Wednesday, April 26, 2017

Here's To Our Health!

We hear a lot about health care though what that means is debatable given the evolution of a corporate influenced disease management industry in our country. The debate has not actually been about health care but about access to it for most people. The recent focus has been on the insurance reform model first cooked up by the Heritage Institute, a conservative corporate think-tank. This later became the Massachusetts health care reform under then Governor Mitt Romney and was later adopted and made into national law by former President Obama.

Keep in mind that insurance is not health care. Insurance companies do not provide anything that qualifies as medicine. The insurance industry acts as a toll taking gatekeeper deciding who gets medical care and what that can be, based on what your policy will pay for. They, unlike your physician, if you are fortunate enough to have one, decide based on profit margins rather than science what your Doctor can do for you.

We spend for more for less than any other modern country for health care services. Given an aging population and many uninsured crowding E.R.s across the country, medical access remains a growing issue with major economic consequences for individuals as well as for our nation. The Affordable Care Act (ACA), or ”Obamacare” was controversial from its onset. Even though this was corporate-friendly legislation originating with Republicans, the GOP adamantly opposed it as part of their predetermined agenda of opposing and blocking anything Obama did. Progressives initially opposed it as well, advocating for the simpler, less costly and more effective universal coverage of a single payer plan – a nationwide, publicly run group plan. Public hearings were held led by the Senate Finance Committee headed by Sen. Max Baucus who had received more campaign money from health and insurance industry interests than any other member of Congress. When citizens, including medical professionals, spoke out for a single payer option, they were ejected from the hearing and charged with disorderly conduct.

ACA, written largely by the pharmaceutical and insurance industries, was made law. For all its flaws, it was a significant reform package which reduced the numbers of uninsured. It also made it possible for many with pre-existing conditions to get affordable coverage. It still left many out but was initially designed to include a public option which didn't make the final cut, and to fund Medicaid as coverage for the poorest. Challenges by Republicans led to the Supreme Court ruling that states cannot be forced to participate in Medicaid expansion – that old “state's right to oppress” at play again.

This is still a big problem here in Virginia where at least 400,000 of us are denied access to basic medical care. I'm one of those people. Governor McAuliff continues to advocate and work to expand Medicaid over the objections of Republicans in our State Legislature – mostly from regions where most of their constituents lack medical coverage. Hopefully, with enough pressure from us, either he or our next Governor – Ralph Northram will succeed on our behalf – assuming it is still necessary.

Which brings us back to the national struggle for sane health care policy. Regarding ACA, I know people who have insurance who otherwise would not. Some of them are really sick and losing that coverage might well be fatal. I know others who had coverage but dropped it as insurance rates rose for some plans. I know people that have no coverage because, in our low income area, it was a choice between insurance or rent. They chose the latter. I personally have had no medical coverage since 2008 – a special thanks to those obstinate state Republicans who broke the economy and then quashed state Medicaid access.

During his campaign for president, Donald Trump, in pandering to the most ignorant and basest of bases, vowed repeatedly that he would repeal Obamacare in his first 100 days, falsely claiming that it is in a “death spiral.” Certainly there are problems with industry price-gouging but, as reported in the New York Times, “the newest estimates from the Congressional Budget Office contradict this long-held talking point. According to the budget office, Obamacare markets will remain stable over the long run, if there are no significant changes.” Sadly, after years of visceral opposition, the GOP had nothing to offer as a replacement but the same failed nonsense. This became evident when Trump relied on hollow ideologue and corporate toady Paul Ryan to come up with a replacement.

Ryan presented a disastrous collection of rehashed GOP talking points which would have done little to lower insurance premiums, would have further cut funding for Medicaid, would have replaced subsidies for insurance coverage with inadequate tax credits and would have severely impacted the elderly and those with preexisting conditions, denying many basic medical coverage.

We see how that went. Even Republicans rejected it outright. The Times called it "a humiliating defeat for President Trump on the first legislative showdown of his presidency." This failure was good in that it exposed and set back the agenda of Sen. Paul Ryan as well as allowing many in dire need to keep their insurance coverage. Still, they have not given up. As reported in The Hill, White House officials presented an offer to the conservative House Freedom Caucus as they seek to revive the failed ObamaCare replacement bill. Vice President Pence and other White House officials presented an idea at the Freedom Caucus meeting which would allow states to apply for waivers to repeal two ObamaCare regulations mandating which health services insurers must cover, and that prevents insurers from charging sick people higher premiums. Once again, the mean-spirited corporate lackeys want to deny the sickest of us basic coverage. This too will fail as many in Congress – including Republicans – have to answer to constituents.

Something else is happening that should inspire us to action. In the continuing wake of failed attempts to destroy the even modest advances in medical access provided by Obamacare, the calls for a single payer, “Medicare for all” replacement, are growing. This idea is popular even among Trump voters, many of whom are economically hard hit. The indefatigable Sen. Bernie Sanders is introducing a Medicare for All bill to Congress again. Rep. John Conyers is also planning to reintroduce a national, single-payer healthcare legislation, H.R. 676, “The Expanded & Improved Medicare For All Act,” which enjoyed the support of 77 co-sponsors in the 112th Congress, including our own Bobby Scott. Beyond getting more Congressional support in the present atmosphere, this legislation would give Trump, who is not tied to the Ayn Rand ideology of GOP extremists like Ryan and the so-call Freedom caucus, a chance for a much needed victory.

Though it sounds like a long shot to expect support for such progressive legislation, it is possible. It might be that we can actually get more done under Trump than we might have with Clinton – not because he is better but because when we are awake and active, we are a force to be reckoned with. The times may be 'achangin' but we have the wind in our sails and have to keep pushing forward beyond resistance on this and other issues. We certainly have our work cut out for us but our health is at risk if we do not demand better.

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