Kent Pitman

Kent Pitman
New England, USA
Philosopher, Technologist, Writer
I've been using the net in various roles—technical, social, and political—for the last 30 years. I'm disappointed that most forums don't pay for good writing and I'm ever in search of forums that do. (I've not seen any Tippem money, that's for sure.) And I worry some that our posting here for free could one day put paid writers in Closed Salon out of work. See my personal home page for more about me.


MARCH 27, 2012 12:34PM

Our National Health

Rate: 15 Flag

I guess the Obama administration has decided that rather than fight the moniker “Obamacare” they might as well embrace it. A smart move, I think. Calling it the Patient Protection and Affordable Care Act is long and clumsy, and its acronym PPACA is really no better.

And anyway, they could do worse than to be associated with caring. Is the opposition volunteering to oppose caring? Well, let them. It doesn't sound like a winning position to me. It also doesn't sound very compassionate. There's been nary a whisper by or about George Bush this primary season, as no Right-thinking Republican wants to be associated with him and his policies, so I guess they're running against compassion as well.

Speaking of compassion, the Supreme Court will today consider an unusual death penalty case. No, not for rape or murder. Those on trial today are just American citizens whose only crime is to be covered by Obamacare. Yet they may be penalized by losing critical coverage if the Supreme Court decides that's how we as a nation spell justice these days. And some of those penalized by any such Court action will die.

And why? Well, I hear it's about freedom. Somehow our freedom is enhanced if we're free to be at the mercy of individual insurance plans. Hey, if this works out, I've got an idea: Rather than debate whether lethal injection is humane or not, why don't we give convicted murderers a choice of how they'll be killed. Then when they complain they don't like it, we'll say: Hey, you chose it freely.

Funny (in a kind of sad way) that the GOP spends so much of its energy arguing that we have to “spare the lives of the unborn,” often babbling about how it's necessary compassion due to their religion, or how we might lose the next Einstein. But apparently they're pretty comfortable with little Albert, once born, losing his care. The government shouldn't be in the business of raising or educating Einsteins, just seeing they get born. I guess that's why they don't want birth control. If some of these up-and-coming Einsteins are going to plan poorly and die early, before they can crank out some useful formulas for us, we're going to need spares.

Oddly, it's the “mandate” that's being challenged. What's weird and ironic about that is that what many wanted was single-payer, universal care paid for out of taxes. There would be no Constitutional challenge to that. Taxes have clear Constitutional basis. What the Republicans don't like is the mandate, but the mandate is part of a market solution proposed by Republicans as an alternative to the Constitutionally-sound universal health care approach.

Not that the GOP would be happy with it even if it were seen as Constitutional. How offensive that people can be forced to buy something they don't want. We can be taxed, legally and Constitutionally, even to the point of nearly bankrupting the nation, to support wars we don't want. They're OK with that. But Heaven forbid we should be asked to pay for something that might save lives. That would be immoral.

And so, for reasons that seem utterly procedural, lives hang in the balance in this real life episode of Chopped. Whose insurance policies will be spared, and whose must be chopped? I guess we'll have to stay tuned.

But don't worry, if it turns out things go badly and some of us lose our health care, the others won't be forced to watch the aftermath on some sort of societal jumbotron ultrasound. Such in-your-face information is only good for individual abortions. If we end up instead casting out a large swath of society with the Constitutional bathwater, forcing the Court or the People to see the consequences of that action is not really something we'd ever want to mandate.

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Yeah, I got an opinion here Kent.

I cannot for the life of me understand the insanity of opposition to health care. Since my 'pre-existing condition' is Lupus, I had expected 'Obamacare' would be my ticket to finally getting some kind of coverage for health care.
Yet the naysayers and attack dogs are in full riot gear, braying away at how bad this new health care is going to be.

All out of words fit to print here.
Hypocrisy heaped upon hypocrisy. Mandates ARE the Republican plan, or at least they were until the Dems bent over -- again -- for a congressional colonoscopy.

Same goes for the "family values" conservatives who insist it is their responsibility to demand that every child be brought into this world, but that they have no responsibility for a child once born.

Jesus wept.
Mission, they don't object to you getting care, only to evening out the cost. They want a rebate for being healthy and a penalty for not being, as if everything in life were fixable by a free market solution. It's shameful, and it's not Christian, no matter how much they want to be the party of Christ.

Tom, maybe if we did require the GOP to view the consequences of their action there'd be some hope. But this is America. And that would infringe their freedom to ignore.
Like the Yankee Doodle song, proudly labeling Obamacare is making a negative a positive. As to the cons, they're facing the law of unintended consequences. When Barry Goldwater and Ronnie Reagan's people conceptualized their New Right society, they probably thought they were going to make prosperity in a "Leave It to Beaver" society.

Unfortunately, we've reverted back to the 1870s, with the 1880s not far behind -- massive popular and labor unrest, a corrupt and dysfunctional government, and no Indians to kill with new territory for us to use as a safety valve. Thus, the Kons have a major rear guard action problem on their hands. How do they preserve their power, which is more important to them than anything? And so we see the dilemma of the Supremes. Do they support their corporate masters, or the Federalist Society that is financially supporting the Justice Thomas family?

I'm very much looking forward to seeing what you have to say about my latest posting.
I suspect most people oppose not the pre-existing condition or covering kids parts but only the federal requirement for individual coverage. They would tell you their argument is simply that people ought to do for themselves; that's how it's always been. Thus, if you don't choose to have health insurance, you're on your own. If you lose your job and don't have health insurance, this is private industry at work. In any event, it's all as it's supposed to be and the feds ought not interfere. If one tries the argument that uninsured people w ho nevertheless need services are bankrupting the system, these folks will tell you (quietly) that the uninsured must be turned away from the emergency room. And I'm almost 100% certain those uninsured would be told to seek help through their churches.

It's mostly about whether the government is in the business of mandating care of any kind. Most people would say not. Their care is a family-centric, church-centric kind and if you have neither, too bad.
Lefty, I think the Supreme Court is in a bind, in that if they do what their Right-leaning intuitions tell them, they may wake the sleeping beast of the Democrats. I expect their response to want to be measured/narrow, but I'm not sure it can be without unraveling the whole program. They won't like the result of that, as people (Democrats and Republicans alike) will suddenly know what they've lost. It's all going to be inevitably political and nothing about what's just.

Nikki, I agree. I also think it's about creating false senses of choice so that when it comes time to deny people stuff, we can blame any ill effects (pardon bad pun) on their choice rather than society's callousness. Lost in all of this that experience is the fact that in other countries with socialized health care, the costs are lower and the health outcomes better. The assumption is that complete care would be worse, but if it means more preventative care and better planning of costs/resources, that's not obviously true at all.
what most people don't realize is that if they like the feature that requires companies to cover pre-existing conditions, they they must also accept the mandate.

Here's why: the pre-existing condition coverage is called guaranteed issue. It's not the way a private health insurance company wants to operate to enhance it's bottom line. The private insurers have an incentive to deny coverage to people statistically likely to be expensive to cover.

Most people recognize that this incentive of private insurers is contrary to basic human decency and undermines the entire reason we want to have health insurance.

The answer to this fundamental failure of free-markets to provide fair health care to everyone is to require guaranteed issue. The problem with guaranteed issue alone is that it now gives health insurance customers the incentive to wait until they get sick before they buy insurance. This has an even worse impact on the bottom line of the insurers.

If we must have private for-profit companies providing insurance (and we seem to be stuck with that for now) then in order to avoid the pre-existing condition problem we MUST have BOTH the guaranteed issue and the individual mandate. The one doesn't work economically without the other.
Okay, I own a small business. I have paid through the nose for years for family coverage. I want this healthcare reform. I want it now. I have something else to say, loud and clear. We are not inventing the wheel here. We have seen this kind of thing done successfully in other nations. I have no understanding of why this is so difficult for Republicans and others to understand. We are messing with some unknown. We know that this concept works. I am at a loss as to why we have to keep trashing our progressive ideas here for the one percent and all their minions who just don't read, and aren't aware that this is the better deal for everyone, it works and life goes on. No, they must be fixated on fetuses, sex and misogyny. Keep the subterfuge up 1% until you think you can get away with more of your bs.
Jeff, thanks for that clarification. I agree, for what that's worth.
"What the Republicans don't like is the mandate, but the mandate is part of a market solution proposed by Republicans as an alternative to the Constitutionally-sound universal health care approach. "

Which just goes to show, the Republicans wanted to derail this whole thing, right from the start. Obama included their ideas, and now they are screwing him! Goes to show, that Liberals should never trust Conservatives. We are apples and oranges! There is no compromise.

What Obama needs to do, is get a better PR crew. Evidently the general public believes all the lies, in conservative ads. They obviously have a better advertising crew!
Sheila, I've dealt with this in a small business, too, and the last thing I want to care about is whether anyone I employ is covered by insurance. That would occupy my time and I'd focus not at all on product. I don't understand why the GOP is allowed to obscure the simple fact that getting health insurance out of small business and into the basic infrastructure of society, so that business could just presuppose a healthy supply of workers and focus on product, would be a tremendous gain. My guess is that the politicians listen to Big Business and think it's the same. Big Business can afford the ridiculous overhead of having on-site staff to manage health plans and the associated legal bureaucracy, and it's even a hiring advantage to be able to say “You don't want to work for a small business because they won't be able to offer this.” Small businesses often just hope employees will get covered on others' plans, and there are exceptions to allow them to technically not have to care, though by their nature, small businesses know their employees and care nonetheless. So in this, in my view, Small Business and Big Business are just not aligned in the slightest.

I think I'm agreeing with you.
Kenny, Obama is certainly evolving in his savvy about strategy as things move along. And PR is indeed central. Hence the recent “I like ObamaCare” campaign.
Isn't it ironic that the Supreme Court turns out to be the Death Panel.
rated with love
Poetess, indeed it is. I suspect they will find a way to avoid having it look that way. But death panels aren't always about death, they are about deciding who dies and who lives. So even if the Supreme Court ends up deciding to keep Obamacare, it's still a death panel. It's unavoidable that there will be such things. What bugs me about the death panel rhetoric is that it's usually used by people who think the choice is between death panels and not. Of course there are always resource issues in the world. The question is how to be humane, and certainly the people saying that government will be a death panel are not offering something better by throwing us to the corporations. I've evoked this imagery as much as “fair play” as anything else. To some degree I don't think these questions should be decided this way. But the Right rallies its base with vivid imagery, and if those with other points of view don't do the same, then only the Right will bother to vote.
I am totally in favor of single-payor health care supported by taxes. Call it socialized medicine, or whatever, I'm in favor of it. But that's not what "Obamacare" is. I wish it were, but it isn't.

I don't know what will happen in the Supreme Court. What I do know is that the problem of unaffordable health insurance, and by extension unaffordable health care, is already a crisis and threatens to become a disaster. Addressing matters of such great importance is why we have a federal government and a congress in the first place. It is odd to me to think that the federal government would have no power to address such issues, and that instead we would have to rely on the "invisible hand" of the market to fix the problem, when the invisible hand is what has brought us to this place.

The health insurance issue is becoming the tail that wags the dog, affecting countless individual decisions and threatening the whole country. There are many thousands of people who would like to start their own businesses, but can't because they can't afford individual policies. Many thousands of other people would like to retire but can't, again for the same reason. The products of U.S. companies are becoming less competitive as the companies have to bear the cost of employee health insurance. Other thousands of people go bankrupt due to medical bills. Yet other thousands of people die from lack of affordable medical care. Other thousands of people are sucked dry by the high cost of buying individual or high-risk health insurance. The health insurance issue is like a python, wrapped around the entire country and increasingly squeezing the life out of it.
In this debate, everyone misses the essential point about how we came to have a system in which health care is provided through the work place. The short history is that labor unions started providing medical insurance for their members....and big business retaliated by incorporating health care into the employee benefits for the specific purpose of undermining union loyalty. When labor was relatively scarce and employee retention was an important goal, big business used it's health care contributions to bind workers to their jobs. Right now, my GF works because if she were to quit we would both lose our health care after the 18 month Cobra period. Since I will 65 by then, it doesn't matter to me.....but my GF is twenty years away from medicare and she would never be able to get individual coverage.

What you are all missing is that universal health care, regardless of the method through which it is delivered, would erode Corporate America's control over the working class since, if health care is universal, it no longer shackles employees to their work places.

Right now, employer managed health care is keeping millions of people in jobs they don't want, at salaries lower than they deserve, because - for one reason or another - they cannot afford to lose their health care coverage.

I have a long memory. I remember how my father got our health care through the Teamsters rather than through the companies he worked for, none of whom had health care plans....but the unions have been strangely silent about their historical role and how that role could be updated to help the present generation of workers....if there was a labor union left, which I doubt.
Mishima, Obamacare is a poor substitute for universal, single-payer healthcare but it's better than what the GOP would offer us, so I don't know what to say.

Sage, I agree. See my comments to Sheila above, which speak partly to your point as well. But you're right, too, on another point. I'll say it the way I think of it, though I think you touched on it using different words: I think The Market is at least two markets (maybe more). There is a Product Market, in which companies compete to sell their wares to consumers. There is much public debate on how to keep this a healthy market in terms of price and diversity. There is another market, which I call the Employment Market. This market is largely captured, including by Health Care. People stay at companies for reasons other than that they like the work they do, which means people who could do great things for an industry do not move to the companies best suited to them for product production because they are busy optimizing their health care instead of their work output. This is bad. It's spun as a greed issue (labor wanting more and more stuff) or at best an issue of benefits (which still I think makes it intentionally sound like gift-giving), but really it ought not be in the gift of an employer to offer health. What should get you to a company is their promise to use you efficiently and pay you well. If they don't offer that, you should be moving to another company that will. But these things act like superglue, holding you to companies for no good reason, and completely messing up the Employment Market while having a cascade effect of reducing the efficinecy of the Product Market. Approximately. I will write a blog about this sometime, trying to say it more clearly.
"Somehow our freedom is enhanced if we're free to be at the mercy of individual insurance plans. " I've never understood this. It seems clear to me that we have to give up some 'freedom' to gain other freedom. Of course I live in Canada where, yes, we pay our taxes to cover universal health care.
Myriad, you've put it well. I noticed this some time ago about privacy and freedom of speech. They are somewhat at odds. Improving privacy requires reducing someone's free speech. This is a property of the world, not of our political system, and to criticize the political system for creating the problem, rather than lauding it for confronting the complexity and attempting to strike a useful balance, makes no sense other than to score petty political victories. So of course it makes complete sense to some politicians to go the criticizing route—what if politics about other than power and personal gain, after all?

It doesn't even occur to some that there are two kinds of politicians—those trying to use broad powers to benefit some at the expense of others, and those just trying to create a fair system, even if it means some give and take. There really are both politicians of the second kind and citizens who elect them. Just sometimes the first category disguises itself as the second, or the first try to convince supporters that there are none of the second, so it's OK to be selfish. Sigh.
I'll just keep it simple and reiterate Tom's comment about how, "Mandates ARE the Republican plan, or at least they were until the Dems bent over -- again -- for a congressional colonoscopy."

If the 10% or so of Americans directly affected by this bad legislation end up losing what little help it provides, they can split the blame between both sides of the aisle. And ultimately, we don't even know that having it struck down by the court would be the worse in the long-term. That's assuming (foolishly, perhaps) that the Dems might actually remember who they are SUPPOSED to represent and make some firm stands on principle instead of on badly judged political gamesmanship.
Rick, I agree the Dems need to get it together and show some courage. We ask soldiers to die for our country. Those who serve us in Washington can at least risk a possible non-reelection in the search of truth and justice. And they may be surprised at where re-election support really comes from.
Yes, they may be surprised, but that only further indicates just how out of touch they are with reality, especially after the 2010 elections, one would think.
When I first found Open Salon, it was at the suggestion of a friend who wanted to help me share my health care concerns, fears, experiences, thoughts ... as she was trying to share her own. That was at the beginning when this administration was only beginning, when Ted Kennedy was still here. That was when, regardless of what I would hear, somehow I still had hope.

That was when I first met you.

I find it hard to lay down hope ... but ... as all of this goes on and on ... I hardly have the strength ... to pick it up. I have no logic left. I have only emotion ... and beginning edges of total fear ...

And so I try to find ... moments of calm ... and think about moments I ... we ... may all face ... when there is nothing to be done ... and no care to be had ... only waiting ... and hoping ... that when it comes ... death will ... come ... peacefully.

Thank you for watching and sharing your thoughts, Kent.