Dishonesty And Healthcare

As the blizzard of political television ads becomes ever more annoying–and less informative–one thing about them has become very interesting. Even Republicans who have previously made it clear that they don’t want government involved in healthcare are airing advertisements touting support for Medicare and willingness to protect pre-existing conditions.

I’ve been particularly struck by the U Turn in Indiana’s Fifth District, where a radically-reactionary, pro-Trump Republican noted for opposing “socialism” (which she has defined to include pretty much anything done by government) has begun running commercials supportive of Medicare and coverage of pre-existing conditions. Evidently, her polling has overcome her previously expressed belief that government should have no role in health care.

She’s not alone.

When the Affordable Care Act (aka Obamacare) passed, several Republicans went on record with their concern that its trajectory would mirror that of Medicare and Medicaid: despite initial resistance, the public would come to expect/demand/approve of the program. Survey research has confirmed those fears, which is why GOP officeholders continue to pretend that they will protect access to healthcare at the same time as they are feverishly working to eviscerate it.

The Brookings Institution recently published a report detailing six ways Trump has sabotaged the ACA.The report began by stressing that its authors did not use the term “sabotage” lightly.

For analytic purposes, the term “sabotage,” should not be used lightly. Presidents upon taking office typically have priorities that trigger executive actions strengthening some programs while weakening others. The losing programs often face resource reductions, pressure to deemphasize certain goals, directives to alter their administrative approaches, and other measures that can undermine their effectiveness. In doing so, a president often pays lip service to the program, claiming it has been “modernized” or otherwise improved. In contrast, Webster’s defines “sabotage” as efforts to foster “destruction and obstruction” and to “cause the failure of something.” In the context of the administrative presidency, it reflects a commitment to program emasculation and termination through executive action. As such, it sharply departs from the constitutional requirement that the president “take care that the laws be faithfully executed.”

There were six actions detailed in the report.

1) The administration dramatically reduced outreach about, and opportunities for enrollment in, the ACA’s insurance exchanges. The administration sharply reduced support for advertising and exchange navigators and reduced the annual enrollment period to about half the number of days. 

2) Together with Congressional Republicans, it reneged on commitments to private insurance companies. Those insurers had been offered various subsidies that reduced the risks of participating in the exchanges. The GOP failed to honor those commitments.

3) The administration has constructed what the report calls “off-ramps to cheaper, lower-quality insurance.” One goal of the ACA was to improve the quality of health insurance by specifying essential benefits, guaranteeing coverage of those with preexisting conditions at reasonable rates, and prohibiting insurers from imposing certain spending caps. The Trump administration expanded access to coverage that was cheaper because it didn’t meet these standards and that siphoned off the healthier enrollees whose participation is needed to make the ACA work.

4) It allowed–indeed, promoted– a variety of state waivers that decreased ACA enrollments and undermined its regulatory structure.

5) It discouraged legal “aliens” from enrolling in Medicaid. In a particularly evil move, Homeland Security promulgated a “public charge” rule authorizing officials to treat Medicaid enrollment as a negative factor when reviewing the requests of legal non-citizens to extend their stays or change their status (e.g., from temporary to permanent resident).

6) And then there’s the existential threat. The Trump Administration brought the lawsuit that is now pending at the Supreme Court, attacking the constitutionality of the ACA. If that suit is successful–despite a legal argument that has been widely characterized as ridiculous, despite its endorsement by an appellate court composed of Trump-appointed judges– millions of Americans will lose access to health care.

As a student once reminded me, the United States doesn’t have a health-care system; we have a health-care industry. As a result, millions of Americans remain underinsured or completely uninsured, other millions are bankrupted each year by medical costs, and our health outcomes are among the absolute worst in the developed world. 

Deeply dishonest political rhetoric to the contrary, the current Republican Party wants to keep it that way.

18 thoughts on “Dishonesty And Healthcare

  1. Indiana had readied its own “health care system” sabotage and set it in motion October 1, 2013, under then Gov. Mike Pence. Applicants were NOT ALLOWED to apply to ACA unless and until they had been denied coverage by all insurers in the state system, to apply for coverage through the state system, applicant must not have current health care coverage. A Republican trap for working people with high monthly insurance premiums and unreal annual deductibles and one in which my family got caught. I won’t repeat that ugly, costly experience but have always wondered how many others paid the price for trusting local government for their health care. The one single person “token” who signed up for decent coverage and an affordable premium and low deductible was please through 2014; the surprise came January 2015 with the increase in premium and deductible amount and loss of coverage. The Indiana state health care system was carefully planned and carried out to trap those denied and those accepted into the system.

    My primary question has always been; was it a violation of civil rights to deny Indiana (and other Republican state residents) from applying directly to the ACA for health care insurance coverage? This “Dishonesty And Healthcare” began under Republican leadership at the state level and Trump has been expanding on the dishonesty ever since. He is increasing his stronghold in the the Supreme Court with his Catholic nominees; the farce of “hearings” on Amy Cony Barrett will culminate and set full control in place with her appointment by the end of next week.

    “As a student once reminded me, the United States doesn’t have a health-care system; we have a health-care industry. As a result, millions of Americans remain underinsured or completely uninsured, other millions are bankrupted each year by medical costs, and our health outcomes are among the absolute worst in the developed world.”

    Indiana has a Democratic physician candidate for Governor, Dr. Woody Myers, whose experience is primarily in the administrative end of health care. This is what is needed here in this now “hot spot” state in the nation due to increasing COVID-19 Pandemic numbers under Republican leaderless control by Pence’s puppet replacement.

  2. JoAnn is correct about the Pence disaster for Indiana’s “healthcare plan.” It is nothing more than a way for several corporations to get their hands into the patient’s pockets while providing little to no service. Indiana is suffering from so called leaders that make every decision based on what higher up office they want to pursue, and the working folks in our state are paying the price for their self-centered ambition. I used to work for an attorney that did collections for a hospital in southern Indiana and learned that we are all victims of the political aspirations of the egoists that have been our governors for the past decade or two. A $15/hour job (standard pay for anyone south of Bloomington) with a $10,000 deductible is all anyone here can get, including the folks that work for our US Senator that bragged about his company’s insurance plan that he created. A $10,000 deductible is no insurance, but the state of Indiana makes it difficult for competition among insurance companies and areas with small populations such as about half of the state, have limited insurance options that are costly and provide literally nothing for the consume except a large premium payment to match that large deductible.

    I truly hope our voters will throw all the bums out and they have to resort to going on the Healthy Indiana Plan.

  3. What’s even worse is that, in the face of all this chicanery, they have allowed Covid-19 to kill over 218,000 Americans. If this were an episode of “Law and Order,” Jack McCoy would be trying them for depraved indifference murder.

  4. If a new bridge to provide a critical lifeline between communities was christened in honor of Obama, the incumbent would do everything he could to sabotage safety of the crossing. Ludicrous? That bridge to life is the Affordable Care Act. What bridge has the incumbent designed that is better and safer? I have written Senator Mike Braun, twice in the last two months for a copy of the incumbent’s America First Healthcare Plan he touted during a speech … alas … to no avail. The emperor speaks boldly without any clothes. I grew up in West Texas from which I am inclined to believe: “All hat no cattle.”

  5. Theresa Kendall; my daughter-in-law was paying $450 monthly for family plan which these days was reasonable but…the $9,600 deductible with a disabled son was, as you said, no insurance at all. She had dropped her coverage as required in October 2013 and applied to the state, checked her status in December and they didn’t have her application so she reapplied. Checked for status January 2014 only to be told that applicants would not be told their status until May or June. In June 2014 she was accepted by one company with a $1,200 monthly premium and $12,000 annual deductible which she declined. Had to wait till October to resign with her earlier coverage but due to being uninsured all year she was fined $900 which was deducted from her 2015 tax refund.

    “Dishonesty And Healthcare”

  6. Promise the world, deliver nothing is the motto of the GOP. If you believe anything they say, it’s on you. Sadly, it has gotten to this, but it’s better for your sanity. Lower your expectations, increase your serenity. The relationship is inverted.

    The democrats, not much better, Obama promised us progressive health insurance but delivered RomneyCare, written by the ultra-conservative Heritage Foundation, which profited the health insurance industry. An industry that pays CEOs $21,000,000 a year.

    If you haven’t figured out the oligarchs have access to the best shit spreaders, well, keep your heads in the sand. The problem is they don’t pay for the shit spreaders — we do. We subsidize the propaganda laid on us. Some of us need heavier doses than others, but it’s all the same.

    I think it’s comical now to watch what is happening to our social media platforms for “censoring” the NY Post story, which was so full of holes in wasn’t funny. It was clearly a hit piece against Hunter/Joe Biden. So, our social media oligarchs will be called to Washington to testify in front of republicans. What’s funny is the same republicans appear almost exclusively on Fox News, who employs a multitude of shit spreaders applying heavy doses to their viewers.

    We’re now going to go down the rabbit hole of who’s propaganda is more believable and who should be censored, and who shouldn’t be. Absolutely incredible for such an exceptional nation.

    We need to democratize the free press as step one to a global Truth Campaign. The media should be accountable to the people occupying this globe. People’s so-called mass movements hit a massive logjam with the media and all the other oligarchs controlling the communications industry. We need to open up the logjam and see where it leads. There will be so many aha moments; it will be another period of enlightenment.

  7. The GOP roiling against healthcare and to a greater extent, the social safety net, has been going on for almost 100 years! So we can’t say this is something new!

    Just look at the GOP campaign buttons roiling against Social Security, Medicare, and the ACA! They are almost identical, just recycled for the next target.

    But you would have to ask yourself why? Why a party that aligns itself with good graces of God, be so anti-compassionate?

    Why has this particular party so corrupted religion for their own selfish desires on power and influence? Because as they remove the net from beneath you, they offer the olive branch as a saving grace! But it’s just the last nail in the coffin to complete brainwashing! Because what they offer is not accurate, as there religion is also manipulated and dumbed down to keep people in line looking for that sliver of hope.

    Why dismantle public education? Why deny healthcare? Why dismantle mental health infrastructure? Why deny any financial safety net? Why deny nutritional supplemental assistance?

    Because, if you can keep the Masses, Sick, Hungry, Poor, Uneducated, and on the brink of disaster, those people are less likely to make waves, and be a threat to the Minority trying to rule the Majority. They are also susceptible to disinformation!

    When you’re grasping for life, when you’re trying to pull yourself out of your tailspin and your hanging by your fingertips, the GOP doesn’t encourage those citizens and offer a helping hand, they are stomping on your fingertips as you’re holding onto that ledge.

    I don’t believe in the phrase “Compassionate Conservative” because, over the years it’s been proved deceptive and hypocritical!

    They roil against abortion, they roil against healthcare, they roil against contraception, but what about all those children born to the poor or disadvantaged folks that can’t be taken care of? If you make the sanctity of life your Standard, and you hitched your flag to that standard, then how could you do everything to make that life a living hell? A life of misery?

    Keep people fighting for life and they’re not a threat, there is nothing compassionate or empathetic about that whatsoever!

  8. Todd does not yet understand his constant talking against Democrats is helping Trump. He also does not yet understand that this election is between Donald Trump & Company and the United States of America. But; Todd will accept the benefits IF the Democrats can oust Trump, Barr, McConnell, Graham, Nunes, Giuliani and the others on the list of pro-Russian dictatorship supporters. And the safety of a working vaccine against the Covid-19 Pandemic rather than Trump’s miracle cure.

  9. The Republican strategy has been remarkably consistent for a number of decades. Favor donors over workers and rile malcontents as required to gather enough votes to have power to reward and sell to donors. The surprise of Russia entering the mix for the 2016 election seemed like icing on the cake.

    It turns out it was for them too good to be true.

  10. The health care industry violates the Hippocratic oath “Do no harm”. It’s harmful when someone has to declare bankruptcy or 2nd mortgage their home to pay for health care. Nurse managers now have to prove to executives that a decrease in nursing staff would actually decrease their profits. Forget about having adequate staff so you can reduce patient falls and other complications. Forget about quality care.

    The Republicans have always fought against socialized medicine. They continue to whine about the cost of Medicare and yet refuse to look at good solutions to make it solvent.

    I hope that should Biden be elected he can improve upon the ACA that allows us to ensure many more Americans have health care coverage. I hope he can find a way to reduce drug costs.

    I can only hope that the lame attempt to dismantle the ACA through SCOTUS fails.

  11. Todd,

    The fact remains, the Democratic Party trying to be inclusive, which means people of all ethnicities and creeds, is not going to reflect a panacea of liberalism.

    If the Democratic tent is to envelop many, there has to be, and will be issues that many don’t agree with concerning its political canon.

    The great socialist experiment which turned out to be Nazi Germany, where the upper class and corporations received all the benefits, and everyone else ended up in concentration camps or slave labor is not something that should be revisited.

    Any single form of government can be compromised and manipulated, that’s where the guardrails come in! Every single individual is not going to get everything that they desire in an all-encompassing big tent, but life will be exponentially better.

    The exclusion of religion in political affairs, the access to quality healthcare for every single citizen, housing for all, education including college for all, mental health facilities for any and all citizens who need it, the elimination of using freedom of speech to promote lies and conspiracies, the repeal of citizens United to get corporations out of politics, because corporations are not people! And lastly, rectifying systemic racial, credo, and caste animus is a must!

    The color of one’s skin, the language that a person’s ancestors spoke or that they speak themselves, the religion that they believe in, should never ever enter into the compassion this country shows or the empathy that we have towards our fellow man. Everyone deserves the basic human rights of food, shelter, healthcare, and education! Too bad the racial divide runs much deeper than anyone realizes.

  12. Today, I look on the bright side.

    The Republican “embrace” of affordable healthcare and protecting coverage for preexisting conditions is heartening. Simply put, they know that they are losing on this issue and are running scared.

    From what I hear in ads for Spartz (IN 5th), she has a simple plan, that is pursued correctly will bring millions to Indiana.
    Step 1 – Allow all health insurance to be sold in any state.
    Step 2 – Pass Indiana health insurance law that says insurance companies know what is best.
    This will bring all insurance companies to Indiana, like credit cards are all issued from South Dakota and Nevada, and corporations are formed in Delaware. Affordable Care? Sure, $100 per month, $10K deductible, $5K lifetime cap, pays 50% of bill – done; Per-existing conditions? $200 per month and $20K deductible – done
    Step 3 – Indiana rolls in the bucks, to be squandered by the Republican government.

    The other silver lining – if they do overturn ACA, we may get Medicare expansion – sign up if you are over 50 or if you have no other health insurance. Note – this isn’t the Bernie plan – supplemental insurance would still exist – but still be regulated. Oh, and the Hyde Amendment goes away.

    John Sorg – Sorry, but beyond names, don’t use Russia, China, or Nazi Germany as examples of “socialism”. They aren’t/weren’t. If the oligarchs get more, it ain’t socialism. Russia was Czarist without the hereditary component. The same for China. It is Imperial without a hereditary Emperor. I don’t know that “pure socialism” exists in any nation. Israel tried to be that way in the beginning, but even then, it wasn’t “pure socialism”; now, sadly, they are ruled by a Trump clone (or were both Trump and Bibi cloned from Putin?)

    Otherwise, John, I totally agree with you. Well said.

  13. Len,

    Actually, Nazi Germany was considered nationalistic socialist. They were considered right of center!

    Nazi Germany used left of center communism to ensconce the Nazis as a controlling influence in germany. The Nazis used a false flag operation to blame the Communists for the Reichstag fire.

    Thereby allowing the Nazis nationalist socialist government to round up all of the Communists and execute them.

    Besides nationalistic socialism being manipulated, communism is also nowhere near its original incarnation. When the hierarchy of those governments realized the amount of money they could skim, they’ve all moved to a more authoritarian form of capitalism. A form that does not allow Fair election of Representatives, thereby keeping them in power. Basic human rights can be snuffed out with the stroke of a pen. We can see that happening here!

    Just my take on it anyway Len, thanks!

  14. John – Sadly I agree with your analysis – and more sadly, I do see the attack on human rights happening here. I can only hope that our country makes a u-turn next year.

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