So it’s Sunday, and things should be pretty calm around here, with Bach, or Mozart, or Charles Mingus.
But that’s not going to happen, so some notes on the comments on the last post.
1) Michael’s post was a perfect example of exactly what I was talking about.
The shutdown was Christmas in October for the Obama administration on the subject of the launch of the ACA.
A lot of things went wrong–and continue to go wrong–with that launch, and none of them had to do with the shutdown.
But when the screwups continue to cascade, the administration can go, “look! it was the Republicans who wouldn’t open up the government and give us money!”
In reality, h owever, not that much of the government every actually got shut down, and the administration had considerable discretion in what it decided to call “essential” workers and what it didn’t.
We’ll leave for a discussion at another time the administration’s decision to reduce rations to troops in the field to two meals a day while funding NPR with$1.4 million.
But the fact is that HHS was not subjected to shutdown austerity at all. It was kept fully up and running and operational all through the sixteen days of the shutdown.
Granted, it couldn’t get any more money, but we’ve already spent about a billion dollars trying to get this thing operational, and you’ve got to wonder why that wasn’t enough.
2) No, it WASN’T because the system had to be in compliance with HIPPA.
Or, if it was, the attempt failed.
One of the biggest issues with the system at the moment is exactly that your personal information is not secure.
The way this thing was set up, if you’ve put your information out there, it’s pretty much up for grabs.
3) Admitting the obvious–that this thing has been badly implemented–is not the same thing as saying you’re opposed to government provision of health care.
4) Neither is pointing out that this particular bill was a very bad bill–a VERY bad bill–on about fifteen different levels.
It was, in the first place, corporate welfare for insurance companies on a grand scale.
It was, on top of that, the most blatant example I’ve ever seen of the complete betrayals of democracy.
Instead of passing the actual law, what it did was to go “the secretary will decide” on literally thousands of different questions.
In other words, it gave Katherine Sebelius the impression that she’d inherited the divine right of kings, and she’s been using her power that way ever since.
That’s the real issue behind the “contraceptive mandate.”
An issue like that should have been debated in Congress and only passed by elected representatives.
Instead, it will go to the SCOTUS, and if the SCOTUS lets it stand, that will be the end of freedom of religion in the US.
Because freedom of religion doesn’t mean going into the privacy of your home or church and believing things and praying.
It means living your religion day by day, identifying yourself with it and using your actions and words to set an example of how that religion is to be lived.
And no, don’t tell me that this means religious employers will be allowed to “deny access” to birth control to women who don’t believe as they do.
There’s no denial of access involved.
The condoms and the diaphragms and the pills will still be in the drug stores. Consultations between doctors and patients will still be private. You’ll still be able to get a prescription for birth control pills–or even the morning after pill–and go get it filled. You’ll just have to use your own money.
And since most birth control is dirt cheap, the use your own money thing won’t deny anybody access either.
5) Anecdotes aren’t evidence, and that anecdote isn’t even an attempt at evidence in the direction of how awful it is that the US doesn’t have “unversal health insurance.”
I’m sure some people don’t go to a doctor or a hospital because they don’t have the money. Some people don’t go because they have to be forced at knifepoint to go under any circumstances.
But lots of people do go, even when the money is tight. The largest difficulty with that is that doctors and hospitals are not allowed–get that, NOT ALLOWED–to charge patients anything less than Medicare pays.
But on top of that–why is NOT going to the doctor or the hospital when it isn’t necessary a bad thing?
Since the people in the examples given were all right significantly after the event, then the visits would not actually have been necessary.
6) Canada may or may not provide health care for “everybody,” but the ACA won’t.
The administration’s own estimates are that it will cover only about half the people who were uninsured at the time of its passage, and will not–without further legislation–ever cover any more.
The issue is not the “working poor.” The issue is people who do not work for giant corporations, who own their own small businesses or work freelance, and who therefore have to buy their insurance in the individual market.
Every single plan available to me will be at least twice as expensive as the cheapest insurance available to me as of January 1, 2013.
Of course, it will be that much more expensive because it will provide me with all this new, extra coverage!
The problem is that I don’t want any of the new, extra coverage. And I don’t get a choice whether to buy it or not.
7) I have always been a big fan of single payer, and I am now, but I am not naive.
What we should have had was a system that got rid of Medicaid and put everybody into what is now the Medicare system. The roll out would have been a lot smoother, the confusion would have been a lot less, and it would have been operational a lot more quickly.
But there is no chance in hell that we will ever have a system here that BARS private medical care. Any public system we erect will have at least some competition from doctors and hospitals that choose to operate outside the public system (that is, not accept government funded patients, as some places don’t accept Medicare patients any more) and some patients who will choose to pay out of pocket for everything rather than deal with waiting lists, restricted choices of doctors or health care plans that carry coverage for things they don’t want or even actually object to.
Actually, that was already happening long before the arrival of the ACA.
At least some of the people who don’t have health insurance in this country are the very richest among us. Concierge doctors take only very limited numbers of patients, who either pay entirely out of pocket whatever the doctors may ask for or pay a premium (around $7500 to $10,000 a year) over what their insurance companies pay.
In return, they experience no waiting times for anything, and in the most expensive practices, they even get housecalls.
Most hospitals these days are perfectly happy to take cashier’s checks for prime private rooms with no waiting and first-in-line access to surgical facilities, MRIs, cat scans, and the rest of it.
Any government system will not only not fix this, it will accelerate the trend.
In England, the government provides that NHS and does not much regulate private insurers, so in that system, the middle class has been steadily bailing for private insurance plans for decades.
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