First Do No Harm

A Short History of the Affordable Care Act

When the affordable care act was being argued the first time by the Supreme Court, the arguments concerned the constitutionality of the “mandate.” Pundits everywhere pointed to George Washington’s mandate that every able bodied citizen keep a weapon and ammunition ready.

This was known as the Second Militia Act of 1792. It first had to pass the House and then the Senate and was signed into law by George Washington. Here is part of its text:

"That every citizen, so enrolled and notified, shall, within six months thereafter, provide himself with a good musket or firelock, a sufficient bayonet and belt, two spare flints, and a knapsack, a pouch, with a box therein, to contain not less than twenty four cartridges, suited to the bore of his musket or firelock, each cartridge to contain a proper quantity of powder and ball; or with a good rifle, knapsack, shot-pouch, and powder-horn, twenty balls suited to the bore of his rifle, and a quarter of a pound of powder; and shall appear so armed, accoutred and provided, when called out to exercise or into service..." [http://healthcarereform.procon.org/view.resource.php?resourceID=004740]

The argument was nearly as old as our country; that “the nation's founders" had no problem requiring citizens to enter into commerce.

“‘George Washington thought that a purchase mandate was OK,’ says Ian Millhiser, a legal policy analyst at the liberal Center for American Progress.”

We have found our precedent: a mandate requiring citizens to “purchase” something. What all the pundits missed, apparently, was that two years previous to this act, there had been another mandate that is even more apropos of our health care debate: Congress had mandated that ship owners buy health insurance for their seamen. Again, it was signed by George Washington, the Father of our Country. [GEORGE WASHINGTON SIGNED THE FIRST HEALTH INSURANCE MANDATE!]

So as you can see, the Affordable Care Act finds its roots way back in the early history of this country.

I am quite sure everyone has heard the phrase “legislating from the bench.” This is when judges choose capriciously (at least to those who disagree with the decision) to support a law which others might not find constitutional.

When up for Senate confirmation, we often hear Supreme Court candidates use the term “stare decisis,” a legal term meaning that person will make his/her determination according to “precedent.” If it happened previously, then he/she must go along with it in new cases she/he rules on. “Legislating from the bench” ignores (or seemingly ignores) precedent and is a political decision that people agree with or disagree with along political lines.

Chief Justice Roberts, in his decision (the first time the ACA came before his court), chose the precedence of “taxation” over all these other arguments. Since the government has a right to tax (it’s in the Constitution) he chose to call the mandate a tax.

From Our History of Medicine Pages

So now we know that our health care mandate goes all the way back to 1790. Health care in the US, back in those early days, was not expensive. Nobody filed bankruptcy over health care bills. In the year 2000, half of all bankruptcies involved health care bills.

Keeping in mind that the Affordable Care Act is a “free market” solution, back in the early 1800s the free market kept health care costs down. If you’ve not read our History of Medicine pages, I can point out, briefly, that in “The History of Medicine – The Revolutionary War,” (where we acknowledge our beloved president George Washington is killed by his physicians) that one of the signers of the Declaration of Independence, Dr Benjamin Rush, warned us about health care freedom back then:

"The Constitution of this Republic should make special provision for medical freedom. To restrict the art of healing to one class will constitute the Bastille of medical science. All such laws are un-American and despotic." He went on to say: " Unless we put medical freedom into the constitution the time will come when medicine will organize into an undercover dictatorship and force people who wish doctors and treatment of their own choice to submit to only what the dictating outfit offers."

In our article “The History of Medicine – 1800 – 1850,” you’ll learn one reason the American Medical Association formed was that medical doctors were going broke having to compete with homeopaths, Native herbalism, and midwives. Then in the early 1900s, the Flexner Report came out (a subject I had planned to cover years ago but…) and the birth of modern medicine in America took off wiping out herbalists, homeopaths, and medical schools that admitted women and blacks. (A few black medical schools were allowed to stay open since many white doctors didn’t like having to treat black patients.)

Today, we have the dystopia Dr Rush warned us about. With a monopoly on the medical field, the cost of medicine rose over the years and people have been calling for health care reform for nearly one hundred years.

As you can see from the article published in the NY Times, “a compulsory health insurance system” was being called for way back then. In fact, Teddy Roosevelt called for health care reform even earlier.

But it was right about this time, our entry into WWI, that there started quite a bit of blowback about “universal health care.”

Remember that we just told you that one of the reasons the AMA was formed was because doctors were having trouble making a living. With the advent of WWI and the world suddenly being overwhelmingly aware of Bolshevism, and the AMA promulgated enough anti-communist rhetoric to kill off any chance of universal health care for years to come. In fact, Roosevelt had wanted to include universal health care in the New Deal but the AMA fought back so hard that he pulled it out thinking it would destroy the chances of Social Security ever passing. [A Brief History: Universal Health Care Efforts in the US]

Every president since Roosevelt spoke about health care for the American people. The opposition always won.

After WWII the term “socialized medicine,” with all the “communist” associations of that era, was used by opposition to any and all health care reform Ronald Reagan Speaks Out Against Socialized Medicine.

Reagan helped sell a lot of things back then, including cigarettes and Boraxo. As previously stated, since WWI, opposition to health care reform got a lot of mileage from their anti-socialism, anti-communism campaigns, but it was at this time that a very powerful grass-roots movement, pushing to get health care to our aging population, made so much noise that the AMA could not counter it with the usual arguments using the big "isms" or that that “the government was coming between you and your doctor” [the same argument we heard all through the ACA debates]. They were eventually cornered into creating their own plan called “Eldercare,” which, under LBJ, eventually became the bipartisan Medicare bill.  

Until the ACA, in 1965, when LBJ signed Medicare/Medicaid bill into law, this was the greatest progress made to date in the struggle for universal health care. A few changes to enhance the programs have been made over the years, but mostly, those opposed to health care for the people (and huge profits for providers) have been slowly chipping away at the system. In fact, one recent change has crippled the entire system with introduction of Medicare Part D, which was a huge and expensive giveaway to the pharmaceutical industry. Many critics have said that it was aptly named because that’s the “grade” they would have given it: D.

Following LBJ’s Medicare Bill, President Nixon signed into law the federal HMO Act in 1973, which he told the American public would expand access to health care. However, the “White House Tapes” show a different story. In secret talks between Nixon, John Erlichman, and Edgar Kaiser, we learn “how Kaiser has manipulated our government and the public into believing an untruth. It appears that President Nixon knowing full well that Kaiser was not being honest with their presentation of the HMO thought he was using this to his advantage. Unfortunately it has taken decades for this to become public knowledge which is a shame.  President Nixon knew from the time of this conversation that Kaiser was for-profit and he also knew that they are able to profit because "All the incentives are toward less medical care, because—the less care they give them, the more money they make." - Mr. Erlichman quoting Edgar Kaiser to President Nixon on February 17, 1971.” [The Kaiser Papers]

And today we know that “managed care” was exactly that: less care and more profit.

In 1974, Nixon became another president to propose a “mandate.” You see, at that time, many of the problems facing President Nixon were the same problems facing President Obama:

  • Insurance did not cover preventive care
  • Families and individuals without adequate care could go bankrupt over medical bills
  • The system was wasteful and inefficient, constantly inflating medical costs that were passed on to the consumer.

Thus much of what Nixon proposed eventually ended up in the ACA. You can read Nixon’s speech here: Nixon’s Plan For Health Reform, In His Own Words. Nixon’s troubles and resignation put a quick end to these plans and his mandate, but the mandate did not die.

The next great push for health care reform came under President Bill Clinton when he put his wife, Hillary in charge of designing it. It was in this process that Hillary learned all about partisan politics because, like most of us, she was shocked to find out that anyone would come out against health care reform. The entire industrialized world all had health care; all of them, except us.

The fact is, there is only one ostensible reason anyone would be against health care reform or universal health care, and that is money. If it’s going to cost you money or lose you money, you’re going to fight it. The insurance companies, AMA, private physicians, and HMOs all came out to fight universal health care. However, there was one more reason to fight universal health care: politics. One party did not want to see the other party succeed.

William Kristol headed up the push that led to the destruction of the Clintons’ health care plan. You might remember Kristol as one of the people who was wrong on just about everything concerning our invasion of Iraq. Kristol sent memos to the minority party (at that time) often. Here is one of them entitled: "Defeating President Clinton's Healthcare Proposal" 12/93

The long-term political effects of a successful... health care bill will be even worse — much worse... It will revive the reputation of... Democrats as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government. [Wikipedia]

I hate partisan politics. This country got to be the leader of the free world by people working together, not against each other. Yes, there were problems with the Clinton plan, but there are problems with every health care plan. The biggest problem of them all, however, is NO health care at all.

Millions of Americans are just a pink slip away from losing their health insurance, and one serious illness away from losing all their savings. Millions more are locked into the jobs they have now just because they or someone in their family has once been sick and they have what is called the preexisting condition. And on any given day, over 37 million Americans—most of them working people and their little children—have no health insurance at all. And in spite of all this, our medical bills are growing at over twice the rate of inflation, and the United States spends over a third more of its income on health care than any other nation on Earth. [Bill Clinton’s health care speech to a joint session of Congress on September 22, 1993]

Opponents spent upwards of $50 million to fight the Clinton health care plan.

To counter HillaryCare, the Republicans brought into the conversation something the Heritage Foundation (a right-wing think tank) came up with, and as we’ve seen already, they were neither the first nor the last to suggest it: the individual mandate. [Original 1989 document where Heritage Foundation created Obamacare’s individual mandate]

At this time, a “free market” solution was preferable to “government control of health care” which HillaryCare wasn’t. But the truth has never stood in the way of a good story, and the people soon believed that HillaryCare would destroy the planet, give everyone tooth decay, and turn all your gold jewelry into brass (exaggerating, but what the people believe and what actually is are oftentimes universes away from each other). Opponents spent somewhere between $14 and $20 million on these cute Harry & Louise anti-HillaryCare television commercials that beat the American public over the head with this phrase: When we let the government choose, we lose.

Here is a great (cute) compilation of these ads contrasted with the administration’s response: https://youtu.be/CwOX2P4s-Iw

I was going to give a short history of the individual mandate (as we’ve already discussed above), but I found a lovely site with all that right here: History of the Individual Health Insurance Mandate, 1989-2010

The opposition won. The American public lost. However, the biggest winner in this whole thing was the phrase: "Big Government."

It’s a totally meaningless phrase, and I’ll show you why, but meaningless phrases exist all around us. "Support The Troops" is a meaningless phrase because it says nothing about our policy of murdering and maiming innocent men, women, and children in a country that was never a threat to us. Everyone supports the troops. Not everyone supported invading Iraq. Today even fewer people support it. Everyone supports the troops, but it's veterans who saw their hospital budgets cut at the same time that veteran suicide rates rose to the highest point in our history. [And today (7/20/15) I just read in the news that female veteran suicide rates are just as high today as the men's rates.] "Support the troops" is meaningless and empty.

The phrase “Big Government” won big, ended the Clinton plan forever, and ushered in the first completely Republican Congress since the mid-fifties, who gained popular support with their “Big Government” BS.

I call it BS because historically, those who claim government is too big and that government is the problem have always been the same ideologues who've grown the government bigger, making it a problem; A self-fulfilling prophecy based upon the partisan politics that I despise so richly.

In partisan politics, one side will always blame the other side for what it (the calling side) is doing. It’s a lot like the Freudian concept that states we hate traits in others because we first see them in ourselves.

So, as a minor digression, let’s take a look at the two battling parties.

One says government is the problem, hates big government, hates regulation, and hates spending.

The other says that government is the solution, loves to grow the government, establish regulation, and loves spending. They are the “tax and spend” party.

Hates Big Government

Loves Big Government

   

Took Office 1981, total debt: $1 trillion

Took Office 1993, total debt $4.8 trillion

Left Office 1989 , total debt: $2,9 trillion

Left Office 2001, total debt $5.7 trillion

190% increase

37% increase

 

The main point her is this: "Big Government" is an empty, meaningless phrase.

I'm not about to start a fight with anyone right now because I know some people will have all sorts of arguments to explain the discrepancy above, but that is what partisan politics is all about: arguing minutia. Let's just end this with a little sign that was on Harry Truman's desk: "The buck stops here."

If we could rid ourselves of partisan politics, there would be no big government or small government but rather: Good Government or Efficient Government; government that serves the people.

Who Created The Affordable Care Act

Some have claimed that Nixon created the Affordable Care Act. Close, but nope. Some claim the Heritage Foundation created it. Again, close, but nope. Some have said that RomneyCare is ObamaCare. Really close, but nope. Sure, the ACA (Obamacare) was designed after Commonwealth Care (RomneyCare) as Roberts mentioned in his latest ruling, but there are minor differences. 

And keep in mind that how the ACA was originally designed has very little to do with what it turned into. For one thing, it was designed after they took Single Payer off the table.

We often hear that Obama had a super-majority (60 votes), so he could have done everything he wanted to do. In a perfect world, maybe, but not in reality. Someone got to Joe Lieberman and he refused to vote for anything unless Single Payer was off the table, so suddenly 60 votes turned to 59 votes, and that wasn’t filibuster proof.

It doesn’t take much money to buy people in Washington. Just a little goes a long way. This is one reason why an investment in Washington gives a return that is greater than any investment anywhere else in the world. This is also one reason most Americans want to get money out of politics.

We know what was proposed and how it was designed, but how it came about is a whole nother story. The minority party at the time had no intentions of voting for it at all, for all the wrong reasons.

They hated to see their opposition do anything for the American public. The American public likes things done for them and politicians who do that get more votes. And sadly, after President Obama was elected (on the night of the inaugural ball), the opposition got together (this is fact, not fantasy) to make sure Obama was a one term president, and that they would stop anything he tried to do.

As I said, it is now common knowledge about that meeting, and in fact, Newt Gingrich actually admits it in this video: https://youtu.be/yd0fVf5CsCc 

Since President Obama was elected, the Senate has set a record in their number of filibusters. That is another sad, partisan fact.

Many people hate the ACA because they hate Obama. This is quite obvious in the anecdotal studies in which people were told what was in Obamacare and then told what was in the Affordable Care Act and people liked the ACA better than Obamacare even though they are the exact same thing.

I hate partisan politics. This is not how my country was built, but it sure looks like how it will be destroyed. A house divided against itself cannot stand.

And so, we have a bill, a health care bill, that no one from the opposition will vote for and without a Super Majority in Congress will never pass, so what does Congress do? It asks the opposition party to help design the health care bill.

I don’t get it. Nobody from the opposition will vote for it so why allow them to help create it? And we wonder why so many of the American public were against it. Duh.

Obama Steps In

Even the president doesn't mind the ACA being called Obamacare. He was very instrumental in its design and in its passing. He met with key members of Congress regularly to guide them, and many of his supporters who would later say he "caved" or that he "gave in" to corporate demands simply don't know how politics is conducted in this world.

Obama wasn't about to see this bill fail. He was keenly aware of the history of health care and how the industry can kill something they don't like, so he met with leaders of the health care and insurance industry. He negotiated deals, shook hands, and twisted a few arms, and though some today still say he caved, he got the job done and got a bill created that would pass in both the House and Senate and land on his desk with no opposition from the industry.

So for people who hate Obama, well, that's their problem. Many continue to hate Obamacare because they hate Obama; that is, until they need it. [Handyman who would rather go blind than sign up for Obamacare begs for money in crowdfunding appeal after his eyes started bleeding.]

Bring On The Detractors!

Do you remember what everyone called the Great Lie of 2009? “If you like your doctor you can keep your doctor.”

I’ve researched this and it wasn’t much a lie at all; it was stupid wishful thinking and it affected only around 4% of the population.

You see, nowhere in the ACA was it written that you would have to change doctors. That was not anywhere in the bill.

But it was left up to the insurance companies, and when you leave anything up to insurance companies, they will do what they can to cut costs and raise profits. That is exactly what all businesses do, and the ACA was a free market solution that put a lot of decisions in the hands of business: the insurance industry. So feel free to call it the biggest lie of the year. What really matters is if it affected you. If it didn't, no big deal. If it did affect you or someone you love, then it's a big deal. And though you can continue to scream "LIAR" as loud as you can, it was the insurance companies that took away your doctor, not the ACA.

The ACA was inevitable. It had the votes, it was going through, but it was attacked as if it was a plane full of suicide bombers.

Being a journalist, I like to get the facts straight. The attacks on Obamacare/ACA were ridiculous, wishful thinking at best, but mostly nowhere close to the truth:

  • Death panels

  • Healthy people won’t sign up

  • You won’t be able to choose your plan

  • Government control of health care

  • A politician will come between you and your doctor

  • It will explode the federal deficit

  • Premiums will shoot through the roof

  • Jobs will be lost

And they even continue on today. Sure, it’s not perfect. We really needed single payer or a public option (Medicare for all). And while everyone focused on “If you like your doctor . . .." they seemed to be oblivious to the biggest lie of them all told by 90% of the media: "A majority of Americans were/are against it (still today)."

This is where the manipulation of statistics comes in, so pay attention. For example, because I prefer single payer, I’m listed as being against the ACA. So everyone who wanted Single Payer or a Public Option is listed as being against the ACA. They are not against the ACA; they wanted more, but they are willing to start with the ACA. It's quite simple. People are not against something that doesn't turn out as good as they had wanted. The American people got "something" and that something will save thousands of lives.

Congress has voted over 50 times to kill the ACA. This was a total waste of money by the party that proudly waves the flag of fiscal responsibility. It was a waste of time and money when they could actually be doing something of consequence (like funding the repair of our infrastructure) and a truly laughable waste of energy since the President would have to sign that piece of legislation.

Before the Supreme Court

Twice it’s been before the Supreme Court. The first time for the mandate and had an outcome few could have predicted. Justice Roberts gave the deciding vote, calling the mandate a tax.

Many conservatives cried out that Roberts was a traitor to conservatives, but few people realize just who Justice Roberts is and know little about his record. When he was up for Senate confirmation, I took a look into his record. When a person fighting a corporation came before his court, you could bet the bank that he would rule in favor of the corporation.

When the mandate was up before the Supreme Court, Justice Roberts followed suit. He did not rule in favor of the people. He ruled in favor of the insurance industry (corporations) and their profits shot up the very next day.

The second time, this most recent time, the ACA went before the Supreme Court because of a “writing” error in the bill. This error could have been fixed quite simply by Congress sitting down and re-writing the things that had been written in error. And, with the majority of Americans now on the side of the ACA because it has helped some 17 million of them, many who have been fighting it since it first passed were secretly wishing the court would not kill it, because they didn’t have an alternative plan and their constituents love their health care.

And this time, Justice Robert was also the deciding vote, making the most logical decision I’ve ever seen from the Supreme Court: he voted for the “intent” of the bill, not the logic or illogic of the writing. And again, the very next day, insurance companies’ stocks shot up on Wall Street.

And still there are those in Congress who are working to destroy it by trying to kill the Medical Device Excise Tax. Killing it, of course, would a give-away to the industry. It would save them billions. So why not kill it?

The Medical Device Excise Tax is helping to pay for the ACA and keep costs down. Duh.

So, I’m going to have to conclude this here saying: It’s not perfect. We truly need a “public option” or single payer. People everywhere point to the health care systems around the world and find fault with the best of them, but aren’t we America? Aren’t we the country that is supposed to do things better than all those other countries?

No, it’s not perfect, but it’s health care and it’s a start.

The Present State of the ACA

More people are insured right now than have ever been in America. According to Gallup, the uninsured rate has dropped to its lowest point in recent history. In just January of this year, 9.5 million signed up.

Premiums have come down. Of course they would because this is a free market solution in which insurance companies are not allowed to fix prices, thus they must compete for our business and prices come down.

It has created jobs. According to Forbes, by June of 2014, nearly a million new jobs opened up in the health care industry, and in the last year alone, 408,000 new jobs have opened up because of the ACA.

The overall costs of the ACA, which we were told would bankrupt our nation, are down and the CBO (congressional budget office [non partisan]) says costs are now 11% less (over the next 10 years) than what they predicted just last January. [Obamacare’s projected cost falls due to lower premiums under health care law, CBO says]

The only death panels so far have been in Arizona, where bureaucrats have determined who gets organ transplants and who doesn’t, but below is a statistic that should open your eyes widely:

A Matter of Priorities or The Real Cost of Not Having Health Care

The US has spent $500 million per victim of foreign terrorist attacks, but less than $10,000 per person with cancer.

Your odds of being killed by a foreign terrorist are less than your odds of being killed by lightning, yet states are refusing to extend Medicare to their people and causing between 7,000 and 17,000 fellow Americans to die early deaths.

Is that logical? or fiscally responsible? or sane?

Do you really understand that? Do you see the disconnect? We’re spending trillions of dollars on our military to protect our people (supposedly) but we’re not extending Medicare (costing the state nothing initially) to protect our people and save the lives of 7 to 17 thousand Americans.

This is from January of 2014, and these states have left nearly 8 million Americans uninsured, but you can bet that all of those states have people in Washington who are giving away your money to the military industrial complex to protect us from … terrorism.

And refusing to extend Medicare to its people is NOT about saving money. In Texas, not extending Medicare has cost them $5.5 million. Not extending Medicare to the people is a political move only, one which most of us don’t understand, but somehow someone sees political benefit in it.

The real terrorism in America is that we let our people in Washington get rich while they make their friends rich while slowly killing off their constituents while pretending that terrorists are the problem. (Now that’s a mouthful.)

So, do you really think the ACA is a “train wreck?”

  • Lowest uninsured rate in 40 years

  • Lowest Health Care Inflation rate in 50 years

  • Reduced deficit because it’s $300 billion cheaper than expected.

  • Jobs.

Sure, it’s not perfect, but it is saving lives and we all need to focus on the real problems in this country instead of letting Washington and the media scare us into fighting ghosts.

Or look at it this way:

Worldwide Causes of Death (2010 stats):

64% chronic illness
16% infectious disease
12% hunger
4% water (polluted)

That leaves 4% for all those other things killing us, including terrorism, which is around .011%. How much money have we budgeted for chronic illness? Or for infectious disease? Or for hunger? Or for cleaning up and delivering safe water?

Yet we put billions and billions and billions into our bloated military budget to battle over .011% of deaths due to terrorism.

But states won’t extend Medicare to save American lives, even though it costs them nothing up front.

This is not a situation that makes people proud.


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