Thursday, November 21, 2013

Homecoming, a kludge, and reason to hope


Back on the ground in the USA, I see we are living through a panic about the long delayed launch of what this country has been able of offer as a response to human infirmity. That Obamacare, that unwieldy kludge, is struggling with its own complexity is not surprising. When you promise to preserve a mass of historically accreted work-arounds and pockets of private profit, it is not surprising that you get a mess.

It's worth going the root of why this mess inspires such fanatical resistance. In a nutshell, from Thomas Edsall:
… the Affordable Care Act can be construed as a transfer of benefits from Medicare, which serves an overwhelmingly white population of the elderly – 77 percent of recipients are white — to Obamacare, which will serve a population that is 54.7 percent minority.  Over 10 years, according to the Congressional Budget Office, the Affordable Care Act cuts $455 billion from the Medicare budget in order to help pay for Obamacare.

Those who think that a critical mass of white voters has moved past its resistance to programs shifting tax dollars and other resources from the middle class to poorer minorities merely need to look at the election of 2010, which demonstrated how readily this resistance can be used politically. ….
Yes indeed, a dwindling white majority doesn't want "its taxes" used for "those people." And it can't hear that Medicare changes are designed to squeeze profiteers who drive cost increases, not the patients.

Fortunately, however miserable the interim will be -- and people will suffer unnecessarily during it -- the last few decades in California have showed that betting against the inevitable browning of the United States initiates a political death spiral for the party that chooses that path. Republicans are marginalizing themselves. And good riddance to them! Exclusion, greed and resentment are ugly -- our dark side -- the antithesis of what can make this society exceptionally good.
***
By the way, the country of Bhutan -- a resource-poor Himalayan quasi-monarchy/quasi-democracy where I've just spent ten days -- makes education and medical care free to all Bhutanese. I'm sure there remain issues of imperfect access to these common goods, but this obscure fragment of the back of beyond seems to have a clue about how a well functioning society behaves …

3 comments:

Rain Trueax said...

The only way we can make any of the social services work, and that includes SS and Medicare, is to up taxes. We cannot offer what we don't pay for and right now upping taxes appears to be a no-no for either party.

And from what I hear of those being impacted by the ACA, it has very steep increases (as in 3x the rate of last year for one friend) if you live in a resort area (where many are not as rich as the tourists who visit). Added to concern that doctors will retire early due to the paperwork, confusion, and limitations on fees.

We need a big push on getting new medical schools with more doctors. Right now the cost of becoming an MD is so steep that many who would be qualified, don't want to borrow the money-- or can't. We need a LOT more doctors to give everyone health care where even if you have insurance you might find no doctor you can go to. I also wonder what this does to those doctors who had earlier set up concierge plans.

Listening to legislators in Oregon talking about why Oregon hasn't been able to sign up a single new patient, you can clearly see this is a mess. I don't know why with three years to get ready and I read $300 million to set it up, this has turned into such a debacle but it sure sounds like it has.

To me it sounds like Obama needed one of those czars they claim he has so many of, who could really do this and it couldn't be Sebelius who had a lot of other work on her plate. It should have had a general or some kind of techie CEO dedicated to making it work (oh wait, we couldn't afford a CEO,they'd have wanted the whole $300 million lol).

That said, this should have gone to Medicare for all because as you said above, leaving in all those insurance companies wanting their usual profits, which have risen astronomically in the last 10 years, it was doomed to be more expensive than what people already had. Why didn't they realize it before the roll out?

And why would they add all the requirements to the policies (giving insurers an excuse to drop people) the same day they hoped to enroll 30 million uninsured. Did nobody think that pushing people off their junk policies would complicate adding the new people? One or the other should have gone first and maybe a year apart.

It is maddening as the whole world can do this. To me it seems like deliberate sabotage... dumdedumdum... Okay I am into the twilight zone maybe with that but given all the richest people out there and their primary goals to keep themselves where they are, is it really so far out there to think somebody didn't want this to work or is it all about a 2000 page bill full of too many complexities?

Listening to right wing radio yesterday, they are ecstatic and milking the failure, which goes way beyond a website, to paint it as Obama's Waterloo. This is all aimed at getting a Republican Senate and House and right after that two years of impeachment proceedings if it happens not to mention more personal Civil Rights taken, and voting limitations to kick out more minorities. 2014 is critical for Dems whether we are thrilled with ACA right now or not. Donate and volunteer as if they get control nothing will happen until '16 and we aren't living in a time we can afford nothing to happen.

I think they are wrong about it being catastrophic for obama or that it can't be fixed, but we can't pretend it was all done right or we sound like righties, always defending and never facing reality. And reality is we need this change in health care-- now how do we make it actually work for families across this country? Basic health care shouldn't be a fear but a right.

janinsanfran said...

Hi Rain: I think you are profoundly right that one aspect of this is the need for more doctors after a less expensive education. When the people of the United States really want something, we can get it done. This is something we should dearly want!

Michael Strickland said...

Looking forward to your account of the "obscure fragment of the back of beyond."

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