we’ve really stepped in it this time

“Deja vu all over again.”

We all noted, back in 2009, that we’d really stepped in it this time.

Pundits have said that the new Administration’s need to stack accomplishments during the first 100 days is the reason for the rush to pass a health care bill. Nothing could be further from the truth.

Nicky Shaw and I talked about the two big issues in Washington before the 115th Congress left for their 97th vacation so far this year. “This Congress has been very busy,” she said.

Yeppers. They codified the Presidential Innovation Fellows Program, passed a GAO access act, disapproved of an SEC rule, authorized the National Science Foundation to support entrepreneurial programs for women (I guess women weren’t allowed to be NSF entrepreneurs before that?), and passed a joint resolution to appoint a citizen regent for the Smithsonian Institution.

Oh, yeah. And they repealed ObamaDon’tCare and are about to cut the corporate tax rate.

“I’m all for dumping the Unaffordable Care Act,” Ms. Shaw said. “I know it’s politicspeak to say this, but it is unsustainable.”

We’ve covered that taxpayer-financed insurance bailout for seven years. She’s right. And that pullquote up there about the rush to pass? That’s from 2009.

I’m also all for dropping the corporate tax rate (I’m all for any drop in tax rates) particularly since corporate earnings are double taxed, once when earned and again by the shareholders when received as dividends (corporations may not legally deduct their dividend payments). Here’s some background on business taxes

In 2014 the United States had the third highest general top marginal corporate income tax rate in the world at 39.1% (consisting of the 35% federal rate plus a combined state rate), exceeded only by Chad and the United Arab Emirates. Shareholders of most corporations are not taxed directly on corporate income, but must pay tax on dividends paid by the corporation. However, shareholders of S corporations and mutual funds are taxed currently on corporate income, and do not pay tax on dividends.

Despite what the tax-and-spend crowd tells you, it’s not the just the Kochs and the Soroses who get those dividends; retired geezers and all the still-working-soon-to-be geezers get the dividends on more than $25 trillion in retirement funds alone. “Trillion” with a “T.”

Hmm, if corporations are people (viz. Citizens United) then they are taxed without representation. I’m thinking corporate income tax is unconstitutional if they are taxed without representation and we shareholders should revolt. And, bonus, we can blame the Democrats for the income tax! See, the Democrats first called for income taxes back when the whole idea of it was still unconstitutional.

During the two decades following the expiration of the Civil War income tax, the Greenback movement, the Labor Reform Party, the Populist Party, the Democratic Party and many others called for a graduated income tax. The Socialist Labor Party advocated a graduated income tax in 1887. The Populist Party “demand[ed] a graduated income tax” in its 1892 platform. The Democratic Party, led by William Jennings Bryan, advocated the income tax law passed in 1894, and proposed an income tax in its 1908 platform.
In 1894, Democrats in Congress passed the Wilson-Gorman tariff, which imposed the first peacetime income tax. In 1895 the United States Supreme Court, in its ruling in Pollock v. Farmers’ Loan & Trust Co., held a tax based on receipts from the use of property to be unconstitutional.

Do ya feel as if we’ve been here before?

Do ya remember electing a President who promised “change”?

Same Old Stuff, Different Day
No matter how you dress up the typeface, the “UnAmerican Health Care Act” is just the “Unaffordable Care Act” in a new TV costume. No health care reform there. No matter how you dress up the characters, the “Tax Cut” is just the 4,037 or 70,000 page tax code in a new TV costume. No tax reform there.

And the only actor who has changed in this play is the guy at the top.

Passing a health care bill in the first 100 days. Why was it critical in 2009 and critical in 2017? Back then I thought even Congress would rebel if they actually read the bills. Turns out that was wrong this year, too.

Passing a tax cut in the first months. I had hopes for tax reform. This year, it looks like that was wrong, too.

“Maybe We the People should revolt instead,” Ms. Shaw said.

And there you have it. Since corporations are people and they buy their representation, that means We the Overtaxed People are no longer represented and that’s the hook to use.

 

Doctoring the New Millennium

“Hi, Laura, what are my choices?” I asked.

This is my personal health care story. Sadly, there is scant pathos, little conflict, and no resolution.

Although I moved to South Puffin more than a decade ago, I have maintained my medical ties to North Puffin and even to Canada because it takes a lot of effort to break in a new doctor.

I’m an engineer, so I usually know a lot more (and can hash out even more) than a doc figures on. I’m also very much a minimalist, meaning I will opt in for a procedure only if it fits my own idea of “value added,” not if it is merely “doctor’s orders.”

All that does not make me the best patient.

Anyway, we met “Dr. Bob” when we first moved to North Puffin. We were a young family then and he was about our age. We’ve all kind of grown up together. His kids and ours knew each other in school. SWMBO married his daughter. Mrs. Dr. Bob and I have done some artsy stuff. Dr. Bob acts in the hospital’s bi-annual Cardiac Capers. And, with the exception of the time I cleaved my finger with the chainsaw and the other time SWMBO broke her leg, Dr. Bob has treated pretty much everything that ailed us. He understand what it takes to treat me. He gets it.

Primary care is an onging conversation, not a brisk look at a chart and tap on the knee.

The connection is even deeper. Just before we bought our house, we were driving around, seriously lost, in North Puffin. We stopped to ask directions of an older gent walking along the road and told him we were house hunting. Mr. Smith told us where we were. He told us a bit about the area. He told us he had lived there all his life so far. He was 96. He didn’t tell us that his lovely, brick, farmhouse with barn was for sale.

First, check the insurance.
Then, do no harm.

A couple of months later, we bought a different lovely, brick, farmhouse with barn on the lake and a fellow I worked with bought Mr. Smith’s home. Then he sold the Smith house to Dr. Bob and Mrs. Dr. Bob.

Getting back to health care, Dr. Bob is a couple of years older than I and he has retired. Ah hah! I thought. I can transfer my primary care (what we used to call the G.P.) down here.

Side story. Dr. Bob told me my increasing snifflinesss [<==technical medical term] is an allergy and I should find a specialist. I talked to a nurse at a sprawling medical practice in Vermont about an hour from North Puffin. I’m looking for someone to do allergy testing and they have three. The nurse told me two of the docs there are Peds only. The third allergist there as well as the one doc in Puffin Center don’t have the greatest reps. In fact, Dr. Bob won’t send patients to the one allergist in Puffin Center.
I asked a friend if she knows anything about an allergist in South Puffin or even the one in Key West who also has offices in Palmetto Bay and South Miami. Turns out the Marathon guy is the doc who admitted he sexually battered a patient in Illinois and then got sued by an employee he groped and pointed a handgun at. He also does weight-loss workshops. That’s worse than the Puffin Center guy.

Jeez.

Laura told me (remember Laura?) that their new medical director is an ER Specialist at our critical care hospital in Puffin Center but he’s the only doc listed on staff at the Federally Qualified (rural) Health Center Dr. Bob built. They have a nurse practitioner, two physican assistants, and a wellness counselor.

Doctor's OfficeMeanwhile, down here we find the 57-year old who diagnosed that I had either flu or pneumonia a few years ago. He treated for both. Either his treatment or tincture of time worked but it didn’t leave me feeling particularly confident. There are four other family medicine docs, two men and two women. Three are over 60 and the one with the most recommendations from neighbors is 69. That’s a year older than Dr. Bob. The youngest is a 54-year old. She’s not taking new patients.

So my choices seem to come down to one of a bunch of physician’s assistants or a doc who will likely retire tomorrow.

I don’t care if I have the pro from Dover for day-to-day stuff but I do care that I get the same person. Primary care is an onging conversation, not a brisk look at a chart and tap on the knee.

Is it too much to ask to see an actual doctor, let alone one young enough that I might not have to do this again for a couple of decades? I don’t mind training a newbie too much if they seem to be in it for the long haul.

Our dentist lives and works in Quebec. He was about 12, I think, when he bought the practice there, so I figure I can keep him at least as long as I can keep what’s left of my teeth.

Whew!

 

Lying Liars #2,749

Welcome to the first day of Spring, the day when day and night are the same length and politicians tell you one is the other.

“The affordable health care’s purpose was to lower costs, expand access, and improve benefits,” Rep. Nancy Pelosi (D-CA) said on Face the Nation yesterday. “It has succeeded in all three.”

It has succeeded? Succeeded? Really?

Let’s take how Ms. Pelosi knew the facts and said just the opposite. Out here outside the Beltway, we call that “Lying.”

• “[Its purpose was to] lower costs…
Health care cost Americans $2 trillion in 2008; ObamaDidn’tCare grew it every year so health care will cost Americans $3.6 trillion in 2017. Alabama premiums jumped 28% from 2015 to 2016 for individual plans purchased through the marketplace. They went up another 36% this year. The cheapest “Bronze” plan here in south Florida costs $4,660 this year, almost double the unsubsidized cost in 2013. A Bronze plan comes with a $6,000 medical and $500 prescription deductible and $12,500 out of pocket maximum costs. And your premium skyrocketed anyway! True believers can’t accept those facts but the NY Times does.
Nancy Pelosi - Pants on Fire
• “[Its purpose was to] expand access…
Enrollment tumbled in 2016 at a faster rate of decline than in 2015 as people got kicked off for not paying premiums. UnitedHealth Group dropped out of almost every ObamaDidn’tCare market.
The Congressional Budget Office estimated in 2016 that ObamaDidn’tCare would leave 27 million uninsured through 2019.

• “[Its purpose was to] improve benefits…
Slightly true. Some of the 20 million folks who never had insurance before ObamaDidn’tCare definitely got better benefits. Anything more than nothing is “better.” The rest got stuck with far less. And for the 75 million Americans who got their insurance through large companies in 2013, according to NBC News, ObamaDidn’tCare caused companies with the most generous plans to cut benefits.

Lying liars who lie a lot.

Ms. Pelosi’s definition of “success” seems a wee bit different than ours, I’m thinking.

“[The Unaffordable Care Act] should be respected for what it does,” she said.

We’ve seen what it does. In that, for once in the past nine years, Ms. Pelosi told the truth.


No matter what the true believers think, ObamaDidn’tCare — the original Unaffordable Care Act — is disintegrating. It’s collapsing politically. It’s collapsing financially. It’s collapsing medically.

As we learned last week, the new Unaffordable American Health Care Act doesn’t address the biggest issue: cost. It needs bring costs down and to do that it needs to address [wait for it] American Health Care. So far it doesn’t do that any better than what we had foisted on us in 2013.