Is Obamacare a National Crisis? No, but Russia’s Involvement in Our Election Was.
The Wealth of the Nation Versus the Health of the Nation
As most readers of the nation’s political trends know Obamacare repeal is an on-again-off-again proposition. Whether Obamacare survives repeal this time around, there is no guarantee as to its longevity in a Republican controlled Congress and White House. Vice President Pence recently remarked that health care reform “is not an option.” That means that uninsuring millions of Americans, making America less healthy, is a necessity — like water, air, and housing (note that Trump’s deregulation binge is repealing some of those commodities too).
Pence also had this to say, “President Trump and I fully support the majority leader’s decision to move forward with a bill that just repeals ObamaCare and gives Congress time, as the president said, to work on a new healthcare plan that will start with a clean slate.” (The Hill )
This sounds like Obamacare (ACA) is a very serious threat, a matter of “Stop it now, and we’ll figure out the details later.” But what is the great urgency? From all appearances the rhetoric and sheer legislative fury over repealing the Affordable Care Act you would think there was was a national emergency.
But how does entitling people to access to health care qualify as a national emergency?
The energy and money hurled at Obamacare repeal would make a foreign visitor believe that Obamacare was a ticking time bomb. But it’s not, of course; it just makes medical insurance cheaper for people who need it. It is a national investment in people’s lives — probably the most useful and the most socially responsible investment a nation can make, which is why all economically developed nations — except the US — have national health care.
How then to explain the Republican passion and sense of urgency over Obamacare repeal to a foreign visitor when that same Republican Congress has for the last six months blown off, poo-pooed, and otherwise dismissed the election interference issue?
The urgency around Obamacare repeal is explained by one simple fact: money. Specifically, the wealth of 1.5% of the population.
Let’s begin with investment income.
It has been pointed out (NYT} that the repeal of Obamacare directly benefits those making $200,000 per year on up. The largest beneficiaries would be those earning one million or more per year. What is particularly irksome to the finanical elite is the 3.8 % tax on investment income to help pay for Obamacare. That’s the national emergency! Investors want more investment income.
There are other taxes that help pay for the ACA:
• Tax on Brand Name Drugs
• Tax on Health Insurers
• $500,000 Annual Executive Compensation Limit for Health Insurance Executives!!!
• Employer Mandate on business with over 50 full-time equivalent employees to provide health insurance to full-time employees.
One more fact is that earners making more than $200,000/yr have seen their premiums go up under the ACA. That’s 1.5% of the population.
(Source.)
It is dumbfounding to see such a naked attempt to transfer wealth and social benefits away from the elderly, the ill, and the poor and into the hands of 1.5% of the population. It’s pure delicto flagrante. The audacity of doing this in plain sight however is lost on so many who voted for Trump. The great roaring masses who shouted “Lock her up” — where are they on this issue? Is the concept of an upward wealth transfer under the ruse of a fake emergency just too complicated? Do they really believe that if Obamacare is not repealed a national catastrophe is imminent? By and large, these hoodwinked Trump supporters won’t stand to benefit — if I have my demographics right — from this proposed repeal. By and large, they stand to lose — especially after retirement. They don’t understand that Make America Great Again means Make America Great Again for a tiny fraction of the population.
And Russia?
From what we understand about Russia there was a virtual invasion into the American election process. Even early on the evidence was at a high level of believability; the CIA stood by its assessment and has not wavered since June 2016. Though no major political figure is willing to say it, in all likelihood Russian interference tipped the scales in the election.
This invasion was the real emergency — not un-insuring those who need medical insurance. How can Republicans ignore a true emergency that has distorted American politics and governance and at the same time shriek on about the necessity to deprive their constituents of affordable health care? (Of course, it is no coincidence that this interference enabled Republicans to begin repealing Obama era entitlements.)
The question above is more than merely rhetorical. To the uninitiated it might seem a political mystery how Republicans can with impunity act uniformly in the worst interests of the majority of Americans (by having acquiesced to Russian participation in the election, among other things) and have supreme confidence that they will remain in power. We know why they act against the majority of Americans’ interests: they contradict the findings of the CIA because those findings might interfere with their legislative agenda, which is essentially to increase the distribution of wealth to the upper 1.5% of the economic spectrum. But how this is possible without the majority catching on is a source of profound bemusement to the external observer.
(It also a mystery why the income gap or wealth gap has not been a major talking point among Democrats during the last six months.*)
Mitch McConnell is a case in point. As senator, he represents approximately half of all Kentuckians. Kentucky is one of the poorest states in the nation. It is a state afflicted by numerous medical issues — cancer, obesity, and diabetes are big on the list. The per capita annual income of the poorest county, Owsley, is $10,767. Per capita income statewide is $18,093. The national average is just a few dollars shy of $29,000. (These figures are several years old.)
Yet McConnell continually supports legislation that keeps the poor poor. He opposes a minimum wage hike. He opposed the Paycheck Fairness Act. His largest donors are finance, insurance, and real estate. He wins his elections because of his prodigious ability to raise funds from corporate sponsors. Money spent on improving the lives of the poor is money that is not enriching those he actually represents: the monied class. McConnell has also consistently opposed funding to improve education, voting for example against bills to reduce class size. (As a former educator, I can say that class size is the most pressing issue in education — even at the university level.)
McConnell and other Republicans are able to walk all over the bulk of their voters, privileging those interests that contribute most to their campaigns — finance, insurance, real estate, and fossil fuel. And yet our democratic system continually re-elects McConnell. But this form of democracy is really about who can spend the most on ads and who can tell the best lie. In other words, it’s about who can best dupe the voter.
In this context, McConnell’s aversion to quality education for Kentuckians — and other Americans — can be seen as politically tactical. The less people know and the weaker their critical skills, the less defence they have against McConnell and his emotions-based and ad hominem ad campaigns, and, the easier they are to dupe. A significant fact is that in Kentucky’s 2014 Senate election, the poorer regions of Kentucky, the east and west of the state (the two coal producing regions) supported McConnell over Senate contender Grimes. These regions also contain the most poorly educated voters. Their lack of education is a weakness that McConnell repeatedly exploits through Hee-Haw-style rhetoric while at the same time this lack of education and critical skills is the direct result of McConnell’s policies.
McConnell like most on the Right understand that the education of the electorate is the greatest threat to their political survival.
And yet in any plan to improve society and the lives of the people education is the greatest catalyst. The Right’s aversion to quality mass education correlates with the Right’s political survival as hand maidens to the financial class.**
Obamacare’s foes are united by a desire to increase the profits of the financial class. Of course, this is not their stated rationale; instead we only hear that insurance companies are raising their premiums and that Obamacare is a catastrophe.
Why are they raising their premiums? One cause according to Bloomberg is the Republican meddling in the ACA. Uncertainty over the individual mandate is fueling rate hikes. But so are rising health care costs.
Medical costs are sometimes — perhaps all the time — inflated. A major contributor to McConnell’s campaigns, Kindred Health, settled twice for overbilling between 2009 and 2016. In the last instance Kindred settled for 130 million for unnecessary services for the elderly. In the overbilling camp can be found UnitedHealth, TeamHealth, Carolinas HealthCare System; and Humana, a McConnell contributor, has faced a number of federal probes into overbilling the elderly. *** Along with unnecessary treatments there are the frequent facts of double billing and hidden fees (source).
Another practice that inflates health care costs is out of network billing. Explained in this NYT article, the practice involves outsourcing the staffing of ERs to companies who charge patients and insurers significantly higher fees.
So the question is why is there not stricter oversight of health care costs when that seems to be the root of the problem, and not the ACA itself?
Where is the legislation that imposes stricter sanctions on the above activities and that polices the health care institutions? The entire focus of discussion in the ACA debate is that Republicans want to kick people off of low-cost insurance. That is indeed a great concern, but an even greater concern is how those in the health care industry cheat in order to raise costs for their own economic advantage.
Either that practice has to be stopped or the nation has to recognize that health care is too important to be in the hands of corrupt private enterprise. This issue represents a fundamental conflict between wealth and health. Our government cannot let the wealth of corporate America compromise the health of working America.
Republican response to Russia’s interference was do nothing. Its response to the Affordable Care Act is do everything humanly possible — and then some. In the case of the former, the electorate was being cheated out of a fair election. The voter’s political franchise was fundamentally denied. In the latter, millions of people who can now afford health care are being cheated, and we are all being cheated out of a healthier, happier society — even the top 1.5% because ultimately everyone benefits when everyone is healthier.
These two cases display a stunning rupture in the mission of democratic government. The disheartening part is that this is all happening in plain sight and with virtual impunity. Part of the reason why is the electorate is unfortunately unprepared to think critically about their own interests. Through default in states like Kentucky they have elected someone whose interests are to ignore the majority’s interests. The electorate has been denied the education that is necessary for it to make well-informed decisions. Because of what appears to be an enforced cycle of poverty (Owsley County) under-capitalized Americans’ main concern is survival and generally short-term goals (pay the rent and keep the car running). They are discouraged from long-term pursuits such as a bachelor’s degree, and they are denied a rightful share of the nation’s wealth with which they might be able to buy into a robust equity market.
Mitch McConnell and other right wing politicians have engineered this 21st century peasant class. It is something right out of pre-revolutionary Europe. The rage and anger that paved Trump’s path to power was incorrectly discharged on the lesser evil of Clinton. Trump exploited this rage which simply required an object. Trump and the right wing in general should have been the target, but Democrats did not present a full and clear case to the electorate.
Mitch McConnell (and others), the ACA repeal, financial deregulation, and the defunding of education are all of a piece and are political targets in plain sight. All Democrats have to do is teach the electorate why it is so angry, teach it why its standard of living is drifting lower. Politicians on the left must do more than legislate. They must teach the voter how to vote in his or her own best interest.
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* Schumer and Pelosi recently anounced the Better Deal initiative (NYT, the Post). However, its response to income inequality and the wealth bias in Congress is weak. Corporate mergers will come under scrutiny, they say, but scrutinizing future mergers does nothing to address things as they already stand. And employer training programs are really nothing more than a shell game. Employers receive tax breaks to improve the quality of their personnel with no wage guarantees? Bad deal. This only puts more public wealth into private hands. Public wealth needs to stay in the public sector to capitalize public investment — as in for example better schools.
** We could conceive of an education bill similar to the ACA, which guarantees a quality education for all instead of what is in fact a sub-standard one. Going into the economics of education is complicated and outside this essay’s scope. But as someone who has paid attention to budgeting issues in higher education I can say much of the money spent is wasted on outsize investments in infrastructure. Generally, at most state universities the portion of the budget devoted to instruction and research is 20%, the remainder burned up by administration and facilities management. Regarding K-12, NPR reported in 2006 that the LA school district devotes only 9¢ on the dollar to instruction. Instruction of course is the core mandate of any educational system.
*** Allegedly Humana encouraged the use of “more profitable diagnosis codes.” This is part of a health-care industry-wide practice (illegal) known as “upcoding.” (https://www.publicintegrity.org/2015/02/19/16794/humana-facing-new-federal-scrutiny-over-private-medicare-plans) It should also be noted that because of inflated claims the Obama administration had reduced funding significantly for the Medicare Advantage program under which this fraudulent practice was taking place. I should note that Humana pulled out of the ACA in February, apparently discouraged by the lack of profitability. (As of May, 2017 The DOJ is also investigating Aetna, Bravo Health, Cigna, and Health Net.) From this it would appear that health care corporations like Obamacare when they can rob from it but not when they can’t.
This note reveals that there is so much about the health care complex we don’t understand. Why would an insurance company, Humana, encourage providers to inflate costs when the insurance company must make payments from its reserves? Since this seems to be a general practice it is not an isolated fluke and so suggests that the depths of the health care financial system have an insidious design that requires deeper investigation.
