The shutdown and “Obamacare”

Be sure to check out this great comic, The Strip | By Brian McFadden
New York Times  Sept. 29, 2013  URL: http://www.nytimes.com/slideshow/2012/07/08/opinion/sunday/the-strip.html?ref=sunday#1

September 29, 2013–updated Oct. 1

Despite Republicans having witnessed the passage of the Affordable Care Act in 2010 and then enduring the reelection of President Barack Obama in a campaign where he championed the ACA as a central achievement and the defeat of Mitt Romney who promised repeal of the ACA “on day one,” the GOP members of Congress threatened–and now delivered–a government shutdown unless Obama agrees to totally postpone the implementation of the ACA effective Oct. 1 for one full year.

One Republican congressman stunningly admitted in an interview on MSNBC Saturday that the goal of this demand is to hold off on the start of “Obamacare” until Republicans can win majorities in both houses of Congress in 2014 mid-term elections and then repeal it. (The House Republicans have already voted at least 41 times to overturn the ACA.

This underscores how the Republican demends to extort  first the destruction, then the delay, and finally the dismantlement of the Affordable Care Act (note how the scale of the Republicns' demands progresively shriveled in the face of crumbling GOP unity and the public's increasingly adverse reaction)  are a shameless effort to reverse the democratic decisions made by Congress in passing the law and the democratic process of President Obama's reelection by 5 million votes.

Sen. Bernie Sanders, the independent democratic socialist from Vermont, articulated in an MSNBC interview both the immediate attack on democracy and the attack on the ACA as only the precursor of Republican efforts to repeal legislation going back to the New Deal, like the minimum wage, Social Security, and Medicare Far more than conventional Democrats, Sanders clarified the full scope of the stakes involved in the Republicans' vow to shut down government unless their already-repudiated demands were granted,

The Republicans' attempted coup should have been no surprised given the party's increasingly obvious contempt for democracy, visible in every policy area from voter-suppression laws in North Carolin and numerous other states and the The Republicans now hold an overwhelming but artificial 234-201majority in the House.  As Sam Wang explained in New York Times, "Democrats received 1.4 million more votes for the House of Representatives, yet Republicans won control of the House by a 234 to 201 margin. This is only the second such reversal since World War II." as I discuss here. But they spent as much as $30 million on a redistricting plan called REDMAP to create distorted district lines across the nation following the 2010 election. In Wisconsin, for example, the Republicans were so secretive about their redistricting plan—which they out-sourced to a large conservative law firm and required Republican legislators (the only ones allowed to view the redistricting documents as they were being developed) to sign a confidentiality agreement—that a panel of judges repeatedly fined the law firm and demanded the release of all documents, which the firm never fully complied with.
Among other effects—like stopping the provision of health insurance to 30 million people now uninsured—a one-year delay in implication of the Affordable Care Act would mean:
§  Insurers would no longer be required to keep children up to age 26 on their parents’ insurance plan—adversely affecting millions of college students and other young people
§  Insurers would again be free to reject applicants for “pre-existing conditions.”
§  Insurers would no longer be required to devote 80% of their revenues to healthcare costs as opposed to administrative overhead, top executives’ salaries, and profits

Dedicedly not. It was largely based on a plan developed by the right-wing Heritage Foundation (yet manyt Republicans call it “socialistic”) and much of the actual draft of the bill was written by a top insurance executive assisting Sen. Max Baucus.

Many unions and groups like Physicians for a National Health Plan (www.pnhp.org) sought a plan—like those existing in Canada for over 50 years and other nations including Taiwan—that eliminate for-profit insurers. The for-profit insurers consume about 1/3 of all healthcare costs while imposing numerous bureaucratic barriers to care. In contrast, the single-payer plan in Canada and Taiwan cuts out the parasitic middleman of the insurance industry, while delivering better care at about half the costs. Polling has also shown that plans like these were popular both with the American public:  a 2005 poll cited in Business Week  found that "67 percent of all Americans think it's a good idea to guarantee healthcare for all U.S. citizens, as Canada and Britain do, with just 27 percent dissenting."  An Indiana University poll, released April 2008, showed that no less than 59% of US doctors now favor a “single-payer” health care system like those in Canada, Taiwan, and other nations, where for-profit insurers have been replaced by a public entity paying medical claims and negotiating rates.
The ACA has many good regulatory features stopping some of the insurance industry’s worst abuses, but winds up keeping them at the command center of healthcare and provides an estimated $480 billion in subsidies to the industry.

In the cobext of the Republicans' ongoing and ferocious assault on the ACA, liberal commentators in the media–especiallay on liberal MWSNBC-TV–have been reluctant to point out the plan's fundamental shortcomings. However, there have been scattered mentions–by MSNBC' Chris Hayes and The Daily Show's Jon Stewart–of Obama's decision to exclude the single-payer plan from any consideration, or the absence of even a "public option.

Among ACA's flaws: the regresssive taxation of excellent healthcare benefits for which unions fought long and hard is alienating members of some unions, as with the International Longshoremen and Warehouse Workers Union IILWU and in industries where multi-employer plans prevail, as in the construction trades.
But for the most part, unions and other progressive groups seem the Affordable Care Act as a flawed start toward making a universal right for everyone in the US.  Their efforts are devoted, in the short run, toward reforming troublesome features and not repealing it; over the long run, many seek a “single-payer” system without for-profit insurers


Moreover, the ACA runs the risk of reinforcing the increasing trend toward “unaffordable under-insurance, as described below:

WEDNESDAY DEC 7, 2011 1:30 PM

Health Reform Devolves Into ‘Unaffordable Under-Insurance’

URL: http://inthesetimes.com/working/entry/12348/health_reform_runs_into_unaffordable_under-insurance/
“….Healthcare reform in the shape of the 2010 Affordable Care Act (aka "Obamacare") was supposed to relieve working Americans of the burdens of rising healthcare costs as they struggle to survive the jobless recovery.
“Instead, working Americans are being confronted with the emergence of a new stage in America’s downward slide on healthcare. "'Unaffordable under-insurance' is rapidly becoming the new standard in the United States,” Dr. Don McCanne, senior health policy fellow for Physicians for a National Health Program (PNHP), told In These Times.
“One of the most telling symptoms of the “new normal”: Visits to physicians’ office have dropped a stunning 17 percent from the second quarter of 2009 to the second quarter of 2011, according to a recent Kaiser Family Foundation report.
“This drop illustrates how the ever-growing burden of healthcare costs—in the form of out-of-pocket deductibles and co-pays—is making Americans reluctant to seek care despite having the supposed protection of health insurance. “We know that a lot of people are foregoing beneficial treatments for conditions like diabetes, or not getting vital preventive services like Pap smears," McCanne says.
“As people’s health conditions deteriorate because of a lack of preventative care, the eventual cost of treatment will be much more costly and the chances of a healthy outcome reduced. With high-deductible insurance plans proliferating among pattern-setting large employers like General Electric, a pattern of unaffordable under-insurance will be well-established by the time that the Affordable Care Act, which will include state-level healthcare exchanges, is fully implemented in 2014.
According to McCanne, the various levels of coverage offered under the ACA will leave working families with the same problem of increasingly skimpy insurance coverage that is too expensive to actually utilize. “The ‘bronze’ plan will have an ‘actuarial value’ of 60 percent, meaning that people will be paying 40 percent of their healthcare costs,” he says.
‘Affordable Care’ or a Rip-Off?
By Elisabeth Rosenthal
Sept. 29, 2013 New York Times
…“As Americans begin signing up this week to buy insurance, they will begin to test the legislation’s tantalizing promise to make health financially viable. Will the policies deliver care at manageable prices, or will “affordable” seem like a hollow promotion?
…The insurance marketplaces, or exchanges, will sell four different levels of plan — bronze, silver, gold and platinum — with the more expensive plans offering the most extensive benefits. And while premiums for the low-end plans may be relatively cheap, they still require significant out-of-pocket payments, in the form of co-payments and deductibles that could add up to more than $6,000 a year.
“The perception of cost will vary a lot,” said Dan Mendelson, the chief executive of the consulting firm Avalere Health and a former associate director for health at the federal Office of Management and Budget.
Mr. Mendelson predicted that the plans would be welcomed by people who had wanted to be insured but couldn’t obtain or afford insurance because of pre-existing conditions…
But the required outlays might seem like a lot of cash to healthy families who previously did without insurance. And they could be downright shocking to patients who last had insurance a decade ago, when health plans tended to require little if any patient payments.
“More of the cost responsibility is being shifted to patients, and more to patients with serious chronic illness,” Mr. Mendelson said, noting that the silver plans, the second cheapest, are intended to cover only about 70 percent of a patient’s medical costs. “This is different from the concept of insurance we’ve been carrying around for a long time. So people who sign up for insurance thinking all will be covered are in for some surprises.”…
Health experts also point out that the larger patient payments required under policies developed for the Affordable Care Act are increasingly a feature of private health care insurance as well.
“We are going through a period of revolution in what health insurance is, from more comprehensive to less comprehensive,” said Drew Altman, president of the Henry J. Kaiser Family Foundation. In 2006, he said, only about half of employer-provided insurance plans had any deductibles; now 78 percent do.
Insurers impose co-payments and deductibles as an alternative to raising premiums, which are often more tightly regulated. But many health economists approve of the practice because even a small co-pay can push patients to price shop for cheaper care, studies show."

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