Avoidable Healthcare Act

AHA: As far as mandates go, the Affordable Care Act may be considered far more gentle, reasonable & well-meaning than, say, the Vietnam War era draft. Oh, so you want to require me to have some kind of health insurance, since society may otherwise have to pick up the tab for the minimal care it would be more or less obligated to provide in a pinch. (Emergency vehicles & response personnel are standing by.)

Let’s face it. Some degree of healthcare is a matter of the society, including much physical & staffing infrastructure, research, etc. Like roads, the individual’s active role ends where the driveway turns into the street. The driveway needs the street. In the case of individual health, it’s an inherently mixed equation between what individual & social responsibilities. One without the other leaves everyone more vulnerable. You can be the most health-conscious person alive & still breathe air-in-common with others, & subject to every more or less randomly occurring acute health care emergency.

Facilities & systems are more or less held in common, although a variety of payment systems overlap. Nevertheless, we can’t pick-&-choose only the capacities we expect to need, partly because we may end up needing the unexpected, & partly because most health care issues end up having large numbers put at risk. For reasons others have described in detail, it’s not particularly subject to free market forces.

Even without a driving license, every citizen, every resident, has some responsibility for the infrastructures that make modern life possible–roads, power-grid, schools among them. Costs of the healthcare system at large is clearly among these. It makes as much sense now, with everything cost-per-service correlated, as having every block in a street grid toll-boothed; never mind the cost added by having the driver needing to calculate the costs of different routes as tolls change (if disclosed at all). Now do it in a medical emergency.

A society provides its constituents certain benefits of mutual membership. It’s not a one-sided arrangement. You don’t get to enjoy the benefits of society without also having a fair share of the responsibilities, including a share of the costs. What percentage of transportation-infrastructure costs should be paid by high-usage corporate entities and/or by other various user-groups may be a matter of some discussion, but the principle is clear. Nor is actual current use the key question, where it’s the over-all capacity provided by society at large to itself that matters: roads, rails, ports, medical facilities….

Still, phrasing the responsibility of an adult to the healthcare system as a whole as a “mandate” gave it a strange twist, albeit one with clear Republican roots (Romney’s system in Massachusetts), as a way of universalizing coverage without having the government take over the whole system. It was a worthy attempt to finesse the gap between social responsibility & a system private (insurance) providers.

Many Democrats would feel more at home with a single-payer, government-managed system as a way of universalizing coverage on the basis of social responsibility without imposing a mandate. And then there’s a “pragmatic center” that accepts the social responsibility all have for coverage in the system as a whole, but which would allow roles for both private & governmental coverage providers in what is inherently a mixed system.

It’s mixed from the beginning. Illness is not simply an individual matter, as infectious disease, emergency response, and agencies of public safety make clear. The community has a vested interest in all such matters. Use of public roads may fairly require various kinds of dues, fees, taxes, and coverage, therefore. The same principle may be extended to off-road emergencies & coverage.

Indeed, against some historical resistance, a minimal degree of coverage has been provided for all “senior citizens.” A patchwork of clinics, public health agencies, and other community resources has developed in response to perceived needs. Nevertheless, the need to address significant gaps in the system had become clear enough for the Democrats to pass the partly Republican (in theory, not in actual political buy-in) ACA, believing it an incremental improvement, despite its imperfections.

On the one hand, the whole topic takes on a mind-boggling complexity of moving parts. On the other hand, the central issue isn’t complicated by details down in the weeds. It’s how does the country/society/community reconcile public & private elements & functions. Any satisfactory solution must start by acknowledging the validity of both public & private elements. One must also recognize that these aren’t neatly separated. The most private of enterprises (e.g., pharmaceutical companies) depend on government oversight, as well as other goods & services. The most public of functions (e.g., emergency response) may also depend to some degree on private contractors & products.

Public safety, a primary function of government, requires “responsible community management” of its mixed system–from its roads & emergency response capacity to its community protections, including courts as backstops. Of all community services, healthcare may be considered most basic of all, on the one hand the most intimate & personal; on the other a community matter since the time when that meant no more than family, band or locality, yet a sense deeply embedded in the profession of medicine.

Obama’s effort took the view that it was less critical exactly how the public-private functions were divided than that the community improve the level (extent of accessibility), quality & effectiveness. It started with level or extent of coverage. Effectiveness involved costs, and how paid for. Quality must always be a major part of the concern in measuring the other two, since you haven’t necessarily improved things by providing (or paying for) bad treatment, at whatever price. Even so, in comparison with extent of accessibility, these can be elusive goals, moving targets–how to deliver the best service to the most with the least waste….

Things weren’t improved by the politically motivated attempt to muddy “Obamacare,” which remains far less popular today than the “Affordable Care Act,” though they’re the same thing. The philosophical challenge that might have derailed the ACA in the Supreme Court was the mandate, whether the federal government had the right to require citizens who could afford it to buy a private product (insurance), imposing a penalty otherwise. This was settled by the Chief Justice siding with the Act by declaring the penalties & subsidies tax matters….

It’s a bit strange–not so much how healthcare coverage become a tax matter as how the tax consequences can end up wagging the healthcare dog. The 2017 House Bill, for example, wouldn’t just lead to 25 million or so more people uninsured, but transfer the 800 billion dollars saved into a tax break for a small percentage of the wealthiest. In one state, it was calculated, over 700,000 medicaid recipients would lose coverage, a cost-transfer  going to 400 tax-payers at the top, who need financial help least.

By masking the argument in complexity, the majority of would-be “repeal-&-replacers” don’t actually acknowledge their position comes down to rejecting the social responsibility argument. On the one hand, by treating access to services as if it were purely a privately negotiated matter with minimal government role, the self-described conservatives avoid the issue of social benefits-&-responsibilities entirely, when in fact it’s like putting roads in private hands with unregulated toll booths, & saying that only those selectively covered (who can afford buy-in, for example) can have access to the infrastructure.

In the case of healthcare, it’s a ridiculous argument. Better to address the real questions, like what level of system do we as a society want to provide? how is it paid for? how can it be improved? If may note that I’m personally at an age when I personally prefer the Avoidable Healthcare Act, which comes with a full supply of placebo-based miracle drugs & laugh therapy emergency services, but I would not presume to self-prescribe for others.

As Hippocrates the Hypocrite’s doctor used to say, “One person’s placebo, another’s poison–take your pick, & pickle.” Nevertheless, I pay taxes, medicare dues, retirement insurance premiums covering all kinds of things I’d sooner die from than from the toll the healthcare system would take trying to help. Still, I’m glad the system’s there, & happy enough to pay my fair share to facilities I no longer expect to use. These don’t have to save your life–or the life of someone you care for–more than once to have been worth the contribution….

–March 8/ July 6, 2017

Telling It Like It Ain’t

[under review by the works-in-progress administration]

Or as the blind seer Steppin Holes put it, “We’ll see.” In the meanwhile, our dedicated Flake News staff goes on telling it like it ain’t, like it was, like it seems, like it is, &/or like it should be, whichever comes next….

2017: Year of the Rooster

I thought the golden rooster’s tough cock-talk “lock her up” candidacy showed the vulnerability of the system going forward, for having gotten that far, not expecting it to win. Now we get to see if the new administration may also show the resiliency of the system. Some of the things that had been hindrances might just turn out to look different with the shoe on other foot–as fickle democracy hops along.

From the perspective of our high-altitude weather-balloon, there’s more than enough combative hypocrisy to go around, along with plenty of provocateurs, whether volunteers or assigned. Attempts to use reason as an influence to moderate events–or as an explanation for them–may now be considered irrational. What psycho-economist Sigmoid Floyd called irrational protuberance will likely predominate.

Nevertheless, the urge to prognosticate &/or predict can’t easily be held down without ropes & weights. Allow for zigs & zags, feints, twists, knots & surprises, therefore, as foretold by the Grrr8 Prognostic 8-er, Otto Predictor, aka, the headless wonder, an auto-editing by-product of Mishugunah Engineering, in an exclusive interview with student whizz staffers from the No News Jr. High Capacity Magazine, in which the master of absence admitted expecting, “besides a higher than usual level of the unexpected.”

[The complete prediction report, with full list of things to watch for, with probability %’s,
will be included in “The Year of the Fluke” pdf. soon, which will also include full drafts of all all other abbreviated 2016 campaign-related posts, unless I can figure out how to have posts self-abbreviate with “Read More” clickers.]

Postit Pastit

I should probably call Past Posts my Pistachio Pastiche or Post-date Pasta& put’em in the freezer. I should go through & figure how to condense them to a short starting paragraph–or less, a clickable file, just to make the Post Scroll Collection navigable. Otherwise, best to take shortcuts to other posts of interest, as it’s a long way down….

[The rest of this post will go into the clickable Post Date Pasta pdf. file as soon as the Revisionist History Committee has had its way with it.]

Waiting to see results 1st–the problem

The simple answer to “Are you prepared to accept the results whether you win or lose? is, of course, “Of course.” From there a candidate might add qualifications excluding situations with genuine evidence of fraud or other legitimate uncertainties, like the fight that culminated in Bush v. Gore in 2000. It’s one thing to fight over the legitimate mechanisms, and quite another to declare one will wait to see the results before deciding whether to accept them or not, which is as problematic as most commentators are pointing out.

Of course the problem isn’t nearly as dangerous for the country as it would be if the candidate making such a claim were an incumbent, or candidate of the party in office, when such an attitude becomes really dangerous, a direct threat to the principles of democracy, for then it really raises doubts about the peaceful transfer of power….

[Rest of this post, dated Oct. 20, 2016, in the Post Date Pasta file.]


Gary Johnson, Ahead of his time

A truly non-partisan debate commission, unlike a bi-partisan one, would have a sliding scale poll threshold, e.g., 5% to get in the first, 10% the second, & 15 or 20% for the third.

A World Upside Down: The two two-term Republican governors, one from the old Eastern establishment & the other a Western free-enterprise libertarian, are running as a 3rd party,  while the G.O.P. of Lincoln, Teddy Roosevelt & Ike are represented by….

[This post, mostly about Gary in New Mexico, is now in the campaign collection file.]


Imagine John Lennon rolling over in his grave. Imagine.
Imagine Joe McCarthy, Roy Cohn or Vladimir Putin as president.

Now can you imagine Donald’s “Law & Order,” & how much actual disorder & discord would inevitably result? (And the widespread disrespect for law that would get provoked?)

It’s reported that only 19% of Americans now think their government will tend to do the right thing, down from 77% in the mid-1960s (a steep slide coming, thanks to LBJ & RN). Nixon ran on “law & order,” and look where that went–anything BUT…..

Nothing erodes trust faster than language designed without respect to reality, to mislead for a personal end, using a touchstone entirely tactical, advantage-seeking, soon infecting the entire system & society at large…. [Rests of this in “Year of the Fluke” pdf.]


Trump’s Mega Merger–Semper Bi

No, TP has not (yet) put his Trump-Putin, Eastern Ukranian-Estonian-Balonian reverse bankruptcy takeover plan on the table–or much of anything else that might be called a “plan.” There are plenty of abstract generalities & assertions of pie in the sky, but the plans themselves, if there are any, are kept under wraps, presumably for good reason.

As practice for the blind trust he’ll put his kids in charge of after he’s elected, we hear he’s putting Trump Steaks, Miss Universe & Trump University together in a new entity to be called Trump Universe of Miss Steaks University, Inc. (TUMSUi). Headquartered in the Trump-owned Bone Inn, site of the annual Miss Gristle Pageant, TUMSUi is already being sued by various “losers” disgruntled over the company’s bait-&-switch policy. “We thought we were getting lobsters, but got bait instead.”

Some evangelicals, meanwhile, are still having conniptions over their presumptive nominee’s “New York values.” Despite throwing them a bone or two in Pense & Platform, the supreme leader has been acting friendlier to the LGBTQ community than to Muslims, Mexicans, & Nato, an attitude seemingly at odds with both Pense & the Platform. He’s said that trans-gender guests at his Defunc’t Casino can use whatever bathrooms they want, all of which are now equipped with T-P monogrammed T P, which some think a harbinger of the Trump-Putin partnership being rolled out behind the scenes.

Apparently Trump’s campaign manager has worked (&/or is still working) for the Russian-supported ex-Ukranian president who fled back to Russia when his lavish lifestyle & iffy deals became public, with ties to Putin & the Russian-supported Eastern Ukranian separatists (who want to separate only long enough to be annexed to Mother Russia). “Remember the Alamo,” said Putin, on horseback. “Crimea River,” said Trump. “No, think bigger. Crimea Peninsula.”

On reflection, not even the peninsula, river & rest of the Ukraine was big enough for the likes of either half of the T-P partnership. Putin insisted that deep down, anyplace where Russian was spoken, heard, &/or listened to over Radio Free Siberia was rightfully his, or Russia’s, whichever came first (a joke, since they were one & the same). Chechens in exile immediately asked about places like Chechnya where Russian was not spoken.

“You must be crazy,” mocked Putin, “or deaf, because there are huge numbers of Russian speakers there, mostly armed & in uniform.” Of course the situation was worse in places like Estonia where Russian speakers had no armed forces to protect them from cultural oppression by Estonian nationalists, under the guise of protecting their own country. .

Trump himself has bigger fish to fry, & real estate to deal. Some say he’s already looking beyond not just the election, but his consolidation of American power. “It’s big country, but  let’s face it, it’s not as huge as…the galaxy, or even the whole universe.”

Those who suspect a mild case of megalomania may take comfort in the fact that he remains keenly aware of the scope of that challenge. “I alone can fix it,” may work for the problems of a single country, even a super-power like the U.S. of A., but not the universe at large. That will require others pitching in, notably including the marines.

And that’s where we hear he’s taking some flack from Evangelicas over his support for a Mornangelical plan to make SEMPER BI the new Marine Corps motto. As distinct from their evening brethren, the Mornangelicals were Moron-Angelicals who shortened their name to join Reagan’s Morning in America Revolution. “Feel the heartburn.”

Trump reportedly said he’d deny supporting the motto change if the story got out before the election, at which he immediately let the story out by tweet. Did that mean he would or would not support Semper Bi, reporters asked. “Yes. I will or won’t, whichever is most appropriate,” he answered, apparently in a more responsive mood than usual.

Some believe this reflects his deal-making style–leaving things ambiguous, with enough wiggle room to turn completely around, and inside out if necessary, based on future convenience & personal advantages not yet clear. The only thing better than wiggle room is: a) making others squirm; b) bankruptcy; c) casino chits; d) doubling down; eczema.

One thing that is clear, however, is that this is the first American election in which the same person wrote the best speech for both major-party conventions–Michelle Obama. I guess it’s like the old saw, often repeated, “Imitation is the sincerest form of flattery.” And stealing is the fastest way to get what you don’t have, when what you don’t have is something to say for yourself in your own words.

And while it’s surprising they’d want to flatter Mrs. Obama, whose hand in Mrs. Trump 3rd’s speech they first denied as a ridiculous charge (until the denial was obviously far more so when the two were examined side by side), you’ve got to admit she’s a wonderful role model–though not for plagiarism. With such large chunks involved, It’s less understandable how no one caught it in house, or considered it wrong. Or thought no one else would notice.

Plagiarism, submitting someone else’s words as your own, used to be frowned on, except by poor students facing threatening deadlines, risking a failing grade in the course to avoid an F on the poor &/or missing paper. Then came Wikipedia, the creative commons, & a generous view of the “public domain,” which, as Trump followers have long noted, can be a conveniently free source of private value.

“What’s mine is mine, and what’s yours, his & hers is mine too.” Although offered as a “sure-fire formula for financial success” at prestigious institutions like Trump U., this may not have the ring of an “e pluribus unum” as a guiding principle for the nation or its titular head as a hole. For that, the new coinage will carry mottos for both heads & tails: “I assert, so you can believe it. ” & “In the Donald, we trust.” Believe it [& trust at your own risk]. –July 26, 2016

PS This was written before various DNC speakers said the same thing last night, including the vice-presidential nominee. Others said they trusted the country not to be conned, while both doing & encouraging the work necessary to help make sure. It’s not something to talk for granted. More or less good people–& even countries–sometimes do stupid things. –July 28