Category Archives: muttering to myself

A Foolish Belief in Democracy?

The young Thomas Jefferson, shortly after he married the widow of Bathurst Skelton, three years before becoming the Author of Liberty, increased his wealth threefold.  He became the master of Bathurst’s 135 slaves [1]  (Jefferson had inherited only 50 from his parents) and added 11,000 acres of property formerly held by Bathurst [2] to the 5,000 he had previously inherited.   To say that young Thomas Jefferson was born booted and spurred to ride the backs of his saddled countrymen would not be entirely unfair.  His marriage to the wealthy young widow added luster to both boot and spur.

With all this inherited wealth, and in spite of an eloquently expressed life long hatred of tyranny,  which compelled him to risk being hanged as a revolutionary, and his deep moral opposition to slavery, the Author of Liberty should have had the luxury, more than fifty years later, of freeing his remaining 130 slaves in his will, as the Father of our Country had done.  Sadly, that luxury was denied to him.  John Adams, who comes down to us far less heroically than Washington and Jefferson, and not nearly the moral equal of either (in the simplistic popular imagination), never owned a slave.  But that is another rant for someone else to go on about some other time.

Fictional, aspirational president Josiah Bartlet, of  The West Wing TV series, is fond of learned quotes.   He quoted Jefferson some time toward the end of season six.   “A man’s management of his own purse speaks volumes about character,” he said.   And it struck me anew: motherfucker!  

The reason Jefferson could not free his slaves, as he heartbrokenly regretted he could not do toward the end of his life, is that in spite of his great inherited wealth, his management of his own purse was less than perfect.  His love of luxury far exceeded his  ability to pay for shipments of the most expensive French wine, the finest Italian furnishings, the clothes made for him by the greatest tailors in Europe, the magnificent horses he rode, the no expense spared constant remodeling of his gracious and beautiful home, Monticello.

He had racked up impressive debts over the years of his long, luxurious life as a philosopher king.  If he had freed his slaves, instead of bequeathing them as property to his daughters, he would have left his progeny penniless.  The shame of that outweighed any other qualms he might have had.  Even leaving aside the several slave children he fathered with the illegitimate half-sister of his late wife, his long-time slave mistress Sally, (unacknowledged during his life and indignantly denied on his legacy’s behalf for a century and a half after his death) let us say, in unison: motherfucker.   History is kinder to him, by far, than I am.  No doubt.

My meditation on the man who bravely declared the self-evident truth of human equality leads me to wonder about my ongoing belief in the idealistic democracy he played such a large role in shaping.  I continue to believe in the importance of our public institutions.  Most large steps forward as a People were the product of principled government initiative in response to overwhelming events and popular agitation. Think about the use of the Interstate Commerce Clause and the courage and determination of both activists and jurists in the federal courts to end centuries of racism at law.  (Much work remains to be done there, but that’s not the point.  The laws needed to be changed, the government acted to change and, in some cases, even enforce the laws.  A triumph of democracy.)

The importance of principled government action is confirmed for me over and over as I watch the ongoing failure of profit-driven business, our so-called Free Market, to solve any of the pressing problems of our society.  Exponentially increasing the wealth of a few makes the country’s wealth look good on paper, but human lives, like baseball games, are not played on paper. Wall Street’s health in most cases has little to do with healthy lives on Main Street.  

Without a pragmatic and honest government to unite and inspire us we have no hope of solving the biggest challenges we face as a nation, as a species, as a planet.  I am probably even in the majority in this opinion, of those with the leisure to consider the question seriously, and who do not stand to lose wealth by taking this position.  Not that it makes much difference, if my belief in democracy is a silly as other fond beliefs of childhood.

Leave aside the damning fact that our highest court has decided that, Constitutionally speaking, and as intended by the Framers, money is speech in a land where 97% of all political campaigns are won by the side that spends the most money speaking.  Has there ever been anything like democracy for most of the history of this nation, the world’s first modern experiment in government of the People, by the People and for the People?   At isolated moments, perhaps, the best aspirations and highest motives of our citizens have become enshrined in our laws.  Sometimes these isolated moments are decades or centuries in the making.

Slavery and lynching, two practices long protected by American law, the former embedded, obscurely but robustly, in our Constitution, the latter winkingly left up to the states to, er … uh, regulate, are now universally reviled.  Today nobody but the hybrid of a moral cretin and a talking jackass would make an argument in favor of slavery or lynching, though both were the law of the land for generations.  Medicare, once unthinkably controversial, is now something even the Tea Baggers want the government to keep their hands off of.  Social Security too, at one time renounced as part of a Socialist plot, has become something most retired people rely on, at least in part, and value as part of a decent society’s social safety net. Not long ago homosexuals were hunted down and locked up, today they legally marry in many states. Millions are in jail today for preferring marijuana to alcohol as their drug of choice. [OK, I know, an exaggeration, please see note… 3]  Democracy does over time move forward, although more often than not only after excruciatingly long struggles against powerful, organized, determined, well-funded forces. 

In light of all this, can I really be angry at a president who campaigned by appealing to the highest ideals and hopes of many of our citizens and continues to talk the talk, though often obliged to speak less than the truth, the whole truth and nothing but the truth, while ruling in slavish obedience to the corporate bottom line?  Sure I can, but I don’t know how fair it is.  He is not the only “sell-out” to find life much more complicated as the indebted to campaign donors leader of the free world than he may have wished it to be.  Bill Clinton is often considered the greatest Republican president of the last fifty years, though he was relentlessly attacked as a liberal.  Heck of a liberal Bill was, really.

If Jefferson could have freed his slaves, you just know he would have done the right thing, even as the management of his purse showed most of what we need to know about the actual content of his character.

It bears repeating, as was done a few times on The West Wing:  we campaign in poetry but govern in prose.  Call me strict, but I believe  the Author of Liberty should be judged by his own formulation– ditto this well-spoken idealist we have in there now.  

When someone who talks like a psychopath, or a slave holder, acts like one, I know how to react.  I am mobilized, adrenaline flows.  I’m angry, maybe, but not hurt.   I certainly feel no surprise, no betrayal of principle or trust.  When someone talks like a true and compassionate friend, and acts exactly like the guy who talks like a psychopath, and people around me act like he’s still our true friend — it robs me of hope.  It crushes my soul just a little bit more.   Makes me feel something I strongly resist believing:  that my faith in democracy, in the power of the  People to see the truth and walk toward the light, may be entirely foolish.

I don’t believe that, deep down, but, damn, these complicatedly nuanced idealist motherfuckers who eloquently speak our fondest hopes make it hård.

 

 

[1] These 135 slaves were inherited from Martha’s father John Wayles, not Bathurst Skelton, and in 1773.  Among the slaves was Betty Hemings and her last daughter by John Wayles (she had six of his children), the baby Sally.

[2] He inherited the 11,000 acres from Wayles, too.  I just like writing Bathurst Skelton and didn’t have my copy of Fawn M. Brodie’s excellent, groundbreaking 1974 Thomas Jefferson; An Intimate Biography at hand when I wrote the post earlier today.  (see W.W. Norton softcover, pp. 80-87)

[3] Fine, not millions locked up for pot.  But read these shameful statistics.   Could a democracy spend the more than $51,000,000,000 annually that goes to the endless, senseless “War On Drugs” any more wisely?  How about 10% of it to make sure no old Americans are ever forced to be cold, or homeless, or eat cat food?

Integrity 3- imaginary dialogue

“Do you realize how it will look if I have an executive from the second largest health insurance giant in the country write the new health care law?”  

“It’s not as if the chairman of the committee who is tasked with crafting the law has clean hands either. Max Baucus took almost $5,000,000 in campaign money from that industry in the last five years, Mr. President.   He’s a Democrat, that’s bona fide enough for your average supporter.  He’s one of the good guys in this partisan knife fight, as far as they know.”  

“But a staffer who was an executive at Wellpoint until a couple of weeks ago?” asks the president, “how will having her as the primary author of the law, the architect of Obamacare, look to my supporters?”  

“Believe me, you’ll be as safe as an octopus in a cloud of ink on a dark night, sir,” says one of the president’s closest advisers.  “Only a few Americans will ever even hear the name Elizabeth Fowler and, of that few, even less will care.”

“But the bill before me is plainly a gift to the insurance and pharmaceutical industries.  We get a  concession on ‘pre-existing condition’ because we’re delivering potentially 40,000,000 new customers to them, mandating the purchase of insurance while agreeing to very gently regulate how much they can gouge patients.  Increasing deductibles to almost $2,000 out of pocket for people 150% above the poverty line.  Pay an insurance premium every month to a private company and then reach into your pocket to pay the first $2,000 of your medical bills before insurance kicks in?  Is this the Hope and Change I campaigned on?”

“Whatever law you pass will be put up for repeal dozens of times, they’ll drag it through every court in the country, shut down the government over it.  The opposition, you may have noticed, is truly rabid.  You can pass Romneycare, or Nixon’s plan.. well, no, not Nixon’s plan, you’d look like a Socialist… but you can pass the Republicans’ own plan, Mr. President, and they’d come after you with torches and pitchforks.  Your supporters will realize you were in no position not to compromise.”  

“Even though we have the Senate and the House, I have to take the only plan that truly makes sense, a buy-in to Medicare, off the table right at the start, ensure that insurance company and pharmaceutical industry profits will be as robust as before, in fact, make purchase of private health care mandatory, in legislation that still leaves millions of Americans uninsured?  Is that what you’re telling me, Phyllis?”  

“Yes, sir,” she says.  

“I realize I’m arguing with myself.  I’m a charismatic campaigner, I’m accomplished, my ideals are beyond question.  I was voted into office on a wave of hope.  Is this really the best I can do as president of a country longing for real change, desperate for hope they can believe in?”  

“At least you weren’t a governor, sir, when you were running.  You were spared going back to your home state to execute a brain damaged murderer on the eve of the primary.”  

“I suppose I’ll have to make do with that,” the president says, closing the folder on his desk.  “What’s next?”

Integrity 2– imaginary discussion

“I ran against the anti-democratic secrecy of Cheney and Addington.  I promised, many times as a candidate, to run the most transparent administration in history.  I promised I’d protect whistle blowers.  The Bush administration classified literally everything, used sovereign immunity, state secrets, national security rationales, intimidation, the pressure of jailing, lawsuits and everything else, to keep crucial information from the People, from the electorate.  Cheney had a safe in his office big enough to hold half a dozen detainees, for Christ’s sake.”

“That second Bush Administration dramatically shifted the public’s right to know to a need to know basis.  They shifted the traditional burden on government of showing something needed to be secret to the burden on the public of proving it should not be secret.  Tricky for the public to do that when they don’t even know there is a secret.   Testimony by the President and Vice President at the 9/11 Commission was top secret, no recording, no transcript, no notes.   Commission members sworn to secrecy.  What the hell was up with that?  Scandals and war crimes were reported in government reports, the reports were classified.   The press was used as a megaphone to broadcast government policy.  I vowed that my administration would reverse that anti-democratic crap.   Now you’re telling me we should try this American journalist under the 1917 Espionage Act, like the guy is a spy during wartime for doing research for his story on CIA torture?”

“It would send a strong message, Mr. President.  We are still obliged to work in the shadows, sir.”

A long pause.  “Ah, hell with it.  Tell Holder to use the stinking 1917 act.  We can’t ask for the death penalty under it, can we?”

“No, Mr. President.”

“Wait until my supporters get a whiff of this…”

 “Our country is so divided, and your opposition so virulent and irrational, Mr. President, that your supporters will defend you, no matter how foul the cologne you might be obliged to douse yourself in from time to time.”

“Get out of my sight….”

Integrity — exercise in imagination

“You mean to tell me this American citizen has been locked up, without charges, in solitary confinement, for almost a year over there?” asks the president sharply.

“Yes, sir,” says a high ranking advisor, “at our request, sir.  He’s articulate, and pissed off and self-righteous.  He preaches in perfcct English and in native Arabic.  He has a worldwide following of young jihadi types.  He could be lethal winning hearts and minds for al Que’da.”

“Can’t we charge him with anything?  He’s an American citizen, are we now detaining American citizens without charges, without habeas corpus, without any sort of judicial process? Has the Constitution been suspended for citizens who are too critical of our policies and I’m just the last to find out?”

“We really don’t have grounds to charge him with anything, sir, other than abusing the First Amendment.  We need to hold him, though.  He’s dangerous, charismatic, his internet sermons are inspiring fanatical youth around the world.”

“Can’t we shut down his website?”

“We did.  The sermons circulate on DVD.  It’s best to keep him locked up, sir.”

“Under the secret detention black site policies Dick Cheney and David Addington put into place when this country went to the dark side?”

Sometimes no answer is the best answer, the advisors hold their peace.  

“Charge this guy and have him extradited or tell Yemen to cut him loose,” orders the president, turning to the next name on the list.  

A year or so later, still not charged with any crime, the American cleric was released from prison.  

A couple of years later his name appears on a kill list given to the president.  The president is known for his  eidetic memory.

“Isn’t this the guy who Yemen had in solitary without charges, the American citizen we finally told them to cut loose?”

“Yes, Mr. President.  He’s still giving sermons, and his rhetoric is on fire.  We need to silence him.”

“I ask you again, general, can we charge this motherfucker with a crime before we kill him?  Any crime?  At one time extra-judicial executions were frowned upon.  We Americans always frowned upon them, publicly at least.  Are we now killing even American citizens without feeling the need to even charge them with a crime?   Doesn’t his father have a lawsuit in our courts to keep him off the kill list?”

“The law suit will be moot, sir, if we shoot.”

Moment of decision, where one would like to imagine a man of integrity drawing a principled line he will not cross.  An American citizen cannot be killed without judicial review.   Even if he is charged and tried in absentia, there is some legal process, some requirement to prove guilt of a crime serious enough to punish with execution, before we sentence one of our citizens to death.  It’s just wrong, putting a name on a secret list and designating him for death, especially one of our own citizens and it sets a very dangerous precedent.

“Mr. President, he’s been eluding us for many months, for over a year.  He’s becoming a hero in that wild tribal area in Yemen and a symbol of defiance.  We know where he is tonight, we have a small window to act.  We need to kill him now, sir.”  

A long pause.  “Fine,” the signature scrawled left-handed next to the American’s name, marked for death.  “Just don’t come to me in a couple of weeks and tell me you also killed his teenaged son with the dreadlocks, or the kid’s friends listening to hiphop somewhere.”

“Will do, Mr. President, absolutely.  Thank you, sir.”

 

 

Idealism 101

Idealists
have never ruled the world,
grow up!
It’s hard enough
to get rich
without worrying about fucking ideals.
Be serious,
you know very well
what this world does
to people who try too hard
to be saints,
lacking the power to nail it.

Put it this way,
if Jesus had had
the Pope behind him
they’d have put every one
of those crucifiers
to the sword,
end of story.

When were you wont to be so full of songs, sirrah?

Wednesday 2-18, downtown A train

“Oh, happy fucking day,”

said a bitter old face

like mine

ceiling sprung a new leak

drip, drip

onto my last nerve

woman at Obamacare

didn’t know much about benefits

but read my 1099s to me,

including the one I received yesterday

“Do you still work at EVCS?” she asked

teeth and eyes not

needed for our health

not here

in the land where we no longer

tolerate

the lynching of former slaves

here

in the land of the free

and the home

of brave

corporate personhood  

“Whoa! calm down, man…”  

“Don’t you fucking

call me ‘man’, man,

don’t you fucking call me ‘man’!”  

There was a time

my hand would become a fist

where humans

forced to wear signs saying

“I am a man”

would have made me want to holler

arms hard,

ready to strike  

“Who is there to strike?”

a voice asks,

reasonable, kindly.  

“Those who benefit

from the murder

& enslavement of others,”

I say.

 “Ah, yes,” the voice says,

sadly,

“but one can never touch them.”  

ii

“When were you wont to be so full of songs, fool?”

the king asked me  

“Since every sweet lake, sire, receded to shoals of piss

a cool drink not sold by the bottle

living now only in fond nostalgia

while the priapic, tireless

thrusting, twisting, plunging

forms the rhythm section,

the recoiling cringe replacing dance.”

“There is more hope

for a dog returning to his vomit 

than for you, fool,” noted the king

“Yes,” I said,

“another song, sire?”

Shining the Light of Reason

It turns out there is a good reason I am responsible for a few hundred dollars in connection with a preventative procedure 100% covered by the Patient Protection and Affordable Care Act.  Once it was explained to me, it became perfectly understandable.

The procedure is 100% paid for (with only a token $100 payment required from me), a $4,050 colonoscopy that was paid, on my behalf, at the contracted price of $852.  In consideration of this deep discount, the PPACA also protects the interests of doctors shorted by insurance company payments as well as the insurance companies themselves.

The PPACA requires a pre-colonoscopy office visit, something not previously required.  This visit with the specialist is subject to a $50 copay.   The doctor may charge up to $250, but the patient will only be responsible for the difference between the copay and the contracted price for this required visit, $131.   So the bill for the additional $81 is correct and the full responsibility of the patient.  The $131, which goes toward the $1,750 deductible, reflects another deep discount, almost 50% off the sticker price.

The diagnostic code 2113 was properly entered by the doctor’s office, even though no diagnosis was involved.  It’s called a diagnostic code, sir, and you chose a plan with a deductible, even if it was the only plan offered at your income level.  Pay the bill.

Procedure code 88305, level five, means that the patient, and not the insurance company, is responsible for the other half of the pathology charges related to the colonoscopy.  If the preventive procedure had not discovered any abnormalities requiring a pathologist, the patient’s preventive care would have been completely without additional cost, except for the $131 deductible and the $100 pre-colonoscopy fee.

As my father so often reminded me, I’d complain if I was hanged with a new rope.  The main thing is– what a great step forward Obamacare is for every American patient everywhere and how generous the discounts it affords.   And as President Barack Obama himself would say:  what are you going to do about it anyway, bitch?

Here we go, the ACA, in a nutshell

Haven’t discovered how to enforce my right not to receive apparently fraudulent bills from health care providers (so far I’ve had a few hundred dollars for duplicative demands for payment dismissed, after calls to billers).  But part of the difficulty with the law is put in context by the following:

The Patient Protection and Affordable Care Act (PPACA), codified as amended at scattered sections of the Internal Revenue Code and in 42 U.S.C. commonly called the Affordable Care Act (ACA) or “ObamaCare“, is a United Statesfederal statute signed into law by President Barack Obama on March 23, 2010.  (Wikipedia)

When I wrote the other day that it was written by the health insurance and pharmaceutical industry to benefit those industries, I was lacking the name of the author of the ACA.  A friend found it for me in remarkably short order.   Her name is Elizabeth Fowler and she worked closely with former Senator Max Baucus between three separate stints in the industry.

Here’s a good article about Elizabeth Fowler, health industry insider and primary author of the PPACA, now back working for Johnson & Johnson — with a very worthwhile five minute video editorial by Bill Moyers at the end of the article.

(Thanks to JDS for sending link to article on Liz Fowler and her stinking ilk)

If you prefer an article in the New York Times, read this.

A bit more about Ms. Fowler and her former boss, Mr. Baucus:

Fowler’s career in Washington stretches back more than a decade, when she first left a private sector hospital group in Minnesota in 2000 to join the Health Care Financing Administration, a federal agency now known as the Centers for Medicare & Medicaid Services (CMS).

By the following year, Fowler had landed at the powerful Senate Finance Committee, working on health care issues for Montana Democrat Max Baucus. Lobbying records show that Fowler stayed until 2006, when she departed for a two-year stint at health insurance company WellPoint, only to return to the Senate in 2008, again working on health policy for Baucus.

When it comes to health care, and health lobbyists, Baucus isn’t just any senator. Since 1998, he has collected more than $5.1 million in campaign contributions from the insurance, pharmaceutical and nursing industries, making him one of the health care sector’s most heavily backed lawmakers.

 (the rest of the article is here —->)  yawn, yawn 

The Difficulty of Even Researching the ACA

The Patient Protection and Affordable Care Act is one of those taunting, ironic names government sometimes gives to things.   That patients are not protected from billing practices that violate the law, that the rights that must be protected are not discoverable without massive effort (my own efforts continue, I’ll let you know when this lawyer discovers the section of the massive and complicated law that outlines these inviolable rights)  that there is no place to have a clear adjudication of the many violations of protected rights, and that the health care is not necessarily affordable add to this citizen’s sense of being taunted.

My frustration reminds me of how angry I felt, the day after millions gathered across the globe, and I was one of hundreds of thousands in New York City out protesting on an arctic day, threatened by NYPD on horseback and kept blocks from the U.N., when then President Bush announced that we would invade Iraq in a war based on endlessly repeated lies and the profit calculations of a few powerful corporations.

“Those stupid, cynical, Nazi motherfuckers!”  I remember thinking as Operation Shock and Awe began in my name.  That was just my frustration speaking.   The architects of that illegal war were not stupid– they made a ton of money whacking that hornet’s nest and destabilizing an already volatile part of the global warming puzzle. Nobody whose actions lead to amassing a fortune can be called stupid, not here.   Cynical?  Perhaps, you could make a good argument there, but there is no law against being a cynic.  

Nazis?  Well, to put things into perspective, the Nazis started a war that killed tens of millions while deliberately exterminating many millions in specially designed death camps.  The Bush Administration killed only about 500,000 Iraqis, many of them, undoubtedly people who hated America.  Moreover, not one of these Iraqis was killed in a death camp, there simply were no death camps.  Perhaps 1% of that number of Americans were killed liberating Iraq from a monster, so already comparisons with the Nazis seem a bit strained, don’t they?  

The Bush Administration, as President Obama finally admitted “tortured some folks”, but even a quick comparison makes one realize how unfair it is to call them Nazis.  They really believed they were doing the right thing!

Maybe Max Baucus, whose committee wrote the Patient Protection and Affordable Care Act so reviled and attacked by the President’s legions of bitter enemies believed the same thing.  The health insurance industry, and the pharmaceutical industry, two huge supporters of the long-time senator, would be badly hurt by a single payer system that would allow a few hundred million Americans to bargain for health services that could be fairly regulated by the federal government.  Where is the freedom in that?  Stinks of Socialism and restraint of the free market, don’t it?

Don’t believe me, here’s what Wikipedia says about Mr. Baucus  and the practical conflict of conscience * he endured while overseeing creation of the immensely dense Patient Protection and Affordable Care Act.  In a five year period prior to beginning his work on Obamacare he took in almost $5,000,000 in campaign contributions from the industries the new law would either make much more profitable or rob of a good share of its profitability.  Doesn’t take a genius to put the sad facts together.

What I’m looking for, and haven’t found yet, in addition to a clear cut answer on whether I should pay bills for hundreds of dollars for a covered preventive service, on top of my $471 monthly premium, is the name of the woman, one of the primary authors of the grotesquely tangled ACA,  who went through the revolving door President Obama announced would be closed, and returned to work for the health insurance industry at an annual salary in the millions.   Can you say “job well done”?   Good thing Mr. Obama closed that revolving door, as important as his closing of Gitmo.   Ask the prisoners there who are being force fed with tubes down their throats how that closing of Gitmo thing worked out for them.

Sarah Palin winks atcha.

 

 

* Baucus has been criticized for his ties to the health insurance and pharmaceutical industries, and was one of the largest beneficiaries in the Senate of campaign contributions from these industries.[40] From 2003-08, Baucus received $3,973,485 from the health sector, including $852,813 from pharmaceutical companies, $851,141 from health professionals, $784,185 from the insurance industry and $465,750 from HMOs/health services, according to the Center for Responsive Politics.[49][50] A 2006 study by Public Citizen found that between 1999 and 2005 Baucus, along with former Senate majority leader Bill Frist, took in the most special-interest money of any senator.[51]

Only three senators have more former staffers working as lobbyists on K Street, at least two dozen in Baucus’ case.[51] Several of Baucus’s ex-staffers, including former chief of staff David Castagnetti, are now working for the pharmaceutical and health insurance industries.[52]Castagnetti co-founded the lobbying firm of Mehlman Vogel Castagnetti, which representsAmerica’s Health Insurance Plans Inc, the national trade group of health insurance companies, the Medicare Cost Contractors Alliance, as well as Amgen, AstraZeneca PLC and Merck & Co.Another former chief of staff, Jeff Forbes, opened his own lobbying shop and to represent thePharmaceutical Research and Manufacturers of America and the Advanced Medical Technology Association, among other groups.[citation needed]

A statistical analysis of the impact of political contributions on individual senators’ support for the public insurance option conducted by Nate Silver has suggested that Baucus was an unlikely supporter of the public option in the first place. Based on Baucus’s political ideology and the per capita health care spending in Montana, Silver’s model projects that there would be only a 30.6% probability of Baucus supporting a public insurance option even if he had received no relevant campaign contributions. Silver calculates that the impact on Baucus of the significant campaign contributions that he has received from the health care industry further reduces the probability of his supporting a public insurance option from 30.6% to 0.6%.[53]

In response to the questions raised by the large amount of funding he took from the health care industry, Baucus declared a moratorium as of July 1, 2009 on taking more special interest money from health care political action committees.[54] Baucus, however, refused to return as part of his moratorium any of the millions of dollars he has received from health care industry interests before July 1, 2009, or to rule out a resumption of taking the same or greater health care industry contributions in the future.[54] His policy on not taking health care industry money reportedly still allowed him to accept money from lobbyists or corporate executives, who, according to The Washington Post, continued to make donations after July 1, 2009.[54] A watchdog group found that in July 2009 Baucus accepted additional money from the health care industry in violation of his own self-defined moratorium terms, reportedly leading Baucus to return those monies.[55]

source

Obamacare 101

If you receive health insurance under the Affordable Care Act (“ACA”), Obamacare, you already know that it has all of the elements of a corporate scam.  If not, the jury would seem to still be out.   I’m here to tell you that the verdict is in.

I have a politically progressive friend who reads the Wall Street Journal every day.  He argues that the ACA has been a great step forward.  It covers millions more uninsured Americans than ever before and is beginning to rein in runaway medical costs.   As a participant in the ACA, and no fan of the Wall Street Journal, I can tell you from direct experience how closely Obamacare resembles an insurance industry scam.  

On the plus side first, it can’t be denied that eliminating the loophole of “pre-existing conditions”, the term that enabled American health insurance companies to deny insurance if you were ever sick with a particular disease, was welcome, and long-overdue.   There are other good features, no doubt. The perfect should never become the enemy of the good, as the president has said, but for the most part the ACA, that great free market compromise with comprehensive health care reform written primarily by and for the insurance industry, profits mainly that industry.   Like many other boons applauded by the Wall Street Journal, it involves large profits for the canny few at the expense of the clueless many.  

The opacity of the 900 page ACA is one of its most notable features.  If your rights and remedies are hard to discover, most people pay the bills they are sent and kiss their rights and remedies goodbye.

New York State set up a Health Care Marketplace at the earliest possible date.   We were all in for Obamacare.  Visit the New York State of Health website and you will marvel at the opacity of the consumer-friendly system.  From the difficulty of signing in (that’s called Get Started, by the way, no matter how many times you’ve already gotten started), to the lack of easily navigable plan details, to the absence of a clear statement of what the ACA is, or what it guarantees, to the almost completely useless help number (“we are experiencing more than the usual volume of callers, your business is very important to us”) you will see enough to discourage the casual seeker of health insurance from persisting there.  Also, enough to deter anyone looking for the rights guaranteed by the law in clear, unequivocal language.

“Preventative services are 100% covered,” the helpful woman at the NYS of Health assures me, after only 35 minutes on hold.  I ask her where I can see a list of these covered services, since I’ve already paid $150 in co-pays towards my recent colonoscopy and am being dunned, and threatened with collection letters, for an additional $281 connected with this preventative service.   She isn’t sure where I can find that language, the NYS of Health Marketplace only sells the plans, they don’t actually administer them or oversee the individual insurance companies.  

This particular woman is great, sympathetic, smart.  I kick myself that I did not get her name.  We look together for language that says I’m entitled to have my colonoscopy paid for 100% under the ACA, for my $471 monthly premium.  I find, several screens later, in only 4 or 5 clicks, this page, under Resources, and on the pull-down menu there’s a link for Using Your Plan, that eventually takes me to this, at the bottom of that page:    

Sep 26, 2013

Covered Benefits and Out-of-Pocket Costs for 2014 Standard Health Plans

And I read, under What Are Essential Health Benefits, number 9, the closest I will find to any kind of confirmation of this seemingly simple yes or no fact that preventive services are not subject to any deductible, to wit:  

Prevention & wellness services and long-lasting disease management

“You are entitled to be repaid that $150 you already paid for a covered service.  If your insurance company is making you pay any fee in connection with a colonoscopy they are not in compliance with the ACA and you should hold their feet to the fire,” this bright woman, a former health insurance industry appeals expert, tells me firmly.  

She informs me, in answer to my question, that the Department of Financial Services (“DFS”) is the state agency that holds insurance companies accountable for compliance issues.  She gives me their 800 number (800-842-3736  M-F 8:30-4:30).   I ask why there is no information about that on the NYS of Health webpage. They are discouraging frivolous complaints, she explains, since so many people are having problems with the ACA.  Not publishing the complaint number reduces the amount of angry callers making unfounded complaints before they have followed up with their individual insurance plans to make sure the insurers are out of compliance before calling DFS to lodge a complaint.

Makes me think of President Obama’s laudable campaign promises about transparency in government, protection of whistle blowers, and robust protections for consumers. Clear knowledge of one’s rights, after all, is a precondition to exercising them.   Few things are more important to the proper functioning of a just and accountable democratic republic than government transparency.   Few things are more useful to exploiters, despots and profiteers than the secret concealment of devilish details that might galvanize righteous opposition.

I recall the president’s campaign rhetoric and think of the Obama administration, the most opaque in our history, whatever else one might say about it, and my jaws clench. And I have to say, between Obama and Bush, dealing with the latter is much less soul crushing to an idealistic citizen than listening to the glib eloquence of the Equivocator in Chief, great lover of justice and defender of the common citizen that he is.