Tag Archives: American Health Care

When You Rest on Your Laurels, You Become a Stationary Target

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The defeat of the Republican-sponsored American Health Care Act (AHCA) was a great victory for the people.  Thanks go to the organizing leaders at, in alpha order: ACLU/PeoplePower.org), Grassroots Alexandria, Indivisible (and its many local arms), MoveOn.org, Women’s March, plus the many other national and local groups whose names I don’t even know and, of course, to the individuals who called, wrote, marched, protested, demonstrated and rallied against the atrocity of the AHCA. And thanks also to AARP, American Hospital Association, American Medical Association, American Psychiatric Association, National Alliance on Mental Illness, and Planned Parenthood, among others.

I have noted that some people feel that we have somehow “won the war” with this victory and that they can now either step back or at least “move on to something else.” This is an understandable response to what has happened. At the same time, we must not become complacent about the Trump administration. The AHCA could be brought back by the Republican majority at any time. So by all means celebrate, relish the feeling of a huge and, I must say it, improbable achievement. Then prepare to fight the enemy in our front.

But also post guards on the flanks and in the rear. Trump blames the loss of the ACHA on Democrats and, of course, he would. It is certain as the sunrise, however, that Trump never expected any Democrat to vote for the bill. Blaming Democrats is just another head-fake. Remember, as someone (not Thomas Jefferson) famously said, “the price of freedom is eternal vigilance.” This is particularly true now. Trump and Ryan are humiliated and angry and they have shown that they do not grasp what “the welfare of the people” really means.

Moreover, Trump has tweeted that the way forward is this: “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!” That tweet has been “liked” over 91,000 times. As suggested by Deepak Gupta and others, what does this say about Trump’s constitutional obligation to “take Care that the Laws be faithfully executed?” U.S. Constitution, Art. II, sec. 3. Trump appears to believe that the Take Care obligation is part of the “fake Constitution” and does not apply to him. Wrong again.

What comes next is not clear. It could be “tax reform” or something else. Or multiple things. We already know that the Trump administration, through executive orders and Cabinet appointments, has declared war on the environment. Many more craven acts of legislative and regulatory vandalism are coming. But the March for Science is also coming – on April 22 in Washington and elsewhere … and many other demonstrations of the peoples’ commitment to resisting the destructive agenda of the Trump administration. It is critically important to show Trump that the people do not accept his assault on the air they breathe and the water they drink, that the people do not accept his attempt to shift the burden of taxation toward the population sector already suffering economic hardship or worse and that the people will not accept his effort to turn the country into “fortress America” with border walls and distrust of everyone who does not fit his narrow concept of what it means to be an American.

The Resistance must remain constant, relentless and ubiquitous so the administration sees that there are no weak spots to be exploited. Resistance is the only course left to stop the right-wing idealogues from undermining American values. In this regard, finally, it is important to make clear to Democratic lawmakers at every level that supporting the Republican agenda in any respect is unacceptable.

We have seen what the Republican agenda is prepared to do to achieve its imaginary wonderland of the “free market” in all things: just consider that the leadership was prepared to strip from the Affordable Car Act replacement legislation most of the “essential benefits” in order to appease the Freedom Caucus and secure their votes. Fortunately for the country, enough of the extremist demands of the Freedom Caucus were rejected to stop them from supporting the legislation. While Trump’s oft-touted-but-never-demonstrated negotiating skills failed him in this instance, we have seen the price the leadership was willing to pay to achieve their ideological ends, regardless of the consequences to the people who need those “essential benefits” the most. We cannot afford to take chances with a group that is willing to drive the country off a cliff to prove a point.

What Is the Democratic Alternative to the American Health Care Act?

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We are about an hour and a half from the House vote on the ludicrously named American Health Care Act, which brings to mind the famous phrase from Joseph Conrad’s Heart of Darkness: “The horror! The horror!” In typical fashion, Not-My-President Trump is threatening recalcitrant Republicans in the House that he will “come after you” if they don’t support the AHCA. Changes are being made to make the legislation more palatable to extreme right-wing Congressmen in the so-called Freedom Caucus. It’s hard to tell what is going on because most of the action is behind closed doors, but it seems clear that major reductions in benefits for low-income people have been incorporated into the legislation to buy votes of the ultra-conservative far right wing of the Republican Party. Those Republicans coldly and calmly stand before media cameras and boast about removing health care benefits from the AHCA package.

Given the inhumane indifference with which the AHCA treats most health-challenged people and given that it includes a large tax break for the wealthiest Americans, there is nothing good to say about the legislation. Most Democrats have railed against it since its details were released after much secret negotiating among its Republican sponsors.

What has begun to stand out to me is that while Democrats have rightly and righteously opposed the AHCA, they, including former President Obama himself, have acknowledged that there are issues with the Affordable Care Act (aka Obamacare) that need to be addressed. Instead of producing an alternative to the AHCA that would make repairs where needed, however, the Democratic leadership has focused entirely on the multitude of negative features of the “repeal and replace” legislation.

This may be a political attempt to make the Republicans “own” the AHCA and its inevitably horrific consequences, but it strikes me, late in the game (I admit), that this is not the best strategy. Rather than simply counting on a handful of Republican legislators to block the legislation in the House or Senate, it would have been better, I think, to offer a realistic alternative to the current Obamacare.

Perhaps most interesting are the observations of Jennifer Rubin, described by the Washington Post as a person who “writes the Right Turn blog for The Post, offering reported opinion from a conservative perspective. She covers a range of domestic and foreign policy issues and provides insight into the conservative movement and the Republican Party.” http://wapo.st/2nSfAyQ. Rubin said this:

“… the legislation is a dog’s breakfast. It’s a bill that does not repeal Obamacare and does not address the most acute issue, namely rising premiums. Speaker Paul Ryan (R-Wis.) keeps promising that will be addressed in the third prong of legislation, but as Sen. Tom Cotton (R-Ark.) points out that is never happening (since there are not eight Democratic votes). If the GOP passes this, it will be stuck with the worst of all worlds — a highly regulated insurance market with skimpier tax credits than were available under Obamacare. That, plus the roll back on Medicaid expansion, explains why so many conservatives and moderates oppose it.

The bill was so unworkable Ryan had to come up with a last minute “manager’s amendment” to, for example, try to improve support for rural, older voters who are badly hurt. But there is no legislative language laying that out. Those who vote for this literally won’t know what is in the bill. In short, it’s bad legislation that will hurt people, many of whom voted for President Trump. If it passes, the problems with the bill and the hard luck cases will be on the heads of Republicans.

As for the politics, it has already split the party and pitted Republicans against one another. It gets a pitiful level of support. Voters, as opposed to politicians and political insiders, rank health care relatively low on their priority list. Voters really are not clamoring for this. Rather than get mired down in an endless negotiation back and forth with the Senate and be responsible for a lousy outcome, Republicans would be wise to move on to jobs, just as the president said he wanted to do.”

Further:

“Obamacare’s faults don’t make the case for this particular bill. Significant numbers of Freedom Caucus members are saying the bill does not do what it is supposed to. Perhaps they have internalized the real lesson of Obamacare: Don’t pass a bad bill, take responsibility for people’s health care and hope it gets fixed later. Right now, Sen. Cruz won’t vote for the bill. And he’s right. It should die in the House.”

http://wapo.st/2nnIh93.

It is not the case that some of the fixes to Obamacare have not been identified. For example, Nalini Pande, Sappho Health Strategies, LLC’s Managing Director, who has significant health care policy credentials and experience, has identified three “repairs” worth consideration:

“(1) Increasing subsidies for the poor so that the Exchange plans are more affordable; (2) Encouraging state insurance commissioners to conduct stronger rate reviews/rate regulation to prevent unreasonably high rate increases … and … to ensure that for-profit insurers are not increasing rates at a dramatically high rate to ensure more profits for shareholders at the expense of their customers – this goes for employer plans, not just plans on the Exchange under ACA; (3) stronger evaluations on plan performance, premium increases and surplus and reserves, especially for-profit insurers/health plans.”

As I stated in my previous post, I claim no expertise in health care or insurance policy, but Pande’s prescriptions make sense. There are likely many others. Hopefully for the country, the Democratic strategy will work out in the end and the AHCA will be defeated. If not, the failure to offer an effective alternative may be seen as a very serious error.