Politician Proposals...Safety Net, Not Universal Health Insurance

It's really difficult to take the political talk of universal health insurance or universal health insurance access seriously when the very labeled premise is inaccurate and misleading. None of the proposals are about universal health insurance nor are they about universal access to health insurance any more than Obamacare is or was. As consumers, calling these approaches what they are should be the first step for buy-in.

Safety net, entitlement program, NOT universal: Time to dump the Medicare for all and NY's claims of universal anything when it comes to health insurance and health care. It's ridiculous because it relies, as Democrats did for Obamacare, on the stupidity of the American voter,(Jonathan Gruber) and I'm hoping we're not.

These plans are entitlement creations, safety nets designed to pick up specific groups of people whom legislators decide are in "need" of some kind of health insurance, without realistic regard for the cost to taxpayers nor the quality of the health insurance being provided, without addressing clawback provisions in the event a person makes strides in income, without detailing the registration requirements, whereby government would be able to document everyone who uses such a program, including previously undocumented individuals, without assurances that insurance companies will not "balance" out the new entitlement coverage by charging other individuals purchasing health insurance much more, without outlining COST controls on all medical providers and prescription drugs, which would have to be part of such legislation in order to stop the arms race of increased charges imposed on consumers.

Instead of starting with misleading lies, such as "universal," legitimate politician marketing of universal health insurance must begin with their definition of universal, the way in which they will limit expenses, either by further curtailing services and care available to individuals or finally addressing the critical need for COST controls on providers and LIMITS on insurers as to what they can charge both for self-only AND for family coverage, how the registration for health insurance will be used by taxing authorities, and how the "universal" insurance will cover consumer costs without limiting consumer access to needed medical services or care.

This is where it starts, and the best way to make sure it's beginning from legitimate roots is to make sure that the lawmakers will be covered by the law they're enacting, rather than Obamacare's case whereby lawmakers specifically protected themselves from the shoddy, limited, expensive plans that they found good enough for everyone else. (See: Congress' Obamacare is Obamacare in Name Only: The de facto Exemption, https://conoutofconsumer.blogspot.com/2018/10/congress-obamacare-is-obamacare-in-name.html )

Shifting Whom We Disbelieve is Just New Bias and Prejudice and an Opportunity for New Perpetrators

Guilt by allegation, prejudice against males, presumptions of lying, this is not progress, it's just a shift in the opportunity for a new perpetrator class. That's what came across to me in the "hearing" yesterday with Brett Kavanaugh and Christine Blasey Ford.

Bias, including gender bias, remain in society today, and our acceptance of discriminating against individuals on this basis simply makes us perpetrators of discrimination. The important lessons are the lessons of working to avoid the injustices of prejudice and bias and that applies to everyone, even men.

The issue is relevant here, because as I've documented many times, Obamacare is also an unequal piece of legislation that reflects insurance company and governmental partnerships that support women OVER men. Gender bias against men is evident in Obamacare's coverage of physical exams, paid for women, not men, domestic violence counseling paid for women, not men, sterilization paid for women, not men. Shifting bias and prejudice is harmful to someone, it simply is someone ELSE.

Yesterday was a victory for bias against men. The hearings were conducted by a group of frightened Congresspeople, terrified of being called anti-woman if they questioned Dr. Ford's salacious accusations in a thorough and meaningful way. Sure, Dr. Ford wasn't on trial, but NEITHER WAS BRETT KAVANAUGH. Even those who objected to the proceedings' unfairness carefully protected Dr. Ford's "victim" status, rendering the hearings themselves, to me, ridiculous.

Since Brett Kavanaugh's behavior and responses have been the subject of much criticism, though no Brett Kavanaugh fan, I here critique why these hearings were a waste of taxpayer money in my opinion, of course.

From Dr. Ford's babyish voice and the "I'm terrified," claim to the two demands for caffeine, that struck me as hardly the behavior of someone terrified. From the 100 percent certainty that the perpetrator was Brett Kavanaugh and the equal 100 percent certainty that as an underage drinking teenager at a country club party that she had only "one beer," I did not find Dr. Ford believable.

Even Dr. Ford's touted reference to meeting up with Mark Judge and saying, "Hello," to him in the grocery store after the incident did not ring true to me. In my opinion, most teenage girls would shy away from such contact weeks after such an incident if they recognized someone from that incident rather than initiate it. The subsequent "verification" of the sighting of Mark Judge by Dr. Ford based on the truth that Mark Judge worked in the grocery store, was a published fact in Mark Judge's book in 1997. Also not persuasive.

Dr. Ford's story was prepared and refined and retold countless times, solidifying it into memory as anyone can be influenced by being told they're fat, or stupid, or a victim over years and years, ultimately believing the untrue. There were no aha revelations, no gotcha moments.

Dr. Ford's denial that she knew the current best approach for interviewing victims of sexual abuse as a multi-degreed professor of psychology was unbelievable even as she threw in some scientific or medical language to bolster her own understanding of herself.

This hearing, to me, was at best a colossal waste of US taxpayer money for a salacious he said-she said story about teenage misconduct, underage drinking, privileged lives at the country club and lack of parental oversight from three decades ago and at worst might end up being another governmental stamp of approval for the anti-male bias that's become acceptable, a new age of injustice.

Ignore Fantasy "Free Market" Arguments for 2016: Obamacare

The "free market" argument is NEVER used to benefit consumers directly if at all. It's an argument rolled out to get individuals to ignore what government is doing for other stakeholders in healthcare and preys on those consumers foolish enough to believe that by opting out government will do what's best for consumers and the free market will take care of everything else. Laws are leaders in the money-grab of consumer dollars for everything from taxes to industry incentives. If you believe that there's a free market you might ask yourselves why industry spends so much on purchasing government influence in order to get laws favorable to their industry year after year?

The website OpenSecrets.org presents information on how much a given industry spent on lobbying government for laws--not free market but LAWS that benefit them. Health insurers (https://www.opensecrets.org/lobby/indusclient.php?id=F09) during the years of 1998 to 2015 spent the most in 2009, the year before the enactment of Obamacare and spent $118,603,460 according to the site.

Lobbying for pharmaceuticals/Health products was at $179,053,490 for 2015, with its two highest spending years from 1998 to 2015 in 2009, 2010, right around Obamacare enactment (http://www.opensecrets.org/lobby/indusclient.php?id=h04).

The American Medical Association spent $23,955,000, the most they've ever spent lobbying this year with their highest year from 1998 to 2015 before this year the year 2010 at $22,555,000 in 2010, Obamacare time. (https://www.opensecrets.org/lobby/clientsum.php?id=D000000068)

Obamacare: Money and Care and Trust

On October 26th, 2014, “the New York Times,” published an article called, “Is the Affordable Care Act Working?” Naturally the report begins with emphasis that more people are insured.

At least the Times mentioned that over half of those newly insured are from Medicaid enrollment and also noted that 3 to 4 million young adults are insured thanks to changes where parents can insure their grown children which was accomplished prior to Affordable Care.

The article is better than some because it at least brushes with reality noting that subsidies helped make insurance affordable for some while others saw costs rise. The article also notes that meaningful data about actual care is sparse and that slowing down healthcare spending is merely a “perhaps, but mainly around the edges.” (10/26/2014, “The New York Times,” “Is the Affordable Care Act Working?”)

But the article fails to mention meaningful data for consumers that speaks to issues of money and care, two important aspects of consumer experience that should certainly be relevant to an affordable CARE act.

While it is too early to determine with data whether our care improves, stays the same, or worsens under the act, the text of the act, its provisions and our experience likely will mirror the act’s strong adherence to insurance industry guidelines that focus on prevention rather than more costly treatment and taking away coverage to preserve affordability—meaning the traditional formula of more expensive and/or less coverage.

Certainly the evidence-supported conclusions of the article point to what we already knew, more covered individuals by spreading costs of such coverage to taxpayers, privately insured and parents of young adults…quality of care unknown, costs up for some individuals (down for others), spending really not down, and the healthcare industry got more paying customers, (10/26/2014, “The New York Times,” “Is the Affordable Care Act Working?”)

There is evidence that we consumers have gotten the message: Obamacare is a massive law designed to spread around a little bit of coverage to many while charging those most in need of health insurance coverage (those in need of medical care and treatment) more through increases in cash payments required for copayments, coinsurance and for those with unsubsidized premiums.

An October 2014, “New England Journal of Medicine,” article addresses, “Public Trust in Physicians — U.S. Medicine in International Perspective,” Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero, M.P.H., N Engl J Med 2014; 371:1570-1572October 23, 2014DOI: 10.1056/NEJMp1407373, http://www.nejm.org/doi/full/10.1056/NEJMp1407373.

In that article, The New England Journal of Medicine discusses recent research that indicates that US citizen trust in our healthcare system is at about 23% and that the US ranks near the bottom of 29 industrialized nations researched in that category. The study notes, “We believe that the medical profession and its leaders are seen as a contributing factor,” (http://pnhp.org/blog/2014/10/24/improving-trust-in-the-profession/).

There was an anomaly in the results. 56% of adults polled in the US said they were “satisfied” with the care they received. As reported, “Of the 10 countries that rank lowest in public trust…all but the US also rank 19th or lower in patient satisfaction,” Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero, M.P.H., N Engl J Med 2014; 371:1570-1572October 23, 2014DOI: 10.1056/NEJMp1407373, http://www.nejm.org/doi/full/10.1056/NEJMp1407373.

So, we’re satisfied with our care but don’t trust our healthcare system and providers.

The article recommends that physicians should “deliberately take visible stands favoring policies that would improve the nation’s health and health care…” specifically regarding “high costs,” as a means of raising trust levels to the higher percentage of US citizens satisfied with care. I agree that cost is crucial in understanding the anomaly, but I disagree that “taking a stand,” is likely to improve physician trust numbers.

The article is designed as food for thought for physicians about preserving their authority in healthcare decisions and warns that without improving trust physicians are “likely to find that many policy decisions affecting patient care will be made by others, without consideration of their [the physicians’] perspective,” NEJM, 10/23/2014.

The research explains the seeming anomaly of low public trust yet high satisfaction (note, satisfaction is not that high at 56%...a little over half, NEJM, 10/23/2014, but certainly better than the 23% with confidence in the health system) as possibly due to a variety of factors but does indeed recognize that “…nearly two thirds of the public (65%) believes these costs are a very serious problem for the country,” http://pnhp.org/blog/2014/10/24/improving-trust-in-the-profession/.

Loathe to address how much they’re charging, physicians will likely contribute to the full demise of their credibility.

Consumers are saying what the problem is pretty clearly, “The care we get is satisfactory much of the time (56%) but few of us trust our healthcare system (23%) likely because we believe we’re paying too much (65%).”

No amount of spin will budge those facts and more rhetoric designed to manipulate consumers also will likely fail.

But there’s more at risk for physicians than having others take the lead in medical decision-making and that is that is the risk of consumers going from feeling they’re charged too much to feeling that their treatments are being manipulated to maximize profits which will erode the 56% satisfaction with care.

It’s not an impossible scenario and physicians have certainly contributed to the problem by making money the priority in discussions of health. Sure, money has always been an issue, but the perception used to be health first, money second and now that is reversed oftentimes.

For example, physicians blabbed about defensive medicine the practice of protecting themselves financially from claims of negligence, admitting to putting patients through unnecessary treatments and tests. While the discussion included tort reform, obviously it showed a new face of medicine, wallet first, patient second.

Then we have many physicians who go off-insurance, not accepting insurance plans—maximizing their profits by avoiding accepting a “negotiated” rate with an insurance company. Anyone trying desperately to cling to some old-time notion of a healer would have a hard time fitting such physicians into their mold.

More and more instances of whether care is worth it have been codified by Obamacare often penalizing practices for going the extra mile with patients where outcomes are deemed likely to be “poor.” This likely means that the most desperate among us will have reduced choice and unspeakable expense in pursuing a “chance” even if they’ve decided they have the strength to pursue that chance.

These are dollar-priority decisions that while in existence before Obamacare, now dominate discussions of treatment creating an environment where asking who is worthy of our best medicine has moved us farther away from notions that healing should at least be the primary goal of healthcare.

Today, few if any consumers would react to a patient claim that a doctor pushed for a more expensive procedure and test as crazy. That’s a credibility problem for physicians.

But a bigger problem for physicians is that mistrust of what we’re being charged by providers will ultimately lead to mistrust of how we’re treated, after all, there are two ways to preserve money, earn more and spend less…whether it’s in substandard medical supplies used, or treatment on the cheap, or something else.

More than taking a “stand” is required, though hearing patient care thrown in as more than afterthought in enriching our healthcare system would be helpful.

For consumers, return to policy and practice that incentivizes greater group coverage and group plans that truly negotiate with providers for best rates in exchange for more customers would be better than Obamacare which incentivizes individual plans and plan selection.

Obamacare has decimated group insurance, the strongest power citizens had for trading lots of customers for a cheaper rate by creating mandates and taxes in order to fund the artificial “marketplace” created by the subsidy and Medicaid expanded entitlements of Obamacare leaving the majority of Americans paying higher prices for needed medical care in order to fulfill the imaginary idea that simply having insurance regardless of its quality could somehow improve healthcare.

Physicians could be advocates in this task of supporting policy to encourage group insurance and by simultaneously leading their professionals against the practice of not accepting insurance plans, Medicaid or Medicare “…even if doing so might be disadvantageous to some physicians,” NEJM, 10/23/2014.

Doctors Eying Credit Card Purchases: Consumers, “NO.”

In a June 26th, 2014 article entitled, “Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her,” by Shannon Pettypiece and Jordan Robertson, http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html, reports that, “Carolinas HealthCare System…is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.”

To use for what, supposedly? According to Michael Dulin, “chief clinical officer for analytics and outcomes…Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.”

Because of the large number of comments listed (974, bigger than some survey results that are reported), I decided to go through the comments.

Probably no surprise to anyone in the US, the NAYS had it. Only a handful of people showed any support at all for the Carolinas HealthCare use of personal purchases to establish a RISK PROFILE of patients. I counted fewer than 10 supporting the practice, or who didn’t care about the practice, or who didn’t believe it was true.

What was interesting is that NONE seemed to believe Michael Dulin’s, of Carolinas HealthCare System, justification for the data mining, that the information would be “passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.” That’s NONE.

Most believed the data would be used “against” patients, explaining the most commonly offered solution to the situation by commenters: USE CASH.

There were a few who had some novel suggestions, such as Tanstagcopc who gives the White House address and phone number when asked for hers by a cashier and always claims to have lost her rewards card to get a new one which many cashiers will scan and remind you to finish your registration at home after your purchase.

There was another commenter, by Notademocrat that said that’s why the “worst thing anyone can do is use a smartphone.” To which another commenter Sourcecode-v3 who explained, “Why I still have my burner phone.”

Then there was Ivan Denisovitch who said, “What’s next is a back-door, underground black market medical service community.” To which Guest replied: “My physician’s exwife saw her friends as off-the-record patients…she was only interested in their cash.”

FelliniFan said, “Electronic medical records have destroyed patients’ privacy.”

Thinker warns: “…while some groups may appear to be ‘favored’ now, human history shows that they are always the first to go.’

Buck recommended: “Maybe consumers should band together and analyze data on American hospitals and why they charge $10,000 a day when hospitals in other western developed nations charge a small fractio nof that for the same service and provide better quality care.

And Common_sense 96 did indeed have some: If a doctor/hospital ever brings up things that I have/haven’t purchased I will not answer but immediately demand in writing on their letterhead what they are asking me and where they got the information from.”

When it came to blame, the answers reflected public diversity in who’s to blame that our world has come to this concoction of a RISK SCORE based on shopping. JimH said, “The use of informatics to improve patient care—especially driven by government res is called ‘care management,’ this is the reality healthcare providers face now.”

Some blamed HIPAA such as Polmom who said, “I refuse to sign HIPAA…but I don’t believe that stops anyone from accessing my records.” Or DaveB who said, “You can add mass shootings to the list of unintended consequences caused by HIPAA.” Or Jodie, who replied, “So true.”

So it was clear that the process of data mining was NOT supported primarily because of interests in privacy and that NOBODY believed Michael Pulin’s lame claim that the information would be used to help prevent illness because of any concern for patients (except as a means to save money for government and insurance companies).

But the bulk of the arguments divided down Republican-capitalist lines and Obamacare-social programs lines reflecting that we as consumers are aware of the hybrid nature of Obamacare that benefits both government and private industry off the backs of citizens, but we’re not sure what to do about fixing it. This is important because who our lawmakers, as we will choose them through voting, will influence changes to Obamacare.

There are those who forgive the Democrats because the Republicans do it too. Like Earl Turner who says: “Welcome to the Corporate States of Amurrica. All you neocons and Republicans would be screaming bloody murder if the government did this (and the government does) but it’s perfectly OK for business to do it.”

Not quite sure what that was about since the vast majority of ALL commenters were against Carolinas HealthCare System policy of gathering and distributing citizen purchasing habits via credit card and store discount cards.

Harry Taft responded to our confused friend Earl, “Earl, it may have escaped your notice but after the implementation of the ACA all of healthcare is simply a subsidiary activity of government.”

While hyperbolic in terms of “all,” Harry makes a good point, Obamacare simply created a new entitlement system where the government helps more people purchase health insurance from corporations and taxes them for a failure to do so.

Then there’s informatics Jim H who comments again, “Obamacare wasn’t the origin of quality measures.” Same argument. It’s not worse, it was happening before.

I respond to JimH, True, but rewarding these practices through government payouts in the form of dollars for outcome-based care and penalizing hospitals for re-admissions does make things worse than before by providing financial incentives to keep scores up by excluding the "RISKIEST" patients.

Finally it was GREAT to see that most people who commented recognized the arbitrariness and unfairness in singling out particular groups for uneven treatment. Those who supported singling people out usually did so by relying on untruths.

For instance, Ricecake202 commented: “When you make it law that everyone must buy healthcare insurance or else must pay fine you must also make it law that everyone must live healthily or else must pay fine for the risk and cost the tax society [actual words in comment]. It’s only fair.”

While the argument sounds almost reasonable, it is not relevant in terms of Obamacare which ONLY permits higher premiums be charged to tobacco smokers and older people.

As pointed out by Srh S: “Don’t forget gun owners, motorcycle drivers, and extreme sports participants.” We might also add those who use illegal drugs (not usually purchased with a credit card or store discount card), those who engage in promiscuous sex without protection (so condoms wouldn’t be showing up on their purposes), those who have gym memberships but never attend, or those that buy healthy in the grocery while paying cash at bars, restaurants and other places.

Srh S also says, “So what is wrong with trying to limit or eliminate the things that cause ER visits and cost taxpayers money? Sorry cons…time to stop living in the past.”

Unfortunately, experience so far does not support our snarky Srh S. For instance, on 7/8/2014, “USA Today” reported, “More patients flocking to ERs under Obamacare,” by Laura Ungar, http://www.usatoday.com/story/news/nation/2014/06/08/more-patients-flocking-to-ers-under-obamacare/10173015/.

Recovering Liberal wrote: “The situation is bullsh-t but Milton’s point is valid. If I’m forced to subsidize your healthcare then I should have the ability to mitigate the risks to my pocketbook by restricting your risky behavior. This is the dark…consequence of socialized medicine.”

This was what was going on before Obamacare (which by the way is not socialized medicine). It was being done by insurance companies who were paid premiums by citizens for the right to coverage in the event something happened and then were dropped when they became sick, denied insurance because they were sick, or were charged more in premiums based on that fact that they'd become sick. Obamacare, naturally, is not worse or better, it’s merely the SAME approach with a shift in who’s paying more.


Under Obamacare smokers and older citizens are to blame and charged more instead of women using expensive maternity services, drug users, those with pre-existing conditions from drug abuse or otherwise, or even the fat. Now we’re “paying” for all of that INSTEAD.

One of the biggest boosters of Obamacare who called himself Fartolio Fatso, confirmed my two conclusions so far: First, that the information mining is not believed by anyone to be the benefit to citizens so that healthcare workers can “reach out” to them but rather as an invasion of privacy that will be used against them and second that NOT understanding Obamacare is a barrier to reform.

Fartolio Fatso went on and on. Some of his comments were, “To decrease healthcare cost must go to the roots of problem…it’s bad behaviors.” And, “Now we’re talking about making smokers, alcoholics, fatsos have to chip in their fair shares of health care system’s costs burdens.” Finally, “I don’t like smokers, alcoholics and fatsos.” OK. Regarding the punishment aspect, obviously saying you don’t like someone is a great indicator. Regarding education, obviously this commenter doesn’t know that only smokers and NOT alcoholics or fatsos are affected by higher premiums under Obamacare.

One of the trends that COULD worsen is the trend in using emergency rooms if information from data mining is used by healthcare providers to deny care to patients who will bring down their good numbers for outcomes and efficiency in getting more federal dollars. Patients will and SHOULD go to the emergency rooms because they cannot turn you away in this case though emergency costs will be higher than seeing physicians elsewhere.

If physicians begin denying care Obamacare itself, I believe will also be in jeopardy since healthier older people and those with habits doctors don’t like who find they cannot obtain medical treatment will simply buy catastrophic policies which ultimately means that those individuals who eventually will get sick will have cheaper insurance up to and including the time when they get ill. Of course, older Americans in Medicare will begin to cost more money as people don’t get regular medical care which means that the Independent Payment Advisory Board will kick in and…

Still, thank you to the commenters regarding the June 26th, 2014 article entitled, “Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her,” by Shannon Pettypiece and Jordan Robertson, http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html, discussing Carolinas HealthCare System and their practice of tracking your credit card purchases and discount card purchases to calculate your patient risk score for YOUR OWN GOOD.

Christie versus Obama: In Plain Sight

When you consider everything that “surprised” consumers about Obamacare, and our individual health insurance policies, it’s important to consider how we were “surprised,” or “tricked,” or “misled,” about the PPACA to avoid further trickery in the future.

For the most part, aside from the Supreme Court ruling about Medicaid expansion and whether the individual mandate was a tax or a penalty, news coverage of Obamacare that included its scammier elements, the cover-up (defined here as it is in freedictionary.com as “to hide from view or knowledge) really was not that newsworthy until the end of the year, 2013 even though PPACA has been law since 2010.

Obamacare is full of provisions people claim they “didn’t know about,” as if they were secret. But how could they have been secret if they were there in black and white the whole time? In my opinion, it’s because the length of and confusion presented in reading the law, in combination with a misplaced reliance that we were getting accurate descriptions of the law amounted to hiding what the law is in plain sight.

As the facts of Obamacare became more familiar to people at the end of 2013 in preparation for health insurance provisions becoming effective in 2014, we started hearing about how people’s trust in the President was floundering. We realized that in spite of all the talking the President had done that he had OMITTED key provisions of the law that promise negative impact on both the physical and financial health of many citizens. In other words, we had at best been told only the good things about the law. We’d been scammed.

Finally we realized that this was about passing healthcare reform for the sake of the President’s legacy, not to address the healthcare crisis as we knew it nor the affordability issue impliedly covered by the law’s name.

But the provisions of Obamacare were discoverable by us. In accordance with a White House policy that promises “transparency,” we were FLOODED with information about Obamacare and after 2010 could read the law in any number of places so we were slow to realize that the volume and complexity of material we could see in combination with the selective discussion of the popular features of the law only actually created a cover-up, again, “to hide from view or knowledge.”

One of the many lessons of Obamacare is that transparency can be used as a tool in aiding with a cover-up when the sheer volume of information presented and the language used to present it creates the likelihood that people will not understand and will have to rely on others to interpret what they’re reading.

This is a critical for us as consumers with health insurance policies. Obamacare itself requires summaries of health insurance policies in the form of Summary of Benefits and Coverage. But it is important to note that NO summary governs what your health insurance policy is, only the policy itself governs that.

In terms of our changing practices, it’s imperative to incorporate calling your insurance company into your repertoire, finding out what they say, keeping a record of your communications and even sending a confirming email back to them mirroring what they said in order to avoid “surprises” of features of your health insurance policy that are in plain sight regarding your coverage.

Rep. Henry Waxman: Post-Obamacare Departure

As reported, Representative Henry Waxman, D-CA is retiring. He stated that, “It’s time for someone else to have the chance to make his or her mark,” referring to his departure from Congress after many decades (look this up anywhere).

After a long career, however, like the President himself it seems that Representative Waxman inextricably has his own achievement record and perhaps his ego so intertwined with Obamacare that he cannot be truthful about the PPACA.

It is this ego, this sense of legacy that represents an enormous barrier to consumers, in addition to the fact that we have such legislation, in changing or modifying provisions that have and promise to do nothing more but increase out-of-pocket costs to consumers AND increase the hoops they must jump through to obtain covered “services” under health insurance policies.

As long as those taking credit for Obamacare, (though they’ve omitted credit due health insurance companies, the true creators of Obamacare, as you can read in, “Insurance Companies Created Obamacare,” in my 7/28/13 post, citing the 2008 AHIP proposal, http://conoutofconsumer.blogspot.com/2013/07/insurance-companies-created-obamacare.html) are still in positions of authority, with their same ego involvement, there can be no “fix” of Obamacare that will address the serious consumer threats created by the law.

Representative Waxman, in his February 2013 interview persisted in the view that the PPACA is, “A great achievement,” as you can see on a video of his interview with Madeleine Brand in February of 2013, “KCET SoCal Connected,” http://www.kcet.org/shows/socal_connected/content/interview/waxman-obamacare-important-landmark-piece-of-legislation.html.

In that interview, Representative Waxman declares that because of the Affordable Care Act, “EVERY [emphasis added] American has the security of knowing the can get health insurance when they’re sick,” (refer to the cite for the interview above). We KNOW that’s not true, the PPACA leaves the position of MANY unemployed Americans untouched in terms of an ability to obtain health insurance.

Regarding the “affordability,” of “Affordable Care,” the interviewer did mention that many health insurance companies raised their rates for the 2013 benefits year as much as 20 percent and she queried whether this might not be in preparation for Obamacare provisions taking effect in 2014.

Mr. Waxman glibly stated, “It may well be…” and launched into yet another “promise” that post-2014 insurance companies would have to justify such increases or provide refunds. Luckily, we didn’t have to wait until 2014 to see the underwhelming reality of this provision.

In my July 21, 2013 post, “How Obama Does It: Accurate Headlines (Sort of), http://conoutofconsumer.blogspot.com/2013/07/how-obama-does-it-accurate-headlines.html, I discussed the whitehouse.gov announcement, “A Refund from you Health Insurance Company? Thank the Affordable Care Act,” which disclosed that IF you received a refund it was about $100 per FAMILY, not exactly headline-worthy, and certainly grotesquely insufficient in terms of the increased costs facing many if not most Americans.

Representative Waxman has decided to retire. But as a supporter of Obamacare, and as evidenced by his misleading statements about the PPACA, which could be said to have passed and become law at least in part because of the misinformation that was put forth as well as the information put forth, he underscores that the chances of addressing provisions in the law that hurt consumers, is likely going to have to await the departure of all of those in government who have tied their legacies and their egos to Obamacare, either against it, or in the case of Rep. Waxman, those who are for it.

Supporters of Obamacare who can admit no failures, who cannot recognize the weaknesses already revealed and those unfolding, who adamantly defend the PPACA with the same blind zealotry that repels us from the equally “blind” Tea Party counterparts, shrieking, “Repeal,” cannot be the source of rescuing consumers from some of the law’s worst provisions.

As they say, recognizing the problem is the first step, (see explanations of the Rational Planning Model, including information on Wikipedia, http://en.wikipedia.org/wiki/Rational_planning_model, which requires “defining the problem as the first step,” to solving a problem.

We cannot fix those aspects of Affordable Care about which we were and are being grievously misled until like Representative Waxman, those whose egos and legacies have become synonymous with Obamacare have departed from their positions, because they are unable to admit to the substantive problems with the law and because by thus denying recognition of the problems, also deny us the possibility of solutions.

Chris Christie, No Dummy: Obamacare

While Chris Christie is taking a hit about “Bridge-gate,” in terms of effectively working for his state concerning Obamacare, it’s clear he’s no dummy. Both Hurricane Sandy and Obamacare actually point to strengths in his leadership that for Americans should be appealing. Specifically, he has enough smarts to research an issue and take a stand based on facts.

In fact, though I am not currently pro or anti-Christie, I think he’s less vulnerable to the “hypocrite” label than the President or Harry Reid whose dreck and demagoguery were used to mislead and cajole us to supporting policies and laws that have injured our citizen well-being, while carving out exceptions for government workers.

In fact, this President's Administration could be described as, "Government working for government workers." This attitude is still fresh in our minds on the heels of government cuts to SNAP and unemployment benefits and the failure to raise the minimum wage which by the way hasn't gone up since 2009 yet SOMEHOW finding a way to give raises to government workers (who received their last raise three years ago).

We are not unfamiliar with some of the goings on in politics, and scapegoating Chris Christie is absurd. I actually don’t care how his deal with Zimmer arose or any other deal. They are politicians playing their political game and labeling something as a threat or as a compromise is and has always been a murky enterprise when it comes to politics.

What is clear is when we, citizens are exploited, where because of our weaker position eg non politicians we become unfairly used, essentially pushed around because we don’t have equal footing in the political dance. Though Zimmer may argue she was exploited, used unfairly, it’s not persuasive since she is in the same arena with the same resources, and though perhaps somewhat less powerful equally capable of making political “deals.”

For citizens, it’s different. When the President told us there would be no increase in income taxes and then raised payroll taxes, that was exploitive. When the President promised we’d be able to keep our own plans, but not so much, that was exploitive.

In fact, there is one area where I think Chris Christie has done his citizens a great service and that is regarding Obamacare. While he opted out of a state health exchange, later on, “…Christie agreed to expand Medicaid under the federal law…” (http://www.huffingtonpost.com/2013/11/26/chris-christie-obamacare_n_4346752.html, “Huffington Post,” by Mollie Reilly, November 26, 2013, “Chris Christie on Obamacare, ‘I’m Really Glad the Train Wreck’s not Mine, It’s His”)

Unlike other Republicans Chris Christie was not so trapped by ideology he made decisions bound to injure his states' citizens, as opposed to, for instance, NC Governor McCrory, (read post, “NC Defers to national Control, Opts Out,” February 14, 2013), where I discussed NC's opting out of Medicaid expansion.

The decision from a citizen point of view to opt out of Medicaid expansion is not only stupid because the Federal government picks up the bill for years, but also because hospitals, assumed to treat more patients with insurance if Medicaid is expanded will receive LESS federal money under the PPACA for Disproportionate Share Hospital Payments from the Federal government, which is the law regardless of whether a state chooses to expand Medicaid or not.

Unlike other Republicans, Chris Christie recognized that, “Accepting these federal resources will provide health insurance to tens of thousands of low-income New Jerseyans, help keep our hospitals financially healthy and actually save money for New Jersey taxpayers.” http://www.huffingtonpost.com/2013/11/26/chris-christie-obamacare_n_4346752.html, “Huffington Post,” by Mollie Reilly, November 26, 2013, “Chris Christie on Obamacare, ‘I’m Really Glad the Train Wreck’s not Mine, It’s His”)

That decision for me IS a big deal. Not only does it show a leader capable of reconsidering a decision based on facts (something the President is really bad at), but it shows the ability to make a decision contrary to political rhetoric in order to benefit the PEOPLE he represents.

Chris Christie has shown some brains and some loyalty to the people he represents, and that will likely carry him through the airing of dirty political laundry which leaves no NJ politician smelling too sweet in the bridge-gate episode.

Obamacare Entitlement: Income Verification

Beware the word Entitlement. In Washington-World “entitlement” is a magic and dreaded word. For those receiving the particularly unfortunate monies designated as entitlement it’s a sure sign that the money is on the chopping block.

For those in Washington posturing about being anti-waste and anti-big government it’s a means of trimming Washington’s expenses without affecting themselves, sort of a macrocosm of the Congressional gym remaining open during the “shutdown.”

With the agreement on a debt ceiling provision, known currently as the “Default Prevention Act of 2013,” you can read about the entitlement of those qualifying for health exchange enrollment to a free pass on healthcare premiums, with governments and insurance companies advertising ways that individuals can obtain health insurance for a cost of $0.

What about the rest of us? The new Act has no impact on us. The unemployed poor left out of the entitlement to credits and rebates available on exchanges since only the employed can use exchanges, those who obtain health insurance from their employers who are facing higher premiums because, hey, insurance companies need to make up their money somewhere, and dependents, like spouses, who formerly could be covered by a head-of-household who can no longer afford their insurance who will not qualify to use health exchanges because other insurance is available to them even if it’s at price-gouging levels.

The premium credits and rebates, and cost-sharing provisions of Obamacare are an entitlement, rewarding some citizens with low to no premiums through federal funding. Yet, the word entitlement is not attached to the rebates and credits in Obamacare.

Today, a big deal is being made that the income verification provisions of the Obamacare credits and rebates entitlement have been resurrected by yesterday’s “Default Prevention Act of 2013.”

While already this morning politicians are talking about dismantling “entitlements “such as Social Security and Medicare, you know, those programs we’ve paid into all our lives, the only change to Obamacare entitlements of rebates and credits is a return to a former timeline for income verification.

Under the Act, “Division B-Other Matters,” income verification is addressed, and it’s essentially nothing but a resurrection of the plan to verify income of those receiving credits and reductions available requiring the Secretary to “…certify to the Congress that the Exchanges verify such eligibility…”

Income verification is back on beginning in January, 2014. Under the heading “(b) Report by Secretary-Not later than January 1, 2014, the Secretary shall submit a report to the Congress that details the procedures employed by the…Health Benefit Exchanges to verify eligibility for credits and cost-sharing.” In the next section “(c) Report by Inspector General,” it is provided that a “…report regarding the effectiveness of the procedures and safeguards…for preventing the submission of inaccurate or fraudulent information,” will be submitted to Congress “…not later than July 1, 2014.”

A few interesting aspects of this provision come into play. First, what are we resurrecting? If you look at the CBO.gov website and search for the July 30th 2013 to Paul Ryan as Chairman of the Committee on the Budget from the Director of the CBO, Douglas Elmendorf, notes that income verification under the PPACA is going to be conducted by HHS for “…a statistically valid sample of applicants in 2014, as expected.” In July, the only suspension of the income verification was this step of taking a statistically valid sample and verifying income by HHS for state-run exchanges until 2015.

Under yesterday’s Act, presumably the state-run exchanges will also be subject to the “rigors” of having “a statistically valid sample” of individuals getting rebates and credits subjected to governmental follow-up. For a gambler, it comes to weighing the odds before cheating, and determining whether they believe they’ll be part of the sampling.

There were already stiff penalties in the PPACA for defrauding the government in obtaining subsidies and credits under Obamacare which provides a band of workers with the Obamacare entitlement in the form of virtually free premiums for healthcare.

There’s also the issue of why the extension of the income verification provision was put off to begin with, presumably because HHS couldn’t manage it, in the letter above only explained by noting that “…the final regulations indicate that HHS will not conduct follow-up verification on behalf of the state-run exchanges until January 1, 2015.”

Two choices on this one, either there was no reason to extend the provision in the first place OR there is no way HHS will be able to implement the provision by January 1, meaning that the extension will be reincorporated into law.

Obamacare: Dangerously Old-Fashioned

The sky didn’t fall with the beginning of open enrollment for benefits season on the new health exchanges. Few anticipated a drastic negative effect. After all, beyond the politics, the bureaucracy, and the arguing, Obamacare is not revolutionary. But there is a loss of “THE POINT,” in all the rhetoric we’ve heard and we’re hearing.

After all, the basic goal of Obamacare, getting individuals to “have insurance,” is not only old-fashioned in terms of a measure of whether you’ll have sufficient health insurance coverage that will provide you access to needed healthcare services that you can afford if you become sick and require medical treatment, but it ignores the tremendous dependency Obamacare has on our dollars coming in to sustain it, dollars from all individuals and businesses to help support the system of a national clearinghouse for gathering health information by getting people to purchase insurance, which is the most noteworthy feature of Obamacare.

Obamacare promises to be a tremendous and ongoing money pit. The government knows this. We’ve already seen other grabs for money from citizens. For example, the increase in how much your healthcare costs have to be in order to be able to deduct them on your taxes, which goes from 7.5 to 10 percent this year. The imposition of the personal mandate (tax) for those who opt out of health insurance that will increase next year. The increase in payroll taxes, up two percent. Legal changes that your employer will make, such as dropping eligibility for spousal coverage (if spouse has access to other insurance), or the sky-is-the-limit charge for dependent coverage. Some employers will choose to pay penalties for NOT providing health insurance options which can add up to less than what it will cost to maintain an employer provided health insurance program, and still others will choose to dump retirees into a private health exchange like IBM recently did.

Then there are all the changes imposed on healthcare providers who want to take advantage of the financial rewards given by the Federal government to healthcare providers who streamline their business.

But regarding the “carrot” use of money for healthcare providers, as opposed to the “stick” used on consumers in the form of financial penalties, the illogic of Obamacare is that once the “streamlining in order to get dollars,” is completed by healthcare providers, what will they do to keep maximizing profits? The answer is obvious. While the Administration brags that healthcare costs have gone up at one of their slowest rates in recent times, costs are still rising. Once the Federal government stops giving money out to healthcare providers who save money (incentives), those providers will likely raise prices to sustain the extra money they once got from Obamacare. There is no cap on what can be charged by healthcare providers except those participating in the entitlement programs of Veterans Benefits and Medicare.

Obamacare is the newest government bureaucracy that will require a constant flow of money into it to sustain it. That means that unless new, healthy participants are added year after year, that the Federal government will have to get the money for the Obamacare exchanges from somewhere else, eg by charging exchange participant health insurers more, which increases you know will be passed on to individual consumer customers using those insurance companies outside of the exchanges, or perhaps the government will decide to decrease subsidies under Obamacare that this year have exchange participants yippy-aye-oh-yaying about their premiums.

The biggest risk to the old-fashioned approach of Obamacare that “having insurance” is meaningful is the risk to the other key factors that have created our healthcare crisis, access to care and quality of care. Very little is accomplished by Obamacare in this regard.

Many argue persuasively that by adopting this old-fashioned approach Obamacare will negatively impact both access to and quality of care. You’ll read about “thin” options, meaning that the availability of participating providers under your insurance plan may be insufficient for their demand and at the very least will drastically reduce your choice of provider. More people will be pushed into bad insurance policies, those that will NOT sufficiently cover the expense of illness to avoid financial difficulty.

If you look at the HHS website, (search PPACA timeline) it’s almost laughable to read, “October, open enrollment begins, January, coverage begins, March, open enrollment closes, Future, all Americans have access to affordable health care.” Not only is it stupidly simplistic, but since when did having health insurance mean you had affordable CARE?

It is past time for Americans to push for legitimate caps on the costs of healthcare treatments and services instead of believing that health insurance that chases the expenses of healthcare services is the way to go.

Naturally, this idea currently is a non-starter. Republicans will take refuge in their phony ideas of “free market,” phony because they’ve worked long and hard to pass laws that protect them, and because they’d never dream of touching the Veterans entitlement. Democrats would rather squeeze patients than providers, and gradually erode benefits under Social Security and Medicare by selling changes as "opportunities".

But moving forward there is a wall and that wall is that if you can’t afford medical treatment when you need it, then health insurance is a waste of money. There is no point to any of this unless individuals have sufficient coverage to avoid financial ruin by using the health insurance product they pay for to help pay for needed medical treatment. Everything else is a distraction.

Obamacare is law, but it is NOT a done deal. The President himself noted that laws can be changed, repealed, and modified as he berated Republicans. The key driver of our healthcare crisis, the cost of NEEDED medical CARE and TREATMENT is untouched by Obamacare. After all, the healthcare crisis did not arise because people couldn’t afford a checkup (though I anticipate that now that these are mandated in insurance policies that the cost of checkups will rise too.)

Religion and Contraceptives as Part of Essential Health Benefits

So, technically, HHS has come up with what it considers a “solution” to the “we won’t pay for contraception” argument put forth by certain religious organizations. For consumers it means that TECHNICALLY, if the proposed rules go through as delineated that female employees who work for covered religious organizations WILL have access to contraceptives as a part of the essential health benefits preventive services Affordable Care provides to women.

The general solution provides for a third-party, another insurance company to provide contraception and preventive services coverage if a religious organization doesn’t want its own insurance company to provide such benefits.

But there’s a pattern emerging here and it goes back to the divergent goals of consumers, health insurance companies and the government. The government wanted more people insured based on the assumption that having health insurance would improve healthcare. However, the immediate goal was to get more people insured. This is why the PENALTY TAX for uninsured individuals made it through while early on the public option for health insurance was tossed by Affordable Care advocates.

Making such insurance affordable, not health care, but health insurance is the reason we see so much consideration of paying for health insurance rather than the costs of health care which remain largely unfettered. This is the Achilles heel of the Affordable Care Act.

Without effective controls on the cost of health services, we’re in a relentless chase between paying for insurance that is intended to cover us for needed health care that we can’t afford even with health insurance in many instances. This inability to cover health care costs through health insurance means that insurance companies keep raising their premiums charged for health insurance coverage and in the case of the Federal government, it means that government will reduce its costs of providing health insurance through Medicare or Medicaid by slashing benefits and increasing costs to consumers.

With Obamacare now law, we’re seeing that the assertion in the above paragraph is no longer a guess, but is in fact how the costs of providing health insurance are being managed. Health insurance costs are going up and the “sharing” of costs is costing consumers more than ever before in insurance premiums. The bone we’ve been thrown is that certain rules will apply to this product we’re purchasing including the infamous removal of lifetime limits and the provision of “no-cost” essential health benefits. As our experience unfolds, we’ll find that the commitment to having more people insured is PRIMARILY balanced with a need for the Federal government to make sure it can continue to FUND its dream of Obamacare, which in turn is the dream of having people insured. Quality, accessibility, and affordability to consumers have already been relegated to the backseat of priorities when it comes to health insurance reform.

Since Obamacare, we’ve seen leniency in deadlines. We’ve seen leniency in allowing for greater deductibles (more money paid before insurance benefits cover individuals at promised levels) for some insurers who claim that they won’t be able to afford to provide essential health benefits without such increases in money taken from their insureds. We see it with the cash is king rules put out by HIPAA allowing individuals to pay for their own services and bypass their insurance company in the hopes of achieving greater privacy for their personal health information. And now we’re seeing it with contraceptive services.

In the face of a conflict of religion and Federal law, specifically the Patient Protection and Affordable Care Act, and the inclusion of contraceptives as part of essential services for which employees cannot be charged co-payment or deductible costs, some religious organizations want to maintain their ability to offer Qualified Health Plans without having to comply with offering contraceptive services.

Contraceptives are considered “preventive services” under the Affordable Care Act.

On 2/1/13, HHS issued its proposed accommodation to keep the peace between religion and government. You can read the article entitled, “Administration issues Notice of Proposed Rulemaking on recommended preventive services policy,” on the HHS website.

While it’s debatable whether anything is ever free or “included” in your insurance coverage (as expressed previously in many of my posts regarding increased costs of health insurance coverage that frequently goes hand in hand with less coverage for illness, a lose-lose situation), there is a “policy” message that the ACA tried to communicate through its provision of no cost sharing for certain preventive services for women, a pro-female rights message that has rubbed many religious organizations the wrong way on similar “policy” grounds concerning their views about reproductive rights.

The clash has resulted in a mean-spirited debate that includes articles that you can look up including threats of firing for employees who use contraceptive coverage.

HHS in its January 2013 announcement intends to accommodate the religious organizations by providing a convoluted way for non-profit, religious organization employees to have access to contraceptive coverage while not requiring that the religious organization pay for insurance that provides such coverage through the use of separate policies arranged for by the insurance company with another insurance company that would provide such coverage at no cost to the religious organization or its insured employees.

The cost of the insurance coverage would be borne by the insurance company for the non-profit organization which supposedly would reap the benefits of providing such coverage from another insurance company in terms of reduced costs for other medical services that might be required by women denied free preventive services coverage such as for illness or increased number of childbirths which the Affordable Care Act assumes would increase without such coverage.

Self-insured group health plans are also required to provide the benefits to women (excluding certain educational institution self-funded plans because students are not employees and therefore those plans are excluded). The separate coverage provided by these plans would be paid for by the insurance companies which would be eligible for an adjustment (reduction) to their Federally-facilitated Exchange user fees.

Interestingly, the issuance of these proposed rules follow closely on the heels of allegedly improved “privacy” rights for patients. As previously noted here and in the numerous reports of breaches of patient privacy that you can research, privacy protections are grossly inadequate and therefore, breaches of patient privacy are bound to also impact those who work for religious organizations who choose to use the contraceptive coverage. Neatly available, is the option for purchasing contraceptives without going through insurance under the new HIIPAA provisions which allow individuals to pay for privacy and avoid insurance company notification.

So what has HHS really provided? HHS has created an opportunity for insurance policies of protected religious organizations to technically comply with the law without compromising their policies of not paying for contraceptives. HHS has created an opportunity for the government to say it’s been sensitive to religious organizations and has honored the requirements of Affordable Care. But for women? Those who dare to use the separate insurance for birth control are provided with no additional protections of privacy. Interestingly, the only improvement to consumer privacy is the option to bypass insurance companies by paying for services out of pocket. Women who value their privacy will NOT use the contraceptive insurance provided if they work for religious organizations once they consider that a breach to their privacy leaves them with little recourse aside from bringing their own lawsuit. In other words, HHS timed its announcement of the privacy available by paying out-of-pocket for healthcare services and products therefore removing insurance company notification very well as an important provision for women to consider before electing to use the third-party insurance coverage for contraceptive services if they work for religious organizations. Unfortunately, paying for a healthcare service out of pocket means that it isn’t covered by insurance in terms of reality.

Twenty-Somethings: Obamacare the Supreme Court and You

What’s in it for you? Are you benefiting from the President’s rhetoric about the right thing to do? You arguably provided the necessary votes that put the President in office. You arguably can influence your state and local elections.

While the mean-spirited Republicans and their meaningless rhetoric and faulty economic ideas promise Obama victory and your vote, the fact that the President is not worse than the Republican candidate does not excuse his inattention to US citizen young people.

What has the President done for you? Yes, your parents can keep you on their insurance plans until you’re 26 and yes, you’ll likely be able to borrow money to stay out of the job market by going to school at lower interest rates, neither of which is a direct path to independent living.

Yesterday the next shot at young people was put forth by the Supreme Court which declared the health mandate a legal tax in addition to declaring unconstitutional the Affordable Care Act’s attempt to expand Medicaid coverage to include non-elderly adults without children who are living at up to 133 percent of the Federal poverty level.

In accordance with the new mean-ing of America, naturally democrats declared victory, Republicans declared they’d still fight against Obamacare and not ONE word of attention to the persistent crippling of our next generation was addressed.

The Supreme Court found the Medicaid expansion provision unconstitutional because it jeopardized all Federal funding for state Medicaid programs that did not implement an expansion of coverage and naturally the Supreme Court was not prepared to see what happens when Medicaid funding is removed from states.

For young people voting remains the best opportunity to get your voices heard. Voting at the state level will be critical in terms of expanded Medicaid coverage since states will have the opportunity to receive additional federal funding IF they expand Medicaid coverage.

There are many places to find out about your state policies regarding Medicaid eligibility and coverage including at a Kaiser Family site titled “Statehealthfacts.org”, “State Medicaid Fact Sheet,” (http://www.statehealthfacts.org/medicaid.jsp ).

If you’re young your vote became more important in the face of yesterday’s Supreme Court decision that says YES you can be taxed if you don’t purchase health insurance and NO if you are a non-parent, low-income adult you will not be able to count on being eligible for Medicaid.

Win, Lose, Draw, Obamacare Remains the President’s Strength

Waiting for the Supreme Court’s decision regarding the Affordable Care Act has stalled meaningful discussion by the candidates about healthcare because the President considers healthcare done and Mitt Romney has promised to repeal Obamacare.

The void has been filled with schoolyard bickering that leaves me thinking, “BAM!” when a candidate takes a particularly good verbal shot at the other candidate. But is “BAM!” a basis for voting?

It’s time to regroup, for both sides. President Obama has veered onto a particularly chaotic course that is eroding both his “likability” and the smarts that came across when he campaigned for President the first time.

Here are some new and losing Obama approaches.

Losing Obama stance, the HE’S-RICHER-THAN-I-AM APPROACH: It’s curious that the President keeps arguing that Mitt Romney’s a rich guy in direct conflict to his man of the people persona. Mitt Romney is not less of a man of the people because he’s rich. After all, President Obama is also richer, a lot richer than most Americans.

It’s Mitt Romney’s statements that show a lack of awareness of how most people live where he’s vulnerable rather than his wealth.

Losing Obama stance, THE-MIDDLE-CLASS-IS-DOING-FINE APPROACH: When the President informed us that the middle class is doing fine it wasn’t simply a misspoken sentence as his fans claimed. In context when the President repeated this sentiment he connected those words to his push for jobs for civil servants. He even has an ad promoting the same and his weekly address pushed for the same.

President Obama is redefining the middle class as civil servants alienating the vast majority of Americans who are not civil servants. By redefining the middle class, his efforts are focused on this newly defined class of civil servants rather than the American middle class.

The reason for this push by the President is likely that the Federal government can impact government better than a loosely defined middle class of Americans by providing money to government for government which is what the jobs bill does, it provides money to state governments to build up their civil service middle class.

Unfortunately, most people don’t want more state-level civil servants any more than increased numbers of Federal civil servants.

In an America where the new mean-ing of being American means adjusting to scarcity, more civil servants is not a populist idea since our tax dollars pay for much of civil service salaries and because civil servants frequently fare better in terms of salary, job security and benefits than their tax-paying middle class counterparts and in many instances, better-educated peers who are unemployed or underemployed.

Losing Obama stance, the HE-OUTSOURCED-JOBS APPROACH: Bain Capital was a leader in outsourcing. OK. Is outsourcing worse than creating a whole new illegal class of employees competing with Americans who are out of work? That’s what the President has done with his Executive Order. He doesn’t need to legally outsource when he can with a sweep of the pen take away American jobs right here at home.

Losing Obama stance, the United States-Should-Not-Enforce-Its-Immigration-Laws-Using-Available-Tools-Such-As-E-Verify Approach. E-verify is around 94 percent effective. It is free for employers. Address a real part of the issue: It costs the United States money to deport people, estimated at around $9,000 per person deported by some estimates.

This makes the act of deporting an expense for government. By strengthening penalties against employers who hire illegal immigrants AND who did not use E-Verify with penalties that include that they pay the expense for deporting such individuals, the system stops losing money on deportation.

Why healthcare is different. The Affordable Care Act remains a great change in the laws regarding healthcare that attempts to address the real-world issues that have culminated in millions of uninsured as well as those who go bankrupt in spite of having insurance. While the healthcare law is flawed in serious ways, laws can legitimately be amended and portions of laws repealed legitimately, just take a look at the tax code.

The healthcare law is a legitimately passed law. Whether portions of it are stricken down is immaterial to its value as a change to a system that was not working. It’s OK to let Republicans argue that the old system was working or that the changes they would make to healthcare laws would be better, it makes them appear more out of touch than any single statement about Cadillacs ever could.

Let Republicans try to dupe Americans into believing that they want less government as they put forth how they will change laws of the land and then throw in the words “free market” like a magic amulet. There is no genuine free market in the US. We have an enormous Federal government and it doesn’t shrink regardless of who’s in the White House.

Let citizens who argue that they don’t want any part of the government continue to lobby and manipulate, fund-raise and use money to influence candidates desperate for their support in the hopes of getting laws passed that favor them continue to claim they’re pro “free market.” It’s this kind of irrational and hypocritical reasoning that helped the President get into the White House.

Healthcare reform may be subject to modification but President Obama has gotten the ball rolling in a way that promises to advance US standing in terms of life-expectancy (we’re currently 52nd in the world) by not bankrupting sick individuals. (Many of the countries ahead of the US in life expectancy have socialized medicine.)

Let Mitt Romney argue that tort reform (New laws? How’s that for free market?) will solve the problem even as factually malpractice insurance costs for physicians has dropped every year for six years and physician income still rises.

There are some questionable provisions in the Affordable Care that likely will be amended or repealed. It remains a stunning effort of how government can work in passing legislation that directly addresses an ongoing problem caused by runaway greed and legislation favoring industry over people.

Let Mitt Romney argue that corporations are people. If corporations are people then they have personal responsibility for hiring US citizens or face prosecution and fines or imprisonment. If corporations are people they should pay individual tax rates rather than seek tax breaks. The American landscape would vastly change if we treated corporations as people.

President Obama should regroup and replay his original campaign speeches and note his original campaign promises that sought to unite US citizens rather than divide them based on selective criteria.