July/August links

Don't forget healthcare.  Oops, the GOP did. They are cheering a lawsuit that may end Obamacare even though they haven't considered the chaos if it's struck down. There should be a special word for this beyond 'unbelievable stupid.' Two articles on this: the first features the full-on stupidity of some GOPers; the second features the beginnings of a GOP plan from those that aren't complete morons. And a bit more about the situation.

Walking the high-wire in the Middle East. Qatar is doing this successfully, to the benefit of themselves and the US, and maybe others.

Canadian healthcare. It's very popular with Canadians. We should be taking a look, but most conservatives simply snipe at it.

Lindsay Graham stumbles. He used to be John McCain's best friend. Now he wants to be Trump's sidekick. Sad to find out that he was really just a sidekick with no backbone or moral compass.

Early primary prediction. This article predicts the three frontrunners in the Dem primary based on big donors. It might be a good test of 1) accuracy, and 2) whether only big donors matter.

Predictions about the Iran conflict. Probably no war.

McConnell helps the Russians. McConnell was called out in a big way, and he was mighty angry about it. Nonetheless, he earned it.

Furor over Trump tweets again. What this week? He told 4 Dem congresswomen to (fucking) leave the country.

Bathroom issue ends in a whimper. N. Carolina and their horror at transgender people ends... for now. Related: in Poland, gay pride marchers are attacked.

Armed Iranian speed boats

Image: en.radiofarda.com

Quick summary: Repeal FAIL

This is an important issue, but I don't have a bunch of time to spend on it. The Senate failed to repeal and replace Obamacare. McConnell proposed, negotiated, twisted arms, and pulled bills from votes. It was a big embarrassment, so McConnell and the Senate made a last ditch effort TO DO SOMETHING (never a good situation).

McConnell had the Senate voting on bills or amendments within an hour or so of when their text was released. So much for 'a deliberative body' or not 'ramming it down their throats.' John McCain, with stitches on his left eyebrow and newly diagnosed with brain cancer, flew in from Arizona as a necessary vote to start debate-athon.

Two days later, McCain was one of three GOP senators who killed the effort. Maybe it was doomed anyhow. The conservatives vowed that they needed a fuller repeal, with more taxes gone. They folded pretty quickly. The moderates wanted assurances that Medicaid funding wouldn't disappear--this is a higher priority to senators as state-wide representatives, as I mentioned before.

McConnell promised his colleagues that the bill would go to conference, and their concerns would be addressed in the future. Paul Ryan didn't promise that. What is the promise of a politician like McConnell?

A lot of senators who were leery voted for the measure based on these assurances, but McCain didn't, and that was the killing stroke.

Image: kitv.com

Extras. What next? Maybe some bipartisan negotiation.

Short: The cynicism of the GOP

This issue is too important not to have its own post. The Washington Post pointedly tells how very cynical the GOP is in its push to do something-anything about ACA. Mitch McConnell wants the Senate to start considering an ACA repeal, and they don't even have the text of the bill. They don't have the text of proposed amendments. He made promises on an earlier bill that certain parts, if enacted, will never be implemented.

On Thursday night, McConnell finally released the text of the bill most likely to pass. He's trying to talk senators into passing it--promising that it will fail in the House, and ultimately a different version will be available. This is amazing, and probably a bait-and-switch, or bait-and-not-switch-as-promised. Four senators, including John McCain, threatened not to vote for the measure "unless there was a guarantee the House wouldn't pass the Senate bill." PLEASE, PLEASE, PLEASE don't give us what we vote for! Please, someone else kill this, but not me!

I can't believe that a senator has to pray that his vote isn't final. He has to hope someone else will block the bill, and he can get away with a yes vote that he despises. I'm not sure how many senators are planning to vote yes and hope no. They are hoping that their bill won't be passed by the House. But will they feel betrayed if the House turns around and passes the bill they just voted for? This is exactly what I expect will happen. What a cynical game they are playing, the culmination of 7 years of cynical bombast.

Extra. A good summary.

Another roundup of links

What to do about North Korea. This is very tricky, until you realize that the answer from history is obvious. Sometime last year I spent many hours listening to a podcast detailing the history of nuclear strategy. From that I learned that you don't go crazy and make a pre-emptive strike. You sit down and sanely wait things out. That's how the least number of people will die--hopefully none will die. A friend from South Korea was relieved to find an American who gets it. Here's a great article that explains most of the situation, and it only takes minutes to read. As someone who has spent hours and days reflecting, I endorse the article. As my friend says, a pre-emptive strike would mean the destruction of all of Korea. I vote for a waiting stance, and hoping no one fires the first missile.

Black Lives Matter. A good but painful article by Jamelle Bouie on the acquittal of a police officer who shot a black man. Bouie explains that there is fear, and fear will be considered a valid reason. Makes me wonder if there's any way out.

Meme goes viral and then the shit really hits the fan. Trump tweeted out a tasteless meme of himself beating up a CNN logo. A freelance journalist identified the original creator. The journalist is pelted with violent threats. There's pushback against CNN for threatening to out the creator and extorting an apology from him. (I'm sure about the ethics of CNN threatening to out him, but his apology reads like actual, honest, well-deserved contrition.) Finally, there is the Daily Stormer, laughing at the journalist and all the threats leveled at him. Basically, they act like threats are completely justified. That should be enough of this slimy underbelly of American culture.

Real assessment of fake news - retractions. Finally, a believable story of what CNN and other MSM have gotten wrong in the Russia megastory. It should come with a reminder of what they got right, like Flynn lying, Sessions lying, Russia hacking here, there, there, and there...

Voter fraud that looks for real. Here's a report on voter fraud in Virginia. Unfortunately, it's written for outrage instead of clarity. However, it looks like Virginia has had several thousand illegal votes in the past seven years, perhaps more.

How to punk Trump. This is a guide for Putin on how to fool our foolish president. I'm not overly worried because Donald doesn't stand by his promises, so any promises he foolishly makes to Putin won't matter.

Important ACA factoid. This is an important nugget. The medical risk profile of people in the individual market isn't getting worse. That means healthier people aren't being driven out--if this report is true. No death spiral yet. We will have to see how it pans out.

Image: speedwealthy.com

Replacing Obamacare is harder than they thought

No surprise about the complexity of the task. The House just barely passed an Obamacare repeal-and-replacement. Now the Senate is trying to do it, and having even more trouble. While the House has some moderate Republicans, every moderate Republican in the Senate has a critical vote. Three defections to 'no' will scuttle the ACA replacement, so the margins in the Senate are even tighter. Also, each senator represents the whole state, not just the more conservative parts of it. It could be that senators need to be more concerned with Medicaid recipients than their colleagues in the House.

It's fascinating to read in this article what different senators want. Rand Paul and Ben Sasse (he of anti-Trump fame) would support a straight repeal. Is that position for real? Don't they worry about the ensuing chaos if there is no replacement plan?

Sen. Bill Cassidy of Louisiana, someone I wouldn't expect to be a moderate, is holding off on supporting the bill if it removes too much money from Medicaid. Louisiana isn't one of the richest states, so it probably has a fair number of people who have gotten their healthcare through the Medicaid expansion. Cassidy seems loathe to throw them back into healthcare limbo. Some senators, like Rand Paul, don't have such quibbles.

These negotiations will be interesting to watch. A pro-Trump PAC already targeted a senator leaning toward 'no' and already had to drop their pressure tactics. Whether the senators will be able to come together, compromise, and satisfy enough of them is an open question. A cool graphic in this article shows that more senators are concerned with the bill not covering enough versus those concerned with that it won't repeal enough. It leads me to expect a more moderate bill passing the Senate. But we shall see. Failure is certainly possible: only three senators need to decide to be stubborn to sink this bill.

Image: cbsnews.com

Short: Is a shutdown looming?

The US federal government runs out of borrowing authority on April 29. The GOP, now that they have the House, Senate, and presidency should be able to avoid a shutdown, and they probably will. However, it's a possibility that a shutdown will still happen because of doctrinaire GOPers who refuse to compromise, and the Dems and main GOP group not reaching a compromise either.

The GOP was almost always terrible at extracting concessions from the Dems in these shutdown showdowns. They didn't know what to ask for, bumbled, fumbled, and waited to the last minute, with predictable results (bad--from their viewpoint).

It seems that the Dems are doing better. They want something specific--the continued funding of an important part of ACA. We'll see how it works out. Here's a fairly short readable article about the issues.

Image: washingtonpost.com

Short: Drop dead date for ACA?

In all the reporting on the failed attempt to repeal and replace ACA, I didn't hear that an important vote will need to happen by the end of April.

ACA has always had a lot of moving pieces, so many ways that it could fail either quickly or slowly. If this article is right, there is a complicated interplay between a court case, subsidies to insurance companies, appropriations, and possible backlash. I would rehash all the details here--who knows if we even know all the details? The upshot is that there may be an important development concerning ACA within the next month, so be alert for news.

Bandage removal: fast or slow? Now or later?

Image: 123rf.com

Links about 'Repeal and Replace'

For seven years the GOP bragged that they could make a better health insurance program than Obamacare. For seven years, they waved their hands, gave us bullets points sprinkled with pixie dust, and didn't deliver.

After winning the presidency, and already having majorities in the House and Senate, the GOP was supposed to be poised to repeal Obamacare on the first day of President Trump's term. Somehow, that didn't happen. BECAUSE REALITY IS A BITCH!

The GOP can't wave their hands anymore and fling pixie dust. They have to seriously crunch numbers, and it hasn't been going well for them. They can drop coverage for millions of people, they can zap the mandate and see cost rise even higher, they can repeal the taxes and blow up the deficit. What they can't do is figure out how to make a program cover more people and cost less. I wonder why not. Maybe not enough pixie dust.

Image: worldwide.chat

Extras. Problems with repeal and replace (with less snark). True believers among Congress just don't understand the delay. Trump makes another promise about the replacement, sprinkled with prodigious amounts of manure-scented pixie dust.

Hillary panders on the Cadillac tax

This is disappointing but not surprising. Hillary Clinton is calling for the repeal of the Cadillac tax provision of ACA. And like many repeal proposals, she's vague on what she'd do to make up for the lost revenue. Actually, she's silent on what she'd do.

This is just bad, typical pandering. Some unions want to protect their benefits as much as possible, and they don't want members hit with the punishing 40% excise tax on the primo health benefits. However, the premium must be over $27K for a family. That's pretty damn high. How many people really have such generous health benefits?

I couldn't readily find any numbers. Companies have been trying to change their plans in preparation for the Cadillac tax starting in 2018, but also to rein in health insurance costs and to get employees to share the burden. I don't think that's at all bad. It's better for employees to be aware of healthcare costs, rather than treating it like a perk that someone else pays for.

The arguments for repealing the Cadillac tax aren't very strong. Opponents claim that it will hit 82% of all employers by 2023 because of the indexing (if they don't make adjustments, which they are). That leaves plenty of time to adjust the indexing if needed. Opponents also don't answer about how to make up for the lost revenue, which is just so typical.

Image:freerepublic.com

Extras. Forbes complains about higher cost or lack of choice, ignoring responsible decision-making. The Fiscal Times seconds that. A different author calls it 'modest.'  The typical economist response here.

Short: Interesting observation on campaign issues

Here's a somewhat biased article on campaign issues from the Daily Beast. It notes that a majority of Americans support Obamacare or want something even more progressive. It also notes that a supermajority of Americans now support same-sex marriage being legally recognized.

What's interesting is that Obamacare probably should be a more defining issue since it affects many more people. But contrary to expectations, marriage may be more important when it comes to voters' decisions because the GOP may make themselves look "prejudiced or out of touch..." And it's easier to see that with same-sex marriage than with the complex issues of healthcare.

I really wish Americans didn't subcontract their thinking out to strident and shallow third parties. But I'm lazy about some things too, so I should be more understanding.

It will be interesting to see if the prediction in this article is correct. But we can't be sure what really affected people in the voting booth. A better indicator may be the chatter in the media and social media. And that will be visible.

Don't be a cranky old fart.

Image: abcnews.go.com

Another chance to whack Obamacare

The Supreme Court now has another chance to kill deeply maim Obamacare. This time it's a technical question about whether subsidies can be given in states that don't have their own exchanges, which is a lot of states.

If the court rules that ACA can't give subsidies in those states, that probably throws a few million people off their health insurance. Congress could restore the subsidies, but I don't think that will happen with the GOP in control. They won't care about the suffering of a few million people, who are perhaps mostly Dem voters anyway.

However, the GOP may want to avoid looking hard-hearted, so they'll probably figure out how to blame this on the ACA law, and its complexity, and how it was rammed through without being well-constructed, so it's all the fault of those Dems. They may be able to get away with that story because enough of it sounds true enough.

The GOP may even get extra lucky, and the loss of the subsidies will send Obamacare into a death spiral of massively higher premiums and fewer people covered. Again, they may be able to cause this death spiral without receiving the blame. It's hard for me not to believe that many Republicans are hoping for exactly this outcome.

But at the end of that death spiral will be some very big problems, and ultimately the GOP won't be able to ignore them. There will be a massive number of uninsured people, which will include plenty in the middle class or former middle class, and they won't be forgiving the GOP for the end of readily available health insurance. The GOP will have to come up with an answer, or a partial answer--enough to keep them in office. Maybe they'll cobble something together, but that would be several years down the road. In the meantime, the road will be littered with people bankrupted by healthcare costs or dead from lack of coverage. I doubt the GOP will pay a high enough price for what they wrought--if it plays out this way. I hope we don't get to see if it plays out this way. It's too big a risk for too many innocent people.

Image: bet.com

Extras. Bernstein is much more optimistic than me. This WaPo column is more realistic in the dangers.

Short: Who, me? I'm not for Obamacare.

Look at this double-speak from a GOP senator who's freaked out that people will lose their health insurance subsidies:

"We're not going to help the law, but we're going to help the people, so they are not left in the lurch."

This senator (John Barrasso of Wyoming) is thinking ahead, and making some plans in case the Supreme Court rules that subsidies can't go to people in all states. 

Barrasso would 'not help the law' by continuing a key provision of the law that many people depend on. Does this mean that the law isn't quite as horrible as advertised? Why keep part of it going if it is horrid? 

Oops, pay no attention to that man behind the curtain.

Your invisible need for Obamacare

Image: mikehoolboom.com

The high stakes of culture: Mississippi

I continue to see the effects of culture almost everywhere. I listen for cultural differences, and the effect of culture on values and the choices that people make.

So I thought this was a very striking observation by Jamelle Bouie, a black political columnist:

"White supremacy built a politics of racist antagonism. Blacks were substandard people & thus received substandard schools, services, & law. Anything public had to be kept separate from blacks, and if that wasn’t possible, it had to be degraded..."

Further down in the same post, the author links to a tragic story of what happened to ACA in Mississippi. It's a worthy of Shakespearean treatment. There are the heroes who try to step above the usual bitterness, and the banal villains who shred those attempts and congratulate themselves while doing it.

I'm a northerner and  hardly know about the south. But when I read these kinds of stories, and consider what I do know about the south and about Arizona (settled by southerners, and where my parents now live), I start to see the patterns that Bouie writes about. Why do northern states spend more on education than southern states? Entrenched racism and the resulting antipathy to public services could be the answer. What a sad answer that is. And is it just a 'neutral' cultural difference, or is it actually a inferior culture that should change? I can't be a fair advocate for southern culture, but I'll keep my ears open for such an advocate.

Image: blogslucianneloves.com

How big an issue is Obamacare?

Is Obamacare (more properly called ACA) a major issue in this election? Is it a major issue for most folks?

It's hard to tell. The comment boards are still stuffed with vociferous supporters and detractors. Conservatives are still predicting a train wreck, which was supposed to materialize for two years now. Liberals are counting up the successes, and recounting how conservatives' worst predictions haven't panned out.

It's still too early to call ACA a success. We don't know the effect of the health systems or what the costs will be in terms of the federal budget within a few years. The Medicare program costs almost double its projected expense: the program needs a yearly infusion of over 45% of its expenditure beyond the payroll tax that are collected.

IT'S BIG!

ACA really should be a big issue. It's a major piece of legislation affecting a lot of medical care and health insurance, particularly in terms of cost. However, if it's not a big issue, it's because the GOP don't know how to talk rationally about it, and don't know how to criticize it rationally. Most of all, they don't know how to replace it.

The usual conservative meme is that Obamacare is a takeover of the healthcare system, which is about 17% of our economy, maybe higher. This is an exaggeration, of course. You don't have to check in with some government department to see your doctor, as you would have to, say, register a car. The government has a monopoly on car registration, but nothing like that with doctors. Most of the other conservative claims are also wild exaggerations.

This irrational talk can't help too much with swing voters, so I wonder why the GOP does it. Perhaps a party really has to energize the base and the haters in the run-up to an election. Maybe it's just habitual for the GOP, who never stopped hating on the Clintons. But it definitely doesn't help with voters who are trying to make rational choices. On the other hand, that group of voters (the rational swing voters) may be so tiny that it doesn't matter. That's a really sad thought.

Repeal and ... um ... um

I'm not sure which is worse: the irrational critique or that the GOP haven't settled on a replacement. They should have had one for the 2012 election. Maybe they lost partly because of that gap in their agenda. I certainly wasn't going to vote for them with a gaping hole like that.

This vagueness was a problem for them in 2012, and continues to be a problem. Dems can run on the status quo--"don't let the GOP undo what we've accomplished." The GOP can't run on that, but they haven't figured out what they will run on, other than irrational exaggerations about how bad the status quo is. What a stupid party the GOP is, and what a shame for voters who deserve a choice.

Sure, that passes the reality test.

Image: thelastgreatstand.com

Sorting real from fake in the ACA claims

So we were deluged with warnings from conservatives about the economic devastation Obamacare would wreak. It was a lot of hype because they didn't know how many business weren't going to hire because of Obamacare, or how many people would lose insurance they loved because of Obamacare, or how many doctors would quit because of Obamacare. 

Yes, the website roll-out was a disaster, but that was fixable. The insurance rates weren't as awesome as Obama predicted (saving families an average of $2000). Some people are paying more for less coverage and with no access to the doctors they had before.

This isn't surprising to two groups of people: those who thought Obamacare was going to be terrible, and those who were realistic about what mandated health insurance could do. Hint: it's no magic bullet.

All this year people will be learning what the real effects of Obamacare are. Next year there will be more changes and more effects, and the year after that. Of course Obama will try to manage the situation so that Obamacare doesn't fail, delaying this and that, maybe changing some mandates for insurers.

It won't be easily to find out if Obamacare has failed, because people involved with healthcare will try to help it succeed. Doctors, hospitals, insurers, patients, lots of people other than the GOP want to see the changes improve healthcare, so this gives an advantage to the program.

The people who want to see it fail don't have the power to make it fail, but they will try to highlight all the discrepancies, disappointments, and failures. However, even if they do push the stories of the failures, it won't be believable unless you know it's true rather than political posturing.

Here's one claim by the right that is less than what it seems:

Poll: 1 in 4 voters know someone who has lost insurance under Obamacare

The problem here is that maybe the polling is correct. Perhaps only 25% of the US knows someone who's been badly hurt by Obamacare, meaning 75%  haven't been personally hurt or know anyone who has. If those were my odds, I'd run on them. I'd get up in front of crowds, introduce a few people who have been helped, and then ask the audience if they personally know someone who's been hurt. A few hands go up, but not many.

I don't know Obamacare well enough to know whether it's a bureaucratic nightmare that will eventually ruin healthcare in this country... if we never modify it where needed. The thing is, we will modify it. We will try to get it to work. If Republicans ever get in a position to repeal it, they will be forced to replace it with something better than we had in 2008.

Now, Obamacare will make healthcare more expensive for some, and it may increase overall healthcare spending. It may add wasteful, expensive paperwork to the system that is already overburdened (or so I hear). But it won't ruin the country. I'm stating that categorically because it makes no sense for 18% of the economy to allow itself to self-destruct.

(PS. In Massachusetts we were warned that Romneycare would ruin healthcare. It didn't happen. The adjustment period wasn't even horrible. Predictions like that are just a bunch of foolish bullshit.)

These creepy ads didn't work either.

Image: caintv.com

Denying Contraceptive Coverage is Slut-Shaming

First, I'm sorry that this topic is getting so many posts, but there is a good reason. This is one of the few issues where it's possible to nail down the logic and see it for what it is.

People who argue against contraceptive coverage fall into three categories:

1. Those who are against ALL drug coverage, but make the mistake of focusing on contraceptives. 
2. Those who don't want any of their money to go to subsidized contraceptives for parasites who are probably irresponsible sluts.
3. Those who follow religious tenets against the use of contraceptives. 

I'm giving category #1 people the benefit of the doubt. It's easy to identify them. If you ask, why should contraceptives be any different from, say anti-cholesterol drugs, they readily agree that they shouldn't.

For category #3 people, I have to argue that their church's tenets are misguided and/or outdated in this age where we have over 7 billion people thronging the Earth. Also, they cannot and should not force their church teachings on employees. Do they make their employees swear religious oaths? No. So keep religion out of healthcare also.

But a lot of religion tenets come down to category #2, which is disapproval of sex. Often it's clothed as disapproval of wanton, irresponsible sex, but when you scratch the surface, it's a general disapproval of sex.

Image: politicalfun.blogspot.com

However, it makes no sense for this disapproval of wanton sex to apply also to contraceptives. These are used mostly by very responsible people for responsible purposes. Just because prostitutes and sexually adventurous people also use contraceptives, that doesn't make contraceptives evil. Prostitutes and the unchaste also drink water for the same reasons the rest of us do, but we don't have religious prohibitions against water.

So there's no logical reason to deny contraceptive coverage--unless I've missed some other argument. If that's the case, I apologize. However, I really doubt that there is any other argument.

Slut or responsible person?

Image: thebottomline.as.ucsb.edu

Update 1/31/14. Answer to O'Reilly's questions above: No, Bill, I want you to shove that money so far up your ass that it comes out your foul mouth. Plus, I hear you're quite a slut yourself.

One thing I learned: Cultural differences, cancer, and ACA

I'm a strong supporter of ACA. However, I didn't realize until this fall how much my middle-class background contributes to that viewpoint.

Here's the background. Middle-class people are used to living comfortably, with enough money so that running out of money isn't a problem that they've faced. Sure, some get into money trouble by excessive spending or risky investments, but most middle-class people avoid that because they strongly fear poverty--the hand-to-mouth existence is the opposite of middle-class security.

So imagine how a cancer diagnosis affects a middle-class person. He isn't used to the uncertainty, and the treatment of cancer is almost always physically unpleasant. However, it's manageable if there's a good chance that you can return to your old life.

Wrenching choices

Now imagine that cancer diagnosis if you knew you couldn't return to your old life. This is how it feels when a middle-class person faces an extremely expensive, uncovered medical expense. You are almost guaranteed to plunge yourself and your family into a poverty they have never experienced before.

It's little wonder to me that some/many middle-class people in this position might choose to ignore the signs of illness. On one hand, it looks like they (that is, me) value money over life. However, a different way of interpreting the choice is that they choose to maintain their family's comfort and way of life over their own lives. They sacrifice their own lives to maintain the family--something which is easier to understand than why they won't pay what it takes to treat the illness.

This is how I think, and perhaps I'm generalizing too much. But I'm not the only one who feels this way. This also explains the behavior of the woman made famous in the anti-Romney ad. She chose to ignore her symptoms because she didn't have medical insurance, and died because of it. She avoided saddling her family with debt--maybe they even got a life insurance payout. That could well have been preferable to her. I certainly would be to me.

This is why good medical coverage is so important to the comfortable middle class ethos. It's probably one of the first questions families ask when someone gets a job. With more of the middle-class out of work, 2008 was a great time to push for universal coverage, and it finally passed, though more because of the 60 Democrats in the Senate.

Answers from the class divide

If you don't believe there's a class divide in how people view health coverage, read this post giving advice to the uninsured. Look at the range of answers, from which social workers are the best; to how to cash in your insurance to pay for your care; to shopping around for care in other countries. The advice strikes me as coming from solidly middle-class people... until this answer from a commenter named so_so (sorry, no link):

"In August I was diagnosed with a Nice big fat cancerous tumor in My Bladder,,, It Required surgery because I had to have a Catheter .. Could not Pee!!!! [...] I was with a Catheter for almost 1 month and family took up a collection for me to give the Doctor 500.00 Otherwise I was just out of luck.... Needless to say I have not been to the Doctor again... Can not afford it... I do not have money....And do not want Charity... It does not make me feel good at all....( Still not over the Family and X family I had sending 500.00 here... Yes grateful, But taking help from People You know hate you is not a good feeling... ) And that will never let you live it down,,,EVER!!! despite the 500.oo they sent I now owe the Hospital close to 10 thousand.... And it was a day surgery,,,, I talked them into letting me go home....I knew i could not afford the stay.... Glad I did not stay,,,, It will take me a good long while to pay that off..... The Doctor told me 50/50 chance it will come back...."

I don't believe this woman will pay her $10K hospital bill, but it didn't keep her from getting or taking the medical care. I was astonished by this post because it is so different from my attitude. I wouldn't take on medical debt I couldn't pay as this woman did. Though she doesn't admit it, she is a charity case pretending that she isn't one. That option probably isn't open to me, nor should it be necessarily.

Why should my child's college fund, my retirement savings, my additional savings, and the equity in my house be exempt from the bills I run up? Sure, I'd like them to be, but that's not how our personal finance laws work. So I assume charity care is reserved for those who don't have the funds I have.

Self-reliance vs. Outside security

Here's another example of the difference in attitude to how the uninsured should deal with medical expenses:

"I have a good friend...  He is a manual laborer of sorts and has never had health insurance all the time that I have known him.  I am aware of one time that he experienced kidney stones and was in real agony.  He went to the Emergency Room and was treated.  The bill was $4,000.

He depleted his entire savings account and paid the bill in full.  The only thing he owned, which would have been attached had he not paid the bill, was his 12 year old pickup truck which he had to use to work.  I would also add that he has suffered with a bad back for 10 years but still has been able to work, most of the time, in pain.  But work, yes he has continued to do so."

The teller of this story, a conservative I follow named Anson Burlingame, sees this as a story of self-reliance. I see it somewhat differently. Yes, this man was self-reliant. He's been careful and hasn't squandered his money, and toughed it out what he could. But he's also used his entire financial cushion in one day, and he doesn't have any money for the next emergency. What will he do next time? That might also be another reason why he's a hero to conservatives. This man is willing to do what a middle-classer fears so much--pay all the money he has to settle his debt, and go on with his life. Why can't a middle-class family do the same?

There is a cultural difference, not just political differences, in attitudes to ACA. Many approve of charity for the truly poor, but everyone else should be self-reliant. The safety net shouldn't be provided by government, but by the family and community. The Mommy-State takes away this self-reliance and eliminates the need to stay on good terms with your family and community. You can be selfish, lazy, rebellious, or irresponsible, and Mommy will still take care of you. There is some truth to this, but it doesn't capture the whole truth.

Through the filter

The whole truth is that we each have a filter through which we see universal insurance. Some of us see it as a necessity for the financial security we value highly. Others see health insurance as a bonus, but it's wrong for it to creep into the category of a necessity or a birthright. We used to be made of tougher stuff, and not rely on government guarantees for our lives and healthcare choices.

As much as I respect self-reliance, I'm solidly middle-class by birth and education, and I don't want to be uninsured. That happens to be the same sentiment expressed by this Tea Party thirty-something: "This is my only option for employer care and I don't want to be uninsured." We bourgeoisie, we really can't imagine life without our security blankets.

As I said before, possibly I'm overplaying how an uninsured middle-class person would respond to a cancer diagnosis, or I'm generalizing too much from my own personal reaction. I'm not certain, but I see the evidence that others respond the same way.

What we're scared of: expensive and no guarantees

urology.ufl.edu

Extra. Uninsured cancer patients are twice as likely to die.

One thing I learned: a case against ACA

I'm not as open to different ideas as I would like to be. It seems to me that most people who are firmly against ACA fell into one of more of these categories:

• Libertarians who don't want federal government in any kind of social program. (I give them a pass for deeply held, coherent beliefs that I happen to disagree with.)
• GOP partisans who hate all Democratic programs regardless of their strong points.
• People who think the country is made up of makers and takers, and the takers don't deserve access to health insurance, or probably healthcare either.
• Fools/zipperheads who think that the GOP proposals would have solved the problems well enough at a much lower cost.

I found another category, or maybe I just started hearing the argument: fiscal conservatives who don't trust the finances of the program.

"Obamacare is basically just another entitlement. It has no solid foundation to pay for it despite all the rhetoric. I'm not 100% opposed to entitlements per se, but we do a pizz poor job of administering them - so in my view we don't need another one." -- National Review commenter

This is a strong argument. If I take the argument sentence by sentence, it holds up quite well:

• Another entitlement--check. It's a federally-guaranteed and financed large-scale program.
• No solid foundation to pay for it--a strong possibility. The dedicated revenue streams may not be enough.
• Pizz poor job of administering them--check. The track record for federal programs include no cost containment in Medicare and Medicaid, welfare that grew far too large, etc.

I support universal health coverage for a variety of reasons, but I'm also aware that it could be a failure. I want to try it anyhow for the many benefits, which I already have as a Massachusetts resident. My empathy for people in need outweighs my worries. But for many people, the scale falls the other way. 

They have good reasons for their opinions, perhaps stronger than mine, yet I still don't agree. It's not that I'm giving in to illogical motives. It's because of the mystery of how some values take precedence over others.

Image: nationalmemo.com

The woes of healthcare.gov

Now that Congress isn't shutting down the government, the biggest news story is how badly the healthcare exchanges (online health care signup sites) are working. In particular, it's how bad the federal healthcare exchange is.

This website is reputed to have cost $600 million to develop (well, maybe not that much), and it's a disaster. It freezes, people can't get through the signup procedure after hours of toil, the determined folks wake up at 4:30am to sign up, etc.

Some have said that this shows how ridiculous it is for the federal government to be involved in healthcare. Well, that's nonsense for two clear reasons. 1)Government is already involved a lot of healthcare like Medicare, Medicaid, federal employee healthcare, VA healthcare, and Tricare, among others. 2)It's a computer system problem. Any problems with the political philosophy are completely separate.

And it is a whale of a computer system problem. Kathleen Sebelius, the cabinet secretary in charge of the program, deserves to lose her job. She should have been all over this program making sure it was on-track. Obviously she didn't do her job. Whoever she had in charge of supervising the program also deserves to lose his job. This is a major cock-up, and I don't accept excuses. As someone who has been involved with computer systems since 1976, I can tell you that more difficult programs than this have been successful completed.

Sebelius will probably get to keep her job because it's too damn hard for her replacement to go through confirmation hearings--which is a reflection of a different area of dysfunction in the government. I hope she will be firing others in the department she oversees. I doubt this will happen either because continued employment is the best bribe she can pay to prevent them from revealing the government mismanagement.

The dream team of system wizards who are now working on the site will probably do a decent job of fixing it. I've seen other crappy programs (cough, Microsoft Word, cough) fixed well enough. But this debacle will be a lasting reminder of the incompetence of part of the Obama administration... or if you prefer, of all of the Obama administration.

Image: walnutdust.blogspot.com

Extra. Some of the trouble was due to a decision to protect users from sticker shock:

Sebelius ... didn’t discuss her department’s now-criticized decision not to let online visitors shop around before creating accounts. Aides have said they wanted consumers to avoid experiencing “sticker shock” ... -- Dallas Morning News

Some (most?) policies cost so much that users need to be numbed by excessive bureaucratic form-filing before they see the cost. Not really--but it's best if they see the subsidized cost, not the true cost of the policy. That just shows they are moochers... unlike the rest of us who just don't know what healthcare really costs.

Is Obamacare ALREADY a train wreck?

Everyone has heard this. Obamacare is a train wreck. Well, I don't take anyone's word for it. As I frequently tell other internet commenters, your assertion doesn't make it true. So what is the evidence that Obamacare is already a train wreck, even before exchanges crash, subsidy costs balloon, and healthcare providers are so pissed off that they give surly care?

The evidence:

1. In a Gallup poll of small employers, 40% are holding back on hiring because of concerns about the employers mandates in Obamacare. Well, maybe this is true, or maybe it's like the polls showing how many people thought that Obama wasn't born in the US. Some of the respondents will have political reasons for complaining about Obamacare. Refuting data: see the graph below showing trend in full time employment. Or maybe the sluggish job growth is due to a combination of Obamacare and poor sales and demand. On the whole, I think there's some validity to this complaint.
2. People are losing their satisfactory healthcare plans and being dumped into exchanges or forced to pay more for plans they don't want. This is true, but for how many? This tweeter says "After over 5 yrs of no group health ins I finally get a job that offers it and here's the thanks I get [a cancellation notice]. If you think about it for a minute, that tweet isn't a slam-dunk against Obamacare.
3. Here's a rehash of reasons from Heritage Foundation, including job losses due to taxes on medical devices and lower Medicare reimbursements. They mention less than 3000 jobs lost, not a horrifying number considering that the US lost 524,000 jobs in December 2008. 

No, Obamacare isn't a train wreck at this point. It's not as though no one knows how to implement it, what the rules are, or when they will have that information (might describe Dodd-Frank, but not Obamacare). It may turn out to be a train wreck, but it's politically motivated jumping-the-gun to call it a train wreck at this point.

Image: oops, lost the link

Graph above:  theatlantic.com

Extra. Obamacare will explode medical spending, just like Medicare did. I have a few obvious questions about this, including asking about the effect of covering mostly the healthy instead of the elderly. But the kicker in this article is that Medicare didn't positively affect mortality rates. Um, does that means Medicare is an expensive failure? Please defund Medicare immediately and see how that turns out.