An American Editor

February 23, 2011

The Forked Tongue Dialogues: Romneycare vs. Obamacare

Here’s my question, one that no potential Republican candidate for president has been willing to directly tackle, at least not to date: Why is Romneycare good for Massachusetts but bad for America?

I used to be a Republican, back when one didn’t have to pass a special test to be a Republican. Remember those days when what mattered was a belief that big government wasn’t the answer to all questions and people’s rights and well being were important mainstays of Republicanism? The days of the Rockefeller, Ford, even Reagan?

Civil Rights legislation passed in the 1960s because Republicans cared about people, not because Democrats were overwhelmingly in control. It was the Republican Everett Dirksen who ensured that there were enough Republican votes to pass Civil Rights and Medicare and other Great Society legislation as the Southern Democrats and the Dixiecrats rebelled.

But today, I couldn’t be a Republican even if I was desperate to be one because I couldn’t pass the ideological litmus test: I believe that what has made America great is that its politicians ultimately sought the middle ground and compromised. Today, “middle ground” and “compromise” are banned from the Republican lexicon.

Which brings me back to Romneycare. Massachusetts undertook, at the instigation of its then Republican governor, Mitt Romney (who desperately wants to be the next president of the United States), an overhaul of healthcare, requiring that every resident of Massachusetts have health insurance or pay a fine/tax — universal healthcare for Massachusetts. And it apparently is working. The latest information indicates that nearly 99% of Bay Staters are insured and that insurance premiums have declined over the past several years (or at least the rate of increase has declined) as compared to pre-Romneycare.

On the other hand, in my state, not only has it been difficult to get good healthcare insurance, it has been exceedingly expensive and every year premiums have increased by 20% or more over the prior year. Plus there is a large swath of residents who have no insurance, can’t get insurance, or can’t afford insurance. So I ask again: Why is Romneycare good for Massachusetts but bad for America?

Perhaps instead of calling it Romneycare I should call it Republicancare. Maybe then Republicans would own up to having “coerced” citizens of Massachusetts into buying healthcare insurance whether they wanted it or not. Why is it a good argument that Obamacare is unconstitutional because it “coerces” citizens to do something they do not want to do (buy health insurance) but Republicancare/Romneycare is constitutional because it “coerces” citizens to do something they do not want to do (buy health insurance)?

Clearly, or so I would think based on Republican Second Amendment arguments, Republicans don’t believe citizens lose their constitutional rights at the state border. So where is the Republican outrage against Republicancare/Romneycare for Bay Staters? I guess the answer is wrapped up in the old state’s rights argument — states can do harm but the federal government can’t.

The reason that argument fails (at least in my thinking) is that Republicancare/Romneycare has a direct impact on interstate commerce, which the federal government can regulate. So where are Mike Pence (R-Indiana), Michelle Bachmann (R-Minnesota), and Rand Paul (R-Kentucky), or even Mitch McConnell (R-Kentucky) when their help is needed? Why haven’t they, or one of them, introduced legislation to repeal the Bay State’s Republicancare/Romneycare and rescuing millions of Americans from fiscal enslavement? Or legislation cutting off all federal funding for that bit of socialized medicine?

The answer lies in the origins of that bit of state socialism: it was brought to America by Republicans and therefore cannot possibly be socialism or bad for the citizenry. So I ask yet a third time: Why is Republicancare/Romneycare good for Massachusetts but bad for America? Where is the moral outrage? Where are the witty Palinisms that rile up the Tea Party and the Republican right?

Obamacare is Republicancare/Romneycare just on a broader scale. But one would never know that by listening to the Republicans or the Tea Partiers. I offer this suggestion to Republicans and Tea Partiers: Solve the healthcare reform problem by repealing Obamacare and replacing it with Republicancare/Romneycare. Alternatively, a simpler and quicker approach would be to introduce legislation that renames Obamacare as Republicancare/Romneycare. Now you can trumpet your triumph over big government and socialized medicine yet show that you want to treat all Americans equally — a win-win for Republicans and Americans.

February 21, 2011

From Obamacare to Pencecare: The Illogical Republican

…or Sometimes You Just Gotta Keep Those Matches Away

I admit that since I became a thinking adult way back in the 1960s I have thought there was something wrong with America’s healthcare system. Even then a single-payer system made the most sense to me. But I wasn’t rabid about it. I did think that Medicare, which I strongly supported and wrote my first-ever political letter to my congressperson about, would be the baby step that would move us down that path. As history has demonstrated, 50 years later we haven’t really gone beyond either that first step or beyond the internecine wars regarding what is and isn’t a proper government role in healthcare.

I do respect the views of those who fear government encroachment into healthcare. I don’t discount some of their arguments as some of them do have merit. But I do discount and have little respect for those whose arguments essentially boil down to “your government intervention threatens my freedom and thus is bad; my government intervention threatens only your freedom and thus is good.” Alas, that is the rhetoric being applied to Obamcare (“your government intervention threatens my freedom and thus is bad”) and Pencecare (“my government intervention threatens only your freedom and thus is good”) by Republicans and Tea Partiers.

(For those who haven’t quite caught on, Pencecare is the healthcare plan that Congressperson Mike Pence, Republican of Indiana, and his fellow Republicans and Tea Partiers would like to foist on me and America — essentially, fend for yourself. Obamacare needs no definition today.)

What raised my hackles this week was the cutting of all funding for Planned Parenthood, abortion under any circumstance, and Obamacare. I don’t agree with everything Planned Parenthood does; I don’t agree 100% with the current plans for Obamacare; I don’t agree that abortion should be lightly undertaken or given — but I more fervently do not agree that Planned Parenthood should be wholly defunded; that Obamacare is not good for America and should not be funded; or that all abortions should be prohibited or made so difficult to get as to de facto prohibit them. There needs to be middle ground.

The Republican illogic runs many paths. It is not that Democrats aren’t often illogical, they are, but when it comes to healthcare, budgets, and morals, today’s Republicans are significantly more illogical (and more likely to run amuck) than Democrats. Consider this bit of budget busting: According to budget-cutting Republicans it is logical for the U.S. military to spend millions of taxpayer dollars sponsoring NASCAR races (which as a sport has a declining fan base; it would have been more logical to sponsor NFL football) but it is illogical to fund Sesame Street or family planning or universal healthcare. There is a severe disconnect.

And hasn’t the Republican-Tea Party battle cry against Obamacare been government intrusion into personal healthcare decisions — putting the government between the patient and the doctor? OK, let’s step aside from whether I think I am more likely to get an unbiased and better-for-me decision about my healthcare from a government bureaucrat who doesn’t have to worry about quarterly returns for shareholders than from a private insurer whose staff bonuses are determined by how much profit the company makes, not by how much healthcare it delivers to its insured. Instead let’s look at what the Republicans-Tea Party combination wants to give us: Pencecare. Pencecare puts the government squarely between the patient and the patient’s doctor because it has predetermined that universally certain forms of healthcare shall be denied the patient. No ifs, ands, or buts.

The difference between Obamacare and Pencecare is the neutrality factor. Obamacare is neutral. It gives citizens a menu of choices, from among which the citizen can choose. In contrast, Pencecare dictates what is permissible healthcare; it gives no choice. Whereas under Obamacare the patient, the patient’s family, and the patient’s doctors can consider the totality of circumstances and choose to take action (and among actions) or inaction, under Pencecare the patient has no need to consider anything, the family’s decisions are irrelevant, and the doctor might as well not exist — the government has made the decision in advance and regardless of circumstances.

Pencecare is the Republican formulation of Sarah Palin’s “death panels” for the rest of America. Sarah Palin’s “death panels” were dealing with end-of-life decision making (should we, for example, spend $1 million dollars of taxpayer funds to prolong the life of a 90-year-old person for 30 days?); in contrast, the Pencecare “death panels” deal with beginning-of-life decision making (should we, for example, compel a 12-year-old girl who was raped by her father to carry the fetus to term even though it is likely that she will die during the childbirth process?).

The other difference between Obamacare and Pencecare “death panels” is that under Obamacare the end-of-life discussion was voluntary whereas under Pencecare the beginning-of-life discussion cannot be held — to discuss it is forbidden.

One other thing that is striking about Pencecare. Unlike Obamacare which affects all classes of Americans, Pencecare almost wholly affects the lower socioeconomic classes. Enacting Pencecare has to be a relatively easy thing to do when your income is $170,000+ a year, enabling you to financially skirt its effects, and it is clear that the primary people affected will be those who earn less than $35,000 a year and often less than $15,000 a year.

Voters gave the Republicans and Tea Partiers matches to play with in this past election. The Republicans and Tea Partiers seem to be giddy with excitement about finally being able to play with fire, and so indiscriminately keep lighting those matches. The problem is that such giddiness is blinding them to their own hypocrisy. The least we should expect is no hypocrisy.

(For one perspective on the availability and affordability of health insurance, see Money Won’t Buy You Health Insurance, written by Donna Dubinsky, a cofounder of Palm Computer and CEO of Handspring, who begins: “This isn’t the story of a poor family with a mother who has a dreadful disease that bankrupts them, or with a child who has to go without vital medicines. Unlike many others, my family can afford medical care, with or without insurance.”)

September 28, 2010

Rationing: An American Conundrum

The election season is now in full swing with the primaries over and only a few weeks to a shorter-than-usual campaign season. I guess there are still some things one can be thankful for.

But this campaign season differs from past seasons in one major respect — not since the Civil Rights legislation of the 1960s can I recall a campaign in which so many candidates are running on the vote-for-me-to-repeal issue, which, in today’s case, means repeal of the recently enacted healthcare legislation.

An underpinning argument made by opponents to healthcare is that it will result in Xyz-style (substitute country of your choice for Xyz) rationing of medical resources. I guess I must live on a different planet because of all the possible arguments against the healthcare legislation and of all the possible reasons to support its repeal or modification, this is the weakest argument. But, then, we need to consider the circumstances of those who are making the argument of rationing — it is hard to see millionaires like Mitch McConnell who also happen to have gold-plated medical insurance at someone else’s expense (yes, I know he pays a monthly contribution, but that is all it is — a contribution; the bulk of the cost is borne by those of us who do not have access to that gold-plated plan, and often have no access to any plan, gold-plated or lead-plated) even knowing what medical rationing really means.

What brings this to mind is a story in yesterday’s newspaper titled “$93,000 cancer drug: How much is a life worth?” This article demonstrates the conundrum of medical rationing in America.

Provenge is a new, unique cancer drug. A patient receives it once and that one-time treatment costs $93,000. In return, a patient, on average, gains 4 months of life. The patient interviewed in the article who received the treatment put the issue out front: “Bob Svenson is honest about why he got it: Insurance paid. ‘I would not spend that money’ because the benefit doesn’t seem worth it, [said] Svenson, 80,….” The insurance that is paying for it is his supplemental Medicare plan — until Medicare itself decides whether the drug will be paid for and for whom.

Provenge has several problems as regards rationing: (1) the drug is in short supply because it has to be made uniquely for each patient; it can’t be mass produced, and (2) it is an all-or-nothing $93,000 gamble because it can only be given once and there is no assurance it will work in a particular patient. As regards the short supply, doctors at the University of Texas’ M.D. Anderson Cancer Center plan a lottery to see who of the otherwise eligible patients will receive the treatment (there are approximately 150 eligible patients at the Center but only 2 can receive treatment).

None of this rationing is brought about by the new health legislation; in fact, if anything, the new health legislation has broadened the pool of people who will be eligible for such treatment because it will broaden the number of insured. So exactly how does the healthcare legislation cause rationing?

The usual focus once one gets past drugs is on access to doctors. You might have to wait to see your doctor. Hmmm — I believe we already see that. Try getting in to see a specialist, or even your primary care doctor immediately. Except in an emergency (and then they usually tell you to go to the emergency room at the hospital), appointments are made 2 to 4 weeks or even longer down the road. I suffer this wait, my neighbors suffer this wait, my friends suffer this wait. Maybe the problem is that I don’t have Republican branded on my forehead because if I listen to the Republicans, I don’t have to wait unlike in Britain or Canada. Again, I think the problem is that they have immediate access to Walter Reed Hospital as VIPs, something I can’t get.

I’m also told that part of the rationing will be a loss of choice of doctors. Huh? The only way such a statement makes any sense whatsoever is this: Either the government-sponsored and taxpayer-funded health plans they have will pay for treatment given by any doctor or hospital on the planet or they are paying the full cost out of pocket. I know in my case, my plan limits me to doctors who participate in the plan. Doesn’t matter if another doctor is better or less expensive, if the doctor isn’t in the plan, my insurance doesn’t cover any visits. As for paying out of pocket, well I’m already paying out of pocket $1500 a month between insurance premiums, doctor copays, and drug copays, which stretches my budget; I just don’t have the resources our elected representatives seem to have.

The rationing is being done by the “private” marketplace — the insurance company who tells me who I can see based on whether or not the insurance company was able to cut a financial agreement with a doctor and by how much money I can earn and devote towards medical treatment and bills. And before the new healthcare legislation, if I found that my financial circumstances had changed and I could no longer afford insurance premiums, I could have been excluded from ever getting insurance again because of preexisting conditions. Seems to me that that is much more egregious form of rationing than what is done in the more level playing fields of Britain and Canada and what is feared by healthcare opponents in the United States.

When really analyzed, the rationing argument boils down to this: The people trying to convince us of the evils of government legislation on healthcare are the people who will always walk outside the restrictions of any such legislation because of wealth and connections. They are the people who stand to gain personally from the failure to provide the majority of citizens with decent healthcare. Why is it alright for the private marketplace to ration Provenge but not for the government?

I don’t mind their being opposed to healthcare legislation; I just want them to be honest about why. Treat us more like equals than like sheep; give up their perks and privileges so that they have to deal with the situation as ordinary folk do. Take us back to our founding roots — “All men are created equal” except those that have and those that have not.

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