Medicaid Expansion in MT - Framing the Debate

Health Insurance Slavery (HIS), or Ripped off by the ACA

I think I've finally understood the real purpose of the "health insurance racket."   Obviously, it's to make money, and use healthcare as a means of social control and class warfare.  But there is more.

Americans for Prosperity spent a bundle to defeat Medicaid expansion in Montana. Here's why they lost

ERIC STERN  (an official in the Bullock Administration)

http://www.salon.com/2015/04/21/kochs_defeated_in_montana_6_lessons_the_country_can_learn_from_this_rural_western_state/

Kochs defeated in Montana: 6 lessons the country can learn from this rural Western state

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Let me add some additional commentary, not restricted to Democratic Party dogma...

"Americans for Prosperity" is the notorious lobbying and "dark money" group based on ALEC's projects to repeal or abolish the entire "welfare state" along with the EPA,  protection of workers, consumers, the poor, veterans, minorities, immigrants, etc., while massively increasing military procurements and contracts, prison and police state spending, and turning Montana into a "resource colony" for the Asian "Tiger Economies."  

Unfortunately, the Democrats here or anywhere else still cling to the corporate model of "health insurance" which is totally wrong as a means of actually providing health care to people who need it, or even those who want to pay for it at an affordable price.  

Americans for Prosperity has framed the debate in such a way that all the sociopathic prejudices are marshalled and reinforced:  socialism is wrong, along with any kind of state-supported "welfare" or even health care programs like Medicare.  We don't want people to be healthy and happy with their health care system, because then they'll want more of it, and think that socialism actually works.  

Thus, these "conservatives" are obsessed with "welfare fraud", "free-loaders", and lazy people who just don't want to work at those fantastic minimum wage jobs which pay half or less, in real terms, than they did 40 years ago, while the top 10% and most of all the 1% are making many times what they did only a few decades ago....

"Health insurance" was always seen as a privilege, not a right.  "Do you DESERVE health insurance?  This is for the best and brightest workers, the God-fearing, patriotic Americans, not the riff-raff who have acted irresponsibly.  We, the corporations, want to keep "our people" healthy and productive.  But if you're a marginal worker, and sick a lot, a drug addict or a criminal, then we don't want you.  Rely on private charity or die."

In effect, that's what the ALEC types are saying, along with some pleas for "balanced budgets" and "reducing dependency on the Federal Government"  (except when it's military spending, bailing out the banks, or building more prisons and surveillance infrastructure). 

Why Obamacare?

The ACA was immediately branded "Obamacare", although President Obama was always for Single Payer or at least "a Robust Public Option" - whatever it takes to provide everyone with "health care coverage".  "Single-payer" became Medicare for All, (or at least anyone who wants it - but if you're rich, you'll pay the full price) - still much cheaper than any private insurance scheme. 

The bill as it finally emerged was reminiscent of Hillary's plan in the '90's, which provided "something for everyone" - except that hers was even better - everyone would have some access to health care.  You'll remember the horror and outrage which was expressed towards the Clinton Administration on that account.  And that was the plan which the insurance companies promptly destroyed because they would only get part of the action - the Middle Class and those who had good-paying jobs and were thus covered by their employers.  One would have thought that they would be very satisfied with that.  Perhaps they understood that if there really was a "robust public option", no sane person would want to buy their flawed and monopoly-ridden "coverage", which is all dead weight for the healthy, or those whose bills don't exceed the deductibles.  

Co-payments are another racket.  Providers should either take the Medicare/Medicaid reimbursements as full payment, or give up their  licenses.  Every doctor or clinic should have at least half of their patients come from public "coverage", and they should be restricted in what they can charge others, including private insurance companies.  

Then, there's cost-shifting.  This is the excuse invariably given to justify their fraudulent billing, and why people with no insurance are billed much higher than those who have it.  Hospitals and insurance companies must hire batteries of lawyers and accountants just to get paid, and that, too, is blamed on cost-shifting.  Instead of standard billing reflecting real costs and alternatives, it's all about maximizing total revenues from whatever source.  

If everyone is covered to a minimum extent, there is no reason to bill the healthy for the care of the sick - as if there were ever any reason to do that.  That is the greatest injustice, besides the basic principle that we must be free to select whatever health care facilities, treatments, and philosophies we prefer, and not be forced to pay for a system which is not only financially exploitative, but which is medically suspect in any number of ways, depending on our own philosophies and preconceptions.  

Price Competition

When you compare prices for various procedures and services, as well as the standard rate for a hospital room of whatever grade, with other countries, you find that Americans pay 4-10 times more, on average, than patients in other countries.  The prices are entirely fictional, and have only a proportional relationship to costs - that is to say, a multiple of what the actual "market-clearing" and cost-based price would be.  They've had programs on 60 Minutes and other places about how hospitals and clinics bill their patients.  And if you know anyone who has been in the hospital, and seen their bills, you know what they're talking about.

 The "list price" is about 3 times the private insurance reimbursement (supplemented by co-pays, etc).  Yet, they can collect that bill from insurance companies who don't contest it (or aren't recognized by the providers), and more importantly, from the patient, himself, or his estate.   What other name for it but outright consumer fraud, extortion, and with malfeasance..  

Is there any real "Health Insurance"?

Employers offered health insurance (often HMO's like Kaiser Permanente) to recruit people with families and higher health care needs, as a kind of bonus and evidence that the employer cared about the well-being of employees.  The rest of us would be served in our local communities by church-connected or public hospitals and clinics, with staff doctors (emphasizing different specialities) working for the various hospitals and clinics on salary.  The idea of "free markets" where any health care provider could charge whatever they like, and use the courts and collection agencies to foreclose on dead patients' homes and pensions was considered preposterous.

Is there such a thing as "Compulsory Insurance?"

Insurance, as it developed in business and protection of homes, automobiles, etc. against theft or loss by fire, flood, etc., has a very simple rationale.  It is a hedge - a way to protect one's material assets from accidental loss or destruction.  You buy it if you calculate that it is worth the cost, or necessary to protect your family.  But it is not a means of supplying one of the "necessities of life" - health care services and products.  In that sense, "Health Insurance" is a category mistake.  The only people being protected is the providers of health care services, who know they will get paid if the patient has "insurance" - even if she dies or the care was less than adequate for whatever reasons.   

I suspect that this "compulsory" aspect was sold as "socialized medicine" precisely to "prove" that it was "too expensive" and not very good - even though most of the rest of the world does very well with universal coverage and health care being seen as a prime responsibility of government - at an average of 1/4 the cost to patients and taxpayers, alike.  More than half of our "health care dollars" (what we spend both publicly and privately) provides no health care at all, and that is the crux of the problem - an inherent flaw in the "Insurance Protection Racket."

What we have, today, is more vicious than ever before, and health care as a percentage of GDP has risen from about 6% in the 1950's to more than 18%, today, all the while reducing actual access to health care services desperately needed by people who can't begin to pay for them.   Medicine has always been charitable, with "cost-shifting" from those who can't pay to those who can, along with generous (sometimes enormous) endowments and donations from the estates of people who were happy with the care they received, as well as all kinds of government support. Religious communities had their own health care facilities, reflecting their beliefs, with a lot of charitable outreach to the larger population. 

Since the 1960's, we've had Medicare and Medicaid which saved millions of families from medical bankruptcy, or simply provided health care which elderly and low-income people would have never sought or purchased with their own or family resources. 

Because of price-fixing and fraudulent billing which is all but universal these days, approximately 3/4 of our health care dollars (the total amount paid by taxpayers, employers, and individual patients) goes not to health care providers, but to the various middle-men such as lawyers, collection agencies, and the "insurance racket" itself, which only wants to make money and couldn't care less about whether the now-enslaved "customers" actually get what they want and need.  

Instead of maximizing public health and patient satisfaction with the system, today's medical industry maximizes two things - revenues (profits, higher incomes for providers) and political clout.  By politicizing the issue, all the wrong people are in charge, and profiting themselves and their "corporate sponsors".  Literally, the worst of all possible health care systems.

Sen. Baucus actually defended his monstrous scheme on the lie that "most people are happy with the insurance they have, and that won't change."  Satisfaction with existing health care in the US is something like 15% or less - the same proportion who thinks that Congress is doing a good job managing whatever it is (the Federal government and 28% of total GDP) they control.  No wonder that Republican cries for "smaller government" resonate widely.

After 30 years of service to the banksters, Boeing, Monsanto, the nuclear mafia, prison industry, and other ALEC groups, Max Baucus became the architect of the ACA.  They knew they could depend on him to do whatever they asked.  His lobbyist-backers from "Club Baucus" designed nearly every aspect of it - the "insurance" rackets, the drug cartels, private hospital associations, all the "research institutes" and universities which rely on the NIH and other federal sponsorships, etc.  

The real mystery is why Chambers of Commerce and other "pro-business" and "economic growth" advocates support it.  Forcing employers and individuals to participate in a racket is not good for business - especially since it wastes at least 10% of our national income on an "industry" which grossly under-performs by any standard.

"Obamacare" (as enunciated by Obama, himself) explicitly shifts the burden of health care for the poor and terminally ill (estimated to be 75% of all health care services) on to the workers, employers, and taxpayers through subsidies to private, profit-making insurance companies, which are now forced to "cover everyone" and to ignore "pre-existing conditions" and other "high-risk" insured, which added at least 1/3 (over what they were before the ACA) to insurance costs for everyone.   But it really isn't "insurance" at all.  It's simply a scam by which the medical "industry" extorts an additional 10% of GDP from workers and taxpayers.  

If you've ever had your insurance company refuse to cover something, you know that the doctor or hospital can still sue you and collect their (unregulated, massively inflated) bills.  It's time to resist this massive injustice and transfer of wealth to those who provide no health care or any other useful goods or services, but use the power of the state to prevent us from creating better alternatives and "opting out" of their rackets.