Tag Archives: obamacare

45 C.F.R. § 92.4; or yes, there is a difference between the parties.

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For any Bernieite or other lefty grumbling that there’s really no difference between the parties, I hereby present section 92.4 of the implementing regulations of section 1557 of the Patient Protection and Affordable Care Act:

On the basis of sex includes, but is not limited to, discrimination on the basis of pregnancy, false pregnancy, termination of pregnancy, or recovery therefrom, childbirth or related medical conditions, sex stereotyping, and gender identity.

…

Sex stereotypes means stereotypical notions of masculinity or femininity, including expectations of how individuals represent or communicate their gender to others, such as behavior, clothing, hairstyles, activities, voice, mannerisms, or body characteristics. These stereotypes can include the expectation that individuals will consistently identify with only one gender and that they will act in conformity with the gender-related expressions stereotypically associated with that gender. Sex stereotypes also include gendered expectations related to the appropriate roles of a certain sex.

Boom.  Now go forth and proudly vote for Democrats, up and down the ticket.  Because there is a difference.  A real difference.

 

Chief Justice Roberts quietly burns Scalia in the Obamacare decision – The Washington Post

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Chief Justice Roberts quietly burns Scalia in the Obamacare decision – The Washington Post.

From the WaPo article:

The main question in the case is about the subsidies used to buy health insurance by people who otherwise can’t afford it. Roberts and Scalia disagree on whether Congress meant for the subsidies to be available through the federally run insurance marketplace set up under the law, as the Obama administration argued, or if Congress wanted to give subsidies only to people who bought insurance through an exchange operated by a state government, as the law’s opponents claimed.

Roberts agreed with the administration. He wrote that it was “implausible” for Congress to set up a system in which people who used the federal marketplace wouldn’t be able to get financial help buying insurance. Scalia disagreed. But, back in 2012, he had written that without subsidies, “the exchanges would not operate as Congress intended.”

And then there was this, from yesterday’s decision affirming the validity of the disparate impact theory of fair housing decision.  The majority opinion by Justice Kennedy explains that the Court had previously held similar language in Title VII and the Age Discrimination in Employment Act (ADEA) to support that theory.  Regarding the ADEA decision, Justice Kennedy wrote:

In a separate opinion, Justice SCALIA found the ADEA’s text ambiguous and thus deferred under Chevron U.S.A. Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837 (1984), to an Equal Employment Opportunity Commission regulation interpreting the ADEA to impose disparate-impact liability, see 544 U.S., at 243–247 (opinion concurring in part and concurring in judgment).

Texas Dep’t of Hous. & Cmty. Affairs v. Inclusive Communities Project, Inc., No. 13-1371, 2015 WL 2473449, at *8 (U.S. June 25, 2015).  In other words, in 1984, Scalia believed that the language of the ADEA was ambiguous on the question of disparate impact and deferred to the regulations, something he refused to do with respect to the Fair Housing Act yesterday.

And this was just gratuitous, as I’m confident there are approximately 10,000 statutory construction treatises Kennedy could have quoted from:

Against this background understanding in the legal and regulatory system, Congress’ decision in 1988 to amend the FHA while still adhering to the operative language in §§ 804(a) and 805(a) is convincing support for the conclusion that Congress accepted and ratified the unanimous holdings of the Courts of Appeals finding disparate-impact liability. “If a word or phrase has been … given a uniform interpretation by inferior courts …, a later version of that act perpetuating the wording is presumed to carry forward that interpretation.” A. Scalia & B. Garner, Reading Law: The Interpretation of Legal Texts 322 (2012).

Id. at *11.

Such weird unpredictability from someone who believes the meaning of the constitution was fixed in 1787.

[Updated to add the second Inclusive Communities quote.]

Many Obamacare Critics, Including Koch Brothers, Accepted Its Subsidies

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Many Obamacare Critics, Including Koch Brothers, Accepted Its Subsidies.

File under “R” for Republican Hypocrisy, though by now you may need a larger filing cabinet.

I continue to wonder what their plan is for people who are not millionaires.  The free market will magically deliver cancer treatment at the local Wal-Mart?

Clearly they (Kochs; Republicans in general) are not opposed to Obamacare purely on principle, because of course they’d never accept subsidies, right?  What does that leave?  The pure political battle, in which they attack a policy that has provided insurance coverage — and related benefits like health, peace of mind, and the ability to leave an old job or start a new business — to millions of their fellow Americans simply to win the football game that is modern American politics.

This was, in fact, the theory of leading Republican pontificator William Kristol in 1993:  no negotiation; no compromise; no health care plan.  Let’s not figure out how to help people (i.e. govern); just kill it in an attempt to harm the other team.

So to my various conservative friends & family members who are likely to unleash the hounds in the comments — what’s the plan?  How are we going to pay for cancer treatments for minimum-wage workers?  How are we going to delink work and health care so that people — even those with pre-existing conditions — can have the freedom we hope all Americans have to innovate, to leave old jobs and start new businesses?

What is the plan?

Fox News: Random Word Generator

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Fox Freaks Out Over CVS Ending Sales Of Tobacco | Blog | Media Matters for America.

On Fox’s The Real Story, host Gretchen Carlson approached the CVS decision with suspicion and a remarkably uninformed premise, asking, “Is it OK legally … to restrict tobacco availability in a private store like this?” She questioned her guests as to whether they would continue shopping at CVS and observed that, “For people who smoke, you know, they have a right to buy cigarettes. It’s not illegal.”

So a private company makes a business decision that liberals — and specifically President Obama —  think is a good idea, and suddenly it’s not clear to Fox News whether it’s OK.  What’s the alternative:  requiring CVS to sell its quota of tobacco to meet the current five-year plan?

The GOP is supposed to be the party of private enterprise.   Then CVS makes an inventory decision, or Costco makes a salary decision, or Coca-Cola makes a marketing decision, or Obamacare makes it easier to quit your job and start a new small business (or stay home with your kids), and the right rejects these monumentally pro-business moves for the simple reason that the left likes them.

Today’s Republican party is not the party of private enterprise.  It’s the party of anger.  Knee-jerk anger.  I guess its chances of long-term success depend not so much on policies or demographics, but on the ability to sustain content-free anger.

OrmayberomneyDOEScare.

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Who knows?

Just last Sunday, Mitt Romney was touting the benefits of Universal Emergency Room Healthcare.   Yesterday, he apparently decided that sounded too crass, not to mention thoroughly ineffective.  Via Risking Conservative Ire, Romney Touts Romneycare | TPM2012.

“[D]on’t forget — I got everybody in my state insured,” Romney told NBC. “One hundred percent of the kids in our state had health insurance. I don’t think there’s anything that shows more empathy and care about the people of this country than that kind of record.”

In other words, “message:  I care,” . . . every third day until November 6.

Romneydoesntcare

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I’m sure this has been covered more thoroughly, eloquently, and learnedly elsewhere, but how the hell can Romney say this with a straight face:

In the 60 Minutes interview, Romney protested the idea that government doesn’t already provide health care to the uninsured: “Well, we do provide care for people who don’t have insurance,” he said. “If someone has a heart attack, they don’t sit in their apartment and die. We pick them up in an ambulance, and take them to the hospital, and give them care. And different states have different ways of providing for that care.”

So no mammograms, but once the cancer has metastasized to your lungs and you stop breathing, an ambulance will take you to the emergency room.

No dialysis, but when your kidneys fail, an ambulance will take you to the emergency room.

No annual physical, but when you have a heart attack, the ambulance is ready!

This isn’t about those grabby poor people Romney has clearly written off.  It’s about people who are too rich for Medicaid but too poor to buy their own health insurance.   And THAT category includes many hourly workers, independent contractors, and people who are starting their own businesses.  Future job creators rather than current job destroyers.

And how on earth is his plan pro-life?  Seriously — you can defend this approach on doctrinaire libertarian grounds, but how can you square it with the position that life is sacred and that the government has a legitimate role in protecting it?

 

Amycare: replace doctors with veterinarians

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Anyone who has ever taken a pet to the veterinarian has probably thought:  geez, why can’t humans get health care like that?  I mean, at the most basic level, vets are just cooler than MDs.  Think of all the vets you’ve known in your life and then all the doctors:  who would you rather hang with? Case closed.

But it’s more than that.  Our older dog is now seeing a specialist, so we are having a good deal of exposure to the veterinary profession.  This has placed the differences in stark contrast.

Both our regular vet and the specialist call us a day or two after each appointment just to see how our dog is doing.  I’m not sure my PCP would know me if she ran into me at the Target the day after my annual physical.  And I really do like my PCP; it’s just not part of the human medical culture to follow up.

The vet specialist also faxes a report to the regular vet after each appointment, and calls *him* to follow up.  When I needed one doctor to send my file to another doctor a few years back — just send the damn file; no communication; no follow up — I had to make multiple phone calls and fill out multiple forms, and I still showed up at the second doctor’s office to find that no communication in any medium had occurred between the two doctors, their staff, or their file rooms.

And our vet appears to use computer technology from the post-1995 period.  At a recent human medical appointment, the receptionist handed me a form when I checked in.  I pointed out that none of the items on the form had changed since the last appointment.  No good:  “It’s a policy, we have to update our information.”  But there’s nothing to update.  “Sorry, it’s a policy.  We require this form.”  A form made of paper, from dead trees, which they expected me to interact with using primitive ballpoint technology.  I pointed out that they had also every single piece of information requested on the form having photocopied my driver’s license and insurance card only moments ago, but I was instructed to please sit down and just fill out the form.  After I filled out the top half, I handed it back and pointed out that since I was the insured, the information requested on the bottom half of the paper was already filled in on the top.  Nope.  Still not good enough.  “The two halves of the form go to different places,” I was told, “You have to fill out both.”  At about that moment, I looked at the receptionist’s computer and noticed:  DOS.  That’s right, green type on a black screen.  In 2011.  I can go up to a computer terminal at the Bed, Bath and Beyond and find out what wedding gifts my friends and family in distant cities have registered for, but MY DOCTOR is using DOS, and asking me to fill out identical information on the top and bottom halves of a piece of paper in much the way I filled out a field trip permission slip in 1971.

You can’t really do a head-to-head comparison of the financial aspect of human and dog care, because the veterinary industry lacks many of the important cutting edge features of the American human medical system:  astronomical insurance company executive salaries; palatial insurance company corporate campuses; and cubical farms staffed with adjusters trained to deny your claims.  So it’s not really fair to point out that the financial aspect of dog care is much simpler:  after each appointment, we hand them our credit card and we’re done.  But that is at least part of the point:  the vet industry doesn’t have to support legions of insurance executives, so the amount we’re paying is a very small fraction of what our insurance company pays our doctors.  And honestly, how different *is* a human body from a dog’s?  We seem to have many of the same internal organs.  Can human treatment really be that much more expensive?  (This is where my brother will blame the lawyers.  Love you, Bruce!)

Finally, of course, no matter how intrusive the medical procedure, I have *never* been offered a treat.  Not once.