Socialist Death Panels

From the blog "Texas on the Potomac," reporting on the comments of U.S. Congressmen from that state's delegation concerning the House vote to "Repeal the Job-Killing Health Care Law Act:" 

Rep. Jeb Hensarling, R-Dallas, chairman of the House Republican Conference:

"The American people don't want it. It's personal.

"Here's my story, two days ago, I was in San Antonio, Texas, and my mother had a large tumor removed from her head. They wheeled her away at 7:20 in the morning, and by noon, I was talking to her along with the rest of our family. It proved benign, thanks to a lot of prayers and good doctors at the Methodist hospital in San Antonio. My mother's fine. I'm not sure that would be the outcome in Canada, the U.K., or anywhere in Europe.

"No disrespect to our President, but when it comes to the health of my mother, I don't want this President or any President or his bureaucrat or commissions making decisions for my loved ones. Let's repeal it today, replace it tomorrow."

Now, first of all, this holder of one of the highest offices our nation has to offer believes that the reason his mother's tumor was benign was "thanks to a lot of prayers and good doctors ..." Prayers? Well, okay; if they'd been doing a better job of praying maybe the lady wouldn't have had the tumor in the first place. But good doctors? I know a lot of doctors, but I don't know of any who can make a malignant tumor benign. So we have to question Rep. Hensarling's understanding of how things work. Not in medicine; I mean, in the Universe in general.

But to move on, Hensarling, 53, doesn't want Obamacare. Specifically, he doesn't want the government making decisions about his mother's health care. Presumably, his mother is at least twelve years older than he, and so is most likely a Medicare beneficiary. Medicare, unlike private health insurance would have done, did not require that her surgery be pre-approved in order for the hospital and the surgeon to be paid. It did not, as some private insurers do, place limits on the pain medication or other drugs she could have in connection with the surgery. And unlike most private insurers, Medicare will in all likelihood pay the physician within 30 days.

Hensarling was pretty happy with his mother's government-provided health care. And, of course, as a congressman, he also has government-provided health care, and top-quality care at that, just like Mom. 

He just doesn't want the rest of us to have it. 

Universal Coverage: A Suggestion

As I understand it, the argument in the big lawsuit being brought against the President's health care plan is this: Under the Commerce Clause (in Art. I, Sec 8 of the U.S. Constitution), the federal government has the right to regulate commerce among the states.

This has been interpreted very broadly, to reach almost all economic activity that occurs within the U.S.

The lawsuit, however, argues that this rule provides only the power to regulate commercial activity that is taking place, or might take place; there is no power to compel that any particular activity be undertaken by anyone.

Example: You can be forced, if you, say, sell beef at wholesale, to abide by various federal restrictions on how beef cattle are slaughtered, packaged, graded for quality, and so forth. But if you grow vegetables, or just have some idle acreage, you cannot be compelled to begin raising and selling beef cattle.

To a layman, this argument makes some sense. Of course, the government has the power to tax; but by definition, taxes apply to economic activity, not inactivity. [this may need a separate examination]

It would be unfortunate, from my perspective, if this argument were to prevail. The individual mandate is key to the Affordable Care Act, for well-rehearsed reasons that go like this:

1. The system will depend on the availability of private insurance for everyone not covered by Medicare, Medicaid, or similar government programs; and the lack of a "public option" means that tens of millions will not be so covered, and so will have to seek private insurance.
2. Private insurers are required to offer coverage to all comers, on substantially comparable terms, so that everyone will have access to coverage.
3. To avoid "adverse selection" --a situation in which healthy people stay away because of the cost of insurance-- everyone not only can, but must, buy insurance. Subsidies exist to support those who may not be able to pay for the coverage.

This third point needs elaborating: If the cost of insurance is high, and I am healthy, why not just forego the insurance? After all, because of item #2, I can always buy in if I get sick, or start to age, and so forth. The result, of course, would be that (1) only the sick would sign up, (2) this would drive costs up, and so (3) even more people would begin to drop their insurance.

They key point in all this is that you can sign up whenever you want to. And this is a mistake. First of all, it's not true now even for Medicare participation: if you don't sign up within a specified time after you become eligible, you will be charged more to join; and if you miss the window for signing up, it will remain closed for a time.

This could easily be applied to private insurance under the Affordable Care Act:

• Everyone is allowed, but not required, to sign up for health insurance;
• If you fail to sign up, any insurer with whom you subsequently sign up can charge you a premium based on how long you went without coverage.

But there's more: If you don't sign up, you won't have another opportunity to sign up for five years. And, when you do apply, your application cannot be approved prior to the date that is 12 months after your application is received. So, if you don't sign up when the program is first available, you are guaranteed to be uninsured for a long time.

There are details to be ironed out, including notification, what to do with people who don't sign up but then join a company that provides coverage, and so forth. These are, I think, administrative matters that can be resolved fairly easily.

What's the catch? It's a big one: What do we, as a society, do with the person who fails to sign up, and then has a catastrophic accident, or a stroke, or gets cancer?

I'm sorry; but I suggest that we have to be harsh here: these people are on their own.

No, we won't leave them to die in the alley outside the ER entrance. But they will receive maintenance care ("palliative care") only, unless they pay, in advance, for any extensive treatment, curative or otherwise. And they (or their estates) will be billed for that care.

So, you don't have to have health insurance. But you do have to face the consequences, just as those who now rail against this requirement would presumably prefer.

The Gamble

The Congressional Republicans, clearly, have drunk the venomous Kool-Aid that has poured forth in an ever-increasing torrent from the likes of Limbaugh and Beck. [Q: why are the most listened-to voices on the radio not, somehow, part of the "mainstream media?"] They have accepted anger and denial as their governing philosophy. Having done so, they now must substitute symbol for substance, spectacle for plot (although "character," in the personae of some of the wing-nuttier new members of the House, looks promising as well).


Among the first items in the order of business:

• Read the Constitution on the House floor. The Constitution has become, for the Tea Party, what Mao's little Red Book was to the Cultural Revolution. It is Holy Writ, inerrant, universal, timeless. It's every word is sacrosanct. Well, okay, not every word: they skipped the part about slaves counting for 3/5 of an actual human being in determining population for purposes of Congressional apportionment. [It occurs to me to wonder: if a slave was the bastard child of his owner and an unfortunate slave-girl, would that child be counted as 1/2 x (1 + 3/5)?] Only the parts we like (or must pretend to like, such as the 13th Amendment) are holy.
• Pass "The Repealing the Job-Killing Health Care Law Act." And whatever we do, let's not record any votes on the specific provisions of the Law, which everyone likes.  We'll just repeal the whole thing. And the CBO's analysis that such repeal will add to the deficit? The CBO is wrong, because its conclusion is inconvenient. So we don't have to find the cuts we promised to find to match any and all increases in the deficit.

These are just two of the growing list of things the Republicans in the House will spend their time on. There are others, and they fall into two categories: Symbolic gestures, and reformulating their own campaign promises, including the Pledge to America, so that they can be excised from the public mind like gangrenous tissue.

The symbolic gestures won't hurt anyone. Sure, some of them will make some people look ridiculous; but that's in keeping with what has become the Republican style of late. No, the symbols are fine, and it's hard to avoid the suspicion that they are getting so much play just now, in part, out of a fervent hope that symbols will be enough.

And here is where the gamble comes in. Having cynically used the most extreme of the excesses of an ignorant, jingoistic, hopelessly confused minority as their rallying cry, the Republicans must now hope that they won't actually have to deliver. They'd like to; but they can't. They can't lower taxes and balance the budget. They can't cut  spending, win in Afghanistan, and bring back full employment. They cannot remove the regulations (whatever poor shades those might be) that are "killing jobs" and stifling entrepreneurship while helping the middle class return to prosperity. They can't turn back the clock.

Unfortunately, this is what they have promised to do. The risk is that those who voted them in will expect them actually to deliver. The gamble is that, as voters often do, these voters will forget what they asked for, and accept instead the clever naming of bills that will go nowhere, the subtle but persistent disrespect for, and de-legitimizing of, a president who won 53% of the popular vote, and the fulminating against socialism in the form of government regulation.

The gamble is the Republican hope that Republican voters don't really care about substance.