It’s the big question and the answer is…Yes with a big BUT.
As the President noted in the text of his speech this week regarding, “Keep your plan,” “Doing more will require work with Congress.” These are the most significant words of the speech (which you can find full transcripts of in places like the Washington Post.)
The polarized extremist views in Congress are creating a problem and that problem is the loss of excellence, the loss of creativity from two sides with more middle-of-the road goals and ideas for reaching them, and this is where we come in.
Whether you’re someone who wants the government to replicate its model of entitlements currently best illustrated by single-payer programs like Medicare and Veterans Benefits, or you’re someone who advocates less government funding for entitlement programs, the first thing is to use your vote to support people with less extremist views on either side.
Much easier said than done. Regarding Obamacare, you may hate it, I surely have spent years pointing out some of the biggest loopholes in both its approach and implementation, you may love it but recognize that the Federal Exchange program currently is dependent on Federal dollar spending that will be difficult to maintain to pay out entitlements to Exchange participants, but either way, there is no going back, not because the law cannot be changed, but because of the changes in the practice of healthcare, in the real healthcare industry, that have occurred during the last three years since the Act’s passage.
So where do you go between the extreme views of tweaking Obamacare creating changes that move Obamacare more closely to other entitlement, single-payer programs like Veterans Benefits and Medicare or those changes that move it towards Repeal. That is where your choice lies, but to avoid a Congress that collects paychecks for being obstructionist, babyish and ultimately ineffective, choosing extremes on either side is likely not the way to go.
The first thing to “DO” to fix Obamacare therefore, is to decide what parts of the law you’d like to see changed, and how.
The second thing to do is to go deeper into your concerns about Obamacare. For me the concern is controlling the costs of medical care, treatment for illness that both before and since Obamacare are rising. What can be done about reining in those costs?
Under single-payer systems such as Veterans Benefits and Medicare, the federal government can restrict how its money is spent by including things such things as the PPACA’s provisions concerning the “Death Panels,” by some Republicans which is actually, as described in my post of October 4, 2012, “The Mean-ing of America Debate 2012: Insurance Doesn’t Advise on Treatment, It Just Decides on What it Pays for,” is still in the Act.
As a matter of fact, this year the Independent Payment Advisory Board will begin its implementation, but it will not really kick in with its purpose and powers to “bring Medicare costs under control,” until January 2020.
For Republicans, using the phony notion of free competition which I’m pretty sure no reasonable person would say is at work in our society, especially when they view how much money different sectors of the healthcare industry spend on lobbying to get laws passed in their favor, (See my post, “Politics and Healthcare: Big Business, October 13, 2013), they must first join the real world and acknowledging that there is NO completely free competition and that without protecting people from the rising costs of needed medical care we will become a sicker nation whose life expectance drops even lower. (We come in at 51 according to CIA Facts, 50 countries have better life expectancies than we have.)
Currently, our neglect in managing what doctors can charge whether by utilizing laws in existence against price-gouging or by establishing laws that require doctors to accept at least two forms of insurance (yes, there are specialists who accept no insurance, not merely Medicare or Medicaid, but NO insurance, therefore leaving people to struggle with paltry out-of-network reimbursement for things like their cancer surgery) is THE biggest problem in governmental approaches to healthcare reform.
For years the only focus has been on managing the patient, blaming the patient for “choosing” illness because of his bad habits of overeating or smoking, and managing “costs” through an approach that essentially claims that if people would behave right they wouldn’t get sick…Loser approach. Refer back to life expectancy statistics.
Even the President acknowledged the fallacy of an approach that would bring health costs down by making people healthy enough so that they don’t need medical care, (after all, if you’re not sick, you don’t need a doctor) this week when he said, “It is important to understand, though, that the old individual market was not working well…Too often it works fine as long as you stay healthy. It doesn’t work well when you’re sick.” (I will be addressing this in another post this week.)
I was amazed to finally hear the President say those words of truth. Unfortunately, Obamacare makes this problem worse, in my opinion because of its heavy emphasis on essential health benefits and mandated “free” exams, rather than an emphasis on making sure that health insurance provides sufficient coverage of needed choices when a person faces illness.
Third, require that any claim that Federal expense is being cut include a description of a reduction in Federal employees. Neither Republicans nor Democrats address the issue of starting with government.
On August 30, 2012 in my post, “The Mean-ing of America: Elderly, Children and Women first? Think Again,” I cited the report by the Center on Budget and Policy Priorities, “Policy Basics: Where Do Our Federal Tax Dollars Go?” At that time four percent of the budget went to salaries for Federal civilian workers and retirement benefits for those workers amounted to 7 percent.
The President’s policies have created a nifty loophole for his enlargement of the Federal government so that he claims he has not enlarged the government through the use of third-party contractors, paid by the government but not technically part of it. On the Republican side, there’s the “Paul Ryan Budget,” that just won’t die that Republicans keep wheeling out that calls for all sorts of cuts but does not provide for specific reductions in Federal workforce and spending in conjunction with gutting governmental programs. Cut a program, cut a Federal job, we should accept no less.
Fourth, stop automatically assuming that Democrats support social programs and that Republicans support a hands-off approach to social programs. That is a lie. For instance, look at recent cuts to SNAP or the fact that PPACA includes Draconian cuts to Medicare including the “Advisory Board,” and as for Republicans, look at propositions for “Personhood” amendments and generous entitlement boosts for the armed forces entitlement programs.
Neither party is reducing entitlements or social programs, they’re just choosing to spend our money differently. If you’re pro social programs, demand to know where the money is coming from directly, not some hypothetical, “This will save all the money in the world over the next 40 years approach,” and if you’re for cutting Federal spending, demand to know for every dollar saved what specific federal expense will be cut and which personnel become unnecessary immediately as a result of the cut.
