Tag: Affordable Care Act

Cross posted from The Stars Hollow Gazette

In 1960, the country was set to elect its first Catholic president, John F. Kennedy. Many conservative protestants in Southern states were wary of JFK’s faith and ties to the Vatican, questioning whether as president he would be able to make important national decisions independent of his faith and Vatican influence. In September of 1960, he gave an historic speech in Houston, Texas before a group of Protestant ministers, on the issue of his religion, declaring, “I am not the Catholic candidate for president. I am the Democratic Party candidate for president who also happens to be a Catholic. I do not speak for my Church on public matters – and the Church does not speak for me.”

Now, fifty-four years after that speech, there is a predominance of Catholics on the Supreme Court, mostly men and mostly very conservative. The five conservative male Catholics are voting in lock step to restrict the use of birth control, a necessary part of women’s health care, and income equality by siding with ant-union groups to limit union representation for some health care workers who are mostly low income women and minorities.

After Hobby Lobby

by Dahlia Lithwick, Slate

The Supreme Court term wrapped up nice and neat last week. Unless you are a woman.

For the first time in my memory as a reporter, there was a men’s term and a women’s term at the U.S. Supreme Court. The men’s term ended last Monday, with a pair of split decisions in Burwell v. Hobby Lobby and Harris v. Quinn, and a lot of mumbling on both sides of the political spectrum about the fact that-as Supreme Court terms go-this was a fairly uncontroversial one, marked by high degrees of agreement and consensus-seeking by the justices, and minimalist, incremental changes where there might have been tectonic shifts.

Not so, for women, who-almost a week later-are still reeling over the implications of the Hobby Lobby decision for contraceptive care in America; still parsing the emergency injunction granted in the Wheaton College case only three days after the Hobby Lobby ruling came down; still mulling whether the Hobby Lobby decision may prove a boon for women in the long run; and generally trying to understand how a term that was characterized as minimalist and undramatic by many male commenters, even liberal male commenters, represented a tectonic shift not just for America’s women, but for the three women who actually sit up there and do their jobs at the high court. [..]

It almost doesn’t warrant explaining yet again why the term was such a disaster for women’s rights and freedoms. One need look no further than the trifecta of the abortion buffer-zone case, McCullen v. Coakley; Burwell v. Hobby Lobby; and Harris v. Quinn, which determined that for purposes of the “agency fees” rule, home health care workers – 90 percent of whom are women v] and [minorities – are not really public employees, because the home is not really a workplace. And the fact that the female justices dissented from two of the above cases in the strongest terms is rather remarkable. But looking at the three cases together, it’s difficult not to notice something almost more remarkable: In the majority opinions in all three, there is scant attention paid to real women, their daily lives, or their interests, and great mountainous wads of attention paid elsewhere. It’s almost as if the court chose not to see women this term, or at least not real women, with real challenges, and opted instead to offer extra protections to the delicate women of their imaginary worlds. [..]

All this would be difficult enough, were it not for the fact that the five-justice majority at the court seems determined to offer all this help and chivalry in the face of the strenuous objections of their female colleagues who seem, at the close of this term, to have spent a good deal of energy howling into the wind that women need less delicate handling and more basic freedoms. The final irony is that the quality of “empathy”-the much maligned, squishy solicitude that is so often associated with female justices-is the quality that seemingly drove each of the decisions above. It wasn’t so much a clash of rigorous constitutional values that determined the outcomes in Harris, McCullen, and Hobby Lobby. It was simply a strong identification by the majority justices with the values that were arrayed in opposition to women’s freedoms and economic equality: the poor home-care worker, forced to support the speech of a union; the beleaguered sidewalk counselor denied the opportunity to counsel and persuade; the sympathetic religious employer, forced to pay for something his religion cannot tolerate. Nobody disputes that in each case those values are heartfelt and compelling. But the almost complete erasure of the values on the other side is a constitutional hat trick if ever there was one. It’s bad enough that the term ended so poorly for women. That it happened because of an abundance of empathy-the quality that allegedly makes us women bad judges and justices-is kind of the icing on the cake.

The Supreme Court Has a Favorite Religion, and That’s a Big Problem

by Charles Pierce, Esquire’s Politics Blog

Jesus H. Christ on a three-month bender, if they’d just let Al Smith use his peyote the way he believed his supreme being meant it to be used, we all might have been spared this trainwreck.

Back in the early 1990’s, Smith and another man were denied unemployment benefits by the state of Oregon because they had tested positive for the active ingredient in peyote, which has been a sacrament in various Native American religions since before bread and wine became sacramental in Christianity. Smith pursued his case all the way up to the Nine Wise Souls then sitting on the Most High Bench, who ruled against him. Not yet short-timing his day job, Justice Antonin Scalia who, of a Sunday, takes bread and wine instead of peyote as part of his own religious rituals, wrote the majority opinion in the case, [..]

Almost everyone from the religious right to the ACLU popped their corks over this and, in purported response, the Congress passed the Religious Freedom Restoration Act in 1993. (And yes, you are still entitled to ask, “Restoration? Where’s it been?”) Bill Clinton, just beginning to triangulate himself toward re-election, signed the thing. Since then, a gradual slippage regarding that act has been quietly underway. The RFRA is no longer about peyote. It has become a Trojan Horse, sliding the country toward a de facto kind of established religion, which today’s ruling in Burwell v. Hobby Lobby makes eminently clear. Religious freedom exists in the realm of medicine only to those religions that the Court finds acceptable-and, I would argue, only to those religions to which the members of the Court belong.  Much will be written, and rightly so, about the boneheaded social subtext of the following nut paragraph in the 5-4 decision read today by Justice Samuel Alito. It is so obviously discriminatory toward ladies and their ladyparts that no explanation seems necessary.

Charlie up dated that article because of objection by some about his Papist take on Justice Alito’s majority opinion:

UPDATE — If you’re thinking that I’m hitting the whole Papist thing too hard, look at these two passages from different documents:

The belief… implicates a difficult and im-portant question of religion and moral philosophy, namely, the circumstances under which it is immoral for a person to perform an act that is innocent in itself but that has the effect of enabling or facili-tating the commission of an immoral act by another.

And…

Neither is it valid to argue, as a justification for sexual intercourse which is deliberately contraceptive, that a lesser evil is to be preferred to a greater one, or that such intercourse would merge with procreative acts of past and future to form a single entity, and so be qualified by exactly the same moral goodness as these. Though it is true that sometimes it is lawful to tolerate a lesser moral evil in order to avoid a greater evil or in order to promote a greater good,” it is never lawful, even for the gravest reasons, to do evil that good may come of it.

The first is from Alito’s opinion today.

The second is a section of Humanae Vitae, the 1968 encyclical from Pope Paul VI that restated the Church’s opposition to artificial birth control and pretty much blew up the Vatican’s teaching authority among a great percentage of the Catholic laity in the United States. I would guess that the percentage in question does not include Samuel Alito.

This begs to question: is this Supreme Court out of Control?

Supreme Court’s out-of-control spiral: Ideologues rewriting their own laws

by David Dayen, Salon

It may be incremental, but make no mistake: This court is using absurd eccentricities to legislate from the bench

John Boehner wants to sue the president for pursuing executive authority without congressional input? He may want to file a copycat suit against the Supreme Court, who have executed plenty of extra-legislative rule making of their own.

On Monday, the court established multiple new distinctions in the law, inventing them largely to satisfy ideological whims. If any branch of government is engaging in de facto legislating and overstepping the bounds of authority, it’s the Roberts court.

As you probably know, the court ruled in the Hobby Lobby case that closely held corporations, where the top five shareholders control more than 50 percent of the company, must be given an accommodation for providing birth control in their employer-based insurance coverage, if they say it violates their religious beliefs. The decision, written by Justice Samuel Alito, explicitly argues companies like Hobby Lobby could be granted the same accommodation as churches and religious nonprofits, where the government effectively provides direct access to contraception coverage. (I didn’t know the court’s majority exhibited such [strident support for single-payer v] healthcare!)

But the ruling also makes a number of novel assumptions. First of all, Alito found that, for the purposes of the Religious Freedom Restoration Act of 1993, corporations are not just people, but people with religious beliefs, granting them the right to free exercise of that religion, which the contraception mandate “substantially burdens.” But Alito clearly worried about a slippery slope, where suddenly religious corporations would ignore all sorts of laws by invoking their conscience. So he drew a completely arbitrary line. [..]

This has become a familiar pattern for the Roberts court, using an initial ruling to indicate eventual overturning of precedent, and then employing a subsequent case to finish the job. It perhaps makes the court look more moderate and judicious, treading ground carefully to reach their desired end state. But since there’s no real distinction under the law between the initial “signal flare” ruling and the second, deeper one, it amounts to making up the rules as it suits the conservative majority, either for public relations purposes or to better carry out their agenda.

And that’s the real point. The Roberts court has a history, as shown in these recent cases, of basically legislating from the bench, of making idiosyncratic, agenda-driven choices about which parts of laws to uphold and which to strike down.

Linda Greenhouse, a New York Times columnist and Dahlia Lithwick spoke with Bill Moyers about the latest decisions>

The latest session of the US Supreme Court was especially contentious, with important decisions on the separation of church and state, organized labor, campaign finance reform, birth control and women’s health, among others, splitting the court along its 5-4 conservative-liberal divide.

On the other hand, nearly two-thirds of the court’s decisions this term were unanimous – the first time that’s happened in more than 60 years. But there’s more to that seeming unanimity than meets the eye: in some instances, conservative justices went along but expressed their wish that the court had gone even further to the right, and many believe that some of the decisions might simply be a preliminary step toward a more significant breaking of legal precedent in years to come.

One more word on this court and future vacancies, there are those on the so-called left who will say we must vote for Democrats because of, omg, “It’s the Supreme Court.” Yet, Democrats failed to filibuster their nominations and, while only four Democrats voted for Alito, 22 voted for Roberts, Scalia was unanimous (98 – 0) (pdf), as was Kennedy (97 – 0) and 10 voted for Clarence Thomas. Even if the Democrats manage to hold onto their Senate majority, so far the Republicans have successfully used the filibuster to stop the body from dong its job. Unless, the Democrats are willing to ditch filibuster of SCOTUS nominees, I don’t see any Democratic president getting a nominee on the court that is as left as Ginsburg or Breyer

Cross posted from The Stars Hollow Gazette

On Tuesday, the Congressional Budget Office released it’s latest report on the Affordable Care Act’s impact on the economy. In the report it estimated that the work force would be reduced by 2.3 million workers by 2021 (pdf). Needless to say, the right wing media and Republicans seized on this as proof positive that Obamacare was a “job killer.”

Well not so fast, this is what the report said:

CBO estimates that the ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor-given the new taxes and other incentives they will face and the financial benefits some will receive. Because the largest declines in labor supply will probably occur among lower-wage workers, the reduction in aggregate compensation (wages, salaries, and fringe benefits) and the impact on the overall economy will be proportionally smaller than the reduction in hours worked. [..]

The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses’ demand for labor.

In other words, this isn’t about jobs, it’s about whether or not workers will choose to work less in order to hold on to their eligibility for subsidized health care or Medicaid.

The Washington Post‘s fact checker, Glenn Kessler clarified:

First, this is not about jobs offered by employers. It’s about workers – and the choices they make.

The CBO’s estimate is mostly the result of an analysis of the impact of the law on the supply of labor. That means how many people choose to participate in the work force. In other words, the nonpartisan agency is examining whether the law increases or decreases incentives for people to work. [..]

Some might believe that the overall impact of the health law on employment is bad because it would be encouraging people – some 2.3 million – not to work. Indeed, the decline in the workforce participation rate has been of concern to economists, as the baby boom generation leaves the work force, and the health care law appears to exacerbate that trend.

Moreover, the argument could go, this would hurt the nation’s budget because 2.3 million fewer people will pay taxes on their earnings. That’s certainly an intellectually solid argument – though others might counter that universal health care is worth a reduction in overall employment – but it’s not at all the same as saying these jobs would be lost.

On the brighter side, before a House hearing on Wednesday the Director of the CBO Doug Elmendorf made this argument:

“The reason we don’t use the term ‘lost jobs’ is there is a critical difference between people who like to work and can’t find a job – or have a job that’s lost for reasons beyond their control – and people who choose not to work,” he explained. “If someone comes up to you and says, ‘The boss says I’m being laid off because we don’t have enough business to pay,’ any other person feels bad about that and we sympathize for them having lost their job. If someone says, ‘I decided to retire or stay home and spend more time with my family and spend more time doing my hobby,’ they don’t feel bad about it – they feel good about it. And we don’t sympathize. We say congratulations.”

Matt Iglesias at Mother Jones makes a very salient point about the impact on the job force:

Obamacare will reduce employment primarily because it’s a means-tested welfare program, and means-tested programs always reduce employment among the poor.

If, for example, earning $100 in additional income means a $25 reduction in Obamacare subsidies, you’re only getting $75 for your extra work. At the margins, some people will decide that’s not worth it, so they’ll forego working extra hours. That’s the substitution effect. In addition, low-income workers covered by Obamacare will have lower medical bills. This makes them less desperate for additional money, and might also cause them to forego working extra hours. That’s the income effect.

This is not something specific to Obamacare. It’s a shortcoming in all means-tested welfare programs. It’s basically Welfare 101, and in over half a century, no one has really figured out how to get around it. It’s something you just have to accept if you support safety net programs for the poor.

It’s worth noting, however, that health care is an exception to this rule. It doesn’t have to be means tested. If we simply had a rational national health care system, available to everyone regardless of income, then none of this would be an issue. There might still be a small income effect, but it would probably be barely noticeable. Since everyone would be fully covered no matter what, there would no high effective marginal tax rate on the poor and no reason not to work more hours. Someday we’ll get there.

Optimistically, people leaving jobs or working less may be an opportunity for someone else to take their place. On the other side it could increase costs for employers who would then reduce the number of people they hire. This is an educated guessing game that we would not be engaged in if there were single payer or a public option that leveled the playing field.

Cross posted from The Stars Hollow Gazette

In a NYT‘s op-ed in New Year’s Day, Michael Moore called the ACA awful

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.

Emergency Room visits have increased for those with insurance rather than decrease. This is probably due to the problem of finding a physician who will accept the patient’s insurance plan. What was needed was a mandate that physicians and hospitals accept all insurance plans.

Access to Health Care May Increase ER Visits, Study Suggests

   Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits as people sought care from primary care doctors. But a rigorous new study conducted in Oregon has flipped that assumption on its head, finding that the newly insured actually went to the emergency room more often.

   The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts. The pattern was so strong that it held true across most demographic groups, times of day, and types of visits, including for conditions that were treatable in primary care settings.

   The finding casts doubt on the hope that expanded insurance coverage will help rein in rising emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act.

   Instead, the study suggests that the surge in the numbers of insured people may put even greater pressure on emergency rooms and increase costs. Nearly 30 million uninsured Americans could gain coverage under the law, about half of them through Medicaid. The first policies took effect on Wednesday.

This will only push up the costs of health care and increase the costs for consumers and tax payers.

This video explains in less than 8 minutes why healthcare in this country is so expensive and still sucks.

Published on Aug 20, 2013

In which John discusses the complicated reasons why the United States spends so much more on health care than any other country in the world, and along the way reveals some surprising information, including that Americans spend more of their tax dollars on public health care than people in Canada, the UK, or Australia. Who’s at fault? Insurance companies? Drug companies? Malpractice lawyers? Hospitals? Or is it more complicated than a simple blame game? (Hint: It’s that one.)

For a much more thorough examination of health care expenses in America, I recommend this series at The Incidental Economist: http://theincidentaleconomist….

The Commonwealth Fund’s Study of Health Care Prices in the US: http://www.commonwealthfund.or…

Some of the stats in this video also come from this New York Times story: http://www.nytimes.com/2013/06…

This is the first part in what will be a periodic series on health care costs and reforms leading up to the introduction of the Affordable Care Act, aka Obamacare, in 2014.

Cross posted from The Stars Hollow Gazette

You could label this “what were they thinking” but we’re talking about the Republican Party here. IT seems that in the midst of the latest “crisis,” the failure to launch of the Healthcare.gov web site, the genius Republicans of the House of Representative decided to ask a murder suspect to testify as an computer expert. No, I am not pulling you leg.

House Republicans Asked Murder Suspect John McAfee to Testify on Obamacare Website

by David, Crooks and Liars

According to emails obtained by CNBC, House Republicans asked the founder of McAfee Associates to “guide our oversight and review” of the Affordable Care Act website.

In 2012, McAfee went on the run from Belize authorities after being suspected of the murder of his neighbor. He was later detained in Guatemala and deported to the United States, but has not been charged with a crime.

“This is the Committee of jurisdiction for the Patient Protection and Affordable Care Act (or Obamacare),” House Committee on Energy and Commerce counsel Sean Hayes wrote to McAfee’s lawyer on Oct. 14. “For three years we have been monitoring the implementation of the law and have been trying to dig into what has happened with the Exchange rollout.”

“Given the failures of Healthcare.gov, and Mr. McAfee’s expertise, I was hoping he might be able to discuss his views with staff on the hill,” the email continued. “It would be an informal discussion: we would take notes but these would not be for attribution, it would mainly guide our oversight and review of the program.”

“This would hopefully not be a heavy lift for him: what problems could lead to the compromise of personal identifying information? What could we be doing to prevent data or identify theft? What advice generally does he have?”

The deal fell through when the House wouldn’t pay for Mr. McAfee’s travel expenses. In case you aren’t aware of the hilarity of this invitation, Rachel Maddow gives us the Cliff Note version of Mr. McAfee’s biography

Can you imagine the hilarity of McAfee’s testimony as his mind wanders from the technicalities of launcing a web site to his sexual prowess and drug expertise? C-Span’s ratings would soar.

Cross posted from The Stars Hollow Gazette

Over at Esquire’s Politics Blog, resident curmudgeon, Charles Pierce reminds us of his “five minute rule” with this little snippet:

If you listen to Crazy Uncle Liberty (!), Senator Aqua Buddha, or their disciples for five minutes, you find yourself nodding in agreement with almost everything they say. At precisely the 5:01 mark, however, the person to whom you’re listening will say something that detaches the entire conversation from the plane of physical reality and sends it sailing off into the ether.

As an example of the stupid that abounds, he presented a link to this video at a Rand Paul supporter’s web site.

I suppose those who signed the petition didn’t see the tee shirt. Sheesh.

The Affordable Care Act is a very flawed bill that lines the pockets of insurance companies by forcing people to purchase junk insurance that even if the premiums are low, the high out of pocket deductibles and co-pays make care unaffordable. Nor are the insured guaranteed access the treatment and medications they may need, since the bean counters can deny permission and referrals. These are facts that the government and media aren’t telling you

The only reason the right wing is trying to defund/repeal this law, which they can’t, is because they have nothing left to draw attention to themselves and try to scare people into believing that President Barack Obama is a socialist, even though has given the right wing and corporations nearly everything they’ve wanted, including the ACA. The war on the 99% continues from both sides of the aisle.

Cross posted at The Stars Hollow Gazette

In the United States, 62% of all bankruptcies in the United States are due to medical bills. It is not among who you would think but most often effects middle aged, middle class, college educated homeowners. 80% of those people had health insurance, so why are they filing for bankruptcy? No other industrial country has this problem.

Our fellow blogger, lambert, writing for naked capitalism, featured this video from Real News Network:

Paul Jay of the Real News Network interviews Dr. Margaret Flowers, a pediatrician from Baltimore who advocates for a national single payer health system, Medicare for all, and Kevin Zeese, co-director of It’s Our Economy, an organization that advocates for democratizing the economy.

At his blog, Corrente, lambert continues to document the atrocities of the Obamacare ClusterFuck.

Cross posted from The Stars Hollow Gazette

Journalist Steve Brill wrote brilliant cover story for Time magazine, Bitter Pill: Why Medical Bills Are Killing Us, which lays out the reason US health care costs are out of control, just follow the money. He explains how the hospitals and their executives are scamming the system through billing to maximize profits. As an examples of the absurd charges, for a 15 cent Tylenol tablet hospitals charge as much as $1.50, $6 for a marker used to mark the body before surgery and as much as $77 for each of four boxes of gauze used. In hospital a patient can be charges as much as $450 for an electrocardiogram that in a doctor’s office would only cost $150.

This doesn’t happen in other countries where costs are controlled by government set rates for what both private and public plans can charge for various procedures. The problem here in the US isn’t that we don’t have single payer, it’s that the government doesn’t regulate the prices that health-care providers can charge. But in an article at the Washington Post by Sarah Kliff for the Wonkblog writes that we don’t need to look to other countries:

Maryland has succeeded in controlling costs for about four decades now. It is the only state that sets rates for hospitals, with the state government deciding what every Maryland hospital can charge for a given procedure..

That system started in 1976, when Maryland had hospital costs 26 percent higher than the rest of the the country. In 2008, the average cost for a hospital admission in Maryland was down to national levels. “From 1997 through 2008, Maryland hospitals experienced the lowest cumulative growth in cost per adjusted admission of any state in the nation,” the state concluded in a 2010 report (pdf).

Here is a brief summery of the article and what you should know about why health care in this country costs so much (and it isn’t malpractice lawsuits, as some would have you believe):

Hospitals arbitrarily set prices based on a mysterious internal list known as the “chargemaster.” These prices vary from hospital to hospital and are often ten times the actual cost of an item. Insurance companies and Medicare pay discounted prices, but don’t have enough leverage to bring fees down anywhere close to actual costs. While other countries restrain drug prices, in the United States federal law actually restricts the single biggest buyer-Medicare-from even trying to negotiate the price of drugs.

Tax-exempt “nonprofit” hospitals are the most profitable businesses and largest employers in their regions, often presided over by the most richly compensated executives.

Cancer treatment – at some of the most renowned centers such as Sloan-Kettering and M.D. Anderson – has some of the industry’s highest profit margins. Cancer drugs in particular are hugely profitable. For example, Sloan-Kettering charges $4615 for a immune-deficiency drug named Flebogamma. Medicare cuts Sloan-Kettering’s charge to $2123, still way above what the hospital paid for it, an estimated $1400.

Patients can hire medical billing advocates who help people read their bills and try to reduce them. “The hospitals all know the bills are fiction, or at least only a place to start the discussion, so you bargain with them,” says Katalin Goencz, a former appeals coordinator in a hospital billing department who now works as an advocate in Stamford, CT.

Recently, Mr Brill sat down with Hardball guest host Michael Smerconish  and Neera Tanden from Center for American Progress to discuss how the rising health care costs are killing Americans:

   And it actually that bears on the conversation we’re having, because a chunk of that money is paid by Medicare. Medicare is I point out in the article is very efficient at most things. It buys health care really efficiently, which is a great irony, because it’s supposed to be the big government of bureaucracy.

   Where Medicare is not efficient is where Congress, because of lobbyists have handcuffed Medicare. Medicare can’t negotiate what it pays for any kind of drugs. It can’t negotiate what it pays for wheelchairs, diabetes testing equipment. And if Congress took those handcuffs off of Medicare, you could get about half of the spending cuts that we’re sitting around here talking about.

Raising the eligibility age and/or applying a means test as ways to reduce the cost of Medicare will not fix the rising costs. Only government regulation of the hospitals and the ability of Medicare to negotiate pricing for procedures, equipment and supplies will cut the cost for the patient and the tax payers. Take the profit motive out of saving lives and keeping Americans healthy.