So what’s wrong with democratic socialism?

The Thinker by Rodin

We are told socialism is bad and un-American, but is capitalism really all that great? Consider how poor a job the free market is doing in providing affordable health care. Before the Affordable Care Act, insurance companies did their best to keep their insured pools as pristine as possible. They had no problems canceling people’s insurance when they judged they were too risky and often when they needed it the most.

In spite of the ACA, which Republicans and Trump are working hard to kill, premiums still are going up. Since this latest tinkering by Trump, they are going up a lot while kicking millions off health insurance. Premiums for 2019 will be announced shortly before the midterm elections and they are expected to rise twenty percent or more. This will likely result in lots of disgruntled voters. Right now, the cost and availability of health care is their number one concern. So I really don’t see why Democrats running on a “Medicare for All” platform should fear the wrath of voters. It’s much more likely they will be cheered on instead.

Ask any senior citizen if they want to give up their Medicare. Even the senior citizen gun nuts will give up their guns if the choice was between giving up guns or Medicare. Medicare is wildly popular, despite its issues. The rest of us simply wonder why if it’s good enough for old folks, we younger and healthier people can’t buy into it.

After all, Medicare takes all comers, at least if you meet the age and eligibility requirements. There are certainly aspects of the program that are annoying and baffling. I have been studying them as my Medicare eligibility looms in a few years. I’m not sure why parts B, C and D can’t come as a general benefit for one premium. I don’t understand why there has to be a donut hole if you use their drug program. In any event, universal health care is not that hard. Every major industrialized country except for ours has done it. Surprisingly, people in these countries are quite happy with their systems overall. So while we are creating Medicare for All, let’s improve the system too.

Of course with our Congress awash in health care money, their real mission seems to be to keep these companies flush with profits. Which is why I and the majority of Americans could really use Medicare for All, which is basically democratic socialism at work. It’s socialist in the sense that the government creates and manages the system. It’s democratic in that we the people get to elect people who will enact such a system.

The private sector has proven not up to the task. That’s why Medicare was created in the first place. The private sector didn’t want anything to do with insuring old people. There was no profit in it so it was either put grandma in the poor house or create a government program to fix the issue. Now health care costs are getting so high for the rest of us that we simply can’t afford it even if we can find insurance.

Republicans don’t get that the government’s purpose is to do things the private sector can’t or won’t but which the public needs. If there were no needs like this, we wouldn’t need government. Private health insurance is a failure. Rather than lowering prices, it raises them for all while kicking millions off health care altogether. Competition between insurers with an even playing field was the basis of the ACA. It helped but it has not proven to be the solution. We need something a whole lot more socialistic.

So sign me up as a Democratic Socialist. There’s no Democratic Socialist party to join, but maybe there will be if the Democratic Party can’t get its act together on these pressing issues. Government exists to help all its citizens and to provide solutions where the free market can’t or won’t affordably or at all. I see this out here in western Massachusetts where I live. Cities out here have high speed Internet, but many in the hill towns don’t. Comcast and the like can’t be bothered. It’s not profitable. No wonder local governments are engaging in some democratic socialism by creating community networks, an effort I am helping lead in my city, and we already have Comcast. (We’ve figured that without Comcast, we could get 1 gigabit per second fiber to the home for a third less than Comcast charges. No wonder Comcast can afford to buy all those arenas.)

Ironically, many of the tenets of Democratic Socialism put Trump in the White House. During the campaign he promised much better health care than we have now for much less. He’s done nothing to implement this promise; in fact he has gone in a completely different direction. Many Obama voters voted for Trump because they thought he could break this gridlock by being different. Obviously they were crassly used, but the idea of having great health care while paying a lot less for it is sound, and is now the number one concern of voters.

Let’s bring in a whole new crew of Democratic Socialists to Congress in the midterms. Hopefully we can replace every Tea Partier elected in 2010 with a Democratic Socialist instead. Let’s let government govern again. Lyndon Johnson was the right leader in the 1960s to bring Medicare to fruition. Medicare for All can be done providing we elect leaders committing to doing the people’s business first.

Republicans continue to make the rich richer and the poor poorer

The Thinker by Rodin

It’s pretty hard to keep up with the inanities coming out of the mouth our “president”. As a Democrat he sure embarrasses me, but I often wonder why Republicans are not. If retiring Senator Bob Corker (R-TN) is correct, most Republicans in Congress are embarrassed by Trump, but can’t summon the political will to say so.

Trumps tweets and remarks get weirder and weirder. This is probably due to 50% ignorance and 50% cognitive decline. Still, it’s quite embarrassing. Yesterday, a day after his Secretary of Energy Rick Perry declared that Puerto Rico was a country, Trump told a convention of evangelicals that he has spoken with the “president” of the Virgin Islands. So two top administration officials including our “president” don’t understand that both Puerto Rico and the Virgin Islands are American territories. What’s next? Sending in the marines to take over these “countries”?

Yet on such capable shoulders we are entrusting our nation. The only thing seeming to restrain Trump from his worst impulses seems to be a few officials, principally Chief of Staff John Kelly, Defense Secretary Maddis and Secretary of State Tillerson. They are our firewall of sorts, although there is no guarantee they can restrain Trump. Reportedly they have a suicide pact: if one gets fired they all resign. In any event depending on one unflagging Chief of Staff to babysit Trump 24/7/365 doesn’t seem like a great plan. Trump might launch nuclear weapons against North Korea while Kelly is in the bathroom.

So what does all this have to do with the rich getting rich and the poor getting poorer? Nothing really. I am just venting. But in the boatload of stupid that has come out of Trump’s mouth and Twitter feed recently, there was this from his interview with Sean Hannity on Tuesday:

The country — we took it over and owed over 20 trillion. As you know the last eight years, they borrowed more than it did in the whole history of our country. So they borrowed more than $10 trillion, right? And yet, we picked up 5.2 trillion just in the stock market.

Possibly picked up the whole thing in terms of the first nine months, in terms of value. So you could say, in one sense, we’re really increasing values. And maybe in a sense we’re reducing debt. But we’re very honored by it. And we’re very, very happy with what’s happening on Wall Street.

Aside from the numbers themselves that are off, there is the amazing conclusion from Trump, a graduate of Wharton. Remember, Trump recently bragged that he could beat Rex Tillerson in any IQ test. Trump apparently thinks that gains in the stock market cancel out federal debt. This is surprising in itself, but apparently it only works if he is in office. It doesn’t apply to the Obama administration, which saw the longest sustained growth of the stock market in history. There is no doubt that the stock market is doing very well since he took office, but it’s not doing appreciably better than it did under Obama. Those of us with lots of stocks are just seeing our pile of wealth get larger and larger.

I certainly see it in our portfolio. We take $1900 a month out of it to supplement our retirement. Just our investments (almost all of it in retirement accounts) amounted to $795K on February 1, and is now valued at $857K. Add in our house and other assets are we are millionaires, if a net worth of about $1.41M means that much these days. Gains in the stock market though create wealth only for those who own stocks. Guess what? Many of those who voted for Trump don’t have much if anything invested in the stock market. That’s due in part because there is little money left over to invest in stocks. According to one study, in 2013 the top 1% alone owned 38% of the stock market. The top 10% owned 81.4% of stocks. That leaves 19% for the rest of us. I may be technically a millionaire but rest assured my assets are part of that 19%. In reality I am not even close to being rich, at least not by the standards of the top 10%. I sure don’t plan to buy a Tesla or fly on a private jet to Monaco.

To make money in the stock market though you need to invest regularly over many decades and hold onto the assets. And that’s only possible if you have money left over to invest in the first place. It also means that you also need a relatively secure job, so that you are not raiding your nest egg in lean times. You also need it just to get through recessions and downturns with your investments able to wait out the hard times. If you don’t have all these factors in your favor you probably won’t be investing much in stocks and if you do it will be periodic retirement investments during relatively flush times.

So the surging stock market is really creating wealth principally for the rich who already have plenty of it, exacerbating income inequality. At best its effect for the rest of us is indirect, perhaps by keeping unemployment low thus maybe pushing up wages a bit, or by stimulating investment in the economy. Nothing about the stock market’s rise though fundamentally changes things for the middle class, poor and working class.

Indeed, Republicans seem intent to make things worse. Just yesterday Trump ordered an end to Obamacare subsidies for the working class. This will have the effect of pricing almost all of them out of the health insurance market. This will make healthcare more expensive, increase the probability of bankruptcy due to medical debt and make their financial situation more precarious. In short, they are likely to be pushed down the ladder again. The major reason these classes saw any gains recently was from having affordable health care, which helped protect their assets.

Having tasted real health insurance, these voters are likely to be furious when they vote next November, particularly as the rich will keep getting richer. While the stock market may continue to surge until then, these changes will directly affect the financial stability of the middle and lower classes. It’s likely that when these voters realize they have been shafted once again that Republicans will pay a huge political price.

Ted Cruz is worried about a blowout if Republicans don’t deliver on tax cuts and repealing Obamacare. As he will discover next November these are the factors likely to cause the blowout.

At the health care inflection point

The Thinker by Rodin

Back in January I mentioned a mindful eating course I was enrolled in. A full discussion of the course is probably for another time if I think it warrants a blog post. (I’ve become pickier about what I blog about, as I post less frequently and am trying hard to make my posts more relevant and topical.) One of the interesting takeaways from the course though was to learn to trust your body.

It turns out this is a really hard thing to do, particularly here in America. For most of us spend lives trying to respond to conformance requests coming mostly from outside ourselves. It’s constant and incessant. In the area of eating, you get endless “shoulds” and guilt-laden advice about what to eat, when, how much and using which techniques. These techniques rarely work in the long term because they are not natural to us, which is why so many of us are overweight and obese. Trusting to your own inner wisdom shouldn’t be hard, but it is hard because we simply don’t know how.

Of course it’s much more than food. We spend much of our lives being inauthentic to ourselves. We pray to gods we don’t really believe in. We chase after status symbols thinking we’ll be better or happier when we possess that McMansion or that BMW. We take advice from popular people in our class or some loudmouth on the TV or talk radio thinking they are actually wiser than we are. More topically, we vote for people who don’t have our best interest at heart, ending up more unhappy and miserable as a result.

We do this at least in part because we’ve learned that to get along you got to go along. We want to belong and since most of us don’t have local tribes anymore, we join our virtual tribes instead. They are often led by people looking to screw us over, if not monetarily then at least mentally. Facing the reality of our bad choices is hard. If we were to face them, we would often realize we were played for a fool. So rather than face them we continue to work against our own self-interest.

Logically most of those who voted Republican or for Trump should be regretting their choices. Many of them are but of course even Trump has a dependable group who will stick with him no matter how much he sticks it to them. As I noted recently, ninety percent of Republicans voted for Trump, despite knowing full well what he was about: a bankrupt-prone, pussy-grabbing businessman with zero common sense and a racist streak a mile wide.

It seems though that many who voted for Republicans are waking up. We see this not in a pressing desire to vote for a Democrat, but in polls showing waning enthusiasm for their fellow Republicans. There are other polls that show even majorities of Republicans disapproving of their party’s actions. Both the House and Senate health care “reform” bills are widely despised, even among Republicans.

Trump ran partly on a platform of reforming health care. It would be easy to reform he told us, and you would get better coverage for less. Whereas the sad reality is that Trump really has no idea what’s in the bills he has been promoting, other than he heard the House bill was “mean” so he instructed the Senate not to make their bill “mean”.

Trump is not being mendacious; he is simply unable to absorb detail. But if the Congressional Budget Office is to be believed, either 22 or 23 million people will be uninsured within ten years if either of these bills become law, with 14 million losing health insurance within the first year and likely a majority of them will be Republicans. Those with insurance will pay a lot more, both in higher premiums and higher deductibles. Technically these don’t amount to higher taxes since this money is not going to the government. If it did, it might buy something useful. It will feel like a tax hike however as your standard of living rapidly erodes.

If either of these bills becomes law, it will be a disaster. It certainly will be for those losing health insurance. The reality however will be much more brutal. Health care spending is a huge part of our economy. It will close hospitals, mostly in rural areas. Without insurance people won’t see doctors, so doctors will bill fewer hours and make less money. The cost of emergency care will be foisted on those still with insurance, raising the cost of insurance even higher. It will have a huge cascading effect of not only people dying prematurely and in misery, but in creating huge amounts of medical debt and lost health care jobs. It will careen like a locomotive off its tracks and wreck much of our economy. It won’t affect just the healthcare industry, but all those businesses that depend on health care employees and health care spending, which is most of the economy.

All this is to give huge tax cuts to the 1% who don’t need the money. Arguably the taxes these rich people pay pay for themselves in sustained economic growth, which is keeping stock prices and their portfolio rising.

Some lessons for me:

  • Our current healthcare system must be fundamentally changed if it is to survive at all. The current system works poorly, but it works a whole lot better than it will if either of these bills pass.
  • It’s really in everyone’s best interest to reform our health care system, as it is unsustainable. If there is any industry too big to fail, it’s not on Wall Street but our health care system. It feeds off patients. And patients need insurance to see doctors because only the top 1% can pay for their own healthcare.
  • Obamacare is dying, but not for the reasons people think. It’s dying because it tried to work using a system of private insurance. It’s the private health care system that no longer works as it puts profits first, not people.
  • Expanded Medicaid is demonstrating to new generations that socialized medicine does work. Ask most of Mitch McConnell’s constituents, who are on the program. Only to them it’s something called KyNect.
  • Like it or not we are at a health care inflection point. We must solve this fundamental issue in the only way it can be solved: through comprehensive national legislation that addresses its critical defects. Obamacare does not need amending. And it needs to be replaced with something that is the complete opposite of what both bills in Congress purport to call “health care”.
  • My life, and yours, depends on us rising to the occasion.

Republicans fall into their own health care trap

The Thinker by Rodin

House Speaker Paul Ryan’s laughably named American Health Care Act bill went down in defeat yesterday. It was abruptly withdrawn before yet another planned vote Friday afternoon. Millions of Americans, particularly those who stood to lose under the law, breathed a sigh of relief. I was not surprised by its defeat. It was inevitable.

Without complete Republican control of government, it was an impossible needle to thread. Republicans don’t have total control in the Senate, although they do have a majority of its members. Thus the only way to “kill” Obamacare was to gravely wound it. It would have to be done using the Senate’s budget reconciliation process, which would leave in place the structure of the Affordable Care Act so as to avoid a filibuster. Consequently a House bill (where all financial legislation must emerge) must have met the constraints of this Senate rule to have a chance of passage. In essence that was what killed it.

House Democrats would not vote for it, which left Ryan to persuade all but twenty-two Republicans to vote for something that would meet the Senate’s budget reconciliation criteria. For members of the Freedom Caucus in the House then a vote for the bill would amount to a tacit endorsement of the ACA, the exact thing they ran against to win their seats. Attempts to make the bill more punitive were not enough because the ACA’s basic structure would still be in place. It was doomed.

Why it was doomed though is interesting and part of a larger story about the challenges of governing and points to a fatal flaw in the Republicans’ governing structure. It was doomed because the Republican Party, like all parties, is full of factions. These factions could not come together and find consensus. It was the same problem that drove former Speaker John Boehner into an early retirement. It’s okay to be true to your principles as long as you know doing so won’t affect anything. Republicans could to this during the Obama Administration, passing more than fifty votes to wholly repeal the ACA. These were acts of symbolism and statement, not actual legislating. When you control Congress but you still can’t move legislation for the same reasons, these principled but unmoving factions become self-defeating.

If they compromised, the Freedom Caucus effectively continued the health care legislation they so revile, albeit in a crippled form. Yet by not compromising they undermine their own cause. It’s like being in a battle and wounding your opponent instead of killing him. In their eyes, the only option is to kill. They ran not on a “no Obama” platform but a “never Obama” platform. This left them no place to go toward, at least not without embracing hypocrisy.

Much has been written about the polarization of Congress on both sides of the aisle. Right now with Republicans controlling Congress this polarization affects the whole Republican agenda. The only legislation that can go forward will be bills that have general Republican consensus and can survive Senate filibusters or can be narrowly written to pass the Senate’s budget reconciliation rules. Republicans are going to find more success in these areas like tax cuts. Where factions inside a party don’t agree and won’t compromise, progress is impossible.

What fascinated me was how big the explosion was yesterday. It tarred the whole Republican brand. It showed that Trump’s claims of being a master negotiator were simply bluster. He could not deliver on this promise that he said would be easy. It proved that Paul Ryan couldn’t govern using the normal legislative process. His only hope was to draft something in secret and try to rush it through the House. It was a very long pass indeed. Given a lack of an offensive coordinator it’s no surprise that he didn’t have a player in the far end of the field to catch the ball.

The Affordable Care Act, as imperfect as it was, was at least a process of a lot of open discussion and back and forth negotiating. Republicans were offered a seat at the table but refused to sit down, leaving it to Democrats to write the bill. Even that turned out to be long and tortuous and resulted in many of the flaws that affect the ACA today, principally the lack of a public option. But at least Democrats were able to get the ball somewhat down the field. In doing so Americans got a taste of what affordable health insurance was like. The nearly visceral reaction to Ryan’s bill, approved by only 17% of Americans based on a recent Quinnipiac poll, demonstrates that what was proposed was deeply reviled.

Withdrawing the bill was a bad option but the best available. Had it gone to a vote a whole lot more House and Senate seats would be in jeopardy in 2018. As it is though it left a bad taste in Americans’ mouths. It demonstrated that Republicans largely have forgotten how to govern and this is a problem they own by empowering the far right to gain the majority. Trump was elected based on his so-called “talent” to get things done. Expect few things to change in government in the years ahead and that due to this disillusionment and being in charge that Republicans will be paying a heavy price.

Letting freedom (and common sense) reign

The Thinker by Rodin

It was just a year ago that I blogged about the Supreme Court’s Hobby Lobby v. Sebelius decision. While not entirely unexpected due to its earlier disastrous Citizens United decision, this decision, which let a “closely held corporation” opt out of the birth control provisions of the Affordable Care Act, still felt like a kick in the groin to us progressives. June can be a very frightening month in the United States since it’s when the court’s most controversial opinions get released.

For 2015 though progressives have much to cheer about, and it’s the conservatives that are furious. This is principally because of two cases decided in the last two days that had seismic impact.

In case you just climbed out of a cave, these were King v. Burwell and Obergefell v. Hobson. In the former, a majority of the court said the Affordable Care Act could not be gutted because of the ambiguity of one section of the law that talked about state health care exchanges. In the latter, a closely divided court decided that no state could prohibit two people of any sex or gender from marrying, and that every state had to recognize same sex marriages issued in other states. In short, gay marriage was instantly legal everywhere in the United States.

If you are a progressive, this makes for a very good week indeed, but it gets even better. Almost ignored was Texas Department of Housing and Community Affairs v. The Inclusive Communities Project, Inc. The ruling said that even if a housing developer did not knowingly engage in housing bias, it could still be subject to a civil suit for such bias. Apparently, ignorance of the law by housing developers is no get out of a civil suit free card, even though the plaintiffs were hoping it was.

So while the court’s decisions last June were mostly a fright show for us progressives, this year it is mostly a fright show for conservatives. It caps an excellent week for President Obama, who also resurrected his Trans-Pacific Partnership proposal by getting Congress to agree to special rules to enact it with an up or down vote with no amendments by either chamber. For progressives though this was the sour political note of the week. The TPP, or actually the TPA, sort of rose from the dead after we thought we had put a stake through its heart two weeks ago in the House.

Include into the melee the nine people brutally murdered by Dylann Roof last Wednesday at Charleston, South Carolina’s historically black Emanuel AME church in what but only a few of the craziest conservatives agree was a racist act of domestic terrorism. The tragic and horrifying event though had a special power in a way that its perpetrator did not intend. Just a few months after the 150th anniversary of the end of the Civil War, the South seems to suddenly want to actually end it, just in spirit this time. The Confederate flag, even in the South, is no longer cool. Once South Carolina governor Nikki Haley spoke in favor of the removal of the Confederate flag from its special flag post at the state’s capitol, Republican politicians were practically jumping on top of each other trying to agree that Confederate flags everywhere needed to go to museums and stay there. States across the South are anxiously revisiting their previous pride about the Confederate States of America.

Despite Republicans controlling a majority of the state houses and governorships and the U.S. congress, their agenda is being beaten back. It’s not supposed to be this way and in fact in many ways it’s not happening. It’s largely not happening with their increasingly onerous restrictions on abortion rights, or voting rights, or on many other issues. But on some of the issues that animate them the most, like gay marriage and Obamacare, they got bitch-slapped something bad this week. They are furious but largely impotent. If you see someone foaming at the mouth these last few days, it’s probably a Republican.

Whereas progressives like me are kind of stunned by it all, but particularly on the court’s ruling on gay marriage. It’s not its decision that surprised me, but I am stunned by how quickly the nation and the courts evolved on the issue. I wrote in this post back in 2008 that I expected it would take a few more decades for gay marriage to be legal in all fifty states. In the court’s 5-4 decision today, it’s now legal in every state, just seven years later! To put this in perspective, it was just 11 years ago that Massachusetts became the first state to legalize gay marriage. This is a stunningly fast change. Justice Kennedy, writing for the majority in Obergefell v. Hobson, was almost poetic in his writing:

No union is more profound than marriage, for it embodies the highest ideals of love, fidelity, devotion, sacrifice, and family. In forming a marital union, two people become something greater than once they were. As some of the petitioners in these cases demonstrate, marriage embodies a love that may endure even past death. It would misunderstand these men and women to say they disrespect the idea of marriage. Their plea is that they do respect it, respect it so deeply that they seek to find its fulfillment for themselves. Their hope is not to be condemned to live in loneliness, excluded from one of civilization’s oldest institutions. They ask for equal dignity in the eyes of the law. The Constitution grants them that right.

The 14th amendment to the U.S. constitution was the legal rationalization for the decision. It is also known as the “equal protection” amendment. Its citing was not a surprise, but using it as a justification was poetic as well. Here’s why: the 14th amendment was passed after the Civil War to protect the rights of blacks who were no longer slaves. The amendment can be thought of as the “equal means equal” amendment. The Supreme Court simply stated that its ruling was constitutional because otherwise gay, lesbian and transgendered individuals would be denied privileges available to others, which is both the intent and spirit of the 14th amendment. Progressives can feel giddy because had there been no Civil War it’s unlikely that this amendment would have been introduced at all, so it’s quite possible this ruling would never have been enacted. There probably would have been no constitutional rationalization for this decision otherwise, and conservatives would have won the day. In short, you can tie the court’s ruling on gay marriage as a very belated response to the insurrection of the southern states and the apartheid principles that Dylann Roof perpetrated last week.

In the case of King v. Burwell, the Supremes essentially undercut the premise of the self-proclaimed constitutional conservatives on the court. Constitutional conservatives believe that every law must be judged against the original intent of the constitution and it means exactly what it says and nothing more. No less that Chief Justice Roberts, who wrote the majority opinion, explicitly undercut that rationalization. He wrote:

The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner. Congress made the guaranteed issue and community rating requirements applicable in every State in the Nation, but those requirements only work when combined with the coverage requirement and tax credits. It thus stands to reason that Congress meant for those provisions to apply in every State as well.

Roberts and a majority of the court affirmed, as it has hundreds of times throughout its history, that when a portion of a law erroneously works against its clear intent, then the intent of law is what prevails. It was a ruling that faithfully reflected the will of Congress when the ACA was written, and a majority of the court thus held to the fidelity of the law.

For us progressives, this has been a week of largely good news. It is good news that gays, lesbians and the transgendered have the same marriage rights as heterosexuals. Equal now really means equal. We see it as an expansion of freedom. Strangely, conservatives only want to expand freedoms for those who look and act a lot like they do. Anything else is the overreaching hand of big government at work. Similarly, in the case of the interpretation of the Affordable Care Act, conservatives think that every law should be interpreted literally, whereas the Supreme Court reaffirmed that its rulings should be faithful to the law’s clear intent. These rulings were victories for common sense and for the spirit of the law and constitution.

What goes around though will come around. These court decisions seem to ping between favoring liberal and conservative wings, usually based on Justice Kennedy’s interpretations of the law and the constitution. So it wouldn’t surprise me if in a year from now I will be railing against the court again for their ill-informed judgments. For now though it’s pop the champagne time. Obergefell v. Hobson in particular is a landmark opinion of a scope and breadth rarely seen these days, and whose impact will be strongly felt for decades to come.

The point of the Affordable Care Act

The Thinker by Rodin

Sometimes you want to cheer and shake your fist at the same time. That was my reaction to this Washington Post article that curiously arrived on my birthday, Saturday, when I turned 57:

Nine days into the new year, the 41-year-old call-center worker headed to the health clinic on Highway 15. She saw a doctor about her chronic stomach ulcers, had her blood drawn for tests and collected referrals for all the specialists she had been told she needed but could never afford.

Health insurance finally came last month to Breathitt County, Kentucky and a lady named Mary Combs. Previously, like many of the people in this part of Appalachia, she saw a doctor irregularly if ever. She could not afford health insurance or even to see a doctor most of the time. She could occasionally afford to see a doctor at the local clinic, which at least had a sliding scale of payment based on her meager income. But even twenty dollars came hard to her and many of those who form the working poor of this country. Seeing specialists was simply out of the question. She was uninsured and in the eyes of many, principally Republicans, she did not deserve health insurance. Let them be miserable. C’est la vie.

Of course because she was working, albeit at starvation wages, she made too “much” money to qualify for Medicaid. At least that was the case until the Affordable Care Act finally caught up with her, which made it possible for her to enroll in Kentucky’s version of Medicaid, thanks to a healthy subsidy from the federal government. Mary Combs, like many of the people documented in this article, finally could do something to heal herself. Finally, at last, government gave a damn.

So many people like Mary Combs live in a world of hurt, always a paycheck or less away from losing all they have, and rarely with enough cash to see a doctor, even one with a sliding payment fee. Life for them is mostly suffering, something that is largely endured. Sometimes it ends abruptly and prematurely with a stroke, but often it means slow declines and frequent hospitalization for bills they cannot pay, but which simply adds to their indebtedness and drive overall health care costs higher. Often they come home from the hospital without a job. It left them when they couldn’t show up for their shift for a week. The hurdles just to stay alive simply grow higher every day for people like Mary Combs.

However, now she can afford to see a doctor, and specialists, and maybe start treating one of her many medical conditions. She can do so without going bankrupt, and by avoiding the hospital perhaps without losing her job as well. She had a chance not just to live, but to get better and maybe eke out some modest enjoyment from life again. It’s still a very long road and with her chronic conditions the odds are still against her. But she is getting some relief: psychological as well as medical.

Elsewhere in the article:

“Yeah, sometimes his face will get real red like he’s going to blow up?” Terri said. “Then he gets sick.”

“Okay,” Freeman said, pressing a stethoscope to his chest. “Big breaths.”

“Sometimes my heart hurts,” her new patient said as she listened to his stomach. “All I know is when you get 30, you start falling apart.”

No, at fifty you start falling apart. You don’t start falling apart at thirty unless you simply cannot afford to get treated and your job and environment stress you like a professional football player. At thirty you should be able to go three years without a physical. You should not have crushed discs in your back, suffer from sleep apnea and have already filed for bankruptcy. But if you live in Appalachia like John Wagers profiled in the article, and repair heaters for a living and never had health insurance before, then maybe you do fall apart at age thirty. This is what happened to our ancestors a few centuries back when medicine was more black art than science and most people never escaped a poverty they were born into.

Having affordable health insurance is something I have taken for granted. I can spend most of my life out of pain. I can enjoy most days. I can look forward (I hope) to an active and happy retirement. Now perhaps can the John Wagers and Mary Combs of the country too. Maybe as their health improves they will be able to compete for better paying jobs, because they are healthier and can be productive but also maybe because the minimum wage is raised, as us Democrats want to do. Maybe they will be able to attend a community college when they are healthy and have a few more dollars in their pockets. Just maybe they will get a real chance at the American dream, which needlessly denied them by tactics like only allowing those who can afford it to see a doctor.

The Affordable Care Act is hardly perfect, but it is a start. It warms my heart that in our fractured way we are finally moving people like John Wagers and Mary Combs out of misery and into health. They are being treated like human beings now instead of someone in a lower caste. It’s why elections matter and it’s why I am a Democrat and progressive.

Spock in charge

The Thinker by Rodin

In case you haven’t noticed in the last five years, we seem to have a Vulcan in the Oval Office. Spock is in charge.

Obama as Mr. Spock
Obama as Mr. Spock

Oh, I know what some of you are thinking: we have an atheist/Muslim, Kenyan-born unnatural American in the White House instead. All that stuff about Barack Obama being born in Hawaii is faked, and even if it isn’t, Hawaii was barely a state in 1961, so he’s still not a naturally born American, and thus is not qualified to be president! The good news is that if Obama really is Mr. Spock, well, then we do have an imposter for a president, since anyone with knowledge of Star Trek canon knows that Spock is a Vulcan from the planet Vulcan.

Not so fast! There is the minor matter of Spock’s mother Amanda, who happened to be human, which means Spock is a product of a mixed-species marriage. Curiously, Obama is a product of a mixed-race marriage. It’s unclear from Star Trek canon whether Spock’s mother Amanda was born in the United States, and it’s also very unclear whether in the 23rd century world of Star Trek there is a United States. It sort of sounded like in Gene Roddenberry’s imagination we had evolved past nation-states. However, Spock’s mother Amanda was white and spoke English with a flawless American accent. If she had a son on Vulcan and was a member of a 23rd century United States, why, Spock would be no less eligible for the presidency than Senator Ted Cruz (R-TX) is for being born in Calgary, Canada to American parents. Hmm.

So I am going with this assumption, because President Obama is so much in mind and temperament like a Vulcan in general, but Spock in particular, that I figure Spock is real. He figured out a way to transport himself back to our time, got a little plastic surgery on his ears and otherwise inserted himself seamlessly into our national consciousness around 2004 when Obama made that famous speech at the Democratic National Convention. I mean, Obama is a dead ringer for Spock anyhow: tall, thin, highly logical and low key. I don’t know where the Barack Obama before that speech is, but I figure he is deep in a holding cell somewhere out of the way, probably in Guantanamo. Maybe he will be released after Spock finishes his term in 2017.

Some rabid Christians believe in the antichrist, and many suggest that Obama is the antichrist. If the opposite of religious is secular, then Obama seems to qualify. It is true that he belonged to a predominantly black church in Chicago, but since assuming the presidency he and church have been strangers at best. He had not joined any of the local churches. His attendance is sporadic at best. Vulcans don’t need no stinkin’ churches. They are entirely logical and that certainly describes our president.

Obama, more than any president I can recall, is a relentlessly pragmatic politician, which means that he is driven by logic, not emotion, just like a Vulcan. It is borne out in so many ways, but most importantly to Americans perhaps in Obamacare. It was an imperfect law at best but the main thing was that it could get through Congress, although it just barely made it out of Congress. When it arrived it quickly showed imperfections. However, its imperfections were not as important as the fact that Obama and Democrats in Congress had at least moved this political football down the field, an accomplishment that eluded many past presidents and congresses. Obamacare was certainly not the best health care legislation, but it was doable. It was the logical choice as opposed to doing what so many others had done: nothing.

I find Obama/Spock’s pragmatism welcome. I see it not just in the Affordable Care Act, but in lots of other actions Obama/Spock has taken. The Iraq and Afghanistan Wars were good examples. Mr. Spock would look at these wars and say, “There is no way to win these wars. We need to get out quietly, set up some fig leaf governments that suggest that we care about the inevitable mess we’ll leave behind, but basically just go. We can’t afford them anymore.” And so we did. For the most part, even the Republicans who started these wars aren’t complaining. They have moved on to other issues that excite their base, like cutting spending in general.

The Hindus recognize the god Shiva, whose job is basically to destroy things. This is because life is about change. If it didn’t change, it wouldn’t be life. Curiously, Republicans who claim to not want things to change seem to be channeling Shiva, eager to destroy pretty much all the social legislation of the 20th century. Obama/Spock seems to be trying to cope with change, to build on what has worked in the past to make for a better tomorrow, making him in some ways conservative. The Affordable Care Act demonstrates this principle at work: build a health care system on top of our existing private health insurance market to minimize the shock of change. It’s highly logical in the context of where we are today, which is why Obama/Spock supported it.

Obama himself has repeatedly spoken about his intent on playing a “long game”. He tries to ignore the ups and downs of the moment and keep his eye on the far end of the field where the goal line is. Whatever it takes to move that ball down the field is fine with him. As quarterback though Obama prefers to rush instead of pass. He may start out with a pass, as he did with the Affordable Care Act, but once it proved politically impossible to get a single payer system through Congress he found it less risky to rush instead. He got his first down, which was the Affordable Care Act. Some other quarterback will get to the goal line: a single payer system. Obamacare makes this conversation possible in the future. Without it, it could not happen at all.

Obama is obviously not a perfect president, so the Spock analogy is imperfect as well. But I find his relentless pragmatism quite refreshing. At times it gets him in trouble, such as in national security matters with electronic eavesdropping and the use of drones to kill terrorists. Spock though would fearlessly make these choices. “The needs of the many outweigh the needs of the one,” he has said in various TV shows and movies. Disconnects like these can happen when you elect left-brain presidents. What is logical is not always what makes the most political sense, and it can come back and bite you from time to time. Overall though, I prefer a left-brain president to a right-brain one.

We face terrible problems from overpopulation to climate change. No Messiah is going to come down from the skies to solve these for us. We made this mess, and only we can clean it up. We need clear thinkers and people of practical action to pull it off, if we can pull it off at all. The odds are very long.

So I for one am glad that Spock is in charge.

The meta on Republicans

The Thinker by Rodin

Of course, Washington D.C. is consumed by shutdown madness. It’s all we can talk about in this federal town because, really, there isn’t much else to talk about. It’s kind of like Detroit not manufacturing cars, or Hollywood during an actors’ strike. Governance is what we do, imperfectly perhaps, but it’s our thing.

The shutdown seems kind of crazy and arguably it is crazy. How this happened is well known. It amounts to Democrats staying home during the 2010 election, in retrospect a fatal mistake. It put those with an animus to vote to come out, and we ended up with the Tea Party controlling the House. The Tea Party can now get Speaker John Boehner to dance on a dais like an elephant at a circus. What was lost were legislators that were willing to compromise. That turns out to be a huge problem with no real solution.

The current shutdown is a classic case of an irresistible force meeting an immovable object. It’s unclear what it will take to fund the government again. Forces should favor the Democrats as they control both the Senate and the White House but of course nothing is guaranteed because Republicans in the House, at least those holding the leash around Speaker Boehner’s neck, seem content to burn the house down if necessary to get their way. Their strategy for winning this battle was summed up by Senator Ted Cruz (R-TX): “Don’t blink”. Only of course either someone has to blink or there has to be genuine compromise. For a change it appears that Democrats don’t intend to blink. Time will tell if it is true, but it’s understandable that Republicans figure Democrats, or at least President Obama, will blink in time. After all, he has in the past and past behavior is a reasonable predictor of future actions.

Some things are crystal clear: Republicans are very angry, with Democrats in general of course, but with President Obama in particular. Their rage is focused on the “Obamacare”, i.e. the Affordable Care Act, which they claim was enacted without bipartisan support. The latter point is true, but it’s not like Democrats did not do a lot of reaching out. A bipartisan “gang” in the Senate worked seven months on a bipartisan bill, but Republicans got cold feet. As I documented, President Obama went out of his way to get input from Republicans when health care reform started. He was icily spurned. Republicans were not serious players in this negotiation because they did not want health care reform. They still don’t. There is not even an alternative plan to the ACA that enjoys widespread Republican support.

What is fueling this anger? Is it really President Obama and his mixed race? Is it really that people they don’t like may get to live longer because they will be able to afford some health insurance? How do you reach political compromise when the very idea is anathema to Republicans?

I believe that understanding the true source of their anger may help affect a positive solution. In my opinion, Marcos Moulitsas, owner of DailyKos.com, inadvertently uncovered the real animus in this word cloud. A word cloud is a list of words that come up frequently in discussions with Republicans. Some words come up a lot including “worried”, “concerned”, “scared”, “anxious”, “nervous” and “discouraged”. To understand Republicans, you have to focus on these core emotions. They are engaged in an exercise in bravado which points out they understand the underlying truth: their way of life is dying, probably for good, which means they are desperate. They hold on to some political power via governorships, state legislators and in the House via gerrymandering, but they know it can’t last, so they must hold onto it as long as possible.

Conservative are value programmed to resist change. They are like a dog backed into a corner, hissing and snarling at anything that approaches and ready to lunge forward and bite to prove their sincerity, while secretly hoping they don’t have to because they know their bark is their power, not their bite. The proof is already out there in polls that show Republicans are getting disproportionate blame for the shutdown. They are setting their party up for a more rapid decline than necessary in the 2014 elections. Their current approach is giving Karl Rove cold sweats, as the house of cards he constructed in the late 1990s appears to be swaying.

Arguably Democrats should use this opportunity to kill the sad spectacle that is today’s Republican Party. Benign neglect is not a bad strategy either. As I noted before, demographics will be the Republican Party’s undoing. Like it or not, the country is becoming colored and more tolerant. Attempts to restrict access to voters they don’t like may win a battle or two, but this is ultimately a war that they cannot win and keep their values too. They really have just two choices: transform their party into something else that can attract a lot of women and independents, or prepare to go the way of the Whig Party. Ironically, the Republican Party was forged from the remnants of the Whig Party. What we are seeing taking place in the House is not so much a battle between Republicans and Democrats, but a nasty intra-party Republican fight. As John Boehner goes, so goes the Republican Party, but the party is doomed to lose in the end. There simply are not enough Republicans to hold this party together much longer. This dike is about to burst.

Here’s what an enlightened Democratic Party could do: create safe zones for Republicans to be Republicans. The real animus against the Affordable Care Act is because it is a federal mandate: red states have to follow this law they loathe and which pushes all their panic buttons as well. It’s about being forced to adhere to someone else’s values. So here’s one compromise this Democrat would be willing to make on the Affordable Care Act: let red states opt out of the ACA altogether if they want, providing they will allow those states that do want the ACA to have it. This is not a “my way or the highway” solution, but “you can do things that fit your state’s culture, and blue states have the same privilege.” Allow states to opt in or opt out. The price of this accommodation: no changes to this rule until at least 2020, to give the ACA time to work.

This sounds like surrender but I am not worried. Yes, I would like to see the uninsured in red states get health insurance like the rest of us. But I am not worried that red states would opt out of the ACA for long. The experience in blue states will teach citizens of red states that there is nothing to fear. They will soon learn that the lack of containment of health care costs will work to their state’s disadvantage. Soon, they will choose to opt in. They will find, hey, that money from the federal government to subsidize the care of our poor citizens is a good thing. But they cannot come to this conclusion until their ideological fever fades.

It will work the same as it is happening now with gay marriage. The values of this country are changing to be more progressive, but that doesn’t mean the future shock underway will happen gracefully. Right now we are building a huge national bonfire of threats and rhetoric. Opposing forces are screaming at each other from opposite sides of the fire. We need to put the fire out and to let tempers cool. With a little time I believe that common sense will return.

As for red states, they too are becoming colored and will become more progressive as well. They cannot change their demographic trends either. Change will happen but it will probably happen better if it happens gradually in these states. Resentment builds a new bonfire that could burn across generations. There are lots of feelings to process and this will take time. This Republican frog needs to be boiled slowly.

Moreover, our nation needs healing. It does not need more polarization. Enlightened Democrats need to respect these feelings through local accommodation if possible. These demographic changes underway do not have to be 8 on the Richter Scale. Done the right way, they can be minor trembles instead. In the long run, this approach is a better way to heal our polarized nation.

Republicans can’t kill Obamacare

The Thinker by Rodin

One of the ironies of the Affordable Care Act is that Republicans were the ones to derisively name it “Obamacare”. So when it works, as it is going to, President Obama is going to get all the credit. This will make the Republicans look particularly stupid, not that they need a whole lot of help looking stupid lately. It might kill them as a party.

Perhaps it is the fear that it actually will work which is having them go into overdrive with desperate, last minute attempts to make it fail by convincing people not to enroll. They are doing so by refusing to set up state health exchanges but more recently by placing burdensome state regulations on Obamacare “navigators” (people paid to promote the insurance with uninsured communities) that effectively keep them from “navigating”. These tactics likely won’t work and worse are unconstitutional because of the supremacy clause to the U.S. constitution, not to mention the right of free association. Their hope is that by throwing sand into its engines before the courts tell the states their laws are invalid that it will cause the program overall to fail.

Good luck with that Republicans, because it won’t work. Granted, there may be some fits and starts to get the Affordable Care Act fully in gear. Whether or not navigators promote the law or not, it’s a straightforward matter for anyone who wants to get health insurance to acquire it: just get on line and sign up! On the national or state health exchange they can sign up for health insurance regardless of preconditions. If they don’t make a lot of money the government will subsidize some portion of their premiums.

The only ones to truly get screwed by Obamacare will be the working poor in red states, at least those red states like Texas which won’t accept Medicaid subsidies to expand the insurance pool. This is only possible, of course, due to the Supreme Court’s decision earlier this year that gave states the right to opt out of this part of the law. Now that decision definitely threw some sand into the Obamacare engine, but it was not fatal. It just meant that the poor, as usual, would continue to get screwed over in many red states. That will change with time.

So many ironies! It turns out that red states are essentially screwing themselves. By turning away free money to pay the medical expenses of their poorest citizens, these people will simply clog emergency rooms for costly “free” health care. This unofficial tax will be added to the price of health care services for the insured of these states, making their premiums proportionately higher than in states where Obamacare goes into full effect. This, in effect, makes blue states more desirable places to live because there is less health care cost shifting going on: health care expenses become more predictable. “Live free or die,” is the state motto of New Hampshire and by inference much of red America. But of course “freedom is not free”, as states like Texas will discover to their sorrow. The only interesting part of this exercise is how long they will hold out before they realize the futility of their own pigheaded stubbornness. There will be a whole lot of money that could have been used to build bridges and fund schools that will be needlessly squirreled away into higher health care costs instead.

This is because the whole point of insurance is to spread the risks, and thus the costs, lowering costs for everyone and thereby providing services that would otherwise be unaffordable. I don’t expect my house to burn down this year, so in the eyes of red America I am probably wasting money sending $600 a year or so to USAA. Essentially I am giving my money to someone else who will use it to rebuild their house when they have a fire. Of course should I have a fire, I’m out $600 in premiums and likely some costly but not catastrophic deductibles. But I am not left to rebuild my house with money from my savings account or using some loan that is based on my creditworthiness. $600 seems amazingly cheap for this investment of $500,000 or so. Essentially I pay .12 cents per dollar of the house’s value so I don’t have to pay to rebuild it in the event of catastrophe.

The same idea works with health care costs, of course. Only a very stupid wage earner when they measure their potential financial shock without health insurance will pass it up if they can possibly afford it. And with subsidies, they will be able to afford it, well, unless they make so little they count as working poor. If the states won’t take the federal money to insure these people then these low-wage workers will get screwed if they develop a costly condition. Many of them will die prematurely, but most will linger in pain and in poverty while racking up huge hospital bills that they cannot pay, but whose costs will simply be passed on to those who can: the insured.

Anyone who can possibly afford insurance is going to want to get it, and if they think they cannot they will find the cost of dodging it will increase every year with fines collected on their federal income taxes. At some point they will say, “If I am going to spend this much money not to be insured, maybe I should just be insured.” For now, these red states are hoping that ignorance will kill Obamacare. Keep the cheap to insure out of the market and it raises premium costs for the rest. In short they are betting on ignorance, hence their obsession with keeping “navigators” from navigating. It may work for a short while, but not forever, and if it works it will be locally, not nationally. Eventually some peer is going to tell them that they are insured now and it only costs X dollars and they are being subsidized with Y dollars of free money. It’s like a 401K employer match. Free money will get their attention, so let’s hope those navigating the navigators tell them to pitch it like this.

Despite attempts by some states to “overturn” Obamacare, it cannot be overturned by a state’s fiat. It is a done deal, a law largely upheld by the Supreme Court. It can only be repealed through an act of Congress signed into law by the president, or by a Congress that overrides the president’s veto.

It’s just like that scene from the movie Lincoln when, after the passage of the 13th amendment Lincoln meets with the vice president of the Confederacy who is making peace overtures. “Slavery,” President Lincoln informs him, “is done. Finished.” Check and mate! The Affordable Care Act is finished too. It can’t be overturned because it wasn’t overturned. Certain red states will screw themselves for a while as they try to make it not work in their states, but it won’t work nationally. Obamacare is done. It is potentially possible to repeal it, but it won’t happen without a Republican House, Senate and White House, and only if there are sixty or more Republican senators. In reality, at this point it can only be amended, and by amending it, it will only be strengthened, not weakened.

Obama may screw up his legacy by sending missiles into Syria to avenge the use of chemical weapons by its government. But he won’t screw it up through Obamacare. Ten years from now most people even in red states will be scratching their heads wondering why they opposed it in the first place. They probably won’t like paying their health insurance premiums and copays too much. I don’t like paying mine either. But I do like knowing one costly illness won’t wipe me out financially. So will millions of Americans simply trying to reach old age in a state resembling solvency.

Perhaps the most ironic part of Obamacare is that Obama will get credit for something he largely did not contribute to. He basically said he was for the idea of national health insurance but left the details to Congress. The Affordable Care Act was what emerged. Republicans named it “Obamacare” to tar it to President Obama, who they obviously loathe, and the frame stuck. Even the president now calls it Obamacare. It will be seen as the major accomplishment of his term of office. At least President Franklin D. Roosevelt truly instigated the New Deal. Obama, the man Republicans love to hate, will be gratefully remembered for Obamacare in the generations to come. He will wear laurels placed on his head by Republicans, who thought they were putting on a crown of thorns.

The real credit for the legislation though should go to the Democrats who controlled Congress at the time. Senator Harry Reid and Speaker Nancy Pelosi should be wearing those laurels, but also the sixty Democratic senators who, as a block, held themselves accountable when push came to shove and overcame cloture in the Senate. It was an improbable act of great bravery. Sadly, their contributions and these moments will be largely footnotes.

Republicans: Let’s talk real national security

The Thinker by Rodin

There is a little irony that a day after the Supreme Court narrowly decided the Affordable Care Act was constitutional after all, that I would undergo surgery. The surgery to correct a deviated septum (known as septoplasty) was actually scheduled six weeks earlier. My mother in law’s untimely death and my plastic surgeon’s busy schedule meant I had to wait until today for the outpatient surgery. It went well, but my time in the recovery room took longer than usual, perhaps due to aging. While waiting for the surgery, the TV playing in the waiting rooms was all about the Affordable Care Act decision.

My surgery was theoretically elective, but that did not seem to be the case for others in the waiting room. They included a ninety plus woman, virtually deaf due to plugged inner ears, who needed to get some tubes put into her ear so she could hear again. She looked miserable and her son acting for her largely could not communicate with her. Yet she was lucky. She was covered by Medicare. I was lucky too as I am covered by Blue Cross, and they approved my surgery. Even so I know there will be a whole slew of bills waiting me. It was nearly $900 just for the hospital to admit me. Doubtless the anesthesiologist and surgeon will bill as well, and there will be substantial copays for their services too. I’ll be lucky to escape this surgery for less than $2000, and that’s just for the copays. Blue Cross pays 85%.

I was back home by noon, my septum duly aligned and with various sinus polyps removed. Maybe this surgery will mean that I won’t need to spend my sleeping life tethered to a BiPAP machine for my sleep apnea. It’s a big maybe. Most likely I will continue to need the machine, but with the improved airflow, perhaps I can adjust the pressure settings downward, which would likely make sleep far more restful. Meanwhile I am downing Keflex and extra strength Tylenol every six hours and wearing a guard over my nose that is attached to little diapers to capture the bloody discharge from the surgery. Recovery from this sort of surgery is generally straightforward, and involves lots of use of QTips and hydrogen peroxide.

Mostly I am lucky because I am insured. My employer cares enough about me to provide it as a benefit, with me providing about a third of the cost of premiums. I am even luckier because even before the ACA I was already in a plan that required insurers to accept all comers. You see we federal employees have been been enjoying “Obamacare” for decades, and those employees I might add include members of Congress eager to repeal the ACA. And I must say, I like it. For decades I have been covered by health insurance, as has my wife and daughter. Insurers in the Federal Employees Health Benefit Plan have to accept people into their plans regardless of age and preexisting conditions. There are dozens of plans to choose from. On rare occasion, a health insurer will drop out of FEHBP, but it is a very rare occurrence. Mostly, health insurers are glad to cater to our market.

As I age, unsurprisingly, I have been using more health care services. I am quite certain that in spite of premium and my voluminous copays, we consume more in services than we pay in direct costs. It’s likely to be this way for the rest of my life. I don’t feel guilty about this. I feel grateful. I also feel like I’ve paid my dues. For the first twenty years or so that was likely not the case. I was paying for those older and sicker in the system. I did not resent this. It comes with the insurance territory. Health insurance only works if we are all in this together.

Essentially, the Supreme Court agreed yesterday. While Chief Justice Roberts surprisingly voted with the majority to uphold the law, and while he was silent about whether he personally thinks the ACA is a smart decision, he decided it is constitutional. This is good for our nation because by upholding the law at least for the moment he has likely fended off our devolution to a second world country.

Republicans are always anxious to vote more dollars for national security. I find it sad but curious that they don’t understand that national health insurance is also vital to national security. Most other first world countries figured this out decades ago, but we dithered. It is not surprising to me that since then we moved from greatest creditor country to greatest debtor country, and that our standard of living has devolved. National security is measured in many ways and it’s not just in the strength of our armed forces and intelligence. It is also measured by our willingness to invest in the human capital of its citizens so we can stay a prosperous country. In this we have been getting failing grades for some time.

We seem unwilling to pay the freight when it comes to education. We cheapen our public schools by increasing class sizes and shortening school years. We shortchange our public universities and expect students to mortgage more of their future by increasing tuition rates so they need to take out larger and larger student loans. This is keeping many from even attempting college, although many also have the talent. We also dumb down our curriculums. Courses like art, music and civics are considered expendable. Instead, we push highly structured and dumbed down standardized tests. Colleges are not immune from the phenomenon. As The Washington Post reported recently, college educations are becoming dumbed downed, or at least less time consuming. The Internet certainly makes research faster and more efficient. For most majors, the need for a full time college student to spend twelve hours a day on education, including often on weekends, as I did, is a thing of the past. I suspect this is to our detriment.

Education is vital to our national capital, but so also is our national health. It baffles me why this is not completely obvious. A healthy workforce is going to be more productive than a non-healthy one. If you are suffering from a health condition, your productivity is going to be compromised. If you suffer from a chronic condition, you may not be able to work at all. Where’s the good in that? Aside from inflicting needless misery on our citizens, why throw away the talent of so many of our citizens because they have a chronic condition? It’s such a tragic and needless waste and speaks poorly about what we really think about our fellow Americas. By throwing away our most precious asset, the skills of our own citizens, we guarantee our devolution as a nation. This is equally as dangerous to our national security, if not more dangerous, than securing our borders from illegal immigrants.

Mostly though while I waited for my surgery today I felt a mixture of relief and anger, not nervousness. The ACA, if we can keep it the law of the land, will do enormous amounts to make us a healthier and more productive nation, not just those like me still lucky enough to have health insurance. It will also relieve incredible amounts of unnecessary misery. Mostly though I felt anger that so many of my citizens are so ideological that they can no longer see our common humanity, who appear to think sadism is a virtue. These people, in the name of ideology would, like that heckler at a GOP debate last year, be enthusiastically rooting for people to be miserable and die.

The ACA gives us the opportunity once again to show our better nature. Let’s hope we find it again.