Repeal Without Replace: Out The Plane Without A Parachute

Healthcare and healthcare coverage is an important topic for me for two reasons.

1.) Because my father died without coverage. He went without coverage because he had a pre-existing condition, and he was in the gap between his actual retirement and the proper retirement age, so he went without coverage for a short time until he could pick up Medicare at 65. In that time he got prostate cancer, as he went without any kind of preventative checks. It metastasized. It killed him. And that was that.

2.) Because the ACA has been a boon for me as a writer — which is to say, as a small business, because that’s what I am. I went to get health insurance initially and it was very expensive to cover my family, and it did not cover a great deal… and that was before we even got into any tussle over pre-existing conditions. The institution of the ACA was fortuitous, and allowed us to instead go to the marketplace, where we got health insurance that was considerably cheaper and covered considerably more. It allowed me to embark upon the “novelist” phase of my career in a real way. Like my books? They exist, in part, because of the ACA.

So, with those two previously-mentioned caveats mentioned once more —

Hey, how’s the healthcare debate going in this country?

Good? Yeah?

*checks watch*

*stares off at a pile of medical waste on fire*

*someone adds a pile of diapers to the conflagration*

Oh, so that good, huh?

*clears throat*

So, last night, in case you missed it, the healthcare repeal and replace failed in the Senate because it did not accrue enough support — those who bailed on it (Senators Moran and Lee) suggested they wanted an open legislative process, and some even suggested a bipartisan look at healthcare going forward (gasp, what, you mean you’d like to, to, to cooperate whoa holy shit what a revolution). And then ol’ Turtle Waddle, ol Mr. Turkey Dildo, ol’ Senator Mitch McConnell, he said, OH HELL NO, and he released a statement that said they will now pursue a repeal of the ACA without a current replacement.

In case you are unsure what that looks like, imagine that it looks like a person holding a sewing machine swaddled in fabric, and then that person leaps excitedly out of a plane in the hopes of stitching together a proper parachute before turning into a pancake of blood-and-bone.

Then, this morning, our melting shit-scented candle of a president endorsed an even uglier version of this idea, saying, and I quote, “As I have always said, let Obamacare fail and then come together and do a great healthcare plan. Stay tuned!”

Stay tuned.

Like this is a reality show and not:

a) a massive industry on which our economy hangs

b) people’s lives.

This is our, ahem, “leader” —

Someone who is content to let a thing fail instead of leading the way. Instead of fixing or repairing. Can you imagine seeing a bridge that’s failing and saying, “I’ll let it fail, then replace it.” Worse, it’s like he’s ready to commit some grand guignol of insurance fraud — “As I have always said, let the house burn down, or maybe I’ll burn it down myself, then I’ll collect the insurance and we can come together and pay for a great big new house. Stay tuned!”

He will let the system fail.

He will let people die.

And then he’ll swoop in and we’ll do “great” healthcare.

What a pal, what a chum.

Anyway, back to the Senate.

The Senate passed a repeal-without-replace in 2015, and that succeeded — in part, I suspect, because it was purely performative. They knew Obama wasn’t going to sign it, because c’mon. Obama wasn’t going to undo part of his legacy. But they showed solidarity. They passed it, he vetoed it. It gets more complicated now because what McConnell is proposing is that they excise the ACA over two years, giving them a window of replacement.

But I want you to pay attention —

They last tried to repeal in 2015.

It is now 2017.

That was two years ago.

They still have no replacement.

That wasn’t the beginning, though —  they’ve been trying to undo the ACA for SEVEN years.

And still, no replacement.

They now control the executive and the legislative branches of government.

And still, no viable replacement.

So, to assume that in two years they will come up with a capable healthcare system in place is not only absurd, it is statistically unlikely. (Never mind the fact that the CBO score on “repeal-without-replace” is the most devastating of all in terms of costs and people thrown off healthcare.) The GOP have nothing. They don’t have the chops. They’ve had seven years, then two, then they gained control of everything, and we’re still with the ACA.

Which, by the way, is a good thing.

Yes, the ACA is imperfect, but guess what? It’s fixable. (It in part was hamstrung by Rubio, who eliminated high-risk corridors.) Listen, as a parent with a kid, I gotta tell you — it’s an epic fucking blessing when you learn a thing is broken-but-fixable. It saves you money to fix the things that you can fix rather than replacing them. (That, one could argue, is a truly conservative mindset. Conserve what you have, fix what can be fixed.) Furthermore, it is galling to know we have leaders who are willing to play chicken with people’s actual lives and an entire industry in order to pursue a dogged crusade against what is, very honestly, a Republican-based plan (yes, the ACA was originally a Republican plan) that happened to be implemented by a black Democrat.

So, as always, I urge you:

Call your senators.

Thanks.

44 comments

  • Thank you for your post. I am not in the US, so it is useful to me to read your take on it, given the partisan opinions that make it difficult to get some proper information without dedicating a lot of time on the issue :-).

  • Hi Chuck. Sorry about your Dad. A simple blood test could have given him a clue or beginning of a diagnosis. I’m writing a blog post right now and will post to my site theivorytide.com. I don’t have all the answers but I am a nurse and “Nobody Asked” me for an idea. By the way I’m writing novels with your encouragement and help and I do include medical conditions in them. My contribution.

    Theivorytide.com

    Thanks. Best.

  • Welcome to the post-Brexit, post-logic world.

    Right-wing ideologist: “I don’t like this thing upon which a large part of our society relies, but I’ve got no fucking idea what to replace it with. But I really don’t like it, because spurious reason that you should believe too, so let’s just get rid of it and then see what comes along to replace it.”

    Rest of governing party: “Yeah, wow, that’s a great approach! Why didn’t we think of doing that before?”

    Majority of electorate: “I’m going to vote for this party because they say what they think, and look, spurious reason for getting rid of this thing!”

    Rest of electorate and anyone else with any kind of brain: “But you… No, you don’t understand, you can’t… No, really… Oh fuck” (facepalm)

  • I am beyond disgusted with the GOP and their shenanigans. All they seem to be engaged in is destroying anything Obama managed to put in place despite their constant opposition. Of course the ACA would be at the top of their list. That they can’t see beyond their racist hatred to the people who will suffer because of their decisions is chilling and infuriating. They truly are the Party of No Ideas and so much worse.

  • Amen to this.

    However, the tarnished silver lining in this debacle is that single-payer once again seems to be gaining more steam. Before the 2016 election cycle “single-payer” (or is it “single-payor”?) was something only policy wonks discussed…

    I find it telling (and you did this as well – so maybe it’s just natural or better) is that folks often list the dollars/business impact before the personal impact. “Hey, this big rich industry who’s made billions (probably trillions) of dollars from exploiting this situation is going to be hurt. That’s really sad. Oh and by the way lots of folks are going to DIE and a lot more will have their lives RUINED in other ways. But, man what about those insurance companies? That’s really gonna suck.”

    That’s not criticism of you – just an interesting observation – the NYT, WaPo (you know all the bleeding heart fake news organizations) often categorize things the same way. Not just on health care. Read an article yesterday that bemoaned the Iran war that cost TRILLIONS and, oh, there were also 4,500 US military deaths. It should be the other way round. The dollars we’ll get back. The 4,500 dead soldiers? Not so much… (And of course no mention on the 10X impact on civilians).

    Ho hum.

      • Yeah – sorry about that – simple typo. The article was about how we lost lives & spent money on the IraQ war but how IraN still has influence in the region.

        Thanks for proof-reading. 😉

        And, hey, what’s with two countries next to each other that only have the last letter different? Whoever came up with that didn’t consider the increased chance of typos!

  • Thanks, Chuck. We all need to keep speaking out, which at this time can make us hoarse. There are SO MANY issues we have to speak on it can make your head spin. Keep up the good work! 🙂

  • July 18, 2017 at 10:07 AM // Reply

    Very well said, thank you! Mitch McTurtle has a profound, pathological hatred of anything accomplished by Barack Obama. At this point, his fellow Congress people should be taking a very close look at this guy’s motivations. He is willing to throw our health system into absolute chaos, and millions of American citizens health be damned! An astute (it is possible!) Conservative commentator on CNN said it very well, “We own the Presidency, the House, and the Senate, We own this mess. In other words, they have no one to blame but themselves, but of course they will flail around and blame Obama for everything and their dim witted base will believe them. When they cross the line of what is decent or legal, they merely move the line. God help us.

  • Trump–‘let Obama fail’–he has to discredit Obama, or anyone else he sees as against him–in order to be someone himself (in his own mind). What a sick bastard.

  • I’m sure you remember that at the end of Herbert’s “Dune,” Paul says, “The power to destroy a thing is the absolute control over it.” This is unquestionably true, and absolutely terrifying as a governing philosophy. I’m sorry about what happened to your Dad. This is a very poignant break down of the issue.

  • As you pointed out, the Republicans have control of the executive and legislative branches of our government. They also control the judiciary and a majority of the state houses and state legislatures. If Obamacare fails without replace and repeal or without repeal but because of the machinations they are able to instigate without 50 votes, it is the failure of this Republican government. It is not the failure of “Obamacare.” When does the narrative shift? It is the failure of this government.

  • I fail to understand resistance to a sensible single payer health system such as the one on Canada. Since Canada spends about 10% of GDP on health care while the US lays out a whopping 17%, there would be substantial savings. Individuals freed from onerous insurance premiums (which are a fat health care tax) would pay a much more reasonable sum through their regular taxes. The ordinary citizen would have more money to spend and be protected from the horrendous debt and bankruptcy so often visited on families through illness.

    In Canada, if you get sick, you go get treatment, you go home healthy again, the thought of money does not enter your head. Imagine the peace of mind that brings. While a big improvement, the ACA is a still subsidy to the insurance industry. A single payer system would bypass the bloated insurance bureaucracies, saving their cut of the take, and give the money directly to health care providers.

    I know Americans are led to believe that people north of the border are left to expire in hospital parking lots for lack of care but none of that is true. The Canadian universal health care system, while it certainly has its issues, is excellent and a bargain to the nation. It remains a major pillar of economic and social stability. It attracts business and industry because companies do not have to deal with medical coverage. It frees workers to move from job to job without fear of losing a health plan. It saves on future costs because people get treatment early instead of putting off costly care until some disease becomes full blown and chronic. It lets hard earned family assets pass on to boost the next generation instead of draining inheritances into the pockets of medical corporations.

    People are free to chose whatever doctor and care they wish. The system remains private. The only difference is the single payer. Isn’t it better to let caring community bear the costs together rather than abandoning individuals to pay up with everything they have when illness strikes them down?

    • “…and give the money directly to health care providers.”

      Who are also running a for-profit business, charging patients and insurance companies far in excess of what things actually cost. We need (reasonable!) price caps in the US: we need healthcare to stop being for-profit. Without that, single payer will quickly become financially unsustainable.

      • Here in New Zealand, there’s the expectation that one of the reasons we pay taxes is so the government will provide us with medical care. The government subsidizes visits to private practices, especially for those on low incomes, and it’s the government who decides on that subsidy, not the private practice. If the private practice decides to up what it charges the patient, the patient is free to just go somewhere else. The government also subsidizes a wide range of prescription medications.
        As for insurance, we have the ACC – money goes in from employers according to how high-risk their employment is, and people have the comfort of knowing that if something happens, they’re covered, even if they lose their job as a result.
        It isn’t a perfect system, but it works better than most. On the other hand, our government is now, disturbingly, playing with the idea of for-profit prisons.

      • Doctors recieve fixed fees for services, set at a reasonable amount for each service paid for by the government. They do not charge patients or deal with insurance.

      • Paperwork for payment takes a Canadian doctor an hour or two each week instead of the many hours US doctors must spend dealing with multiple plans, insurance companies, etc.

        • As a dentist in the US, I can attest that the time commitment to dealing with insurance plans is, even for us, a huge expenditure of time. In larger offices, they often have one employee (full time) who does nothing but deal with insurance.

          We providers feel pressure from below in the form of insurance company reimbursement levels being held steady for years with no increases, even though everything has gone up (except my salary) and from above with increased costs both inside and outside the practice. Not to mention increased taxes. We have to do more work per hour when we should be spending more time on each procedure and with each patient. It isn’t the providers who are getting rich. It’s the hospital administrators and the insurance company execs.

          I didn’t push either of my kids into the medical fields because of what’s been going on with the business end of things…

    • Well said, Meg. The return on investment into universal healthcare as you describe, is indeed as profound and far-reaching as you’ve described.

  • Ugh, my mother is standing on the precipice of where your dad was, since she has an autoimmune disease, isn’t covered by an employer, and currently has private insurance that she can barely afford. I’m thisclose to very calmly walking over to McConnell’s office and bursting into tears until he promises not to hurt my mommy.

  • I found myself in a similar boat as you, Chuck. The ACA became law just at a time where I was transitioning from an employee to a self-sustaining small business owner. Obamacare has helped us retain the insurance coverage we needed while my wife went through breast cancer recovery and all the subsequent reconstructions & complications.

    If the healthcare industry in this country wasn’t such a screwed up mess to begin with, we wouldn’t have to have such a complicated & Rube Goldberg-esque law governing it. More to the point, if the uber-rich weren’t so focused on taking even more for themselves, we could actually do what other industrialized nations do and provide healthcare for all (as a right). No, such systems aren’t perfect, but damn, they’re a helluva sight better than what we have today in this country.

    Unfortunately, Congress (at least a specific party therein) is too beholden to their rich & powerful lobbyists and truly doesn’t give a damn about the chunk of the population not covered by group insurance, Medicare, Medicaid, or other government-provided insurance (such as the VA). While we’re only 7% of the total population, we’re the small business owners these clowns in D.C. claim to want to encourage to pursue the American dream.

    Hopefully, the “appeal & replace later” bill will die like the others & then MAYBE the majority party will work across the aisle to come up with a repair for the ACA. The markets need stabilization, the beneficiaries need relief from the constant stress of possibly losing their insurance coverage, and we need to join the rest of the free world & actually care about ALL citizens.

  • Look at the history of Social Security and Medicare. Both started out with minimal benefits for as small a population as possible, then were *amended* over the years to adapt to changing conditions and public support, to cover more people more effectively. That’s how the system works. Unless you can flunk the IQ test low enough to qualify as a Republican.

    And as a nonsequitur, I’m glad to see all the butthurt from the white male morons of s-f – the audience I wish could be gathered up and launched into the sun – over the new Dr. Who.

  • I am so very very pissed at all this. The majority of the damned country actually wants this! Screw the fucking repuGlicans (I have a few smart and wanting-single-payer Republican friends so don’t want to bash them.)

  • It is not so bad to look at the existing – far from perfect – health care policies, if it means constructing a better one, but in your country it probably should be a bi-partisan effort.
    I cannot believe that a smart country, rich and powerful like the USA, cannot get a better plan in place. Of the 11 richest countries its health care resides at the bottom of the list in terms of benefits for its population and efficiency of spent dollars allocated.

    An article in the Globe and Mail about a recent report that compares the Canadian plan – so coveted by the Americans – found that it is only third from the bottom of the list. Why not look to other nations and how they manage, instead of trying to reinvent the wheel? The Netherlands, Scandinavian nations, etc.

    Don’t think Canadian health care is so great.
    When you compare it to the Europeans and not the US (which is on the bottom of the list of rich countries).

    Canada lags in ma­jor health-care study
    KELLY GRANT HEALTH RE­PORTER
    The Globe and Mail (BC Edition)
    15 July, 2017

    Lack of coverage for dental care and prescriptions, as well as long wait times, prompt ninth-place finish in report on 11 rich countries.
    Canada placed third from the bottom in a major new study of health care in 11 affluent nations, a score that reflects this country’s poor performance on measures such as infant mortality, access to after-hours medical care and the affordability of dental visits and prescription drugs.

    Canada’s ninth-place finish is a slight improvement over 2014, when the Commonwealth Fund, a private-research foundation based in New York, put Canada in 10th place, ahead of only the United States.
    In the group’s new report, released Friday, Canada pulled ahead of France, but stayed well behind such standouts as Britain, Australia and the Netherlands, which ranked first, second and third.

    The United States remained in the basement of the rankings.

    “The domains that put Canada in ninth place are really access, equity and health-care outcomes,” said Eric Schneider, senior vice-president for policy and research at the Commonwealth Fund.
    “On those domains of quality, [Canada] is fairly similar to the U.S.”
    The Commonwealth Fund is one of the few organizations that tries to systematically grade and compare the health-care systems in high-income countries.
    Although crafted for a U.S. audience, the group’s reports are often cited by Canadian politicians and policy makers looking to see how this country stacks up against its peers, especially when it comes to the bang Canada gets for its health-care bucks.

    As the report notes, Canada spent the equivalent of 10 per cent of its gross domestic product on health care in 2014 – the most recent year for which figures were available – more than higher-ranked Britain, New Zealand, Norway and Australia.

    The United States, meanwhile, doled out the equivalent of 16.6 per cent of GDP for the shoddiest results among the 11 countries.
    Drawing on its own international surveys and data from groups such as the World Health Organization and the Organization for Economic Co-operation and Development, the Commonwealth Fund’s new report grades the 11 countries on 72 metrics grouped into five categories: care process, access, administrative efficiency, equity and health-care outcomes.

    Canadian patients and healthcare providers might be surprised to see that Canada fared best on care process (sixth place) and administrative efficiency (sixth) and worst on access (10th), equity (ninth) and health outcomes (ninth).
    But the results make more sense when you delve into the survey questions and data undergirding the report, said Raisa Deber, a professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto.

    “One of the things that was striking to me was their equity measure,” she said. “The equity measure was focusing a lot on things that are not part of medicare. Do you skip dental care? Do you not fill prescriptions? Well, the government doesn’t pay for those. So, yes, we do a lot worse than we should.”

    When it comes to administrative efficiency, the report’s grades are based on Commonwealth Fund surveys that included questions about how much time patients and doctors spend fighting insurance companies – generally not much of a problem in the single-payer parts of Canada’s health-care system.
    The access category, on which Canada placed second to last, was split into two subcategories: affordability and timeliness.

    Although Canadians do not have to pay out of pocket for the care they receive from physicians and at hospitals, Canada scored poorly on affordability because of its lack of universal coverage for dental care and drugs.
    On timeliness, Canada was hurt by long waits to see specialists, undergo elective surgery and receive care in the emergency room, among other measures.

    Canada also performed poorly relative to its peers on health outcomes. Canada’s infant-mortality rate of 4.8 deaths for every 1,000 live births was second only to the United States. Sixteen per cent of Canadians reported having at least two of five common chronic conditions, again, second only to the United States at 21 per cent. However, Canada ranked near the top of the pack for five-year survival rates for colon and breast cancer.

    As Dr. Deber pointed out, on some of the indicators, the difference between the best and worst performers was vanishingly small.
    “On some of the things, if you’re doing well enough, the differences are very small,” she said. “But if you’re doing a ranking, a small difference can turn into a big difference in the ranking.”
    Dr. Schneider, the lead author of the report, said the comparisons are most useful as a means to learn what the best healthcare systems get right, no matter how they’re structured and financed.
    “One of the striking things in this report,” he said, “is that Australia, the Netherlands and the U.K. all use very different financing mechanisms and yet they’re able to achieve top performance.”

    © Copyright The Globe and Mail Inc. All Rights Reserved

  • I think you said it all. If I didn’t have VA benefits, I would have been up that wellknown creek and no paddle with a very expensive pre-existing condition. Except for the ACA. I worry about my brother, Pat and my sisters who also have pre-existing conditions. It is a fact of life, if you have the temerity to live long enough.

  • What makes me nuts is that most americans a), don’t want the ACA repealed and b) would suffer if it was. And yet the Rs are trying to sneak this through, because their donors want them to? I dunno. I know many people whom the ACA has helped. The only negatives I’ve heard about it are vague theoretical ones (ie the government shouldn’t be meddling in healthcare) or people complaining about premiums going up. But guess what? Your premiums BEEN going up! I paid like $30 a month for my employee-sponsored plan in 1997. It would be ten times that today. If there were a market solution, the market would have soluted it.

  • here are some thoughts on a parallel, historical situation; one I heard stated from a person it happened to. Long ago, an american citizen, born in mexico to a petroleum corporation executive, was told, don’t worry, you’ll never want for anything in your life; this is a gold mind. and then, mexico nationalized all it’s oil resources; does the name PEMEX ring a bell?

    so, thinking about that bit of history, lets look at pharmaceutical corporations and medical practice corporations. rather than nationalize them why not just discard them. rather than putting all those tens of thousands of employees out of work draft them into the works progress administration and the civilian conservation corps. no unemployment stipends to pay out. we might even get the pot holes fixed, the marginally safe bridges repaired, trees planted, and the general well being of all the people taken care of for a change.

    we know not ONE of the corporate employees is going to willingly go for this. at this point, who cares, the rest of us are not willingly facing no insurance. it’s way past time for single payer health coverage.

  • Feel that I should point out that dental care is not generally paid for by the government in Australia. Mostly we look in bewildered horror at the US system though. How can you subject your own people to this madness?

  • July 18, 2017 at 5:49 PM // Reply

    Since I live in California, I don’t have to call my Senators. And, oh, BTW, my Representative is Ted Lieu. 🙂 No worries about how *they* will vote.

    And I’d be wasting my time calling out-of-state members of Congress, since the ones who’d vote for Trumpcare hate me, my state, and all we stand for. On the bright side, looks like CalExit is back up and running. Will be interesting to, see how the majority of Californians vote on it if it’s on the November 2018 ballot.

    • Me too. Grateful for our reps right now. Instead of pestering them (though I do follow on FB) I am sending money & signing petitions for activist organizations, and sending money to progressive campaigns in other states. Warren, Booker, Harris et al have email lists that provide a heads-up to 2018 campaigns that need money now.

  • Thank you for a very well thought out post. Well written and informative and it is a shame that most of the gutless, spineless weasels in our Legislative Branch never give this much thought to anything that doesn’t end in the words “tax cut.”

  • A couple of thoughts:

    1. Great post, Chuck. And I’m sorry about your father.
    2. My understanding is that McConnell pretty much knows the straight up repeal won’t pass, and that it’s a move meant to show “the base” that he tried everything possible. I don’t know if he’s also willing/hoping to sacrifice a couple of ‘bad Republicans’ in the mid-terms (if anyone is actually unsafe, I don’t know), but who is a ‘bad Republican’ in his eyes? The Republicans look almost as divided as our country as a whole, at least on this one.
    3. It speaks volumes about the ‘expertise’ of our President that he wasn’t out there twisting arms, rallying support, and playing the great dealmaker that he fashions himself as. Simple truth: Trump knew nothing about what was in this bill, and I believe he really didn’t care. It should be clear to everyone now that he has no real interest in governing. I think he likes the prestige and trappings of the office, and that his real interests are in is lining his pockets and pulling down every. Single. Thing Obama did.
    4. Republicans are now finding it’s a lot easier sticking your fingers in your ears and saying, “Nyah, nyah, nyah” as loud as you can than actually governing. I’m hoping Democrats will start being proactive, start pushing agendas, and not spend the next couple of years sitting around with their thumbs in their nether regions.

  • I am appalled at the Republican outlook- it seems all their policies seem hellbent on one outcome- undoing everything Obama did. I think that’s why, after seven years, they don’t have a ‘beautiful’ healthcare bill that can replace the ACA. Is it really so important to destroy Obama’s legacy that you will snatch health coverage from millions benefiting from it? Perhaps it is. They could just fix ACA but no, undoing everything America’s first black President has done is more important. Because, IMO, they aren’t half the person he was- in brains, in decency, dignity or class.

  • My family’s story.

    My late husband was the biggest toughest man you’d ever want to meet. He’d worked like a mule since he was 16. As a result of doing work no human should, he had a pre-existing condition. Both of his shoulders were torn up. As a result, our small business couldn’t get insurance for him.

    Then, came the knock at 1 am and the four words that change everything, “There’s been an accident.”

    My husband had become a paraplegic in one split second. Without insurance.

    I had no choice. I nearly bankrupted us to get him on medicaid. I lost my entire 401K from a previous corporate job. I held onto the house and business by sheer force of will and my knowledge of the legal and regulatory system.

    I’m a damn lawyer and I used to sit in the hospital chapel and cry out of fear and frustration.

    Now, let’s take away the human suffering to him and those who loved him and benefited from his artwork. Let’s look at the business side of it.

    Because of the pre-ex exclusion:

    1. Instead of his medical expenses being spread out across the risk pool in a free market solution, the taxpayers paid every last cent of his estimated $5,000,000 in medical care.

    2. Because of the strictures of medicaid, I had to shrink the business by 80% to keep under the asset caps. So, instead of creating jobs and paying taxes, a thriving business because a kitchen table affair.

    3. I had to work 3 PT jobs to keep a roof over his head. There was not a single penny extra after basics like utilities. Therefore, the family paid less in sales tax, fuel tax, etc. I moved, as much as possible, into the off-the-books underground economy because every penny I put on the books, the state took it. I got a $100 raise at one of my jobs, the state took it.

    4. I didn’t pay my income taxes for 5 years. It was a pragmatic risk evaluation that I made, but he had to be cared for. He had to have a home. There was nothing left for taxes. I came within inches of losing the house to property taxes, but held a private fundraiser and was bailed out by friends.

    I want a conservative to look at the above and tell me how this was good business by the government. Just dollars and cents. How the taxpayers benefited from the insurance industry being able to refuse coverage for everything because a man had two torn rotator cuffs.

    End of the story. Kansas was one of the states that “streamlined medicaid via privatization.”

    1. Instead of a local social worker, he had to call an out-of-state “customer care center” that rolled off-shore after hours.

    2. He had different cards for medical care, drugs, and lab work and often got bills because the wrong account number had been charged for the wrong procedure.

    3. He was hectored constantly about how much in-home help he needed. He was bed-ridden. First we had to argue and get his doctor involved to get him a motorized bed that he could raise and lower to ease the pain of his shattered spine. The state tried to argue that his caregivers could crank it up and down. Then they questioned him at length about how many hours a day/night he slept and used this as justification of cutting his caregiver hours (because “you’re just sleeping”) without considering that he couldn’t even use the bathroom without assistance.

    4. He was forced to re-certify every three months that, yes, his spine was still shattered and he was still paralyzed from his armpits down and re-justify every penny that came into the house. I ended up moving out and living in the 200 sf office (with no kitchen and a shower that was a box built of 2X4s) at the warehouse so he could qualify for the help he needed.

    In October of 2014, he’d just gotten another round of paperwork challenging his need for in-home caregivers (after all, he’s just paralyzed, guys in wheelchairs play basketball!)

    In the wee small hours of the morning on a crisp October night, he sent the state his response. He took his own life.

    Oh wait, maybe that’s the “good business” the GOP keeps touting.

  • Quick reply to James F. Brown and his reference to CalExit–it’s being pushed by these guys: (an excerpt from the National Review. I’m a liberal btw, and don’t care for NR, but this sums it up, and it’s not the only publication to write about this) Anti-Globalization Movement of Russia, which is, depending on whom you ask, either a group that enjoys some financial backing from the Kremlin or an outright Kremlin front. It provides Marinelli with office space in Moscow, where he has opened a kind of California embassy, a cultural center whose most recent exhibition was on civil rights. (Short version: California good, United States bad.) It provided travel expenses for those far-flung separatists from around the world to attend the conference it organized in Moscow… Marinelli says he supports the Texas Nationalist Movement and others who attended the event in Moscow. And he scoffs at the notion that the Kremlin might be attempting to use him and his daft little crusade for its own ends.

    Read more at: http://www.nationalreview.com/article/446783/yes-california-independence-campaign-has-russian-backing-deserves-defeat

  • I’m uninsured also. My late dog had insurance, but he was considerably more helpless than me, when it came to health insurance. I didn’t care for the ACA (its real title, not “Obamacare”) because of the individual mandate. As a freelance writer, my income is already unstable enough without another expense forced upon me, alongside the high costs of just being alive in America.

    Still, I can understand its premise and its need. The Republican Party has spent more time trying to repeal the ACA than helping the economy grow, so we know where their priorities are. House Speaker Paul Ryan also has no intent on working with anyone from any party on restructuring the ACA. Remember, he’s an Ayn Rand conservative; if he had his way, all of the various social programs implemented over the past century – from Medicare to worker safety – would be eliminated.

    And Donald Trump may be vice-president of Russia, but he’s definitely not president of the U.S. We’re essentially leaderless right now.

  • July 21, 2017 at 10:54 AM // Reply

    I have nothing to say about that insular, gene deprived thing called the GOP.

    I do think the ACA was left waiting for the winner of the popular vote to take the next step. She has spent twenty years getting it to the point when it could be passed.

    I think that next step would have been to put the entire VA Healthcare system under the ACA umbrella. Isolated cases of that had already begun and the VA is never going to get fixed any other way. It is also the first step toward a single payer plan.

    If we are lucky, not everything will be dismantled by the GOP. All of the smoke and mirrors so far give me hope for 2018.

  • I am really sorry, my American friends.

    *Kisses the ground I walk on* I won the citizenship lottery, IMHO, by being born in Canada.

    I honestly don’t want to imagine life without universal insurance, for which we can thank Tommy Douglas, grandfather of Kiefer Sutherland.

    I am a very grateful recipient.

    This is a lame hope, but I hope it eventually gets better for all of you…fight on.

  • In 2004, the Canadian Broadcasting Corporation held a nation wide vote to decide who is the Greatest Canadian of all time. Who won? Tommy Douglas, father of universal health insurance. He beat out the founder of the nation, prime ministers, the discoverers of insulin and the telephone, a founder of the United Nations and Nobel laureate, and so on. The vote shows how deeply Canadians love the man and appreciate what he did for them.

    If anyone wants to see his sheer raw courage in overcoming the fierce opposition to his universal health care plan, most of it fueled by US medical companies terrified the idea might leak across the border, I recommend watching Prairie Giant– The Tommy Douglas story. It is on YouTube. Might get some hints on how to deal with the Republicans.

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