The ACA - Health Reform Explained

Today's Nifty PSA is pretty self-explanatory. Most of us haven't a sweet clue what the Affordable Care Act really says. This video helps to shed light on some of the mystery and misconceptions.

Take An Ambulance to ER....Really?

Livin' the dream in the Romney/Ryan America! 

On CBS 60 Minutes Sunday night, Mitt Romney surprised viewers with the suggestion that the uninsured would not go unserved under the Romney/Ryan new world order. Of course there would still be access* to medical care for the uninsured and the under-insured! Instead of dying alone in a cold-water flat, a 70 year-old in cardiac arrest can always call an ambulance and be treated in an ER!

Never mind the pesky problem of the heart-attack or stroke victim possibly being unable to reach a telephone or to dial for help. That could happen to an insured person, too (although a person with insurance who is able to visit a doctor regularly is much more likely to have had not only preventative healthcare but also safety measures in place for just such an emergency). Concerns like that do not figure into the Romney/Ryan calculus for smaller government.

What do you mean gutting
Medicare could leave seniors
high and dry?
Let them take ambulances!

Never mind that an ER is, by its very definition, a triage area where waits can be several hours and any treatment given is only intended to stabilize patients until they can be seen by their regular physicians. Oops! Uninsured patients rarely have regular physicians! That heart attack patient will only be stabilized and then sent home with an expensive prescription for stopgap heart meds and/or blood thinners and a stern recommendation to see his (non-existent) regular physician ASAP for follow-up care regarding actual treatment, surgical options and more personally-tailored drug therapy to treat the underlying condition - all prohibitively expensive for the uninsured. In other words, the patient will go home in almost the same condition in which he arrived and he probably will not receive any actual medical care for his underlying cardio-pulmonary disease.

Never mind that not only is the ER not the place for regular, preventative and wellness "health care", but when the patient receives the bills for that ambulance and ER visit (often thousands of dollars for ambulance transport and ER visit, not counting prescription medications), it could very well bring on the fatal heart attack that will finish him off. Of course, in the Romney/Ryan calculus, this may very well be a positive collateral effect.

Never mind all that. We ought to focus on the economic implications of candidate Romney's blithe assurance that no one need ever go without medical care under a Romny/Ryan regime because "we pick them up in an ambulance, and take them to the hospital".

ER treatment is among the most expensive of medical services and unpaid ER bills are one of the drivers of rising medical costs which make the USA the leader in the world in inefficient spending on healthcare. The vexing problem of the poor and the uninsured using the ER as a healthcare facility was one of the things Governor Romney cited as a good reason for passing his universal healthcare law in Massachusetts. Yet, now he describes it as an option for the proposed Romney/Ryan federal revamp of medicare and medicaid? How exactly does Mr. Romney think such an expensive form of medical attention will save taxpayers money?

Pimp my ride - ambulance edition!

Of course, he probably knows very well that such a backup "plan" for the uninsured makes no sense at all from a fiscal perspective, which makes it even more ridiculous coming from the candidate who claims he will run America like a successful business.  One is tempted to believe that Mr. Romney will say almost anything to avoid giving the President any credit at all for the improvements to healthcare made possible by the Affordable Care Act.

Perhaps Mr. Romney's stunning announcement was a secret message to the bottom 47% - those whom he is "not going to worry about" - that he plans to look the other way while all you freeloaders out there cash in on taxpayer largesse. After all, Mitt has already told us that millions of Americans - nearly half of the entire population, in fact! - are inveterate moochers, impervious to the efforts of productive citizens like Mitt and Bain Capital to get them to be responsible for their own lives. What can anyone expect, Mitt seems to imply, of the feckless rabble of incorrigibly lazy takers?

The Romney/Ryan plan for the future of America is one which not only repeals the Affordable Healthcare Act, but one which goes much further, ending current Medicare and Medicaid programs, too. But, Lord Romney does not see that as something the 47% ought to be complaining about. After all, if he and Paul Ryan succeed in getting elected, the soon-to-be uninsured seniors, veterans and poor children - like Reagan's "welfare queens" - still can (and probably will, damn them!)  ride in style to the ER since they probably won't have the decency to just expire in their slovenly digs and get off the taxpayer dime.  It's pimp my ride - ambulance edition!

No Health Insurance? No Problem. Romney Says That Freeloading In the ER Is Now All Good, Rick Ungar, Forbes Magazine, September 24, 2012.

Hey, maybe Gramps can mooch a
free scooter from the taxpayers, too.
What d'you say, Mitt?

Apparently, when 2002 Mitt Romney decided to divorce himself and split into two, distinct entities, the ‘other’ Mitt Romney gained possession of the Governor’s cognitive skills —including the ability to recall why Romney supported the Massachusetts universal care effort in the first place. It was, after all, 2002 Mitt Romney who often highlighted the inefficiency of emergency room care as the sole option for uninsured Massachusetts residents, allowing them to get free care while those who are insured are left to pay the bill.

It would also appear that it was the ‘other’ Mitt Romney who gained custody of the understanding that while our laws require emergency rooms to treat patients in an effort to stabilize their health condition, the law does not require the treatment that can ultimately restore all of these patients to health.

Mitt Romney, On 60 Minutes, Cites Emergency Room As Healthcare Option For The Uninsured, Huffington Post, September 24, 2012.

"Well, we do provide care for people who don't have insurance," he said in an interview with Scott Pelley of CBS's "60 Minutes" that aired Sunday night. "If someone has a heart attack, they don't sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care."

This constitutes a dramatic reversal in position for Romney, who passed a universal health care law in Massachusetts, in part, to eliminate the costs incurred when the uninsured show up in emergency rooms for care. Indeed, in both his book and in high-profile interviews during the campaign, Romney has touted his achievement in stamping out these inefficiencies while arguing that the same thing should be done at the national level.

Romney's New Health Plan: Go to the ER, Jonathan Cohn, The New Republic, September 24, 2012.

Not kidding, America.

It’s possible to believe simultaneously that ERs provide care to everybody who needs it and that they are an inefficient, expensive way to do that. But the Romney who made that statement in 2010 was making the case for having government do more to cover the uninsured, while the Romney who made that statement yesterday was making the case for having government do less.

And that’s really the most important point of all. Remember, Romney doesn’t simply want to repeal the Affordable Care Act, effectively taking health insurance away from 30 million people who, starting in 2014, are likely to get it from the law. He also wants to end Medicaid, making cuts that would leave between 14 and 27 million additional people without insurance. And he wants to change the tax treatment of employer health benefits, in ways that could make coverage more expensive or harder to get.

Medicare, Just Elderly Welfare Queens: And What IS Insurance Anyway? Heartland Liberal, Daily Kos, September 24, 2012.

What we are talking about here is the attempt by the Republicans to demote and denigrate the elderly on Medicare to the status of welfare queens. After all, they have been so successful with their past campaigns of demonization of target segments of the electorate, recently upping the ante and telling us that unions, teachers, firemen and policeman are the great drain on the economy, why stop now?

But it occurs to me what is totally missing from the Republican definition of the problem is the very simple and straightforward issue of just what is medical health insurance, anyway?

The Republicans seem to think that everyone, even those Americans at the poverty level, if they just set aside enough savings, will have plenty of money to cover all their medical expenses. After all, isn't personal responsibility the watchword of the Republicans?

But that is not how medical insurance works. That is never how it has worked, since it's current incarnation started really less than 100 years ago, nor is it how any insurance works.

*Emergency Medical Treatment and Active Labor Act, U.S. Act of Congress, 1986 (wikipedia)

The Emergency Medical Treatment and Active Labor Act (EMTALA) is a U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. Participating hospitals may only transfer or discharge patients needing emergency treatment under their own informed consent, after stabilization, or when their condition requires transfer to a hospital better equipped to administer the treatment.

Move over, Welfare Queens! Granny the ER Queen is on a roll! (photo via daughternumberthree)

Tuesday Tonic - Save the Rich!

Sit back and enjoy a bit of awesome on a Tuesday morning.

Garfunkel and Oates:  Save the Rich  (language may be NSFW)

"Save the rich, it's so easy to do!

Just let yourself be ignorant to what's been done to you.

Save the rich, by doing nothing at all

deny all sense and logic and just think really small

You should think really small

Or just don't think at all

and save the rich."

Vatican Reprimands Women Religious

The LCWR march to support preservation of the Louisiana wetlands

[This is the first post on this story. A very cool follow-up post can be found here.]

When the stories about Catholic women religious and clergy coming under fire from the Vatican for upholding true Christian values*  made the rounds of the news cycle last week, a lot of people were surprised to learn that any Catholic organizations might actually be working for social justice. But there are orders of women religious (aka nuns or sisters) who have been quietly providing real help for the poor and the marginalized in our society (and around the world) - no religious conversion or test required - and they have been doing so for years. Catholic orders of women religious have been working tirelessly for decades with the most disadvantaged people in society, and often in direct - if quiet - defiance of the official stance of the Church hierarchy

Public antipathy toward the Catholic Church as an institution has grown and is understandable given the heinous crimes and even more heinous denials and cover up that have rocked the church over the past few decades. Catholic politicians like Rick Santorum - whose Catholic fundamentalism is terrifying in its coldly relentless misogyny - has further entrenched the public perception of the Catholic Church as an authoritarian, ultra-conservative, misogynistic organization that seems to be completely forgetting its frequently stated mission to promote social justice.

Sadly, this characterization is undeniably true.  It is a reality that is obvious to objective observers, but which has gone largely unnoticed by parishioners who continue to participate in their traditional communities happily (willfully?) oblivious to the church's recently renewed rightward tilt. One of the things every Catholic knows is that one can visit a Catholic Church almost anywhere in the world and feel at home. The liturgy, the music, the incense - care has always been taken to ensure conformity around the world so that a Catholic community can transcend national borders and national loyalties. It is this conformity and continuity which has lulled many Catholics into a false sense that the Church that they grew up with in the 60's 70's and even the 80's - an emerging progressive and ecumenically-minded Church focused on social justice - has continued to progress. The soothing sameness of Catholic rituals and celebrations served to smooth over and conceal the rightward lurch of the church hierarchy from its rank and file members. People were fooled by the same old-same (wonderful) old appearance of the Church they grew up loving and admiring, while behind that mask, the progressive and socially conscious movement that had at long last been launched by Vatican ll was being dismantled and discarded.

I almost feel like thanking Rick Santorum for bringing the hard-right swerve of the church to the public's attention - and particularly to the attention of sleeping progressive Catholics. While still not quite mainstream Catholicism, this fundamentalist strain of Catholicism has been resurging under the radar for over four decades (the most conservative elements began pushing back even before the Vatican ll council was adjourned), until it has come to dominate the church in a way which is bewildering to many liberal Catholics, and frightening to secular Catholics and non-Catholics. Clearly, though, Catholics are waking up to this reality now and even more clearly, many of them are not happy about it.

On the heels of the contraception debacle, some Catholic clergy are now in hot water for defying the hierarchy and refusing to lobby their parishioners to oppose gay marriage. Polls showed that a whopping 90+% of Catholics use forms of birth control other than the approved "natural family planning" (aka the "rhythm method") and that the vast majority of Catholics support the coverage of contraception by employer insurance, defying the official church position against contraceptive coverage. Perhaps encouraged by the solidly progressive views of a majority of ordinary practicing Catholics, a few priests have begun to refuse to obey their archbishops on other issues where they cannot, in good conscience, agree with the Church.

In Seattle, WA, at least two Catholic priests have refused to gather signatures for a petition for a referendum to ban gay marriage, defying the explicit urging of their Archbishop, Peter Sartain. Among the dissenters were Rev. Michael Ryan of St James Cathedral and Rev. John Whitney, SJ.(Jesuit) of St. Joseph's.

Rev. Michael Ryan

"I have decided that we will not participate in the collecting of signatures in our parish. Doing so would, I believe, prove hurtful and seriously divisive in our community." Rev. Michael Ryan, St. James Cathedral, Seattle.

"The leadership of the church sometimes confronts the world as an enemy of the Spirit. The church needs greater humility and openness." Rev. John Whitney, SJ. St. Joseph Catholic Church, Seattle.

"I am particularly concerned about our youth who may be questioning their own sexual identity and need our support at this time in their lives." Pastoral life coordinator, St. Mary's Church, Seattle.

Rev. Ryan, in particular seems to have risked serious censure by defying the archbishop because he is the pastor at the archbishop's home parish, the archdiocese Cathedral of St. James. But Rev. Whitney, as a Jesuit, has also taken a bold and courageous step:  Jesuits take a specific vow of obedience to the Pope, over and above the usual clerical vows taken by other orders. So far, though, there has not been a reaction from the church like, for example, public censure of the priests.

Interestingly, however, there has been a seemingly out- of-nowhere attack by the Church hierarchy on women in the Church. During the same week that this open act of defiance from priests was occurring in Washington State, news broke that the the Vatican had issued a stunning reprimand of the Leadership Conference of Women Religious (story from NPR) for their stance on social issues.  It may be a coincidence that the Vatican has assigned Archbishop Peter Sartain - yes, Archbishop Sartain of Seattle - to investigate and oversee an overhaul of the nun's association. In keeping with the Bible-based and historically deep-seated misogyny of the Catholic Church, it would appear that the Vatican's outrage over acts of defiance from within the clergy could only be adequately assuaged by chastising and humbling female servants of God. Quelle surprise!

What stance suddenly and so deeply enraged the Vatican, you might ask?  Why, that would be the sisters' long-standing (and publicly expressed) view that social justice should never become a political kickball.  It would be their stance that, as women religious, they have a duty and a right to follow their conscience when serving people in need. It would be their stand that when the requirements for social justice conflict with Catholic doctrine, that perhaps it is the doctrine which should be evaluated and not justice that should be sacrificed.  On the website for their social justice lobby, these sisters regularly expressed views which have only now landed them in a great deal of trouble with the men of cloth.

Check out these radical feminists!

The sisters' work and their opinions are not actually news to people who work with them, but as so often has been the case over the centuries, the Vatican largely ignored the women religious. Though these women have taken on the lion's share of the Church's work giving aid and comfort to the poor and suffering, they are rarely acknowledged and even more rarely praised by the male hierarchy for their efforts. Yet, in a time of social upheaval, when issues surrounding women's rights have come to the fore, the Vatican is suddenly focusing on the women they have branded "radical feminists" and punishing them for the sins of moral independence and following their social conscience led by their understanding of the teachings of Christ. They have been given notice that they will be taken in hand by Archbishop Sartain, and their entire cooperative of women religious may be completely overhauled to conform to new, stricter Vatican boundaries including - naturally - a male overseer.

The sisters are not taking this harsh censure with complete submission.  These are women who love God and love the Church, but they also believe in social justice and - though their spokeswoman stops just short of saying the Vatican is dead wrong - they have steadfastly defended their position, in spite of the painful sense of rejection and humiliation:

Sr. Simone Campbell

"And it's not about the giving up but it's about the fidelity to the call to be faithful to the Gospel and have that so unseen and to have this edict never mention the Gospel, never mention the responsibility to be God's arms and hands with people who are poor and suffering, the people at the fringes, people who suffer injustice, to have that not at all seen is extremely painful." Sr. Simone Campbell, executive director of  Network.

Allowing that the edict was like "a sock in the stomach," Sr. Simone nevertheless was generous enough to offer an apologia for the Vatican's unexpected slap down:

"When you don't work every day with people who live on the margins of our society, it's much easier to make easy statements about who's right and who's wrong." Sister Simone Campbell.

Sr. Campbell is more generous - and more submissive to unearned male authority and privilege -  than the Vatican or the Pope deserve.  It should not be surprising that the pervasive misogyny in the Catholic Church which would happily see women everywhere subjugated as inferior, less than human beings, extends even to its servants inside the Church, but somehow it still is. The Church has shown its moral bankruptcy in so many ways throughout its history, but has generally had clever enough leadership to hold on to its position of "moral authority" in society, in spite of behavior which has shown it to be the complete opposite in every way.  The one thin beacon of light in the entire decrepit organization has been the outreach work of people like the women religious, and the Vatican seems determined to snuff it out.

Women helping women.
Retired nuns volunteer to tutor
women for GED

I am a little late getting this post off the writing desk. Started this post last week before, you know - crime - but I still wanted to write about it. There was a time in my life when I was determined to join one of the orders now under the umbrella of the LCWR - when I was fired up with enthusiasm to pursue the kind of "mission" that would be unrecognizable to anyone unfortunate enough to be the target of what opportunistic, proselytizing evangelical churches call "missions" today.  "Sisters" were models of strong womanhood; performing important, meaningful work, giving up comforts and conveniences to minister to the poor and sometimes risking their lives to bring nursing, education and other humanitarian aid to people in war-torn places. In an era when strong female role models (not to mention prospects for a life of adventure) were exceedingly rare for girls, these women exemplified one of the few pathways that a girl could embark upon to make a difference in the world outside of domesticity. 

The people who made the news last week for displeasing their Church masters represent the kind of Catholicism that almost was. The courageous work of Catholic women religious, and the recent willingness of some Catholic clergy in Washington to challenge the Church hierarchy represent the kind of loving and inclusive Christian stance that I once believed permeated the Catholic Church.  While I have rightly abandoned any romantic delusions of that kind over the past several years, it is a relief to know that my youthful belief that there were sincere people who devoted their lives to the social mission of the Church was not entirely without foundation.

*Not to be confused with the brutally hypocritical True Christian Values™ of the religious right.

More in touch with the rest of humanity than most religious people, sisters at Villa Maria by the Sea  host an annual surfing contest.

Attention Supreme Court: The People Will Decide

Another in the long line of inexplicably "surprising"  revelations that seem to be coming fast and furious these days:  a Pew Research Council poll shows that public disapproval of the U.S. Supreme Court has tripled during the hearings regarding the Affordable Healthcare Act.  The American people have registered their awareness, once again, that conservative lies criticisms about progressive trickery are more often than not breathtakingly brazen projection.  The "activist liberal judges" we have heard so much about for so many years have failed to materialize in any powerful way, while the United States Supreme Court has been stocked with activist Republican conservatives. Finally, the American people seem to be waking up to this reality.

The religious right and the libertarian wing of the Republican party have long accused "the left" of a litany of evils ranging from the myth of the "liberal media" to the incredible accusation that "godless socialists" were bent on destroying this country. For years, the fiction that these "dangers" from the left not only exist but are a threat to all patriotic Americans has been promulgated and, unbelievably, accepted by a majority of conservatives and even some liberals in the USA. Always prominent among these false claims was the suspicious accusation that the left was somehow packing the judicial benches across the land with "activist" judges.

Even while their own churches and business leadership were busy organizing followers to do their bidding in the voting booth, even while powerful conservative backers were financing the establishment of a network of schools and colleges to produce an entire generation of dedicated workers for their pro-religion, anti-social cause, even while libertarian billionaires and billionaire churches planned and financed a scheme to infiltrate every school, every influential profession and every level of government, right-wing American leaders and their followers continued to accuse the left - that scary, elitist, monolithic left - of trying to do the very thing that they were actually doing.

Patrick Henry College est. 2000

It was the uncertainty and unease felt by the great American middle class following the social and sexual revolution of the 1960's that set the stage for the right wing's greatest opportunity, and its leadership did not waste it. Acting quickly to fill the void that social turmoil often brings to the collective psyche of a population, the religious right shifted its proselytizing and church-planting into high gear. Money was poured into the establishment of Christian schools and "colleges" which popped up all over the country seemingly overnight.  Massive infusions of cash from the coffers of wealthy churches and like-minded wealthy corporations enabled the construction of old-looking, brand new campuses, to give the air of legitimacy to institutions created for the singular purpose of graduating a generation of ideologically-driven businessmen, lawyers, doctors and politicians to fill the leadership positions in the future, theocratic, conservative America of their dreams.

Yet, notwithstanding such a well-financed and determined strategy, the right-wing has found it an uphill battle to beat down and crush the independent American thinker. The traditional wide band of moderate Americans in the center of most policy debates throughout our modern history has been eroded far more slowly than the so-called "moral majority" might have expected given their relentless religious and political proselytizing.  Even at the pinnacle of their power in 2004, the extreme right was only able to grab the top ring of political power with a surprisingly small margin, barely heaved over the finish line by an incumbency that was only made possible by an activist Supreme Court, disturbing voting irregularities and the fear and uncertainty of war.  The fact that - even with a well-funded, carefully-planned, long-term strategy to undermine and further weaken the American social contract using religious indoctrination and inflammatory political propaganda - right-wing conservatives have only managed to thoroughly convert roughly 30% of the population to their extreme ideology says something encouraging about the resilience and independent toughness of the moderate American center.

Polls taken last week indicated public support for the Affordable Healthcare Act is split along partisan lines, but that support is rising as the provisions of the Act are beginning to go into effect. A small majority want the bill struck down by the Supreme Court - many because they think the Act goes too far, but some because they object that the Act does not go far enough. This comes in spite of the fact that, when questioned about specific provisions of the law, a much larger majority of respondents actually support many of them!  While the libertarian arm of the Republican propaganda machine (via conservative-dominated media) has seemed to succeed in muddying the waters in the short term, it seems that the American public is beginning to smell a rat. The Pew Research Council poll may be the proverbial canary in the mine: an early indicator that deep in the heart of America, a sense of the fundamental inappropriateness of an unelected body potentially striking down a law which was passed by democratically elected representatives of the people is beginning to reassert itself.

David Frum had an interesting take on the role of the Supreme Court in the election (!) last week on the Daily Beast.  Frum believes that, this time, even a high court stocked with hand-picked conservative ideologues might not bow to partisan pressure to use its unelected power to influence a hugely important matter of public governance - not even to bolster the flagging fortunes of the current crop of Republican primary contenders.  The nine justices may actually perform their constitutionally-defined duty, and nothing more, to the frustration of the conservatives who expect obedience from them,  and to the relief of progressives everywhere.  It is the American people who hold the right to decide in November whether they are satisfied with the work of the current congress.

Out of an apparent "going for broke" recklessness, virtually all of the Republican leadership has openly joined in this intensely partisan and miserably destructive strategy to polarize the American public in order to eke out political victories by small but sufficient margins to retain power. I suppose there may be a cleverly hidden strategy behind this latest spectacle.  What appears to be the disintegration of the GOP might in fact be the birth pangs of yet another well-orchestrated power play, but from where I sit it looks like a nuclear, if temporary, implosion.  They did their worst,  but the extreme right-wing could not completely win over the great American middle. The Pew poll seems to suggest that any attempt by the Supreme Court to interfere politically on behalf of the Republican agenda will be viewed with disapproval by the American public, particularly by progressives and independents.

And that is very good news to me.

* Update: Maureen Dowd's column Men in Black on this topic is a must read.