brainiac conspiracy

Give The Voters What They Want

And you can spare yourself no end of grief:

Phil was a letter carrier in the neighborhoods around the Serb Hall for nearly 40 years, but he retired last year when his days were cut back to three a week as part of the fiscal crisis forced upon the USPS by Republican legislators who would like to see it go away entirely.

"A friend once told me, 'Well, we only need mail three or four days a week,'" Phil told me. "I politely told him, 'Dave, we're gonna have to agree to disagree.' I could have told him, 'Dave, you know, maybe at that engineering place where you work, they only need you three days a week, and then you could come help us.'

"The politicians, I think, it's a tough call, because if you don't keep the postal service in business — you and I will both agree that there's nothing more personal than taking pen in hand to write to your mother, sister, or brother. Until June of last year, I gave my heart and soul to my job. I worked right through lunch most days."

Eventually, I asked him why he was here, at the Serb Hall, supporting Scott Walker, whose politics were far more in tune with the people who are trying to strangle the postal service than they are with the people who still work there. Phil told me that it was about his sister-in-law. "The problem is that, when you start handing out free health care out to teachers, that annoys me to no end," he said. "I never got free health care. My brother's wife is a teacher and I once asked her, when I was getting my teeth worked on, what it cost her and she said, 'Nothing.' It should never get to that point where somebody's getting free health care. Something's way out of whack there."

One can only wonder how many more votes Team Democrat could have won by simply giving everyone free dental care under Medicare For All instead of forcing voters to patronize a for-profit medical insurance-industrial complex that's the cause of our health care crisis in the first place. Put another way: You want to put an end of the politics of resentment, stop giving people more reasons to be resentful. Just a thought.

---Vitelius

Also Too, Unicorns

Not buying this on its surface:

Over the last week, the signals have been abundant that congressional Republicans are pivoting from their total opposition to “Obamacare” toward supporting the more popular chunks of the law.

It’s an election-year strategy to mitigate the fallout if the Supreme Court grants them their wish and strikes down the law next month. The House GOP is weighing a replacement plan to reinstate its more popular components, such as guaranteeing coverage regardless of pre-existing conditions, letting people under 26 stay on a parent’s policy and closing the Medicare “doughnut hole.”

That may be what they're saying, but they're not going to propose any of those things---at least not in the forms that are being advertised. What you'll see coming from these clowns are a bunch of individual bills aimed at reinstating each of the Affordable Care Act's most popular provisions, and each bill will have a number of "poison pill" amendments attached to it---a rider permitting open carry on commercial airliners, or a rider creating a national Birth Certificate registry, or a rider defining abortion as a form of "domestic terrorism": In other words, proposals that they know Democrats can never vote for in good conscience. So the kabuki plays out: Republicans will vote unanimously in favor of these bills, Democrats will vote (mostly) unanimously against, the bills will die in the Senate, and Republicans will blame the Democrats for killing off the best parts of health-care reform.

Whatever approach they take, the Teabillies are not going to co-opt liberal health-care policy just because it's an election year, they're going to sabotage it---and use it as a tool to embarrass the opposition. Because if there's one thing these people like even better than winning, it's humiliating liberals. Sadism is baked into their psychic DNA; it's a signifier that defines their worldview.

And you know what? They'll probably be successful with this tactic. They can always rely on some headline writer at the Post or the Times to frame the narrative as "Senate Dems Vote Down Under-26 Health Coverage," and they can always bitch to the editors of Politico if the coverage doesn't suit them; and all the Serious Persons in Washington will shake their heads disapprovingly and wonder why Democrats can't find a commonsense middle ground with Republicans, and this is why we need Generalissimo Bloomberg, etc.

But either way, I really wish the President's supporters would try to stop spinning the impending nullification of the Affordable Care Act into some P.R. victory for the White House when the likeliest possible outcome in the court of public opinion is the exact and diametric opposite.

---Vitelius

Market-Based Solutions

Sure is a good thing we're going to be requiring everyone in America to purchase health insurance, assuming the Federalist Five doesn't fuck up the program:

Unknown to most consumers, many hospitals and physicians offer steep discounts for cash-paying patients regardless of income. But there's a catch: Typically you can get the lowest price only if you don't use your health insurance.

That disparity in pricing is coming under fire from people . . . who say it's unfair for patients who pay hefty insurance premiums and deductibles to be penalized with higher rates for treatment.

The difference in price can be stunning. Los Alamitos Medical Center, for instance, lists a CT scan of the abdomen on a state website for $4,423. Blue Shield says its negotiated rate at the hospital is about $2,400.

When The Times called for a cash price, the hospital said it was $250.

What it means, of course, is basically:

This election will be fought between two men whose "solutions" to this debacle are based on a system that cannot possibly solve it [...]

Maybe we'd be better off if we encouraged people not to buy health insurance? It just might drive down the cost curve a bit if several million people opted out of their coverage all at once, don't you think? I guess this is yet another reason why I probably won't lose any sleep if the Roberts Gang throws out the Affordable Care Act next month. It may be an egregious violation of stare decisis and all that legalistic stuff, but if it forces our leaders to come up with a universal health-care plan that actually makes care affordable and doesn't reward profiteering, well, good. Because up to now, they haven't tried that approach.

---Vitelius

Also Too, Prolific Wastes of TIme

Sure glad we expended so much political capital a couple years back to pass a landmark piece of legislation that ensures universal access to affordable health care. Sure, we midwifed the Teabillies, alienated the netroots and lost the House of Representatives in the process, but hey, this was a big fuckin' deal! Eggs and omelettes, bitches.

---Vitelius

Barney's Right

The PPACA was a disaster of politics and of policy, though Josh differs:

Stepping aside from the politics of the matter and the atmospherics of this story, to me it seems delusional to assume that the Democrats could have pulled back from the effort and come back later and gotten bits and pieces of reform. How much do you figure will get through Congress if the whole thing is struck down by the Supreme Court? You can’t choke at the gut check moments.

Seems here as though the real gut-check moment occurred several months earlier, at summer's end in 2009 when our still-new President still had favorable approval ratings; a health-care bill with a public-option provision that was ready in the House of Representatives; and broad public support for the bill's most contentious element. Instead of seizing the moment to re-frame the narrative after the inaugural Teabilly Summer of Love, the White House committed an unforced error---one of many during its first two years, and nearly all of them following a similar pattern---and unilaterally pulled the rug out from under itself in the name of Getting a Big Deal Done™. To me, that was the "choke" moment that stalled the initiative's momentum because it accomplished little other than alienating Congressional Democrats, angering the netroot activists, and ensuring that getting any health-care bill through Congress would be a horrendously protracted and tortuous process; and that the final product would be a needlessly complex and confusing laundry list of concessions to the balance sheets of the insurance, drug and HMO lobbies, as well as to the personal vanities of a couple dozen Senators.

Kinda like making sausage out of ammoniated meat scraps, come to think of it.

Bad policy. Bad politics. One often follows the other.

Put another way: Considering the beating Team Democrat took at the polls in 2010 after getting the ACA passed, would they really have fared that much worse if they'd just tabled the bill until after the midterm elections? Shit, they lost 63 House seats as it was, so I'm having a hard time believing the alternative would have been appreciably worse.

As to getting "bits and pieces" of reform after the midterms: Agreed, there was little chance of that happening. But this only confirms the wisdom, indirectly to me, of pushing the most ambitious, far-reaching piece of legislation out of the gate. That is, if you're pushing one of the most ambitious and far-reaching legislative agendas of the last 100 years. And I think we can agree that the White House's push on health care was certainly among those---and yes, if results are all that count in politics, they got their Big Fuckin' Deal. Unfortunately for them, public consensus has long held steady that it was also a Bad Fuckin' Deal. Granted, the public may be ill-informed about many of the ACA's provisions, but notwithstanding the Teabilly 27, whose fault is that, really? Team Democrats' messaging on this bill has always been lousy---which could be symptomatic of the fact that it's, like, a generally lousy law.

---Vitelius

Just Like Wrestling II

Still not understanding what the suspense is all about:/p>

If five justices want to strike down the individual mandate, they can. But to do so honestly, they would have to admit that they were rejecting precedent and drawing new lines around federal power.

That would assume they are honest men. They're not, and they won't admit anything. They'll simply say the health-care mandate and the rest of the PPACA are unconstitutional because Madison and Hamilton didn't write about them in the Federalist Papers. That's what they've been groomed for, and that's what they're going to deliver. As always, would loved to be proved wrong here, but I have a feeling I won't be.

---Vitelius

Also Too, Making Up Fees as They Go Along

It's been written about elsewhere, but shopping for health care is really not anything like shopping for a car or a computer:

To see what consumers were up against, The Times contacted 10 California hospitals and asked for the cost of a routine gallbladder surgery for someone with a high-deductible insurance policy.

Seven of the hospitals offered at least partial estimates, but the quoted prices ranged widely from $1,200 an hour for the operating room to a $8,687 facility fee. None included the cost of the doctors, although California Pacific Medical Center in San Francisco did say that the total cost for hospital services, including a room, drugs and other supplies, could be $37,217.

One hospital, Desert Regional Medical Center, didn't return calls. Contacted later, spokesman Richard Ramhoff apologized and said Desert Regional "strives to make sure everyone with a question about rates gets an answer." Another hospital said it would take 10 business days to get an estimate, and another required detailed insurance information before discussing prices.

"This really highlights how impossible it is for consumers right now with high-deductible plans to effectively shop for care," said Ateev Mehrotra, a policy analyst for Santa Monica-based Rand Corp. and an assistant professor at the University of Pittsburgh School of Medicine.

Mehrotra's Rand study in 2009 produced similar results in California. Only 28% of the state's hospitals responded to a request for an estimate from a fictional uninsured patient and less than 3% offered detailed price quotes including hospital and physician fees.

Let's see here. Medicare For All would be universal, would cost less, and would eliminate the guesswork. So why didn't our leaders even bother discussing it?

And to those who think that the Supreme Court invalidating the Affordable Care Act will "pave the way" for single-payer, what the hell are you smoking? We can't even get a decent transportation bill out of Congress these days, let alone a Favorite Toy like universal health care. Too bad nobody at the White House was lobbying for this when they had the votes to get it done. Who knows, they might even have succeeded.

---Vitelius

Story of My Life

Too young to die, too old to start over:

It's not just about the illness. It's also the fear that your entire life will be in shambles and you'll have to start all over again if you are lucky enough to recover. The years between 50 and 65 are quite terrifying in that respect. Not much time left to rebuild.

Tell me about it. I've had a lot of the same concerns since I got laid off my job last September---and wouldn't you know it coincided with several thousand dollars' worth of dental work I needed to have done, some of which I've postponed indefinitely until I'm working again. And even though I'm in (generally) good health at 55, the financial stress that our medical-industrial complex exerts on people with limited incomes (i.e., unemployment insurance) is borderline immoral; in my case, outside of rent (which is fairly modest for the neighborhood), my biggest single monthly expense is the fucking COBRA payment. Granted, it's better than nothing, and I'm darn glad to have it, but boy, if I was still on the hook for a mortgage payment, or was in the process of putting a couple of kids through USC or Juilliard, I don't know how the hell I would handle it. I guess, like a few million other people, I'd simply go uninsured.

---Vitelius

Market-Based Solutions

They're the cure for what ails us:

Many of the drugs in short supply, particularly older generic ones, are “sterile injectable” medications that are more complicated to produce and more prone to manufacturing problems.

Sometimes these older drugs are discontinued in favor of newer, more profitable drugs, officials said.

That leaves only a handful of sources for the drugs. More than 50 percent of the drugs on the FDA’s shortage list are supplied by three or fewer manufacturers, industry and government officials said. If one facility has production problems, cannot obtain ingredients or fails an inspection, other companies cannot ramp up production quickly.

Quality problems, including fungal contamination and findings of glass shards and metal filings in drugs, were the leading cause of drug shortages, according to an FDA report in October.

The shutdown of four factories by an Ohio lab because of serious quality problems contributed to the cancer-drug shortages. Although those have eased somewhat because of new suppliers, the idled factories are a big reason for the scarcity of other drugs, said Valerie Jensen, associate director of the FDA’s drug-shortage program.

Also too, price fixing.

But at least we know we're free.

---Vitelius

Also Too, Unicorns

Sure, it's reassuring to think that the pending demise of the ACA will somehow pave the road for single-payer health care in the future. But as single-payer is an example of liberal social legislation, you need legislators who will actually, you know, propose liberal social legislation, then vote for it. We really haven't experienced this phenomenon at the national level since the 1970s, and there's a reason for it: Because we no longer have a liberal political party to propose and vote in favor of liberal laws. When we get one, things will change again, but thinking that this change will somehow occur organically on its own without institutional regime change within the Democratic Party strikes me as an exercise in self-delusion. Again, as always, would love to be proved wrong here, but the last 20 years of Third Way centrism suggests an opposite outcome.

---Vitelius

Nothing Will Change

The "legitimacy" of the Court after they trash the Affordable Care Act. Three reasons:

1. Most people don't follow this stuff all that closely, so when the Court rules against ACA, the public at large will simply internalize the decision to harmonize with the conventional external narrative that their preferred media outlets have barraged them with, i.e., that "Obamacare" was an example of "executive overreach";

2. The religious crusaders on the Court don't give a shit about "legimitacy" because that's not something that can be bestowed by the rabble:

Every one of these men was a member of the Federalist Society. Every single one of them was groomed for exactly what they are doing right now. This is their time to shine, to do what they have been groomed to do. When you train soldiers to fight, and drill their mission into them every day, and drill the rightness and correctness of their mission into them every day, and assure them they are fighting for truth, justice, and the American way, only a fool would be surprised that they are eager to go into combat.

3. In the most painfully obvious way, the Court stopped being a "legitimate" arbiter of Constitutional disputes on December 12, 2000. What, this is news to anyone?

---Vitelius