massachusetts, addressed many of the elements that conservatives had cited as unacceptable in Clinton’s proposed 1994 reform package and solicited input from the other party.  It also passed without  Republican support, but how much better could it have been (be?) if all parties had worked together?

There were other examples of the right digging their heals into the ground attempting (and sometimes succeeding), to thwart any action that could cast the president in a positive light, even if the action would have benefited their own constituents.  Ironically, they did not prevent Barack Obama from being re-elected.

True to his original campaign word, President Obama made attempts to include “the other side”, but they were rebuffed.  Since neither the current Potus nor any incumbent Republican that ran again in 2016 claimed to foster bipartisanship, it is not surprising that they feel no need to now include Democrats in decision-making.  That attitude does not, however, excuse Democrats from trying to contribute (as an excellent case in point, see Senator Claire McCaskill is Stunned).

We have a representative form of government, from Dog Catcher to President, and we all have the opportunity and obligation to not only keep our representatives informed of our views, but also to keep them accountable, to let them know we’re watching…and not just on election day.  I implore liberal voters to request that their representatives and senators resist any and all actions that may be counter to their values, but I also ask them to request compromise and cooperation where ever possible on those issues that would benefit all citizens, regardless of who may receive the credit.  Democratic leaders should not be guilty of the childish pouting and breath-holding behavior that we’ve witnessed from Republicans for the last eight years.

“Just Say No” didn’t work for Nancy Reagan’s anti-drug campaign in the eighties and it hasn’t worked for Republicans in the new millennium.  It’s ineffective and destructive and as tempting as it may be to make sure no one can attribute anything good to the existing Potus, I firmly believe that he will do and say enough on his own to ensure his demise.  Besides, there are 321.4 million folk who need all of our legislators to be bigger than that.






Ya Vol, Mein Fuhrer!

I apologize for the brevity of this post, but I don’t think I can compete with the clip below.

Megalomania / noun / meg·a·lo·ma·nia / mania for great or grandiose performance

Why is it that we might believe James Comey is being truthful regarding POTUS’ request for loyalty?


Repeal and Replace the President

My stated goal for this weblog was to “elevate the political discourse…based on actual facts, and…keep hyperbole and name calling to a minimum”.  With a couple of name calling exceptions, I believe I’ve adhered to those objectives, however…

I and at least 65,844,609 other Americans have had enough!  I personally have tried to understand—even perpetuated excuses for—the 62,979,636 ignorant and/or selfish voters that put an egomaniacal, racist, misogynistic individual in the most powerful position on the planet.  I thought by employing empathy (or even sympathy), I could better understand what caused some of my friends, family or complete strangers to intentionally bestow power on this brute, thereby being better equipped to address their issues.  I was wrong.

Conservatives may not understand why so many liberal Americans were paralyzed for weeks after the election.  It wasn’t that our political agenda had been thwarted, that the Affordable Care Act might be in jeopardy or that isolationism might be in vogue again.  Our ideas have been rebuffed at the polls before.  The reason we were in shock was the realization that voters had chosen as the leader someone whose incompetent and dangerous behavior had been fully documented.  Liberals went to bed on November 8th knowing that we had friends and neighbors who disagreed with us on tax policy, immigration and states rights.  But we woke-up on November 9th to find that many of those friends and neighbors had ingested some Apprentice-flavored Kool-Aid and were willing to play Russian Roulette (pun intended) with our nation and our planet.

The jester now occupying the White House had succeeded in seducing many Americans with either his unsubstantiated “Greatest Show on Earth” promises of material wealth or his “I’ll keep those bad Mexicans and Muslims away from you” wall-building and anti-refugee rhetoric and in spite of his “can you find my principles?” shell game.  He also reaped the benefits of some liberal voters who decided to throw a political tantrum.  In the end, he secured enough votes to claim victory in the Electoral College, which is all he needed.

From research, personal conversations and witnessing “man on the street” interviews since the election, I think I have identified the primary groups responsible for sending the snake oil salesman from Queens all the way to Washington, though these categories may surely overlap.

  • There were the disenfranchised conservatives and some blue-collar Democrats who culled the guy from the rest of the Republican herd (remember, there were originally 17 options in the primaries), because he’s the one who “tells it like it is” or “says what he thinks” or “will shake things-up”.  I have to choke back my own vomit every time I hear those rationales.  He says the first thing that comes to his underdeveloped mind, sometimes it’s the truth, sometimes it’s not, and sometimes he reverses himself the next day (80 Times Trump Talked About Putin), but there is no evidence that he thinks about anything before speaking.  We have all let something slip from our lips before we completely process a thought, though it’s usually at a bar after we’ve had a few and we hopefully learn from the mistake.  And history is replete with slick politicians who only deliver well-crafted but meaningless dribble.  The President of the United States, however, needs to be measured in both thought and word before ever communicating in any way. Words matter, and words coming from the leader of the free world impact countries, fortunes and individual lives—not just the quality of their lives, but their very existence.  The  current White House resident exhibited diarrhea-of-the-mouth each day of the campaign and continues to do so.  Whether it’s because he is incapable of intelligent discourse or just wants to hear the cheers of a gullible crowd, it is horrifying and dangerous.  As for “shaking things-up”, the government of the United States of America is not some Parent Teacher Association chapter with a candidate promising to use cloth napkins instead of paper at the next fund-raiser.  How dare you?
  • There were Christians.  Since it is a long-established truth that “only Republicans are God-fearing citizens”, it should not have come as a surprise how they voted in 2016.  Exit polls revealed that 58% of protestants and 52% of Catholics who bothered to vote cast their ballot for the Republican choice.  I’m someone who knows his way around the Bible, but I have been unable to find the New Testament passage that condones famous men grabbing women by the pussy.  Nor have I been able to identify the parable illustrating that all Muslims are latent murders.  Equally difficult to locate are any of the stories about Jesus healing the disabled only after he mocked them in public.  So Christians who voted for Lucifer, I guess you had economic or different social issues that outweighed your candidate’s known “short-comings” and hopefully you can explain to your god why they were more important.
  • Although I was reluctant to believe that such a voting block existed, it turns out that the current chief executive received help from some disappointed Bernie Sanders supporters.  Apparently they believed that universal health care or income equality could best be achieved not only by with-holding their vote from the Democratic candidate, but by actually giving it to a corporate deity.  The testimonies from this group reveal that they basically voted to show their complete dissatisfaction with the Democratic National Committee as well as many Democratic voters.  You certainly showed us.  Well played!
  • Lastly, there are the folk who proudly proclaimed that they would vote for ANYONE other than “her”.  You have clearly demonstrated that your country is very important to you and that you fully comprehend the importance of the right to vote.

So what now?  The offenders can’t take their votes back.  Impeachment is just a reprimand from the House of Representatives which then allows the Senate to have a trial to determine removal from office and can take forever.  And while Deputy Attorney General Rod Rosenstein has finally decided to buck his boss (POTUS toady, Jeff Sessions), and name a special counsel to continue the Flynn/Campaign/Russia investigation, there are still too few Republican representatives or senators openly acknowledging that anything is wrong, so…

Normally I would never suggest that name calling and personal denigration could achieve anything positive, but nearly half of the voters in this country have helped create a situation that is anything but normal.  It is not normal to have a government controlled by an attention-craving man-child suffering from serious daddy issues for whom positive television ratings, twitter likes and cheering crowds act as an opioid.

I believe the quickest and most efficient way to end this national nightmare is to get the man to voluntarily step-down, which will only happen if those who got us into this mess will stop liking his tweets, stop attending his Hitler-like rallies and start calling their other elected officials to let them know of their dissatisfaction with this president.  If people will just stop stroking this maniac, I believe he will pull-up his pants and go home.

I know that most of the followers of this blog have not supported this president and have never been guilty of feeding his ego in any way, but you know people who have.  If you agree with this post, even in part, please forward it to those you know who put us all in harm’s way or link it to your social media sites.  The folk most capable of undoing this thing are the ones who started it.  To be clear, this is not about ideology.  I’m not asking conservatives to sacrifice their political victories.  If POTUS leaves, his position will automatically be filled with one of the staunchest Republicans in the land, Vice President Mike Pence along with the House and Senate will still be controlled by the Republican party.  While Vice President Pence and I share very few ideals, I do not doubt that he is intelligent enough to steer the ship for a while, at least well enough to keep it from running aground.  We can discuss policies and politics during the next election cycle.  What we have to do now is save the Republic.

Health Care in America – Part 3

This is the third and final post in this series, though I’m sure it will not be the last relating to health care.

By January 20th of 2017 the federal government was controlled by Republicans, most of whom had been promising to kill the ACA for seven years.   The Showman-in-Chief now residing on Pennsylvania Avenue had campaigned on it and the Speaker of the House Paul Ryan loudly proclaimed that the party had to keep its promise to the base and immediately repeal and replace the failing health care plan.  Of course, Ryan’s entire career has been focused on reducing taxes and balancing budgets and he knows that he can’t tackle either until health care is resolved.

By the beginning of March, Ryan had hastily thrown together what was to be the death knell of expensive and freedom-stealing Obamacare, although February polls showed that 54% of all Americans approved of the ACA, and even 42% of surveyed Republicans indicated they just wanted the plan fixed, not completely dismantled (Pew Research Feb 2017).  When specifics of the Ryan plan were made public, only 17% of all voters polled approved of it (Quinnipiac University Poll).  The bill failed to pass.

The Speaker calmly announced that Republicans would just have to try it another time, while immediately meeting with competing opponents within the party, promising changes and amendments to the bill, some conflicting and almost all guaranteed to anger the public.  Meanwhile, POTUS wined, dined and threatened conservative lawmakers before taking to Twitter with bold promises, many of which were in direct contradiction to what was being documented in the revision.  Finally, on May 4, 2017, all of the cajoling was complete and it was rumored that even a couple of Republican representatives had read the bill.  A vote was called and the bill passed, 217 to 213, along with the assurance that any imperfections would be smoothed out by the Senate before final approval (H.R. 1628).

So what will the America Heath Care Act do?  The high points are:

  • Eliminate the individual mandate to have insurance and the employer mandate to provide insurance.
  • Eliminate any cost sharing (patient out-of-pocket) subsidies and modify the subsidies for premiums from income based to an age-based flat credit and add a credit phase-out at higher income levels.
  • Eliminate the incentives for small businesses to provide coverage along with ALL of the taxes imposed by the ACA, including the penalties for not having or providing coverage, the increased payroll tax and investment income tax on high earners, the added tax to pharmaceutical companies and insurance companies and the increased medical device sales tax.
  • Continue to define a child up to the age of 26 as a dependent child and prohibit the declination of coverage to someone with a pre-existing condition.  However, states can request a waiver to use experience rating instead of community  rating, terms you may remember from my first post in this series.  Insurance companies in states who receive the waiver couldn’t deny coverage to folk with pre-existing conditions or old people, but could increase premiums for those individuals and redefine what essential benefits are.  Not to worry, says Speaker Ryan.  The act also provides up to $138 Billion (over 10 years, possibly divided by 50 states and the District of Columbia), to help any waiver victims pay for extra premiums and/or out-of-pocket expenses, though the funds come with lots of caveats and time-frame limitations.
  • Keep essential coverage definitions, but again, allow states to request waivers to redefine “essential”.
  • Mandate that Insurance companies MUST impose a one-year late enrollment penalty of 30% for folk who let their coverage from any insurance source lapse for more than 62 consecutive days.  Meaning if you lose your job (and consequently either your employer-provided policy and no way to pay for cobra or no way to pay for your private policy premiums), you have to come-up with an additional 30% just to get back in the game.  I was unable to determine the impacts on a Medicaid recipient who loses eligibility for 62 days.
  • Defund Planned Parenthood for one year, even though ALL of the previous rules preventing funding, subsidies or tax credits related to any insurance policy providing non-Hyde Amendment abortions (abortions not needed to save the mother or not related to pregnancies resulting from rape or incest), stay in place, so this was apparently just a spiteful jab at liberals without concern for the low-income victims of reduced family planning services.
  • Ends the Medicaid Expansion program and then changes funding from matching to block grants and creates caps.  The Congressional Budget Office (CBO) indicates that move will cut Medicaid spending by $880 billion, but which Paul Ryan insist will help more low-income citizens.

While there can be many interpretations of this bill, mine is that conservatives believe health care is only for those who can afford it.  If that is correct, then why don’t they just admit it so that the country has a baseline for the discussion.  If the majority of Americans believe that basic health is a commodity available only to those with the ability to pay for it instead of a right, then let’s stop wasting time and resources trying to develop a government solution.

Those with means can continue to have their ills and their pains treated while those without can just do without, or try to convince one of our religious institutions (Christian, of course), to assist.  However, since churches currently enjoy tax-free status, some individuals might interpret such aid to the sick as a government subsidy.  A subsidy not up to interpretation would be the pre-tax treatment of employer-provided policies, so that policy would need to be rescinded immediately.  An expense that will have to come from the public coffers, however, is that for the collection and disposal of the bodies.  Not even a health care system for the affluent can adequately compensate for the diseases caused by heaps of decaying flesh.

It’s curious that even the staunchest, voucher-loving conservative doesn’t suggest that only the children of employed parents should be educated.  They understand, if even from the most selfish vantage point, that an educated population is necessary for society to function properly.  If for no other reason, we should all want an educated populace so that they can become good workers, hopefully supporting themselves, thus limiting their reliance on public assistance and allowing them to contribute to our Social Security system (retired Republicans still cash those checks, don’t they?).  Why can’t we agree that the health of our citizens and the protection of their financial well-being are equally important?

The following 26 industrialized countries have Universal Health Care (UHC), with various  combinations of funding sources, available services and government versus private delivery systems:

Czech Republic
Greece                                                                                                                                       Hungary
Korea, South
New Zealand                                                                                                                             Norway
United Kingdom

Before you enlist the “if your neighbor jumped off a cliff, would you?” argument, please note that most of the countries above are routinely rated by their inhabitants as great places to live and I don’t believe any of them currently comprise a large portion of the waiting list to immigrate to this country.

UHC does not mean that every conceivable treatment or service is offered.  Yes Sarah Palin, there would be Death Panels.  They have existed for years, but they haven’t been run by bureaucratic committees, they’ve been headed by the CEOs and CFOs of insurance companies.  Why not let elected (or at least appointed), folk develop those answers, without a stock-split or dividend pay-out as the goal?

UHC is also not limited in scope to just providing insurance. It has to include participation in service delivery, medical technology and pricing (yes, Big Pharma,  that includes negotiation for drug prices).  The free market has and will continue to create great things, particularly in the areas of “wants”.  But we should not leave the he operation of systems providing what we define as “needs” to lords of profit.

The ACA is far from perfect, but solutions will take both liberal and conservative efforts.  If we can all agree, even for self-serving purposes, that a healthy country is a successful country, then we can start working together to make it a reality.  We are a nation full of bright folk and we have the experiences and ideas of at least 26 other countries to build upon.  I believe it is only our attitudes that are holding us back.

Health Care in America – Part Two

Though economics has always been a concern, there has also been an interest by many leaders over the years to provide health care to all U.S. inhabitants for humanitarian reasons.  Franklin D. Roosevelt attempted to achieve it when he pushed through Social Security, but the insurance plank was defeated as it was “socialist”.  His successor Harry Truman included the idea of universal health care in his Fair Deal, but that piece was eventually voted down because it was “socialist”.  The idea gained new life with the election of Bill Clinton who submitted a comprehensive proposal developed by First Lady Hillary Clinton.  It, too, failed to become law not just because it was “socialist”, but because it was associated with “her”.

Progressives never stopped pressing, however, and the issue was front and center again in the 2008 presidential campaigns.  Candidates from both parties appeared poised to address health care reform, but Barack Obama was early in offering specifics.  Essentially he wanted every American insured so that everyone could be healthy while at the same time address the ever rising costs of care.  It was a plan based in large part on the Health Care Reform that Massachusetts had just implemented in 2006, under the leadership of then governor and Republican darling, Mitt Romney.

After the 2008 election, followed by two years of meetings with insurance representatives and medical professionals, considerable arm-twisting, many concessions and lots of presidential selling, the Patient Protection and Affordable Care Act (Affordable Care Act) became law in March 2010, though most elements would not take effect until 2014.  The link above points to an in-depth summary of the act while the Kaiser Family Foundation ACA Summary is more succinct, but below is my attempt to summarize the high points:


  1. Provide all citizens and legal residents with health insurance through Medicaid or through private policies (provided either by employers or purchased by individuals), that have minimum “essential” benefits, no penalty or denial for pre-existing conditions and allow children to remain on their parents’ policy until they turn 26.
  2. Reduce national health care costs.


  1. Offer states a Medicaid Expansion plan that would raise the income limit for eligibility and provide 100% Federal reimbursement of the increased costs at the beginning, which would taper to 90% by 2020.
  2. Mandate (and incentivize with income-based subsidies), that all citizens and legal residents obtain health care coverage or incur a tax penalty.
  3. Mandate (and incentivize with tax credits and/or subsidies), that all companies provide employee coverage and penalized those who fail to do so, exempting companies with fewer than 50 full-time employees.
  4. Create a national exchange and encourage states to create their own exchanges where individuals and small businesses can shop for coverage.
  5. Contain or reduce health care-related costs by simplifying insurance administration, tweaking payment systems for both Medicare and Medicaid, enhancing efforts to eliminate waste and fraud, and shorten the approval time for generic drug availability.

Paid For by:

  1. An increased payroll tax on individuals earning more than $200,000.00 a year or couples earning more than $250,000.00 along with an increased tax on their unearned income.
  2. New fees from the pharmaceutical and insurance industries.
  3. A special tax on medical devices.
  4. Reduction of costs (see Implementation #5 above).

Republicans despised the law and vigorously fought its approval, but in March of 2010 they were the minority and Democrats believed that passing health care reform was worth risking losses in the 2010 mid-term elections.  The casualties were realized that fall when Republicans took back control of the House of Representatives, nearly got the Senate and also won many state house and governors races.  There were other factors in that poll, of course, like the perpetually low mid-year election turn-out for Democrats as well as it being the first opportunity some voters had to (re)act since a black man had been elected president.

Conservative lawmakers were incensed from the start.  Few invoked “socialism”, however, as the final product was based on Romney-care, after all, and wasn’t a single-payer program.  Instead, the most vocalized complaints were the mandates and the tax increases.  There was also Sarah Palin’s declaration that the act would produce “death panels”; bureaucratic committees who would decide who would get care and who wouldn’t.  So Republicans immediately launched a campaign to “Repeal and Replace” the ACA and for the next seven years repeatedly called for votes to either kill it, defund it or delay implementation, most of which failed.

The ACA was admittedly an imperfect plan.  The major flaw, in this writer’s opinion, is that it did not result is a single-payer system, but it was at least movement.  Many claim that there were major misrepresentations (“lies”, they call them), including “you can keep your current plan and your doctor” and that “premiums would stabilize before eventually going down”.  While these may have been misrepresentations, it is possible that folk just failed to understand all of the implications of the voluminous act and had a limited ability to read tarot cards.  The facts are, though, that 20 million more folk have health insurance today than did before the ACA and it has cost the federal government less than was predicted (New York Times – ACA Successes, Failures and Incompletes).

It has not, however, necessarily made health care more accessible.  While insurance certainly protects against complete financial ruin due to catastrophic health issues, it does not guarantee easy or affordable access to a doctor or other basic care.  While many employers were moving to High Deductible Health Plans (HDHP) even before the ACA, it has only gained popularity since the passage.  One of the stated benefits associated with those plans is that it helps people understand the true costs of care and so they might slow their “over-use” of the medical system.  That may be true, but for many gainfully employed individuals, coming up with $5,000 a year for non-preventative but very necessary doctor visits, testing and drugs is simply not an option.

Also, many insurers underestimated their profit margins or overestimated the number of young, healthy clients who would buy their policies, so in 2016 begin either implementing double-digit premium increases or completely canceling their offerings in some regions.  Additionally, many of the 20-plus million people who gained insurance did so via Medicaid, which limits their access to a smaller number of providers and services, often resulting in the same “emergency room care” scenario as before.

So take some highly publicized weaknesses of the Affordable Care Act (all of which have undeniable personal consequences), cement conservative control of government by electing as President a non-ideological carnival barker who just wants to hear the crowds cheer and the stage appears to be properly set for HR 1628 (American Health Care Act).



Health Care in America – Part One

This post is part of a series related to health insurance and access to medical care, but before I add to all of the noise resulting from passage of HR 1628 (American Health Care Act), by the House of Representatives on May 4th, I thought it might be a good idea to document what we know (or should know), about the current state of health insurance in America and how we got here.  While I always want to encourage readers to express their opinions regarding information found within this weblog, I know that at least one current subscriber worked in the insurance industry for many years, and I would especially welcome any contributions or corrections from them, submitted either through “Comments” or the “Contact Me” link.

Insurance to pay or off-set health care expenses in the United States essentially appeared in the early 20th century, having morphed from disability (workers compensation), insurance developed in the 1800s for railroad and other industrial workers.  An early form of health insurance was devised by hospitals during the depression when fee collection was down, but charity care (read “uncompensated care”), kept rising, so they offered prepaid options—an idea that eventually became the Blue Cross system.  The program only applied to hospital services, though, and not to doctor’s fees as the AMA didn’t like the idea of prepaid service programs and what it might due to profits.  By 1939, however, the Blue Shield system was developed to address physician fees, but was set-up to indemnify policy holders, meaning it would pay the patient for a covered procedure and the patient then had to pay the doctor.

Both Blue Cross and Blue Shield tried to forecast what future claims would be based on previous claims and divide that total forecast by the total number of subscribers to determine everyone’s premium.  This was called “community rating”.  Other companies in the 1950s, however, began using “experience rating”, meaning they would identify groups of folk and measure their average health care needs.  Groups that needed less (young people, for example), posed a smaller liability and consequently could be charged a lower premium while still yielding a profit (a system that also began siphoning the lowest-risk subscribers from the systems utilizing community rating).

Some employers offered assistance for health-related insurance programs in those early years, but employer-paid insurance didn’t really surge until World War II when employees were scarce and wages were capped by federal law.  Employers could offer fringe benefits (including insurance), as a way to entice workers.  Making the those programs even more attractive was a tax code that did not consider employer-paid premiums as income.  Those premiums are still not considered income and therefore are not taxable, meaning that all employer-paid health insurance is federally subsidized and also subsidized by those states which have an income tax.

Employers who offered health insurance chose either Fully-Insured or Self-Insured plans.  Fully-Insured meant the company just paid an insurance company to cover their employees.  A Self-Insured plan meant that the company paid any employee claims (and premiums for “stop-loss” insurance to cover the odd, catastrophic employee illness), thereby paying less than a fully funded plan, avoiding State Premium taxes and State Insurance regulations.

But clearly not everyone in America worked, and of those who did, they  couldn’t work indefinitely.  Also, not every employer provided health insurance and no employer was required to do so.  In partial response,  the Medicare and Medicaid programs were created in 1965, both of which involve fee schedules which cap the reimbursement that health care providers can receive.  Medicare was designed to take care of the elderly, who were both less likely to still be working and more likely to have increased medical needs, while Medicaid was designed to assist America’s poorest individuals.

Medicare Part A covers the hospital expenses for folk eligible for Social Security and is almost all paid for via a pay-roll tax on both employers and employees with the remainder covered by general revenue.  Medicare Part B covers doctor’s fees and non-hospital related fees or services and is funded by general revenue as well as premiums paid by the participants.  Medicare Part D is designed to assist with prescription drugs and is funded primarily by general revenue and user premiums.

Medicaid is a health care insurance program for low-income individuals, though income is not the only criteria.  It is a joint venture between the U.S. Government and the states that choose to participate (a portion of state expenditures are matched with federal dollars), and covers some federally mandated hospital and physician expenses along with additional services and fees mandated by the participating state.

So, all bases were covered and the problem was solved.  Except that as of 2010 16.3% of Americans had no medical insurance (Uninsured Rates for 2010), which translated to 49.9 million people.  When members of that very significant number became ill or were in an accident, they headed to the emergency rooms of the nation’s hospitals, who, due to the Emergency Medical and Treatment Labor Act (EMTLA) of 1986, are unable to deny emergency care to (or fail to continue care once started), any patient based on their inability to pay.

In order to remain solvent while providing uncompensated care, hospitals implemented cost shifting: the process of charging an insured patient more for a service or product than an uninsured patient to offset the missed revenue.  No insured patient reviewing their bill was ever supposed to believe that a Tylenol cost $5, but the hospital had to recoup the cost of the free Tylenol they gave the uninsured patient.  So technically the uninsured have insurance for some health issues (if they are willing to wait in an emergency room), by piggy-backing onto the coverage the rest of us have and inflating our claims.

Enter the Patient Protection and Affordable Care Act.




Flag Burning…Can Everyone Just Grow-Up?

Thanks to Jonathan Karl, who substituted for George Stephanopoulos on ABC’s “This Week”, flag burning is back in the news.  On the April 30th episode, Karl asked POTUS surrogate and chief-of-staff Reince Priebus if the president was sticking to his November 29, 2016 tweet suggesting that those who burn the U.S. flag should lose their citizenship or spend a year in jail.  Priebus was quick to reply that there had been no change in that opinion and went on to share that 70% of Americans agree, though he did not cite his source for that statistic.

The legal right to burn a United States flag is settled law (United States v Eichman), so regardless of public opinion, those seeking to light-up a banner can currently do so without fear of prosecution.  But when they do, some observer is going to go berserk and demand incarceration and/or a hefty fine for the perpetrator, something commensurate with the “horrible, un-American act”.

It’s time for all Americans to grow-up.

It is almost inconceivable that there are rational adults in this country who cannot recognize that a flag is just a symbol.  However, there are currently five generations of Americans who have either been exposed to or forced to recite (depending on locale), a pledge of allegiance as part of a national effort to instill patriotism in all its young citizens.  And since 1931 our national song has been—wait for it—“The Star Spangled Banner” which we (try to) sing at many public gatherings.  One of the (intended ?) by-products of these patriotic exercises, however, has been the erosion of rational thought.

The recitation and the associated choreography of the pledge and song have resulted in an unquestioning loyalty and often some “Stepford Wives” behavior  Even the wording within the pledge suggests that the flag is more than a symbol.  “I pledge allegiance to the flag…and to the republic, for which it stands…”  The pledge should be to the republic, not to the symbol of the republic, but the repetitive drilling of the vocabulary above along with other patriotic theater practiced for over seventy years has often resulted in both a belief that the flag dispenses our freedoms and a fierce loyalty to that belief.  The United States is not the only government to successfully induce a strong, emotional connection to a flag, but it is one of the few countries that has codified the right to desecrate the symbol that represents, among other things, the right to say “I hate this country” (Which countries is it illegal to burn the country’s flag?).  

When a U.S. citizen sets a flag ablaze to protest continuing American imperialism or a failed justice system, it might be because they are not articulate enough to verbalize their concerns and believe that the torching of Old Glory will adequately communicate their dissatisfaction with a broken government.  Maybe some even believe that it will facilitate dialogue which will ultimately yield a remedy for their concerns, but that is doubtful.  It’s more likely that they are counting on the visceral and completely predictable reaction from their opponents, and commit the act with the smugness that comes from knowing their opponents can do nothing to stop them.  Many observers have described such behavior as juvenile and I’ve come to agree because it is similar to a child throwing a tantrum, which is just a cry for attention.

But we do not criminalize tantrums or cries for attention (unless someone else’s person or property are threatened), and the subsequent cries coming from some of the opponents to “lock them up” are just as juvenile.  We do not live in prehistoric times, the middle ages or even Eisenhower’s cold war era.  We exist in the most enlightened and informed times in human history.  As adults we should analyze information and actions for meaning and possible resolution instead of simply resorting to the auto-pilot reactions we were taught as children.

Protesters either have a message they desperately want to convey or are just seeking attention.  Mature observers should either attempt to identify the issues so that they can examine them for merit and resolution or at least recognize the act as a tantrum and understand that the destruction of a piece of cloth (possibly manufactured abroad), does not depreciate one’s life.  We should also be wary of politicians who feign personal indignation when a flag is ignited.  They are not acting out of concern for the republic, but are exploiting our lazy, auto-pilot mentality in an attempt to wrap themselves in patriotism.

A great amount of energy has been expended on this subject, while issues that really impact our country and citizenry have been ignored.  As indicated in a previous post, democracy is not perfect, is not always pretty and does not always produce the expected results.  In a country—or even in a room—with more than one person, conflicting opinions will occur resulting in different actions, but we must be careful not confuse actions that threaten our safety, property or liberty with those that just threaten our sensibilities.  Living life on auto-pilot may be easier, but it doesn’t utilize our intellectual capacity and it doesn’t help us play nice with others.  If we can’t prevent public tantrums, we can at least try to be the adults in the room.

The Electoral College aka King George-Lite

You can find a succinct history of and explanation for the constitutionally established Electoral College at History, Art and Archives of the U.S. House of Representatives.  The fast facts found there do not, however, reveal the actual motivations for the creation of the indirect election of our country’s highest office.

Historians have proposed many reasons as to why the framers didn’t support direct election.  The list includes the belief that only the most savvy and government-connected men could understand the issues and the candidates due to limited communication systems within the physical expanse of such a large nation (thirteen whole states at the time).  The list also includes the distrust of political parties and the fear of campaign shenanigans as reasons to keep the choice for president out of the common man’s direct reach.

According to Joe Miller of in The Reason for the Electoral College, constitutional convention members like James Madison were worried that direct election might result in the majority of citizens imposing their will on the minority.  Rational observers might conclude that Mr. Madison’s concern should have been assuaged by the constitutional protections that were being simultaneously inserted into the same foundational document.  It might also occur to some that letting states cast the ultimate ballots instead of citizens could result in the same “tyranny of the majority” Madison claimed to be worried about.

A better understanding, however, of Madison’s push to prevent a “one man, one vote” system can be found by referring to Akhil Reed Amar’s account in The Troubling Reason the Electoral College Exist.  According to Amar, Madison actually had his fellow Virginians and the other southern “citizens” in mind when he referenced “the minority” because, since only white men could cast ballots, the South would have fewer votes than the North, given the demographics of the time.  But it had already been decided that states could include three-fifths of every slave (who of course couldn’t vote), in their representative calculus, giving states with high slave populations more electoral votes.  Consequently, shifting the election of the president from individual voters to a group of hand-picked electors would allow the elector-heavy southern states to potentially prevail in the selection of a national leader for the foreseeable future.  Genius!

The rules regarding the electoral college have since been modified; once to separate the election of President and Vice President and again to allow the District of Columbia to participate in the game, though the federal government has never dictated how states should implement their electoral systems (leaving most to opt for the “winner takes all” method which has—for the fifth time now—allowed a candidate who lost the popular vote to become president).  We also subsequently decided to let women and black people (of all genders), cast votes…presumably to include votes for president.  But the electoral college is still a mechanism that—whether devised for the best of reasons or the worst—is anachronistic, elitist and a cloaked extension of the “monarch knows best” system that this country’s original war was fought to escape.

It is now 2017.  Regional differences and motivations still exist, political parties and candidates still engage in shenanigans and the physical expanse of this large nation has only grown.  But we are also in an age of the twenty-four hour news cycle combined with the instantaneous sharing of information on the universally accessible internet.  Fears of fake news and alternative facts should be taken seriously, but it is my hope that every voter is diligent in their research and understanding of issues and of candidates.  It’s true that democracy is not perfect, is not always pretty and does not always produce the expected results.  It is, however, the system we hold out to the world and to our own citizens as the optimum form of government and the system we claim to defend with both lives and treasure.

The elimination of the electoral college is not a partisan issue.  While conservatives have yet to experience the sting of a college defeat despite a popular victory, given the current polarization of the U.S. electorate, each presidential election is a mis-carriage of democracy just waiting to happen.

And at the risk of fanning the flames of partisanship, I am inserting a passage from Joe Miller’s article referenced above as an example of irony that even some republicans will surely acknowledge:

“As Alexander Hamilton writes in ‘The Federalist Papers,’ the Constitution is designed to ensure ‘that the office of President will never fall to the lot of any man who is not in an eminent degree endowed with the requisite qualifications.’ The point of the Electoral College is to preserve ‘the sense of the people,’ while at the same time ensuring that a president is chosen ‘by men most capable of analyzing the qualities adapted to the station, and acting under circumstances favorable to deliberation, and to a judicious combination of all the reasons and inducements which were proper to govern their choice.’”

The electoral college is not going away on its own.  It is part of the 12th amendment to the U.S. Constitution.  The process for repeal is found in Article 5 and is as follows:

  1. An amendment to the 12th amendment must be proposed to Congress where both houses must approve with a two-thirds vote.                                                        OR                                                                                                                                              Two-thirds of the state legislatures must call on Congress to convene a constitutional convention.                                                                                            THEN
  2. Three-forth’s of the state legislatures must approve (ratify) the amendment proposed by Congress.

You can see that it takes the approval of both your U.S. representatives and your State representatives, but as a reminder, ALL of them represent YOU.

Ratification of the amendment must occur within 7 years of the proposal.  Since it would certainly be procedurally crippling to force political parties and presidential candidates to adjust their “50 State” strategies to “321 million voter” strategies by 2020, it follows that 2024 would be the best target for implementing the truly democratic system of electing the leader of the free world.  Contact your U.S. and State representatives today to request that they propose the abolishment of the Electoral College by amending the 12th Amendment.