Health Care Kabuki

Since hell hath no fury like a president vindicated, Donald Trump has again gone on the attack against Obamacare. This time, though, Trump is doing an end run around Congress and is using another recent Texas court decision to try and overturn the law. 

The fake resistance Vichy Democrats, meanwhile, are doing their own oligarch-pleasing part by introducing a bill to merely "shore up" Obamacare and keep the private insurance predators in business. Single Payer is off the table. House Speaker Nancy Pelosi has made sure of that, just as she has made sure that impeachment is off the table.

Trump isn't even bothering suggesting a replacement for Obamacare this go-round. He wants, or at least pretends to want, to destroy the whole thing in one fell judicial swoop. He is using the tried-and-true Goebbels method of viciously going on the offense as a way to play cowardly defense. For despite all his boasts of "exoneration!" Trump is not out of the woods yet.  Special Prosecutor Robert Mueller III has reportedly farmed out acres of new evidence to states attorney general and US attorneys which tie him and his extended family to bank fraud, tax fraud, and real estate fraud, to name just three treats on the criminal smorgasbord. Never mind that these are the same local prosecution shops that have let the Trump empire get away with its sleaze for whole decades, absent making secret deals and paying the occasional civil fine. This time could be different, especially when there are political names to be made for any number of hungry headline-seeking prosecutors.

Now, here's where Trump's crusade to destroy Obamacare could hit a snag. As Vicky Ward lays out in her new book, "Kushner, Inc." the president's son-in-law Jared has a big financial stake in keeping Obamacare alive and kicking. His brother Josh's online health insurance company, currently valued at close to $3 billion, could be destroyed right along with the Affordable Care Act. Jared was adamantly opposed to the first attempt at repealing the law, for very good reason. Ward writes:

Josh had co-founded the online health insurer, Oscar, which was predicated on Obamacare: it could be purchased on the state exchanges that the Affordable Care Act had created.... If the new (repeal) legislation rolled back Obamacare, it could be financially catastrophic. Someone close to the brothers pointed out to me that "no other asset (in the Kushner family) comes close (to Oscar)." 

Trump's former economic adviser, Gary Cohn, a Democratic alumnus of Goldman Sachs, also opposed repealing Obamacare. Ward adds that at one point, Jared even brought in Obama health adviser Ezekiel Emanuel, to consult on saving the law and by extension, saving the family's financial skin.

It all became moot when the late John McCain cast the deciding GOP vote that saved the law.

I wonder if Ivanka might now whisper in Daddy's ear that, as pleasurable as it is to scare and sicken millions of people by ripping their health insurance out from under them, it might be smarter to keep the family peace, and most important of all, keep the windfall profits flowing to the family, all thanks to Obamacare. The Oscar company's bronze plan requires subscribers to pay an $18,000 deductible before they receive any benefits at all, making it as legally corrupt as most neoliberal schemes designed to extract money from the desperate and put it in plutocratic pockets for the greater pragmatic good.

It's quite the dilemma for Trump. He will have to choose between pleasing his base, and pleasing his kids and the insurance companies. What variety of greed and graft shall he pick? Stay tuned.

It's possible and even probable that Trump's latest authoritarian gambit is just another head fake to distract the country from his own cowering fears and continuing legal woes. It could even be a way of thanking Speaker Nancy Pelosi for squelching impeachment talk, for slapping his main rival Bernie Sanders' Medicare For All plan, and for fighting her very hardest to further enrich the health care marketplace which has been so good to Trump's in-laws and other wealthy investors.

The corporate Democrats' bill, after all, greatly expands federal subsidies to the insurance cartel, which is already flush with record windfall profits.

The Moral Bankrupts of the Duopoly

Are you among the millions of Americans sweating the possibility that you'll lose your health care if Republican "reform" gets passed?

Well, New York Times columnist Paul Krugman wants to make you feel better. In the event that you do have to endure more pain, suffering, depression and premature death because of GOP sadism, at least you'll have helped make the Democrats look good in the process.

This is exactly how Krugman grotesquely closes his piece on the "Trumpcare apocalypse."

Even though the legislation kicking tens of millions of people off Medicaid and increasing the premiums for Obamacare coverage to even more unaffordable proportions now looks to be D.O.A., Krugman doesn't put its passage outside  the realm of possibility. Some right-wing legislators are so depraved and so fanatical that giving a giant middle finger to the fact-based analysts of the Congressional Budget Office might be an opportunity too good for them to pass up:

Something like this C.B.O. score was a foregone conclusion; would it really have mattered much if it were 15 million losing insurance, not 24 million? How was this supposed to work out politically?

Again, I wouldn’t count out the possibility that this law will be rammed through regardless, with budget analyses relegated to the category of fake news. Democrats might even want to hope that this happens, so that there is no question about who to blame if insurance collapses. But the lemming-like way Republicans rushed into this disaster is still amazing.

The cancer patient on Medicaid whose chemo gets cut off when those proposed lifetime benefit caps go into effect will feel so vindicated. It will be so worth it to say "I told you so" on your deathbed, just to get the satisfaction of watching  multimillionaire Nancy "Embrace the Suck" Pelosi go into nonstop virtue-signalling and fundraising mode, as the United States morbidity and mortality rates skyrocket to even more epic proportions. And if more deplorable Trump voters suffer than righteous Democratic voters, so much the better. It's a prospect to absolutely die for, if you're like Krugman and have "the conscience of a liberal" as well as guaranteed insurance coverage of your own.

The Democrats are as morally bankrupt, in their own smarmy way, as the Republicans. Their tepid health care "fight" is not so much about protecting the tens of millions of people from Social Darwinist ideology as it is about winning back power on the theory that "they suck less." And they conveniently forget that what they are fighting so hard to protect is a Republican plan in the first place. No wonder the Republicans are so tied up in knots over its "repeal." It's hard to call something socialistic and then not admit that the main socialistic component of Obamacare is that it is welfare for the insurance cartel.

Assuming that liberals do manage to prevail in the 2018 mid-terms, they still have no intention of rallying around HR 676 and similar single payer health insurance proposals castigated by Krugman and his ilk during the Democratic primaries and still ignored by them as a sure-fire to win over working class voters.  They will instead be celebrating the fact that they managed to "save" the for-profit predatory health insurance system. Or as Krugman so cynically hopes, they will be gloating all the way to the bank.

Let's get real. Human lives and bodies are way too profitable to just let Obamacare as we know it go the way of the rotary phone. As Nobel Prize-winning economist Angus Deaton put it recently, the pharmaceutical industry is not about to give up its cannibalism when there's so much money to be made by both treating and causing disease in people. Obamacare and its kludge of insurance predators and outsourced Medicaid plans are in the same predatory rent-seeking category as payday loans and rent-to-buy housing scams and charter schools.

Another prime example of rent-seeking is that the Medicaid is funding opioid prescriptions for low-income workers, Deaton said. The results are workers who are becoming addicted and overdosing while profits are going to the Sackler family which owns Purdue Pharma that makes OxyContin.
Deaton said he favors a single-payer health system only because our current part-private and part-public system is exquisitely designed to give opportunities for rent-seeking.
“So I, who do not believe in socialized health-care, would advocate a single-payment system...because it will get this monster that we’ve created out of the economy and allow the rest of capitalism to flourish without the awful things that healthcare is doing to us,” he said.

Democrats have cleverly taken to calling the GOP health bill "Making America Sick Again." Actually, "Making America Sicker by Forcing Poor People to Buy their Own OxyContin" would be more on point. But that would be both too much of a mouthful, and a tacit admission that Democrats like things just the way they are.

 It also helps that the Sackler family of billionaires has generously donated to both sides of the morally bankrupt Duopoly while literally getting away with mass murder.

As a 2016 investigation by the Associated Press and the Center for Public Integrity shows, drug companies have spent more than $880 million on lobbying and political contributions since 2000. Compare this to only $4 million spent on similar influencing efforts by organizations which exist to combat opioid addiction and the proliferation of pill mills, and you begin to understand why there is so much turmoil in bipartisan circles over Obamacare repeal and Medicaid destruction.

Somebody should alert that hyper-capitalist Donald Trump about the imminent danger to the oligarchic bottom line which GOP "reform" represents, especially since he himself has advocated for a single payer health care system on more than one occasion. 

If we can't appeal to his psychopathic selfishness, perhaps we can appeal to his psychopathic greed.

Meanwhile, the Democratic Party should probably just hurry up and get on with its own collapse so that a new progressive party can arise from the ashes.  

As for HR 676,  re-introduced by John Conyers in January, it has now been referred to the House Committee on Indian, Insular and Alaska Native Affairs, where it is bound to get maximum attention from the truth-telling mainstream media. Maybe they'll get around to discussing it as soon as they come down off their own latest high: blissing out over two whole pages of an old Donald Trump tax return.

So when you get the email from the White House asking you to share your own Obamacare horror story, you might consider just sending the president a copy of HR 676, that fantastic and fair single payer bill. It would save both him and you, like, an unbelievable amount of money. Best of all, taxpayers wouldn't be on the hook for expensive elective cosmetic procedures for rent-seeking plutocrats. The ultra-rich need to have some skin in the game just like everybody else. HR 676 would force them to pay for their facelifts and tummy tucks out of their own deep pockets. Sad.

This bill establishes the Medicare for All Program to provide all individuals residing in the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care.
Only public or nonprofit institutions may participate. Nonprofit health maintenance organizations (HMOs) that deliver care in their own facilities may participate.
Patients may choose from participating physicians and institutions.
Health insurers may not sell health insurance that duplicates the benefits provided under this bill. Insurers may sell benefits that are not medically necessary, such as cosmetic surgery benefits.
The bill sets forth methods to pay institutional providers and health professionals for services. Financial incentives between HMOs and physicians based on utilization are prohibited.
The program is funded: (1) from existing sources of government revenues for health care, (2) by increasing personal income taxes on the top 5% of income earners, (3) by instituting a progressive excise tax on payroll and self-employment income, (4) by instituting a tax on unearned income, and (5) by instituting a tax on stock and bond transactions. Amounts that would have been appropriated for federal public health care programs, including Medicare, Medicaid, and the Children's Health Insurance Program (CHIP), are transferred and appropriated to carry out this bill.

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.

Hillary's Miracle Cure: Shop Around

(Optional soundtrack)


Happy Ides of March Eve of the third Super Duper Terror Tuesday of the year, everybody!

I must confess that, suffering as I am from a severe case of Presidential Horse Race overload, I paid only scant attention to last night's Democratic town hall from Ohio. But this exchange between Hillary Clinton and a middle-aged woman from the audience,named Joyce, really got my ear. It encapsulates the cynicism, cluelessness, and utter lack of empathy beneath a thin mask of technocratic concern that is at the very heart of the Clinton candidacy:

 QUESTION: I have voted for Obama, and then my health insurance skyrocketed from $409 a month to $1,090 a month for a family of four. I know Obama told us that we would be paying a little more, but doubling – over doubling my health insurance cost has not been a little more. It has been difficult to come up with that kind of payment every month. I would like to vote Democratic, but it's cost me a lot of money, and I'm just wondering if Democrats really realize how difficult it's been on working class Americans to finance Obama care.

(APPLAUSE)

CLINTON: Wow, Thank you for asking me that, because. May I ask you, before you were buying your family health insurance in the individual family market? Were you getting it through the employer? How were you insured before?

 QUESTION:  I was purchasing it privately, because we both had bouts of unemployment. 

CLINTON:  So you were going to a broker and buying a health insurance policy. 

QUESTION:  Yes. 

CLINTON:  And in effect, it nearly tripled after you went on to the exchange and bought a policy under the Affordable Care Act, is that right? 

QUESTION:  We could not do that.  It was much more expensive than just purchasing private insurance from the insurance company. 

CLINTON:  So you are still buying private insurance directly? 

QUESTION:  Yes. 

CLINTON:  OK.  Well, first of all, let me say I want very much to get the costs down, and that is going to be my mission, because I do think that for many, many people, but there are exceptions like what you are telling me, having the Affordable Care Act has reduced costs, has created a real guarantee of insurance, because if you'd had a pre-existing condition under the old system, you wouldn't have gotten affordable insurance.

So it has done a lot of really good things, but, it has become increasingly clear that we are going to have to get the costs down.  And what I would like to see happen for you and your family is that if we can get the co-pays down, the deductibles down, get the prescription drug costs under control, that you would find an affordable plan on your exchange. 

And one thing that I would like you to do, and I'm not saying it's going to make a difference, but I would like you to just go shopping on that exchange.  As I understand it, Ohio has the federal exchange, is that right, Joyce?  Because they did not set up a state exchange.

So you have the federal exchange.  And to go on and keep looking to see what the prices are, because we have to get more competition back into the insurance market.  One thing that I want to work on with my friends from Congress who are here is we've got the get more non-profits that are capable of selling insurance back into the insurance market. 

You know, Blue Cross and Blue Shield used to be non-profits.  And then they transferred themselves into for-profit companies.  And there was some effort made under the Affordable Care Act to get some competition from non-profit institutions, some of them worked and a lot of them didn't.

I want to know what we can do, because if you could get a range of insurers, some of who were not-for-profit companies, that would lower costs. 

So there is a number of things I am looking at.  And what I want to assure you and your family of is I will do everything I can as president, working with members of Congress where necessary, to try to get the costs down. 

But I do want you to keep shopping, because what you are telling me is much higher than what I hear from other families, and so I want to be sure that if there is a better option out there for you, you're going to be able to take advantage of it.  

And then I'll work as hard as I can to get the costs down for everybody, and that includes prescription cost drugs, which are skyrocketing and increasing costs for everything else. 

***

How does Hillary Clinton verbally diminish and insult this woman living on the edge? Let us parse the ways.

First, she disingenuously professes shock at Joyce's plight. "Wow!"  She immediately casts her questioner as an anomaly in the wonderful world of market-based medical insurance for profit. Ignoring Joyce's all-too-common experience with precarious employment, Hillary pounces on her deficient shopping skills.

Joyce's big problem, in Hillary's view, is not that insurance companies are greedy. It's that Joyce has lazily put her trust in a greedy insurance broker. She gave up on Internet shopping too easily. She didn't shop around. 

Next, Clinton goes full Pangloss, reminding Joyce that it could always be worse. At least her pre-existing conditions won't be held against her any more. Of course she'll have to pay more, because her conditions are not the fault of the profit-driven insurance cartel contributing handsomely to Hillary's campaign and paying her generously for private speeches. It's not the insurance cartel's problem that healthy people aren't signing up for product in the droves that the White House originally predicted. It's not the insurance cartel's fault that sick people are gaming the system by daring to try and use insurance product, thereby forcing the cartel members to either drop out or merge, thus driving up rates.

As sure as the wind's gonna blow, Joyce, insurance companies will come and go, and merge, and screw you any way they can. So you better shop around. Try to get a bargain for your son, and don't get sold on the very first one. You gotta shop around. It is your duty as an American citizen.

Clinton also didn't bother asking the woman how many crappy jobs she has to work in order to make ends meet. She didn't ask if Joyce even has access to a computer or an Internet connection. She didn't ask if she has any time to spare in a futile quest to save a few bucks on her monthly insurance premium, which probably nears or even surpasses the amount the family has to pay in rent or their mortgage. She didn't want to know what it will cost Joyce in co-pays and deductibles, should she ever attempt to use her overpriced insurance.

To the contrary: Hillary bragged about working with her superdelegate "friends in Congress who are here" to magically cajole the private insurance predators into acting a little less greedy. Maybe reduce the co-pays a tad, if not the premiums.Yes, folks: these platitudes come from the same woman who calls Bernie Sanders's Medicare for All plan a severe case of magical thinking.

Hillary instead doubled down in implicitly blaming Joyce for not getting a better rate. Joyce's very typical horror story is apparently not what Hillary is used to selectively hearing. Her trite response is to keep on shopping till you drop  to save a buck on overpriced insurance product. Stop being such an inept consumer, Joyce, and maybe you won't keep feeling so sad and blue now.

Because in Hillary World, health is not a basic human right. In Hillary World, there are no people who must choose between taking medicine and paying the electric bill. In Hillary World, there is no precariat.

There are only consumers ripe for extraction and exploitation.

HR 676: Medicare for All. Everybody covered from cradle to grave. Pay a slightly higher tax rate and forget about shopping around till you drop, forget about premiums, co-pays and deductibles.

You better shop around. Voting for Bernie is probably still the best bang for your buck.

Criminalizing the Sick

As Hillary Clinton cynically vows to incrementally build upon the "successes" of the Affordable Care Act, the Obama administration keeps chipping away at them.

The latest chip punishes people who desperately sign up for expensive private health insurance when they get sick or hurt. Such behavior is a rude slap in the face to the free market predators, who are then forced to dip into their obscene profits and pay a portion of your hospital and doctor bills. 

Of course, the way the insurance companies spin it, it's those conniving sick people who are to blame for driving up everybody else's premiums. It's the same old Divide and Conquer ploy that the ruling class has used since time immemorial in an attempt to hide their own greed and malfeasance.

As Barack Obama might explain it, if you "game the system" by waiting until you're at death's door to use your rent and grocery money to pay hefty insurance premiums, you're going to have to pay the piper. You'll have to wait until the next open enrollment period to have your bursting appendix removed.  You might even have to die as prematurely as you would have in those awful days before the health care sweepstakes were instituted. You can't buy a lottery ticket after the drawing, people! You can't put a flat screen TV on your credit card just to watch the Super Bowl, and then expect a full refund when you return it the next day, all full of smudges and fingermarks. 

As the New York Times explains it,

The administration, which had created more than 30 “special enrollment” periods, sent emails to millions of Americans last year urging them to see if they might be eligible to sign up after the annual open enrollment deadline. But, insurers and state officials said, the federal government did little to verify whether late arrivals were eligible.Kevin J. Counihan, the chief executive of the federal insurance marketplace, said Tuesday that special enrollment periods “are not allowed for people who choose to remain uninsured and then decide they need health insurance when they get sick.”

Since the Neoliberal Project has deemed your body to be a commodity which you only partially own, you are expected to behave like a responsible consumer. If you seize up your engine because you didn't oil the capitalistic machinery as directed, don't come crying to Obama when you stall out. If you don't pay through the nose for the pricey undercoating deal, tough luck if your bod gets rusty. Keep yourself polished and gassed up, and pledge your financial allegiance to the underwriters instead of to the undertaker. Above all, keep up those monthly extortion payments, lest you get an unpleasant visit from the WellCare repo man. 

Mr. Counihan said the administration would eliminate six of the special enrollment periods, including two for certain lawfully present noncitizens who experienced “system errors” and “processing delays” when they used HealthCare.gov. In addition, he said the government would clarify eligibility standards and step up enforcement to prevent abuse of special enrollment periods.

The actions appeared to have several purposes: to motivate consumers to sign up by the Jan. 31 deadline; to prevent an influx of large numbers of sick people into the market in the middle of the year; to persuade insurers to enter or stay in the public insurance marketplace; and to minimize rate increases in 2017 and later.

Medical care cuts both ways, said Counihan. The right of protection racketeers to get rich hinges upon the fear cooperation of regular people, who must pay for Medical Care Product in advance. You see, in the most exceptional nation the world has ever known, health care is still not a basic human right. It is a privilege for only the select few with a high enough credit score and bank account balance to qualify for survival.

The new rules mean that not only will people have to go shopping every year for a new insurance plan, they will now have to prove they have a permanent address. People who temporarily move in with relatives (maybe because they lost their job when they got sick) won't qualify for coverage outside the narrow enrollment period. People who get sick or hurt outside their home states will have to jump through hoops to prove that they're not trying to cheat the system. All citizens shall be considered suspects until and unless they can prove their financial and medical innocence:

In a blog post on Tuesday, Mr. Counihan said, “Our program integrity team will pull samples of consumer records nationally and may request additional information from some consumers or take other steps to validate that consumers properly qualified for these special enrollment periods.”

In addition, he said, officials will emphasize to consumers that “they may be subject to penalties under federal law if they intentionally provide false or untrue information.

These are the same pathocratic clowns who profess to be so amazed that Bernie Sanders' Medicare for All campaign is so popular. They seem to be honestly baffled that people aren't in love with Obamacare. Who, except lefty unicorn believers, wouldn't rather pay high premiums and co-pays and deductibles to the for-profit insurance racket and then get treated like a criminal if they show up in the emergency room?

The architects of the Affordable Care Act and the private insurers they serve are now criminalizing and intimidating the sick. Before you know it, newspapers and websites will be adding photo galleries of Obamacare Cheats to supplement their regular poor-shaming features on Food Stamp Grifters and Welfare Queens.

So use your Obamacare card at your own risk. And keep up those monthly payments to Blue Cross. Stay close to the phone in case a government official, acting on behalf of United Healthcare, decides to call you in for an audit. A hospital-to-prison pipeline could be in your future if you don't get sick responsibly.

Democrats Vindicated by More Uninsured People

The Congressional Budget Office now estimates that three million more people than first projected will either remain, or become, uninsured under the Affordable Care Act when it goes into effect in 2014. Since mainly red states have signalled they will reject federal expansion of Medicaid in their locales, the government will save a bundle of money and the deficit will be reduced. Out of 50 million currently uninsured people, less than two-thirds will now benefit from Obamacare. And since employers are dropping expensive coverage, and people are still losing jobs, look for that number to keep dwindling. The CBO forecasts an additional 4,000 people, or 7,000 additional people will be uncovered by the end of the decade.

And the Democratic Senate Majority Leader is calling this a good thing? Well, yeah, because now Obama can brag about his austerity cred when Republicans call him a tax-and-spend socialist. The hell with sick and dying people when the Oval Office tenancy is at stake. From the AP report:

Thirty million uninsured people will be covered by 2022, or about 3 million fewer than projected this spring before the court ruling, the (CBO) report said.

As a result, taxpayers will save about $84 billion from 2012 to 2022. That brings the total cost of expanding coverage down to $1.2 trillion, from about $1.3 trillion in the previous estimate.

Democrats immediately hailed the findings as vindication for the president. “This confirms what we’ve been saying all along: the Affordable Care Act saves lots of money,” said Senate Majority Leader Harry Reid, D-Nev.

Not one sympathetic word, though, about the new three million, on top of the 20 million already thrown under the bus by the ACA. Reid was mum on the actual victims of this fantastic pennysaver, most of whom unfortunately reside in bastions governed by the GOP (Greedy Obdurate Plutocrats.) This is just more evidence that the Democrats, too, are full-bore austerians, just slightly more discreet than their GOP brethren on the other side of the corrupt duopoly.

Of course, reducing the number of people on Medicaid may eventually steer them into federal exchanges and profiteering private insurance, essentially increasing the final per-person costs to the government. But nobody's talking about that faraway eventuality, because it won't dawn on us until after the election. All anybody's talking about is how Obama has gotten more ammunition to hit back hard against Romney. Score one for the blue team in the Battle of the Deficit Hawks. Great refereeing, too, by the Supreme Court with their new Medicaid opt-out call.

Twenty-seven million abandoned souls, and counting. Three people still dying every single hour for lack of medical care.

It would be pathetic, if it weren't such an egregious case of political malpractice, bordering on felonious assault. 

Let the Spin Begin

Just a few thoughts on the just-concluded Supreme Court hearings on Obamacare. I am no legal expert, so let the lawyers nitpick the merits of the arguments or lack thereof. What I find fascinating -- and frankly disgusting -- is the lackadaisical reaction from Democrats to the possibly imminent demise of their landmark bill. 

Instead of lamenting the fate of the tens of millions of Americans who will be forced to do without even half-assed medical care if five black-robed right wing political hacks strike down the law, the Democrats see defeat as actually being good for them politically. Should the Court rule against the mandate requiring everyone to purchase private health coverage, they have no Plan B waiting in the wings. There will be no attempt to "fix" the law, no stampede to introduce a Medicare for All bill. Why should there be? The fate of Obamacare will not affect the presidential election at all.

Tribalism will trump policy and the outcome of the Rombama contest will hinge on which candidate raises the most cash from the oligarchy. If you're already an Obama supporter, you're going to vote for him no matter what. You are not going to blame him and his fellow corporatists for not pushing for a public option when they had the chance and making the pay-for a tax instead of a controversial mandate. You are going to gleefully blame the nasty Supremes if Obamacare goes down in flames. You are going to point out that this was originally Romneycare, the product of a Republican think tank -- and  the doofuses from "the other side" voted against their own plan! The GOP will be destroying our gigantic giveway to the insurances leeches and Big Pharma.  Not our fault! Maybe the health care industry will donate the big bucks to our side now.

Democratic strategist James Carville thinks that millions of people being deprived of medical care would be absolutely dandy:

 “I honestly believe this — this is not spin,” Carville said. “I think that this will be the best thing to ever happen to the Democratic Party because health care costs will escalate unbelievably. It’s 2012. Twenty out of 100 people are over 65. By 2020 it will be 26. And you know what the Democrats are going to say and it’s completely justified, ‘We tried. We did something and go see a 5-4 Supreme Court majority.”

(Translation: We were perceived to be caught trying, although our hearts have never really been in it.  Oh well. If millions of people have to sicken and die just to make us look good, so be it.)

Jeff Zeleny of the New York Times theorizes Obama will run against the Supreme Court in the good old progressive spirit of FDR, and fight against Congress as a Give Em Hell Harry copycat. One of Zeleny's unnamed Democratic sources confided they'll be unashamedly casting themselves as victims and playing the martyr card. The Dems will be drowning in the bathos as the GOP drowns government in the bathtub. The rest of us will be drowning in our own tears.

The lack of political urgency in what is essentially a humanitarian crisis is mind-boggling. Instead of meeting in emergency session to craft legislation to ensure that the 50 million and counting uninsured Americans get medical care, Congress is throwing out members who wear hoodies. It's passing a bipartisan act to make it easier for financial crooks to bilk investors and then having the chutzpah to call it a JOBS Act.

The White House remains "confident" that Obamacare will stand, and thinks the bumbling solicitor general did a heckuva job in his lackadaisical Supreme Court appearance.

Despite the solicitor general’s shaky performance before the court, (WH Deputy Press Sec. Josh) Earnest called Donald Verrilli Jr., the government’s lawyer in the case, a “very skilled advocate” and “one of the brightest legal minds in Washington, D.C.”

Verrilli “delivered a solid performance before the Supreme Court. That's a fact. We feel good about his performance,” he said.

Methinks Josh was joshing. And his claiming not to know whether Obama had been paying much attention to the court case beggars belief. But he was probably right when he warned against placing bets on Obamacare, calling it a "risky business."

Maybe he was listening to CNBC Mad Money guy Jim Cramer (the same guru who told everybody to buy Lehman Brothers stock right before it crashed.) Cramer was on TV yesterday talking about the futility of reading too much into the lines of questioning by the Supremes. (So far, at least as far as we know, there exists no hedge fund betting on Obamacare futures. But give the geniuses of Wall Street a day or so.)

 The judges were probably just  funnin' with us anyway because, you know, people getting sick and dying for lack of health insurance is so damned hysterical. The word "broccoli" had everyone rolling in the aisles. Still, predicts Cramer, if Obamacare goes down, stocks will go up! If it stands, he advises investing in temporary employment agencies -- in order to avoid mandated coverage, "job creators" will simply hire people and fire them six months later to game the law. The profits of Manpower and other temp agencies will skyrocket as a result, he enthuses. Clip here.

That just about wraps it up. American-style health care policy doesn't have much to do with health. It has everything to do with pretend legislation, pretend bickering between the two sides of the Money Party, and ensuring that each side benefits both politically and financially whether it passes judicial muster or not.  Heads they win, tails we lose.