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Musica lætitiæ comes medicina dolorum.
www.gyromantic.com
A personal commentary • »If you want the present to be different from the past, study the past.« --Spinoza
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Musica lætitiæ comes medicina dolorum.
First, I hold it to be a fact that the only people defending this bill are those who have a political interest in its provisions. Objectively, even initially, 83% of its tax cut benefits (at the cost of huge ballooning of the national debt, which Republicans used to oppose on principle), GOES TO THE VERY TOP in terms of income. It favors non-wage income of the wealthy over the wages of ordinary people, doubly so when you consider that much of the tax burden of ordinary working people are regressive taxes such as sales tax and payroll taxes, that hit working people disproportionately harder than the very wealthy. It's even accurate, factually, not as an opinion, that this soon to be law, benefits the very, very rich, and not just the ordinarily rich. There is no way this is, objectively, good public policy. The Republican leadership even essentially admits that its draconian cuts to revenue will make it easier for them to cut social programs, including Social Security and Medicare, that AREN'T EVEN PAID FOR OUT OF INCOME TAX REVENUES. Cutting those programs because of shortfalls in income tax revenue is just theft, pure and simple, from the funds people have paid in payroll taxes on the promise that those programs will be there. Not to mention that the kinds of investments other countries, such as China and Germany, routinely make in their future: research, education, infrastructure— will be severely impacted by this terrible law. It is not at all hyperbole, in other words, to refer to this Republican scheme as a HEIST.
OK, then, look at the vote:
Republicans 51 Yes, 1 too sick to be there
Democrats: 48 No
We didn't used to have such lopsided votes on major policy measures. But our politics is now ENTIRELY POLARIZED. Democrats have been FORCED to side with the interests of the people at large, because there is nowhere else to go. And Republicans now represent their donors, and to some extent their own interests (several super rich senators directly benefit from tax provisions inserted in the dead of night into the HEIST bill).
Then there is the whole issue of unprecedented disregard for process, and continued promotion of what can only be called subversion of democracy, through suppression of voting, gerrymandering, and foreign-backed meddling in the election. These non-democratic acts are not laid at the door of Democrats, but almost entirely Republicans. And the complete subversion of the executive branch is so manifest that you have to be deluded not to see it. And, unfortunately, millions of Americans ARE deluded in just the way Trump and his oligarchic backers have worked assiduously, through propaganda arms such as TrumpTV (Fox News), to ensure.
It is no longer the case that we have two parties, more or less representing the interests of significant sectors of society. We now have a party that represents oligarchs, the super rich, only, and which will use whatever means necessary to gain and retain power. The other party is still trying to figure out how to deal with this crisis, but it is, finally, coalescing around a broad program of social reform and restoration of small-r republican government in America.
Days of reckoning will be coming, soon. We, as a nation, will have to pull together and destroy the forces of anti-democracy. And that means defeating as many Republicans as possible, at all levels of government, and especially state legislatures, governors, Congress, the Senate, and the presidency.
The Republicans in the Senate just passed the single worst piece of tax legislation in US History, and very probably the worst piece of public policy legislation in many decades, certainly so if measured by its devastating impact on social cohesion. And they did it while destroying comity and orderly legislative procedure UTTERLY. Such actions have consequences.
And if another Republican mentions to me that the ACA was "rammed through," I will scream. A year of solicited input, thousands of hours of hearings, only to be met in the end by no serious effort to compromise, is simply not the same thing as presenting a massive, ill thought out, fiercely unpopular gift to the half of one percent who is their donor class, and everyone else be damned, passed on a straight party vote in the dead of night with no hearings and no debate. Functional representative democracy died last night in the US. It remains to be seen if it can be resuscitated.
I now state flatly, I cannot understand how any reasonable person can continue to call him or herself a Republican.
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The source of all the misery in the world
Lies in thinking of oneself;
The source of all the happiness in the world
Lies in thinking of others.
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Musica lætitiæ comes medicina dolorum.
"Too often we have found, throughout our country's history, we have people in positions of power who make offhanded comments about sending a few thousand troops here, fifty thousand there, hundred thousand there, intervening militarily here, or starting a war there — without seeming to understand or appreciate the cost of war. If our troops are sent to fight a war, it must be the last option. Not the first."
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Musica lætitiæ comes medicina dolorum.
"why should tax cuts even be on the table? We have budget deficits, not surpluses, and lots of unmet needs for future spending. U.S. taxes are low, not high, compared with other wealthy countries. Predictions that tax cuts will lead to rapid economic growth have been wrong time and again. And by large margins, voters want taxes on corporations and the wealthy to go up, not down.
"The ruling theory among Republicans seems to be that going into the midterm elections they need a "win" to offset their failure to repeal Obamacare. I guess this might be right, although it's a theory that reveals extraordinary contempt for voters, who are supposed to be impressed by the G.O.P.'s ability to ram through policies that only benefit a tiny elite.
"However the politics turn out, this is remarkably terrible policy, devised via a remarkably terrible process. Most Americans realize that Donald Trump is a very bad president; they need to realize that his party's congressional leadership is pretty awful, too."
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Musica lætitiæ comes medicina dolorum.
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Musica lætitiæ comes medicina dolorum.
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Musica lætitiæ comes medicina dolorum.
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The Berkeley sociologist Arlie Russell Hochschild spent five years listening to Tea Party supporters in Louisiana, and in her masterly book "Strangers in Their Own Land" she identifies what she calls the deep story that they lived and felt. Visualize a long line of people snaking up a hill, she says. Just over the hill is the American Dream. You are somewhere in the middle of that line. But instead of moving forward you find that you are falling back. Ahead of you, people are cutting in line. You see immigrants and shirkers among them. It's not hard to imagine how infuriating this could be to some, how it could fuel an America First ideal, aiming to give pride to "real" Americans and demoting those who would undermine that identity -- foreigners, Muslims, Black Lives Matter supporters, feminists, "snowflakes."
Our political debates seem to focus on what the rules should be four our place in line. Should the most highly educated get to move up to the front? The most talented? Does seniority matter? What about people whose ancestors were cheated and mistreated?
The mistake is accepting the line, and its dismal conception of life as a zero-sum proposition. It gives up on the more encompassing possibilities of shared belonging, mutual loyalty, and collective gains. America's founders believed these possibilities to be fundamental. They held life, liberty and the pursuit of happiness to be "unalienable rights" possessed equally by all members of their new nation. The terms of membership have had to be rewritten a few times since, sometimes in blood. But the aspiration endured, even as what we need to fulfill it has changed.
When the new country embarked on its experiment in democracy, health care was too primitive to life or liberty. The average citizen was a hardscrabble rural farmer who lived just forty years. People mainly needed government to insure physical security and the rue of law. Knowledge and technology, however, expanded the prospects of life and liberty, and, accordingly, the requirements of government. During the next two centuries, we relied on government to establish a system of compulsory public education, infrastructure for everything from running water to the electric grid, and old-age pensions, along with tax systems to pay for it all. As in other countries, these programs were designed to be universal. For the most part, we didn't divide families between those who qualified and those who didn't, between participants and patrons. This inclusiveness is likely a major reason that these policies have garnered such enduring support.
Health care has been a cavernous exception. Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care, but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can't afford the requisite care get sicker and die sooner. Yet in a country where pretty much everyone has trash pick up and K-12 schooling for the kids, we've been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that's open to all. Some even argue that such a system is un-American, stepping beyond the powers the Founders envisioned for our government.
Dear Dr. XX,
I am writing to you about a matter of great concern to me, as a patient and spouse of another XX Medical Group patient. This is a concern that affects much of the for-profit and even non-profit private health care delivery system in this country, and I believe that it is a specific area where financial practices which are immoral and unethical are being commonly not only tolerated but actively engaged in, including by your organization. It is an area where I strongly believe that right-thinking medical administrators can and should voluntarily institute a simple reform for the good of all the citizens of our country, but most particularly for those who are unfortunate enough to have inadequate or no health insurance at all. I hope to at least suggest to you that this is something worth thinking seriously about. While the ultimate resolution of our ongoing national health care reimbursement policy crisis will almost certainly be political in nature, in the meantime, there are specific actions which providers can take which would increase equity and reduce the adverse impact of our medical cost crisis, especially on those least able to shoulder the burdens. Until our nation faces up to the necessity of ensuring health care as a right not a privilege, it is unfortunately incumbent on health care providers to ensure some degree of equity, to see to it that costs do not fall disproportionately on those least able to bear them.
I need hardly belabor the point that health care expenses are a major source of anxiety and stress for the shrinking middle class in our country. In some ways it is they, as opposed to the actual poor (who receive Medicaid), who are most affected by the problems I am talking about. Unexpected and inadequately insured medical expenses are the leading cause of personal bankruptcy in our country, as I'm sure you know.
The practice I am referring to is that of billing uninsured patients far more than would be reimbursed if they had insurance. I know that your organization offers to work with patients, but merely receiving a bill for $500 when the insurance would pay $350 (or even less) for the same services is a shock and assault on people's well-being. And this doesn't even address the fundamental inequity of the default expectation, contrary to any ordinary sense of fairness, that patients who lack coverage should pay, or at least be presented with the expectation that they pay, more for the same services than those who have coverage. And we should not pretend that it's easy or routine to secure reductions of these "full ride" costs. The entire burden of trying to get out from under enormous medical debts falls on the patient, when frequently the patients are at a point in their lives where they are least able to cope with such considerations and the necessity of negotiation and wrangling over medical bills. People routinely get unexpected bills in the mail that cause them huge distress, only to have to spend time, effort, and mental anguish trying to figure out how to cope with them.
And this is just plain wrong. My attention was drawn to this situation again, when, recently, my spouse went in for a wellness visit, and apparently the insurance was slow to adjust the billing. Upshot: we received a bill for $527, the non-discounted sum, with no explanation, no attempt to call us to explain that there was a delay with the insurance, just a bill. And it turned out that the EOB had crossed in the mail, and the insurance had already paid in full: $398 (the insurance discounted amount). My spouse presented as an insured patient, and even so was billed the full amount. Patients who have no insurance, or coverage problems, who are typically people with fewer financial resources than more fortunate insured patients, are expected to shoulder more than their proportionate share of health care costs. Of course some cannot pay, but that doesn't make it ethical to expect and dun people of limited means to pay more than others who have more resources. I put it to you, Dr. XX: such practice is both immoral and contrary to the tenets of every traditional religion, not least Christianity. I say this flatly and bluntly, and I hope you will consider seriously what I am saying. It is wrong to perpetuate a system that shifts greater financial burdens onto the less well off and the sick. Period. What must be done is that a program be instituted to make sure patients whose costs are not reimbursed receive bills which are no more than the typical insurance reimbursement. No other practice can be tolerated.
In our case, the matter was resolved, and we are not victims of the anomalous inequity I am complaining about, although we were exposed to it. We are fortunate enough to be adequately insured, even if the claim administrator was slow to process the claim. But many people are not, and bills like this are a serious burden on the finances of many who are least able to afford those burdens. Health care providers should never bill uninsured patients more than what insurers would ordinarily pay for the same services. Period. It's wrong, and it's one of the immoral practices that have tainted the entire profession of medicine in our country.
To the counterargument that health care providers as squeezed in all directions and costs for them are spiraling too, I can only say, this may be true, but it does not excuse disparate billing practices that disadvantage the less well off and the sick. Some other ways of meeting expenses simply must be put in place, because this practice is wrong.
Thank you.
Sincerely, XX
That's presidential leadership for you. Promise sweeping, "really good" health care reform, do nothing to achieve it, watch the ridiculous and cruel efforts of your party's attempt to pass a huge tax cut and call it "health reform," then, instead of saying, "Folks, we tried, but we will just have to make the current ACA system work, and my administration will do everything possible to make sure every American gets the best health care possible under existing law," you say "We're not going to own it. I'm not going to own it. I can tell you the Republicans are not going to own it. We'll let Obamacare fail, and then the Democrats are going to come to us." (And the hell with my constituents and all the rest of the American people who rely on a functional government). Read that statement again and let it sink in. The president of the United States said that.
This man is unquestionably the worst president in the history of America. I'm not religious, but I can only PRAY we get through this time without critical injury to our nation's very means of continuing to exist. No rational person can possibly support this monster any longer in good faith; which leads to the conclusion that the only people who do are incapable of distinguishing propaganda from reality, or, in the case of the more well heeled among them, they are lying crooks themselves.
It won't work, though, their plan to devastate health care by sabotaging the Affordable Care Act, and then wait for "Democrats to come to us." REALLY? When the Republicans have both houses of Congress, the presidency, the Supreme Court majority, and they 100% excluded Democrats from ANY participation in their discussions of their bill? No, GOP, you will own this. And we will defeat you in 2018 in large part because of this.
And the main reason for that is what will turn out to be the signature achievement of Pres. Obama and the ACA: we have ESTABLISHED in the hearts and minds of the American people that health care, as a social compact, is a RIGHT NOT A PRIVILEGE, and we will see to it that that promise is DELIVERED to the American people. We will leave the legacy of the Radical Right in the dust, fatally wounded by their own incapacity to govern.
They have lied to voters on a massive scale, and manipulated the government's "operating system," with all its flaws, to achieve minority rule of our major institutions. But they have fundamentally failed to deliver because their governing philosophy is complete crap, totally nonfunctional and out of accord with realities of economics and how public policy actually works. Their failure was inevitable, and it is now absolutely manifest. I truly believe that a huge paradigm shift is about to change the way large majorities of Americans think about trusting the Right to govern, and not in a good way for them.
But of course, it all depends on our ability, as Democrats, to present a coherent, values-driven alternative, that all Democrats can espouse and make real for people. And this we have yet to achieve. We simply must rise to this occasion. Cajole your Democratic leaders, make your views known. Tell them: "Majorities say Democrats don't stand for anything other than opposition to Trump, and that's NOT GOOD ENOUGH. Articulate the Democratic alternative, and appeal to the common sense, decency, and morality of the American people. Do that, and we will win."
What the hell is wrong with Democrats? With the Republicans in FULL MELTDOWN, here is a historic opportunity to create a new policy consensus. But you GOTTA HAVE A POLICY, and YOU GOTTA COMMUNICATE IT.
There should be a ten point agenda that Democrats universally stand for. Any one of us of the "Sandersista" wing could give you a pretty good approximation of what's needed, both in terms of policy and how to promote it. So let's get busy! Seize the day! Every time Trump or the stupid Republicans fall flat on their face, as with this horrible tax cut masquerading as a health bill, we DO MORE than point out how bad it is. WE ELUCIDATE CLEARLY what alternative we stand for (in that case, MEDICARE FOR ALL).
DEMOCRATS failed by being lukewarm Republican-light. WE WILL SUCCEED by offering a convincing and specific alternative.
www.gyromantic.com
A personal commentary • »If you want the present to be different from the past, study the past.« --Spinoza