Ken’s Take on the World


Resisting 45!!

For those of you who follow me on Facebook or on Twitter, and those of you who have read my blogs on WordPress, you know that I have expressed opposition to many of the things that candidate Trump, and now President Trump, has done. I have also expressed opposition to many of the positions and legislation advocated by elected Republicans including the Affordable Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA). As a result of statements I have made, I have recently noted a number of folks who support the current President reply to these statements on social media with a variation of “Well, what have Democrats proposed?” Or, “Democrats will continue to lose elections if they have no policy position to promote and only function as an anti-Trump party!” Comments such as these are beyond annoying as they are simply the comments made by talking heads in the pseudo-conservative media environment and completely ignore the realities of what is happening in our American democracy.

 

Let me address the comments about Democrats losing elections, first. In the 2016 Presidential election, the Democrat, Hillary Rodham Clinton earned nearly three million more votes than her Republican rival in the general election. Of course, her opponent has claimed that millions of illegal votes were cast and that he, without providing any evidence to support his claims, actually won the popular vote. This is a position that is still supported by many of his most stalwart supporters. Likewise, only 33% of Republicans agree with the evidence that Russia, specifically, interfered with US election processes in 2016. This is in stark contrast to what Democrats and Independents believe on the matter of Russian interference in the election. The Republican view also stands in contrast to what US and foreign intelligence services have confirmed which is that Russia, and groups affiliated with the Russian government, made a concerted effort to interfere with the US Presidential election in 2016.

 

With regard to Congressional races and state legislative races, multiple studies and commentary here, here, and here have demonstrated that a major culprit contributing to the makeup of legislative bodies is a result of how district maps are drawn. Several reports including this interesting study looked at whether Democrats or Republicans tended to produce more gerrymandered districts when entrusted with the responsibility of drawing lines. While these demonstrate a modest benefit for Republicans currently, this does not explain the entirety of GOP gains at the legislative levels. Furthermore, gerrymandering does not impact races for state governors as these are decided strictly upon a popular vote within the particular state. Other factors are clearly at play in these elections as well. This brief primer demonstrates some of the changes in voting trends since the early 1900’s. The role of media, specifically Fox News, also appears to drive some of the support for Republican candidates as researched in this older piece by the National Bureau of Economic Research position paper.

 

This May poll from Pew demonstrates the largest historical gap between Democrats and Republicans on the role of the media in providing news and information. This January analysis from Pew found that Trump voters received the bulk of their news/information from Fox News. Among Clinton supporters, no single news or information source provided the bulk of decision-making input. A report from December 2016 pointed out bipartisan concerns relating to the role of “fake” news and its negative impacts. Coincidentally, a fact check of leading political pundits finds that pseudo-conservative pundits have more false statements (> 50%) than progressive/liberal commentators.

 

The second point to address is this very recent claim I have been seeing that Democrats have no agenda other than to oppose the current President and his efforts. This claim is puzzling, not because it is simply what has been put forth by pseudo-conservative talking heads over the past couple of months, but because it is simply false. Democrats are united in their opposition to simply rolling back all of the advancements that were made under the previous Administration. A review of President Trump’s Executive Orders demonstrate the majority of EO’s he has signed thus far are to repeal EO’s signed under the Obama, and to a lesser extent, the Bush (43) Administrations. Even the centerpiece of his legislative agenda thus far, the repeal (and replacement) of the Affordable Care Act, is not a new proposal but merely the rescinding of an Obama-era achievement.

 

It is hypocritical to suggest Democrats do not have anything of value to contribute to the legislative process when they are not even invited to participate in the drafting of legislation that would impact nearly 1/6th of the entire US economy. Republicans, when their healthcare proposals faltered caused folks like Majority Leader McConnell to state that the GOP might have to work with Democrats if they were unable to gather enough votes from their own side of the aisle. As if working across the aisle is a distasteful act that should be avoided at all costs. The fact the Republican proposals from the House and the Senate would be harmful to the most vulnerable of Americans, including large numbers of Trump voters, ensured Democrats would not support these measures. Republicans spent the last eight years obstructing the efforts of President Obama. Democrats have not even had to seriously obstruct the efforts of President Trump. His failure of leadership has meant that even the majority Republican Congress cannot get legislation to his desk.

 

The progressive agenda remains committed to improving the lives of working Americans and their families by reducing tax burdens on the middle and working class, providing educational opportunities for all, and ensuring affordable, accessible healthcare for every American. Democrats have supported an increase to the Federal Minimum Wage, equality for all Americans, the right of workers to organize and collectively bargain, the right of women to decide what medical care is appropriate for themselves, and improving the ease of voting in democratic elections. Considering that the Republican Party opposes these things, I can understand why there are some who think that opposition to the current President and the GOP legislative agenda is demonstrative of a lack of a political agenda. It is, I assure you, not the case. Refusing to stand by while pseudo-conservatives roll back advancements that have been made for the environment, for our kids, for the elderly, for the economy, for the working class, for the sick, and for our veterans is actually part of an agenda. An agenda that continues to maintain that the United States is a great nation that will continue to get better. If only the Republican Party would finally climb aboard that train. Until then, I will resist!!

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Healthcare: Privilege or Right?

As Republicans struggle to obtain enough votes in the US Senate to pass their version of a bill (Better Care Reconciliation Act) that was originally brought forward to repeal, and replace, the Affordable Care Act (ACA) much focus has been placed upon the economic costs and the personal costs to those who would be affected should this legislation become enacted into law.  As one who has paid attention to the debate over healthcare access for the past three decades, I have been thinking of a much deeper question that we should be asking of ourselves as it would, perhaps, better drive the debate over this legislation.  The question that each of us should ask is this:  Should healthcare be considered a privilege, a commodity, that should be available only to those who can afford such care or, should it be considered a necessary right for every person that must be protected, and assured by government?

 

When I have posed this question to those who express opposition to the ACA, the most common response that I receive is that healthcare should be treated as any other service that a person would seek out.  The most common support offered for this position is that every person receiving services should be required to pay for such services.  To bolster this claim, these critics argue that it is not fair to expect others to pay for services that they receive.  On its face this appears to be a reasonable argument that must be considered.  After all, you wouldn’t take your car to a mechanic and not be expected to pay for repairs or maintenance on your vehicle.  You don’t take your family to a restaurant and expect to receive free food, do you?  You wouldn’t call an air conditioning repair person and expect to not receive a bill for the parts and services provided, would you?  These criticisms appear to suggest that healthcare services and products are no different than whether or not your vehicle or your heating and cooling systems at home are functional.  This is a false and illogical argument.

 

When one dines out at a restaurant, one knows what they can afford and if they are unable to afford to dine at a certain establishment they simply eat dinner at home or at a less expensive restaurant.  When your air conditioner is on the fritz, if you do not have the money available for repairs, you will need to open your windows, use fans, or other methods of staying cool.  For those with underlying health conditions in which extreme heat is dangerous, communities provide cooling centers, or family and friends are often able to step in to provide temporary shelter until the air conditioning is repaired.  Even if a new central air system must be installed, the cost is almost always going to be less than $5,000 USD.  Many heating and cooling companies will also finance this amount to keep costs manageable.  Similarly, if you need repairs on your automobile, you can determine what are the most crucial and pay for those and defer other repairs until later.  Or, your community may have decent public transportation available.  Or, you may be able to car-pool to work or use a ride-sharing service.

 

Healthcare, unlike these other services, is not a commodity that can simply be delayed in many cases.  I have frequently likened the provision of healthcare as an essential service that must be available to every single person.  Similar to a community that provides fire departments and trained personnel to operate this life-saving equipment.  Or, law enforcement agencies that respond to safety or criminal complaints.  Or, military agencies like the Coast Guard who respond to emergencies on our nation’s waterways.  We don’t bat an eye when we are asked to fund these critical services.  As a society, we have come to realize these are critical pieces of infrastructure that exist for the benefit of each of us even if we never need to directly use these services.  Why, then, do we look at healthcare differently?

When I have attempted to discern how so-called conservatives continue to maintain the position that healthcare is a commodity, and not a right, in addition to the arguments about paying for services and the burdens of having to pay for those who cannot afford these services, they remind me that healthcare services are already provided to people in the nation’s Emergency Departments (ED) regardless of one’s ability to pay for such care.  This, then, implies there is, in fact, some existential right to healthcare.  When I point out this inconsistency in logic, one person actually mentioned that fewer (uninsured) people seek medical care as if this implies lower costs to taxpayers.  The problem with this (il)logic is that while uninsured individuals are far less likely to present to a primary care physician in the community setting, they are far more likely to present to an ED for treatment of conditions that can be much more effectively, and economically, managed in a community setting by a primary care physician.  This translates into significantly increased healthcare costs for all of us.  The average cost of an ED visit in the United States is nearly $2,200 based on a study described in “The Atlantic.”  Compare this to the average cost to a primary care provider (PCP) in the US which is only $100 based on an Agency for Healthcare Research and Quality (ARHQ) study by the Department of Health and Human Services (HHS).

 

A review of multiple studies has demonstrated that access to health insurance is correlated with significantly improved health outcomes.  The review, published recently in the “New England Journal of Medicine” (NEJM), documents that improved healthcare outcomes are especially notable among pediatric patients.  Further, this review notes that not only are healthcare outcomes improved, but other measures of quality of life, including educational achievement, are improved with access to health insurance.  Other studies have demonstrated the significant economic consequences associated with illness.  I am not only speaking of the direct costs associated with providing medically-necessary care, but the impacts that illness and preventable injury have on individual and societal economic stability and growth.

 

I believe we must frame the debate over access to health insurance as one of a necessary right that must be protected by government actions.  Only then, will we be able to determine the most effective means of financing healthcare in the United States.