Thursday, January 20, 2011

Health Care And the Cost of (Republican) Freedom

Republicans are forcing their hand on health care. Short of repealing the Affordable Care Act, which they cannot do--at least while there is a Democrat in the White House, they are seeking to defund the law that Congress passed last year. That is a real threat, one that angers me and those who, like me, suffer from chronic illnesses (not to mention those who suffer from illnesses that will lead to their death if not adequately treated).

I know my case is not exceptional, and that there are many who are in a much worse predicament. And that is exactly what is so frightening about my case: it is so typical.

Currently, I enjoy fairly decent health insurance coverage via my employer, and--as long as I remain employed--the worst things I have to worry about are the yearly increase in premiums, increasing co-pays, and declining benefits (at least until I find out otherwise). However, whether I like my employer or not, and for the most part I do, I do not have the leisure to quit and take a better offer. Why? Because I suffer from two chronic illnesses and pre-existing conditions are, in this country and in this country alone, a curse that never goes away. Even now, after the passage of the Affordable Care Act, this is what the law provides for in the area of pre-existing conditions: [emphases added]
For most plans starting on or after September 23, these rules stop insurance companies from imposing pre-existing condition exclusions on your children; prohibit insurers from rescinding or taking away your coverage based on an unintentional mistake on an application; ban insurers from setting lifetime limits on your coverage; and restrict their use of annual limits on coverage.

Starting July 1, Americans locked out of the insurance market because of a pre-existing condition can begin enrolling in the Pre-existing Condition Insurance Plan (PCIP). This program offers insurance without medical underwriting to people who have been unable to get it because of a preexisting condition. It ends in 2014, when the ban on insurers refusing to cover adults with pre-existing conditions goes into effect and individuals will have affordable choices through Exchanges – the same choices as members of Congress.

(Source: The Affordable Care Act’s New Patient’s Bill of Rights)

That sounds like a fairly decent deal. However, notice a couple of things in the preceding paragraphs: annual limits on coverage are restricted (but not banned until 2014, when they finally will be). This may sound reasonable, depending on the limits or the condition a patient suffers from, but it does not offer total peace of mind for the chronically or gravely ill. Also, refusal to deny coverage for pre-existing conditions for adults is not outlawed until 2014. In the meantime, people can enroll in the Pre-existing Condition Insurance Plan (PCIP), which comes with its own set of concerns.

First concern: PCIP is not available in all states. For example, it is not available in my state of Colorado, because Colorado has opted to run the PCIP program itself. That's fine now, the rates seem pretty reasonable. But as states face growing budget shortfalls, guess what might happen to premiums, deductibles, co-pays, etc.? What then?

Also, note that in order to be eligible for PCIP enrollment a) you must have been uninsured for at least the last six months; b) if you currently have insurance coverage that doesn’t cover your medical condition or are enrolled in a state high risk pool, you are not eligible for the Pre-Existing Condition Insurance Plan; and c) you must have a pre-existing condition or have been denied coverage because of your health condition. (Source: Pre-Existing Condition Insurance Plan home page)

The rules that limit to PCIP enrollment are disturbing for the following reasons: first, access to PCIP is limited to those who meet strict eligibility rules; second, even those who are eligible to enroll are subjected to a waiting period of at least six months. Tell me: who pays for medical expenses during those six months?

Overall, the changes introduced by the Affordable Care Act are far from comprehensive or adequate, at least until 2014; they still leave a lot of gaps and a lot of questions to be answered. And yet, they are a step in the right direction because they start addressing the uniquely American system deficiencies that cause people to go without adequate care, or to go bankrupt while they are fighting for their lives, and because they unchain many Americans from the yoke of unhappy employment, allowing them to look for better opportunities elsewhere without the threat of being exposed to loss of health care or unreasonable costs (and you would think that Republicans, who always pose as friends of opportunity and free enterprise, would love that).

These changes seem like a step in the right direction for everyone, except for Republicans. In fact, Republicans are so unhappy with them that they would rather destroy a law which has the potential to improve the lives of countless Americans. Why? Because it is a government takeover of health care and, with it, the government is taking away your freedom. You heard me right: Republicans are STILL painting their opposition to the new health care laws as a principled stand for freedom, against a government takeover.

Leave aside the fact that the so-called government takeover of the health care system (the lie of 2010, according to the independent fact-checking organization Politifact) is set to deliver 40 million new customers in the hands of... insurance companies. What freedom exactly is the Affordable Care Act taking from us? The freedom to be sick and die without care? I guess Republicans think that I should thank them because they are fighting to preserve my freedom to die, or to go bankrupt while I try to get better.

The word freedom, in the mouths of Republicans, has lost all meaning. It has lost its uplifting nature and has been disfigured into a scare-word, the dog-whistle that the Republican Party successfully uses when they want the American people to willingly give up something that many generations have had to fight for, or that they are on the verge of achieving. Conquests that have worked for decades like Social Security, Medicare, Medicaid, public schools, are all under assault. How could it be? Because, say Republicans, they are an assault on your freedom. Say what?!?

A crazy gunman loads an extended magazine, capable of holding over 30 rounds, into a Glock and kills 6 and injures 18, so someone says "let's ban extended magazines". Not guns, mind you, just extended magazines. And Republicans scream "Freedom is under attack!", and nothing ever changes, nothing ever improves, nothing ever gets done. And people, increasingly apathetic and dumb, and outFoxed, fall for that trick every single time.

Make no mistake: The Republican Party is no friend of freedom. It is more and more like a tyrannical power that seeks to stifle dissent using patriotism as a pretext, that seeks to destroy critical thought (see their proud, avowed anti-intellectualism) and any criticism of its "pure" motives. Its only interests are never-ending wars and total deregulation. They do not care about you, they do not care about me, and they will not be happy until we are at the complete mercy of the corporations that they pave the road for.

There is no doubt that the Republican Party has become a wholly-owned subsidiary of the U.S. Chamber of Commerce and of the corporations that the Chamber represents. It is obvious that their god is not the Christian god they profess to worship but Mammon. It is obvious that the only language they hear and respond to is the language of political corruption and bribery. And, for these reasons, it is not surprising that they are hell-bent (and I do hope that it is not just a figure of speech) on dismantling any and all improvements in access to and in the cost of health care services, just as they are hell-bent on destroying Social Security (under the pretense of strengthening it, no less), just as they have successfully fought to weaken unions to the point of irrelevance, just as they have started to starve our public education system by introducing charter schools, which are just the Republican Trojan horse to eventually reallocate all public funds to private schools.

The Republican Party's assault on everything public, everything good, is despicable enough when it does not directly lead to the death of Americans. But when it rises to the homicidal level of denying care to the sick it is not just despicable, it is outright criminal. And those who support Republican policies aimed at achieving the total depletion of the Commons to the sole and reckless advantage of the private sector are accomplices, who should be exposed and treated as such. They are, intentionally or not, acting against the Constitution that are supposedly defending from "the enemy within" (liberals, homosexuals, immigrants, "the Washington elite"). A Constitution, let's not forget, designed in such a manner as to make it possible "to form a more perfect Union", "[to] insure domestic Tranquility," and to "promote the general Welfare" of its people. Sure enough, the Constitution was also established to "secure the Blessings of Liberty to ourselves and our Posterity." Liberty, you know, freedom. The Founding Fathers could hardly have envisioned that the word liberty, freedom, would have become little more than a dog-whistle in Republican hands.

Not one Constitution-loving Republican has yet been able to explain how the Union is made more perfect by leaving people to die without care, how domestic tranquility is promoted by creating millions of angry survivors who know that their dear one's life might have been saved anywhere else in the civilized world, or by creating an ever growing underclass of have-nots, or by egregiously and willfully failing to promote--scratch that: consciously sabotaging--the general welfare of its people.

I will patiently wait for an answer. Until one pre-existing condition or another mercifully finishes its job.

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