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Now, in the fullness of time, we speak of what the relief of the Affordable Care Act means. For most of us with stories to tell, we had shouted ourselves hoarse when the injustice of the American system first struck us, individually, and in 2008 we voted, together. Many of us believed, during the summer of dreadful delay and interminable compromise, that we were seeing another deferral, another denial, another loss, another injustice, albeit one that came with excuses rather than accusations. Strangely, as the T.E.A. fools claimed both the stage and the Gadsden flag and the graves of our ancestors, we did not gather to tell our stories. I think we were in despair.

Today we feel as if the dreamer may safely awaken. We have had years enough to actually understand what is worth preserving and amending about the A.C.A. Unlike those for whom the A.C.A. is the death of “America” in some vague way, we who know the brutality of health care in America have been learning more all along about what the smoke of the back room obscured and the chattering bleached smiles of the news anchors of whose votes were up and whose down drowned out, and this act looks more and more like life to Americans.

I do not like autobiography. I find its subject matter boring. However, I know some people who should be honored. If you have patience, therefore, I would like to toss out a few of the conservative positions against health care reform and the single payer, and then, after our Kos Bump of Interest, I'll pay tribute to one of my friends whose life demonstrates the lies. I will then give a brief explanation of how nakedly partisan or willfully infantile a person must be to believe the anti-ACA arguments.

So, if we take the old conservative arguments – before they became incontinent under the pressure of Dick Armey's fist – and the new ones from after, we get something like this:

  • People should save for these things/budget for them.
  • The free market is doing a fine job already, and the real problem is that insurance companies have to pay too much due to law suits.
  • If we had universal access, then poor people and stupid people would be encouraged to be poorer and stupider, and they would engage in riskier behaviors.
  • Government is wasteful. It's way, way more wasteful than private industry. Just look at _, where people have to wait to get a __ and they go to ___ for it!
  • NEW! The gummint can't tell me what to do! If they can tell me to get insurance, then they can tell me to eat brocoli!
  • NEW!  The Government wants to administer your health care so that they can control it and decide when you die, and this is an obvious path to the movie “Logan's Run” or the “Left Behind” (or “Right Behind”) books.
  • Other things seem to be various yolps and screams, and I can't transcribe or transliterate them into propositions. Now, let me tell you about my dear friend Vicki.

I met Vicki at a small private college, where she was running the composition program in English. I was called to fill-in for her for a couple of weeks (while she, in her 30's, had an hysterectomy, though I didn't know that). I didn't mess up, so I later became an adjunct, then full time. The two of us would compete for the "work horse" title (most students per semester or for the year), and she usually won. For years, she and I were composition, for the most part.

She has a doctorate from Vanderbilt in Victorian British literature, but she only taught composition. She did not complain or try to leave, and she kept regular hours in her office from 9:00 to 5:00, as she was also the college's writing center. Her evaluations from students were high, and the grades she gave out were realistic (a C-average). This is praiseworthy in anyone, I think, but she was also very low paid, so she was good and a bargain.

It eats me alive that she could, did, and still does work harder than me, as she has more obstacles, more pain, than any of those around her. In her case, it is severe autoimmune conditions. Rheumatoid arthritis attacks hips, wrists, knees, and fingers. She also has a form of Tourette's Syndrome, and where I came into her story was at the point that she fought ovarian cancer and won. I just have osteoarthritis and congenital heart defects (which have been fixed now -- giving me Tietze's Syndrome) and stupid old metabolic syndrome (it was cooler when they called it Syndrome X). If work is a virtue, and if perseverance is a good, then she's a saint.

The small college had trouble making the interest payments on a loan it had taken out, and it bled people in layers. After cutting muscle, it began to cut bone. We found that the Board of Trustees would create a special panel that would cut faculty. Cuts were going to be made with one thing in mind only: cost versus benefit. The names of the trustees involved would be secret, and neither administration nor faculty would have input.

The result of the careful analysis was that the Division of Music was not cost effective, and several faculty members in assorted places were not needed enough.

Of the faculty who lost their positions outside of Music, almost all were women. This was curious, except that we heard that one of the Trustees felt strongly that Adam tills and Eve spins (lovely link). However, there was something. . . else.

Another of the cost hunters was a proven business expert, a veteran of budgets. His expertise was well known because he owned the health insurance company the school used. Strangely, all of the people outside of the eliminated division who lost their jobs had existing or recent serious medical diagnoses. One man had just gotten into his treatments for prostate cancer. One woman had just gotten her cervical cancer diagnosis. Another woman had a spinal problem that was freshly diagnosed. Vicki, who taught more students for less money than almost anyone, was let go.

Vicki was on unemployment for as long as it lasted. She sought teaching jobs, of course, but did not find one.

During economic prosperity, the job market for college teachers is like something dreamed up by The Joker in one of his more sadistic moments, but today it is simply an open insult to sense and sensibility. (Let's have a single conference, and have every hopeful attend it, at their expense. If the hopeful is favored, she will go meet a group of five professors who hate one another and are in competition to have the greatest number of pet words in answers. That's what it's like in the grand times. I came to believe that that conference was the only conceivable justification for land mines.)

Our state knows that Welfare Queens drive their Cadillacs to the Welfare office, so when she needed relief, they insisted that she spend all of her retirement funds, first. After, therefore, destroying all of the saving she had done to prepare for a catastrophe, she was able to get minimal support -- when it wasn't being cut off. She applied for Social Security Disability and was denied, twice, because, after all, she had just had a job.

Here's the thing, though. Her symptoms never relented. Arthritis pain too severe to sleep, treatments that are ruinously expensive for a rich person -- these do not care about one's job. That's the curiosity and inconvenience of illness and "pre-existing conditions": they afflict regardless of the government, the insurer, or the doctor.

I would not tell you this story if I could not provide at least the illusion of an happy prospect. There are two. The first is that she got hired by one, then a second, then a third, and then a fourth online for-profit college. (Yes, grumble grumble ethics of the for-profit colleges.) One of them offered her a real, flesh and blood campus position, but the others were for online education only. Without prejudice, when bosses saw her teaching, her counseling, and her course design, they were ecstatic. One college promoted her, then promoted her to teaching graduate school, then promoted her again. She is working seven days a week, making only slightly more than she did at a poorly paying college job, and she has to face a 1099 tax form, but her rise will likely continue. Anyone who teaches can tell you that being able to teach what one trained in is a benefit almost as sweet as pay.

The real happy ending? The Affordable Care Act will mean that she will soon have affordable health insurance. It's a year and a half away, of course, but it is coming. When it comes, there will be no pre-existing condition exclusion and no cap. There will be no sneaking around -- jacking up the premiums and communicating with the employer. It's even imaginable that she might get to start rebuilding her TIAA-Cref.

Why there is no argument against the ACA, only a lie and a fantasy


If we look back at the old conservative arguments, we can derive two real proposed positions and objections.

1. Moral arguments: "Individuals should save (and the government should facilitate by individual savings accounts, etc.)," "universal access encourages frivolous use of health care," "Government has waste, as seen in _" are all effectively moral arguments. The "should save by a medical account" claims that those who presently cannot pay medical bills can face any medical expense, regardless, with proper financial planning. The uninsured, this argument posits, lack prudence. Furthermore, the person who makes this argument gets to compliment himself and his class by implying that he does have prudence and can "manage" money.

The argument that universal coverage would lead to a slippery slope of blocked up clinics with stupid people milling about is an encoded race and class fear, but it also implies that the people who now have no insurance and cannot pay are not in need and would stand in the way. This implication has to be present, by the way. If these imagined brown hordes are going to "waste" the medical office's time, then they can only do so by not being sick. Thus, this argument is tantamount to saying, "The people who want insurance don't need it." Since the "they" is almost always undefined ("old people," "crazy people," and "poor people" are meaningless terms), it's a way of saying, "I don't want to see anyone else at my doctor's office."

2. Begging the question: You waste, I profit
The "Government wastes, and you can see because of -Agency- and -Anecdote-" argument deserves special treatment. What is waste? The very selection of the term (not even mentioning that the person will argue from anecdotal evidence and cherry picked evidence) is begging the question. It is waste because waste is what is called waste.

Is it waste, when a crutch is sold at Rite Aid for $17.00 and costs $89.00 when provided by a hospital? Is it waste if a 400 bed hospital spends >$2,180,000 a year on advertising? Is it waste if a company knowingly ships a dangerous product, planning on paying the fine, when necessary, and then has a fine that almost destroys the enterprise? In each of these cases, one ideological camp calls it "business," and the other calls it "exploitation," but no one calls it waste. "Waste" is only something government does, a priori. This is because "waste" is a special term, it means "excess labor cost," and never "excess profit taking" or "inefficient administration" or "excess management."

Making this argument does two things: First, because it uses a licensed premise (waste is only ever excess labor and not excess greed), it tells the speaker and audience that the investor's model of management is the only scale of virtue. Second, it defines good as profit. It's this that's most important.

No one can say, "Government wastes money, so we should have free market insurance" as a proof without having determined that the social duty of government is saving money. Instead of asking about right and wrong, it asks what's cheap. It's government by Wal-Mart shopper. The "government wastes money, so private insurance is best" argument depends upon rewriting the U.S. Constitution so that the government does not provide for the general welfare, but only for the general wealth (and that only in aggregate).

It's not surprising, then that the other arguments all have in common a precondition that there is this thing called The Government that is a foreign entity. The "government gets to control you" is predicated on the idea that this thing -- "government" -- must be hostile and impenetrable. You only fear "the government will control you" if you believe that you have no influence on the government.

If you don't believe in, or want to quit, or you don't think voting matters, then the government can be Government. Otherwise, people who believe in participatory democracy believe that they can change the government. To see government as an inveterate enemy force in a political, cultural, and personal sense requires much, much more than the businessman's creed that regulation is burden: it requires a divorce from democracy.

 = = =

Q.V. Truth

= = =

Far from the slovenly, confused, gleeful hordes of emergency room blocking minorities, the uninsured have been and are as frequently employed as unemployed, educated as uneducated, vigorous as weak. "Uninsurable" is a designation thrown down from the Olympus of the Blue Aegis, the heaven of HMO's, falling on the just and unjust alike. It comprises people who are ill, not people who are bad. The demographics of the uninsurable are the demographics of illness, and disease has no respect for skin, education, or ethics.

My friend Vicki's character should frighten a Republican fear-monger. She worked her way up, paid her own way, came from disadvantage, got a Ph.D., payed off her loans, built up retirement, and has poured hours into labor. Her only failure has been marked upon her by birth and bad luck, and for that, the world would be robbed of her work. For that, students would be denied. For that, she would be dismissed out of hand by someone lucky as undeserving?

I did nothing to gain my birth defects, either. However, no one "deserves" disease -- not the person engaged in risky behavior more than the child born to a dangerous environment. Once we make the cognitive advance, once we realize that no one earns an illness, then we can come to the final realization that therefore all deserve care. Otherwise, the ones who natter on about the morality of health are the people who are healthy, wealthy, and unwise.

It may be that our whole GDP would not get the health care we deserve it may be that healthcare for all is impossible, but let no one say that it is "waste" or impugn moral stances.

As for the government's death panels, perhaps the Freepdom loving could come up with a private, secret underground gurney track, where they can provide a safe haven in Canada for wealthy Americans who can no longer breathe freep. The first day that their flights to the Caymans are cancelled, the freep peoples will slither into action.

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Comment Preferences

  •  Tip Jar (14+ / 0-)

    Every reductio ad absurdum will seem like a good idea to some fool or another.

    by The Geogre on Mon Jul 02, 2012 at 12:02:12 PM PDT

  •  There was an article in Forbes in 2011 that (6+ / 0-)

    I had been watching.  It is titled The Bomb Buried In Obamacare Explodes Today-Hallelujah!  This is one small excerpt but I was wondering if anyone here could determine (after reading full article) if these provisions have been upheld:

    That would be the provision of the law, called the medical loss ratio, that requires health insurance companies to spend 80% of the consumers’ premium dollars they collect—85% for large group insurers—on actual medical care rather than overhead, marketing expenses and profit. Failure on the part of insurers to meet this requirement will result in the insurers having to send their customers a rebate check representing the amount in which they underspend on actual medical care.

    As it turns out, HHS isn’t screwing around. They actually mean to see to it that the insurance companies spend what they should taking care of their customers.

    http://www.forbes.com/...
    •  Yes. No. Sort of. (5+ / 0-)

      That "bomb" did go off. However, the companies could ask for extensions while they "figured out" their percentages, during which time it was in their interests to make their finances as opaque as possible rather than to just obey the damn law.

      However, HHS isn't screwing around, and you'll see another article here at DKos about "the size of the refunds shows the seriousness." Those refunds, I believe, are due to companies having to cough up after being fragged for exceeding the percentages.

      Again, though, this was not "waste," but "administrative services." (Yeah, right. It was investing in CDO's.)

      Every reductio ad absurdum will seem like a good idea to some fool or another.

      by The Geogre on Mon Jul 02, 2012 at 12:28:28 PM PDT

      [ Parent ]

    •  Awesome. (6+ / 0-)

      I thought the really juicy stuff didn't materialize until 2014, but the provision that health insurance companies can take only a certain healthy fraction as profit, really IS huge.

      As I recall, German and Swiss private insurers have been operating until this type of cap for a good long while, and it seems to be working rather well.

      Insurance is still profitable.  Plenty of companies choose to stay in the game.  Yet preventing it from being obscenely profitable, means that consumers are far less likely to be subjected to rip-offs.

      "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

      by lgmcp on Mon Jul 02, 2012 at 12:48:36 PM PDT

      [ Parent ]

      •  These rules apply in Canada as well. n/t (2+ / 0-)
        Recommended by:
        lgmcp, Larsstephens
        •  What sort of health insurance in Canada? n/t (1+ / 0-)
          Recommended by:
          Larsstephens
          •  Single-payer for basic care (2+ / 0-)
            Recommended by:
            BlackSheep1, Larsstephens

            with a variety of private supplementary policies available -- and those, I just learned, with a regulated rate of pay-out.  

            "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

            by lgmcp on Mon Jul 02, 2012 at 01:42:47 PM PDT

            [ Parent ]

            •  From Wikipedia: (0+ / 0-)
              Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized. Cosmetic surgery and some forms of elective surgery are not considered essential care and are generally not covered.
              Comparing government-funded healthcare to private insurance is misleading I think (no insult of any kind intended).

              Many around here used to go to Canada for dentures.  I suppose they still do but don't know.  The costs were much lower I assumed because of the reduction in paperwork.

              I am a little surprised dental work is often not covered.

              Thank you.

              Best,  Terry

              •  It seems to me that a guaranteed rate of pay-out (2+ / 0-)
                Recommended by:
                BlackSheep1, Larsstephens

                is URGENTLY needed for basic care, but to make it also apply to other types of policies would be the frosting on the cake.  

                "The extinction of the human race will come from its inability to EMOTIONALLY comprehend the exponential function." -- Edward Teller

                by lgmcp on Mon Jul 02, 2012 at 02:26:12 PM PDT

                [ Parent ]

                •  Dr. Pain We Called One Dentist (1+ / 0-)
                  Recommended by:
                  BlackSheep1

                  His price was cheaper but normal mortals would not be able to endure the pain for shoddy work.

                  Even an endodontist (you know, root canal specialist) who gave lectures around the country on his specialty was a horror.  For root canals, yet.

                  In an isolated region where I grew up there were two dentists in the nearest town.

                  One you had to make an appointment many months in advance.  The other dentist was always available.  When you had a sudden, pounding toothache, Dr. Lyons was your man.

                  Dad had only the one tooth in his head and Dr. Lyons did all he could to pull it.  My mother said Dr. Lyons had both feet on the the dental chair at one point but couldn't quite do it.  It was some 20 years later a tiny blackened stub was finally surgically removed in a hospital under knockout drops.

                  Dr. Lyons complained  bitterly to my mother that he mostly only got Indians because the government paid.

                  Ever since I have had an absolute awe for the courage and endurance of Indians that is a match only for that of women.  I now know the stoic acceptance of pain by Indians is  no myth.

                  Maybe, just maybe, it might be somewhat difficult to set a standard price for, say, pulling a tooth.

                  Best,  Terry

  •  A heartfelt diary - but to no avail. (1+ / 0-)
    Recommended by:
    The Geogre

    Regardless of the verbiage and ponticifating, all of the versions of healthcare in this country, whether espoused by Democrats or Republicans, cannot survive.

    As long as two conditions exists, this country will not have a sustainable healthcare system. The two conditions are fee for service and for-profit healthcare plans. Either one will make the financial cost of any variation of the present healthcare plans unsustainable. What we have now - in whatever variation - makes the current and future escalating cost unsupportable.

    Stripping the veneer of the Supreme Court ruling, it firmly establishes the private, for-profit, extremely wasteful, insurance companies as the determinators of the direction and cost of our present healthcare system - as before, unsustainable.

    Out of the wilderness comes the cry for single payer, a cry now plaintive and forlorn.  

    •  I hear that call (0+ / 0-)

      Health care is the one place where socialism makes the most inarguable sense, and yet we've had a devil of a time even speaking the name. For-profit health care is wrong in every way: we do not want to set incentives to doctors to go into the most remunerative fields, and yet our shortage of GP's is a result of just that; we do not want doctors to be risk averse, and yet HMO's and PPO's have made them thus; we do not want hospitals to discharge partly-cured patients, but "average stay time" limits on coverage mean that happens every day. We do not want people to see hospice as a cash cow, and yet in the Bush years that's what it was. We want people who provide wheel chairs and catheters to be striving for the public good, but it has become the area with the greatest profit margin.

      Everything about this, and without even considering insurance, is backwards.

      As an undergraduate, my peers were mainly "pre-med" (they thought). Their reasons for it were all, universally, money. None said, "Helping people." I didn't know one of them that I would let examine a cuticle, and I can only hope that medical school washed them out.

      Every reductio ad absurdum will seem like a good idea to some fool or another.

      by The Geogre on Mon Jul 02, 2012 at 05:09:09 PM PDT

      [ Parent ]

      •  One Payer Is Not Remotely Socialism (0+ / 0-)

        England has government run health care but Canada doesn't.  It is the Canadian system that is generally referred to as "one payer."

        If you want to call England's system socialism, fine with me but then our schools and roads and fire departments and police and courts and Congress are also socialism too by the same logic, are they not?

        Best,  Terry

        •  Forest<- ->Trees (0+ / 0-)

          I thought I was making a general argument that socialism is naturally suited to medicine, that socialism is a strong argument there. However, we cannot get single payer (which can be done many different ways). NHS is, in fact, quite socialist. It is probably more socialist than the Swedish system, to tell the truth, but it was constructed in the days of state central planning. That said, NHS is enormously popular, and its failures mainly come from conservatives there not allocating money to it.

          I'm not interested in calling out names of systems here, but single payer is the best option. I actually think the Canadian system is worse than the European models, as rationing is sane and reasonable, but it is too subject to political winds. I think it's a good system, but I feel as if it were temporized to avoid central control.

          Besides, no one really cares what my answer is. I just want us to get the profit motive away from the center of our health care.

          Every reductio ad absurdum will seem like a good idea to some fool or another.

          by The Geogre on Mon Jul 02, 2012 at 06:03:52 PM PDT

          [ Parent ]

          •  Helps to define things (1+ / 0-)
            Recommended by:
            The Geogre

            Socialism was always about controlling the means of production.

            When Israel had communes, the state owned everything including the housing, the children, just everything.

            That may be the root of socialism but it hardly defines evolved European style socialism, for instance.

            we cannot get single payer

            Of course we can.

            And we can get England's "socialist" system too.  

            In fact we already have it (military, prisons) and single payer (Medicare and Medicaid) too.

            What we don't have is universal care and won't have until we get rid of hangups, like connections to work. citizenship, residence.

            Besides, no one really cares what my answer is.

            I do.  That's why I am here.

            I just want us to get the profit motive away from the center of our health care.
            I don't disagree but try to believe this if you will:

            Non-profits are often the very worst.  You want a true horror story or two?  Naww you have plenty of your own.

            Good health and happiness, friend.  And lacking those, I hope you can maintain your fighting spirit that we might be friends to the end.

            Best,  Terry

            •  Not intended to be cranky (0+ / 0-)

              Your distinctions are valid, except when you say "state control" the means of production being socialism. This is only true if the people are the state, and that is only true in a well-functioning democracy without corruption. To the degree that the democracy fails or corruption exists, the state control will introduce losses that will replicate the injustice of the profit margin.

              Socialism almost lacks a definition. She's a word who has been with too many partners and is too agreeable.

              Non-profits can introduce horror. This is particularly true to the degree that they are isolated from the workers and users of the field. When an LA, London, or DC non-profit has a set of rules or a hiring standard, then it can ruin everything in the field.

              The Swedish model sets national rationing numbers, more or less, and then funds clinics. The care is not, after all, "free," and there are long waits when the states have conservatives in power who listen to the GOP and repeat their rhetoric. The critical feature, it seems to me, is the local, communally-flexible, but answerable above system.

              [I still say, we have a single payer, full Medicare for all. It's opt-in. On income taxes, the person checks a box, adjusts his or her taxes, and -boom- has Government Plan. Within 5 years, it would be the ONLY insurance out there, except for super caviar snorting plans.]

              Every reductio ad absurdum will seem like a good idea to some fool or another.

              by The Geogre on Tue Jul 03, 2012 at 04:15:20 AM PDT

              [ Parent ]

  •  A Terrible Story Indeed, Friend, (1+ / 0-)
    Recommended by:
    The Geogre

    but it is far from clear that our awful health care funding is fixed.

    One bit of obscenity not loudly proclaimed is that the insured are subsidized by uninsured, who pay more.  So, of course, the health insurance companies will need to charge more.

    Those comparing health insurance companies in Germany to ours, are comparing kittens to tigers.

    Only here do insurance company clerks have such power to even decide whether treatment is needed and what kind.

    Other countries rely on doctors to decide such matters.

    Best,  Terry

    •  Fixed, no (1+ / 0-)
      Recommended by:
      Larsstephens

      Our funding isn't fixed at all.

      In fact, I would argue single payer all the way. I even had my own clever twist on the game. "If you want to be in the government plan, check this box on your income taxes and use schedule H for determining withholdings." That way, all of the freepers could opt out. However, since health care was the #1 cause of personal bankruptcies until housing loans shoved it out of the way and health insurance is still the #1 issue in all strikes in the U.S., we can safely assume that corporations would stop employer insurance and the risk pool would normalize.

      Still, if Mitt wanted his concierge doctor to give him prescription sleep aids and live in the house with him, he could opt out and do that.
      --

      Our funding isn't fixed, but there is a difference between collusive non-competition and small player real competition, and I think the exchanges can generate the latter, if we don't get a president Romney. (If we do, the ACA will remain, but they'll gerry rig the exchanges so that fifteen names appear, but only two companies.)

      Every reductio ad absurdum will seem like a good idea to some fool or another.

      by The Geogre on Mon Jul 02, 2012 at 05:17:22 PM PDT

      [ Parent ]

  •  The ACa hasn't completely "fixed" the system (2+ / 0-)
    Recommended by:
    The Geogre, Larsstephens

    But it's one hell of a lot better, especially for those of us with crushingly expensive, genetic chronic diseases, than the status quo. At least we can get insurance. Right now, insurers look at us and laugh.

    •  My point exactly (1+ / 0-)
      Recommended by:
      Larsstephens

      Illness does not care one whit about what you do, who you are, how you dress, or how you vote. The genetic lottery doesn't care, either.

      For the hundreds of thousands in the "uninsurable" category, the ACA is the difference between solvency and bankruptcy, perhaps life and death. Compared to that, the GOP whines about "but it might cost munnney" ring very hollow. This is all the more so when we know that it won't.

      As I said at the top, we've had a couple of years to read the blasted thing and to see what's actually in there. We know that it isn't great. We also get to see that it's infinitely better than the 2008 status quo.

      Every reductio ad absurdum will seem like a good idea to some fool or another.

      by The Geogre on Mon Jul 02, 2012 at 05:12:44 PM PDT

      [ Parent ]

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