When National Healthcare is Not Mean, but Vindictive, Not Policy, but Politics

New Orleans  Healthcare is a huge part of the overall US economy and, arguably, of critical importance to every American. Regardless of the cliché, it is in fact a question of life and death. Yet we are watching a horror show spectacle of a White House that is clueless about anything but whether or not it can claim a “win,” and a Congress that is cunning and calculating without any field of vision that can see past 2018 and the midterm elections.

Meanwhile the public is treated to media coverage that, rather than focusing on the complexity of the bill and its evisceration of any semblance of public policy, treats the whole affair as if this were an extra innings baseball game and the only real issue was whether or not Majority Leader Mitch McConnell can get enough votes to pass the Senate version before the totally arbitrary deadline of July 4th. Well, perhaps not totally arbitrary, since McConnell is worried that when his caucus goes home for the recess their constituents will kick their asses so badly his whole secret legislative architecture will collapse.

Remember Kellyanne Conway, so discredited as a Trump aide that we’ve been spared her doublespeak recently. Well, she was back on this bill with the outrageous claim that no one can support, that, oh, no, there are no cuts to Medicaid in the Senate bill, which everyone knows is wrong. Good try, Kellyanne, now go hide out again, because this time there weren’t even any headlines following such an outrageous claim.

How about we look at how the Senate went from mean to downright vindictive? Their bill restored funding for what is known as “disproportionate share” money to hospitals. Pay attention in class now, friends, this is important. In places like Louisiana where I live we know a bit about “disproportionate share” payments because in their heyday they figured so prominently in statewide political scandals. Ever popular, former multi-term Governor Edwin Edwards did court and prison time on the issue of having unduly helped some friends get such money to build hospitals in poorly served and lower income areas of the state. Indeed, disproportionate share payments were designed to subsidize health care costs in lower income and ill-served areas originally in order to assure communities that these institutions could survive, because a “disproportionate share” of their patient base was poor. Obama’s Affordable Care Act flipped the script here. By assuring that everyone would have to get insurance and providing subsidies for lower income families and Medicaid expansion, disproportionate share payments would be phased out to pay for Obamacare. In fact now is the time when $43 billion would be reduced between 2018 and 2025.

What did the Senate do in their bill? They buckled to the lobbyists and restored these disproportionate share payments, but, now get this, only to states that had not expanded Medicaid coverage. This allows them to punish those states and their people by cutting the subsidies to Medicaid in their bill and rewarding the scofflaws by restoring the disproportionate share payments.

Now it’s politics that inflicts real pain and terrible consequences. Need a vote in Alaska or Maine, then sweeten the pot on opioid money even though states throughout the country are reeling under such a crisis. Take away support for mental health coverage, but throw some dollars out here and there to get a vote. Cutback money for the elderly poor on Medicaid, but kick the can down the road past 2018 so that you can keep the votes with a wink and a nod until the oldsters figure out the con.

None of this is good policy, and, frankly, I’ll be darned if I even understand how it is good politics, when all of these repeal bills are wildly unpopular in every poll of the American people. The public wants to live, not die, at the hands of government. Why isn’t that news everyone understands?

Facebooktwittergoogle_plusredditpinterestlinkedinmail

Healthcare Plan is a Killer

Little Rock   How many of us have heard from our mothers that “if we can’t say something good, then don’t say anything at all.” I wish that were the case with the Ryan and some Republicans’ healthcare bill. So far, I’m failing to find any silver lining, other than it’s not a total repeal where we have nothing, but that’s too thin a reed to grab.

There are still no Congressional Budget Office tabulations on the cost of this proposal or the number of people likely to lose healthcare. Some Republicans are even wary and unhappy about being forced to vote on this thing without even that meager level of information. Reporting by the New York Times finds Standard & Poor’s in a report has estimated that 2 to 4 million people would drop out of the individual insurance market, largely people in their 50s and 60s who are too young to qualify for Medicare because of higher costs. Why? One feature of the new proposal is that it would allow insurance companies to increase the gap for older Americans from three times the young to five times the young causing premiums to soar to unaffordable levels.

Several researchers listed the predictable outcomes of transferring these decisions to the states by citing not theories, but the facts on the ground based on what states had done where they have had discretion in the past and get caught with budget shortfalls similar to the ones faced in the 2008 Great Recession. They talked about the blood on Arizona governor Brewer’s hands when that state stopped paying for transplants and allowed people to die. They talked about how states had dealt with billions of dollars from the smoking settlements with tobacco companies and the meager percentage of the funds that had gone to cessation programs as opposed to budget shortfalls, capital expenditures, and a bit of whatever.

Unbelievably there are some Republican Senators who still bridle at any plan at all. More troubling have been some arguments that some are starting to make that we might be better with nothing at all, though that strains credibility as well.

You know it’s bad when we aren’t even getting into the weeds on things like the impact on women. The ban on Planned Parenthood funding just seems like a bizarre, mean spirited outlier which must just drip with questionable legality. Past the first mention, the fact that people would be barred from buying insurance with governmental support that paid for abortions also seems like a flashpoint that hasn’t gotten much attention. Props though to Planned Parenthood for having pushed away the offers for not only continued funding at half-a-billion bucks but an increase, if they were just willing to make a deal and stop doing abortions anywhere, regardless of the fact that no federal money funds any part of their abortion service anyway. Comforting to know that a least one major national nonprofit is unwilling to abandon its mission for money. That must have been something of a shock to the Trumpsters, though the so-called offer was likely something of a wink-and-nod, and never serious anyway.

Or how about mental health services? Will they continue to be supported? Believe me our partners in Alaska with the Mental Health Consumers Action Network (MCAN) are having emergency meetings and deep discussions about this.

The list is endless. The pain tremendous. The death count will be astronomical.

Here’s my point in a nutshell: all of this is bad, and we still don’t know the half of it.

Facebooktwittergoogle_plusredditpinterestlinkedinmail