Moore: We deserve better than Obamacare

Never let it be said that Michael Moore is a Democratic hack. He speaks his mind.

Of course, for some conservatives, Moore's call for single-payer feeds right into their conspiracy theory that Obamacare was always meant to fail, thereby somehow (I still don't get the how) opening the door for single-payer medical insurance for all Americans who want it.

The Obamacare We Deserve

By Michael Moore

December 31, 2013 | New York Times

Today marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.

For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.

GOP's alternative: Un-Affordable Care Act?

I hesitate to post this because of the author's conclusion: give single-payer (aka "Medicare for all") a second look.

Don't get me wrong, I prefer single-payer. But as I said recently, many Obamacare critics illogically believe the conspiracy theory that Obama has intended all along for the Affordable Care Act to fail, ushering in "socialized medicine" to save the day.    

Even single-payer is not socialized medicine; it's socialized payment for medicine. There are plenty of private doctors and hospitals today that make a fine living off Medicare patients, and nobody accuses them of communist sympathies.

Affordable Care Act ... as compared to what?

By Caroline Poplin

November 14, 2013 | McClatchy-Tribune News Service

Republicans can hardly believe their good luck. The Obama administration has once again snatched defeat from the jaws of victory. After successfully holding off Republican efforts to destroy Obamacare by shutting down the government and threatening default, the administration badly bungled the rollout of the crown jewel of health reform: the insurance exchanges. (No surprise to those of us who wrestle with computers daily.) Somehow administration leaders also failed to anticipate the predictable response of insurance companies to a perfect opportunity to raise premiums wholesale, while blaming someone else.

Nevertheless, we need to keep in mind that even as they gleefully tear into the ACA, Republicans have not offered an alternative.

On reflection, however, this is no surprise. Republicans don't see a problem with health care in America. Insurers can sell what they chose to whom they chose; people can select policies they like and can afford, or save their money for other things. This is how markets work. The only change Republicans would make is deregulation, so insurers and good prospects can find one another more easily across state lines.

As Ronald Reagan said: "Government is not the solution to the problem, government (in this case, the ACA) is the problem."

For conservatives, health insurance and health care are ordinary commodities to be traded in the marketplace, just like automobile insurance and automobiles.

But health care is not just another item in the shopping cart. As the African-American spiritual observed, "If living were something that money could buy, the rich would live and the poor would die."

And that is where we are in the 21st century. Health care is a matter of life and death. Our medicine is highly effective. Today, we can cure, or treat, diseases that were once fatal - heart attacks, many cancers, even HIV. That is, if you have the money. Today rich Americans live, on average, five years longer than poor citizens.

Nor is health insurance an ordinary insurance product.

Illness today is not evenly distributed across the population. Some 10 percent of people are responsible for 60 percent of health-care costs in the United States. Because most illness continues for many years after diagnosis, these people are easy to identify: patients with multiple sclerosis, congestive heart failure, lymphoma.

No one wants to pay for the sick people - not the insurance companies (particularly if they cannot recover their costs by charging the sick higher premiums), and not healthy customers. We hear this now, as single men and older people complain that to comply with the ACA, they have to pay for maternity benefits that they will never use.

A free market with lots of choices among multiple insurers, risk pools, policies with all sorts of benefits and price structures, allows insurers and healthy individuals to avoid the sick. The less affluent healthy can gamble on inexpensive policies with spotty coverage (useless to the chronically ill): since most people are healthy most of the time, few of them will ever need to test their insurance. (Or they can join large groups of other healthy people working for large employers who provide insurance.) Insurers can charge sick people thousands of dollars a month to cover the cost of their claims, and then some.

The result? The people who need health care the most have the most difficulty getting insurance that covers it. Doesn't this defeat the whole purpose of the exercise?

That, however, is the Republican alternative to the ACA. And remember, even before the ACA, things were not stable, but deteriorating: as health costs rose, premiums, co-pays and deductibles were going up, employers were cutting back. Without the ACA, those trends will continue.

The ACA was an effort to preserve a private health insurance market, using regulation to achieve a better result. As we see, this is very complicated.

There is a third option. If everyone is in the same, large, pool, everything medically necessary is covered, insurers are paid merely to process claims, and premiums are scaled to income, there is enough money to cover everyone at reasonable cost without elaborate, expensive, error-prone computer programs and geniuses to run them. People will be able to choose their doctors and hospitals. (And the rich can always buy more if they want.)

A crazy, wild-eyed socialist nightmare? No, this is Medicare, a familiar, popular, competently-run public insurance system that everyone's parents or grandparents rely on. Person-for-person, disease-for-disease, Medicare is the cheapest, most efficient health insurance program in the country. (There is virtue in simplicity.) Medicare already controls health care costs better than private insurers, and with a few tweaks, could do much more, forcing prices down to the level citizens of every other advanced democracy pay, with no sacrifice in quality.

Given the alternatives, maybe Medicare-for-all deserves a second look.

Obamacare: Another conservative-lite idea

As I've said before, Obamacare was not what real liberals and progressives wanted: single-payer. In today's op-ed, Zelizer laments that, and warns liberals against "half-baked" liberal policies that are really just conservative-lite ideas.

Obamacare is the classic example. It was first proposed by the uber-conservative Heritage Foundation in the early 90s, then supported by uber-conservative economist Milton Friedman and Republican Speaker of the House Newt Gingrich, among 25 conservative leaders, then implemented on the state level by a Republican governor.  

The only problem is that the conservative party in the U.S. has gone farther to the Right since the 90s.  Now its "best & brightest" like Rush Limbaugh believe that the answer is to get rid of health insurance altogether. We should return to the 19th century. Idiots!

Before Obamacare, Obama never even put the single-payer option on the table. Congress never voted on it. Obama began with closed-door negotiations with insurance companies and drug makers to see what they'd agree to. Obamacare is what we got. Now their revenues are hitting all-time highs and projected to rise in 2014 as well, so don't cry for them.

Nevertheless, there are those on the Right today who ridiculously view Obamacare as a big, elaborate socialist conspiracy to usher in single-payer health care. Talk about a disconnect!  On one side, we have dissatisfied liberals lamenting that Obama missed a once-in-a-generation chance to change the healthcare game. On the other side, we have dissatisfied conservatives who say the liberals are pulling a fast one to get what they want eventually. Eventually, in some distant future.... It's as if paranoid conservatives have more faith in the inevitability of liberal ideals than liberals do!

There are two variants on this conspiracy theory, as far as I can pick up. The first variant goes: expanding Medicaid for the poor is just one more step toward single-payer, since the government already pays for more than half of all healthcare in America.  The second one goes: Obamacare is intended to be such a disaster that Americans will throw up their hands, decide private insurance is a mess, and demand single-payer instead.  

I'll give both versions more time than they deserve, if only because millions of talk radio/Tea Party Republicans really believe in them. As for expanding Medicaid, conservatives can breathe a partial sigh of relief, because their Republicans governors already blocked Medicaid expansion to 8 million Americans in their respective states. There is a problem here though, and it's real. GOP governors also refused to set up their own health insurance markets, thus shifting the burden to the federal Healthcare.gov website. This is delaying people getting health insurance who want it, and they might just give up entirely. 

Rick Moran summed up the self-defeating idiocy of Republicans' spiteful, partisan refusal to establish state health insurance exchanges:

[W]hile conservatives think the Obamacare exchanges are overregulated and oversubsidized, they are actually closer to the right-of-center vision for health care reform than the Obamacare Medicaid expansion, which is happening no matter what transpires with Healthcare.gov. So if the exchanges fail and the Medicaid expansion takes effect (and, inevitably, becomes difficult to roll back), we’ll be left with an individual market that’s completely dysfunctional and a more socialized system over all.

The second variant on this conspiracy theory might end up being true... but only by accident, not by design. I mean, do conservatives really believe that Obama is such a secret, selfless socialist ideologue that he has intended all along for his signature piece of eponymous legislation to be a total failure -- a failure that would define his presidential legacy? Talk about taking one for the team!  

Furthermore, if conservatives really believe Obamacare was designed to fail, then... why do they take such glee at every opportunity to declare it a failure?  Aren't they playing right into Obama's diabolical hands?  But ah, says the tinfoil hat crew, Obama didn't intend for it to fail so soon. Because he's so darn incompetent, see? He can't even screw up right. They say Obama intended for us to get good and used to Obamacare first, so that it could fail several years from now, just when we were about to... so that we would... you see then.... Oh, I can't follow this wacky line of reasoning any further.  

Obamacare and the failure of half-baked liberalism

By Julian Zelizer

November 11, 2013 | CNN

URL: http://edition.cnn.com/2013/11/11/opinion/zelizer-obamacare-liberalism/index.html?hpt=hp_t5

Sanders: Single-payer cure for ailing America

This is just to edumacate you Tea Partiers what real liberals want, and it's not Obamacare. From the start, Obamacare was a concession to private insurance companies and Big Pharma -- Republicans' idea of free markets. Single-payer was never on the table. 

Funnily enough, Republicans liked Obamacare when the Heritage Foundation, Newt Gingrich and Mitt Romney proposed it. Yet it became damned socialism and worth shutting down our government and destroying the full faith and credit of the United States after a black Democrat signed it into law.

A single-payer system, like Medicare, is the cure for America's ailing healthcare

By Bernie Sanders

September 30, 2013 | Guardian

I start my approach to healthcare from two very basic premises. First, healthcare must be recognized as a right, not a privilege. Every man, woman and child in our country should be able to access the healthcare they need regardless of their income. Second, we must create a national healthcare system that provides quality healthcare for all in the most cost-effective way possible.

Tragically, the United States is failing in both areas.

It is unconscionable that in one of the most advanced nations in the world, there are nearly 50 million people who lack health insurance and millions more who have burdensome co-payments and deductibles. In fact, some 45,000 Americans die each year because they do not get to a doctor when they should. In terms of life expectancy, infant mortality and otherhealth outcomes, the United States lags behind almost every other advanced country.

Despite this unimpressive record, the US spends almost twice as much per person on healthcare as any other nation. As a result of an incredibly wasteful, bureaucratic, profit-making and complicated system, the US spends 17% of its gross domestic product – approximately $2.7tn annually– on healthcare. While insurance companies, drug companies, private hospitals and medical equipment suppliers make huge profits, Americans spend more and get less for their healthcare dollars.

What should the US be doing to improve this abysmal situation?

President Obama's Affordable Care Act is a start. It prevents insurance companies from denying patients coverage for pre-existing conditions, allows people up to age 26 to stay on their parents' insurance, sets minimum standards for what insurance must cover and helps lower-income Americans afford health insurance. When the marketplace exchanges open for enrollment on Tuesday, many Americans will find the premiums will be lower than the ones they're paying now. Others will find the coverage is much more comprehensive than their current plans.

Most importantly, another 20 million Americans will receive health insurance. This is a modest step forward. But if we are serious about providing quality care for all, much more needs to be done.

The only long-term solution to America's healthcare crisis is a single-payer national healthcare program.

The good news is that, in fact, a large-scale single-payer system already exists in the United States and its enrollees love it. It is called Medicare. Open to all Americans over 65 years of age, the program has been a resounding success since its introduction 48 years ago. Medicare should be expanded to cover all Americans.

Such a single-payer system would address one of the major deficiencies in the current system: the huge amount of moneywasted on billing and administration. Hospitals and independent medical practices routinely employ more billing specialists than doctors – and that's not the end of it. Patients and their families spend an enormous amount of time and effort arguing with insurance companies and bill collectors over what is covered and what they owe. Drug companies and hospitals spend billions advertising their products and services.

Creating a simple system with one payer, covering all Americans, would result in an enormous reduction in administrative expenses. We would be spending our money on healthcare and disease prevention, not on paper-pushing and debt collection.

Further, a single-payer system will expand employment opportunities and lift a financial weight off of businesses encumbered by employee health expenses. Many Americans remain at their current jobs because of the decent health insurance provided by their employer. Without the worry of losing benefits, those Americans will be free to explore other, more productive opportunities as they desire. For business owners, lifting the burden of employee healthcare expenditures will free them to invest in growing their businesses.

Congressman Jim McDermott and I have introduced the American Health Security Act. Our bill will provide every American with healthcare coverage and services through a state-administered, single-payer program, including dental and mental health coverage and low-cost prescription drugs. It would require the government to develop national policies and guidelines, as well as minimum national criteria, while giving each state the flexibility to adapt the program as needed. It would also completely overhaul the health coverage system, creating a single federal payer of state-administered health plans.

The American people understand that our current healthcare system is not working. But the time is long overdue for them to understand that there is something fundamentally wrong when the US remains the only country in the industrialized world that does not guarantee healthcare to all its people.

Healthcare is a right and we must ensure provision of that right for Americans. A single-payer system will be good for the average American, good for businesses, good for workers and good for our overall economy.

Obama reveals hospitals' real prices. Now what??

There goes that socialist Obama Administration again!:

The database released on Wednesday by the federal Centers for Medicare and Medicaid Services lays out for the first time and in voluminous detail how much the vast majority of American hospitals charge for the 100 most common inpatient procedures billed to Medicare. The database -- which covers claims filed within fiscal year 2011 -- spans 163,065 individual charges recorded at 3,337 hospitals located in 306 metropolitan areas.

This time Obama had the gall to publicly release information about the real prices that hospitals and doctors charge for medical procedures.  So that people, can, like, you know, compare prices and stuff.

If that sounds like something out the free market, you're right. But that doesn't matter, because it was OBAMA who publicized the information!  He always has a diabolical ulterior motive!  We just don't know what it is yet....

Seriously though, I know from personal experience that the prices hospitals charge are totally wacko. Recently my young child spent five days in the hospital while our registration for new health insurance, retroactive to Jan. 1, was still in process.  She's perfectly fine now, thank Allah, but we subsequently received a hospital bill for $31,000.  Bill collectors immediately started to call the house several times a day, every day, and all we could tell them was the same thing the insurance company told us: the paperwork is still in process; later the hospital could re-submit the claim.  

After our health insurance finally kicked in and the claim was processed, the hospital told us over the phone that our share would be about $3,000, but a few months have passed and still no bill for $3,000.  Meanwhile the hospital's billing office asked us to submit an application for a discount, which we did.  I suspect that $3,000 remaining charge will simply disappear, but if not.... Thankfully, I can afford to pay it, but for most poor families an unexpected medical emergency like that would ruin them.  

Indeed, medical bills are the #1 cause of personal bankruptcy in the U.S.

This case illustrates why health care can never be a free market.  First, the patient has no clue what he needs to buy.  If you're in critical condition and the doctor says, "We're going to stick this tube down your throat," you're not going to second-guess him... and meanwhile bargain or threaten to "take your business elsewhere."  No, you just do whatever he says, immediately. (This is assuming you're conscious at the time; otherwise the doctor just does it.)  

As a medical "consumer," you rarely have an actual choice.  Without information/knowledge, prices and choice there cannot be a competitive free market.  

The most that such information provided by Obama can do is help a patient after the fact who asks his provider, "Why did you charge me so much, when Hospital X down the road charges one-tenth as much for the same thing?"  But a patient is in a pretty weak bargaining position ex post facto.

This case also illustrates why everybody needs to be insured.  You cannot plan for the unplanned that costs who-knows-how-much.  And you're in no condition to bargain when you're critically ill.  That's why people buy insurance.  But for any kind of insurance scheme to work, the insurance pool has to be large enough to spread out risk and expense over many customers/insured.

Usually it's the 49 million poorer Americans who have no health insurance. The sick irony is that those people who are least able to pay are the ones asked to pay the full, "real" price of medical treatment.  Of course they often cannot pay.  So the hospital's actual cost for that treatment, whatever it really is, gets passed onto those who can pay, i.e. to health insurance companies.  It's a terribly messed-up "system."

Again, let me remind you that Obamacare opts to work primarily through this existing labyrinth of private health insurance.  This is the same system that Republicans think is not broken so we don't need to fix it.  Obamacare's most unpopular aspect -- the individual mandate -- requires people to participate in this "free-market" system.  It sets up new healthcare exchanges where people can buy private health insurance.  This is all as the Heritage Foundation, Newt Gingrich and Mitt Romney said it should be, before Obama took their suggestion and they decided they hated it.  

Whereas many liberals like myself want us to have a single-payer system, aka Medicare for all, to keep down costs and ensure universal coverage. But our compromiser-in-chief didn't opt for that route, he never even tried.  

Hospital Bill Shocker: U.S. Releases Thousands Of Records Showing Huge, Wildly Differing Prices

By Jeffrey Young and Chris Kirkham

May 8, 2013 | Huffington Post

URL: http://huff.to/16W4BIC

Having a baby cost how much in 1947?!

Today's story on CNN caught my eye for a very personal reason. The idea of having a baby now for the 1947 equivalent in today's dollars of $726 is beyond unbelievable, when the "average" cost, without complications or C-section, of having a baby in America today is in excess of $11,000.

I'm not sure what all the answers are to lowering health costs, but I do know one thing that would help: single-payer health insurance. In the meantime, I'll wait for the insurance statements and hospital bills to come rolling in....

The $70 childbirth bill

By Bob Greene

December 2, 2012 | CNN

URL: http://www.cnn.com/2012/12/02/opinion/greene-birth-bill/index.html?hpt=hp_bn7

Conservatives should back Obamacare

The health care individual mandate to cure the "free rider" economic problem, and pro-market health exchanges were both Republican ideas supported by Republicans in Congress... until Obama proposed them.  Then suddenly these ideas became Big Gubument Socialism.

Obamacare is hated by Republicans today mainly for things it doesn't include -- like death panels, and mandated coverage of abortions.  But they also focus to their detriment on contraceptive coverage that most women, Repub and Dem alike, want covered by private insurance.  Meanwhile, true liberals like moi don't like Obamacare because it's not a single-payer system, and there is no public option (aka "Medicare for all") to provide real competition with private insurance and show which would provide the best outcomes for the lowest price.

Concludes Kleinke:

The real problem with the health care plan — for Mr. Romney and the Republicans in general — is that political credit for it goes to Mr. Obama. Now, Mr. Romney is in a terrible fix trying to spin his way out of this paradox and tear down something he knows is right — something for which he ought to be taking great political credit of his own.

The Conservative Case for Obamacare

By J.D. Kleinke

September 29, 2012 | New York Times

URL: http://www.nytimes.com/2012/09/30/opinion/sunday/why-obamacare-is-a-conservatives-dream.html?_r=1&pagewanted=all

Senate Dems stab Americans in the back, as expected

Big surprise: 3 small-state Democratic Senators on the Finance Committee sided with the insurance lobby and voted down a voluntary public option for health insurance. The amendment lost 10-13, instead of passing 13-10 along party lines.

So forget your stupid fear of "socialized" medicine, government won't even have a role to play outside of Medicare! The draft bill in committee has no way to significantly bring down health costs, since single-payer never had a prayer, and since the public option is officially dead.

This post-vote statement by Senator Thomas "Traitor" Carper (D-DE) goes down as one of the dumbest ever:

"Carper said he did not vote for the [public option] amendment because 'it would give the government an unfair advantage in the marketplace by allowing it to negotiate prices initially based on Medicare. That would stifle competition, not increase it, and the end result, I believe, would not be good for the consumer.'"

In other words, if the government can use its negotiating leverage to get us, the American people, better prices for medical care than the private sector can, then that is unfair to the private sector.

Now we know whose side the Senate Millionaires Club is on. (Hint: not ours).

Senate Finance Committee Votes Against Including Public Option In Reform Bill

By Kris Alingod

September 30, 2009 | All Headline News

URL: http://www.allheadlinenews.com/articles/7016551229