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By Tom Cushing

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About this blog: The Raucous Caucus shares the southpaw perspectives of this Boomer on the state of the nation, the world, and, sometimes, other stuff. I enjoy crafting it to keep current, and occasionally to rant on some issue I care about deeply...  (More)

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Since When are Competition and Lower Medical Costs a Bad Thing?

Uploaded: Feb 7, 2014
I am writing in response to brother blogger Tim's recent description of developments in the East Bay health care market. I'll admit to some uncertainty about the piece, which contains many relatively disconnected facts, conveys an extended commercial for one established competitor, employs language that suggests opposition to these developments, and ultimately hopes for unspecified legislative change -- because if Anything touches on ObamaCare, then it must be bad.

Let's start with the language of "invasion" and "roiling" the local market that is already "challenging." Sounds like a nefarious threat to the proper status quo, right? But Tim's an established free marketeer, and isn't that what competition always does: invade and roil? Or does it matter whose ox is being (b)roiled?

Later, the text speaks of having to "cope" with "the demands of ObamaCare." What demands, you might ask? Apparently, there is a belief that the Great Evil (a/k/a the ACA) "will reduce reimbursements to hospitals." Except that the government does not reimburse hospitals under the ACA, insurance companies do. ObamaCare is distinctly Not a single-payor system, like Medicare is – it simply drives more customers in the direction of insurers by requiring access. Make no mistake – the dominant party in the carnal dance of medical economics is the hospitals – as the insurers accommodate and enable their opaque pricing. And I don't think I have to tell you who's really been getting, ahem, scrod in the process.

Further, let's assume the ACA does mystically exert downward pressure on health care costs – how (oh, How!) would that be that a bad thing? The phenomenon that is Actually moderating such increases, and may eventually bring down medical costs, is price transparency that facilitates comparison shopping. ObamaCare is not intended to address that problem directly, but others – notably large benefits providers like CalPERS and big companies – are just now starting to find and flex their free market buying power. And efficient health care providers are beginning to recognize their competitive advantage and go along. THAT's the competition that will help this mammoth market work the way it's supposed-to, to the benefit of consumers.

The blog then launches into an extended promotion of all things ValleyCare, including its recently deposed CEO. I guess that would be okay, if equal time was given to the new entrant in these 'stakes, but it's not. It's in the nature of a commercial – possibly useful to newcomers, but hardly fair-and-balanced. If the point is that we don't need new providers here – well, that's a decision that capitalism leaves to the free market to decide. Unless health care is somehow different?

The final paragraph is notable for two things. First, the language slant continues, as everyone "strives" to "adjust to the 'demands' of ObamaCare." Again, if true – how would that be bad or unusual? And don't consumers – all of us – gain from such striving in every market setting? Does the blog really want to side with hospitals here, and against users that every market is built to serve? Does it want to choose that side when the evidence is so clear that the market has been rigged to serve the hospitals' remarkably profitable interests? Does it mean nothing that Americans spend double – Double -- for the same health outcomes as the rest of the First World?

Second, the blog calls for completely unspecified "solutions" based on "changes" in DC. Solutions for whom (as above)? If you want to serve consumers, the obvious change is single payor. Otherwise, much greater regulation of business practices and mergers would be required to rein-in the current market abuses by big hospitals, especially as regards pricing. On the other hand, if you want to serve those hospitals' interests, then frankly, ObamaCare helps-out by smoothing and rationalizing the payment stream from several million new or formerly free users. Again, it's not clear whose side the blog takes, but there is a conflict of the respective interests -- it can't serve them all.

Moreover, I am tired of serial miss-characterizations of the ACA to be a whipping-boy for Everything That's Bad. It may end-up being more costly than the non-partisan Congressional Budget Office has projected (as is off-point here, but will surely be pointed-out anyway). Or it may not be – we'll see eventually. But you cannot responsibly just trot-it-out to explain every perceived tribulation of your favorite hospital, as if that was so obvious as to not require either logic or explanation. Its repeal may be the continuing nocturnal fantasy of the Right, but efforts in that direction are bound to be about as productive. You may not like it – but let's at least bring a modicum of accuracy to the objections.

As to the Tri-Valley specifically, come on in, Muir – the water, what there is of it, is fine.

Comments

 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 7, 2014 at 1:32 pm

Doug Miller is a registered user.

Instead of commenting on another\'s blog on that blogger\'s site, you have twice written your own blogs about Tim Hunt\'s blog topics. Tim must be choosing more interesting topics. Is there no respect/boundaries/protocol among bloggers? On the other hand, imitation is often deemed the sincerest form of flattery.

"let\'s assume the ACA does mystically exert downward pressure on health care costs – how (oh, How!) would that be that a bad thing?"

How about fewer doctors, fewer insurance companies and less medical R&D for starters. We can find others if you are not convinced.

"as everyone "strives" to "adjust to the \'demands\' of ObamaCare." Again, if true – how would that be bad?"

It is bad because, this president has amended this federal law about 16 times. Amended is really the wrong word because this legislation was not amended by congress. The president just chose to ignore some parts of the law. When congress threatened to legislate one of his changes, the president threatened to veto that legislative change.

It is hard to know what the law is or what it will be tomorrow. For example, sometime around New Years Eve he declared that previously cancelled insurance policies that did not meet Obamacare requirements should be continued for another year. And the president kept extending the deadline for enrollment in December so that insurance company employees probably worked 24/7 though the holidays so that enrollees would be covered by January 1st. Never mind that backend backend payment systems were not built to pay insurance companies for coverage.

"Its repeal may be the continuing nocturnal fantasy of the Right".

Thanks for reminding us of the disgusting comments by Representative Swalwell. As a writer and lawyer, you should be attributing this comment to the person who came up with it. It is his intellectual property, so to speak.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 7, 2014 at 1:34 pm

Doug Miller is a registered user.

Not sure how all these backward slashes appeared in the most recent respond above.


 +  Like this comment
Posted by Huh?, a resident of Danville,
on Feb 8, 2014 at 12:03 pm

The provision of medical care has been undergoing a significant change for many years now. More and more doctors are working as employees instead of independently than in the past as large, corporate-style physicians groups and hospitals have been taking over and shutting out individual medical practices through a variety of techniques. "Urgent care" clinics staffed by employed health care practitioners in which treatment for routine and minor health issues can be provided at a lower cost than at a full-fledged hospital have been multiplying like rabbits. That's just a simple dollars and cents development, and it's not much different than what happens in lots of areas of economic endeavor.

The change that Obamacare has encouraged is to shift the emphasis somewhat from pay-for-treatment, which makes it more profitable for a medical practitioner to deal with injury or disease after it has gotten serious, to pay-for-health, which rewards the prevention of disease and injury. Kaiser has long followed the latter philosophy, but was an outlier.

As time goes by there will continue to be winners and losers. Various players will look for "friendly" voices to promote their place in the competition. The blog to which Tom refers appears to be an example of that phenomenon. And of course, the politicized voice of "If they're for it, we're against it and everything about it must be bad, bad, bad" as articulated by Doug will continue to be a feature of American dialogue as well. Pointing out such verbiage for what it is is a valuable chore, and I'm glad Tom has taken it on. For too long the canned repetition of corporate spin and focus-group tested political soundbites have been allowed to skate by as if they were actually a reasoned contribution to the discussion. They're not.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 8, 2014 at 10:51 pm

Doug Miller is a registered user.

Huh?'s comment above might be titled, "move along folks, nothing to see here." The comment suggests that healthcare is just naturally evolving. Devolving would be a much better recent description. Huh? suggests that any criticism of Obamacare is just partisan and irrelevant.

Two months ago I visited a medical specialist who I get to visit about every three years. I asked him how his business environment has changed. He gave me an interesting example. He said that ten years ago he had a staff of three. Today it has grown to nine. He said the additions were necessary to handle ever increasing paperwork, stay informed of the many changing rules and to protect his business from the threat of business ending law suits. But, of course, this is only an anecdote.

Obamacare is like a tornado that is bringing havoc and chaos to the lives of many Americans. Last fall six million policies were cancelled. Recently a survey reported that at least 400 companies had scaled back full time jobs to 30 hours or less. This week we learned that the Congressional Budget Office now projects that about 2.3 million American will choose to leave the labor force in order to obtain or maintain highly subsidized Obamacare insurance. A report in the Los Angeles Times this week described the incredible difficulty of not only keeping the doctor you like, but of even getting to see any specialist under Obamacare. It seems that many specialists are opting out of Obamacare.

But the most devasting news is that Obamacare will make no difference in the number of uninsured Americans. In a September 2009 speech, the president urged congress to pass the bill "because there are now more than 30 million Americans who can not get coverage". According to the same CBO report, by 2024, there will still be 31 million uninsured Americans.

None of this matters to those who love big government programs. Like Huh?.


 +  Like this comment
Posted by Tom Cushing, a resident of another community,
on Feb 9, 2014 at 10:45 am

Sorry for the delay in responding -- this making-a-living business is getting in the way of my blogging. Something must be done!

Doug: if you consider my blog above to have been an 'imitation' of its predecessor, then you failed to understand it. As to protocol, do you Really think I'd have written this if it hadn't been discussed as something interesting that we will sometimes do? I look forward to other bloggers' 'takes' on my stuff, too, whenever they choose -- the field is wide open, and often admits of more than one viewpoint.

And while we're at it -- who made you hall monitor in this little high school? Please display your badge while on patrol. And when you have your own blog (see Gina's ad, above in the menu), then you'll be free to choose its topics. Until then ... there's an ac(ronym) for that.

As to your latest catalog of ACA horrors, you plop out "fewer doctors, fewer insurance companies and less medical R&D" as somehow related to either or both of the ACA and medical cost moderation. As is ever the case, this is done without explanation, citation or logic. Until you do that, you're just hyper-ventilating. There's a home remedy for that: Web Link

As to all these confusing changes, kindly tell us how any of them have affected ValleyCare's business, or you for that matter. The folks who are affected are now finding their way to the sign-ups, especially around here where the website provides at least mediocre service.

I'll let Mr. H respond to the other nonsense, although it's tempting. But as to your admonishment about the admittedly crude -- but irresistibly apt -- repeal metaphor, first: there is No original thought in the world, and that's an oldie (but a goodie, eh?). Second, please know that Mr. Swalwell gave me a license -- it was on the Agenda at one of the clandestine midnight meetings we favor.


 +  Like this comment
Posted by Huh?, a resident of Danville,
on Feb 9, 2014 at 11:29 am

Doug, I don't doubt your doctor's story about staffing up to deal with paperwork, but I have to break some news to you: that had nothing to do with Obamacare. And anyone who has an HMO or PPO is only too familiar with the dance we all have to go through to see the specialist of our choice. Again: nothing to do with Obamacare.

And you've misstated what the CBO report says: it says that 2.3 million Americans will now be free to reduce their hours or leave jobs they are working at solely because they need to keep them in order to have health insurance - and other Americans who need jobs to put food on the table can step in to take their places. The guaranteed availability of health insurance has created an opportunity for people who don't need to work for economic reasons unrelated to health care to step aside for those who do.

What the CBO said:
"The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in businesses' demand for labor, so it will appear almost entirely as a reduction in labor force participation and in hours worked relative to what would have occurred otherwise rather than as an increase in unemployment (that is, more workers seeking but not finding jobs) or underemployment (such as part-time workers who would prefer to work more hours per week)."

Maybe you find fault with freeing people to make their own decisions about whether and how much to work without having to fear losing their health coverage, but you're right: I'm kind of in favor of that. You complain about "big government programs" but seem to have no problem with big corporations having their employees by the balls because they're terrified of losing their health insurance, as is the case now.

Your "survey" about 400 companies reducing hours?

CBO: "there is no compelling evidence that part-time employment has increased as a result of the ACA"

As to the number of uninsured Americans, you've made the mistake of believing the right wing spin you've apparently immersed yourself in. There are 30 million uninsured "Americans" today - a number which **excludes** unauthorized "residents."

From the CBO report:
"...the insurance coverage provisions of the ACA will markedly increase the number of nonelderly people who have health insurance – by about 13 million in 2014, 20 million in 2015, and 25 million in each of the subsequent years through 2024 ... Still, ... about 31 million nonelderly residents of the United States are likely to be without health insurance in 2024, roughly one out of every nine such residents."

Of those 31 million uninsured, about half will be either unauthorized immigrants (30 percent) or eligible for Medicaid but not enrolled (20 percent). Most of the rest (45 percent) are expected to be Americans who choose not to purchase insurance. And, the CBO believes, about five percent will not be eligible for Medicaid because they live in a state that has not chosen to expand coverage under the ACA.

So, yeah: Obamacare will "only" reduce the number of uninsured **Americans** by ***25 million.*** And of those Americans remaining uninsured, a portion will be screwed because the Republicans in charge of their state government elected not to allow the expansion of Medicaid which would have covered them, and a portion will simply elect not to have coverage - an option the "big government program" allows them to make.

Granted, the program I would have preferred - a single payer system, instead of the system initially promoted by the Heritage Foundation which grew into Obamacare - would have avoided all of those problems. But Obama elected to try to compromise with the Republicans and chose their preferred type of health care funding reform instead. And it's that compromise which actually at the heart of the criticisms Obamacare has met. But you don't want to address that, do you?

Facts. The unpleasant speedbump to right wing ideology.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 9, 2014 at 4:37 pm

Doug Miller is a registered user.

"Huh?"

We actually agree on what the CBO stated about those 2.3 million people who will choose to leave the labor force. Please reread what I wrote. And it is ironic because a couple of days ago on another one of Mr. Cushing\'s blogs, I cynically predicted that Democrats would call this a jobs bill. And there you go, you have said so.

The problem with this theory is that while they will "voluntarily" choose not to work, we will be paying them to do so. Some of the tax money collected by the program will be used to incent people to leave the labor force. You think this is a good idea, a good use of federal funds. I don\'t.

Let\'s illustrate this absurdity by being more direct about it. Let\'s say that the federal government should create the "TTJASI" program. The letters, of course, stand for Take This Job and Shove It. Each recipient could apply for a $50,000 annual payment if they agreed to leave their job and stay out of the labor force for 12 months. It would be a hit with millions of working people thereby freeing up millions of new jobs. There is no end to the number of jobs we could "create" if we are willing to pay enough money to idle everyone.

TTJASI is not really that farfetched. We already have it in little modules. We pay people not to work with unemployment compensation, SNAP and SSDI, just to name a few. SNAP and SSDI have expanded dramatically under this president. As those 2.3 million "choose" to leave the job force, they might then qualify for these other safety net programs. When would you, Huh?, become concerned that a safety net program is being abused, when everyone is on one or multiple programs?

"Your "survey" about 400 companies reducing hours?"

No, it wasn\'t my survey, although I know some young employees at a Livermore winery who were cut back to 30 hour a week late last year. It wasn\'t because business has declined. The winery didn\'t say that they were cut back due to the pending employer mandate either. But it seems fair to draw conclusions, doesn\'t it?

You can find an article about the survey here:

Web Link hour per week&p=2

I would have written more about my conversation with my medical specialist but the response was already getting a little long. He did also say that he had to spend time studying and preparing for Obamacare. This is no trivial task. The original bill was about 2400 pages (that few in congress read, if any, before passing the bill). And I understand that implementing regulations fill about 19,000 pages. My doctor had to assess his new risks, such as not getting paid. You may have read that many small practices are now asking for credit history and permission to bill credit cards if they are not paid. My doctor told me that he is uncertain if his business will survive the uncertainties he faces. But, of course, this is only anecdotal. And it all has to do with Obamacare.

You are blatantly lying when you say that Obama chose to compromise with Republicans by choosing their program. Did some Republican somewhere come up with a similar idea? Maybe. Did ANY Republican vote for Obamacare? No. How was that a compromise? And wouldn\'t compromise have been much better? If, maybe fifteen or twenty Republican senators and maybe seventy five or one hundred Republican congress members voted for a real compromise, then there would be no continuing debate, even if the compromise was as bad as the current plan. Everyone would be working together to fix things. But now the Democrats own it.

Finally, I am wondering why you hide behind a false name? Wondering if there is some lack of courage to write under your real name.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 9, 2014 at 4:49 pm

Doug Miller is a registered user.

Tom:

Making smug, condescending and arrogant comments doesn't help your case. It is a sign of defeat.


 +  Like this comment
Posted by Tom Cushing, a resident of Alamo,
on Feb 9, 2014 at 7:31 pm

Nah, Doug -- they are signs of smugness, condescension and arrogance, in response to some pretty silly statements.

That said, I understand your preference to not come back on the merits of claims about fewer docs and all those terribly difficult changes. Some might see surrender in that silence (not I, of course, but some folks).


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 9, 2014 at 8:58 pm

Doug Miller is a registered user.

"Silly." Good response Tom.


 +  Like this comment
Posted by BT, a resident of San Ramon,
on Feb 9, 2014 at 11:34 pm

Doug, never argue with a lawyer. The only thing Tom does is open that hole beneath his nose and hope that someone will take him on in a debate. Tom reminds me of what use to be known in ancient Greek as a Sophist. Sophists had one important thing in common: whatever else they did or did not claim to know, they characteristically had a great understanding of what words would entertain or impress or persuade an audience. Sound familiar?

And as for Huh? I can't help but think that he and Tom are one and the same.


 +  Like this comment
Posted by Tom Cushing, a resident of another community,
on Feb 10, 2014 at 6:34 am

I'll take the comparison to Mr. H, Esq. as a compliment. His stuff is lucid, logical and well-written. So, thanks!

The thing that lawyers typically do is to argue points without the process devolving into the nasty personal realm. That characteristic does distinguish them from many other commenters. I've not always agreed with Mr. H on these boards, but the interchange is always spirited and fun. I'd enjoy partaking of an adult beverage with the likes of him, and some others.

I suspect that the personal nastiness has something to do with his maintenance of anonymity hereabouts. But the only ID on this board that we can Really be certain of is mine, and I'm not him. Trust me -- I'm a lawyer, after all.


 +  Like this comment
Posted by American, a resident of Danville,
on Feb 10, 2014 at 11:44 am

My biggest concern about Obamacare is it will either negatively alter or eliminate my Kaiser health plan, that I have had for over 20 years and am very satisfied with. Friday night I had to take my child to Kaiser ER, and he was immediately triaged, seen by medical doctor, had CT scans, and within two hours of stepping foot in Kaiser ER on a Friday night had diagnosis/prognosis by caring, competent ER staff and were on our way home. I pay about $500 a month for Kaiser for us, and my employer contributes a limited amount.

As I explained to my child, unfortunately many people, prior to Obamacare, thought it was more important to have daily starbucks, newest clothes and toys, rather than being prudent and cutting back on their expenses to purchase health insurance. It cost me $100 in premiums to have my child seen at Kaiser ER Friday night, have labs, CT's, and see ER doctor, where if I went to John Muir or San Ramon Regional and did not have health insurance prior to Obamacare the bill would have exceeded $3,000.

Part of the reason Kaiser is able to offer affordable and decent healthcare, is mandatory arbitration of alleged medical malpractice, so they do not have to practice defensive medicine by running up costs for unnecessary care to cover themselves from third party run away lawsuits. Unfortunately, despite the thousands of pages of Obamcare, there is no tort reform or reasonable limitations of lawsuits in this law.

In order to force people to be prudent, who refused to be prudent, President Obama implemented Obamacare, and the concern is that my employer, and many others, may end up not offering Kaiser, but instead forcing us into Obamacare.

I do believe the elimination of a pre-existing condition is Obamcare is a good thing, but as usual I think President Obama is more concerned with "helping those who are not prudent in their life" with laws at the expense of those who live a prudent life within their means.


 +  Like this comment
Posted by Huh?, a resident of Danville,
on Feb 10, 2014 at 2:32 pm

Doug, I really enjoyed this part of your post: "You are blatantly lying when you say that Obama chose to compromise with Republicans by choosing their program. Did some Republican somewhere come up with a similar idea? Maybe. Did ANY Republican vote for Obamacare? No. How was that a compromise?"

You actually stick closer to fact than most of the right so I'll assume that you in fact are aware that Obamacare is in fact entirely based on the Republican-backed program, laid out by the bastion of the right, the Heritage Foundation, in opposition to democrat-supported single payer proposals.

And I suspect that you also know that there is absolutely nothing Obama could have done to get any Republican votes for Obamacare. Period. The reason there were no Republican votes for it was not because it wasn't a program designed on their side of the aisle, it was because Obama was in favor of getting **something** done, and they were determined to prevent him from accomplishing **anything** regardless of what it was. You can't "compromise" with someone who's top priority is to oppose anything you try to do - even if it's their idea in the first place. And I suspect you know that, too. I also suspect that you've checked out the ludicrous "proposal" which Republicans Hatch, Coburn and Burr have trotted out - with its substantial tax increase - and are aware that it in fact wouldn't solve the problem and couldn't get passed in the Republican dominated House anyway.

Your "TTJASI" schtick is less worthy, however. The silliest straw man arguments are often fabricated by taking something that works in moderation, and then saying "if a little is good, why not multiply it by a thousand, huh?! How would you like that!" Arguing that an increase in the minimum wage to ten or fifteen dollars is bad because "Why not raise it to a million dollars, huh!?" was a classic of that genre; your "TTJASI" is just more of the same. Come back when you have a real argument to make.

American, I think you should mull over your concern that someone you consider unworthy will get a benefit from Obamacare, when you think they shouldn't. What comes through your post loudly is a combined sense of superiority, spite, and victimhood - not the most admirable of set of characteristics.

What comes through Doug and American's posts, whether they intend it or not, is a sense that people they look down on should be forced to toe the line or face punishment. "Do as I say or die." OK - not quite that melodramatic, but that's the actual bottom line: the price of making what Doug and American consider poor life choices or not working hard enough or long enough is: no doctor for you.

We're talking health care here, not TV sets. I've made some good choices in life and as a result enjoy economic security. I know others who have made bad choices who face a life of economic insecurity. I also know people for whom you could reverse the factors on both sides. I wouldn't wish a denial of health care on any of us.

I think as a nation we should have the maturity to make it so that everyone gets health care. It's done in virtually every other advanced nation on earth.


 +  Like this comment
Posted by Peter Kluget, AKA Huh?, a resident of Danville,
on Feb 10, 2014 at 2:49 pm

Tom, I want to thank you for your kind words. (Although I suspect you're aware that I can get just as pi$$y as anyone else around here. I just pretty it up with fancy words.) And I do know, as I suspect you are also aware, that I'm not you.

But I have cogitated long and hard on Doug's harsh words bout my anonymity, so I've decided henceforth to drop the nom de 'net of "Huh?" and post under the a real name: Peter Kluget.

It's not **my** name, but it is **a** name.

(True story: years ago on a different forum some other folks who took exception to my opinions thought that they had deduced my "true" identity and started harassing a perfectly innocent guy who had no idea why he was being targeted. It eventually died down with him none the wiser, since he in fact didn't frequent that site and the nasty folks moved on to other crusades.)

I prefer to let the facts and arguments speak for themselves, and not rely on argumentum ab auctoritate. I have no idea who "Doug Miller" is, and my opinion of his comments is neither aided nor denigrated by the fact that that name is appended to his posts.


 +  Like this comment
Posted by john, a resident of Another Pleasanton neighborhood,
on Feb 10, 2014 at 5:00 pm

It's really strange to me that some people refuse to bail out poor people when they make bad decisions, but are more than happy to bail out companies like AIG when they make bad decisions.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 10, 2014 at 10:09 pm

Doug Miller is a registered user.

No Tom, we REALLY can't be certain of your identity either. There is a lot of false information pushed out through the internet. And besides, this is not about you. It is about the discussion of facts and ideas.

As to Huh?, at least he admits he is afraid to post under his real name. In a perverse way, that admission takes some of courage.

But a lie is a lie, unless we redefine the meaning of 'political compromise'. When the majority party takes an idea from a political action group and writes a bill around it, then allows no debate or amendments by real ELECTED minority members, does not allow time to read the bill before the vote ("we have to pass the bill so we will know what's in it"), that ends up gets no Republican votes, that is not a compromise, it is spin, propaganda, and a lie.

Both Clinton and Reagan knew how to achieve political compromise. As a result, they are considered successful presidents. Obama promotes division with incendiary language like "If they bring a knife to the fight, we bring a gun." Or, "They can come for the ride, but they gotta sit in the back of the bus." He has poisoned the well for the rest of his term.

Huh?'s quote, "no doctor for you" is the bottom line of Obamacare. The better and usually more expensive doctors, specialists and hospitals are being excluded by or dropping out of Obamacare. More patients and less medical providers mean longer lines and rationing. Another words, no doctor for you. But we'll all have Obamacare insurance cards and we will feel good about that!

Today, in yet another example of faith in the Obamacare program, the administration announced up to a three year delay in the employer mandate. No doubt the Democrats did not want to see headlines this fall that employee insurance coverage was being cancelled for millions of potentail voters. The cancellation of six million individual policies was enough. This new move was designed to get Democrats past the 2014 midterm elections and the 2016 presidential election.

Obamacare is a disaster for Democrats and a gift that keeps on giving for Republicans.


 +  Like this comment
Posted by Sue Thayer, a resident of Danville,
on Feb 11, 2014 at 7:03 am

No "bus," just a pithy metaphor, circa 2010. Quite funny, actually. Context matters.

In a stump speech in Providence, Rhode Island last week, President Obama said:

"Look, I've been using this analogy as I travel the country. Imagine the Republicans driving the economy into a ditch. And it's a deep ditch. It's a big ditch. And somehow they walked away from the accident, and we put on our boots and we rappelled down into the ditch -- me and Jack and Sheldon and Jim and Patrick. We've been pushing, pushing, trying to get that car out of the ditch.

And meanwhile, the Republicans are standing there, sipping on a Slurpee. (Laughter) Fanning themselves. We're hot and sweaty and pushing, and they're kicking dirt into the ditch. (Laughter.) Getting it into our faces. But that's okay. We said -- every once in a while we'd ask them, "Do you want to come down and help?" They'd say, "No, but you're not pushing the right way, though. Push harder."

Finally, we get this car out of the ditch, and it's banged up. It needs some body work, needs a tune-up. But it's pointing in the right direction. The engine is turning and it's ready to go. And we suddenly get this tap on our shoulders. We look back, who is it? The Republicans. And they're saying, "Excuse me, we want the keys back." You can't have the keys back. You don't know how to drive! (Applause.) You can't have them back. Can't do it. (Applause.) Not after we've worked this hard.

We can't have special interests sitting shotgun. (Laughter.) You know, we got to have middle-class families up in front. (Applause.) We can't -- we don't mind the Republicans joining us. They can come for the ride, but they got to sit in back. (Laughter.)


 +  Like this comment
Posted by Peter Kluget, a resident of Danville,
on Feb 11, 2014 at 9:33 am

Finally the real truth comes out: "Obamacare is ... a gift that keeps on giving for Republicans." That's the real reason for "no compromise" - the Tea Party afflicted Republicans in Congress saw no political advantage in working with the Democrats on any solution to our burgeoning health care financing problem, and an opportunity to seize advantage from adopting a "dog in the manger" attitude instead.

So that's what they did. And the "lie" is that that's not their fault, but Obama's fault. The Republicans didn't want to solve a problem, they wanted "a gift that keeps on giving." And that's the truth.

And on to details: "The better and usually more expensive doctors, specialists and hospitals are being excluded by or dropping out of Obamacare. More patients and less medical providers mean longer lines and rationing."

Really? What are those "better and more expensive" doctors going to be doing? Knitting? Skiing? Or seeing patients? We have always rationed health care in this country - always. The "better" doctors can only see so many patients. The rest of the patients see other doctors (who generally are not bumbling incompentents, by the way.) That won't change. That can't change - it's simple math. And Obamacare won't change that. Will the identity of the ones who see the "better" doctors change? Maybe. Maybe not. So what? Do you have some overarching theory about who "should" get to see the "better" doctors and who shouldn't, that Obamacare is somehow going to change? Because if you do, I'd love to hear it.

Face reality, Doug: all of the obsession with every glitch in the rollout of a new program, the anecdotal claims (many of which have already been exposed as hoaxes perpetrated by ideologues) the "surveys" which don't rely on verifiable data and include responses from your fellow Republican "gift" seekers - it's all based on politics. Sure, there are glitches - just like there were with Medicare, Medicare part D, etc. But the obsessive overselling of every misstep, the "sky is falling" rhetoric - that's all just cynical ploys to advance the political prospects of the Republican party.

I understand where you're coming from, Doug, and that's okay.

But don't try to wrap yourself in a false cloak of morality, or set yourself up as the arbiter of what is a "lie." You are advancing a political agenda, nothing more. You are spinning facts (including out-of-context references.) I assume you're not doing that on purpose; I assume you gorge on the slanted spin you get on right-leaning websites and media outlets without subjecting the content to an appropriate degree of skepticism, then you internalize it and regurgitate it. That's normal.

But in fact, Obama has been an unusually conciliatory President. His efforts to achieve some sort of compromise with the Republicans have been persistent and extreme, despite their lack of success in a Tea Party infected political environment. That is the reality. The only reason for lack of bipartisanship is the Republicans believe that they can achieve more for their brand by being obstructionists than by trying to forthrightly address the nation's problems and needs. That agenda has succeeded with you. That's the problem. In a sense, your willingness to believe and repeat the spin they have dealt out is the essence of the problem facing America today.

And your susceptibility to being spun is not Obama's fault.


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Posted by American, a resident of Danville,
on Feb 11, 2014 at 12:43 pm

"Huh": It seems as though all of your posts are directly out of the Democrats playbook, and that you are fully drinking the President Obama Kool Ade, never challenging or questioning anything your party does or says. Although I usually disagree with Tom's posts, I do respect the fact he will on occasion question or challenge things President Obama says or does, and is at least somewhat open to thoughts and ideas offered from the other side of the aisle. "Huh", if you want to have more credibility, it would be nice to see you at least pretend to be open minded to different thoughts and ideas, and for you to have less personal attacks on those whose views you differ from.

Let me suggest an easy one for you. Eric Holder,your parties fearless AG, is now pushing states to allow convicted felons to vote.(of course, knowing that most convicted felons would vote for Democrats who passed legislation allowing them to vote) How about it, "Huh", should Federal Government get involved in pushing states to allow convicted felons to vote? I think I know your response. Oh well, is there ANYTHING that you disagree with President Obama with?


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Posted by Tom Cushing, a resident of Alamo,
on Feb 11, 2014 at 1:40 pm

This just in: there seems to be something to this stand-your-ground defense, after all.

Still unable to sit comfortably in the wake of last year's government shut-down disaster, it seems that Mr. Boehner has announced he will bring a 'clean' debt ceiling bill to the floor shortly. He claims to have rustled-up the 18 GOP House members who aren't facing TeaPer primary challenges to vote with the Democrats and pass it.

If only Mr. Obama had hit on that no-negotiation-with-terrorists strategy earlier in his tenure ...


 +  Like this comment
Posted by jake, a resident of Alamo,
on Feb 11, 2014 at 1:52 pm

I am somewhat intimidated to make a comment. The level of intellect and the polished prose is beyond my pay grade. The anonymity, however, does afford me opportunity.

Blogs have a life of their own; a comment by one blogger about another blogger turns into a debate about ACA/Obamacare. Tom is a smart guy so I suspect he knew how to enter this debate through the backdoor. I find good points made by both? sides although they do not want to acknowledge each other. I learned long ago that the Democrats and Republicans are engaged in a friendly game of poker and both sides win enough to continue playing; otherwise the game would have ended. The Tea Party has tried to get a sit at the table but neither side wants to face an unknown player so both the Republican establishment and Democrats don't like the Tea Party.

Re healthcare: I believe on this issue as with others, the American public has the same value system; the debate is about how to achieve them. All of our traditional systems are evolving and as individuals we will have varying experiences with the changes and will have different explanation of the causes. For me and my wife, for 2014, our premiums were raised 87% and 230% respectively and we received a letter from our employer that for 2015 and beyond, medicare eligible retirees would have to go through an exchange (yet to be established) to obtain insurance. Is it due to ACA? or some of these things would have happened as the society and businesses react to changing environment? I don't know! Wow, once more I managed to say something without calling anybody any names! I must be growing up! Cheers.


 +  Like this comment
Posted by Peter Kluget, a resident of Danville,
on Feb 11, 2014 at 1:58 pm

American, I was unaware of the felon/vote thing. Of course, I an aware that convicted felons already can vote in many states - in California, once they have completed the period of their parole, for example. There are variations between different states, however, which can lead to confusion. (Sorry, I tend to get stuck on "facts" when confronted with a rant.)

The problem with disenfranchising people for felony convictions is that the definition of a "felony" is pretty inconsistent. If a white guy gets busted for holding powdered cocaine he's likely not to wind up with a felony conviction. Change the two adjectives to "black" and "crack" and the answer may be different. Why should one be allowed to vote and not the other? I once knew a business owner who (unbeknownst to a lot of his clients) had been convicted of manslaughter after a bar fight in his youth. Should he not be allowed to vote? Does it make sense that he can legally vote in one state but not the next? Frankly, I don't see much of a logical connection between criminal record and the right to vote. If you've really thought it through and have a reasoned basis for disagreeing with that, please feel free to share.

As for disagreeing with Obama, I do that a lot. Single payer in the health care field is item #1. It should at least be an option. NSA and Guantanamo are two more. And I think Obama should act on marijuana's status as a "Schedule 1" substance.

I'm sure there's a lot more. But yes, I am a Democrat. It's easier than trying to suspend my ability to think for myself and simply repeat focus-group tested soundbites, as would apparently be required of me in order to become a Republican.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 11, 2014 at 9:13 pm

Doug Miller is a registered user.

I am looking forward to November.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 12, 2014 at 10:59 am

Doug Miller is a registered user.

Jake writes, "I find good points made by both sides although they do not want to acknowledge each other. ".

He is about to experience some of that in describing his dramatic rise in healthcare costs for 2014 and beyond and lobs a softball by asking if this could be due to Obamacare. One side will say yes, the other, no.

I can easily acknowledge and agree with some basic liberal points. For example, Republicans and Democrats agree that having a safety net for the poor, and the temporarily poor, is the right thing to do. But defining and agreeing on the safety net is where both side diverge.

I support the idea of providing basic healthcare relief for those who are unable to provide it for themselves. This is where we all agree. But we did not need to totally restructure a system that works for 85% of our citizens. Instead, we should be working to find ways to address only those uncovered cases where they, in fact, want some coverage.

Obamacare has already disrupted the jobs and medical care for millions of people. Yesterday a newspaper headline stated "Obamacare Signups Slowing to a Crawl". Worse, the proportion of healthy enrollees is much smaller that expected. This will cause the insurance companies to loose money and under terms of Obamacare they will be entitled to a government bailout.

To stop the bleeding, the president has, for the second time, postponed the employer mandate which would have disrupted the coverage for million more, people like Jake. The president's stated reason was to accommodate the pleas from big business. The real reason was to get past the next two election cycles.

No doubt, Tom will call all of these points, "silly".



 +  Like this comment
Posted by Tom Cushing, a resident of Alamo,
on Feb 12, 2014 at 11:14 am

Commenting breathlessly on both blogs about my topic: silly.

Claiming bruised sensibilities over my repeal metaphor: silly.

No source links for false/exaggerated/out-of-context claims: silly.

Trying to get my goat on my birthday: silliest of all. Have fun.


 +  Like this comment
Posted by Peter Kluget, a resident of Danville,
on Feb 12, 2014 at 12:04 pm

I appreciate Doug's comment about the fact that the system is working for 85% of Americans. And in fact the vast majority of Americans were and are already covered by Medicare, employer-funded private insurance, and Medicaid (Medical in California.) The differences Obamacare made in employer-provided policies were minor, and seemingly for the most part non-controversial: extending the age of dependent child coverage to 26, eliminating "caps" above which people had no more coverage, etc. In fact, a significant amount of the caterwauling I've heard comes from people who had policies which were cheap because they had substandard benefits, including those "caps", which can only be replaced with more expensive policies which don't have them. It's true: there have to be some folks who previously paid less than they will now, just as there are those who pay less now. After all, the ultimate cost of providing medical care doesn't change much, only the way the payments are funded. And when you eliminate the right to gamble on going bankrupt due to catastrophic medical conditions which exceed a policy's cap it's going to cost a little more.

Obamacare has a significant impact on the 15% who were previously uninsured, and to some extent on people with pre-existing conditions whose employment status - and lives - were frozen due to fear of losing their coverage. For them it's a godsend. So all of the "sky is falling" rhetoric in fact is based on a program with relatively little actual impact on most people.

That doesn't mean that one party can't decide that it's a "gift" they can capitalize on for political gain, however. And that's what we're seeing.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 12, 2014 at 3:35 pm

Doug Miller is a registered user.

If Obamacare will have such little impact on employee provided healthcare, why has the president now twice delayed implementation of the employer mandate past the next two election cycles? Answer: Democrats won't survive more bad news about the program.

Personally, I am disappointed that the president is not following the law as it was passed by the legislative branch. Doing so would ensure a rout this November.

And who are you to decide if my insurance policy is substandard? We make choices based on our needs and financial circumstances. It is one thing to find ways to assist the needy, in the case of healthcare, about 15% of the population. It is quite another to tell the other 85% who are happy with the it healthcare how they will spend their money, how they are to assess their risk and what policies they must buy.

And, of course, "substandard insurance" to the elitist decision makes means, in part, including features many people don't want or need. Why does a couple in their sixties or seventies need coverage for pre and post natal care? And why should I pay your expenses for birth control. On second thought, maybe I would be willing to do that for you.

According to current government regulations, unless you are driving a brand new car, it is substandard. You are probably living in a substandard house too. You need to bring them all into compliance. Shouldn't cost much. Check with you local building department on the building codes implemented since your house was built. And while you are at it, make sure your neighbors do the same.


 +  Like this comment
Posted by Huh?, a resident of Danville,
on Feb 12, 2014 at 4:29 pm

Actually, Doug, the biggest problem with substandard insurance is that the taxpayers are the health insurer of last resort. If you were a "young invincible and decided that you don't need to pay for insurance (because you're young and healthy and have no significant net worth) that would be a rational economic decision - for you. But it's a rational decision because of the law Reagan signed requiring hospital ER's to treat everyone, even if they can't pay. If the young invincible gambles and loses he's really no worse off for not having insurance - the rest of us will pick up the tab.

If you decide to buy a policy with a million dollar "cap", and suffer injuries or an illness which require medical care which exceeds that cap (which is not that rare these days) then once again, you, too, will leave us holding the bag (after your exhaust your savings and go bankrupt.) That's the current system - you know, the one you're defending.

The baloney about birth control is just spin and focus-group tested soundbites. I have to pay for treatment of Tay-Sachs and sickle cell anemia - which I have no use for. Should I be outraged that the cost of treatment for the people afflicted by those conditions is not excluded from my policy? According to you, it's "elitist" to insist that I share the cost for those conditions even though they only affect a minority of the population which doesn't include me. (Do you ever think this stuff through before you repeat it?)

Young people share the cost of treating Alzheimers. Old people share the cost of pregnancy-related conditions. The whole point of "insurance" is that the cost of the risks faced by any of us are shared by all of us. You don't seem to get that. (Why am I not surprised? The unofficial motto of the Republican Party is apparently "I've got mine, Jack. Back off!")

The examples you cite about cars and houses don't actually make the point you seem to think. You cannot legally sell a new car without required safety features. You cannot legally sell a new house that isn't up to code. When you replace your lightbulbs you're going to have to use more efficient bulbs than you used to. Any permit-related work will trigger a check for compliance with retrofitted smoke detectors and earthquake proof gas valves. Everyone was required by law to retrofit their homes to add CO2 monitors last year. When features of commercial products cause a widespread cost to society (avoidable injuries from car crashes and leaky furnaces, waste of energy from lack of insulation, inefficient lighting, etc.) it's just sensible to enact regulations which require that the people who would choose to ignore the cost they are willing to incur (without having to pay all of the hidden costs themselves) meet minimum standards so as not to leave the rest of us in the lurch.

None of this is new. Making political hay by encouraging ignorant right wingers to feel victimized by it is not new either. (I have heard the complaints about the light bulbs, seat belts, crash helmets, insulation, etc., etc., etc. over the years. Plus ca change...)

I'm happy to see you've taken the mask off and made it clear that your true motivation here is to make as much noise as possible so as to advance the fortunes of your political party. I get that. But don't go on about Obama's lack of "compromise" until you put the mask back on. It's unbecoming.


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Posted by Tom Cushing, a resident of Alamo,
on Feb 12, 2014 at 4:47 pm

Huh, so to speak. We made it to 30 comments -- same as my birthday! Give or take a few more than that.

AND, we did it with nary a Noam, nor an S-P, nor the Lagomorfette-who-shall-not-be-named. We'll have to do this again next year.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 12, 2014 at 10:39 pm

Doug Miller is a registered user.

As someone once said, you are entitled to your own opinion, but not your own facts. You want big government controlling your life. I don't. I will take my risks and make the choices I deem appropriate for my family.

All your arguments for this massive and misguided program based on others having to pick up the tab for our inability to be responsible fall flat when people can still easily and cheaply opt out of Obamacare by paying a small fine.

And all the early victims of Obamacare are of no interest to you. Yet, daily we read about them. Just read that there is no system built to appeal incorrect decisions for applicants. All these files went to some server that no one can access. But who cares. Not you or your those who support all those well meaning but failure prone big government programs.

As Tom would say, your arguments are silly and many of your assertions seem to be made up as you go.


 +  Like this comment
Posted by Peter Kluget, a resident of Danville,
on Feb 13, 2014 at 8:11 am

"As someone once said, you are entitled to your own opinion, but not your own facts. You want big government controlling your life. I don't. I will take my risks and make the choices I deem appropriate for my family."

No you won't. As a statement of "fact" that's flat out false.

If you were to "make the choice" to become uninsured and your child became deathly ill or injured beyond your family's ability to pay for their care you wouldn't accept the consequences of the risks you took. You'd go begging to the "big government" to pay to save your child's life. And nobody would blame you for begging. There are no libertarians in the County hospital ER waiting room.

(Not to mention the false dichotomy inherent in the entire statement; what "facts" do you think you're talking about? All I see you doing is posturing and spouting shopworn ideological soundbites.)

But that's the real issue here: the Republican insistence on privatization of gain and socialization of loss. You want to insist on the right to cheap out on your contribution to the nation's medical care costs while safe in the knowledge that the nation's commitment to step in to save you (and your family) from the consequences of your choice if things go wrong will be honored. You want the benefit of "big government" without paying for it.

That's why I call the GOP the "something for nothing" party. You blithely assume that all the benefits you get from living in an advanced society are just "natural" and whine incessantly about paying for them, insisting that all your tax dollars go for undeserving "others."

Are there problems with the roll out of Obamacare? Of course there are. Every large corporate or governmental initiative has glitches in its early days. And when you have a large contingent determined to undermine it and capitalize on every problem, those glitches will be magnified way out of proportion. That's what we're seeing. No surprises there. Opting out for a small tax penalty? The penalty gets bigger later. If it were larger now you'd be complaining about that. (Don't deny it; your credibility is strained enough already.) The fact that a program of this nature has to be phased in over a period of years is not a sign of fundamental flaws; it's evidence of the fact that it takes time to get people to work through a new system - particularly when ideologues are shouting against it on street corners every day. That's the (actual, not politically spin doctored) reason for the one year deferral for smallish businesses and the ramp up of the "incentive" for participation. No one said that Obamacare would solve all of the problems with our health care financing system (of which there are many) overnight. It will take a while to iron out all the wrinkles. Again: no surprises here.

And we can count on the right wing complaining loudly about it every step of the way, without offering any viable alternatives. After all: ***Obamacare is the Republican's program in the first place.*** What would they replace it with, other than the nothing they've offered?


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Posted by Doug Miller, a resident of Country Fair,
on Feb 13, 2014 at 10:33 pm

Doug Miller is a registered user.

Huh?/Peter Kluget aka Huh?/Peter Kluget/Tom:

You make so many assertions that deserve a response. I think that each of them deserve a separate response. In short order Tom will be sixty years old.

Let's take the comparison I made yesterday regarding your "substandard" car and very likely your substandard house. Our huge government bureaucracy, be it federal, state or local, is always adding to the regulatory burden. Every few years the expected fuel economy is raised, new safety features are mandated and pollution standards become more stringent. Your car probably does not meet these latest requirements.

The same applies to your house. If it was built in 1970 and you made no changes to it, then it does not meet current building codes, unless you live in a natural cave. Your assertion that it must be brought up to code in order to sell it today is wrong, unless you made changes that required a local building permit. Bit, let's say you made no changes and still have that orange shag rug.

In the case of the old car and the old house, these are all essentially "grandfathered in". You get to drive and live I substandard products. Which leads back to the President's biggest lie of his presidency. He promised to grandfather in existing health policies when he said at least 50 times variations of "if you like your healthcare policies, you can keep it, period."

So, since you like his program and all his lies, get your house and car up to standard first. You are wasting gasoline, polluting is all and subjecting your family to unknown dangers in the substandard house of yours. And get on your neighbors to do the same. I am sure they will appreciate your interest in their well being.


 +  Like this comment
Posted by Tom Cushing, a resident of Alamo,
on Feb 14, 2014 at 7:03 am

Frankly, I'm busy inflicting my next blog on this community. I'm also not 60 (as might have been deduced above), not much vulnerable to old guy insults anyway as I'm thrilled at how salubrious 63 feels (if you're fortunate, you may get to find out some day), AND I'm not Huh/Peter Kluget, again. And again. Or ever.

I do have a quick observation: remarkably often, folks who blather petulantly about Big Government invading their lives and telling them what to do, have way too little hesitation before invading other people's lives and telling them what THEY ought to do. Interesting phenomenon.


 +  Like this comment
Posted by Doug Miller, a resident of Country Fair,
on Feb 14, 2014 at 5:31 pm

Doug Miller is a registered user.

Give us some examples.



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