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.