The Supremes speak

So, this just happened.

Justices Back Federal Health Care Subsidy - New York Times headline

The Supreme Court has spoken. Does that mean that the opponents of the Affordable Care Act will finally accept reality and beat their swords into plowshares? Not likely. Just read the statements of the Republican candidates for the presidency in response to the decision. They've spent years enflaming their base with hatred for this law. To give up now would be to disappoint that base that the candidates need for a primary win. So, no doubt the fiery, intemperate rhetoric will continue. 

But, for now, the health care of millions of Americans is safe. And that is a good thing.

All the "skewed" numbers (With update 04/11/14)

I've been bemused but not really surprised at the reaction of the right-wingers to the news last week that the Affordable Care Act had blown right past the stated goal of 7 million people signed up for private insurance under the new insurance exchanges by the deadline of March 31. The figure announced last week was 7.1 million. The revised figure announced yesterday was actually 7.5 million.

And what has been the right's response to this? The same as their response to inconvenient facts like evolution or climate change. Denial, of course!

"It's all a lie! They are cooking the books."

These are the same people who spent the last two months of the presidential campaign in 2012 insisting that all those polls that showed Obama ahead were somehow "skewed." They went to great efforts to "unskew" them and show that, actually, Romney was well in the lead and would win by a landslide.

One of the people who believed that was Mitt Romney himself. He was apparently so sure of victory that he neglected to write a concession statement in advance. He had only written a victory speech and so had to scramble to come up with something a couple of hours after the polls closed and it was obvious that he would lose.

It seems that the Republicans are following the same course in this election year. They are so sure that opposition to the Affordable Care Act is a winning strategy that they do not seem to have a Plan B. They continue to try to repeal it believing that voters will flock to their cause and make them winners once again.

But it's not just the Affordable Care Act they want to repeal. They want to repeal Medicare as well. They just passed a budget in the House of Representatives that would do away with Medicare as we know it and replace it with a voucher program.

What do these people have against their fellow citizens having access to health care that does not result in their bankruptcy?

Meanwhile, health care reform just keeps rolling and Charles Gaba, who has been spot on in detailing the numbers of those who are signing up, now says that the grand total of those who have insurance under all the provisions of the ACA is something like 20 million people! This includes people who signed up through the state and federal exchanges, off exchanges, the under 26-year-olds now covered on their parents' insurance, expanded Medicaid in those states wise enough to do that, etc.

So the Republicans are putting themselves in the position of seeking to take away the insurance of those 20 million, plus all those who are depending on Medicare and would no longer get it under their budget. Somehow that just doesn't sound like a winning political strategy to me, but who knows? As my cynical husband often reminds me, "People are stupid!"

And speaking of stupid, not to mention hard-hearted, none are more so than those Republican governors like our own Rick Perry who are refusing to expand Medicaid in their states.

This is really a no-brainer. The federal government would pay 100% of the costs of expansion for the first three years and 90% after that and millions more Americans could get insurance to help pay for their health care. This is truly a matter of life and death for some people. But these governors couldn't care less. For them, it's all about scoring political points with their base.

There must be a special circle in hell where the fires burn especially hot for people like that.

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UPDATE: Paul Krugman's column today sums up very nicely the attitude and motivations of those Republican governors who refuse to expand Medicaid - the stupidity and the hateful spite.

Stupidity reigns - even in the doctor's office

One of my daughters tells a story about her friend who recently visited her doctor's office here in the Houston area. A prominent sign in the doctor's waiting room proclaimed, "WE DO NOT ACCEPT OBAMACARE!"

Which just goes to prove that apparently you don't have to be very smart or well-informed to be a doctor. I'm not sure I would want to trust my life to that particular doctor.

The thing about the Affordable Care Act, aka Obamacare, is that the insurance is provided by private insurance companies. Contrary to the lies told by its opponents, it is not government-provided insurance. The government mandates that the insurance policies must meet certain standards and must provide a minimum of services and, in the case of some low income people who qualify, it will provide subsidies to help pay the premiums. But the insurance policy itself comes from Blue Cross or Cigna or some other private insurance company and that is what the person's insurance card will show.

So, how exactly are that doctor and his staff going to determine if an individual seeking medical care has "Obamacare"? Are they going to interrogate all their patients by asking them, "Did you get your insurance because of the provisions of Obamacare?" And then turn them away if the answer is yes?

Actually, I don't think I would be surprised if they did exactly that.

Have you heard the good news about Obamacare?

The national media, especially that portion of it that is located inside the Washington beltway, seem to have completely adopted the Republican line on the Affordable Care Act, aka Obamacare. It's a "train wreck." The website is a disaster. Repeal is inevitable.

But if you get past the front pages where all these horror stories appear, you may find quite a different tale, buried somewhere on page six. This week, for example, we saw headlines like these:

No big drop in Obamacare support

and

Obamacare enrollments surging

and

HealthCare.gov website working better

The stories that appear beneath these headlines detail the fact that support for the health care program is holding essentially steady, that enrollments in the program during the first two weeks of November were more than twice what they were for the entire month of October, and, finally, that the glitch-prone website is now working for at least 90 percent of its visitors. These are all hopeful signs that point to the eventual success of the process and the program itself.

While the federal exchange still lags behind where it should be, many of the states which operate their own exchanges - notably Kentucky, Connecticut, and California - are exceeding projections and signing up people faster than had been expected. The states that are working well for the most part have Democratic governors who have worked to make the program a success. These states have also expanded Medicaid so that more of their citizens are now able to be have insurance through that program.

In mean-spirited states like Texas, which have done everything possible to throw a monkey wrench into the works of the federal exchange servicing the states and have refused to implement expanded Medicaid to help more of their citizens, sign-ups for health care have lagged. But even here, people are clearing the hurdles and getting through. As the website begins to work better, as it now is beginning to do, more and more people will be able to take advantage of the insurance plans on offer for their area. By the end of the year, I would expect to see enrollments "surging" there, too.

So, in spite of what you might hear from the national media and from the obstructionists who keep trying to kill it, all is not doom and gloom with Obamacare. Indeed, there is light at the end of the tunnel and it does not appear to be an onrushing train.

Meanwhile, there was this little-noted story from yesterday's news. Yes, that implacable foe of affordable health care, Speaker of the House John Boehner, is now a fully signed up member of Obamacare!  

Cruelty as a governing philosophy

One in four people in Texas do not have medical insurance. That is the highest rate of any state in the country. These people suffer every day because they cannot afford to go to the doctor when they are sick or their children or sick. When things get bad enough, they wind up at overcrowded emergency rooms and, ultimately, we all pay the bills for that care - if in fact the hospitals get paid at all.

The state government of Texas had an opportunity to cure part of this problem by expanding Medicaid under the Affordable Care Act, but that wouldn't fit with their philosophy. That philosophy, to sum it up in one word, is cruelty. Cruelty toward anyone who isn't a millionaire and who isn't able to contribute large sums of money to their political campaigns.

Indeed, it is not enough for Rick Perry to reject the expansion of Medicaid and deny its benefits to about a million needy Texans. No, he wants to restrict the current very limited Medicaid program in Texas even further. This is one mean-spirited son of a bitch.

The irony is that Perry goes around the country spouting about the wonderful climate for business in Texas, but his decision to reject Medicaid will cost the medical industry, one of the biggest businesses in Texas - and especially the Houston area - tens of billions (that's billions with a "b") of dollars.

We have some of the finest medical facilities in the world in this state. People come from around the world to be treated here. But failing to accept Medicaid funding will ensure that many of the people who actually live and work here will be unable to take advantage of these facilities. Their inability to seek treatment will cost each of these facilities significant amounts of funding.

Local hospital district officials, chambers of commerce, economists, and others have all pleaded with Perry to see reason on this issue. But he is a stubborn, spiteful, and, frankly, not very intelligent man who, once he has taken an intransigent position, seems incapable of admitting that he might be wrong.

And so the people of Texas continue to suffer under his overweening pride and his governing philosophy of cruelty to anyone who doesn't have the power to help his political ambitions. His governorship has been and continues to be an unmitigated disaster for the ordinary people of this state.

Bring on the stupid

The implementation of the Affordable Care Act this week along with the government shutdown orchestrated by the tea party Republicans has surely brought out some of the most world class stupid reactions recently seen on our political stage. When you consider all the vast stupidity that has occurred in the political arena in recent years, you begin to get a true idea of just how insane this week's actors on the stage have shown themselves to be.

I think the one who tops my own personal list - and, admittedly, he has lots of competition - is Rep. Randy Neugebauer (R. - Texas, of course!) berating a park ranger at the World War II Memorial and telling her that she should be ashamed of herself because the memorial was closed. As if she personally had made the decision to close the memorial when, in fact, it was Neugebauer and his fellow tea party posse members who locked those gates. Neugebauer and other tea partiers, like Michele Bachmann, who showed up to have their pictures taken with World War II veterans who had traveled to the city specifically to see that memorial were shocked, shocked that anyone would dare to close it to the public.

Of course, their outrage was purely for the cameras and it certainly did not extend to all those pregnant women, infants, and children who are not getting their supplemental food this week or all those Head Start kids who have been kicked out of their classes because of the tea party's actions. No, their photo-op outrage only extends to old white guys in wheel chairs.

Another day and another stupid statement from a Texan. This time from our dear leader, Rick Perry. In a campaign appearance in New Jersey this week, Perry opined that the implementation of the Affordable Care Act was a "criminal act." He said, in part, " If this health care law is forced upon this country, the young men and women in this audience are the ones who are really going to pay the price. And that, I suggest to you, reaches the point of being a felony toward them and their future." Perhaps Ricky could benefit from a brief review of the history of  the law.

The Affordable Care Act was passed by the House of Representatives and then by the Senate, after which it was signed into law by the president. It was then reviewed by the Supreme Court and found to be constitutional. After all that, there was this little thing called an election last year in which the candidate for the Republican Party promised that on his first day in office he would repeal the law. The Democratic candidate, President Obama, promised to implement it. The Republican candidate was defeated, rather resoundingly. So, Ricky, I really do not think that word "felony" means what you think it means.

Sen. Mitch McConnell (R-KY) joined the stupid hit parade by remarking that the president was perfectly willing to negotiate with the Iranians but not with Republicans in Congress. Well, that could be because the Iranians are more reasonable than Republicans in Congress.

And McConnell's teammate, Rand Paul (R-KY) chimed in that so far there had been no debate about Obamacare! Randy, you might want to read two paragraphs back, the paragraph beginning with "The Affordable Care Act was passed..." In fact, the ACA was debated extensively for eighteen months before it was passed and it has been vetted through every branch of the United States government and found to be viable and legitimate.

Finally, the last word in stupid comes from Rep. Marsha Blackburn (R-TN) who said, "People are probably going to realize they can live with a lot less government than what they thought they needed."

Yep, forget about NASA or NOAA or the National Institutes of Health with their totally unnecessary attempts to find cures for diseases like cancer or the Food and Drug Administration with all those food and drug inspectors. We don't need no stinkin' researchers or inspectors or scientists! At least not in tea party world.

And so, until such time as Speaker John Boehner finds the courage to stand up to the tea partiers and allow a vote on a bill to continue funding the government - a bill that would certainly pass with bipartisan support - the government shutdown and the uncertainty that it brings to our standing in the world will continue. Sad. And so, so stupid.

*~*~*~*

UPDATE: Another take on the gross stupidity of the moment.

Can the U.S. catch up to Rwanda?

The one thing that many people know about the country of Rwanda is that there was a terrible genocide there in 1994. Over 800,000 Tutsi and moderate Hutu people were killed in the awful conflict which roiled the country at that time.

Since 1994, Rwanda has been ruled by one man, Paul Kagame. At first he was the de facto leader and then in elections in 2000 he was selected as the country's president. He has been in power since then. His regime is autocratic and repressive and doesn't really brook criticism from any source. He is justifiably excoriated for his record of suppressing dissent.

Paradoxically, he is also considered one of the most effective leaders in Africa. His country is safe and clean and relatively free of government corruption. Per capita income has tripled in 18 years, average life expectancy has increased by 10 years (10 years!), deaths of children under 5 have dropped by half in five years, and malaria deaths have dropped by roughly two-thirds.

The remarkable achievements of Rwanda in the field of public health have come for one reason: Rwanda has universal health care! Their government health insurance plan, called Mutuelle de Sante', reaches all but four percent of its citizenry. The cost to patients is minimal and the health care is good and effective. What an amazing story this is for a small and poor country. What a testament to what can be achieved by human beings when there is the political will to do it.

Every developed country in the world besides the United States currently has some form of universal health care for its citizens. Moreover, many developing nations like China, Brazil, and Thailand also provide universal health care. Many Americans have become medical tourists in recent years, traveling to one of these countries which provides universal health care without exorbitant costs such as we have in this country. It is becoming a more and more common phenomenon.

With the Supreme Court decision on the Affordable Care Act that was announced last week, this country now has a chance to take a giant step toward joining forward-thinking, socially advanced countries in providing a very necessary social safety net - some would say a human right - which every one of us will need at some point in our lives. The ACA is a jerry-rigged system created by a committee dominated by insurance companies and it is far from the best we could do if we had the will. But it is a start.

Who knows? In ten or fifteen years, we might even catch up to Rwanda.

Time to move on

The Kaiser Family Foundation has been polling the public regarding reaction to last week's Supreme Court ruling on the constitutionality of  the Affordable Care Act. Guess what they found? It seems that most people (56%) are ready to move on.  They believe that opponents of the law should stop trying to overturn it and start addressing other burning issues facing the country.

(Click on image to enlarge it.)

So now I guess we can expect the Republican Tea Party to stop throwing its hissy fit and move on to things like shoring up our decaying infrastructure; creating jobs to help pull the economy out of its depression; finally acknowledging and taking steps to slow the heating up of the planet; creating more effective oversight of Wall Street and financial institutions; working to make sure that the food and drugs consumed by Americans are safe; providing more and better support for the public school system in this country; working to protect the rights of voters and to ensure that everyone who is eligible to vote is encouraged to do so; and any of the other myriad of problems that face the nation. We can expect that, right? Right?

The conflicted court

The Supreme Court of the United States has appeared less and less supreme in recent years. Not that its power to interpret the Constitution has been impaired but that its interpretations have seemed more and more politically partisan and less and less actually based on the rule of law. Two high points of this politically partisan court are usually cited by its critics as evidence of its right-wing bias.

The first, of course, was the Bush v. Gore decision in 2000 that stopped the count of votes in Florida and substituted the Court's own vote for the popular vote of the people in that year's presidential election. The reasoning behind this decision was so flawed and convoluted that even those who wrote it (Scalia) stipulated that it could not be cited as precedent in any other case.

The second was the notorious Citizens United decision which declared that corporations have the same rights as people! In fact, in the view of the Court, they have even more rights than people because they can make unlimited donations to political campaigns, essentially buying elections. These two decisions rank right up there with Dred Scott as three of the most egregious and outrageous ever made by a Supreme Court.

Recent opinion polls have shown that many people are cognizant of the bias being shown by the Court in its opinions and that it has lessened the esteem which they hold for that Court. They can see that, in effect, the Roberts Court has become, like Fox News, just another arm of the Republican Tea Party, the radical right wing that only believes in democracy when the majority agrees with them and that  refuses to recognize the legitimacy of democratically elected officials and democratically passed laws when those officials and those laws are not in lock step with their plutocratic agenda. The latest poll that I saw showed something like 45 percent of respondents had a negative view of the Court. Those who held positive views were considerably less and then, of course, there was a segment of respondents who were clueless and didn't know what they thought.

One wonders if such polls trouble the sleep of Chief Justice John Roberts at all. After all, his name is on this court and history will judge him as a Chief Justice based on its decisions. So far, those decisions would not assure him much of a ranking among the Chief Justices of history.

So now we come to this week's decisions.

First the Court overruled Arizona's racist "papers, please" law sending Antonin Scalia into an apoplectic dissent that must have scorched the paint on the walls of the Court chamber. Scalia's language was so over-the-top, unlawyerly, and extreme that it has prompted some to call for his resignation. But this is just the cap in a long career of extremist views for this justice. He's obviously not going to resign.

Now, today, we have the Court's decision on the Affordable Care Act. To the dismay of right-wingers everywhere - and, I think, to the surprise of many liberals - the Court upheld the law, finding it constitutional in all of its major parts. The conservative John Roberts joined with the four liberal-leaning justices on the Court to form a majority opinion. As usual, Scalia and his minions, Thomas and Alito, held the dissenting view and, somewhat surprisingly, the libertarian Kennedy sided with them.

Observers of the Court may see this as some evidence that Roberts has, in fact, become concerned with how history will view him and that this may impel him in the future to moderate somewhat his more radical right-wing instincts. Time will tell on that score. At least now we know why Scalia went bat-shit crazy with his Arizona dissent. He knew what was coming and he doesn't like losing.