Death By a Thousand Tweaks

The New York Times headline "Biden Administration Restores Rights of Transgender Patients" is not only misleading, it deflects attention from the overarching reality that the richest country on earth still does not provide guaranteed, single-payer health care to every single one of its citizens, regardless of race, color, creed, gender or sexual orientation. Even in the middle of a deadly pandemic, tens of millions of Americans are still forgoing care because of costs, or getting sued for their inability to pay for it because they either have inadequate insurance or no insurance at all. 

Moreover, the Health and Human Services Department's reversal of a Trump-era rule which had given health care providers the option to deny care to transgender people without fear of losing federal funding for their businesses paradoxically continues to punish this population by making them prove to the government's satisfaction that any denial of care is based solely upon their existence as transgender people. Since no other group of people is similarly required to submit evidence regarding denial of medical care, the Biden administration's restoration of their rights to "access" is punitive in and of itself. It might be said to deprive these patients of their rights by forcing them to jump through hoops that no other population group is ever forced to jump through to prove that their rights were, in fact, violated.

Rather than issuing a warning salvo to care-denying providers, the Biden administration is initially placing the onus directly on victims, merely "encouraging" affected patients to file complaints. Prosecution of bad actors, such as insurance providers, under existing civil rights laws is not guaranteed. Medical or surgical treatment for transgender people is not guaranteed, nor is monetary relief.

The verbal and ostentatious bestowal of "access" rights upon transgender patients is just one more example of the government nibbling around the edges of a massive social problem rather than addressing the problem in its entirety. They may just as well have declared "We feel your pain" for all the lack of urgency and remedies that the announcement entails.

The rule reversal and possible amendments to the law are - whether wittingly or not -  guaranteed to further inflame and perpetuate the "culture wars" which have become the centerpieces of modern political campaigns and legislative battles whose lack of any concrete policy solutions is guaranteed to please nobody. Conservatives and religious groups will howl on and on about government overreach and tyranny, while liberals will self-righteously defend "science" and make the interests of the oppressed group du jour the be-all and end-all of their artificially narrow discourse. 

These cultural provocations are, in fact, built right into the pathologically bloated Patient Protection and Affordable Care Act, one arcane section of which presumes to address health care rights. But for all its heft, it does not address them specifically enough, because the Biden administration will now have to spend all of its precious health reform capital on further "tweaking" the unnecessarily convoluted law, and enraging religious zealots and Trump cultists in the process.  Perhaps most importantly, it's a nifty way to delay discussing Bernie Sanders's own watered-down drive to "expand Medicare." 

From the New York Times article on the verbal restoration of transgender health rights:

Biden administration officials said they were working to write more complete new regulations on the civil rights provision of the law, known as Section 1557, that will specify which health care institutions are subject to the rules and what sorts of services they will be required to provide.

"We do anticipate engaging in further rule-making," said Robinsue Froheoese, the acting director of the Office of Civil Rights. She said the administration did not have a timeline for when a formal regulatory change would be announced. A formal rule will require reconsideration of a number of legal questions, such as whether the provisions apply to health insurers as well as health care providers. The Obama administration and the Trump administration also disagreed about whether the law's sex discrimination  language encompassed the treatment of patients who had had abortions.

Of course, transgender people could avoid being scapegoated and co-opted in the latest iteration of the culture war method of governing if the language of the ACA were simpler. For example, when the National Health Service law was enacted in England and Wales in 1948, every citizen received the following succinct letter from the ministry of health:

It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a "charity." You are all paying for it. mainly as taxpayers, and it will relieve your money worries in times of illness.

Contrast that to the kludge of arcane minutiae and wishy-washiness that is the "Affordable" Care Act, which in its nearly one thousand pages (and tweakily counting) had already incorporated the word "waiver" 214  times in the original bill. This number does not include the various state waivers, many of which were implemented during the Trump years and which themselves will require further tweaking by Joe Biden. The law is a document of death by a thousand tweaks and a thousand deliberately manufactured potholes in the road to the single payer system supported by seven out of 10 Americans.

 It is also a massive blank check subsidizing private health insurers and other profiteers to the tune of billions and billions of dollars.

Can you imagine what would have happened to the 1935 Social Security Act if it had contained a thousand pages, rather than 37?

Rather than protecting transgender patients, the ACA itself is a loaded weapon which places them smack-dab in the middle of the culture wars crossfire.  Trans teens, already vulnerable and prone to self-harm and even suicide, are being targeted in ten states by reactionary legislatures which have directly barred providers from administering hormone therapy and other care.

If we had a single payer program that guaranteed care for everybody, trans people would not only be provided with necessary treatment, they would be saved from the additional trauma of politicians either demonizing them or deliberately delaying justice for them as they tweak their timelines, in the process merrily co-opting them as pawns in their identity politics game of thrones.

*******

*Update, 5/12: I'd like to make clear that in no way am I advocating any sort of therapy, including gender reassignment surgery. Those are medical issues that I am not qualified to discuss. The point of my post was to critique the "identity politicization" of this particular medical issue by the usual suspects in the Duopoly. The Biden administration seems to be trying to score more points with the liberal class, co-opting the trans population as a way to differentiate itself from the extreme right wing of the GOP, which is demonizing trans people from many different angles, including the bathroom controversy. I found the White House's self-congratulatory bestowal of medical rights on trans people to be just another smug way to both virtue-signal and dump on Trump. I also found it hypocritical in the extreme, given Biden's abandonment even of the public option in health insurance, thus breaking one of his campaign promises. He is only playing a progressive on TV; his statement that health care is a basic human right is a lie, and his co-optation of vulnerable people, many of whom are already traumatized enough, in order to score political points, is pretty damned gross. In my opinion, of course.

Hope that clears things up.

Insurance Company Executioners

If a stoned vigilante security guard can't quite succeed in killing a young black man with a shot to the back of the neck, then the predatory insurance cartel will be only too happy to finish the job.

They might as well take out the "protection" part of the Patient Protection and Affordable Care Act (PPACA). Because if you get sick or hurt in the commission, or vicinity, of what the government-subsidized Predatory Insurance Cartel (PIC, as in nit-picky) deems to be "illegal activity," it can and will deny payment of your medical bills. And it's all perfectly legal. PIC is judge, jury and executioner.

Private insurance subscribers can die, for all PIC cares.  If you happen to be employed at a no/low-benefit job, you're black, or you live in a state ( like Oklahoma) that has denied Medicaid expansion for the working poor, it seems like they're basically praying that you die, and die quickly.

The "illegal activity"of Monroe Bird III entailed making out with his girlfriend in the parking lot of his own Tulsa apartment complex last February. When security guard Ricky Leroy Stone approached the couple and demanded ID, the victim allegedly locked the doors and started to back out.  Stone claimed he shot Bird in self-defense through the rear window of the vehicle as the victim was backing up. Bird himself, rendered a quadriplegic from the shooting, had no memory of what occurred, but insisted he'd done nothing wrong.

Stone was never charged, claiming the standard "stand your ground" privileges of white guys who want to shoot black people.  Tulsa District Attorney Steve Kunzweiler, in blaming the victim, said “Mr. Bird might have made choices that might have gone a different way if he had listened to the security guard and obeyed his instructions."

Never mind that blood tests later revealed pseudo-cop Stone to be stoned on marijuana, and that he was not actually a sworn police officer, and that Bird was under no obligation to obey him.  In Oklahoma, apparently, failure to obey a parking lot attendant can get you shot when you're legally parked while black. You made the "wrong choice" of living in an apartment complex guarded by a George Zimmerman clone. Too bad, so sad.

Of course, the story gets even worse: 

Three months later, as he lay in the hospital hooked to a ventilator, Mr. Bird’s insurance company declined to cover his medical bills. The reason? His injuries resulted from “illegal activity.”

Yet Mr. Bird was not convicted of any crime in connection with the incident. He was not even charged.

Without insurance, Mr. Bird’s family could not move him to a rehabilitation center specializing in spinal cord injuries. He was discharged from the hospital and died at home last month from a preventable complication often seen in paralyzed patients.

The complication was a pulmonary thromboembolism caused by a blood clot in his leg. Blood clots in the extremities are a common condition in paraplegics and quadriplegics. They can be avoided through physical therapy and skilled nursing, either in a rehab facility or through intensive in-home care. Bird was deemed to be deserving of neither. His care was left to his mother and grandmother.

Bird supposedly benefited from the much-touted PPACA clause which allows young people to stay on their parents' insurance plans until age 28. Even so, his family is now left with more than $1 million in unpaid bills. Bird's insurance was through the plan of his stepfather, an employee of the elite and exclusive Southern Hills Country Club, where the application process alone costs members $40,000. You can just imagine how many black people (besides Tiger Woods) play golf there, and how many black people wait on white people there.

According to the New York Times, there are no statistics on how many Americans are denied insurance coverage based on the "illegal activity" clause in many policies. 

Insurers have long relied on allegations of illegal activity to deny coverage to patients injured in a variety of contexts, from traffic infractions to gun accidents. The judicial rationale is that “we don’t want to reward illegal activity,” she said.

In one court case, a union health plan denied the claims of a worker’s son who was injured while allegedly building a pipe bomb, Ms. Patterson (Crystal Patterson of the American Bar Association) noted. In another, an insurer declined to cover the medical expenses of a man who lost control of an uninsured, unregistered car while trying to pass another driver in a no-passing zone.

Courts have upheld the denials even when there were no convictions for illegal activity. The administrator of the policy can deny claims even when no criminal charges are filed, Ms. Patterson said.

Despite the alleged "protections" against denial of care based on pre-existing conditions, the PPACA affords no protections against any and all other forms of predation. You can still be denied coverage if you get sick, should some unelected, unaccountable, anonymous claims adjustor decide you are morally not entitled to it. You can have an insurance card and still be condemned to an unnecessary painful death. 

Black lives matter. Repeal the Stand Your Ground laws. And let's keep pushing for Single Payer health care.

Worried Sick

It turns out that even if you're lucky enough to have health coverage, you've probably denied yourself the privilege of indulging in actual health care. By the time the profit-bloated insurance leeches have bled you dry, there's precious little left over to actually see a doctor. The USA has the unique distinction of spending the most on health care without actually providing much of it to a sizeable chunk of the population.

But the insurance leeches are sure getting richer and richer from their bloated premiums, which have skyrocketed in anticipation of the "Affordable" Care Act kicking in. Or not, depending upon the whim of nine jurists in black robes.

How sickeningly perverse is that?


The Kaiser Family Foundation is reporting today that many people are worrying themselves sick about how to pay their medical bills. They are not filling prescriptions, not going for follow-up visits, not seeing the dentist. The poorer and sicker and older you are, the more you worry, and the sicker you get.

About a quarter of Americans (26 percent) report they or a family member had problems paying for medical bills in the past year. Difficulty paying bills can lead to tough choices as people negotiate tight budgets. In an effort to allay costs, roughly six in ten (58 percent) report foregoing or delaying medical care in the past year due to the cost.

Half of those with private insurance report that increasing premiums and co-pays are causing them financial hardship. They're worried about losing their jobs and their coverage. That can't be conducive to good health.

Meanwhile, it turns out that quite a few people don't even know about the Affordable Care Act. Here's another story from Kaiser, called "Uninsured and Unaware." It talks about dirt-poor people sleeping all night in their cars to get a place in line for a free medical check-up in rural Tennessee. Patients did not seem to know that if the ACA does eventually go into affect, it would drastically increase the number of Medicaid enrollees by raising the threshhold for poverty up to $31,000 for a family of four. Woulda, coulda, might, maybe.... in 2014. People have so much gall to be getting sick right now, huh?

Everything I have read lately predicts that the Supremes will trash some, most or all of the ACA. And that Obama and the Democrats have no Plan B. It leads me to believe that their hearts were never in it in the first place. Or that they know something we don't know and are kind of hoping that, like the rural Tennesseans, we never even heard about it.

Typical politicians -- maybe if they ignore it, ObamaCare will just go quietly into that good night. As Sen. Tom Harkin (D-Iowa) told Politico, there's no point in doing any planning until nine unelected people decide the fate of 330 million people.