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The World Health Organization gives the U.S. health system an overall ranking of 37th in the world, far below other Western democracies. The CIA World Factbook — hardly the work of a bunch of left-leaning one-worlders — reports that life expectancy in the United States is not just lower than in other industrialized countries but also lower than in Jordan and Bosnia.Infant mortality in this country, according to the CIA, exceeds that of Slovenia and Cuba. It is possible to quibble with these figures but not to ignore them. We should be ashamed of ourselves.
That paragraph is from The Supreme Court helps heal the nation, Eugene Robinson's Washington Post column in response to the ACA decision yesterday.

In an earlier paragraph, Robinson also makes a very important point:  

Obama’s great achievement is not any one element of the health-care reform law — not even the now-upheld “individual mandate,” which compels individuals to have health insurance or pay a fine. The important thing is the law’s underlying assumption that every American, rich or poor, should have access to adequate health care.
I said that we need ACA -  it has started to move us in the right direction.  The underlying assumption that I have quoted from Robinson is not, however, something agreed to by everyone:  we can easily remember those during the Republican debates who seem willing to let people die or suffer or go bankrupt just so that they can keep the theological or ideological purity -  except some of them who rant against certain government programs themselves draw benefits from those self-same programs.

But it is not enough.  Not even close to enough.  Let me try to explain why.

We are still for now leaving too many of the poor at the mercy of Governors and Legislatures that can refuse to accept the expansion of Medicaid, at the very time when increasing numbers of Americans seem to need access to that program.

We still see an unfortunate tendency that to pay for expansion of medical coverage we cap reimbursements for doctors under federal programs at a level that many doctors or dentists or other medical professionals will not take - the medical practice to which I go will not accept new Medicare patients, but will allow those of us who are already patients to remain in their practice when they switch to Medicare -  they could not keep the doors open were all their patients paying them at the reimbursement rate the government is willing to pay for Medicare.

What good is medical insurance coverage if one cannot find a doctor willing to take it?

Remember, there are still millions of people here who do not have medical insurance through their employment.

If you are over 26 and either are unemployed or your employment does not not offer healthcare, you are no longer eligible for the provision allowing you to stay on parental plans.

While the President was right to announce his decision to start addressing the immigration issue of those who would have been covered by the Dream Act, they are still not eligible for medical coverage -  we have something over 11 million Americans who cannot get medical insurance, and that creates something of a public health risk, especially in schools and colleges, unless the college has a group plan in which they can participate.

'I am not arguing that passing ACA was wrong, although it did not go far enough.

But like much of what we do in this country, we are not addressing the larger context of the need for social programs.

Politically it may be hard -  what President or aspirant to the Oval Office wants to tell the American people that we are far from the greatest country in the world, which is why there are lots of things that need to be addressed?

What Senator or Representative or Governor is willing to be blunt with the American people, that we have choices to make that may require us to think hard

- on taxes
- on military spending
- on building more prisons

We will not fix the issue of medical care in this country in isolation.

We  have to address nutrition - for a country as wealthy as in theory we are, too many are undernourished, too many do not eat healthily.  These are things that contribute to our escalating costs on medical care.

We have to address what we do to the environment - if we are unwilling to require businesses to be more responsible about what they do to water, soil, air,  we will pay extensively in otherwise avoidable medical costs down the road.

Nutrition and environment  -  the costs are not only those paid for treatment, but the loss of productive work as lives get limited or shortened, and that means loss of revenue for taxes to pay for the necessary work of government.

NECESSARY WORK OF GOVERNMENT -  we need to reclaim the words of the Preamble, that one key reason for the social contract that establishes our government is   to promote the general welfare -  the general wellbeing of the people.  Without proper health we undermine that general welfare.  It is a key purpose of government to address those things necessary for that general welfare.

Ronald Reagan would have had no trouble supporting ACA.  Richard Nixon would probably have argued that it did not go far enough.

It is time for those who truly care about this country to stand up and push back against those who are selfish, concerned only for themselves and their own, their wealth and their (economic, social and political) power.

Hubert Humphrey put it bluntly -  

It was once said that the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.
Or perhaps we can for those Americans who take their lead from Scripture remind them of the words in Matthew Chapter 25, that how we treat the hungry,  the thirsty, the stranger (including undocumented aliens, perhaps?), the naked (which for us could be the homeless) the sick, even the criminals (those in prison) is how we shall be judged, because "whatever you did for one of the least of these brothers and sisters of mine, you did for me."

We need ACA.  John Roberts did the nation a service by voting to preserve it.  

It is not enough.

It is time for all of us to do more.

Lest we fail the moral test, lest we be found wanting in our care for our fellow human beings, regardless of their race, gender, sexual orientation, immigration status, age, economic status, religion, or political philosophy.


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Comment Preferences

  •  Tip Jar (18+ / 0-)

    "what the best and wisest parent wants for his child is what we should want for all the children of the community" - John Dewey

    by teacherken on Fri Jun 29, 2012 at 04:35:40 AM PDT

  •  Of course it's not enough. (7+ / 0-)

    But yesterday gave us the ability to push for more without the chilling effect of the threat of judicial veto.  That is what I am celebrating, the ability and opportunity to evolve into a single payer type of program.  

    Note to self, stop before I emulate the habits described in this diary.

    by Rustbelt Dem on Fri Jun 29, 2012 at 04:42:46 AM PDT

  •  Agreed ... (3+ / 0-)
    Recommended by:
    teacherken, Shockwave, PSzymeczek

    Not enough ... not what should have been ... but improvement over past ... and, hopefully, stepping stone to better.  And, SCOTUS decision enables working toward that better (even as within that decision there is dangerous language ...).

    While within the discussion ("environment"), I would have had (obviously from me ... but legitimately) energy / climate more seriously laid out in the discussion, almost certainly as one of the bullets under "blunt".

    Related, Six Degrees of Intertwining … Energy and Health …

    Blogging regularly at Get Energy Smart NOW! for a sustainable energy future.

    by A Siegel on Fri Jun 29, 2012 at 04:49:25 AM PDT

  •  After all this sturm and drang and conflict (5+ / 0-)
    Recommended by:
    Shockwave, banjolele, CJnyc, roadbear, figurine

    and drama and appeals and upheaval over the ACA,
    I just shake my head.

    It seems like it could have been so much comparatively easier with Dem majorities in both Houses and the Presidency to simply say, look, we have too many uninsured Americans and we're going to open up Medicare on an optional basis to all uninsured Americans and they'll pay on a sliding scale according to income.

    That would have been a better solution - it could have even been presented as a "temporary" solution, wink wink.

    Everything went down the wrong track from the getgo with the determination by the Obama administration that the profit component of healthcare had to be maintained - we will never get where we need to be with that as the jumping off point.

    We'll also have to be fighting off Republican threats to repeal the law for the rest of our lives, whereas an expansion of Medicare would have more of an under the radar effect until so many people's lives were improved that they would fight tooth and nail for the expansion, just as we will do when Social Security is threatened in the future

    The ACA is an improvement, but only time will tell whether it is the beginning of a highway to universal single payer healthcare or whether it is simply a toll booth on a dead end road.

    “Human kindness has never weakened the stamina or softened the fiber of a free people. A nation does not have to be cruel to be tough.” FDR

    by Phoebe Loosinhouse on Fri Jun 29, 2012 at 04:52:14 AM PDT

    •  I'll go with toll booth (1+ / 0-)
      Recommended by:

      All that work to get something remarkably similar to what the Heritage Foundation initially proposed, probably as a bulwark against single-payer and true universal health care. For the same amount of pain and screaming, we could have had the real thing (or at minimum the reputation of an already putrid Roberts court shredded completely). As intended, plenty of Americans will read this as "health care done" and want to hear no more about it – until their rates go through the roof because of the lack of cost reform. Then there's that largely disenfranchised 26 million for which this does nothing good (self possibly included).

  •  Last week, someone on dKos posted that (4+ / 0-)

    we are the only developed or industrialized nation that hasn't outlawed the type of for-profit health care and health care insurance that exist in America today.

    The Republican motto: "There's been a lot of progress in this country over the last 75 years, and we've been against all of it."

    by Hillbilly Dem on Fri Jun 29, 2012 at 04:53:44 AM PDT

  •  Teacherken we have to talk! (0+ / 0-)

    I have seen your diaries for many years now, And I must say that I am jealous. Just kidding! What I want to ask you is if you will help me to craft a response to the GOP attack on Healthcare that State and Local democrats can use this fall. I already have the responses, but my writing skills are not as strong as yours. Please let me know and I will give you the details.
    Thank you!

    •  wish I could help (0+ / 0-)

      although I am officially retired, actually have a lot on my plate right now with some paid peer reviewing for a publisher, a brief consulting contract with a university, several books about which i want to write, and notes from several events I attended for which I should do writeups

      Cannot take this on

      "what the best and wisest parent wants for his child is what we should want for all the children of the community" - John Dewey

      by teacherken on Fri Jun 29, 2012 at 05:12:05 AM PDT

      [ Parent ]

  •  I will continue fighting until we get Single Payer (4+ / 0-)
    Recommended by:
    teacherken, CJnyc, roadbear, PSzymeczek

    Medicare for all or whatever term works better.

    The for profit insurance companies serve no purpose and are not part of cost containment or bureaucratic streamlining or universal coverage.  They have to go.

    The ACA is a step in the right direction but it is just a step.

    It does not quite establish that healthcare is a basic human right.  It does establish it is an obligation.  It helps millions get something (something too expensive for many) but it leaves millions out.

    I am happy that the Repug idiots are in a state of disarray but the fight must go on.

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Fri Jun 29, 2012 at 05:02:01 AM PDT

    •  health care as a human right (2+ / 0-)
      Recommended by:
      Shockwave, roadbear

      from the Universal Declaration of Human Rights (which unfortunately the US has never ratified):  

      Article 25.

      (1) Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
      (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.

      from FDR's January 11, 1944 State of the Union Message to Congress, known as the 2nd Bill of Rights:
      The right to adequate medical care and the opportunity to achieve and enjoy good health

      "what the best and wisest parent wants for his child is what we should want for all the children of the community" - John Dewey

      by teacherken on Fri Jun 29, 2012 at 05:18:03 AM PDT

      [ Parent ]

  •  The fight goes on. (2+ / 0-)
    Recommended by:
    teacherken, roadbear

    The ACA is just one battle, albeit an extraordinarily significant one, in a much larger war for universal healthcare (ideally single-payer). I think an important thing to consider is that the federal government has essentially taken its turn. The fight now moves on to the states. It is vital that as many states as possible adopt the new Medicaid expansion. Unfortunately, there will be a not insignificant number of states that will refuse. It is one of the battles that needs to be fought immediately.

    While the Medicaid expansion is one thing, the fight in other states needs to be the goal of single-payer. This also needs to be passed in as many states as possible. I think one of the most important states for this is California, if not just for the sheer number of Americans that would be covered under such a plan. But all states, big and small, need to go as far as they can possibly go toward this goal.

    For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives and the dream shall never die. - Sen. Ted Kennedy

    by Dem 724 on Fri Jun 29, 2012 at 05:12:38 AM PDT

  •  An honest diary... (0+ / 0-)

    on what this "victory" really means to millions of Americans....not much. WE need a poor people's movement in this country...and continue what MLK started: the fight for economic justice which includes health care justice must be taken to the streets. Expect repression though, cause you got with the Occupy movement under a Democratic president.

  •  An honest diary as to what this law will mean (1+ / 0-)
    Recommended by:

    for millions of Americans and immigrants...not much.
    We need a poor people's movement in this country that continues what MLK started: take the fight for economic justice that includes health care justice to the streets. Expect repression though, as in the Occupy movement, possibly violent repression, under this democratic president.

  •  In the wake of this ruling (0+ / 0-)

    Rather than continuing to flog quixotic dreams of single-payer healthcare or whatever, it's time to, just as with the Republicans, move on and deal with the law as it is. Otherwise it just reads as another version of "repeal and replace."

    It's a monumental achievement and victory for Pres. Obama and congressional Democrats and it is a disservice to damn it with statements like it's "not even close to enough" complete with allusions to Reagan and Nixon.

    BTW, Reagan spoke out against Medicare and I believe issued an LP album on the subject. He said that "Shouldn't someone tag Mr. Kennedy's 'bold new imaginative program' with its proper age? Under the tousled boyish haircut it is still old Karl Marx—first launched a century ago. There is nothing new in the idea of a government being Big Brother to us all. Hitler called his state 'State Socialism', and way before him it was relevant 'benevolent monarchy'."

    Absolutely no difference from modern Republicans--Reagan was a troglodyte.

  •  Great diary. (3+ / 0-)
    Recommended by:
    shanesnana, CJnyc, roadbear

    I want to preface my comment with a recognition that this law will improve access to health insurance for millions of Americans. This will undoubtedly impact the lives of many people for the better, and I want to recognize that.

    At the same time, this is a health care law that is more conservative than the 1990s Republican alternative to Clinton's proposed changes. Again, Obama's "socialist takeover of health care," which many Democrats and liberals are cheering, is basically a conservate-Republican approach to health care reform.

    This is a health care law, as the business press noted, in which the health insurance industry basically got most of what it wanted. Working closely with Democrats in Washington, the health insurance industry is generally on board with this law.

    Let me stress that again - this is a law that, while requiring some mild reforms, is essentially an industry-written law. It helps solidify our for-profit health care system, and with the mandate, ensures billions in new profits for health insurance companies.

    There is also very little in the law that really requires health insurance companies to charge less, and all kinds of loopholes for companies to get around what few reforms were included. Health care costs have skyrocketed in the past couple years, and show no signs of stopping.

    We still have a system where health care is a commodity. We still have a for-profit system. When you have a for-profit system, you have no interest in creating healthy people and communities, because that means you'll lose profits. Just like the private prison system has no interest in lowering crime rates, the private health care system has no interest in healthier communities. It goes against their very purpose.

    And thanks to the Supreme Court's ruling, one of the best aspects of ACA, the Medicaid expansion, is now something states can opt out of. In a country with so many people suffering, with so many people without access to care thanks to massive income inequality and poverty, the Court decides forcing states to expand access is unconstitutional. As is so often the case, our Constitution is interpreted in a way that screws the poor.

    So the ruling is a small step in the right direction. But it's one step with miles to go. I understand folks wanting to cheer a victory for your president and your party. But we should be thinking much bigger.

    Never be deceived that the rich will permit you to vote away their wealth. - Lucy Parsons

    by cruz on Fri Jun 29, 2012 at 06:12:22 AM PDT

    •  Our problem is not insurance companies, our (4+ / 0-)
      Recommended by:
      shypuffadder, cruz, shanesnana, roadbear

      Problem is the medical industrial complex.  If our costs matched those in other counties, many people would only need catastrophic coverage.  Our system is So bloated that no one knows what things cost.   Doctors complain about Medicare reimbursements but how much less can they be than insurance companies that pay 40% of billed charges.  One of the most important things that our Cogress could have required is cost transparency, that would have gone a long way in bringing costs down and making health care affordable.

  •  *sigh* (0+ / 0-)

    I guess being the least bit happy about something for more than 24 hours is not allowed in the "Progressive" world...  Of course more needs to be done!  The president himself said that more needs to be done and that was when he signed the bill, so stop with all of this "it's never going to be enough" bullshit.  It's a first majorly fucking huge step.  Accept that it's a majorly huge fucking step.  Celebrate that's it's a majorly huge fucking step.  The more you decided to dismiss this, the harder the other fights become.

    The greatest trick the Devil ever pulled was convincing online commenters that they have anything to say.-- B.F.

    by lcj98 on Fri Jun 29, 2012 at 08:45:46 AM PDT

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