Further Away from Universal Health Insurance in Massachusetts

"We don't really care whether everybody gets insurance."

The Massachusetts Health Connector might as well emblazon that message on a banner and hang it the middle of Boston Common. It's what they're saying anyway by cutting the plan back 12%.

Already, as I have noted, many people in Massachusetts had coverage without care, because they couldn't afford to pay for the plan AND the deductible. Instead of paying the doctors, they paid the health insurers for plans that didn't give them anything.

Tuesday, the board of the Commonwealth Health Connector, which runs the mandatory insurance plan, dropped the last vestige of a pretense that everyone would even get insurance (useable or not). Are you a low-income resident, entitled by law to a full subsidy, but you forgot to sign up? Too late now. You and 18,000 people like you are out of luck. Even if you did what you were supposed to and enrolled, the Connector just snapped its collective fingers and took away your dental care. Or were you born in Ireland, or Greece, or Haiti, or El Salvador, and came to this country with full legal status? Tough. The feds aren't going to pay their share to insure you, so Massachusetts has decided you're just too expensive.

What makes it worse is that groups like Health Care for All, who should be marching in the streets, are busy making excuses for Massachusetts instead.

But the group said state officials appear to have made the best of a bad situation. “There’s no other place to go for money,’’ said Lindsey Tucker, the organization’s healthcare reform manager. “. . . My concern is people will not get the care that they need.’

Damn straight they won't! And it is not a health advocate's place to take the state off the hook. There are plenty of places to go for money. We just need politicians with backbones, and voters with consciences. We won't get either by dumping low-income and immigrant residents over the side of the leaky health insurance plan to lighten the load for the rich and powerful in this state.

Finally, They Ask Who's GETTING Health Care

The Globe reports:

People with robust [sic] health insurance are putting off doctors’ appointments and skimping on prescriptions because they can’t afford the increasing costs of copayments and deductibles, according to managers of patient-assistance hot lines in Massachusetts.

All right, let's give the reporters credit. Never mind the logical impossibility of health insurance plan being "robust" if you can't actually use it. (The operation was successful, but the patient went broke?) Also, forget about the fact that this only becomes news when it affects middle-class people, the kind who thought they were already well insured.

Let's be happy that finally, it's front-page news that the Massachusetts individual mandate to buy health insurance is failing to deliver actual health care to a large and growing number of people. The key word here is "failing." This is not a model for national health insurance. It's an object lesson in what happens when the hospitals, insurance companies, and doctors all design a health plan without the slightest thought for its effects on actual patients.

Morphing into "Bush Light" on Security Issues

There's more than the proverbial dime's worth of difference between Obama and Bush on domestic policy. In fact, for the anti-poverty agency where I work, there's hundreds of thousands of dollars of difference! But on the questions of intervention abroad and secrecy at home, Obama is rapidly acquiring the taste for an imperial presidency that characterized the previous administration.

Item: wars of choice. Bush famously sent American men and women into the line of fire in Iraq on a fool's errand. There were no weapons of mass destruction, Saddam Hussein and Osama bin Laden had no alliance and very little in common, and Iraq did not threaten the U.S. But the new administration is getting ready for an expanded war in Afghanistan, where U.S. intervention thus far has shifted control from one set of warlords (the Taliban) to another (the Northern Alliance) without making any permanent improvement in the lives of Afghanis and where civil war as soon as the U.S. pulls out seems inevitable.

Obama is also sending money to Pakistan, which more than any other country has offered aid and comfort to al-Qaeda. If Obama has good reasons to believe that the Pakistani military and secret police have changed tunes and now regard al-Qaeda as more of a threat to them than India, he hasn't shared those reasons with the public.

Item: Guantanamo. (Not "Gitmo," an ugly name invented by people who have no respect for the country of Cuba, part of which the U.S. has occupied for decades--imagine if the Cubans had a military base in Baja California!) Obama has pledged to close the prison camp there, site for torture and war crimes that should make all Americans ashamed. Yet he is letting NIMBY opposition keep him from transferring prisoners to U.S. soil to stand trial, and threatening to hold those trials in military commissions that Bush created, not in U.S. courts where a fair trial could be guaranteed. He is also ignoring the well-documented phenomenon of people being held in Guantanamo (and other secret prisons) for no damn reason whatever--just because some local U.S. ally whom they had offended put the "terrorist" label on their heads.

Item: secrecy and assertions of executive privilege. The Obama administration refuses to release logs of visitors to the White House. Dick Cheney took the same stand when he cut deals with the energy industry in secret meetings. The Obama administration also refuses to publish photos of U.S. soldiers, mercenaries, and spies torturing Iraqis or to prosecute torturers. And Obama wants to reserve the right to wiretap people and then try them on the basis of secret evidence. According to the Chronicle of Philanthropy:

President Obama’s administration has told a federal judge in San Francisco that it does not have to release top-secret documents connected to a wiretapping case in which a branch of an Islamic charity in Oregon is suing the government, reports the Associated Press.

The judge told the government in May he would punish it if it did not devise a plan for how the suit could go forward without the release of the documents, the news agency reports. However, the prosecution already had possession of the documents for a short time, when the Treasury Department inadvertently released them. The government has since taken them back.

The al-Haramain Islamic Foundation, whose Oregon chapter is now closed, was designated as an organization that supports terrorism by the federal government in 2004. The documents are a phone log documenting wiretapping of members of the charity, the news agency reports. It says the government did not obtain permission from a judge to place the wiretaps.

Feeling Ill about Health Care Debate

Following the health care debate is enough to make you sick.

Here in Massachusetts, supporters of the state's mandatory health insurance plan talk about how many people now have insurance and how much money that's going to save the hospitals and the state treasury. Critics mostly talk about the cost of the plan and how, soon, paying for those who can't pay for themselves will drive the state to the poorhouse. Some point out that businesses are providing their employees with health insurance plans that don't meet the minimum standards set out in state law, and daring the state to catch them.

All this is beside the point. The goal should not be to provide people with health insurance but to ensure their right to health care. Plans that cost low- to middle-income households a lot of money up front--plans with a high deductible, to use the industry's bland euphemism--insure coverage without care. And that leaves people just as sick as they were before, just a little poorer.

At the federal level, besides using Massachusetts as a model (!), Obama is doing the usual liberal dance: offering something that makes him feel good but doesn't do the job.

• "President Obama will sign a presidential memorandum today to extend benefits to same-sex partners of federal employees, administration officials said last night, but he will stop short of pledging full health insurance benefits," reports the Boston Globe.
• "A key Senate committee voted yesterday to expand a children's health insurance program to cover an additional 4 million uninsured children," but that still leaves many uninsured, and it says nothing about what happens to children when their parents fall ill.
• The current debate is over whether the federal plan should include a "public option." Proponents say that a public plan would give people more choices--which is only meaningful if the choices are any good, and if they differ in significant ways. They also say competition from a public plan would force private insurers to find ways to cut costs. Critics say the public plan could get a public subsidy and put private insurers out of business.

"In response, Senator Charles Schumer, Democrat of New York, has proposed setting ground rules for a public plan that would force it to compete on a level playing field with private insurers." In other words, get rid of the main reason for having a public plan in the first place, its ability to serve huge numbers of people at low cost!

Schumer is no different from the leader of his party in this respect. President Obama has done all but take a blood oath that his plan is not a "Trojan horse" leading the way for a single-payer system. That's exactly what's wrong with it! Single-payer means everybody gets health insurance as a right, the same as the right to vote or the right to a public education. The fact that the Democrats are falling all over themselves to rule out a single-payer solution is what's so sickening about what passes for a health care debate.

You Probably Think This Report is about You

Are they so vain? Or are "conservatives" like Michelle Malkin decrying the Department of Homeland Security's (DHS) Rightwing Extremism Report because, despite the fact that it doesn't once use the word "conservative," the report hits too close to home?

According to The Nation (June 8):

The nine-page report was a routine threat assessment issued to law enforcement and counterterrorism officalis that warned of the potential for a raise in homegrown terrorism. It concluded that the combination of an economic downturn and the election of the first African-American president [sic] could cultivate a right-wing "resurgence in radicalization and recruitment," including among disgruntled veterans.

Specifically, as summarized by ThinkProgress:

Anti-immigration: “Rightwing extremist groups’ frustration over a perceived lack of government action on illegal immigration has the potential to incite individuals or small groups toward violence. If such violence were to occur, it likely would be isolated, small-scale, and directed at specific immigration-related targets.”

Recruiting returning vets: “Rightwing extremists will attempt to recruit and radicalize returning veterans in order to exploit their skills and knowledge derived from military training and combat.”

Gun-related violence: “Heightened interest in legislation for tighter firearms...may be invigorating rightwing extremist activity, specifically the white supremacist and militia movements.”

This is specific and (to anyone who remembers the Oklahoma City bombing) highly credible information. It does not bear the stigmata of ideological bias: "DHS had released a similar report on left-wing extremists a few months earlier." Anyway, who ever accused DHS of being a nest of leftists? Some attention to reality here, please!

It makes me wonder what conservative commentators are thinking when they hear "rightwing extremist" and think it applies to themselves. If they are identifying with the white nationalists and the militia movements, what does that say about so-called mainstream conservatives?

How Fortunate!

We have been seeing how every clause of the first sentence of Bamidbar can be read as a testimony to God's love for the Jews.

• "On the first day of the second month, in the second year following the exodus from the land of Egypt"-- by specifying the date, the rabbis said, the Torah makes it clear that the census was a joyous occasion. (They actually go on to compare it to a wedding, and the census is the marriage contract or ketubah!)
  

• "In the wilderness of Sinai"--in the desolate places, where human beings often leave their bones, God feeds, waters, shelters, and teaches the Jewish people God's ways for forty years.

• "Take a census"--literally, "lift up the head." They will no longer hold their heads down like slaves.

For a coda, let me simply quote what the Midrash Rabbah says about "the Lord spoke to Moses":

How fortunate was Moses! Six hundred thousand people were present, and the priests, and the Levites and the elders, all were present, yet out of these [God] spoke only with Moses!

With midrash, the creative interpretation practiced by the rabbis, there are no boring parts of Torah. It is up to us to be equally creative.

You Must Buy Health Insurance--MGH Needs Your Money

I will get back to the delights of midrash in a bit--but first, the latest outrage from the Massachusetts health care system.

Massachusetts requires all residents to buy health insurance, even if it means coverage without care. Buying a health plan with a high deductible means paying for nothing, which is what thousands of Masschusetts residents are doing. But it's worse than that.

It turns out that our state government forced struggling young people and families into the insurance business partly so that hospitals didn't have to give them free care any more. "Today, hospitals typically spend about 1 percent of expenses on free medical care, as measured by the attorney general, half of what they spent before reform made insurance available to many more low-income people," according to Sunday's Boston Globe.

Meanwhile, nonprofit hospitals are making a profit out of their tax-exempt status--an exemption granted to them largely so that they could offer free care!

The 10 leading hospital companies benefited from an estimated $638 million in federal, state, and local tax breaks as well as state discounts on borrowing in 2007, the latest year for which complete data are available. More than half of that goes to two large and growing companies, Partners and Children's Hospital. Overall, the 10 hospital companies' tax breaks and other benefits were worth $264 million more than the value of the "community benefits" - care for the poor and other charity work - they reported to the state attorney general that year.

It's important to mention the hospitals that ARE offering a lot of free care: "Three companies - Tufts Medical Center, UMass Memorial Health Care (owner of UMass Memorial Medical Center in Worcester) and Boston Medical Center - reported spending more on community benefits than the value of their tax breaks as estimated by the Globe." But they are the shining exceptions--and Boston Medical Center is having severe financial troubles because of its commitment to serving the poor.

In short, so-called nonprofits like MGH and Children's Hospital are stiffing the poor, and we are giving them a tax break at the same time. This should be the shame of Massachusetts.