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Author Topic: The Other Death Penalty take II: ACA and a war on competence
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The original heartbreaking essay by Rachael Pearson, watching the people left to die in states like Texas

The expanded take, by Joshua Holland.

The media have been buzzing with stories — many of them wildly exaggerated — of people facing higher premiums as a result of Obamacare. But there’s a story about rates you may not have heard: According to Jonathan Gruber, a leading health care wonk at MIT, all private insurance premiums in the 25 red states that are refusing to expand their Medicaid programs will be 15 percent higher as a direct result of that decision.
Obamacare has had a completely clownshoes introduction.

To this day I have no idea why this site wasn't talking about it. Overshadowed by the insanity of the government shutdown, perhaps? Obamacare's launch has been terrible.

Someone watching the obamacare launch said it reminded them, painfully, that prior to 9/11 the FBI didn't even use computers that had mice. The ACA implementation is representative of ugly contracting madness, with the government privatized contracting handed off to the same giant government contractor knuckleheads that have ingratiated themselves into the system ... not for a stellar record in IT or 'internet things' (they actually have horrific records) but because they are gimmied by connection into government.

As ridiculously stupid as this is, the GOP has no business topping it handily in pretty much every important way. Wait, except that it's their business.

The reality is that conservatives are complaining about insurance policies being cancelled and the ACA’s error-plagued exchanges at the same time as they actively work to keep millions of poor Americans from gaining coverage under the law’s Medicaid expansion.

The victims of Obamacare’s implementation problems being hit the hardest, by far, are those whose incomes fall between the federal poverty line and the eligibility cutoffs in those 25 states rejecting Medicaid expansion. Not only will they be left uncovered, they won’t even be eligible for the generous subsidies that people earning slightly more than they do can use to buy insurance. It’s brutally unfair. The Kaiser Family Foundation estimates that 4.8 million poor adults may fall into that coverage gap — about twice the number of people expected to pay more for their insurance when their substandard policies are cancelled.

These links are insane. I should not have expected this, or worse, ...

And it gets worse. In 40 states, adults without children are ineligible for Medicaid regardless of their income level. In 30 states, the parents of children who qualify for Medicaid may not be eligible themselves. All of these people would be covered under Medicaid’s expansion, but they’re being left high and dry in the 25 states who have rejected expansion. And while the problems plaguing healthcare.gov result from mismanagement and a contracting boondoggle, those red state lawmakers who refuse to expand Medicaid are inflicting this harm intentionally, based solely on their ideology.

In other words, they’re actively working to maintain America’s shamefully high rate of uninsured. And that comes with deadly consequences. Because, in this country, we do ‘let ‘em die’ – we let the poor and the uninsured die from treatable illnesses every day.

Last week, the Texas Observer ran a heartbreaking essay by Rachel Pearson, who recalled being a young medical student volunteering at a free clinic in Galveston, Texas. Pearson had a patient – a poor, uninsured patient — who was obviously very sick. But Pearson couldn’t properly diagnose his ailment with the resources available to the clinic. When his pain became severe, she sent him to an emergency room, but the personnel there refused to treat him because his symptoms weren’t an immediate threat to “life or limb.” As time passed, his condition deteriorated until he began having difficulty breathing. It was only then that an emergency room finally admitted him and diagnosed the cancer that had metastasized throughout his body. “It must have been spreading over the weeks that he’d been coming [into the clinic],” she wrote. He died a few months later. “The shame has stuck with me through my medical training — not only from my first patient, but from many more,” wrote Pearson, who now heads the clinic.

... but we've come to understand that this is their forte ...

A 2009 study published in the American Journal of Public Health linked 45,000 deaths every year to the uninsured, even “after taking into account education, income, and many other factors, including smoking, drinking and obesity.” The lead researcher of the study, Andrew Wilper of the University of Washington School of Medicine, told the Harvard Gazette, “We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease — but only if patients can get into our offices and afford their medications.”

This is the real-world backdrop for our fierce debates over Obamacare. Yet Republicans’ answer to the uninsured crisis is to claim that having no coverage at all is better than being enrolled in Medicaid. And that’s why conservatives have no legitimate leg to stand on in griping about the program’s flaws, no matter how deep they run. Because when it comes to health care, the American conservative movement has nothing constructive to offer to fix the problem of getting more people health insurance — they can only whistle past the graveyard.

Here’s the sum total of what conservatives propose to fix our health care system. “Tort reform” remains popular; the argument is that malpractice suits drive up insurance premiums and make health care less affordable for the rest of us. But according to a 2009 study by the Congressional Budget Office, the total cost — “malpractice insurance premiums together with settlements, awards and administrative costs not covered by insurance” — makes up just two percent of our health care costs, and Republican proposals to limit payouts would reduce the cost of American health care by just one-fifth of one percent. When the CBO included the indirect effects — doctors performing defensive medicine to ward off lawsuits — they concluded that tort reform would only reduce health care spending by half of one percent. It’s an empty proposal that has more to do with dinging trial lawyers, who tend to support Democratic campaigns, than with improving our health care system.

The Biggest Problem With Obamacare’s Rollout Is Being Caused Intentionally by Republicans
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And, per the title:

The efficacy of government, now the lonely responsibility of Democrats, used to be the province of both parties. (So did liberalism, for that matter, but good luck selling that one outside the faculty lounge.) The Progressive movement of the early twentieth century, with its enthusiasm for “scientific” administration and the emerging field of business management, influenced the approach of Theodore Roosevelt as well as Woodrow Wilson. William H. Taft, Herbert Hoover, and Franklin D. Roosevelt all sought to reorganize the executive branch to better manage the administrative state. In 1936, 1940, and again in 1944, F.D.R. faced Republican challengers who pledged not to repeal or roll back the New Deal, but to be better stewards of it—to run it more proficiently, more economically, with greater flexibility in its operation. Dwight D. Eisenhower, the first Republican President since Hoover, took precisely that position toward the welfare state, to the mounting fury of his party’s conservative wing.

Over time, the Republican abhorrence of government per se eclipsed the Republican interest in efficiency in government. It is hard to maintain, with a straight face, a promise to run a tight ship when you’ve been boring holes in its hull. Republican negligence gave centrist Democrats like Bill Clinton an opportunity to reclaim the mantle of sound management after the failures of the Great Society. Clinton pledged a government that was “more active, more effective, [and] less expensive,” and launched an ambitious effort to “reinvent government”—which may be best remembered not by the amount of red tape it cut but by the image of Vice-President Al Gore in safety goggles, smashing a glass ashtray with a hammer on the “Late Show with David Letterman” to demonstrate the foolishness of certain governmental regulations.

But, as Obama is finding, it’s hard for one party to make government work when the other party is determined to make government fail. Yes, the healthcare.gov debacle is manifestly “on us,” as Obama had to concede last week. But it happened in the face of a relentless campaign by the G.O.P. to do everything possible to prevent the law from taking effect, or from working if it did. Congressional oversight, particularly as practiced by Representative Darrell Issa, is just another theatre in the war on efficacy. On occasion, we hear of Republican reforms to the Affordable Care Act, but these are offered in the spirit of the vandal who blithely assures you that your car will run better with two wheels rather than four, so would you please hold his jacket while he removes your rear axle.

If there is any ambiguity left to the G.O.P. reform agenda, let it be put to rest by Michael F. Cannon, the director of health-policy studies at the Cato Institute and a former Republican Hill staffer: “The only way to eliminate waste, fraud and abuse in a governmental activity,” he testified before a House subcommittee in 2011, “is to eliminate that activity.” When you see virtually every governmental function, a priori, as wasteful, fraudulent, and abusive, from disaster relief to early-childhood education, the only way to save the village, to paraphrase a U.S. military officer in Vietnam, is to destroy it. This, one fears, they can do quite competently.

blah blah more liberals talking
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To this day I have no idea why this site wasn't talking about it.
For my part, it's because I work for a regional insurance company headquartered in Wisconsin and it just makes me sad.
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Heh, that last bit about Vietnamese villages-I would need to see a broader context to be sure, but I wouldn't really be surprised to hear a 2011 Republican use such a comparison and mean it to be in favor of 'saving' the village.
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how do you think this dress?

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i think that dress very the attractive purch of make the time and like in link internets, deals very of great!
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Does come dress with cigarettes?

Samp, those were great posts. Thanks.

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