America's Flawed Health Care System Fuels the Opioid Epidemic

I will be honest right up front.  I fully support a single payer health care system that would put healthcare insurance companies as we know them out of business.  Having done legal work for a hospital system and physicians in the past, the former, like health insurers, care only on maximizing profits despite advertisements to the contrary, while the latter are largely restricted in the practices by what health insurers will pay.  Prescribing a pill to mask the symptom is so much cheaper than addressing the true under lying cause.  And, of course, the insurers care nothing about a preventative approach to medicine.  Put all of this in the context of the opioid crisis in America and there's a reason why other advanced industrialized nations are not experiencing a similar crisis: they have universal health care systems that take an entirely different approach to health care.  America's health care system is literally killing tens of thousands of citizens.  A piece in the Washington Post looks at this reality - something that neither Trump or Congressional Republicans will admit, much less address.  Here are article highlights:

For the second year in a row, life expectancy in the United States has dropped.

It is not hard to understand why: In 2016, there was a 21 percent rise in the number of deaths caused by drug overdoses, with opioids causing two-thirds of them. Last year, the opioid epidemic killed 42,000 people, more than died of AIDS in any year at the height of the crisis.

“We should take it very seriously,” Bob Anderson, chief of the Mortality Statistics Branch at the National Center for Health Statistics, told my colleagues Lenny Bernstein and Christopher Ingraham. “If you look at the other developed countries in the world, they’re not seeing this kind of thing. Life expectancy is going up.”

In other words: In no other developed country are people taking and dying from opioids at the rates they are in the United States. We have about 4 percent of the world's population but about 27 percent of the world's drug-overdose deaths.

What explains the discrepancy?  The U.S. medical system.

Americans are prescribed opioids significantly more often than their counterparts in other countries. In the United States, 50,000 opioid doses are taken daily per every million residents. That is nearly 40 percent higher than the rate in Germany and Canada, and double the rate in Austria and Denmark. It is four times higher than in Britain, and six times higher than in France and Portugal.

That is in large part a result of our health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people, won't pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine told the BBC.  . . . . the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. . . . . . As a result, Americans were being prescribed opioids. Often, they were given several more pills than they could be expected to use, to avoid repeat visits. 

[D]octors in the United States are much more likely to provide painkillers than are doctors in other countries. One comparative study found that Japanese doctors treated acute pain with opioids about half the time. In the United States, the number was 97 percent of the time.

There are other culprits, too. The United States is one of only two countries that allow prescription drug companies to advertise on television. (The other is New Zealand.) The companies do advertise, a lot. In 2016, pharmaceutical companies spent $6.4 billion on advertising. Experts say, too, that U.S. medical schools have not done enough to educate students on pain management, addiction and opioid use and abuse.

Drug companies also try to woo physicians with gifts. Some companies host fancy dinners, and others sponsor conferences and junkets. In 2016, for example, OxyContin maker Purdue Pharma spent $7 million on gifts to doctors and teaching hospitals. . . . .  In the same period, the company doubled its sales force, distributing coupons so doctors could offer patients 30-day supplies of OxyContin and other highly addictive drugs. In those six years, prescriptions for OxyContin jumped from 670,000 to more than 6 million.

That alarmed at least one public-health group, which ran a 2009 bulletin titled, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.”  By then, it was too late.

Did John McCain Kill Obamacare Repeal?

As noted yesterday, the latest GOP effort to kill Obamacare is perhaps the most heinous to date as noted in a post yesterday.   I still remain disgusted with what the GOP has become and just how vicious its agenda has become.  Thankfully, John McCain has shown that a few in the GOP have not utterly thrown away their integrity and morality.  With his announcement yesterday that he will not support the latest Trumpcare travesty, with luck the GOP repeal effort is dead.  A piece in the New York Times looks at McCain's announcement.  Here are excerpts:

Senator John McCain of Arizona announced on Friday that he would oppose the latest proposal to repeal the Affordable Care Act, leaving Republican leaders with little hope of succeeding in their last-ditch attempt to dismantle the health law and fulfill their longstanding promise to conservative voters.

For Mr. McCain, it was a slightly less dramatic reprise of his middle-of-the-night thumbs-down that killed the last repeal effort in July. This time, the senator, battling brain cancer and confronting his best friend in the Senate, Lindsey Graham of South Carolina, issued a statement saying that he could not “in good conscience” support the proposal by Senators Graham and Bill Cassidy of Louisiana.

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” Mr. McCain said. “Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”

With two other Republican senators likely to vote no, Mr. McCain’s opposition to the bill could be fatal. With Democrats united in opposition, Senate Republicans can afford to lose only two of their members.

A bill of this magnitude “requires a bipartisan approach,’’ Mr. McCain added.  Those concerns were compounded by the decision of Republican leaders to press forward with a vote next week before the nonpartisan Congressional Budget Office could complete a full analysis of the Graham-Cassidy legislation. The budget office is expected to provide a preliminary fiscal assessment early in the week, but it indicated that it would not be able to complete an analysis of the bill’s effects on health insurance coverage or premiums by Sept. 30.

McCain has reminded us that sometimes one person can make a difference.  Each of us needs to remember this as we oppose the ugliness of what the GOP and Der Trumpenführer are seeking to do to America.  Another piece in the Times looks at why the GOP is so hell bent to harm millions:

As more than 40 subdued Republican senators lunched on Chick-fil-A at a closed-door session last week, Senator Cory Gardner of Colorado painted a dire picture for his colleagues. Campaign fund-raising was drying up, he said, because of widespread disappointment among donors over the inability of the Republican Senate to repeal the Affordable Care Act or do much of anything else.

Mr. Gardner is in charge of his party’s midterm re-election push, and he warned that donors of all stripes were refusing to contribute another penny until the struggling majority produced some concrete results.

“Donors are furious,” one person knowledgeable about the private meeting quoted Mr. Gardner as saying. “We haven’t kept our promise.”

The backlash from big donors as well as the grass roots panicked Senate Republicans and was part of the motivation behind the sudden zeal to take one last crack at repealing the health care law before the end of the month.

This was not what Republicans had envisioned. Preparing for the 2018 midterm elections, they had thought they were in a strong position to maintain or expand their majority. Democrats must defend 25 seats — including 10 in states won last year by President Trump — while just eight Republican-held seats will be on the ballot. But their governing struggles — and attacks on congressional leaders by Mr. Trump — have soured their base, leaving the Senate majority feeling desperate.

Senator Pat Roberts of Kansas, was even more blunt in a conversation with Vox. “If we do nothing, it has a tremendous impact on the 2018 elections, and whether or not Republicans still maintain control and we have the gavel,” he said.

Republicans say the fund-raising drop-off has been steep and across the board, from big donations to the small ones the party solicits online from the grass roots. They say the hostile views of both large and small donors are in unusual alignment and that the negative sentiment is crystallized in the fund-raising decline.

Republicans are also set to roll out their income tax overhaul plan next week in an effort to build support for it and find something the party can deliver to the president’s desk. They see the tax plan as their best opportunity to win back the allegiance of donors.

With health care repeal teetering yet again, the one thing they know for sure is that they need to show some accomplishments, and they need to do so fast.

What shocks me is that these Republicans seemingly fail to realize that perhaps some of the fund raising drop off is due to the ugliness of what the GOP is trying to pass. Not everyone is like the Koch brothers who happily want to restore the Gilded Age while the vast majority of Americans suffer.

Today's GOP: Cruelty, Incompetence and Lies

As I note frequently, I am a former Republican.  Once upon a time I held a city committee seat for the Republican Party of Virginia Beach.  I even was the original incorporator of that entity as filings at the Virginia State Corporation Commission confirm.  Yet now I find myself embarrassed to ever have been a Republican give the hideousness of today's Republican Party.  A hideousness starkly revealed by the Graham-Cassidy healthcare bill currently in the U.S. Senate which would have millions of Americans and leave those with pre-existing conditions without coverage.  Virtually every part of the healthcare industry opposes the bill as does AARP which will hopefully go on a rampage against Republicans in the 2018 election cycle if this travesty passes (if it does, it will be based solely on Republican votes).  So why is the GOP leadership pushing so hard for this bill?  Two main factors, in my view: thanks to Citizens United, the big money players in the GOP donor class want its passage and will punish the GOP if this massive tax cut for the wealthy disguised as "reform" is not passed.  The other factor is the make up the GOP base which is controlled by Christofascists and racists, groups best defined by their hatred of others and their hatred of Barack Obama.  In their warped and hate-filled minds, this bill will punish minorities and others they despise.  The irony will be, of course, that they themselves will end up suffering greatly when many find themselves without health care at some point down the road.  A column in the New York Times looks at the cruelty, incompetence and lies behind this foul bill.  Here are excerpts:

Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.

Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good.

The Affordable Care Act, which has reduced the percentage of Americans without health insurance to a record low, created a three-legged stool: regulations that prevent insurers from discriminating against people with pre-existing conditions, a requirement that individuals have adequate insurance (and thus pay into the system while healthy) and subsidies to make that insurance affordable. For the lowest-income families, insurance is provided directly by Medicaid.

Graham-Cassidy saws off all three legs of that stool. Like other Republican plans, it eliminates the individual mandate. It replaces direct aid to individuals with block grants to states, under a formula that sharply reduces funding relative to current law, and especially penalizes states that have done a good job of reducing the number of uninsured. And it effectively eliminates protection for Americans with pre-existing conditions.

[E]veryone, who knows anything about health care warns [the bill] would cause chaos.  It’s not just progressives: The American Medical Association, the insurance industry and Blue Cross/Blue Shield have all warned that markets would be destabilized and millions would lose coverage.

How many people would lose insurance? Republicans are trying to ram the bill through before the Congressional Budget Office has time to analyze it — an attempt that is in itself a violation of all previous norms, and amounts to an admission that the bill can’t bear scrutiny. But C.B.O. has analyzed other bills containing some of Graham-Cassidy’s provisions, and these previous analyses suggest that it would add more than 30 million people to the ranks of the uninsured.

Both Cassidy and Graham insist that their bill would continue to protect Americans with pre-existing conditions — a claim that will come as news to the A.M.A., Blue Cross and everyone else who has read the bill’s text.

Independent analyses find that most states would, in fact, experience serious cuts in federal aid — and everyone would face huge cuts after 2027.

So we’re looking at an incompetently drafted bill that would hurt millions of people, whose sponsors are trying to sell it with transparently false claims. How is it that this bill might nonetheless pass the Senate?

One answer is that Republicans are desperate to destroy President Barack Obama’s legacy in any way possible, no matter how many American lives they ruin in the process.

Another answer is that most Republican legislators neither know nor care about policy substance. This is especially true on health care, where they never tried to understand why Obamacare looks the way it does, or how to devise a nonvicious alternative.

I’d add that the evasions and lies we’re seeing on this bill have been standard G.O.P. operating procedure for years. The trick of converting federal programs into block grants, then pretending that this wouldn’t mean savage cuts, was central to every one of Paul Ryan’s much-hyped budgets. The trick of comparing dollar numbers over time to conceal huge benefit cuts has, as I already noted, been around since the 1990s.

In other words, Graham-Cassidy isn’t an aberration; it’s more like the distilled essence of everything wrong with modern Republicans. . . . even if the handful of Republican senators who retain some conscience block it — we’re looking at you, John McCain — the underlying sickness of the G.O.P. 

I again find myself how any one morally decent vote Republican given what the GOP has become both at the state and at the federal level.  It epitomizes moral bankruptcy and cruelty towards others. 

Trumpism and the Ugliness of Today's GOP

As I have often noted, I was once a Republican back in the days before the ascendancy of the Christofascists and the white supremacists (the two generally go hand in hand) within the Republican Party.  Indeed, in May of 1999, near the end of my membership in the GOP, I even handled the incorporation of the Republican Party of Virginia Beach at the request of the then moderate City Committee chair who was later ousted by a coup by the hard right.  Since that time the Republican Party at both the state and national level has continued its descent into ugliness and misogyny.   The only true principles of the party now are trashing the environment, attacking the rights of those its base deems "other" - gays and Muslims being two favorite bogeymen - and concocting schemes to shift wealth from the poor and working/middle class to the most wealthy individuals and the nation's large corporations.  Things that were once too reprehensible to say in public discourse even if one thought them in private are now mainstream in the GOP and there seems to be no limit to how low things will go.  The election of Der  Trumpenführer is the culmination of years of malignancy and, despite the media's efforts to depict economic worry as  the motivating factor for Trump voters, the truth is something much uglier.  An op-ed in the New York Times describes the sickness and the party's leader well.  Here are excerpts:

This week’s New York Times interview with Donald Trump was horrifying, yet curiously unsurprising. Yes, the world’s most powerful man is lazy, ignorant, dishonest and vindictive. But we knew that already.

In fact, the most revealing thing in the interview may be Mr. Trump’s defense of Bill O’Reilly, accused of sexual predation and abuse of power: “He’s a good person.” This, I’d argue, tells us more about both the man from Mar-a-Lago and the motivations of his base than his ramblings about infrastructure and trade.

First, however, here’s a question: How much difference has it made, really, that Donald Trump rather than a conventional Republican sits in the White House?

The Trump administration is, by all accounts, a mess. The vast majority of key presidential appointments requiring Senate confirmation are unfilled; whatever people are in place are preoccupied with factional infighting. Decision-making sounds more like palace intrigues in a sultan’s seraglio than policy formulation in a republic. And then there are those tweets.

Yet Mr. Trump’s first great policy and political debacle — the ignominious collapse of the effort to kill Obamacare — owed almost nothing to executive dysfunction. . . . . it failed because Republicans have been lying about health care for eight years. So when the time came to propose something real, all they could offer were various ways to package mass loss of coverage.

Similar considerations apply on other fronts. Tax reform looks like a bust, not because the Trump administration has no idea what it’s doing (although it doesn’t), but because nobody in the G.O.P. ever put in the hard work of figuring out what should change and how to sell those changes.

[G]iven what we heard in the interview — basically incoherent word salad mixed with random remarks about transportation in Queens — it’s clear that the administration has no actual infrastructure plan, and probably never will.

True, there are some places where Mr. Trump does seem likely to have a big impact — most notably, in crippling environmental policy. But that’s what any Republican would have done; climate change denialism and the belief that our air and water are too clean are mainstream positions in the modern G.O.P.

[W]hat Trumpism has brought is a new sense of empowerment to the ugliest aspects of American politics.

By now there’s a whole genre of media portraits of working-class Trump supporters (there are even parody versions). You know what I mean: interviews with down-on-their-luck rural whites who are troubled to learn that all those liberals who warned them that they would be hurt by Trump policies were right, but still support Mr. Trump, because they believe that liberal elites look down on them and think they’re stupid. Hmm.

Trump gives outright, unapologetic voice to racism, sexism, contempt for “losers” and so on — feelings that have always been an important source of conservative support, but have long been things you weren’t supposed to talk about openly. . . . Fox News in general, and Mr. O’Reilly in particular, is that they provide a safe space for people who want an affirmation that their uglier impulses are, in fact, justified and perfectly O.K. And one way to think about the Trump White House is that it’s attempting to expand that safe space to include the nation as a whole.

And the big question about Trumpism — bigger, arguably, than the legislative agenda — is whether unapologetic ugliness is a winning political strategy.

Will Revived GOP Health Care Effort Bring Back Preexisting Condition Bars?

Those who have felt safer in the wake of the Republican Party's failure to pass legislation to repeal and "replace" Obamacare need to still be afraid.  Efforts are stirring among House Republicans to have another go at "reform" and the consequences could be that the health insurance market would return to much of its pre-Obamacare nature: those with preexisting conditions could be excluded from policy coverage and those with health problems could see premium costs soar to a point where any tax credits awarded under the GOP plan would barely scratch the costs of coverage.  To use a term the GOP coined, insurance companies would become death panels largely determining who gets treatment and who dies.  The main force behind the effort id the "conservative" House Freedom Caucus, a group that espouses respect for Christian values but which obviously has cast aside the Gospel message of caring for the sick.  A piece in the New York Times looks at the foul proposals brewing in the House of Representatives.  Here are excerpts: 

Monday night, word emerged that the White House and the group of conservative lawmakers known as the Freedom Caucus had discussed a proposal to revive the bill. But the proposed changes would effectively cast the Affordable Care Act’s pre-existing conditions provision aside.

The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

The proposal is not final, but Mr. Meadows told reporters after the meeting that his members would be interested in such a bill. To pass the House, any bill would need to find favor not just with the Freedom Caucus, but also with more moderate Republicans. It would also need to attract the support of nearly every Republican in the Senate to become law.

The ability to opt out of the benefit requirements could substantially reduce the value of insurance on the market. A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn’t do her much good if that plan was not required to cover chemotherapy drugs.

The second opt-out would make the insurance options for those with pre-existing conditions even more meaningless.

Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without community rating, health plans would be free to charge those patients as much as they wanted. If both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up.

There is a reason that many conservatives want to do away with these provisions. Because they help people with substantial health care needs buy relatively affordable coverage, they drive up the price of insurance for people who are healthy. An insurance market that did not include cancer care — or even any cancer patients — would be one where premiums for the remaining customers were much lower. The result might be a market that is much more affordable for people with a clean bill of health. But it would become largely inaccessible to anyone who really needs help paying for medical care.

We do not have to speculate to know what the world looks like without essential health benefits and community rating. It was how most state insurance markets worked before Obamacare. Back in 2009, most sick people who did not get insurance through work or a government program were excluded from coverage if they had a history of health problems like allergies or arthritis. Plans that did not cover pregnancy care or drug addiction treatment were widespread.

[I]nsurance in the old high-risk pools tended to be expensive, and often came with long waiting periods or benefit limitations, even for the very sick.

What states would choose to do with this set of options is hard to predict. Before Obamacare, few states required community rating of health plans. And few states required insurers to cover all of the benefits deemed essential under Obamacare, though most did require a few types of treatments to be covered. State governments would face a difficult choice: either take away the requirements, and leave sick patients without insurance options, or keep them and see people unable to afford coverage under the new subsidy system.

Mr. Meadows said that the proposal presented to the Freedom Caucus would retain the pre-existing conditions policy. But that would be true in only the most literal sense. The mix of policies could allow insurance companies to charge sick people prices that few of them could pay. And it could allow them to exclude benefits that many healthy people need when they get sick. The result could be a world where people with pre-existing conditions would struggle to buy comprehensive health insurance — just like before Obamacare.

As I have argued for some time, the only real solution is a single payer system like the rest of the advanced world utilizes that would take the power of life and death away from insurance companies.  It is really that simple. 

Today's GOP: America Has Never Seen a Political PartyLess Caring

Just this week Der Trumpenführer has signed executive orders and directed minions to take actions that will trash the environment, erase LGBT citizens from the 2020 census, rescind non-discrimination protections, and reduce safety regulations.  And this follows last week's thankfully failed attempt to throw 24 million Americans off of healthcare insurance and budget cut proposals that would slash the social safety net. Yet the Republican Party farcically continues to claim that it is the party of Christian values even as its agenda and the seething hatred of much of its base towards others make the biblical Pharisees look like a combination of Mother Theresa and generous philanthropists.  What is stunning is the fact that the GOP wasn't always this way.  Indeed, not to sound like a broken record, the party was not so cruel and, in my view evil, until its base was hijacked by Christian fundamentalists, a large portion of whom (if not a majority) are racists.  Yes, this is a harsh statement, but if one looks at leaders of the so-called "family values" organizations, these groups are lily white and beneath the surface there is a strong current of racism and white supremacy.  Here in Virginia, The Family Foundation traces its roots to the proponents of segregation and "Massive Resistance." At the national level, individuals like Tony Perkins of Family Research Council has open ties to white supremacy groups.  Having seen the rise of these factions in the GOP prior to my leaving the party and having watched the rot that has occurred since, this element of the GOP based bears much of the blame.  Throw in the Koch brothers and those who want to rob the poor to benefit the rich and one gets an ugly and toxic result.  An op-ed in The Guardian looks at the horror that today's Republican Party has become.  Here are excerpts:

Last week I was taking an Uber (I know, I’m sorry, it was a necessity) across an unfamiliar town when the driver, whom I’ll call Randy, started telling me about this cool dude named Jesus. Randy’s big opener, earlier in the ride, was to gesture at a homeless man panhandling by the side of the road and say: “Isn’t it terrible?”

“Yeah,” I agreed, though I was unsure whether he was referring to homelessness as a blight or a form of state violence. “I can’t believe my tax money pays for the president’s golf vacations while people are freezing to death on the street. It’s robbery.”

At least Randy cared about that homeless guy, though, which is more than I can say for the Republican party.
I’ve been thinking a lot about the notion of “care” lately. Care can be florid and romantic or bureaucratic and dry; it is maintenance and stewardship and only sometimes love. You can take care of something without personally caring about it, which is precisely what we pay our elected officials to do: take care of our communities and our planet, whether or not you share our priorities and fears and weaknesses and religions and sexual orientations and gender identities and skin colours. We put ourselves and our money in your hands. Take care.

I don’t know that America has ever seen a political party so divested of care. Since Trump took office, Republicans have proposed legislation to destroy unions, the healthcare system, the education system and the Environmental Protection Agency; to defund the reproductive health charity Planned Parenthood and restrict abortion; to stifle public protest and decimate arts funding; to increase the risk of violence against trans people and roll back anti-discrimination laws; and to funnel more and more wealth from the poorest to the richest. Every executive order and piece of GOP legislation is destructive, aimed at dismantling something else, never creating anything new, never in the service of improving the care of the nation.

That void at the heart of the party, that loss of any tether to humanity, is breeding anxiety on both sides of the political divide. According to the Atlantic, Florida Republican Tom Rooney recently turned on his cohort with surprising lucidity: “I’ve been in this job eight years and I’m racking my brain to think of one thing our party has done that’s been something positive, that’s been something other than stopping something else from happening. We need to start having victories as a party. And if we can’t, then it’s hard to justify why we should be back here.”

In the wake of the Republican party’s luscious, succulent failure to obliterate the Affordable Care Act (Obamacare) and replace it with catastrophic nationwide poverty and death, an old video of a Paul Ryan gaffe went viral. “We’re not going to give up,” Ryan assures his audience, “on destroying the healthcare system for the American people.” 

The clip is from 2013, not 2017, and obviously Ryan did not mean to say into a microphone that he wants to destroy the healthcare system. But here’s the thing. I talk into a microphone in front of people all the time, and not once have I ever accidentally said: “Hitler was pretty cool” when what I meant to say was: “Throw all Nazis into the sea”. Even if we acknowledge that such a slip of the tongue is technically possible (if not likely), we don’t actually need to wonder about what Ryan secretly believes. Gaffe or no, we already know he wants to destroy the healthcare system for the American people, because he tried to pass legislation that would destroy the healthcare system for the American people. And because destruction, not life, is the foundation of Ryan’s party.

I truly do not know how decent, moral people can continue to support the Republican Party.  Those that I know who do, like to see themselves as decent, informed people.  Yet, most are highly uninformed - Fox News brainwashing should be categorized as a clinical condition - and if pressed either cannot support their positions or end up agreeing with liberal positions.  I truly do not comprehend the desire to "be a conservative" when conservatism as represented by today's GOP is something so abhorrent.  As for the "godly folk" who comprise the GOP's care base, they are such hate-filled and hypocrisy-filled people, that I no longer even want to call myself a Christian because the connotation has become so negative.  Witness the under 30 generations, a third of whom have walked away from religion.  I am hardly alone.

The GOP's Biggest Loser on Healthcare Debacle: Paul Ryan

Delcan & Company; Photo by Al Drago/The New York Times

I and others have been making the case that of the Congressional Republicans perhaps the biggest fraud is Speaker of the House Paul Ryan.  His hypocrisy is almost unlimited, especially as he claims to be a dutiful Catholic out of one side of his mouth while at the same time pushing policies that are abhorrent from the perspective of the Catholic Church's social gospel.  For far too long, the media has give Ryan a pass on this breath taking hypocrisy.  Worse yet, many journalists have acted as if Ryan is a serious thinker and a policy expert.  The realty is that these images are empty and unsupported by objective facts.  If Ryan is expert at anything, it is at devising ways to take from the poor and middle class while give to the wealthy and then openly lying about the horrific impact of his policies on average Americans.  Thankfully, last week's American Health Care Act debacle may finally have the laudatory effect of showing the shallowness and cravenness - I would even argue moral bankruptcy - of Mr. Ryan.  A main page editorial in the New York Times does a wonderful take down of Ryan. Here are highlights:

“Look, I’m a policy guy.” That was Paul Ryan’s line before last Friday, when the health care bill he designed in secret went down without a vote, his own party showing what they thought of his policy.

Time and again when he was asked about President Trump’s attacks on immigrants or the courts, his ties to Russia or his claims of massive election fraud, the speaker of the House would say he was too busy working on his agenda, “A Better Way,” to think about all that nasty stuff.

That Mr. Ryan failed on the policy promise that Republicans have been running on for eight years makes it clear that if he is the policy wonk of the Republican Party, then the Republican Party has no policy. And with a health care plan that would have stripped 24 million Americans of basic care and drastically hiked premiums for people over 60, it seems that they don’t much care what Americans need or want.

The discrepancy between promise and reality should be no surprise to anyone who has looked at Mr. Ryan’s proposals over the years. Mr. Ryan has been rolling out grand pronouncements in bound volumes with fancy covers and snappy names, but the main message never changed: America‘s “path to prosperity” (remember that one? 2011) lies in tax cuts for the wealthy and corporations, and slashing social programs and regulations.

Three years ago, a House Republican leader said his report on antipoverty programs showed that “Paul Ryan remains our big-ideas guy.” We called it “a high-minded excuse” to “eviscerate programs like Medicaid, Head Start and food stamps.”

After Mitt Romney, with Mr. Ryan as his running mate, lost the presidential election in 2012, . . . . Mr. Ryan responded by repackaging the same agenda for the 2016 election, even though working-class Americans were demonstrating fury at his establishment orthodoxy. They didn’t want Social Security cut and they wanted the “health care for everybody” that Mr. Trump promised.

After seven years and 60 failed Republican efforts to “repeal and replace” Obamacare, Mr. Ryan finally got his moment, and blew it.

After pulling the bill, Mr. Ryan showed he hadn’t given up on trying to make people think he was someone they could believe in. With no detectable irony, he described his humiliating defeat as “an incredible opportunity,” adding “There remains so much that we can do to help improve people’s lives, and we will.”

But he’s fooling no one any longer. Put to the test, Mr. Ryan revealed that all along, he doesn’t have anything more creative in his cranium than stale conservative dogma.

He had helped fulfill a cynical prophecy delivered last month by John Boehner, . . . . . “In the 25 years that I served in the United States Congress,” Mr. Boehner said, “Republicans never, ever, one time agreed on what a health care proposal should look like. Not once. And all this happy talk that went on in November and December and January about repeal, repeal, repeal — yeah, we’ll do replace, replace — I started laughing.”

We might thank Mr. Ryan for one thing. His dreadful legislation drove voters of both parties to flood town halls and the Capitol, demanding that Congress reject the bill.

One can only hope that going forward, the media will recognize Ryan for the small minded phony that he is and give him media coverage that no longer aids the pretense that the man is a serious thinker.  

Is Healthcare Reform The Republicans' Waterloo?

There are two factors that Republicans seem unable to grasp as they seek to inflict their reverse Robin Hood agenda on America: (i) many GOP congressional seats are held because of gerrymandering, not because the GOP's policies are overwhelmingly popular, and (ii) Donald Trump won the presidency due to an Electoral College fluke - and the gutlessness of Electors - and overall won the vote of less than 30% of voters.  A third factor that may be also in play is the reality that a majority of Americans want the federal government involved in healthcare.  Indeed some pools suggest that a majority of Americans want a single payer system that would take away the power of health insurance companies that only care about making money and, frankly, do not give a damn abut taking cared their insureds or their insureds' best interest.  If the congressional Republicans had joined in passing Obamacare and been willing to take even more power from insurance companies and pharmaceutical companies, the nation would likely have a much improved and better perform healthcare system.  Instead, Republicans sold their souls to insurance companies and pharmaceutical companies and clung to the myth that the free market could improve coverage and reduce cost.  Anyone honest should concede that what the Republicans harp on even today is simply out of touch with objective reality.  Worse yet, a majority of Americans are catching on to the fact that the currently dead American Health Care Act was really all about give a trillion dollar tax break to corporations and the obscenely wealthy. . 

Conservative writer and columnist David Frum warned Republicans back when Obamacare was first being crafted that GOP obstruction and non-participation would haunt the party.  For his candor and insight, he was refarded by being figuratively ridden out of town on a rail by his Republican brethren. He's back again and once more suggests that healthcare and the public yearning for a well functioning national healthcare system will be the GOP's Waterloo.  He makes the case in a lengthy piece in The Atlantic.  It is a long piece, but worth the read and it shows what conservatism should be. Here are excerpts:

Seven years and three days ago, the House of Representatives grumblingly voted to approve the Senate’s version of the Affordable Care Act.  . . . . Rather than lose the whole thing, the House swallowed hard and accepted a bill that liberals regarded as a giveaway to insurance companies and other interest groups. The finished law proceeded to President Obama for signature on March 23, 2010.

A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism. The timing could not have been worse. At precisely the moment we were urging the GOP to march in one direction, the great mass of conservatives and Republicans had turned on the double in the other, toward an ever more wild and even paranoid extremism. 

At that time, I worked at the American Enterprise Institute, the most high-toned of Washington’s conservative think tanks. . . . The mood then was that supporters and opponents of the Obama administration were engaged in a furious battle over whether the United States would remain a capitalist economy at all.

It was no moment for advocates of compromise—indeed, it was precisely because I appreciated its unwelcomeness where I worked that I had launched an independent blog in the first place. There, to the increasing irritation of my colleagues and employers, I fruitlessly argued through 2009 and 2010 that Republicans should do business with President Obama on health-care reform.

It seemed to me that Obama’s adoption of ideas developed at the Heritage Foundation in the early 1990s—and then enacted into state law in Massachusetts by Governor Mitt Romney—offered the best near-term hope to control the federal health-care spending that would otherwise devour the defense budget and force taxes upward. I suggested that universal coverage was a worthy goal, and one that would hugely relieve the anxieties of working-class and middle-class Americans who had suffered so much in the Great Recession. 

[W]hen the Democrats indeed did pass the law without Republican input, just as I’d warned they would, a fury overcame me. Eighteen months of being called a “sellout” will do that to a man, I suppose. I opened my computer and in less than half an hour pounded out the blogpost that would function, more or less, as my suicide note in the organized conservative world.

The post was called “Waterloo.” . . . . Even more provocatively to Republicans already fixed on a promise to repeal the Obamacare abomination, I urged: "No illusions please: This bill will not be repealed." . . . . The next morning came a phone call inviting me to talk things over with AEI’s president. By Thursday, I was an ex-think-tank staffer.

Over the next seven years, Republicans would vote again and again to repeal the Affordable Care Act. Total and permanent opposition to the law would become the absolute touchstone of Republican loyalty. . . . . From time to time, some old veteran would recall my 2010 prediction that the law would endure and smilingly wonder if I wished to reconsider.

I never did, for the reasons that the whole world has witnessed in real time over this week of Obamacare’s 7th anniversary.

Some of the conservatives who voted “no” to the House leadership’s version of repeal may yet imagine that they will have some other opportunity to void the law. They are again deluding themselves. . . . . Too many people benefit from the law—and the Republican alternatives thus far offer too little to compensate for the loss of those benefits.

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

What happens now is that—a few bitter-enders aside—Republican politicians, especially in the states, begin the slow and belated process of entering the next era of health-care politics. . . . How generous should health coverage be? What should be done to control costs? Who should pay, and on what terms? To what extent should citizens be free to impose the cost of their unhealthy choices upon others? Conservative-minded people will converge on one set of intuitions; progressives on another. It’s possible to imagine a Republican health-care politics that rejects the ultra-redistributionary approach of the ACA and instead argues that since all benefit from health coverage, all must contribute to its costs via some kind of broad-based tax. 

It’s possible to imagine a Republican Party that cares about the details of health policy and is not satisfied with poorly informed hand waves toward outworn party shibboleths. It won’t happen soon, perhaps—but the sooner the better.

Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism—and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.

I take no pride or pleasure in saying “I told you so.” . . . . Republicans who were wrong about the evolution of this debate please consider why they were wrong: Consider the destructive effect of ideological conformity, of ignorance of the experience of comparable countries, and of a conservative political culture that incentivizes intransigence, radicalism, and anger over prudence, moderation, and compassion.

Frum is 100% on target and the sooner sane Republicans get on board with what he suggests, the better. That may mean jettisoning the hate-filled Christofascists who rallied to Obamacare repeal, but that would be a very positive development for the GOP.

The Real Reason Behind the GOP's Rush to Repeal Obamacare

There was in truth only one real motivation behind the GOP's thankfully failed Obamacare "repeal and replace" effort:huge tax cuts for corporations and the wealthiest Americans.   Yes, some of the most right wing Republicans are anti-government and want the government out of the healthcare arena completely, but the net effect of a total repeal with no replacement would be the same, namely huge tax cuts for corporations and the truly wealthy.  What I found so utterly dishonest was the GOP claim that tax credits would have allowed individuals the "freedom to choose the coverage best for them."  The reality is that the tax cuts were so inadequate that there'd be only one "choice" available - to have no coverage.  Even if working class individuals were relieved of all income tax obligations, in most instances, it would still not provide the funding needed for healthcare coverage.  The "replacement" offered also ignored the reality that many employees with coverage offered through their jobs fail to secure coverage for one reason: they cannot afford to add coverage for their spouse and/or children due to the expense.   

Like so much else in the GOP agenda, what Paul Ryan and Der Trumpenführer were peddling was one huge lie.  Voters well for it during the 2016 elections, but with every passing day, the abortion known as the American Health Care Act was increasingly recognized as a con job that would harm millions of Americans.  A piece in the Washington Post looks at why the GOP was in such a hurry.  It also suggests what any "tax reform" package offered up by the GOP will have as its underlying motive.  Here are highlights:

Why were Republicans rushing to vote on a health-care plan that they'd barely finished drafting, that budget scorekeepers hadn't had a chance to fully evaluate, and that, insofar as people did know about it, was widely despised?

In part, it's because their plan was so unpopular and because it got more unpopular the more people learned about it. But it's also because only by rushing to reshape a full sixth of the American economy without knowing exactly how they would be reshaping it would Republicans be able to use health care to pave the way for the rest of their agenda, including tax reform. In other words, the GOP didn't want to let a detail like tens of millions of people losing their health insurance get in the way of two tax cuts for the rich.

Here's what we knew about the Republican plan. The latest version that the nonpartisan Congressional Budget Office had a chance to analyze would have, over the course of 10 years, cut taxes by $1 trillion, disproportionately benefiting the rich; cut Medicaid spending by $839 billion, exclusively harming the poor and sick; and cut the Affordable Care Act's health insurance subsidies by about $300 billion, mostly hurting older people of modest means. Add it all up, and the CBO estimated that 24 million people would have lost their health insurance as a result. Not only that, but premiums would have increased 15 percent to 20 percent more than they otherwise would have in the next four years. . . 

This wasn't just a matter of higher premiums and higher deductibles, though. Trumpcare also would have repealed the “essential health benefits” that plans are required to cover now. States would have been allowed to write their own rules, so, depending on where you lived, insurance companies might have been able to sell you “insurance” that didn't cover hospitalizations, prescription drugs, maternity care, mental health care and preventive care, and also imposed annual and lifetime limits on your benefits. 

The surprising thing, then, isn't that as few as 17 percent of people approved of the American Health Care Act. It's that as many as 17 percent did.

But there's a reason the GOP was pushing a bill that would have taken everything people don't like about the health-care system and made it worse. That's the fact that it would have allowed them to pass two permanent tax cuts for the rich. Anyone, you see, can pass a tax cut that expires after 10 years. But if you want to make it last — and you don't have 60 votes in the Senate — then you need to find a way to pay for it (or at least look like you did). Taking health insurance away from poor and sick people would have done just that for the Obamacare taxes, which primarily hit people in the top 1 or 2 percent. 

[T]he combination of tax cuts for the rich and benefit cuts for the poor that was the GOP health-care plan would have been a reverse Robin Hood that redistributed income from people making $50,000 or less to mostly those making $200,000 or more.

If Republicans had repealed the Affordable Care Act's $1 trillion worth of taxes before they revised taxes, that's $1 trillion less they'd have to come up with to make it look like money wasn't being lost. Now, without those phantom savings, tax restructuring, Speaker of the House Paul D. Ryan (R-Wis.) admitted, will be “more difficult.” Not that it was ever going to be easy. After all, the $1 trillion they were trying to save with a “border adjustment tax” seems to be on political life support, since every major retailer, including big GOP donors such as Walmart, is opposed to it.

Republicans will either have to scale back their ambitions for how deeply they will cut taxes or how long they will. Whatever they choose, though, the top tax rate isn't going to stay under 30 percent.  And for the GOP, that's the real tragedy of 24 million people keeping their health insurance.

So why do working class whites who would have been screwed royally by the GOP "replacement" plan vote Republican?  For many of the rich, it is obvious: greed and self-enrichment via tax cuts.  But why the rest?  The answer is the same one that Republicans have used for many years now.  Appeal to racism and white nationalism, generate hatred due to loss of white privilege, use abortion as a snare for right wing Christians, and demonize those deemed "other."  It's the same method used over and over again by the GOP to get individuals to vote against their own best interests.  What's amazing is that so many are so gullible - or perhaps stupid is the better word - that they keep falling for the same ploy. When are these people going to wake the hell up?