Pulse of the Peninsula: No need to fear Obamacare reforms

Karen Rubin

So let’s discuss. What’s so scary about Obamacare that Republicans are willing to shut government, crash the economy and destroy the full faith and credit of the United States forever?

Obamacare is more damaging to America “than anything I’ve seen pass in my lifetime,” declared Jim DeMint – the guy who resigned from the Senate to run the Heritage Foundation which has put millions of dollars into a campaign to distort and destroy public opinion of Obamacare,

Now it was the Heritage Foundation that originally came up with the model that is the basis for Obamacare, a model which preserves the private, for-profit insurance companies as a layer of cost and a gatekeeper between you and your doctor, instead of a single-payer system (Medicare for all) that Democrats favored. And of course, Obamacare replicates the Romney plan that has been successful in Massachusetts, insuring 99 percent of the people. So what’s the problem?

First, that Americans will actually like Obamacare and not want to give it up. Also, that the success of Obamacare will lead people to trust that government in the right hands, can actually do go (oh my god, is renewable energy next? Tax reform? Public education funding? Infrastructure investment?).

What is more, Obamacare breaks the dependency of workers on their employer for their health insurance (like serfdom), and their great fear that if they leave their job, they will lose health insurance for their entire family. But if you aren’t a prisoner to your employer, you can demand higher wages and better conditions. Or you can go off and start your own business. You won’t be so vulnerable to a boss sending a letter around before an election “vote for my candidate or we will be forced to lay off workers,” as was done on behalf of Romney 2012. That also goes for spouses afraid to leave abusive relationships for fear of losing health insurance.

 What really has Republicans peeved about Obamacare though, is free contraception for women, which Republicans have equated with the breakdown of family and society. But at its heart, giving a woman control over how many children she has is key to her empowerment, her financial emancipation. 

 And finally, health care – and how it drains resources from a family – is also key to economic and political power. Health care is not just a huge profit-making sector for CEOs who pocket a billion dollars (think about how many health procedures have been nixed to pay that), but living without health insurance increases health and financial insecurity. 

Half of all personal bankruptcies are related to health emergencies; a single medical emergency can wipe out a lifetime of savings and the prospect for college, a home, retirement. You can’t be very politically active if you are fighting disease, suffering in pain or misery, or if you are watching the suffering of your child, spouse, or parent. Health care is such a big out of pocket expense, it is a big reason why there is such a income gap between the one percent and everyone else. And that income gap is also a power gap.

What else do Republicans and the one percenters fear? They fear that there will be 30 million more people in doctors’ offices and they might have to wait for care because we don’t produce enough doctors. In fact the ACA – for the first time – also addresses incentives for training of doctors and nurses and opening new clinics – something that is desperately needed anyway. In fact, we already face a crisis of care, with the aging Baby Boomers (there is only one geriatric doctor per 8500 people over 65) we will soon be faced with a crisis regardless.

And despite the criticisms to the contrary, ACA also begins to address the obscene cost of health care – mainly by transparency, competition, mechanisms to foster “best practices” and shift payment incentives from more procedures and visits to successful treatment and a focus on prevention, wellness and early treatment, including more treatment of mental illness.

The anti-Obamacare fanatics have made the claim that affordable health care will somehow hurt the budget deficit. But last year, the Congressional Budget Office estimated that repealing the health care law would add more than $100 billion to the deficit over the next decade, and more than $1 trillion in the following decade.

But what they fear most is that Obamacare will lead to single-payer or a public option (how is that bad?). 

What is disgusting about the campaign against Obamacare is that the only way to combat the arguments for Obamacare is to lie.

Remember death panels? Now Congresswoman Michelle Bachmann is saying that the IRS will exert its power to withhold medical care to political opponents of the administration.

“So now we find out these people are making decisions based on our politics and beliefs, and they’re going to be in charge of our health care. So the IRS will have the ability potentially… to deny health care, to deny access, to delay health care,” Bachmann said on Fox News, May 15, 2013. The Washington Post branded her absurd claim “Four Pinocchios.”

As we have pointed out, Obamacare is essentially the Republican plan, and it has nothing to do with this “noble” quest to keep down the budget deficit, since the deficit is falling faster than any time in 60 years, is half of what it was when Obama came to office, and since repealing Obamacare would actually add $100 billion to the deficit over 10 years, and $1 trillion in the next decade. Indeed, the lost productivity due to sickness or death means less revenue to the government and a greater budget deficit.

So there is more to the opposition merely to Obamacare, as the latest list of extortionist demands from the radical Republicans makes clear. Now, to appease this minority of anti-government Tea Party fanatics they are now demanding that Obama not just delay implementation of health care, but also approve construction of the Keystone Pipeline, overhaul the tax code to favor the millionaires, more offshore oil and gas production and energy exploration on federal lands.

Also in a growing list are demands to roll back regulations on coal ash, block new Environmental Protection Agency regulations on greenhouse gas production, eliminate a $23 billion fund to ensure the orderly dissolution of failed major banks, eliminate mandatory contributions to the new Consumer Financial Protection Bureau, limit medical malpractice lawsuits and increase means testing for Medicare, among other provisions. (Why stop there? Why not also demand that the 2012 election be reversed and Obama step aside for Romney?)

There seems a common theme: all of the demands impact health care – the demand to increase fossil fuels and eliminate regulations of pollution and emissions, eliminate redress for medical malpractice, and at the same time, continue to shift wealth to the wealthiest – making Americans sicker, poorer and more powerless.

You know what is depressing? Sitting in on the Clinton Global Initiative and hearing that the developing world is actually doing better and making more progress in delivering health care than the U.S., that they are doing the things that Republican Congressmen would deny Americans.

The successes are extraordinary. Programs have brought down child mortality rate from 12 million to 6.5 million a year – though these numbers are still so high largely because of the lack of access to clean water. They are talking about mobile medical diagnostic systems so that people who live in rural villages far from health clinics can be diagnosed and treated from afar. Through bulk-buying arrangements, the Clinton Foundation has lowered the cost of HIV/AIDS medications, virtually eliminating children being born with HIV from their mothers. Remember that one of the key peeves of Republicans for Obamacare is that it provides contraception to women.

Indeed, it is distressing to sit at the Clinton Global Initiative and hear Margaret Chan, director-general of the World Health Organization talk about the importance of wellness and realize that First Lady Michelle Obama is mocked by right wingers for encouraging families to eat healthy, and that the U.S. is lumped together with developing nations in terms of a scandalous number of preventable deaths. 200,000 die each year from preventable causes in U.S. hospitals – the equivalent of two jumbo jets crashing daily killing all aboard. Worldwide, the figure is three million.

36 million people worldwide die of non-communicable diseases such as heart attack, cancer, obesity, diabetes – of these, 14 million die “prematurely” before age 70, deaths which are “totally preventable.”

It is distressing to listen to the impact of malnutrition in childhood, how it stunts mental and physical capacity for a lifetime, causes premature disease and death – also preventable – and think about how the Republicans in Congress have stripped $40 billion from food stamps, which will mean four million people will lose access to nutrition, more than half who are children. Children who will suffer in school, require mandated, costly (taxpayer) academic intervention, not to mention the lost potential of that individual to society. The other result is that people buy the cheapest calories, and become prone to diabetes, heart disease, obesity, all of which result in costly illness and suffering and premature death. There are 42 million overweight children in the world, and much of that is tied to poverty.

It is really distressing to hear about wellness programs – in other countries and in other companies – and think how any effort whatsoever to get children to MOVE (as Michelle Obama has been trying to do), or stop drinking Big Gulp quantities of high-calorie drinks as Mayor Bloomberg attempted to do, are attacked as being dictators in a nanny state.

But we don’t get to choose how much salt, fat and sugar are in snacks and processed foods. That is a corporate decision calculated based on how much profit can be squeezed. How much credit does Michelle Obama get, I wonder, for “encouraging” restaurants and processed food companies to use less salt, sugar and fat?

Talk about preventable deaths and chronic injury and diversion of scarce resources. Gun violence is a public health crisis. There is a dollar figure, $100 billion, according to Philip J. Cook and Jens Ludwig, author of a study, “Gun Violence: The Real Costs (Studies in Crime and Public Policy). Gun violence – wanton, senseless, epidemic – is a public health menace (more on that in future).

This country is facing a health crisis – which is the biggest source of the debt crisis – because, like the climate change debate, encouraging healthy lifestyles, wellness and prevention has somehow been branded as violating our freedom. How sick is that?

But here’s the reality, “The health system doesn’t have the workers, the right kind of medicine, or intervention for early diagnosis and treatment,“ WHO’s Chan said at the Clinton Global Initiative session, Healthier Futures: Prioritizing Prevention. “So how can we focus on prevention – transport, environment, education – preventing disease and suffering? If we don’t, the cost of care is not affordable.”

For example, she said, “The FDA approved 12 cancer medications, 11 of them cost more than $100,000 a year for treatment. Who can afford that? Prevention is cornerstone of global response to non-communicable diseases.”

Health care is over consumed, wellness is under-consumed, says Adrian Gore, chief executive officer of Discovery Holdings Limited, a health insurance company. He notes that it is his company’s interest, as well as society’s to incentivize a change in behavior to healthier lifestyles. But maybe that’s not the interest of a for-profit health care system, which now accounts for 17 percent of the entire economy (we spend twice as much as any other country for poorer outcomes).

And now I have a figure, a number, the answer to the question of how much money society loses because of illness. 

“In the next 20 years, if we don’t take action [to improve prevention and wellness], we will see $30 trillion in lost productivity – when the world is talking about sustainable development,” Chan said. “An important role of civil society is to hold government to account. We shouldn’t be naïve. Industry objective is to make profit. We have no problem with profit but need balance. We are beginning to see CEOs who understand shared value – that they can do good and also make profit.”

Indeed, McDonald’s earned praise from President Clinton for its CGI commitment to offer healthy menu options and change its advertising directed to children to include a “well being” message.

A big part of Obamacare is that it focuses on wellness, prevention, early diagnosis and treatment that keep down the cost and misery of getting sick, and seeing more revenue come to government because of higher productivity is exactly the prescription that world health leaders say is imperative.

But now the Republicans are using Obamacare – and this reasonable approach to solving the health care crisis while addressing the budget deficit –  in order to organize what amounts to a coup and disposing a democratically elected majority (Obama was reelected with five million more votes than Romney, and more Democratic votes were cast for Congress than Republican votes.)

President Obama cannot negotiate with hostage takers, because this practice is happening over and over. Those that would defeat Obama and his agenda have settled on this tactic because they haven’t yet had the grounds to mount an impeachment.

Obama needs to preserve this democracy. In fact, Congress is in violation of the Constitution – the 14th amendment –  which requires the Congress to pay its debts. Obama could invoke it himself, but that will trigger the impeachment process that the Tea Partiers have been salivating for. Instead, the president should sue Congress for violating its oath, and bring the suit to the Supreme Court, which despite the Republican activists (they were unitary executive proponents during the Bush regime) who have been dedicated to shifting power from the people to corporations while claiming to be “originalists,” have to take the language of the Constitution, “The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned.”

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