Ken’s Take on the World


Healthcare: Commodity or Essential Right

The recently, spectacularly, failed American Healthcare Act (AHCA), once again, brought to the forefront the debate on whether healthcare access should be considered a commodity, much like an automobile, subject to the whims of a free market and made available to those who can afford it or, rather, that healthcare is an essential right of all Americans that must be guaranteed by government.  Democrats appear united behind the concept that healthcare access is crucial to society and must be available to every US citizen regardless of their economic status.  As the debate over the AHCA progressed, it became obvious that Republicans are divided over this central question.  Polling shows that overwhelming majorities of Americans believe every citizen should have access to high-quality, affordable, healthcare.  In this, it appears the GOP is at odds with the majority of Americans.

 

This week, President Trump signaled the AHCA is not actually dead and that his campaign pledge to repeal and replace the Patient Protection and Affordable Care Act, also known simply as the Affordable Care Act (ACA) or, “Obamacare” continues onward.  The problem with this position is that the President has not articulated what this would look like.  Even with Republican majorities in both chambers of Congress, and without input from Democrats, a coherent plan that would meet the President’s promises of providing affordable health insurance to even more Americans, and at lower costs than the ACA, was not presented.  Competing factions within the Republican Congress ensured that no bill put forth would garner a majority of votes or even entice moderate Democrats to join in support.  Party leadership attempted to rush the bill through the House even prior to scoring by the nonpartisan Congressional Budget Office (CBO) which ultimately decided that, although ten-year cost projections would reduce the budget, the result would be more people without health insurance than prior to enactment of the ACA.

 

After the AHCA was pulled prior to a vote, the President commented, “Who would have known that healthcare would be so complicated?”  What?!?!  Besides anyone who has ever studied this topic?  This point underlies a central problem within the Trump Administration.  There is a serious lack of competent Administration leadership that might be able to shepherd complicated proposals through a Congress that is itself lacking in effective leadership that is committed to promoting and implementing legislation that will serve to actually benefit the American people.  Basically, Republicans have demonstrated that, since at least 2010, they lack the ability, or desire, to govern in the best interests of the people.

 

The failure of the AHCA effectively leaves the Republican leadership in Congress with two choices.  They can continue in their efforts to undermine the ACA which will lead to its eventual collapse, or, they can work with Democrats to strengthen the law which is what a majority of Americans currently favor.  It should be noted that the ACA has been effective and would continue to remain viable for at least the next decade but for efforts of the Republican Party over the past seven years.  Elected Republicans, and right-wing talking heads on radio and television, have spent the last seven years misleading the American public.  This has resulted in ballot box gains, however, it has not actually helped the American people.  While the ACA did not seriously further the debate on whether healthcare was an essential right versus a commodity available to the highest bidder, it did suggest that access to insurance to provide for healthcare expenses was a necessary thing that should be promoted by government.  In contrast, the debate among Republicans since 2009 has brought into the open the role of government in healthcare access at all levels.  It should be noted that prior to 2010, there was no question that government should ensure the availability of some access to healthcare for all Americans.  In 1986, President Ronald Reagan signed the bipartisan Emergency Medical Treatment and Active Labor Act (EMTALA) into law.  Likewise, COBRA was enacted under the Reagan Administration which provided individuals with a continuity of health insurance coverage.

 

The most recent debate between Republicans over the AHCA has placed a focus on whether government has any role in determining access to health insurance or healthcare itself.  This debate also served to highlight a disconnect between elected Republicans in Congress and their constituents.  Had the AHCA passed, the harms would have been felt significantly more among rural voters who overwhelmingly voted Republican over the past several election cycles.  The more extreme members of the GOP who make-up the Libertarian-wing (aka the Freedom Caucus formerly known as the Tea Party caucus) believe healthcare should be left to the winds of a completely free market.  Health insurers should be let alone to serve only the customers they desire and to charge whatever rates the free market might bear.  Let the buyer beware lest they procure a policy only to find out it lacks the protections necessary when they are needed, or worse, they are dis-enrolled when they become ill or seriously injured.  Somewhat more moderate Republicans seek to provide competition among insurers by removing obstacles to the sale of health insurance policies across state lines.  Theoretically, this appears to be reasonable, however, there are a significant number of realities that make this an unattractive proposal.  The biggest one is that insurance companies establish provider networks where they operate.  Healthcare providers are not likely to want to participate in a network that is out-of-state, perhaps in a different time zone, when they need to have their billing issues resolved or if they need to seek authorization for patient care.  This is inefficient and costly.  Another major issue affecting consumers is relating to the need to, perhaps, sue an insurance company for denial of a claim.  Consumers would be subjected to the laws of a particular state which might be much more favorable to the insurance company in a classic David and Goliath tale.

 

I doubt there is anyone who disagrees with the idea that society functions better when people are healthier.  Employee productivity is increased, chronic healthcare expenditures are decreased, and individual satisfaction is improved.  The United States outspends every other developed nation on healthcare but has significantly lower health outcomes on almost every measure.  Civilized societies throughout the world recognize this.  In promoting the well-being of their respective nations, leaders have already debated whether healthcare should be construed as a basic right to be assured by government.  It has been unanimously affirmed by economically- advanced societies that some level of healthcare must be provided for each person as by doing so it benefits every person.  The United States continues to be an outlier.  If, by independent measures, it was demonstrated that our status as an outlier made the health of our nation’s citizens better it would make perfect sense to continue our current system of healthcare delivery.  Unfortunately, this is not the case on ANY measure of national health.  Republicans continue to refuse to acknowledge this and continue to permit healthcare to consume ever-larger amounts of spending and an ever-growing share of our gross domestic product (GDP).

 

It is obvious the Republican Party is incapable, or unwilling to, of addressing this.  We, the people, must continue to demand healthcare access for all.  GOP-led efforts to undo the most significant healthcare reform in a generation is harmful to patients, providers, and insurers.  These efforts undermine the healthcare infrastructure and will lead to a significant collapse that would cause all of us to suffer.  If we recognize that a healthy citizenry makes for a more robust society, we must not maintain the idea of healthcare as a commodity to be enjoyed only by those who can afford it.  Essential healthcare must be available for all people.  This must be ensured by government.

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Twinks and Trump

Today I read an Op-Ed in The Huffington Post regarding an actual group called, “Twinks 4 Trump.”  I learned there are actually two such things http://www.huffingtonpost.com/entry/im-a-gay-dad-and-heres-what-i-want-the-twinks-4-trump_us_57a469aae4b0ccb02372168d  One site is, apparently, a parody site with all photographs and the like.  The other is actually a group of younger gay guys who claim to be conservative who further claim to support Mr. Trump in his campaign to become the 45th President of the United States.  The founder of this second group is a young man named Lucian Wintrich.  He attempts to articulate reasons for being a, “conservative” and a supporter of Donald Trump here: http://www.advocate.com/commentary/2016/8/02/twinks4trump-creator-5-things-media-gets-wrong-about-gay-conservatives  The problem with his message, and I applaud, “The Advocate” for including this, is that Mr. Wintrich missed the memo that neither Mr. Trump, nor the Republican Party are conservative in any sense of the word.

 

Many Republicans are claiming that the GOP is the opposite of the Democratic Party.  They are correct as many who claim to be Democrats say the same thing.  The problem that supporters of the Grand Old Party miss is that the opposite of, “progressive” is not, “conservative.”  The antonym of progressive is actually regressive and this is what today’s Republican Party seeks to impose on our great nation.  This is a message they have honed and promoted over the past 50 years, long before Mr. Wintrich was even born.  Lucian Wintrich and another, “alt-right” golden boy, Milo Yiannopoulos, were not even born until after some of the biggest challenges facing the LGBT community had already been fought.  They reap the benefits of the hard-fought efforts of thousands of people who refused to back down in the face of bigotry, prejudice, discrimination, and violence.  I wonder if either of them have even read about Stonewall, Anita Bryant, the AIDS epidemic, Don’t Ask, Don’t Tell, Harvey Milk, Leonard Matlovich, ACT-UP, the Mattachine Society, and others who really paved the way for the lives they are free to lead today?  I will not sit idly by while the demagogues of the Republican Party seek to roll back all of the progress made to prevent discrimination and promote equality for all people.  I will not stand around while Republicans attempt to roll back the economic advancements that have occurred over the past eight years.

 

This phenomenon, that is the fallacy of a GOP that is a tolerant and inclusive political party, is not limited to this group of younger, mostly white, guys.  We have already learned the Republican Party Platform that was approved at this year’s Republican National Committee (RNC) convention is the most notoriously anti-LGBT platform in the party’s 162-year history!!  Another group that has been supportive of the GOP for years is the Log Cabin Republicans who have also failed to recognize the messaging they claim to support regarding smaller government and fiscal responsibility is not embodied in the principles or actions of the GOP today.  And yet, someone like Mr. Yiannopoulos proclaims Mr. Trump to be the, “most pro-gay candidate in history!”  While Mr. Trump is not the most anti-gay candidate in modern history, it is clear by his statements that he is not remotely, “pro-gay.”  At best, Donald Trump is apathetic to the concerns of the LGBT community.  He has promised to appoint judges who would reverse marriage equality and other non-discrimination measures that protect LGBT citizens.  I guess folks like Wintrich and Yiannopoulos think uttering the acronym, “LGBTQ” during an acceptance speech is proof the Republican Party has finally embraced them.  For the record, Mr. Trump’s use of this nomenclature was used in reference to an attack by a Muslim on a gay nightclub in Florida that left 49 people dead and many more wounded.  It should also be noted that Mr. Trump appeared surprised that no one on the convention floor booed at his use of this language.  This comment was not in support of LGBT people, it was designed to stoke hatred of Muslims!!  This is what was being applauded on the convention floor. http://reason.com/blog/2016/08/03/lgbtq-at-the-rnc-and-dnc

 

I can only hope that, “twinks” like Mr. Wintrich and Mr. Yiannopoulos come to their senses and realize there is no place at the table within today’s Republican Party for LGBT people.  The messaging of the party today is not one of inclusiveness.  It is about divisiveness, bigotry, misogyny, racism, xenophobia, and hatred.  There is hardly any reference to fiscal responsibility.  There has been no message of hope or tolerance.  I am happy that folks like Lucian and Milo can live their lives as they see fit and I truly hope they will never have to face the challenges faced by those who came before me and that my generation experienced.

 

I would challenge Mr. Wintrich and Mr. Yiannopoulos to articulate what they believe are the actual, “conservative” principles they believe they are supporting.  I look forward to seeing, or hearing, what they have to say on that.  I am pretty certain they will be limited to the bigoted, xenophobic, arguments espoused by the Republican candidate for President and these are not conservative principles at all.



Craniorectal Inversion Syndrome (CRIS)

The substandard IQ and illiteracy associated with Craniorectal Inversion Syndrome (CRIS) are symptoms generally present among those who misidentify themselves as, “conservative,” as opposed to those who are referred to as, “progressive,” or, “liberal.”  These individuals are actually confirmed upon examination and testing, and then diagnosed as being, “pseudo-conservative” as opposed to, “conservative.”  The syndrome is also referred to as Cranial-Rectal Impaction Syndrome, however, this is inaccurate as the head is not actually, “impacted.”  This incorrect term has been promoted by some on the right-wing of the political spectrum.  The cranium can easily be removed from within the rectum, however, the individual suffering from CRIS fears the result of exposure to evidence-based information making it challenging to address this disorder.  The most extreme cases of Craniorectal Inversion Syndrome, the proper medical term for this condition, involve the spewing of fecal matter from the oral opening while the head remains firmly transposed within the rectum.  The correlation between poor educational achievement and the propensity to vote for political candidates who actively promote economic, domestic, and foreign policy positions that are detrimental to them is well documented in those afflicted.  For example, it is well known that those who do not attain an educational level beyond the traditional K12 educational spectrum leads individuals to vote for political candidates they know will promote legislation that is detrimental to their well-being.  For example, Republican candidates for elected office often run on a platform that promotes wealth redistribution by taking tax dollars from middle class and working families and diverts these revenues to the wealthiest corporations and families.  This is counterintuitive to the economic instincts, and financial stability, of the middle class and the working class economic strata and can, perhaps, be explained by a lack of knowledge about basic economics.  None other than Bush strategist, Karl Rove, who explains that as individuals gain more knowledge they become significantly LESS likely to vote for Republican candidates.  This was confirmed within the past few days by the leading Republican candidate for President, Donald Trump confirming that the GOP depends on ignorant voters in order to win elections.  It is interesting that individual income, or social status, is an inconsistent marker for voting for a conservative or progressive political candidate, however, attainment of knowledge is a powerful predictor of political persuasion with good sensitivity and specificity.  The better educated and informed an individual becomes, the less likely the individual will develop CRIS and the less likely they will be to vote for political candidates who claim to be conservative on social or economic issues.

 

Pseudo-conservatives differ from actual conservatives in many ways.  The most obvious is demonstrated in the complete and utter inability to use documented evidence and proven facts to participate in rational and civilized debate over actual issues that are presented to them.  While conservatives are able to engage and participate in constructive dialogue with people of differing viewpoints to address serious challenges, pseudo-conservatives who suffer from CRIS are unable to do so based on the limited feedback they are able to process on account of confinement and, likely, a lack of oxygen afforded them due to head placement.  Pseudo-conservatives are limited to repeating limited bits of information presented, and amplified, within the echo chamber that their syndrome results from.  Pseudo-conservatives can also be identified by the typical, and frequent, use of insults and profanity as standard linguistic technique during arguments.  While conservatives are able to visualize and adapt to progress and change just as progressives are able to do, the pseudo-conservative actually wants to reverse the space-time continuum in order to physically transport an entire nation backwards in time.  The pseudo-conservative fails to recognize that doing so would eliminate many of the great advancements that have been achieved through scientific knowledge and research.  Medicines, computers, seat-belts, powerful firearms, CT scans, MRI scans, faster jet travel, fuel efficient and affordable motor vehicles, space exploration, the internet, robotic surgery, the ability to limit civilian casualties during war, and the like would not exist without progress.  Pseudo-conservatives, due to their ignorance of history and scientific theory, likely resulting from the over-reliance on religious texts to formulate their knowledge base, are unable to process this using logic and reason.  This lack of intellect leaves the pseudo-conservative open to ridicule, not only from actual conservatives and progressives, but also from the conservative political candidates who are able to easily manipulate their limited thought processes, and knowledge base, into supporting their ideas.  The inability to think critically, means the pseudo-conservative with CRIS is extremely likely to support an extremist political candidate that vocalizes simplistic messages that are void of any substantive or realistic ideas.  These ideas often suggest racist, misogynistic, or bigoted ideologies.  While social theories recognize that individuals often prefer to interact and collaborate with other similarly-situated individuals and groups, those with an ability to use logic and reason are able to network and participate in mutually beneficial goals with others who possess different racial, ethnic, religious, political, cultural, social, or economic backgrounds.  Due to the inability, or outright opposition, to processing proven information and facts, the pseudo-conservative is extremely likely to collaborate only with other individuals afflicted with CRIS.  The condition is actually curable, however the only available treatment is restriction of vocally-conferred information from talk-radio hosts and intense exposure to factually-supported information from legitimate sources of knowledge.  Public libraries, educational institutions, and government agencies can be helpful with this.  Much more so than the internet which may serve only as a placebo if the patient is not highly selective.  Exposure to certain visual media, including Fox News, Breitbart, and the like will further exacerbate the condition.  I hope this helps!!



The “Others!!”

Watching Mr. Donald Trump win three of the first four Republican Presidential primary contests has been a frustrating, and troubling, experience for this self-identified progressive, independent American.  Political pundits have been explaining for the past several months there is no way Mr. Trump could possibly earn the GOP nomination to be President.  In the past few weeks, this narrative has changed to an assessment of how the Republican establishment has failed to contain the damage he has wrought on their party.  The sad and very tragic truth is that what we are seeing in America has not been introduced by the reality show star, real estate mogul, and entertainer, but by decades of intentional actions by the Republican Party establishment.

 

As a result of increasing social disapproval of racial discrimination, especially in more populous and northern states, throughout the 1950’s and 1960’s, and particularly fueled by the overturning of Jim Crow laws that had existed since the period of Reconstruction following the US Civil War, and the adoption of the Voting Rights Act and the US Civil Rights Act, the Republican Party made a purposeful attempt to draw poor, and working class Democrats (who had traditionally voted Democrat) into the fold.  There was a general appeal to these voter’s conservative economic views and the rampant poverty that existed throughout the South.  There was, also, a much more insidious, and covert, appeal to appeal to the racial prejudices that did not fade away following enforced desegregation of public accommodations, including schools and retail establishments.  Social norms began to evolve and overt racism declined only to be replaced by a shadowy, hidden form of racism that continued below the surface of society.

 

With the support of Southern Democrats, Barry Goldwater won the states of the Deep South in the Presidential election of 1964.  These states, Alabama, Georgia, Louisiana, Mississippi, and South Carolina.  These states were all a part of the Confederacy during the US Civil War.  While this was not enough to propel Mr. Goldwater into the White House, they served as a foundation for which Richard Nixon would add Florida, North Carolina, Tennessee, and Virginia, again, Confederate States during the Civil War, in order to become the 38th President of the United States.  The realignment of the Republican Party was nearly complete based on the racial prejudices that were motivated during this time.  In the late 1970’s and throughout the 1980’s Republicans also appealed to religious conservatives in order to increase their support which was eroding as a result of increased tolerance of racial differences.  However, there was a continuing appeal to the racial biases of poor, poorly-educated, working class white voters.

 

The rise of the Moral Majority in the very late 1970’s and into the 1980’s, was sufficient to propel Ronald Reagan, a Hollywood actor and former Governor of California, into the White House after the 1980 election.  The Moral Majority railed against women’s right, gay rights, equal pay, the minimum wage, and for a stronger military in order to prepare for a Christian Holy War against Islam.  It probably did not help that President Carter had a very lackluster Presidency noted for the Iranian Hostage Crisis.  There was an increasing anti-Muslim undercurrent present during this election which bears some similarity to today’s electoral climate.  Republican economic policies introduced throughout the 1980’s served to foster increased economic disparities.  As societal attitudes changed, the influence of the Moral Majority faded, somewhat, throughout the 1990’s and through today, although the promotion of hot button issues, including abortion and LGBT equality, has continued to bring out certain religious voting blocs during election cycles.

 

The election of President Obama in 2008 served as a catalyst for racist groups to increase their public rhetoric which, in turn, helped to fuel the establishment of the Tea Party as a significant political influence within the Republican Party.  The 2010 midterm elections saw a number of Tea Party-backed candidates elected into Congress including Senator Marco Rubio.  Senator Ted Cruz joined him in the US Senate in 2012 with significant Tea Party support.  The 2010 midterm elections began to expose the developing rifts between the Republican establishment and its base.  In light of a Federal government that appeared to be unresponsive to the desires of a Libertarian-leaning base that promoted to an extremely weak Federal government and expressing a, “States-Rights,” mantra, the Tea Party managed to increase gains in Congress during the 2012 election cycle.  Failure of Tea Party candidates to produce desired outcomes saw a bit of a pullback during the 2014 midterm elections.

 

President Obama’s election in 2008 came on the heels of the greatest economic downturn since the 1920’s and 1930’s.  While all economic groups suffered as a result of the collapse of economic powerhouses including banking, housing, and manufacturing, the recovery was most beneficial for those at the upper ends of the economic strata.  This has fueled the frustration of middle-class and working-class folks who believe government is not working for them.  The Republican Party has capitalized upon this by diverting attention away from three decades of failed economic policies and re-directing this frustration against immigrants and the poor.   Don’t blame government, we (Republicans) have been saying government cannot do anything.  It is, “The Others,” that are to blame for your economic and social status in life.  It is the gays who are responsible for the moral decay of our nation.  It is the immigrants who are responsible for low pay for your hard work.  It is the Muslims who are responsible for all terrorism.  It is not the fault of the wealthy that you are unable to advance economically and accumulate wealth, it is the fault of the poor who waste your tax dollars through food-stamp programs and, “Obama phones!!”

 

Mr. Trump, has capitalized on this message of using, “The Others” as a rallying cry for his poor and working class white supporters.  This ugly message of division, as untrue as it is, is remarkable for its effectiveness.  The American people, who should be too smart to fall for this message from a candidate such as, “The Donald” have reverted to an emotional response to fear.  This is what has become so perplexing about the Trump campaign.  Mr. Trump has not waged a political campaign on a single substantive idea.  He is not a conservative in any sense of the word.  He is not a moral man nor does he demonstrate fiscal responsibility.  And, yet, he has garnered support from evangelical Christians and a Libertarian base that supports lower taxes and smaller government.  He promises to spend more on increasing the size of our military and an incredible amount to build a wall separating the United States from Mexico.  Mr. Trump says that he will make Mexico pay for such a wall to the delight of his supporters who surely must know this is an impossibility.  He insults and threatens anyone who disagrees or opposes him.  He has insulted war heroes, journalists, women, Muslims, Jews, LGBT people, our current military personnel, first responders, and people who do not possess college degrees.  These things, alone, should have been enough to doom his campaign earlier in this election cycle.  Instead, his racially-tinged, misogynistic, bigoted, and Islamophobic, comments have drawn some of the biggest applause lines at his campaign rallies.  This is all inexplicable but for one thing.  His promotion of white, Christian, heterosexual, people as being better than others has actually increased his support among people who should know better, but are giving in to the emotions of anger, fear, and hatred.

 

While I still do not believe Mr. Trump has the ability to win a general election (I still have faith in the American people) the fact that he has used differences to successfully pit Americans against one another, and against others, is seriously troubling.  I do not believe Mr. Trump even believes much of what he is promoting, he is an entertainer, after all, but the fact that many Americans support the message lays bare a certain ugliness that is more than simply troubling.  That there exists, within Americans, animosity towards others based on their skin color, their religion, their heritage, or their gender is quite disgusting.  It would be naïve to ever think these attitudes did not exist in 2016, however, the prevalence of these attitudes is bothersome.

 

It should be noted that this concept of, “others” is not unique to the Republican Party.  The Democrats have also promoted a philosophy of others.  The difference between Democrats is that they frame this issue as one of a small group of ultra-wealthy Americans versus the rest of America.  The candidates on the Democrat side point out that the wealthiest of Americans are harming the rest of Americans.  In this battle, we are all Americans, first!!

 

Another difference between the two main political parties that has become evident to me over the past several election cycles is that the Democrat Party promotes an overall message of optimism and hope while the Republican Party markets a message of pessimism and fear.  Fear and anxiety are very powerful motivators, particularly for individuals who are insecure with themselves.  Take Mr. Trump’s campaign slogan:  “Make America Great, Again!!”  Yeah!!  Wait.  This slogan implies that America is no longer great.  I reject this suggestion completely.  The United States IS a great nation!!  It can be made even greater with the proper guidance and leadership, however, to insinuate that, at some point, America has lost her greatness is a reprehensible message to put forth!!

 

The message that must be heard by every person is that we are ALL Americans, first and foremost!!  We must reject the idea that there are, “others,” completely!!  This November, it is critical that we, as Americans, get out and vote.  Vote to reject the notion of, “others.”  Vote to KEEP America great by continuing to promote our ideals of justice, fairness, equality, and opportunity!!  YOU can keep America the greatest nation on Earth!!



Progressive versus Conservative? Not So Fast!

Today’s political dialogue is framed in terms of progressive politics versus conservative politics.  Is this really the case?  Multiple studies and surveys have demonstrated that Americans have become more polarized, politically, over the past two decades.  This has become exceedingly apparent through the observations of the last two Congresses.  Members on both sides have been promoting legislation that the opposing side will not support in an effort to score points with their own political base.  The net effect is gridlock in Washington and in state legislatures across the country where elected leaders fail their constituents in an effort to maximize their abilities to reflect the vocal minorities of their base voters in an effort to become reelected.

While both of the main political parties, Republican and Democrat, are guilty of this, there are a number of underlying issues that need to be recognized and addressed.  While the numbers of Americans who identify as either Republican or Democrat is relatively unchanged since the 1950’s, those who identify as moderate Democrats or moderate Republicans has declined since the 1970’s.  The biggest changes of note are the loss of moderate voices in either party since the 1980’s which has intensified since 2000.  This has been much more pronounced in the Republican Party especially since the election of President Barack Obama and the rise of the Tea Party after 2008.

Two underlying factors have been associated with increased levels of political polarization throughout history.  These include immigration policy and income inequality.  These factors were in play during the first part of the 20th century and are currently at the center of our current polarization crisis.  Recent research has shown that the current polarization effect evidenced in state and federal elections is more significantly rooted in conservatives moving even further to the right on important policy issues while progressive politicians have not shifted much further to the left.  The current shift means that it is so-called conservative political positions have veered into more extreme territory while traditional progressive policy positions have not demonstrated a similar dramatic shift further to the left.

Today’s arguments are not so much a difference between progressive and conservative ideas.  The greatness of the United States has always been its embrace of change and forward advancements.  The United States, for nearly two centuries, was the powerhouse of innovation and creation in technology and knowledge.  Traditionally, both conservatives and progressives believed, and pursued change.  Conservative thought and progressive thought agreed on one defining thing.  The best days of America lay before her and each side promoted ideas and goals that would further this vision.  While the more liberal voices promoted grand, sweeping changes, conservatives were often a voice of reason, of caution, pursuing these objectives over a slower, longer timeframe.  This is one of the reasons that, for most of our history, politicians found the ability to work with their peers on the other side of the aisle to accomplish the things that would serve to benefit all Americans, and, American society.  Conservatives and progressives did not disagree so much on change, per se, but on the rate of change or how sweeping such change would be.

In the last century, Democratic and Republican politicians came together to establish Social Security, the Interstate Highway System, Medicare, Medicaid, public works projects, the Environmental Protection Agency, the National Parks System, public university and college systems, the Civil Rights Act, the Voting Rights Act, FEMA, FDA, NIH, the defeat of Nazi Germany, the atomic bomb, the Arsenal of Democracy, the Hill-Burton Act which led to the building of hospitals to improve access to care, and many more great achievements.

Today, there are a number of voices within the Republican Party, as well as many voices outside of the party, who, while claiming to be conservative, are, in reality, regressive.  These regressive voices see America as a place whose greatest accomplishments reside in the past and would seek to return us to an era where Jim Crow laws ruled the land, where abortion was still illegal, where there was no income protection for senior citizens or the disabled, and where segregation was still completely acceptable.  These voices seek to overturn discrimination protections, access to health insurance, sensible gun regulation, and the foundation of every great society, our public education system.

Within the last decade, we have seen a surge in the number of white-supremacist groups, of so-called Patriot groups, and other hate-groups that actively challenge the legitimate authority of government agencies by threatening force and insurrection.  This weekend marked the 20th Anniversary of the deadliest homegrown terrorist act on American soil, the bombing of the federal building in Oklahoma City that killed 168 Americans, including 20+ children.  These are the voices that are being reflected in the increasingly regressive candidates running as Republican candidates for elected office.

It is not a matter of progressive ideas and conservative ideas being in conflict with each other.  This is an issue of progressive, and according to many polls, mainstream, ideas clashing with a regressive ideology that renders compromise impossible.  We are nearing a dangerous tipping point in our nation’s history.  The trustworthiness of our elected officials is at its lowest point in recorded history, the favorability ratings of Congress are lower than certain types of insects, and while favorability ratings for both Democrat and Republican elected officials have fallen, the Republicans have fallen harder and faster.  Election results from the past several election cycles have consistently demonstrated that more people have voted for the Democratic, or progressive, candidate than voted for the Republican, or conservative candidate.  Gerrymandered election districts have ensured that candidates from either party cannot be readily challenged on the field of ideas in the way these districts are drawn.  This causes frustration among the electorate.

When you hear a political candidate talking about how he or she is the conservative candidate, simply know that they are most likely a regressive candidate.  True conservatives can work with progressives to get things done.  Until we balance, and reverse, this polarization that we are witnessing today, elected officials are not going to accomplish much in the way of benefiting the American people.



Defunding “Obamacare?!”

Among a string of poor public policy positions advocated by members of the Republican Party, the recent decision to attach an amendment to a Continuing Resolution (CR) that would fund the government but withdraw all funding for various components of the Affordable Care Act (ACA) is among the dumbest.  There are several reasons for arriving at this conclusion.  The most dangerous is that it will potentially lead to a partial shutdown of government which affects every single American.

 

First, the amendment that was attached to the Continuing Resolution striking funding for the ACA is purely a political gimmick designed to appease a small, extremely regressive, faction of the Republican base.  It is highly unlikely this amendment will be attached to a Senate resolution for a floor vote.  If it is offered as an amendment, it will likely not be approved.  This means the Bill goes into a Conference Committee.  This will put the House of Representatives into a showdown with the Senate and pushes us closer to a deadline which will result in the stoppage of essential government services.  Think Social Security checks, Military paychecks, the Centers for Disease Control and Prevention (CDC) which is gearing up for flu season!

 

For the sake of argument, let us say that the amendment does become a part of the final Bill that is presented to the President.  It is extremely likely the President the President would return the Bill to Congress with a bright VETO stamp across the top.  Republicans do not have the votes to overturn a veto and would be left holding the bag on a smelly collection of dog excrement when the deadline for government operational funding passes.  American citizens do not like when there is no one answering the telephone at the Social Security Office!  I personally would be quite pissed off if I found that our Military service members were not getting paid!!

 

Let’s enter the world of a Republican wet dream for a moment.  The amendment that defunds the ACA is passed through both chambers of Congress and the President accidentally signs this wrong-headed piece of legislative bovine-manure.  The Republican Party collectively orgasms all over themselves and claims they have achieved a monumental victory!  Orthopedic surgeons in the Beltway will be extremely happy for with all of the folks patting themselves on the back there are sure to be a few Rotator Cuff tears to deal with.

 

What happens next?

 

This amendment does not repeal the Affordable Care Act.  It does not block the implementation of any of the rules and regulations promulgated by the ACA.  It only does one thing.  It eliminates funding for any of the provisions of the Affordable Care Act.  So, what?

 

Hospitals have begun to implement Electronic Health Records (EHR’s) using money provided under the ACA.  Study after study has demonstrated that EHR’s reduce medical errors and have the potential to reduce costs.  The ACA requires that hospitals and physicians adopt the EHR as part of a goal to improve patient safety.  Doctors and hospitals are now left solely on the hook for the expense of this technology.  Failure to comply will result in a loss of eligibility for Medicare and Medicaid reimbursement.  The hospital I work at receives more than 40% of its reimbursement from these two programs.  Fortunately, we have already completed adoption of an EHR system.  I do not know about all of our affiliate physician groups and individual practice physicians, however.  If our surgeons cannot operate on Medicare patients, a huge piece of our revenue stream disappears.  Hospitals generally operate on extremely thin operating margins (gross revenue over expenses), typically 1 to 3%.  Many hospitals have a much higher percentage of Medicare and/or Medicaid patients and would be impacted even more by a loss of access to these revenue streams.  Loss of Medicare funding will mean the demise of a number of independent hospitals and loss of funding for EHR technology will mean that most independent practice physicians and many physician groups will cease to exist.

 

States are required to begin enrolling individuals in Health Insurance Exchanges (HIE’s) beginning on October 1.  Funding to set up these exchanges was allocated through provisions of the Affordable Care Act.  In a number of Republican-led states, the legislature and executive refused to participate in an HIE.  In these states, the Federal government is operating the exchange.  The money to administer these programs is eliminated as a result of the defunding amendment.  Insurance companies are participating in these exchanges anticipating a new influx of customers seeking health insurance.  From a business standpoint, health insurance companies know that having a broad base of customers allows them to spread risk among a broad base of payers.  This means that insurance rates can be maintained at an affordable rate for all consumers.  In a number of states that have already started operating these exchanges, insurance rates, including premiums and deductibles have been lower than suggested by certain folks on the right of the political spectrum.  Many of the folks enrolling are doing so in anticipation of subsidies available as part of the ACA.  Those subsidies are gone as a result of the amendment.

 

Under the Affordable Care Act, which, by the way, remains the law, insurance companies cannot deny coverage or charge exaggerated rates to individuals based on health status.  With the defunding amendment, Health Insurance Exchanges have been hobbled and not able to reach out to customers.  Since they will not be able to obtain, potentially 30 million additional customers, insurance companies will be forced to drastically raise the cost of premiums for all of their customers.  Except for the wealthiest among us, individuals will find they are unable to afford monthly premiums and will be forced to drop their coverage.  Businesses will find it increasingly difficult to afford the cost of health insurance for their employees and will begin to drop insurance coverage.  Instead of stable, affordable premiums, I would anticipate much more expensive premiums.  The result, millions more uninsured Americans!

 

This wrong-headed amendment to defund the Affordable Care Act would be dangerous for patient safety, health insurance companies, hospitals, doctors, taxpayers, and businesses.  The proponents of this legislation have failed to grasp the tremendous negative consequences of such a thing happening.

 

I am absolutely certain the Republican leadership in Congress is fully aware that they are playing political gimmickry with this amendment to defund the Affordable Care Act.  They know, completely, that this amendment will not make it to the President’s desk.  Speaker-of-the-House John Boehner knows this as does every member of the US Senate.  The absolute worst possible outcome for Speaker Boehner, and every Republican member of Congress would be for this to land on the President’s desk as part of a Continuing Resolution and actually be approved by President Obama.  The resulting collapse of the Affordable Care Act will lead to a collapse of the health insurance industry, hospitals and physician practices, and culminate in the establishment of a universal, single-payer healthcare system in the United States.  Speaker Boehner would be credited, single-handedly, with bringing Socialized medicine to the United States of America!