It's Not Trumpism

45* is almost exactly the latest version of the dumbass empty vessel the GOP has been saying they want for at least 20 years now. So it's not Trumpism, and if we walk around using that term to describe what's going on, we allow the GOP to distance itself (again) from what they've created.

driftglass has been making the point forever.  Since Nixon, whenever we go along with the GOP's nutty idea du jour, it leads us into disaster, and as we pull ourselves up, suddenly there are no Repubs anywhere willing to admit they voted for the guy, or there's a concerted effort to revise history and canonize the prick, or we get "Yeah but he did some things the liberals like too".

Anyway. Washington Post put up a piece taking a look at the scam 45*'s running. It's a little hard to pat the Press Poodles on the head when they helped put this rolling clusterfuck in office, but maybe we're seeing a self-redemption thing now, so I want to acknowledge that.

WaPo:

The set of policy proposals and ideas loosely known as Trumpism goes something like this: President Trump is not an ideological fellow traveler of congressional Republicans on the economy, the safety net and immigration. Unlike Paul Ryan Republicans, he sees a robust government role in maintaining protections for the poor, sick and old; and he is much more willing than other Republicans to slam the brakes on immigration to protect blue collar whites from global forces that are making them feel culturally, economically and demographically destabilized.

But little by little, as Trump seeks to make good on his promises, Trumpism — as sold by the man himself — is being revealed as fraudulent to its core.

- and -

The split was obscured for years, because Republicans could call for repeal, secure in the knowledge that it wouldn’t happen. It is between two camps. There are conservatives (mostly in the House) who actually want repeal, because they don’t think the government should be spending and regulating to expand coverage to poor and sick people, and instead want free markets to fulfill this goal. And there are other Republicans (mostly senators and governors) who want to say they’re repealing Obamacare (since they’ve railed against it for years in the abstract) while actually minimizing just how much of the coverage expansion gets rolled back in their states. Trump is more or less in the second camp, since he doesn’t want to be the guy who kicks millions off insurance or shatter Trumpism’s aura of ideological heterodoxy.

Here It Comes

Grease up and bend over, America - the GOP's back in town.

The Hill:

The two committees will be working on the bills even though the Congressional Budget Office (CBO) has not completed its analysis; as a result, estimates of the plan’s cost and how many people could lose coverage will not be immediately available.

Sources said previous versions of the plan faced unfavorable coverage numbers from the CBO.

The tax credit under the GOP plan ranges from $2,000 to $4,000 a year per individual, increasing with someone’s age. That system would provide less financial assistance for low-income and older people than ­ObamaCare, but could give more assistance to younger people and those with somewhat higher incomes.

Democrats warn that between the phasing out of ­ObamaCare’s Medicaid expansion and the smaller tax credit for poorer people, the 20 million people who gained coverage in recent years will be put at risk.

So let's see - the GOP has long contended that 47% of us don't pay federal taxes, so obviously, the best way to help us with this healthcare insurance thing is to give everybody a federal tax break.

Why do I always get the feeling that there's no vision or imagination in the GOP that isn't aimed at fucking us over in another attempt to advance a bogus economic theory, even when every one of those attempts turns out to be further proof that it doesn't fucking work?

And let's not lose sight of the high probability that guys like Ryan would engineer the "collapse" of Obamacare as a political maneuver just so they could use it to bully their way thru with this new bullshit plan (which is nothing new at all).

1. Fuck it up
2. Point at it and say, "Oh look - it's fucked up"
3. Sell your ideology-driven bullshit as the only solution that can possibly help
4. Collect campaign contributions from the cronies who get richer from that solution
5. Enjoy our re-election
6. Find something else you can "fix" and start again at step 1

Ah, Virginia

Hard to believe sometimes that Virginia is where America started; the birthplace of presidents; among the first places where 'commonwealth' was adopted as a governing philosophy.

4 out of the first 5 presidents of this amazing country were sons of Virginia, but lately, we've had Vaginal Bob McDonnell and Kenny the Kooch Cuccinelli and now - just so the Dems don't feel left out (and also too, so pundits and press poodles can propagate the "both sides" meme), we get Phil Puckett.

Former state Sen. Phillip P. Puckett, D-Russell, said Monday that his daughter’s future as a judge was a large reason behind his decision to resign.

Senate Republicans had balked at backing Puckett’s daughter, Martha P. Ketron, for a full six-year appointment to a juvenile court judgeship in Southwest Virginia, saying they oppose giving judicial appointments to family members of sitting legislators.

“She cannot be confirmed into the position permanently as long as I serve in the General Assembly,” Puckett said. “My colleagues on both sides of the aisle acknowledge that she is fully qualified for the position.

“At this point in my life, I feel that I cannot allow my political career to hamper my daughter’s future and her desire to serve the families and children of our area on the Juvenile and Domestic Relations Court.”

--and--

Puckett’s resignation ignited a firestorm by effectively giving the Republicans a 20-19 majority in the previously Democrat-controlled chamber. It altered the landscape of deadlocked negotiations over a new state budget and whether the spending plan will include Medicaid expansion.

Parade Of Stoopid

I should give people something of a break on a lot of this stuff because even if they try to get the straight dope, there's plenty of root weevils out there doing whatever they can to make things unclear, but like the man said, "how come we have to be the stupid country?"

Today's PSA

Of all the slick shit(*) the Repubs have shoveled at us about the Patient Protection & Affordable Care Act, I think the one that's the most dishonest is how they talk about Obamacare as if it were a brand in itself.  It isn't.  If Obama hadn't folded like a fucking lawnchair on the Public Option, then maybe you could make that case - but he did so you can't so shut up already.

If you don't qualify for Medicare; and if you're not poor enough to be covered by your state's version of Medicaid; and if you don't wanna pay a fine; and if you want healthcare insurance, then you buy healthcare insurance from a healthcare insurance company.  That's the law - deal with it.



(*)
The abortion surcharge
Medicare as we know it will end
Death Panels (you don't really need a link on that one, do ya?)
Raiding Medicare for $716 Billion
Obamacare will cost twice the original estimate
Employers are dropping their coverage because of Obamacare
and on and on and on

Dumb Is Dangerous

From a piece in HuffPo:

It's remarkable how low America places in healthcare efficiency: among the 48 countries included in the Bloomberg study, the U.S. ranks 46th, outpacing just Serbia and Brazil. Once that sinks in, try this one on for size: the U.S. ranks worse than China, Algeria, and Iran.

But the sheer numbers are really what's humbling about this list: the U.S. ranks second in healthcare cost per capita ($8,608), only to be outspent by Switzerland ($9,121) -- which, for the record, boasts a top-10 healthcare system in terms of efficiency. Furthermore, the U.S. is tops in terms of healthcare cost relative to GDP, with 17.2 percent of the country's wealth spent on medical care for every American.

In other words, the world's richest country spends more of its money on healthcare while getting less than almost every other nation in return.

A Brief Moment Of Enlightenment

Libertarians (for lack of a better label) are opposed to ObamaCare because taken to the logical extreme - which is where an awful lot of 'em seem to be located now - they have to be opposed to any and all efforts to suck them into any and all kinds of Collaborative/Cooperative/Collective endeavor.

It's not that they object to ObamaCare per se - they have to object to the very notion of Insurance itself.  The idea of getting together with a bunch of people you don't know and can't trust is off-putting enough, but being forced to pool your resources with these unwashed, unwelcome, undeserving miscreants?  Child, please.

Insurance is the Communism of Capitalism, and it must be avoided by all self-respecting Rugged Individuals.

USA! USA! USA!

We're #28 - FUCK YEAH - wait, what?

It's almost like there's somebody actively working against doing anything that might help make this whole mess better.

Sweet screamin' Jesus, I'm getting more than a little tired of this shit.

JAMA came out with a study of 34 "rich countries", and the US is ranked 28th in Health Outcomes.

Overall, population health in the United States has improved from 1990 to 2010. Life expectancy at birth and HALE have increased and all-cause death rates at all ages have decreased. Although life span has increased, rates of age-specific YLDs have remained stable, and morbidity and chronic disability now account for nearly half of the health burden in the United States. However, improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations. Regular assessments of the local burden of disease and matching information on health expenditures for the same disease and injury categories could allow for a more direct assessment of how changes in health spending have affected or, indeed, not affected changes in the burden of disease and may provide insights into where the US health care system could most effectively invest its resources to obtain maximum benefits for the nation’s population health. In many cases, the best investments for improving population health would likely be public health programs and multisectoral action to address risks such as physical inactivity, diet, ambient particulate pollution, and alcohol and tobacco consumption.

For all you clear-eyed, pragmatic, bidness-savvy 'conservatives' out there, here's the deal:  Healthy people cost less than sick ones, and Prevention is way more cost-effective than Remedy. 

If you're the soul-dead corporate clods who care for nothing but the Quarterly Numbers that you seem to be, then you have to recognize that a healthy labor pool is more valuable to you than an unhealthy labor pool.  

Of course, since you guys are so highly attuned to the concept of Other People's Money, you can get around the inconvenience of operating within any kind of ethical boundaries  by adopting the Wal-Mart strategy, and simply dump all your healthcare costs onto the taxpayer, but hey - that's Wal-Mart; those guys are absolute masters of The Big Bamboozle.

C'mon - look:

• We have a healthcare system that's Crazy Stupid Expensive which doesn't produce particularly healthy people
• Unhealthy workers are more costly than healthy workers
• Shifting the cost from one payer to another makes the system more complex and that complexity helps drive up the actual cost 

So here's what I really don't understand: Why are so many of you 'conservatives' so dead set against making changes to a system that is so obviously less efficient and more costly than it needs to be?

Without Apology - Part 2

(con'd from Without Apology - below)

If I argue "when healthcare coverage is outlawed, only outlaws will have healthcare coverage", I suspect "conservatives" to scoff and tell me I'm stupid to think they're trying to "outlaw" healthcare coverage.

But they're wrong.  Being against HealthCare Reform and against ObamaCare (and and and) almost always goes with a package that includes being in favor of Free Market Solutions. These guys will always spout the standard suite of platitudes:

• the market will always find a fair balance on its own
• the market brings innovation to satisfy all needs of every market segment
• the competition of the market will force prices down so everybody can get it on the benefits
• everything is good as long as government stays out of it completely

etc.

But outlawing coverage is (effectively) exactly what happens.  In a system of completely unfettered capitalism, the Market is the law, and your paycheck is Law Enforcement.

In that system, what's the difference between being unable to buy it and being forbidden by law to possess it?

Ryan's Medicare "Plan"

Repub spokesnut goes on and on about how people over 55 right now shouldn't even be part of the discussion, because Ryan's plan doesn't affect us at all.  It's all about how Repubs give younger people a choice in their coverage plans, and gee golly, isn't having a choice a wonderful thing? Wait just a fuckin' minute - if having a choice is the be all and end all, how come I don't get a choice, asshole?



And then, she lurches into the "un-elected 15-member panel that gets to decide whether or not her dad gets a particular procedure"...? What the fuck was that? Are we trying to dog-whistle the Death Panels again?

Affordable Care Act

From healthcare.gov, with a hat tip to Balloon Juice:

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or co-insurance or meet your deductible. This applies only when these services are delivered by a network provider.

BTW: Can somebody please explain to me how the fuck the GOP has managed to make this whole thing about "sluts wanting free birth control pills"?  And then, I'll need you to explain to me how the Press Poodles can't figure out how to say something to these assholes like, "You're being an asshole".


Covered Preventive Services for Adults:
Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
Alcohol Misuse screening and counseling
Aspirin use for men and women of certain ages
Blood Pressure screening for all adults
Cholesterol screening for adults of certain ages or at higher risk
Colorectal Cancer screening for adults over 50
Depression screening for adults
Type 2 Diabetes screening for adults with high blood pressure
Diet counseling for adults at higher risk for chronic disease
HIV screening for all adults at higher risk
Immunization vaccines for adults--doses, recommended ages, and recommended populations vary:
  Hepatitis A
  Hepatitis B
  Herpes Zoster
  Human Papillomavirus
  Influenza (Flu Shot)
  Measles, Mumps, Rubella
  Meningococcal
  Pneumococcal
  Tetanus, Diphtheria, Pertussis
  Varicella
Learn more about immunizations and see the latest vaccine schedules.
Obesity screening and counseling for all adults
Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
Tobacco Use screening for all adults and cessation interventions for tobacco users
Syphilis screening for all adults at higher risk

Covered Preventive Services for Women

(Including Pregnant Women):
Note: Services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012. See Affordable Care Act Rules on Expanding Access to Preventive Services for Women.
Anemia screening on a routine basis for pregnant women
Bacteriuria urinary tract or other infection screening for pregnant women
BRCA counseling about genetic testing for women at higher risk
Breast Cancer Mammography screenings every 1 to 2 years for women over 40
Breast Cancer Chemoprevention counseling for women at higher risk
Breastfeeding comprehensive support and counseling from trained providers, as well as access to breastfeeding supplies, for pregnant and nursing women*
Cervical Cancer screening for sexually active women
Chlamydia Infection screening for younger women and other women at higher risk
Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, not including abortifacient drugs*
Domestic and interpersonal violence screening and counseling for all women*
Folic Acid supplements for women who may become pregnant
Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes*
Gonorrhea screening for all women at higher risk
Hepatitis B screening for pregnant women at their first prenatal visit
Human Immunodeficiency Virus (HIV) screening and counseling for sexually active women*
Human Papillomavirus (HPV) DNA Test: high risk HPV DNA testing every three years for women with normal cytology results who are 30 or older*
Osteoporosis screening for women over age 60 depending on risk factors
Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
Tobacco Use screening and interventions for all women, and expanded counseling for pregnant tobacco users
Sexually Transmitted Infections (STI) counseling for sexually active women*
Syphilis screening for all pregnant women or other women at increased risk
Well-woman visits to obtain recommended preventive services for women under 65*

Note: Services marked with an asterisk ( * ) must be covered with no cost-sharing in plan years starting on or after August 1, 2012. See Affordable Care Act Rules on Expanding Access to Preventive Services for Women.

Covered Preventive Services for Children:
Alcohol and Drug Use assessments for adolescents
Autism screening for children at 18 and 24 months
Behavioral assessments for children of all ages
  Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Blood Pressure screening for children
  Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Cervical Dysplasia screening for sexually active females
Congenital Hypothyroidism screening for newborns
Depression screening for adolescents
Developmental screening for children under age 3, and surveillance throughout childhood
Dyslipidemia screening for children at higher risk of lipid disorders
  Ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Fluoride Chemoprevention supplements for children without fluoride in their water source
Gonorrhea preventive medication for the eyes of all newborns
Hearing screening for all newborns
Height, Weight and Body Mass Index measurements for children
  Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Hematocrit or Hemoglobin screening for children
Hemoglobinopathies or sickle cell screening for newborns
HIV screening for adolescents at higher risk
Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:
  Diphtheria, Tetanus, Pertussis
  Haemophilus influenzae type b
  Hepatitis A
  Hepatitis B
  Human Papillomavirus
  Inactivated Poliovirus
  Influenza (Flu Shot)
  Measles, Mumps, Rubella
  Meningococcal
  Pneumococcal
  Rotavirus
  Varicella
Learn more about immunizations and see the latest vaccine schedules.
Iron supplements for children ages 6 to 12 months at risk for anemia
Lead screening for children at risk of exposure
Medical History for all children throughout development
  Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Obesity screening and counseling
Oral Health risk assessment for young children
  Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years.
Phenylketonuria (PKU) screening for this genetic disorder in newborns
Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk
Tuberculin testing for children at higher risk of tuberculosis
  Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years.
Vision screening for all children

ACA Starts To Pay Off

Don't let the Repubs know, but Obamacare is starting to come thru in a way that's gonna piss off "conservatives" somethin' powerful.

A friend in Charlottesville is a small business owner; single, 2 not-quite-grown-and-gone kids.  She's almost always somewhere between OK and Ah Crap, with the occasional tight-roping along the edge of Holy Fuck.  The way an awful lot of people have had to live for  a good 20 years or more.

Today, she showed me this little slice from her insurance carrier, informing her that they've cut her a rebate check because they didn't quite meet the new 80/20 Rule.  Under ACA, insurers have to maintain a Medical Loss Ratio of 80%:20%.  Simply put, of all the dollars in premiums they collect, they get to keep 20% of it for Admin and Salaries and Bonuses and Shareholder bennies (profit), etc - but they have to pay out at least 80% of that money to Healthcare Providers (docs, nurses, hospitals, etc) in the form of Medical Care Claims.  If they don't come up to that 80%, they have to divvy up the leftover money and pay it back to their subscribers.  So my friend is getting a check for about 80 bucks.  She won't be vacationing in St Bart's or putting in a pool, but it's better than it was and that's good for now.

I wonder if any of my "conservative" friends have gotten the same thing - and if they have, I wonder if I'll ever hear about it.

SCOTUS And ACA

That Was Odd

So ACA is upheld by SCOTUS today, and the wingnuts are having a deuce of a time trying hard to blame Obama for the whole thing while also practically turning themselves inside out to avoid criticizing one of their pet "conservatives", Chief Justice Roberts.  I don't know why, but it just seems a little weird to me.

An Air Of Freshness

Outside of the disinformation bubble of the Baghdad Bob style of "news" at Wingnut Daily, News Fluffer, The RNC and DumFux News, there still exists a fact-based reality.

From Small Business Majority:

Key findings:
Only a third of small business owners want the Supreme Court to overturn the Affordable Care Act; a plurality of 50% would like it upheld, with minor or no changes. This support grows after learning more details about the law’s key provisions:
Only 34% of small businesses want to see the healthcare law overturned, while 50% want it to remain intact with, at most, minor changes. After learning more about its specifics, only 28% want to see it repealed and a 56% majority want it to be kept, as is or with minor changes. A 55% majority say they want it upheld because we need to make sure everyone has health coverage.

Wendell Rides Again

I'd not been aware that Wendell Potter was putting this stiff out regularly, but there he is over at MichaelMoore.com

Some of the best circularity I've come across in a long time:

Health insurers often complain that one of the chief reasons why they are having a difficult time at the negotiating table with hospitals these days is because of consolidation. The reason for that consolidation, however, is the exploding problem of uncompensated care, hospitals have no choice but to consolidate. Well, they actually do have another choice: close. Which is what many hospitals have had to do because they could not find a willing partner with which to affiliate.

Read some of Wendell's posts and then tell me Obama's not trying to do right by us.

(hat tip = VWE)

Affordable Care

From Daily Kos via Democratic Underground:

1. There will be non-profit insurers offering health care plans in the exchanges on top of traditional private insurers (regulated STRONGLY by the health care law). The public option never really disappeared. It was just replaced with non-profit language that will turn into non-profit options just as strong as the proposed public option. Besides, many states are integrating public options into their exchanges.

2. Medicaid will be significantly expanded to 15 million poor uninsured americans in 2014. People in deep poverty will have significantly better lives. Everyone at less than 133% of the poverty level will be covered under medicaid. Native Americans will be insured for the first time in their lives and will enjoy modernized health care. The Indian Health Care Act is reauthorized and strengthened by this medicaid expansion.

3. Medicare's trust fund will be extended 12 years. Seniors have free preventive care and check ups. Lots of money have been saved through waste trimming and fraud recollecting.

4. Small business tax credits will have their amounts magnified for small businesses in 2014. When juxtaposed with the strongly regulated exchanges, coverage will be very affordable for small businesses.

This is what Repubs are trying so desperately to repeal.

And if you're all about helping the little guy in business for himself and strokin' along and doin' his best to make the dream come true, all you have to do is look at number 4 - now how exactly do you vote for somebody who's mouthin' off about Repeal-And-Replace?

Sounds Kinda Important, Actually

via Balloon Juice yesterday:

Today is the day that a significant part of the Affordable Care Act took effect. Today is the day that companies that sell and provide health insurance have to start spending 80% to 85% of their income from insurance premiums actually delivering the services for which they charge their customers. Overhead like office space and supplies, marketing expenses, salaries, and yes, profits have to come out of the remaining 15-20%. The rule is called the the medical loss ratio, and in an important decision recently by the Department of Health and Human Services, the insurance companies cannot count the sales commissions that they give out to the people who sell you your insurance plan against the medical loss ratio.

So lemme see - Repubs are promising to "repeal ObamaCare", which (so far) means:

• they want 4,000,000 small businesses to lose their tax breaks
• they want state governments to lose federal help in meeting their Medicaid obligations
• they want the feds to stop cracking down on Medicare fraud
• they want people taking early retirement to lose their Gap Coverage
• they want 4,000,000 seniors to lose the donut hole discounts on Brand Name meds
• they want the 15,000,000 young adults who can now stay covered by their parents' insurance to lose their coverage
• they want insurance companies to go back to using tricks and traps to justify rescinding coverage; and they don't want any way for a patient to appeal rescission. 
• they want the 20,000,000 Americans who used to be subject to denial of coverage due to "pre-existing conditions" to lose their coverage
• they want the insurance companies to arbitrate payouts according to business considerations instead of clinical evaluation.
• they want 20,000,000 low-income Americans to lose access to Community Health Centers
• they want Americans living in (mostly rural) underserved ares to lose support for the docs and nurses who want to stay in those places, but can't afford it

And as of 02-DEC-2011, they want the insurance companies to continue to have the option of jacking up your premiums in order to pay sales bonuses, and to pay out nice fat stock dividends, and, and, and - the law now requires the insurers to pay out 80% of their revenues to healthcare providers.  As much as I hate strict regulation on actual levels of profit and reward, I can't help but see this as a common-sense attempt to get us all to understand that healthcare is just one of the things that can't be shoehorned into the standard business school model.

Take a quick peek at the ObamaCare Timeline.

Intentionally Stupid

Better access to contraception = lower demand for abortion. It's a measurable and obvious cause-and-effect thing going on. If you're against preventing the pregnancy, then you simply are in favor of keeping the demand for abortion high.

So how can these guys be in favor of sustaining the demand for abortion? Well, first and foremost, it gives them a way to keep abortion as a political weapon; but the kicker is that they can hide their cynicism in the fog of being "against ObamaCare". The politics of fear requires the maintenance of as many perceived threats as possible. If you allow any real progress towards solving even small parts of any problem, then you have to concede that government is in fact good for something; and you start to lose an important way to motivate your contributors and your voters.

There's also a pronounced element of their outright fear of sexuality in general, and the sheer terror they feel when they have to contemplate female sexuality in particular.

What Just Happened

Some good things have just kicked in, no thanks to Repub and Blue Dog opposition to healthcare reform laws.

• Many plans will be prohibited from placing lifetime limits on medical coverage, and they will not be able to cancel the policies of people who fall ill.
• Children with pre-existing conditions will not be denied coverage.
• Dependent children will remain on their parents' health insurance plans until age 26.
• Private plans must cover peventive services with no co-payments, and with preventive services being exempt from deductibles.
• Insurers will no longer be able to cancel your health insurance retroactively due to an unintentional mistake made by you or your employer on your paperwork.
• A way to appeal insurance company coverage determinations or claims is established along with an external review process.
• States are granted money to investigate unreasonable rate hikes by private insurance companies.