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The Voice of Poverty and Disability

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The ACA – crosspost from General Discussion

  • Enlightenment (887 posts)
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    The ACA – crosspost from General Discussion

    Dragonfli asked if I would post this here, which I’m happy to do. It came as the result of a discussion about Aetna’s threat to leave the ACA marketplace, in response to a poster with a rosier outlook on the program than I have.


    I honestly do not mean to be rude, but I need to say this because silence festers.

    President Obama shut the door on single-payer. Advocates were not even allowed to speak, let alone given a place at the table.

    The idea that the administration created this labyrinthine, loophole-filled gift to private insurance companies with an end-game of forcing a move to single-payer is ludicrous – a fairytale created to give the President an ‘out’. It smacks of the excuses made by children who discover they were the only one not invited to the birthday party; or the unpopular teenager whose ‘friends’ take advantage of them, time and time again.

    As for the rest – the ‘it will happen sometime’ mantra? Yes, it probably will. Not anytime soon, but sometime – maybe – in some future that we may or may not be around to see. On the other hand, maybe it won’t. Hope and change don’t seem to mean very much in the end, do they?

    In the meantime, someone else in this nation is suffering or dying because they can’t get the care they need. They may be in a state that was allowed to refuse expanded Medicaid – or make $5 more than the minimum to qualify, can’t afford the cheapest ACA plan available to them, and figure the penalty is still cheaper than the premium. Or they have a crappy ACA plan with high deductibles they can’t afford to pay . . .

    This isn’t a philosophical argument for millions of people.  An estimated 32.3 million – about 1 in every 10 – non-elderly adults in this country are uninsured (Kaiser FF statistics from late 2015). An untold number more are technically insured, but unable to access the care they need. The elderly are left out of the equation all-together – but we know that even with Medicare, many elders are unable to access the care they need and can’t afford the Part D costs of their drugs.

    All the upbeat news stories and carefully parsed statistics in the world won’t change the fact that the ACA has done very little to help the majority. Yes, people with pre-existing conditions can get insurance; yes, many children are covered for the basics, at least. There are some bells and whistles and nice little pluses tucked into the ACA that have pleased many people – and those people are loud and fervent in their support, shouting down the voices of those who try and explain that the ACA hasn’t helped them, or has, in many cases, made things worse, not better.

    Can we please stop pretending the ACA is anything but what it was ultimately designed to be – a permanent placement of for-profit insurance with mandated payments and government sanctioned penalties for non-compliance?

    jwirr, em77, VoiceOfReason and 16 othersRubicon, Lynetta, kath, The Crone, Zopilote, Enthusiast, Mad to the Marrow, 7wo7rees, TheNutcracker, morgwynn, Dragonfli, TM99, Doremus Jessup, Downwinder, MistaP, polly7 like this
    All political parties die at last of swallowing their own lies. - John Arbuthnot, 1637-1735

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12 replies
  • Enthusiast (11183 posts)
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    1. The ACA could be more accurately

    described as the Single Payer Prevention Act.

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. There would be no place to hide."  Frank Church "When plunder becomes a way of life for a group of men in society, over the course of time they create for themselves a legal system that authorizes it and a moral code that glorifies it." - Frederic Bastiat, 1848
    • The Crone (3157 posts)
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      2. That is an elegantly crafted description of the

      Complete fuckwad of a situation that now exists.

      "Let us not seek the Republican answer nor the Democratic answer but the right answer." John F. Kennedy   America is the only country that has real   lemons in its furniture polish, and artificial lemon flavoring  in its lemonade!
      • athena1 (66 posts)
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        4. Yes, it is.

        And the planned/proposed “public option, round two” isn’t going to help at all.

        • The Crone (3157 posts)
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          5. I hadn't heard anything about that. I do

          Know that everyone who likes the ACA tells the public that it is the very first step towards Single payer. I don’t know what they are smoking, but it’s gotta be some pretty heavy duty stuff.

          So who is in charge of public option two? (if you know.)

          "Let us not seek the Republican answer nor the Democratic answer but the right answer." John F. Kennedy   America is the only country that has real   lemons in its furniture polish, and artificial lemon flavoring  in its lemonade!
          • athena1 (66 posts)
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            6. Good question!

            It’s a tad difficult to say. http://www.nakedcapitalism.com/2016/08/the-underground-history-of-the-so-called-public-option-plus-underpants-gnomes-2.html

        • Akallabeth (2234 posts)
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          11. There cannot be any public – its barred. That was never a viable proposal.

          New public services were stood still in 1995 and again in 1998. . The new TISA has a similar clause in it.


          This link is also informative.

          "Out of many, one"
    • Akallabeth (2234 posts)
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      7. Its complicated because the Act that prevented it is still ambiguous.

      Single payer was really prevented by our entry into the WTO in 1995 or by the Understanding on Commitment in Financial Services in 1998.  but in order for it to really “take” a foreign insurance provider has to enter our market and as far as I know that has not happened yet. Its also possible that our signing the deal that cannot be named will trigger the changes. Lori Wallach speaking on Democracy Now in June 2014 described a situation that applies to all financial services, the situation she describes likely also applies to health insurance. It could be rolled back.  So the guaranteed issue in particular (thats the part the insurance companies like the least) will probably not be long for this world once it becomes international trade.

      What would replace it? International trade.


      I think the guaranteed issue was not meant to last very long, that was just as the title says the single payer prevention act. Because once it becomes international trade and the economic well being of the poor countries is tied to it it will be impossible to reverse it.

      The less developed countries/developing world have been promised this for 20 years (since the last Clinton Administration) and with Clinton’s wife coming in they jolly well better get it.

      It will also familiarize America’s poor with how much farther their dwindling money will take them outside the US, as well as remove them from a rapidly shrinking job market, also they are less likely to vote if overseas.  Kills several birds with one stone so to speak.

      "Out of many, one"
  • The Crone (3157 posts)
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    3. Interesting is it not, that we

    consumers get hit with penalties if we don’t comply. But the Big Medical Industry can continue to provide crap service, delay treatment, hike up prices of needed pharmaceuticals, and on and on, with  nary a penalty in sight

    "Let us not seek the Republican answer nor the Democratic answer but the right answer." John F. Kennedy   America is the only country that has real   lemons in its furniture polish, and artificial lemon flavoring  in its lemonade!
    • Akallabeth (2234 posts)
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      8. The way international investment treaties work is that they have a ratchet which

      requires that any changes make the regulatory picture more profitable for multinational corporations and never less.

      Frank Zappa put it well, “The rights to you have already been sold”.

      As you pointed out, health insurance companies make extremely long and restrictive contracts a condition of being listed for doctors and nurses, and other professionals, and in the case of medical workers they can delist them for any reason or even no reason at all.

      The trend is away from family doctors. insurance companies want to control the medical system. Washington has been trying to help them for some time and their plans are about to come to fruition.Complaints about health care losing its profitability will be addressed by international trade in skilled persons across borders.

      The next few decades will see tremendous increases in international trade in services with substantial increases in corporate profitability to occur by fully applying the global value chains concept to services.

      new rules regarding international cross-licensing will make it routine to be treated by doctors from other parts of the world here under trade agreements. They will be far less likely to suggest treatments or tests which their employer does not want because if fired they will have to immediately leave the country and go home.

      ERISA Section 514 is basically a license to “mistreat” or fail to diagnose Americans who get health insurance through a health plan that is a benefit of employment. Its like the situation I described earlier, a sort of escape clause that allows insurance companies to get away with almost anything. Considering how it gives a green light to insurance companies, its a miracle health care in the US isn’t much worse even than it is. And it is pretty bad.  But I am sure its going to get worse as we move into the future because frankly, its there for one reason, to keep working people working and making money for their employers. Once they are no longer employed, disabled, redundant, etc, the way things are set up now,  they are no longer economically relevant to the system and in times when the economy is growing, the grandiose plans of the powers that be start drifting towards all the money they could make if they could just get rid of all that “dead weight”. In other words, the self styled movers and shakers in society would rather replace them with somebody else who is.  Unfortunately, bernie lost and he was pretty much lied to to give him an opportunity to save face. But we shouldnt have any illusions that anything was accomplished there. There is going to be a lot of churning under Clinton and its not going to be kind to people living in urban areas who are seen as living in the path of progress.  Rising energy costs in particular will lead to a lot of “urban removal” as Cornell West puts it. And thats what it is.  They will jump at any opportunity to “free up” land for development.

      The US has been the worst country in the developed world to have a chronic health condition in for a long time.

      This began long before trade deals.

      ERISA Section 514 allows health insurance companies to automatically have any lawsuits over failure to diagnose etc, rendered moot by Federal law as long as they meet an extremely malleable and ever lowering “legal standard of care” the legal standard of care is always going down now, and varies based on what country and state (and probably soon country) the patient is treated in.  By pushing down the legal standard of care they can reduce their potential liability.

      Plus if they tie insurance to jobs and then give employers a “reasonable factor other than age” (“RFOA” or “RFOTA”)  allowing them to lay people off as they get older, because of cost, that makes the real reason for all the job loss less obvious longer.

      So, Obamacare was a gift to a lot more corporate entities than just the health insurance and drug industries.


      "Out of many, one"
      • The Crone (3157 posts)
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        9. What a report. And I don't doubt a single

        Point that you are making.

        As someone who did elder care for almost twenty years, and sometimes got quite an income once older people realized they could have me come in as a personal nursing assistant while they were in the hospital, I uncovered so many egregiously awful practices that I could write a book.

        Medicine mix ups were very common. With the fast pace required by hospitals of their staff, on more than one occasion I stopped a hospital employee from giving my patient a shot that was meant for the patient in the next bed.

        At one point,when I needed a specialized bandaid for a burn victim, I had to call a friend who was a nurse to bring me bandages from her home. Marin Genreal Hospital had nary a bandaid, and the ones they would have  provided me were not for a serious burn victim, and they were over six years old, which means they were no longer sterile.

        Hospitals and Big Medical Firms had persuaded the Calif legislature that there was no need for so many RVN’s or LVN’s per floor. So nursing assistants were allowed to replace many of the more highly trained.

        Eventually patient death tolls and public outrage convinced the State Legislature to reconsider the matter. Which the legislature then did for months. So they kept trying to arrive at some new category of worker, This consideration caused them to spin their wheels for weeks if not months. Everyone I knew in health care was asking, “Why don’t they simply bring the LVN designation back?” I swear that if a person needed the light in their living room on, and the state legislators were there helping, no one would ever get to hit the light switch!

        "Let us not seek the Republican answer nor the Democratic answer but the right answer." John F. Kennedy   America is the only country that has real   lemons in its furniture polish, and artificial lemon flavoring  in its lemonade!
    • Akallabeth (2234 posts)
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      10. its worse than that, we likely will continue to have the mandate to buy it but

      once it becomes international trade they can and likely will petition the WTO to make them dump all the good things that were added in the ACA, like guaranteed issue (covering people with medical problems) and limits on profits . So that will be a manufactured crisis which they will have to solve by the least “trade restrictive” method (Here is a link I just found – am just about to read- on how to figure out how the WTO figures out relative  “trade restrictiveness” ) possible, whatever that is found to be.  (It probably will involve either foreign care for poorer people or foreign firms – perhaps Indian- setting up combination health insurers/hospitals here.) Since it appears the something along those lines was in the Indian media during a recent visit by USTR Froman to India I am wondering if perhaps portability of benefits (which is called “patient Mobility”) mandating medical tourism to India may be proposed as the way to take care of poor Americans who require hospitalization? (either that or the reverse, having poor Americans be cared for by foreign firms here)

      To be honest with you, I knew that when they put forward Obamacare that it would not last very long because similar schemes have been put forward in states at least seven or eight times and they always last around three or four years and then collapse because of adverse selection. But because of our stance in the WTO and other trade deals we cannot do anything else. The GATS which does this is the real Clinton legacy. Soon it will be locked in forever, There is already (has been for quite some time) a strident propaganda campaign denigrating US professional wages (lower wage jobs will be next to follow)  and lamenting how “professional protectionist” Americans who make decent wages are responsible for the failure of health care, education IT and construction/rebuilding/green architecture/legal services to be affordable (actually we waste a third to half of every health care dollar by having the insurance system and its saying no which increases the cost of health care too.) Mode Four is a balancing factor in trade..So high perceived value jobs act as bargaining chips.

      Mode Four is described here, but not very well..

      The liberalisation of services has been in negotiations for twenty years, so the trade community is ecstatic about a Clinton Presidency and no doubt will waste no time in signing the deals which will be like another NAFTA but this time for services “everything you cannot drop on your foot”.

      Think of these service jobs here as a sort of New Deal for developing countries, that also saves US companies money on wages.

      "Out of many, one"
      • VoiceOfReason (985 posts)
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        12. coming soon

        Pseudo health care.

        "Men who do evil brilliantly are often admired"  Voltaire BERN BABY BERN!!  War is madness!