Some Musings on the Affordable Care Act

Let me first state where I stand on the Affordable Care Act: It is a convoluted labyrinth straight out of a Rube Goldberg Cartoon, but it is a step in the right direction and the best that we are able to get for the time being. I also believe that once it goes into effect, all attempts to defund or repeal it will go away fast. The number of uninsured who will be able to afford insurance, the fact that parents will be able to retain their adult children until age 26, the end of refusal for preexisting conditions, and other provisions will prove to be so popular and helpful that the Republicans will claim that it was their idea in the first place. <Well, it was, kinda sorta.> For myself, I would rather restore the public option. <Why was it deleted? Because the for-profit insurance companies realized that the public option would either force them to charge comparable rates or retire from the field, <I think that that is called market economics or free enterprise, or something like that.> The same is even more true for "Medicare for All." The money currently squandered on advertising, public relations, lobbying, and obscene salaries for executives will either go into research and development or some other productive use. Why should anyone make a gigantic profit out of supplying a basic human need?

Obeying the old axiom "Follow the Money," it will become more and more obvious that all of the scare tactics about "socialized medicine" is mostly "smoke and mirrors" obfuscating the fact that the real opposition to ACA, or any other health care insurance plan that will benefit the general public, emanates primarily from for-profit insurance companies and hospital conglomerates, big pharmacy, the makers of expensive medical machinery <which are, of course, available at a far more reasonable cost in civilized countries>,the AMA, which represents fewer than one quarter of the nation's doctors, with an assist from "free market" ideologues. In its usual cynical, "bottom-line" contempt for the general welfare, the insurance industry is reportedly also spending a billion dollars on advertising to help sell its plans on the "exchanges," just in case the ACA proves to be popular and reasonably successful. They are trying to rig it so that they win either way and they can always erase their "losses" by increasing premiums.  I saw a cartoon the other day where a subject vociferously tells a poll taker that he will support ACA, or any other plan,to defeat Obamacare. That is almost as revealing as the oft-quoted Tea Party anthem: "Tell the government to keep its hands off my Medicare."  

The most informative and intensive analysis of the attempt to use both the government shutdown and the debate over raising the national debt limit is "A Federal Budget Crisis Months in the Planning" by Sheryl Gay Stolberg and Mike McIntire the October 5th edition of the New York Times. Sometime in late January of this year, they discovered,"a loose-knit coalition of conservative activists led by former Attorney General Edwin Meese III gathered in the capitol to plot strategy. Their push to repeal Mr. Obama's health care law was going nowhere, and they desperately needed a new Plan." Out of that secret session came a "blueprint to defunding Obamacare, signed by Mr. Meese and leaders of more than three dozen conservative groups." This blueprint articulated a drastic legislative strategy that had long percolated in conservative circles: "that Republicans could derail the health care overhaul if conservatives were willing to push fellow Republicans--including their cautious leaders--into cutting off financing for the entire federal government." <emphasis mine>  According to one coalition member, Michael A. Needham of Heritage Action for America, the political arm of the Heritage Foundation,  acknowledged that his organization "felt very strongly from the start that this was a fight we were going to pick." Interviews with a wide variety of conservatives, Stolberg and McIntire assert,indicate that the current crisis "was the outgrowth of a long-running effort to undo the law, the Affordable Care Act, since its passage in 2010--waged by a galaxy of conservative groups with more money, organized tactics and interconnections than is commonly known."  Although shuttering the government was not their primary objective, these activists "anticipated that a shutdown could occur--and worked with members of the Tea Party caucus in Congress who were excited about drawing a red line against a law they despise." In early September, they developed a "defunding tool kit" that provided "talking points" for answering the question: "what happens when you shut down the government and you are blamed for it?" The lock-step answer, as absurd as it may seem to objective observers, was that "we are simply calling to to fund the entire government except for the Affordable Care Act/Obamacare." This onslaught banded together such right-wing groups as Tea Party Patriots, Americans for Prosperity, Freedom Works, Club for Growth, Generation Opportunity and Young Americans for Liberty. The latter two, especially, were primarily focused on convincing young adults that they did not need "no stinking health insurance," because they were invincible.

Much of the funding came from the "Coke Brothers" and their Freedom Partners Chamber of Commerce, who contributed more than $200 million, including $5 million to Generation Opportunity, which was responsible for the grossly obscene internet ad showing a crazed and leering Uncle Sam figure popping up between a woman's legs during a contrived gynecological exam. The coalition also tried to pressure vulnerable Republican Congresspeople with "scorecards keeping track of their health care votes," burned phony "Obamacare cards" on college campuses, and distributed scripts for phone calls to Congressional offices, sample letters to editors and canned Twitter and Facebook messages. They even schemed to "primary" those Republican lawmakers who refused to toe the line. North Carolina Republican Senator Richard M.Burr, who told a reporter that defunding was "the dumbest idea I've ever heard," was the victim of a radio attack ad sponsored by the Senate Conservatives Fund, as were Lamar Alexander of Louisiana and Lindsey Graham of South Carolina, both of whom are facing Tea Party challengers in the 2014 primary. In Washington,Tea Party Patriots, which created the "defunding tool kit," set up a website <exemptamerica.com> to promote a rally showcasing many of the Republicans in Congress whom Democrats--and a number of fellow Republicans--say are most responsible for the shutdown. Although Conservatives believe that they represent a majority of voters, a recent poll by the Kaiser Family Foundation found that 57% of subjects disapprove. As a growing number of Republican leaders charged that the defunding strategy was "politically damaging and pointless." Nevertheless, the head of Heritage Action called it "a groundswell that changed Washington from the outside in."


"We regard this as a long-term effort," Americans for Prosperity president Tim Phillips proclaimed, stating that his group planned to spend "millions of dollars" in a "multifront effort" that includes working to prevent states from expanding Medicaid. Their ultimate goal, he exulted, is not to defund ACA, but to repeal it. Heritage Action made Dallas the second stop on a nine-city "Defund Obamacare Town Hall Tour" where nearly 1,000 people turned out to hear Senator Ted Cruz and James De Mint, head honcho of the Heritage Foundation.  Cruz declared that "this is the single best time to defund Obamacare " just before he ranted on for more than twenty-four hours on the Senate floor. Although the sentiment to defund ACA dates back to the time of its passage, many Republicans originally thought that "we don't need to worry about it because the Supreme Court will strike it down." Over the next three years--when the Court and the voters upheld the general outlines of the law--"Tea-Party-inspired groups have mobilized, aided by a financing network that continues to grow. both in its complexity and the sheer amount of money that flows through it." A review of tax records and campaign finance and corporate filings proves that hundreds of millions of dollars have been raised and spent since 2012 by organizations, many of them loosely connected, leading opposition to the measure." One of the biggest donors is Freedom Partners, a tax-exempt "business league" claiming more than 200 members, each of whom pays at least $100,000 in dues. The group is headed by a longtime executive of Koch Industries, although the "Coke Brothers" themselves declined to comment in public. Although Freedom Partners has financed organizations that are overtly member of the defunding coalition, its propaganda claims that it is focused on "educating Americans around the country on the negative impacts of Obamacare." According to the group's latest tax filings, it gave $115 million to the Center To Protect Patient Rights, a faux organization headed by a political consultant to the Kochs, that operates out of a post office box in Arizona. Its sole function appears to be to funnel money to such anti-ACA groups as American Commitment and the 60 Plus Association, who were part of a "Repeals Coalition" that sent a letter to Republican solons urging them to insist "at a minimum" a one-year delay on implementation of the ACA as part of any budget deal. The Conservative 50 Plus Association delivered a defunding petition with 68,700 signatures. Although Enroll America, a nonprofit group allied with the White House, is waging its own campaign to persuade millions of the uninsured to buy coverage, it is hopelessly outgunned. "It is David versus Goliath," admits Phillips of Americans for Prosperity. On the other hand, Generation Opportunity, the pornographers behind the "Creepy Uncle Sam" ads, are spending $750,00 to dissuade young people from participating in ACA. So they will be left with no coverage, who the hell cares? The group receives substantial funding from Freedom Partners, and is headed by a 29 year old instructor for a "leadership institute" bankrolled by Charles Koch, who promises more of the "Uncle Sam" ads and campus visits.

Two other groups, Freedom Works, with its "Burn Your Obamacare cards" rallies, and Young Americans for Liberty, are also concentrating on college campuses. When asked if his organization was trying to sabotage ACA, its director said that "our goal is to educate and empower <???> young people," echoing Freedom Partners.         
Ironically enough, the Conservative Action Project urges that the timing is critical because once the public actually experiences the provisions of ACA< "it would be nearly impossible to repeal--even if a Republican president were elected in 2016."  

There are encouraging signs that the "defunding coalition" is beginning to implode. In a New York Times article of October 10, Eric Lipton and Nicholas Confessore proclaim that "Kochs and Other Conservatives Split Over Strategy on Health Law." They say that "the most vocal elements of the conservative wing of the Republican Party are publicly splintering, a sign of growing concerns among even hard-core conservatives that the defeat-health-care-at-any-cost strategy may have backfired." Some groups, like Heritage Action for America, say that they will not fight any short-term increase in the debt ceiling, while Americans for Prosperity still insist that any increase be tied to cuts in social programs. This consternation follows a public statement by the Koch Companies that it did not support the position of Heritage Action claiming that a government shutdown was not the way to defund ACA. In a letter to the Senate, the Koch conglomerate stated that they"want to set the record straight and correct this misinformation." According to Lipton and Confessore, this sentiment has been roiling beneath the surface of the "defunding coalition" for months, amid growing fear that "the Republicans will be blamed for the fallout from the shutdown with nothing to show for it." As one South Carolina Republican put it: "We were fighting a battle where we already lost, on the same battlefield where we already lost it." Ignoring the fact that the "Coke Brothers" and their cronies had donated $500,000 to Heritage Action just before the 2012 election, they reversed their field with no real explanation. A spokesman for Freedom Partners acknowledged that holding the economy and the government hostage might actually set back the goal of repealing ACA, by leading to the defeat of Republican Congressmen in 1914. "Any strategy to repeal, delay, or replace the law," Karl Rove wrote in the Wall Street Journal, must have a credible chance of succeeding or affecting public opinion positively. The defunding strategy doesn't." Incredibly, the brothers claimed that they "had never taken a position on the legislative tactic of tying the continuing resolution to defunding ObamaCare; nor have we lobbied on legislative provisions defunding ObamaCare."  The Daily Kos , however, contends, "that statement is not accurate," and offers as proof a Valentine's Day letter from FreedomWorks entitled "Coalition Letter" and sub-headed "Congress Must Honor Sequester Savings and Defund Obamacare Before it is Too Late." The letter states that conservatives should not approve a CR (Congressional Resolution) "unless it defunds Obamacare. This includes Obamacare's unworkable exchanges, unsustainable Medicaid expansion, and attacks on life and religious liberty." In other words, "they supported a government shutdown strategy." The Daily Kos article concludes that there is no doubt that "Coke Brothers" not only supported the strategy, but were its major initiators and funders.   

Regardless of the apparent splintering within their coalition, it is beyond question that killing "Obamacare" was the defining goal of all conservatives; their disagreements are purely intramural squabbles about timing and tactics. Since I have already expressed my skepticism about ACA above, I take the liberty of expressing my own general "musings" about what a national health care policy ought to look like. My first axiom is that the larger the insured pool, the more the risks are apportioned among the greatest number of people. The affluent will subsidize the poor, the healthy the unhealthy, and the young the elderly. <I think that is called "insurance."> What a lot of critics fail to comprehend is that those categories of people are constantly in flux. Today's "healthy" will be "unhealthy," if they live long enough. Today's "young" will eventually become "elderly".< Boy, do I know that from my own experience! I never missed a day of work due to illness or injury during the 40 plus years of my professional careers. Since I hit 65 a decade or so ago, I have had seven major surgeries and more ailments than I can keep track of. Most of the lower half of my body is made out of titanium and I am mobile thanks only to the expertise of several surgeons and the medical gadgetry that they have so skillfully wielded.


A corollary is that a certain amount of coercion is necessary to "promote the general welfare." <It actually says that in the preamble of the Constitution. You can look it up.> That is the reason for individual and employer "mandates." When I was a neophyte instructor in my 20s and 30s, I griped vociferously when my employer "sequestered" money from my meager pay check to finance health insurance and retirement benefits. Hell, I never got sick and I was alwaya going to be able to earn my own living, no matter what. I played basketball, tennis, touch football, and ran 2-4 miles everyday until well into my 50s. I was one of the "immortals," as my wife refers to people who stroll across the street in mid-block without looking either way when she is driving, or refuse to wear seat belts or helmets. <She worked in emergency surgery for many years and witnessed the horrible results.> When I was a single parent with five children, during my 40s and 50s, I would have done almost anything to get my hands on the money withheld from my salary for insurance premiums and retirement benefits. I wanted the money NOW to give my kids a quality education and all of the amenities that their peers enjoyed. Since I could not touch it, I provided many of those things THE AMERICAN WAY--by going into debt up to my eyeballs. Not until retirement and the onset of numerous physical ailments did I realize how "dumb lucky" I had been, because the health insurance and retirement benefits were there when I needed them.  


One last thought: The main reason why the ACA (and every other important piece of federal legislation involving taxation, regulation, or "the general welfare") is so convoluted and confusing is that it has been revised countless times to placate the demands of numerous special interest groups. The general formula for those opposing any significant law involving federal taxation, regulation, and the general welfare is: 1. try to prevent it ever seeing the light of day to begin with; 2. failing that, lobby the hell out of it in Congress and weaken it as much as possible, so much so that even some of its original supporters might even refuse to vote for the finished bill; 3. Keep delaying passage for as long as possible so the targeted parties are able to adjust to its provisions; 4. use every propaganda device at their disposal to try and persuade the public that this law will mean the end of civilization itself. 5. keep challenging its provisions in the courts until it can be rendered unconstitutional by the always compliant Supreme Court. <for a graphic case study of this syndrome, see my my book The Income Tax and the Progressive Era.>  Put another way, the people who are savaging the ACA for being so complicated and confusing  are many of the same people who deliberately made it that it that in the first place, so as to prevent the enactment of a "public option," Medicare for all, or any of the single-pay, joint public/private alternatives that countries with grown-up populations have had for decades.

JDB