Pondering Healthcare

There have been lots of articles in the news and blogosphere lately about the Affordable Care Act (ACA), more commonly known as ObamaCare.  It has been controversial for some time, but I would like to take a different type of look at some of the history leading up to the ACA and then at what I consider to be significant flaws.

A Little of the History of Health Care

The idea for something like the ACA is neither new nor the product of just one political party.  One President who called for healthcare reform in a similar format to the ACA was Richard Milhouse Nixon in his budget address to the Congress in 1974:

I am once again proposing a comprehensive plan for national health insurance that would make adequate insurance against the costs of health care available to all Americans. This far-reaching reform is long overdue. I urge early congressional action on it. The budget proposes measures to prepare for this program.

President Nixon included a few more details in that address.

The national health insurance plan I am proposing represents another major step toward improving the lives of individual Americans. My proposal calls for basic reform in the financing of medical care. It would bring comprehensive insurance protection against medical expenses within reach of all Americans, including millions of people who cannot now obtain adequate insurance coverage. Costs of coverage for low-income families would be federally supported, with payments scaled according to family income.

It will take several years for this reform to become fully operational. In the interim, the 1975 budget provides $26.3 billion for existing health programs. Under this budget, the momentum of cancer, heart, and other research initiatives would be sustained, and total funding for biomedical research would exceed $2 billion in 1975, almost double the 1969 level. To support continued reform of our medical care system, the budget proposes a total of $125 million in 1974 and 1975 to demonstrate health maintenance organization concepts throughout the Nation. I am also proposing a Health Resources Planning Act to enhance State and regional capabilities and responsibilities for planning and regulating health services.

Congress did not act on Nixon's request.  Nor was there action under Presidents Ford, Carter, Reagan, Bush (41), Clinton, or Bush (43).  This is despite repeated calls for health care in their various messages to Congress.  (The following are examples and should not been seen as exhaustive or complete).

President Gerald Ford

America needs to improve the way it pays for medical care. We should begin plans for a comprehensive national health insurance system. However, in view of the economic developments and the measures I have proposed to combat recession and inflation, I cannot now propose costly new programs. Once our current economic problems are behind us, the development of an adequate national medical insurance system should have high national priority. I urge the Congress to work with my Administration in order to devise a system that we will be able to afford.

President James Earl Carter

about a comprehensive national health insurance program, which can extend health care coverage to millions of needy Americans while controlling health care costs; and about the need for a human rights policy, which I believe is essential in the pursuit of our foreign policy.

President Ronald Wilson Reagan

I am asking Congress to help give Americans that last full measure of security, to provide a health insurance plan that fights the fear of catastrophic illness. My plan would provide acute care for those over 65 by restructuring the Medicare program. Under my proposal, the elderly would receive catastrophic health care coverage under Medicare, while limiting out-of-pocket expenses to $2,000. This coverage will be made available for an additional monthly Medicare premium of $4.92. The plan also aims to improve protection for the general population and for the long-term care of the elderly. For too long, many of our senior citizens have been faced with making an intolerable choice—a choice between bankruptcy and death. This proposed legislation would go a long way to help solve that dilemma.

President George Herbert Walker Bush

Infant and maternal health is an area where we must invest in the future. It is also an area where we must all be committed to improvement. I am particularly disturbed by the fact that the infant mortality rate for black infants is nearly twice that for whites.

This legislation does not do all that we want to do, but it does do what we can do at this time.

President William Jefferson Clinton

Today is an historic day. The Senate Labor and Human Resources Committee has become the first full congressional committee to report out a health care reform bill. The action of Chairman Kennedy's committee gives me great confidence that Congress will pass legislation this year that meets the expectation of the American people: guaranteed private insurance for every American that can never be taken away. Once again, Chairman Kennedy has demonstrated the leadership that has made him a driving force in the fight for quality health care for the last three decades.

Under the leadership of Chairman Moynihan, the Senate Finance Committee is moving. Chairman Moynihan is committed to achieving universal coverage and bringing legislation to the American people this year.

For the first time in our history, committees in both the Senate and the House are seriously moving forward on health care reform. While much work remains, today's actions prove that the job will be done. The momentum demonstrated in the House and Senate this week is heartening to me and all Americans who want and deserve real health security.

President George Walker Bush

This bipartisan Patients' Bill of Rights reflects the principles I laid out earlier this year. It provides strong patient protections for all Americans, ensures that doctors and patients make medical decisions, and holds health plans accountable by providing patients with meaningful remedies when they have been wrongly denied medical care. The bill also protects employers and their employees from unnecessary litigation that would increase health care premiums and force too many Americans to do without health insurance.

While the details vary, all of these Presidents of the United States attempted to get some form of additional healthcare for average Americans.  They all failed.  President Obama is the first to get legislation passed, but it doesn't quite make sense.

My complaint is not with the individual mandate which the GOP and Fox News have inaccurately called the largest tax ever.  As a penalty or a tax, the concept is necessary if we are going to have private health insurers managing our health care.  That last bit is my personal biggest problem with the ACA and should be the second biggest problem for Republicans.

First Concern with the ACA

Despite the cries of fear that the government is taking over your healthcare.  Despite the silliness that the government is getting between your doctor and you.  The reality is that private companies are in charge of your healthcare and are getting between your doctor and you.  That might be reasonable, but those companies have a bottom line goal of spending as little as possible.  Their goal is not to keep you as healthy as possible.  Their goal is not to ease the hassles of getting the care you need to survive.  Their goal, as is the goal of every other private corporation, is to earn money.

The ACA is good in that someone with a preexisting condition can now get health insurance.  One cannot be thrown off of health insurance completely because one's care is starting to become expensive.  The insurers are now required to spend eighty percent of their income on health care (that part is dramatic reform).  Those are all good points.

But, that does not change the insurer's goal of making money.  Their only reason to take reasonable care of you is if there is competition and you might change insurers.  The state exchanges that have so many Republican governors concerned might help with this, but it is an idea that has not be tried yet.

Second Concern with the ACA

If a concern is cost to business, why are we perpetuating an employer based health insurance system?

Many who complain about the ACA are complaining that it will cost jobs because it will cost small businesses too much.  The reason it is costing businesses anything at all is because after World War II some businesses added health care as a benefit to attract employees.  This was not mandated by the government.  It was a business choice.

Since that time, we have gone from having a primarily domestic economy to having a global economy.  The businesses which are competition for American businesses are mostly in countries with single payer health care systems.  Businesses in Europe and Asia do not pay for health care at all (well, they do pay taxes which in turn fund the health care but that is generally in the form of income and value added taxes that are not based on the employees).  It is not a level playing field.

Before someone jumps on me for lauding single payer systems, I will note that not all single payer systems are created equally.  One of the best systems, that of Taiwan, is supposed to be in fiscal trouble.  It is not my purpose to present any panacea for health care in this blog, just to ponder what is happening.

Third Concern with the ACA

The gimmick of pushing most of the costs out ten years is as annoying when done by Democrats as when done by Republicans.  Partly because of this, the Republicans can claim that ObamaCare is a failed system when most of it has not been put into effect yet.  Both the Democratic gimmick and the Republican attacks are lies.  Disgusting politics.

Final Thoughts for This Post

Given the Republican rejection of Republican ideas, such as the individual mandate, it is likely that nothing better than the ACA could have been accomplished during President Obama's first term in office.  While political parties are always rooting for replacement of members of the other party, they usual put country first.  The Republicans stopped doing so with the goal of replacing President Obama.  Perhaps it is racism.  Perhaps it is continued fallout from the near-impeachment and resignation of President Nixon.  Whatever the reason, the loss of the GOP as a political party that places the United States first was a huge loss.  I don't know how this can be repaired.

FollowUp 4: Lost Drones

Technically speaking, this post is about drones that are not yet sold, so they are not exactly lost.  Let's think about what is lost when they are sold ....

The Los Angeles Times has an article today about American manufacturers of unmanned aerial vehicles (UAVs or drones) seeking to sell them on the world market.

Despite concerns about U.S.-made drones ending up in enemy hands, American military contractors are lobbying the government to loosen export restrictions and open up foreign markets to the unmanned aircraft that have reshaped modern warfare.

Considering our most recent experience with the international release of weapons, one might hope that we would have the common sense to restrain ourselves from selling more devices around the planet.  We saw the incredible increase of nuclear weapons with "mutually assured destruction" (MAD) as the only justification for not having another nuclear war.  One can place a weapon on a drone as easily as a camera, so why on Earth would we consider selling them?

"Export restrictions are hurting this industry in America without making us any safer," Wesley G. Bush, Northrop's chief executive, said at a defense conference this year. "The U.S. is struggling to sell unmanned aircraft to our allies while other nations prepare to jump into the marketplace with both feet."

Does the "defense" industry profit trump our safety?

Daryl Kimball, executive director of the Arms Control Assn., said that drone sales are problematic because the unmanned vehicles are more affordable than other military aircraft. And with no human pilot at risk, drones could make it easier to decide to go to war, he said.

"The proliferation of this technology will mark a major shift in the way wars are waged," he said. "We're talking about very sophisticated war machines here. We need to be very careful about who gets this technology. It could come back to hurt us."

The article continues to explain how the manufacturers of drones are stuck on the sidelines while other American manufacturers of weapons can see their products exported for great profits.  Not fair!  We want to profit as well!  "It could come back to hurt us."

By the way, if you Google or Bing "drones for sale", there is an amazing array of UAVs on the domestic market right now.  One can spend less than a thousand dollars for a drone that can carry a camera weighing less than two pounds to tens of thousands of dollars for your personal military-style personal surveillance drone.  E-Bay has some that appear to be real military hardware.

I'm going to side with Mr. Kimball of the Arms Control Association.  Proliferation is a big mistake.

14 December 2011, Original Pedantic Political Ponderings post.
1 January 2012, FollowUp 1.
4 January 2012, FollowUp 2.
12 June 2012, FollowUp 3.

Repudiation: Republicans Against Republican Ideas

Lamar Smith of Texas

The Chair of the House Judiciary Committee, Lamar Smith, wrote an opinion piece for Fox News today, The Truth about the DREAM Act.

The DREAM Act has become a rallying cry for President Obama, members of his administration, and liberal Democrats everywhere. President Obama has vowed to “keep fighting for the DREAM Act,” which would grant amnesty to millions of illegal immigrants.

It’s true when listeners or those polled don’t know the facts that the DREAM Act has some appeal. After all, we are all naturally sympathetic when children are involved.

So, what is President Obama's DREAM Act?

The DREAM Act (acronym for Development, Relief and Education for Alien Minors) is an American legislative proposal first introduced in the Senate on August 1, 2001^[1] by Dick Durbin and Orrin Hatch. ^[2] The act was most recently reintroduced to the senate on May 11, 2011.

This bill would provide conditional permanent residency to certain illegal aliens of good moral character who graduate from U.S. high schools, arrived in the United States as minors, and lived in the country continuously for at least five years prior to the bill's enactment. If they were to complete two years in the military or two years at a four-year institution of higher learning, they would obtain temporary residency for a six-year period. Within the six-year period, they may qualify if they have "acquired a degree from an institution of higher education in the United States or has completed at least 2 years, in good standing, in a program for a bachelor's degree or higher degree in the United States" or have "served in the armed services for at least 2 years and, if discharged, has received an honorable discharge".^[3] Military enlistment contracts require an eight-year commitment, with active duty commitments typically between four and six years, but as low as two years.^[4][5] "Any alien whose permanent resident status is terminated... shall return to the immigration status the alien had immediately prior to receiving conditional permanent resident status under this Act."^[6] This bill would have included illegal immigrants as old as 35 years of age.

Let's slow down a minute.  This isn't legislation that originated with President Barack Obama.  Rather, it was bi-partisan legislation that was first sponsored by Republican Senator Orrin Hatch of Utah.  According to the Library of Congress, Dick Durbin was one of eighteen co-sponsors.  Other co-sponsors included Republicans Sam Brownback, now Governor of Kansas, Larry Craig of Idaho, who had an airport bathroom scandal involving lewd behavior, Mike DeWine, now Attorney General of Ohio, Pete Domenici of New Mexico, retired, Chuck Grassley of Iowa, and Richard Lugar of Indiana.

To be fair, since Barack Obama was inaugurated President of the United States, Senator Hatch has done an about face on his own legislation.  One can speculate as to why.  The answer from Senator Hatch's spokeswoman, Antonia Ferrier, is not convincing:  “He believes that we have to get tough on border security because the American people will have no faith in any immigration legislation until we do that,” she said in an email.

Back to Lamar Smith's opinion article.  He complains that many students will be older, which is true.  He then continues

DREAM Act proposals are also a magnet for fraud. Many illegal immigrants will fraudulently claim they came here as children or that they are under 30. And the federal government has no way to check whether their claims are true or not.

Such massive fraud occurred after the 1986 amnesty for illegal immigrants who claimed they were agricultural workers. Studies found two-thirds of all applications for the 1986 amnesty were fraudulent.

This is not the first time that Mr. Smith has made this allegation of studies finding massive amounts of fraud in 1986.  He made the same claim a decade ago, although links from the article at the Center for Immigration Studies to the studies he cites are broken.  More importantly, a study last year at American University refutes the allegation of fraud.

The rest of Mr. Smith's article is a complaint that President Obama is soft on illegal immigration.  According to the Pew Research Center, illegal immigration peaked in 2007 under President George W. Bush and has declined since ... a reversal of an annual increase for almost a decade.  This is likely due to the Great Recession followed by increasing border security under President Obama.

Since President Obama was elected, Republicans have done everything in their power to undermine his efficacy.  This includes working against their own ideas.  One can argue that we should simply deport all who are here illegally.  One can argue that those who have the greatest potential to help the United States should be allowed a path to legal residency and perhaps citizenship.  But arguing against one's own ideas only makes sense when the motive is no longer what is best for the country but what is best for the political party.

Is the visible animosity to President Obama purely partisan?  My guess is that there is a racial element.  While institutional racism has been illegal in the United States for half a century, it takes longer for old prejudices to be entirely eradicated.  The evidence for racism are the claims that Barack Obama is not a United States citizen or not a Christian, easily belied by his long form birth certificate and the controversies over Jeremiah Wright.

Repudiation: Newt Gingrich on the Food Stamp President

The day of the State of the Union Address, 24 January 2012, jump to about the 3 minute mark for the comparison of President Obama as "the most effective Food Stamp President in American history."



Almost the same wording the next day.  Again, jump to the 3 minute mark.



President Obama responds. The whole clip is only 27 seconds.



And yesterday on the floor of the House of Representatives, Congressman Luis Gutierrez of Illinois responded to Newt Gingrich, who has begun calling President Obama the "Food Stamp President." Armed with facts, the Congressman has a little fun setting the record straight and despite the name calling, concluded that "hunger knows no race or religion or age or political party. Hunger is colorblind."



We should be lowering instead of increasing the number of people on food stamps as a side effect of improving the economy and getting more people working in well paying jobs.  So, this is not a cheer.  But it is wrong to lie about the facts.  Mr. Gingrich, it appears, has not moved entirely beyond his ethical challenges.

Repudiation: ProLifeCon

A short history of legal action around the medical condition of Terri Schiavo

In 2005, following an extended legal battle in the state of Florida, then Senate Majority Leader Bill Frist, himself a surgeon specializing in heart transplants, and his fellow Republicans endeavored to extend the life of Terri Schiavo.   The problem was that Ms. Schiavo was in a persistant vegetative state (PVS).  Three years after that diagnosis, after repeated efforts with various treatments, Michael Schiavo asked the hospital to stop resuscitating his wife.  Ms. Schiavo's parents objected and sued.

For details of Ms. Schiavo's medical condition, see the New England Journal of Medicine.  The bottom line is that she was PVS.  Her brain, following too long without oxygen, had atrophied.  Her body functioned in that her heart was still beating and her lungs worked, but she could neither drink nor eat.  In other words, the body was alive but the brain was dead.  If you believe in a soul that is separate from corporal existence, that soul had already rejoined God.

But that did not stop Senator Frist from pushing for legislation, signed later by President Bush, that would move the Schiavo case from Florida state courts to federal courts.  This despite having run the gamut of the Florida appellate system, Mr. Schiavo never losing the right to make end of life decisions for his PVS wife.  Based on a memo from Florida Senator Mel Martinez, many speculated that this was not about real morality but about positioning the Republican Party for the 2008 election cycle.

Dr. Frist gave a speech against terminating the life of Ms. Schiavo on the floor of the Senate.  He was accused of having done a long-distance diagnosis of her condition.  USA Today discussed this along with other points.

Frist, R-Tenn., said in the full Senate that he supported what he called "an opportunity to save Mrs. Schiavo's life." A heart surgeon, Frist had viewed video ordered by a court and taken by a board-certified neurologist who had concluded she was not in a persistent vegetative state.

So, while Dr. Frist did not conduct the diagnosis himself, he was supporting a long-distance diagnosis that reached the opposite conclusion of the the team of doctors caring for Ms. Schiavo.  Still dubious, but not quite as horrible as the allegation that he was diagnosing long distance in a field in which he did not specialize.

Later, Sen. Frist opined on the case (still from the USA Today article).

Asked on NBC's Meet the Press if he had any regrets regarding the Schiavo case, Frist said: "Well, I'll tell you what I learned from it, which is obvious. The American people don't want you involved in these decisions."

So, the government should not be second guessing doctors and state courts.

ProLifeCon

On Monday 23 January 2012, as part of the protest events around the anniversary of Roe v. Wade, the Family Research Council (FRC), mostly known for the anti-equality stand on homosexuals, is hosting ProLifeCon, a rally of pro-life activists.  FRC boasts that one of those featured will be Collin Raye, a singer and the spokesman for the Terri Schaivo Life & Hope Network.

It is bizarre that the Terri Schaivo Life & Hope Network exists in complete denial of Ms. Schiavo's PVS condition.  Now the FRC, who regularly lie about homosexuality in pursuit of continuing the denial of equality to the LGBTQ Community, welcome those who lie about a past medical condition to protest a Supreme Court decision that helps keep abortion rates low.

Protesting Roe v Wade is counterproductive to those who want fewer abortions, but it does raise a lot of money for the organizations coordinating the protests.  The Washington Post ran an opinion piece on 17 January.

The annual carnival in Washington around the Jan. 22 anniversary of the Roe v. Wade decision (Happy 39th, Roe!) has become more farcical with each repetition. As technology and state-policy changes make the landmark case less important, anniversary observances have devolved into fact-free spectacles that have less to do with abortion than with raising money for advocacy groups on both sides.

I don't mind if religions choose to preach almost anything in their sanctuaries.  They are welcome to call me a terrible person and damn me to hell if they so choose.  I do object to their endeavor to inflict their belief system on the rest of us.

Let's face it, a zygote and an early embryo are each alive in the same sense that Ms. Schiavo was in her PVS.  The flesh is alive, but no one is home.  In the first two, the spirit has not yet been breathed into the body.

Then the LORD God formed man of the dust of the ground, and breathed into his nostrils the breath of life; and man became a living soul.  Genesis 2 : 7.

In the latter case, the spirit had departed years before the body was allowed to stop.  If someone objects to an abortion, they should not have an abortion.  If someone does not want their spouses body to stop breathing despite being in a PVS, they should be allowed to pay for continued care.  But the laws should not be suited to just that particular religious view of life.