Tuesday, August 30, 2016

Advice to Needy Neoliberals

The kludge known as Obamacare is trying desperately to slide down the tubes, but it's too dense with defenders to simply go gently and smoothly into that good night. It's moldering in a limbo between the toilet and the sewer, while its subscribers and rejects are trapped in either purgatory or hell, depending upon the health of their bodies, their faith in politicians, and the size of their dwindling bank accounts.

It seems that the predatory insurance companies, which literally wrote the Affordable Care and Patient Protection Act, just aren't getting enough bang for our bucks, even though executives and Wall Street investors are still getting fantastically rich off the pain and toil of others. Aetna might have just pulled out from 11 states over an alleged lack of a pool of healthy but broke customers to suck dry, but that didn't stop its CEO from entering the Rapture and pocketing $27.9 million in compensation last year. A guy's got to eat, especially a guy with such a ravenous appetite.

Obamacare's defenders, getting worried that their product is increasingly seen as a scam of historic proportions (in an election year, no less) are thus in high concern-trolling gear. They're even daring to utter the previously forbidden "public option" phrase to placate the masses and fool them into thinking that Hillary Clinton and the Democrats can be counted on to help save Obamacare from itself, if not counted on to save any actual lives and livelihoods. (save those of millionaires and billionaires.)

And since the Neoliberal Thought Collective running the public-private partnership known as Government persists in treating medical care as a corporate endeavor rather than as a natural human right, the New York Times published its own advice column of possible fixes in the Business Section rather than the health or science sections.

The headline itself wastes no time in framing the crisis of American health care as strictly a business problem: Obamacare Marketplaces in Trouble: What Can Be Done? 

It's been a hard couple of decades, even generations, for the tens of millions of unemployed or underemployed people lacking basic medical care. But you wouldn't know it from reading the Times lede (the standard Neoliberal buzzwords are in my bold)
It has been a hard couple of weeks for Obamacare. The law’s online marketplaces — where people were supposed to be able to easily shop for health insurance — have been suffering from high-profile defections and double-digit premium increases.
Critics of Obamacare have pointed to the recent problems as proof the market is not working, while even the law’s staunchest defenders are arguing that the marketplaces need some fixes.
In other words, the vaunted free market needs a lot more public assistance and corporate welfare in order to ensure that profits over people may continue to grow. And those damned shoppers searching for health insurance product won't be satisfied until they can be offered the illusion of choice, which fools them into thinking they actually have a say in their fates, as they struggle through the kludge.

Since the illusion of choice is disappearing from the flawed equation, the Times wants to know: What can be done to help the marketplace?
If the market looks as if it’s growing and stable, some insurers might come back. Both President Obama and Hillary Clinton have also revived the idea of the so-called public option, which would be a government-run plan that would either compete with or be a substitute for a plan offered by a private insurer. It’s politically controversial and hard to make work in practice.
The Times tells us that although Barack and Hillary really, really want to help, those nasty Republicans will do their useful idiotic best to thwart all good Democratic intentions. But keep your hopes alive anyway, the subliminal message goes, and vote for the Clinton Restoration. Never mind that the "public option" is in itself a useful idiot, since it displaces true single payer, or Medicare for All. But if the Times calls even a scammy proposal "controversial and hard to enact," then we might as well not even talk about genuine universal coverage. Because it's impossible. Because they say so. And Hillary is a progressive who likes to get things done. Because she says so.

Meanwhile,"we" have to get those outrageous health care and drug costs down - not by implementing cost-effective single payer, of course, but by making it even harder for us to access actual medical care with our pricey Obamacare plans:
 Bring down costs instead of raising prices. More and more insurers are choosing to limit the number of doctors and hospitals they will cover in their plans. A lot of the reason that health insurance is so expensive in the United States is that doctors and hospitals charge more here than their counterparts in other countries. So the narrow network strategy may be a smart way to start getting different groups to negotiate down on their prices.
One of the biggest impediments to capitalist predators profiting from people is that healthy - but increasingly debt-crushed and precariously employed - young Americans are averse to shelling out their meager food and rent money for a Bronze plan. So the answer is not free health care or student loan forgiveness - it's smarter, more effective punishments for irresponsible consumers:
 Change the incentives, so more people who are currently uninsured buy health insurance. Hillary Clinton has talked about giving out more generous subsidies, so insurance costs less and more people can afford to buy it. Many Republican politicians suggest another way to lower prices: eliminating current requirements that insurance cover a wide array of services. Some policy experts, including Uwe Reinhardt, a Princeton health economist, in a recent Vox.com interview, have suggested tightening up the penalties for remaining uninsured, so people can’t wait and buy insurance only after they get sick.
So maybe if the Neoliberal Thought Collective can make Obamacare even crappier than it already is and cover only a few arcane diseases, then the Kludge can still be saved. And if that doesn't work, perhaps Obamacare refusenicks can be tried as political dissidents and sentenced to a long term at a for-profit private prison until they scream: "I love Big Insurance! Where do I sign up?"

 Uwe Reinhardt, who is not to be confused with Carmen Reinhart, the economist  so soundly discredited several years ago for falsely claiming that austerity spurs economic growth, is an opponent of single payer insurance because, he claims, the government is too corrupt. Congress might end up appointing a payment board with prices dictated by the same private insurance vultures now crying poverty, he said. There's always an expert to stop a program for the greater good right in its tracks. Always.

And speaking of austerity, neoliberals don't actually use that word any more, especially during an election year. They must reckon that "tightening up the penalties"  gives a more humanistic ring to Social Darwinism. Plus, if there is anything that neoliberalism prides itself on, it's the ability to grow and change its Orwellian language to keep fooling ("empowering") some of the people all of the time, or all of the people some of the time.
The Obama administration has already made a few changes, including making it a little harder for people to sign up for insurance in the middle of the year. It has also signaled to Congress and state legislatures that a “reinsurance” program, which would pay insurers back for the sickest of their patients, would be a good idea.
There is little consensus among experts and advocates about what fixes would have the biggest impact when it comes to stabilizing the markets. The divides are not just partisan, but reflect persistent uncertainty about the most important things going wrong, and the most effective solutions to fix them.
Obama is already responsibly and expertly punishing people for trying to game the predatory insurance market. They have the unmitigated gall to seek medical care only when they get hurt or sick. The exasperated big insurance predators are simply running out of options for punishing these miscreants. Therefore, Americans might be forced to bail out the private insurance and drug cartels the same way they bailed out the Wall Street banksters and General Motors.

Here's my published response to the Times advice column to the vampires who are so worried about their dwindling blood supply:
The problem with the health insurance market is that it is even a market in the first place.

Forget the public option.That's a cop-out. We need true single-payer health care, a/k/a Medicare for All. Financed through a progressive tax, no co-pays or deductibles, universal coverage from cradle to grave, none of those opt-outs allowed in Red States where hatred of the poor is both a managerial strategy and a cultish dogma.

Obamacare is all about protecting big business and fostering competition for profit and making a handful of insurance and pharmaceutical moguls even more obscenely rich. Some 30 million people are still uninsured, while millions more are under-insured. Even those lucky enough to have insurance constantly have to shop around, prove their incomes, their addresses, their existence - and who still can't afford to visit a doctor or hospital when they get sick.

The idea is you shouldn't and/or mustn't use your plan, and that way the neoliberal bean counters can brag about medical costs going down. It's "best practices" and efficiency and the bottom line over the actual health and the actual care of people.

 It's a big, fat scam and a monumental rip-off.

So enough of making our human rights and our well-being subservient to endless economic growth. It's time to join the rest of the civilized world.

If we can afford trillion-dollar wars and negative effective tax rates for predatory oligarchs like Donald Trump, we can certainly afford universal health care.
Physicians for a National Health Plan, the group which was barred from the original Obamacare negotiations and even threatened with arrest, has the lowdown on why the "public option" isn't at all the progressive rescue it's cracked up to be. It would be an effective bailout of the insurance cartel because it would allow the predators to cherry-pick their subscribers and foist them off on the government, should they actually become sick and need care. It would allow investors to grow richer, because there would be fewer payouts required by the private insurers.

Additionally, a public option plan would not reduce costs, as would a genuine single payer scheme. It would keep intact private, investor-owned hospitals and clinics and end up delivering deficient care to the poor. It would be ripe for constant de-funding, especially if its control is exported to individual states.

Speaking of states, staunchly habitual Obamacare defender Paul Krugman chose to devote his own latest Times column to the evils of Texas - specifically, linking the doubling of that state's maternal death rate to the closing of its Planned Parenthood clinics. Although he feebly admits that correlation doesn't translate to actual causation, that remains his premise. As always, Krugman's approach to our great humanitarian crises is to blame them solely on those nasty old Republicans in Congress and Red States. Plus, it's all totally based on Trump-style racism. And Texas is just like misogynistic Russia, which is supposedly backing Trump and fooling with our free and fair elections.

And echoing his newspaper's neoliberal advice column, Parochial Paul concurrently toasts the "cost-effectiveness" of the Obamacare Market in California.

 Because if there's one thing that neoliberalism is extremely good at, it's creating competition where it shouldn't even exist: 
 California — where Democrats are firmly in control, thanks to the GOP’s alienation of minority voters — shows how it’s supposed to work: The state established its own health exchange, carefully promoting and regulating competition, and engaged in outreach to inform the public and encourage enrollment. The result has been dramatic success in holding down costs and reducing the number of uninsured.
Why are states like Texas so cruel, wonders Krugman, after he blames the cruelty solely upon racism and ignores the actual class war (which, by the way, disproportionately punishes women and minorities.)

My published response, along much the same lines as my previous Times comment:
 The solution is simple: centralize the medical care payment and delivery system. removing the profit motive from health insurance completely. Join the rest of the civilized world. No deductibles, no co-pays. Everybody gets covered, cradle to grave, no matter where you live. Take the power away from all these sadistic state governments and implement Medicare for All.

Texas is the extreme case, but the maternal death in the US overall is up by 27% - at the same time it has fallen sharply in other countries. It's not only that women in some states don't have access to prenatal care or Planned Parenthood. It's that they have little to no access to any kind of medical care at all, all across this country. According to the journal Obstetrics & Gynecology, the major cause of the maternal death rate increase is the rise in such preventable chronic diseases as diabetes and obesity.

Black women are two to three times as likely to die as a result of pregnancy and childbirth as white women. According to a 2014 U.N. study, the maternal mortality rate in one Mississippi county surpassed that of countries in Sub-Saharan Africa.

It's a racist war and a class war of the richest elites in the richest country on the planet against the rest of us. Lowered life expectancy is just one glaring symptom of a sick society that puts profits for the few above the well-being of the many.

If we can afford trillion-dollar wars and Wall Street bailouts, we can afford universal health care.


Pearl said...

‘Forget the public option.That's a cop-out. We need true single-payer health care, a/k/a Medicare for All. Financed through a progressive tax, no co-pays or deductibles, universal coverage from cradle to grave, none of those opt-outs allowed in Red States where hatred of the poor is both a managerial strategy and a cultish dogma.’
‘If we can afford trillion-dollar wars and Wall Street bailouts, we can afford universal health care.’

Yes, indeed Karen and well spoken. True universal health care cannot coexist within a capitalist system and I wish you and other Sarsonickies would give credit to Bernie Sanders for his battle to create complete health care coverage in my birth country and continue to fight for a political revolution to permit

Even Canada with its great history for introducing health care coverage years ago as a result of the fight by Tommy Douglas of the New Democratic Party, is now beginning to become frayed by its capitalistic environment. I know, because I am now caught in the trap of needing caretaker coverage for my health problems that do not permit me to take care of everyday duties and which is privately required unless one qualifies for government assistance. As a result, I will have to use up all my assets if I live much longer to have help in my home and avoid having to go to a nursing or long term care set up which are suffering from lack of financial support for decent care.

Due to the tenure of Prime Minister Harper before Justin Trudeau, money was denied for increasing needs for older citizens or training enough doctors to cover the increasing population needs for citizens, and the present prime minister is left with a portfolio which has little to improve the medical situation needs of the country. In addition, instead of including care for eyes, hearing, teeth it was never complete universal care as practiced in the Nordic and Swedish countries. A very disillusioning experience for me personally.

Needless to say, the cost of inadequate health care is higher than if the population was healthy and able to contribute their energy to the nation. I think this is an issue that effects everyone who cannot afford care they should be entitled to and is a chance for change if properly supported and advertised.

The information you have supplied in your column and reply to Krugman’s comments, are vital for encouraging real action at this point in time. Thank you for publishing it.

Ste-vo said...

Karen, Thank you for this. Kludge? I had to look it up. Excellent word. I am going to put that somewhere in my brain and wait for an opportunity to spring it. I love it.
And I wish I could post a picture? I actually think Goya's "Saturn Devouring His Son' would be more appropriate.....in its utter gruesomeness. And the Times article in the business section....consider the source. And Paul Krugman? I don't even read him anymore, although I do look for your comments. AmeriKa sucks the big one - a la the University of Tex-ass - Austin, that liberal oasis in a parking lot of red!

Kat said...

And why is the Times even giving credence to Uwe Reinhardt as a "policy expert"? This is the economist who was so soundly discredited several years ago for falsely claiming that austerity spurs economic growth.

Are you confusing him with Carmen Reinhart?

Jay–Ottawa said...

Karen's post in favor of single payer as the right road to universal health care is not something new at Sardonicky. She and most of those who hang around here have been humming this tune since at least the early days of Obama's first term. And before that,
in our pre-Sardonicky lives, some of us were already strong supporters of Physicians for a National Health Plan.

What strikes me as special today is how well Karen has, in a short space and better than ever, summed up the unbeatable arguments for single payer. I'm sending her post to PNHP. The crispness, economy and wit found in these passages should be used by the PNHP to sharpen its pitch.

Karen Garcia said...

Thanks for the catch. I did get Carmen and Uwe confused. Uwe has his own anti-social democracy issues. So many experts, so much ka-ching!

Jay, thank you for your kind words and yes, I have been advocating for single payer for a very long time. When I wrote an article about it for my local newspaper about 20 years ago, people looked at me cross-eyed, it was such a "radical" idea and so cornily Canadian, eh? The argument back then was that if you had govt health care, you'd have to wait six months for a medical appointment.

Ste-vo, I have used the Goya rendition of Saturn Eating His Children in a couple of previous posts. If memory serves, it was during the Sequester/Austerity years, when Obama admonished everybody to tighten their belts and eat their peas.

Pearl, sorry for your troubles, but I still say Canada is light years ahead of Amurka in the humane department, despite Harper. And even Maggie Thatcher couldn't get rid of socialized medicine in Britain.

Jay–Ottawa said...

What can I say, Pearl, eh? Canadians voted strategically (ABH-Anything but Harper) in the last Canadian election, and ended up with Liberal Justin Trudeau. Conservative Harper received a drubbing at the poles and has since retired from politics, but Canadians only wound up with the lesser of the first two evils in a field of four or five, only one of which, Elizabeth May (Green) is the most virtuous, politically speaking. In any event, Harper's overlong reign of conservatism endures through legislation Trudeau is so slow to reverse, and Harper's government appointees intend to serve till the end of their terms in office. Aside from the binge of austerity under Harper hurting great programs like universal health care, cultural institutions, like the Canadian Broadcasting System, continue to be run by Conservative majorities on their boards of directors. Harper's appointees are doing to the CBC what's being done to Saturn's son. As they say in Quebec, "Plus ça change, plus c'est la même chose."

Pearl said...

Jay: The only party to bring up the problems of medical shortages during the election were the New Democratic party of which I am a member but I do not vote here. My current problems are nothing compared to those who cannot afford physical help or the caretakers I have had who receive minimal pay and were less than helpful for me until only recently after 5 months of finally finding decent help. I have waited for more than 6 months to see a specialist for one problem and cannot find a decent family doctor due to shortages and stuck so far with one that allowed my health to deteriorate. Stories told to me of conditions for other seniors who struggle with less than needed help are extremely troubling.

Two close friends here with very serious health problems have not been able to get the help they need and forced to wait for long periods of time for tests, doctor appointments, and proper assistance to keep them going.

You certainly would be knowledgeable about this and I am circulating a letter to the head of a major hospital about the treatment I received when in their ER, to all the major parties. I was kept for 24 hours without food or water and no help until discharged in worse shape than when I had arrived.
This ER problem is similar in many hospitals in Canada as is in the U.S.

As to the humane problem Karen mentioned, during the recent election there were many comments and emails from citizens about their resentment and reluctance to have to pay medical costs via their taxes for those who could not manage their finances properly.
As you pointed out Harper's influence still muddies the waters and capitalism in Canada is alive and well with many wealthy citizens influencing the political scene.

The structure for good health care is in place but not the financing to support it nor the party in power to push very hard for improvements in many other areas as well.
But I am still fortunate to live here compared to the daily horrors from the U.S.of

Meredith NYC said...

Thatcher, Reagan's counterpart, and notorious, proud conservative did say she supported UK's natl health, started in 1947 or so, since she actually believed all should get medical care regardless of income. Our single payer fans should quote her and discuss why she differed from US rw on that.

Meredith NYC said...

This piece is well targeted, eloquent sarcasm. Helps to put business buzz words in bold.

The Cal better example should be publicized by media using interviews with citizens and officials. We also lack the contrast of positive working models in dozens of other nations—how is h/c paid for, taxes and used by all---this would counter the US propagandists’ lies about sky high taxes, rationed care, and big govt interfering in the dr/patient relationship.

Americans have sky high premiums and unregulated medical charges. It's big corporations that come between dr/patient due to affordability, and care is still being rationed in certain states, with profits the highest priority. US voters have no idea of other nations attitudes where profit isn't the 1st priority.

We need testimony from countries where insurers can’t just pull out of states. Their systems apply nationally to give equal protection to all.

Sadly, our only progressive candidate Bernie Sanders only fleetingly cited how we differ from 1st world nations---repeating his sentence ‘til we could recite by heart---“ the US is the only major or industrialized country to not provide h/c to all”.....But then with no concrete explanations on how it works in these countries to open US eyes and refute critics. Thus it had little real effect and likely caused more Gop backlash while not offering any practical roadmap.

This was odd since Sanders in 2013 held unique Senate hearings on foreign h/c systems with actual witnesses from Canada, France, Denmark, Taiwan. Hardly covered in media—except Cspan. Strange he never cited this in his campaign to buttress his point. Can only wonder why.

Hope we’ll get a better progressive for 2020 that just might use our differences from modern nations to enlighten US voters instead of just making them feel more angry, cynical and powerless.

Some countries have single payer, some not, some regulate insurance co’s. It appears their rw parties don’t aim to destroy their h/c systems, even with budget cutting. This is one shocking fact ignored by US media, that usually loves shocking facts.

Tell us those exotic, strange foreign examples work---seeming to exist on another planet.
Krugman would never go near them. He shames himself more with every column. I think he no longer realizes what he sounds like. Embarrassing.
But Robert Reich who wants Medicare for all never uses foreign examples either. Strange.

Jay–Ottawa said...

Good points, Meredith, enumerating what "should" be done in the USA about healthcare, among other things, and how benighted our elite moneyed class is, yet in near-absolute control of everything. From here it does indeed appear our elites are more rapacious than their privileged counterparts in Old Europe, although tough reports do come in from time to time about how bad things are over there. Yes, let's pose the same old, same old Socratic questions again and again in an attempt to get past the distractions of play or overwork that leave the average citizen no time for reflection or action. The potential of the majority has been neutered by shocking economic misery or distracted by electronic gadgetry.

There are two types of progressives currently in the US: (1) the real ones and (2) the make-believe-ones, now termed liberals (a pejorative), and who vastly outnumber Type 1. At long last, concerned citizens should by now be able to spot the difference between Type 1 (real) and Type 2 (fake). Places like Sardonicky provide tools and examples for slow learners in helping them distinguish at a glance the real from the fake.

Type 2 progressives can be found without too much searching in public office, noble institutions like universities, or think tanks and foundations chartered to help everybody in the pursuit of happiness. They make some fine points in their speeches, writings and program proposals; but you shall always know them by their deeds, to coin a phrase––specifically, that they risk nothing in personal careers and accomplish next to nothing in the cause of justice despite all that magnificent liberal machinery. Type 2 progressives can usually found barking up the wrong tree, because the pursuit of survival has replaced the pursuit of happiness. Some thinkers suspect they are really working for the ugly elites without donning the usual livery.

Then we turn to Type 1 progressives, the good guys and gals. They are real but scattered, divided and disorganized, and therefore not much better than Type 2. They cannot find a unifying cause, a way to link up. They are like clean, bright, well-maintained greenhouses in vast plains of kudzu, kudzu that has been spreading with ever greater alacrity in recent times, effectively suffocating and strangling whatever might possibly have been noble, artful, wise and fair in America. In those greenhouses, smart people are busy testing for a magical breakthrough that will do away with the rampant kudzu. To this day they have come up with nothing.

Yes, they really "should" get their act together. (Continue by returning to first paragraph, above.)

Karen Garcia said...

Thanks, Meredith. I hadn't realized good ole Maggie actually had nice things to say about the National Health. Once a good socialistic thing is in place, it's very hard for the elites to claw it back

What's made it so hard to criticize Obamacare is that it does do some good for people, therefore to diss it is to begrudge them their good luck. Of course, Krugman is not going to compare our system with anything in Europe, where most of the payment systems are centralized. One of the reason for neoliberalism's success is that it has decentralized and deregulated social programs. Thus we can blame Texas and celebrate California as the lesser of two evils instead of throwing the baby out with the bathwater. (as Hillary said, we don't want to "relitigate" Obamacare, because it was so kludgey and hard to get done to begin with!)

I am glad that more people seem willing to criticize the kludge these days, although of course this doesn'tinclude pundits with mainstream media platforms. Most liberal establishment criticism of the ACA involves cosmetic fixes and tinkering around the edges in hopes that that will be seen as "getting something done."

Jay, thanks for pointing out the glaring difference between liberals and the left/progressives. If we can thank Bernie Sanders for anything, it's that he has brought that y-u-u-ge difference into glaring relief. Still waiting to see how his "Our Revolution" proceeds before I pass judgment. The big tell likely won't come until after the election.

Ste-vo said...

My wife was in Burlington, on Tuesday, Church Street to be exact, that five or six block pedestrian mall championed by Bernie as Burlington mayor in the early 80s, that is largely responsible for the city's vitality, and who did she see walking, alone, but Bernie. Looking very dejected, she said. I asked if she said anything to him. She did not, it was not like she walked beside him or whatever, but she said she would have said "thank you" if she was within speaking distance.

My complaint against Unethical Attorneys blog said...

In January 2015, I started paying the $200 monthly premium for a relatively reasonable catastrophic ($7,500 annual deductible) Blue Cross Blue Shield health insurance policy for my then 22 year old son. The plan promised one "free" checkup with three followup visits. I bought it for the "just-in-case" situations that you supposedly buy insurance for -- a terrible accident, a cancer diagnosis, etc. That year he never bothered to get a check-up and he wasn't sick a single day. I also bought it because I believe in the idea that if everyone paid into a pool, then those that need the health care will get it, and those that don't need it will benefit later when they do need it, like with Social Security. Well, in November of 2015, BCBS sent a letter saying that they were moving him to a more expensive HMO because they were no longer offering the high deductible plans. I don't recall the amount, but it was much more than I could afford to pay. And every knowledgeable person knows that HMOs are highly restrictive and patients lose considerable amount a say in the health care choices, which totally flies in the face of those that claim the free market knows best. I was forced to cancel the policy and he has not been covered with health care insurance since. The image of Saturn/Kronos eating the traumatized child is says it all.