Obamacare Is Not Dead–It’s Just “Resting” And “Pining For The Fjords”

Trump and the Republicans, bless their hearts, have not passed a single law repealing or replacing or even modifying Obamacare, that is the Affordable Care Act (for anyone who still has been tricked into believing there’s daylight between the two).  And yet President Trump today said: Obamacare is dead; It’s an ex-health care law;  I stomped all over it, I may have even peed on it, you’ll know the details in a very short period of time, believe me.

I am counting on the law still applying two weeks from now when the signup period starts.  It’s much shorter than last year, unless you live in one of twelve or so states that run their own state exchanges.  Even so, I do not believe the Affordable Care Act is dead.  I do not even believe I will need to go to court, even small claims court, to ensure that I get covered.

But I do not expect President Trump to tell me any of that.  I would like to respect the “office of the Presidency,” but I cannot afford to fool around with my health care insurance, so I am just going to have to reconcile myself to the huge credibility gap between what my president says and what the law says.  Hat tip to Monty Python, they could have and kinda sorta did predict it all.  Pining for the fjords, indeed.

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VP Pence Turns Heathen: This Catastrophe Of Nature Must Be Made Into A Catastrophe Of Future Debt

After Hurricane Katrina, Mike Pence, then an Indiana Congressman, said on the House floor that “as we begin to rebuild…let’s figure out how we’re going to pay for it.  Congress must ensure that a catastrophe of nature does not become a catastrophe of debt for our children and grandchildren.”  That was then. Today Pence said in Rockport, Texas, that Houston is going to be rebuilt “bigger and better.”  Pious hypocrisy at the expense of poor people and non-Republican people comes naturally to the Vice President.  But Pence leaped beyond hypocrisy today into heathenism.

If Pence actually cared about not creating a catastrophe of future debt, rebuilding Houston even bigger is wrong and stupid.  Paving over what’s left of the prairies that used to soak up rainwater, and loosening lax building codes even further, is not going to reduce future government debt unless the federal government treats Texans as if they had truly seceded and excludes them from disaster relief.  President Trump signed an executive order just ten days before Hurricane Harvey hit that revoked prudent regulations set in 2015 but not yet put into force.  The Obama-era rules, according to Business Insider, “would have required the federal government to take into account the risk of flooding and sea-level rise as a result of climate change when constructing new infrastructure and rebuilding after disasters.”  That kind of basic stewardship of resources and that kind of cautiousness are apparently foreign to the Trump-Pence administration.  In fact, Pence’s “bigger and better” promise today goes beyond hypocrisy and amounts to false piety.  How so?  What Pence’s embrace of Osteen-style prosperity gospel doesn’t get about Christian faith is something John Calvin grasped quite clearly: the doctrine of God’s providence does not authorize or empower us to stop paying prudential attention to the “secondary causes” we find in the visible world.  Believing in God’s providence does not allow, much less require, us to rebuild “bigger” in a subtropical coastal plain that has become a toxic swamp of hazardous and explosive chemicals.  Faithful Christian stewardship (and Jewish, Muslim, Buddhist, or pagan stewardship, for that matter) of our only planet is a far cry from the heathenish YOLO attitude we hear from Trump and Pence whenever it suits their political purposes.

Paul Ryan, by the way, has attacked Obamacare because it crushes “freedom” and forces healthy people to pay for sick people.  How does Speaker Ryan feel about forcing dry people to pay for flooded people?  That is how risk pools work, Paul.  I do feel that if the federal government makes sensible regulatory restrictions on rebuilding after disasters difficult or impossible, we are in for an even faster race to the bottom, and an ugly future in which an universal American risk pool for health care or disaster relief recedes onto an even more distant horizon.

Our President Is Way Too Much Uninterested And Way Too Little Disinterested

The first part, i.e. “uninterested,” hardly needs elaboration: President Trump shows so little interest in learning the details that his tweets on Obamacare make little sense.  Could he explain to us what his beautiful Trumpcare would look like?  No.  He can threaten, but his threats have become self-contradictory.

Regarding the second part: Why would I accuse our 45th president of being way too little disinterested?  “Disinterested” means impartial; it means not having an axe to grind, not calculating to seek personal advantage.  Disinterestedness is thus good because a government of “laws, not men” (as they used to say) won’t work well at all without it.  The structure of the Constitution accounts for interests and factions and strives to control and limit them.  But if the executive acts like a thug, and the other branches don’t act decisively to repudiate the bad actors, we are in trouble.  I am not expecting the 71-year-old man to change or learn.  Actually truth be told I am worried that if he did learn any new tricks we would be in even more of a fix.

Note: I am interested in upholding the distinction between “disinterested” as unbiased and impartial, i.e. not moved by consideration of personal advantage, and “uninterested,” which means “not interested” or “unmoved.”  I realize that usages change, but maintaining the distinction with a difference serves a good purpose here.

Why Did President Trump Just Declare That President George Washington Was A Crazy Loser?

Donald Trump tweeted this morning that “the Senate must go to a 51 vote majority instead of current 60 votes.  Even parts of full Repeal need 60.  8 Dems control Senate.  Crazy!”

He may be right that our system of checks and balances, and our tradition of separation of powers, is crazy.  It is certainly inconvenient right this minute for a Republican president and a Republican House and a Republican Senate.  The Republicans control the Supreme Court too.  But their control is apparently not yet solid enough to erase “Obamacare.”  (Their control over the hearts and minds of Americans is also apparently not solid enough for them to take a real stand against foreign hostile powers such as Russia hacking our next election.)  So Mr. Trump in effect calls George Washington a loser and a fool.  Really, you may say.  Yes, really: according to Moncure Conway, writing in 1872, “there is a tradition that Jefferson, coming home from France (after the Constitution had been drafted), called Washington to account at the breakfast table for having agreed to a second, and, as Jefferson thought, unnecessary legislative chamber.  ‘Why,’ asked Washington, ‘did you just now pour that coffee into your saucer, before drinking?’  ‘To cool it,’ answered Jefferson, ‘my throat is not made of brass.’  ‘Even so,’ rejoined Washington, ‘we pour our legislation into the senatorial saucer to cool it.'”

The Senate was not designed to achieve the rapid resolution of conflicts possible in a parliamentary system.  Our second legislative chamber’s “cooling saucer” has blockaded and obstructed plenty of social progress (civil rights being Exhibit A) but it has also slowed or stalled plenty of horrible ideas, as 2017 (so far) shows.

If the president is fed up with all the obstacles to absolute rule, and wants to toss the Resolute desk over and go home to Manhattan, I say let him go .  If, however, he can overcome his snowflake personality and offer any ideas whatsoever that would improve upon the many flaws in the delivery of health care in this country,  let him speak now.  Let him spell out in detail just how he proposes to reshape the American healthcare system, or else be judged as the shallow and vindictive blowhard he now appears to be.  George Washington is watching him–and the rest of us too.

P.S. Donald Trump on Twitter, September 26, 2012: “Obama’s complaints about Republicans stopping his agenda are BS since he had full control for two years.  He can never take responsibility.”

Republicans Glowing Over Glorious Repeal Victory–Glowing In The Dark, That Is

Hat tip to Nancy Pelosi for naming the fate of Republicans who voted to trash, not repair, Obamacare today.  Now it is up to friends of actual affordable healthcare for Americans to reject rightwing “framing” and “narratives” and tell the American people plainly what just happened.  Republicans voted for this bill without any clear idea of its cost, without any budget estimate from the nonpartisan Congressional Budget Office, but when those numbers are released the ugly realities will become clearer.  “Framing” or no framing the nasty impact of this bill, if it becomes law, will hit many millions of citizens who have benefited from coverage through the Affordable Care Act, and many more millions of their family and friends.

Regarding the “freedom” Paul Ryan and his fellow zombies say we are about to enjoy, I would ask them to let go of their childish libertarian dreams and acknowledge that they are leaders of a government that got involved in the provision of health insurance because the human toll of destitution and premature death became unacceptable.

Of course there are sometimes tradeoffs between security and liberty.  In the case of health, however, most people experience health, security, and freedom as mutually reinforcing.  There is a loss of freedom, perhaps, if you are forced to acknowledge that you are part of a giant risk pool when you feel fine, or that you may face a day when, if you opt out of acknowledging your membership in that risk pool otherwise known as “society,” you are going to need healthcare at any price right now, and you might not have $150,000 on hand.  Oh, well, that’ll surely never happen.

Healthcare is not a “good” that can be subjected to simple free-market logic without causing massive unnecessary suffering, partly because the market for healthcare does not and cannot operate with the benefit of an essential precondition of efficient Pareto-optimal “perfect competition,” which is “perfect information.”  Perfect information is sometimes almost the opposite of how the healthcare market works.  Think of the market for used cars.  Think of all the very imperfect information,  not to say unrepentant lying, that occur during the sale of a used car.  Now think of yourself as a used car and of trying to “sell” yourself to an insurance company.  You tell them that you have very low mileage, excellent maintenance record, and all kinds of fibs.  They squint at you and want you to pay more than you can afford.  Depressing scenario, isn’t it?  But it gives some idea of what the rightwing framers and narrative-spinners are going to be up against and why the majority of Americans, if polls be believed, are feeling warmer and warmer about Obamacare as they realize their safety net or plan B, or maybe just plan C, could actually be taken away.

Now it is time for Democrats and others sickened by the new regime to make those who voted to mess with the Affordable Care Act pay the price and glow in the dark next year.

Did God Punish Poor White Trump Voters By Leaving Their Healthcare Untouched?

Could the Almighty have such a refined sense of irony that poor white Trump voters were punished this week by G-d leaving their health benefits intact?  Maybe G-d does not really believe in karma?  It was real problematic for a lot of folks to have to take healthcare entitlements and handouts from a skinny black dude.  But times change, and now we have a really rich, old, large, obnoxious white man in the White House.  It would be awful if everybody who needed to get low-cost care got cut off now.  Thank goodness the Freedom Caucus understood all this and preserved our Obamacare just when we were starting to think of it as the Affordable Care Act (surprise!).  Just hoping the

Republican Plan To Suppress 24.1 Million Votes Following CBO Report 24 Million Losing Healthcare

Paul Ryan said he was “excited” and “encouraged” by the CBO report that Trumpcare/Ryancare will cause just 24 million Americans to lose their healthcare insurance.  Ryan is said by some to have planned to suppress 24.1 million votes in the midterm elections.  So it’s all good.  Cost-benefit analyses that a Koch group may well have carried out show that the cost of voter suppression, even on the grand scale needed to invalidate 24.1 million votes, is far cheaper than the cost of allowing Americans to feel that they are not serfs any longer.

Take The Ribbon From Your Hair, President Trump

Didn’t you promise you were going to help us make it through the night, Mr. President Trump?

“I am going to take care of everybody.”

“There will be no cuts to Social Security, Medicare & Medicaid.  Huckabee copied me.”

“Everybody’s going to be taken care of much better than they’re taken care of now.”

I don’t care who’s right or wrong, Mr. Trump.  You could even copy Huckabee and put a squirrel in your White House microwave and if you liked it a lot I would not judge you for that.  But keep your promises.  Or at least try.  Don’t complain about how complicated healthcare is.  That’s a precious snowflake excuse.  And don’t listen to Paul Ryan.  He’s a zombie moocher who lived off Social Security for two years after his daddy died when Paul was just sixteen.  He is probably still ashamed of it.  Don’t mind him, and for heaven’s sake don’t think he’s a “policy wonk.”  He doesn’t even understand insurance at all if he doesn’t realize it’s about healthy people paying for sick ones.  Because even you, Mr. Trump, are going to get old and sick and dependent and vulnerable.  So let the devil take tomorrow, Mr. Trump.

P.S. So glad your man on health care, Dr. Tom Price, said yesterday “no one will be worse off financially” when Trumpcare kicks in.  I am making a note of how much I paid in premiums in 2016 and putting it in a safe place, and you can be sure that I will not pay any more while you are president, sir.  And I know you won’t put me in debtors’ prison.  Plus I can keep thinking what I’m thinking and drinking what I’m drinking–no more no less so I won’t be any worse off.  Feeling pretty good now.  Would hate to see you mess up my good feeling.

Paul Ryan Announces Dates For 2017 Freedom And Carnage Tour

Speaker Paul Ryan, in the wake of his announcement that he will give us freedom by abolishing Obamacare and replacing it with freedom, all freedom all the time, has announced his Summer 2017 Freedom and Carnage tour schedule.  See his twitter feed for details, but the gist of it is, if he takes away your healthcare coverage, shut your mouth and be grateful for all the freedom you have to “access” the free market of medical services.  You are free to enter into a voluntary transactions with any and all providers of care.  You and only you have the freedom to negotiate with Humana or Aetna or Kaiser and don’t be a begrudger about it because you are just as free and big and powerful as your corporate negotiating counterparty.  You are also free to ignore the carnage by plugging your ears and shutting your eyes and pretending the protesters you see are all zombies paid by George Soros and French socialists.  You are free to enjoy the “deconstruction of the administrative state” because you know that they are going after those other elite people, they are not coming for you.

Why Paul Ryan Is Right That Obamacare “Is Collapsing As We Speak”

Speaker Ryan is right that “Obamacare is collapsing as we speak.”  That’s because his Republicans are voting to repeal the Affordable Care Act.  Thus it is collapsing.  Platitude solved.

Personally, I am happy to see that horrible Obamacare law go down.  That’s because my coverage, which is great so far, is with the ACA.  Oh, really?  You don’t say.  Hmmm… where did you say that protest march is next week?

No Opting Out Of The Trump Risk Pool

Repeal or no repeal of the Affordable Care Act, we are all captives in the Trump America Risk Pool.   Sure, there are problems with Obamacare’s risk pool dos and don’ts, but they are pretty much limited to health care.  The Trump risk pool is a wider, deeper problem.  For example, the news that we may well have a suborned and blackmailed president next week: that puts all Americans in a scary risk pool, even if it is of our own devising.  (Scary enough that Trump is almost halfway right that his tax returns are a minor concern now.)  As Charlie Pierce put it today, “everybody is waiting for somebody else to do something.  It’s like we’re all the crew of the Pequod, waiting for the mad captain to emerge from his cabin for the first time to explain how his obsessions should be ours as well….the president-elect may, in the words of Bruce Springsteen, have debts no honest man can pay.”

P.S. if you are ready to see Obamacare go down the tubes, because your own terrific health care is the Affordable Care Act, I have some bad news for you.

Snowflake-In-Chief Donald J. Trump

You say you woulda coulda won the popular vote and bigly?  Maybe you will–next time.  The campaign is over, dude, and you have a lot of actual work to do if you really want to drain the swamp.

And taking the easy way out of keeping the two most popular parts of Obamacare and skipping away from the unpopular mandates and penalties–that’s a real snowflake move that will make the whole system crash.  Reality bites.

Exercise Freely All You Like, But Bearing False Witness Does Not Count As Free Exercise Of Religion

Re-reading my January 2 post on “Free Exercise,” I wondered if I should adjust my spectacles more toward the fine details or the bigger picture.

First, into the weeds: on Friday, January 3, Solicitor General Donald Verrilli presented the U.S. government’s response to Justice Sotomayor’s temporary injunction against enforcement of the contraceptive mandate portion of the Affordable Care Act in the case brought by Little Sisters of the Poor in Denver (by their legal team at the Becket Fund for Religious Liberty).  When you get down to details, as Verrilli pointed out, accepting the nuns’ objection to filling out form EBSA 700 leads to absurd results (hat tip once again to Marty Lederman of Balkinization.)  Signing the form in their particular case would ensure that their female employees do not receive contraceptive coverage, in part because their health insurer, Christian Brothers Employee Benefit Trust, prefers not to provide it and is not subject to any government regulation under provisions of the ERISA law of 1974 exempting churches.  Obamacare regulations also give the Little Sisters a simple way out of any possible taint, again because the Christian Brothers entity is considered a church group, not merely a religious nonprofit.  (I can see an objection to the clericalist bias of the federal regulations, but that is a separate issue.)  So the Little Sisters and their lawyers are refusing to take yes for an answer.  Moreover, as Verrilli notes, they “draw flawed analogies when they say that under the court of appeals’ reasoning [which went against the Little Sisters’ position] ‘Quaker conscientious objectors would suffer no penalties if they would just join the military; Jewish prisoners would suffer no burden if they would just eat the pork…’  To mirror the situation here, the question in all of these cases would be whether the religious objector could be required to sign a certification form in order to secure the religion-based exemption he sought…. [the Little Sisters/Becket Fund position] would seemingly mean that the…Jewish prisoner could not be required to fill out a form saying he had a religious objection to the consumption of pork before he was provided an alternative meal… When extending religious accommodations, the government must be allowed to provide for regularized, orderly means of permitting eligible individuals or entities to declare that they intend to take advantage of them.”

Amen.  Anybody who has a problem with that is just itching for a lost cause to fight.  The Notre Dame case and other similar cases are different in detail, but not in kind, in my opinion, as I discussed the other day.  And when Kyle Duncan of the Becket Fund argued on EWTN’s “The World Over” TV show the other day that the Little Sisters were being coerced to sign a “permission slip” for their insurer or administrator to provide birth control coverage, Michael Sean Winters of National Catholic Reporter rightly called him out for bearing false witness against the truth.

And what about the bigger picture?  I still do not wish to seem rude to the Little Sisters of the Poor or Notre Dame, but a distinction should be made between the official position of the Roman Catholic Church and the lives of an overwhelming majority of American Catholic women–98% or so of whom have used contraceptives, obviously not continuously, but at some point.  That number tracks comparably with the general population of American women.  Morality and righteousness may not always lie in numbers, but it is relevant that many if not most American Catholics, including theologians and even clerics, are dubious about the rationale of the papal encyclical from the 1960s against contraception.  Government policy on abortion is obviously strongly contested, but the Supreme Court’s Griswold decision legitimizing birth control is pretty unlikely to be overturned.  Public health policy is, or ought to be, nonsectarian and detached from particular creeds and confessions.  The health law is a neutral law of general applicability, which was the test the Supreme Court used in a 1990 free exercise case involving peyote rituals, the upshot of which was that states may but do not have to accommodate claims of religiously-based exemption from such neutral laws.  Nobody is force-feeding birth control pills to anybody, least of all the Little Sisters of the Poor. The cases against the contraceptive mandate, as revised by the Obama administration, are essentially aimed, seems to me, at reasserting control over (especially poorer) women’s access to birth control, with the usually unstated aim (depending on the audience) of restricting female autonomy more generally.  Does the free exercise of religious belief really depend on that?  Any lawyer, or woman religious for that matter, who has thought it through and still says “yes” should have their knuckles rapped.

Free Exercise In This New Year

Justice Sonia Sotomayor did double duty on New Year’s Eve 2013, ringing in the New Year in Times Square while joining a kick dance on TV, and also, acting as Circuit Justice for the Tenth Circuit (yes, each Supreme Court Justice is a “circuit rider” too, without having to travel outside their chambers in D.C.), “temporarily blocked the enforcement of the Affordable Care Act’s birth control mandate against some Catholic groups challenging the mandate, including the Little Sisters of the Poor in Denver” (SCOTUSblog).  Notre Dame tried and failed to get a similar injunction against the mandate from a federal appeals panel, and has not appealed to their “circuit justice,” Elena Kagan.  Justice Sotomayor surprised some people, but the issue was headed to the full Supreme Court anyway, I expect, so she is simply not impeding that, rather than judging the merits.

It would be very rude of me to say anything bad about the Little Sisters of the Poor.  I have no strong feeling either pro-  or anti-  Notre Dame (and I have no skin in any football game they play).  Still I would be most unhappy if they won their cases.  How come?  Simply because I do not believe that any of the mandates or regulations (after they were amended) of the Affordable Care Act impose much of a burden on the Little Sisters, Notre Dame, or any Quaker, Muslim, Conservative Jew, Buddhist, or Greek Orthodox person or entity.

Marty Lederman (at the Balkinization blog) explains why the law does not burden religious nonprofit groups.  First, churches and auxiliary groups are “exempt altogether from the requirement that they include contraceptive coverage if they offer a health-insurance plan to their employees.  The women who work for such churches thus…will not be afforded this new national benefit….Under…the ‘secondary accommodation,’ other religious nonprofits who object to contraceptive coverage also can exclude it from their employee (and student) health-insurance plans.  These…organizations need only certify that they have religious objections to providing coverage for contraceptive services, in which case they will not be required ‘to contract, arrange, pay, or refer for contraceptive coverage.'”  But for most of these nonprofits the insurance company or third-party administrator for self-insured group plans assumes responsibility for providing contraceptive coverage and is prohibited from imposing any extra fees or penalties for that coverage.

Lederman notes that the secondary accommodation’s whole purpose is to relieve religious nonprofit groups of any obligation to “contract, arrange, pay, or refer.”  Notre Dame, moreover, is not forced to “choose between violating its religious obligations and ‘paying enormous penalties,” since they have the “perfectly lawful option of not offering a health insurance plan at all.”  If that seems harsh or unreasonable, Lederman asks us to back up and recall that the health care law lets Notre Dame or the Little Sisters file a certification to insurers that “it is eligible for and exercising the available religious accommodation because it objects to providing contraceptive coverage.  By certifying, Notre Dame would not ‘authorize’ anything: Federal law does that work.  As the district court explained, ‘if Notre Dame opts out of providing contraceptive coverage, as it always has and likely would going forward, it is the government who will authorize the third party to pay for contraception’….If that is enough to establish a substantial burden on Notre Dame’s religious exercise, then…’opt outs’ for dissenters [to public laws] would themselves often create the very conflict with religion that they are designed to alleviate–and would thus threaten to prevent the state from both accommodating religion and satisfying its state interests through an alternative means, such as the use of a non-objecting party.”

To put Lederman’s point another way, if Notre Dame or the Little Sisters want to preserve such a degree of purity that they not only decline to provide birth control to employees themselves, which is generally agreed to be part of their right of conscience, but also seek to gum up the works of a law passed by democratically elected representatives of the people who chose to supply birth control as part of the overall project of improving national health and well-being, how can they complain that they might have to pay some sort of penalty? Lederman asks us to consider an analogous situation: there is a federal law permitting a district court judge to recuse him- or herself from a case where he or she likely has a bias or prejudice.  “In a 1998 article, former Notre Dame professor (now President of Catholic University) John Garvey argued that a judge who adheres to Catholic doctrine [against] the death penalty would have to invoke this law to recuse himself (meaning “sit out”) from the sentencing hearing in a capital case.  In such a case, the federal law provides that ‘any other judge’ can step in and conduct the hearing.”  But according to Notre Dame’s theory in this 2013-14 case, the Catholic judge “would be able to object to the sentencing hearing altogether–not only to his own participation in it–on the theory that his recusal would ‘trigger’ or ‘authorize’ the replacement judge to act immorally.”

The Little Sisters, and Notre Dame, and Sikhs, adherents of no religious faith, Methodists, etc. all have a right to express their “voice” in the public square.  They can also exercise the options (as Albert Hirschman put it) of exit, or loyalty, or some mixture thereof.  But the objections to the Affordable Care Act in these cases seem both strained and mixed-up.

Could Bill Clinton and Joe Manchin Worry About A Health Plan For Mayor Rob Ford And Leave Obama Be For Just Another Month Or So?

Takes a lot of guts to point out the obvious about the Affordable Care Act/Obamacare, doesn’t it, Mr. Clinton?  And you too, Manchin.  But watch out you’re not being too cute by half, Mr. Bill.  Why not take a page from your successor (or Winston Churchill)  and take up painting, and maintain a little political silence (though W., I am sorry to say, is speaking this week at a fundraiser for Messianic Jews in Texas–oops).  Your failure and Hillary’s failure to pass universal health care isn’t held against you by anyone with sense–nobody else had complete success either (though LBJ gets way too little honor on this, because of Vietnam) and the current law is nowhere near universal.  But it sure will be held against you if you succeed in provoking mass Democratic panic, so soon after the Republicans made such fools of themselves while Harry Reid held his caucus together.  Maybe Obamacare will be so unworkable that it will implode, but may it not be on your head.

Livin’ The Insane Gangsta Pretend-Libertarian Thug Vida Loca

In fairness to the insane gangsta thug pseudo-libertarians in Congress, President Obama did give them reason to believe two years ago that they ought to keep doing what they are doing. So it is up to Obama to explain early and often why he is doing what he is doing. And I thought he did a good job of that both at the Clinton Global Initiative the other day and then at a speech in Largo, Maryland. I do not believe, though, that it is the President’s fault if we the people prefer the narcotic of Breaking Bad to the more serious work of paying just a little more attention to basic details of the health care law and of the non-equivalent stances of the parties in Washington. The substantial point spread between approval of the “Affordable Care Act” and that of “Obamacare” is testament enough to our slothfulness.