Tag Archives: Obamacare


9 Nov




This victory is a testament to you. Take pride in your hard work over the past 18 months: the countless calls you made, the doors you knocked, the people you inspired to support our president.
I know it wasn’t always easy. But through your perseverance, you proved that a strong, grassroots organization could overcome powerful interests on the other side.
You built this organization from the ground up. You helped this country stay the course. Enjoy this victory for now and rest up. There will be more work to come. Stay tuned.- Jeremiah Bird, Obama For America


”Stay tuned” We have heard this before from OFA, the grassroots organization which continued to work in support of President Obama after they did so in the 2008 election. It was OFA who announced to those of us who had already started organizing marches and rallies, collecting signatures on petitions, and garnering support for single payer health care that we must cease, and instead, push for The Affordable Health Care Act-Obamacare. We joined the effort to see near-universal health care passed,hoping it would be a beginning,understanding that if the votes are not there in Congress, compromise is necessary. But it does not sit well with those of us who understand that the most affordable health care system is one which eliminates profit for investors, and delivers dollars to direct service. Built into Obamacare is the 85% required delivery of direct care; with refunds to patients whose insurance carriers spend less than 85% of money collected on direct care. Still, this allows a 15% overhead for administrative costs,which exceeds that of medicare. The amount of difference could fund more direct service rather than to investors for profits off our illnesses. But, it is a start.


Yesterday, Speaker of the House, Rep.John Boehner (R-OH) responded to Diane Sawyer during an ABC interview when asked about his desire to repeal Obamacare:

“It’s pretty clear that the president was re-elected ,” Boehner added. “Obamacare is the law of the land.” But, he then added that there were parts of the law congress would try to change. Shortly following the interview his spokesman said,that repealing the law ‘would be on the table.’ Clearly, the re-election has not changed Boehner’s attitude, nor his operational style.

Stay tuned: Obstruction by Boehner and the GOP is still on the table.

Obstruction takes many forms: It blocks bills in committee,not allowing them to be voted out of committee for floor vote. It refuses to put a bill or discussion of a bill on the calendar. It refuses to discuss bills with both parties in attendance, Republicans locking out Democratic members who retreat to a separate room for discussion. It holds votes in the middle of the night when the public and news media are not paying attention to the machinations of voting irregularities; such as, stopping the vote at the last minute when it appears your side is losing and holding the vote open for hours while arms are twisted and votes are changed. It requires a supermajority to override a filibuster,which is an impossibility with the number of current party members. It walks out of bipartisan meetings with the President and holds a news conference belying the president’s efforts to find a compromise. It is the party of walk-backs,confusing reporters and the public as to what GOP’s true position is, or if it has ANY position other than OPPOSITION.

If you thought the ugliness and lies were over, you are wrong. GOP has learned nothing from the 2012 election. They campaigned with no respect, dignity nor integrity. This is how they intend to govern. Do not expect Republicans to govern with respect, dignity,and integrity.

Already,I am disgusted by newspersons concern over the fate of the Republican Party, the endless hours of commentary suggesting how it can change and grow. Where is the discussion about what this country needs to do NOW and what this country has a right to expect from the GOP to see that what we need happens? I say to the GOP what I say to those who discriminate against women and people of color, “Heal yourself! I have enough on my hands doing what I can for the betterment of my fellow citizens. I must heal my own pain at your insensitivity to the needs of my fellow citizens;I have no time to heal yours.”

Our focus should not be on the improved chances of Republicans to win future elections but their failure to support the efforts being made by Democrats in Congress and by President Obama to stimulate economic growth, create jobs, protect our environment, educate our children, reform immigration, reduce poverty, assure health care for all, reduce the deficit fairly,increase taxes on the top tier of income and capital gains, end useless and harmful wars, solidify and extend diplomatic gains etc.

The morning after the election I awoke with a smile on my face, a feeling of increased security, with no fear that my civil rights were in jeopardy, knowing our president is one who sees a future full of promise and has a plan for leading us in the right direction. It was a place of calm I had not been in since January 20, 2009. I needed that peace of mind to last longer. It ended too soon. It ended when I realized the direction media is leading us: away from serious discussion of issues of governance and on to the 2016 election. Shame on the Third Estate for failing us…again. Stay tuned.



MIRROR,MIRROR ON THE WALL,By Louise Annarino,October 26, 2012

26 Oct

MIRROR,MIRROR ON THE WALL, By Louise Annarino,October 26,2012


“Mirror, Mirror on the wall, who’s the fairest of us all?”  Have you ever forced yourself to stare into your eyes while looking in a mirror? Common knowledge tells us that our eyes are the mirror of our souls. Most of us look in a mirror only to make sure every hair is in place, nothing is stuck in our teeth, or our tie is centered properly. We seldom really look at our selves. Too often we squirm away from what we see of ourselves. Soul searching is uncomfortable.


People are not fixed in space and time, but move within a forever-changing creative energy. This is what makes getting to know another person so interesting. We are in the final days of getting to know candidates for public office. The image we each create for ourselves, which makes it sometimes difficult to look at ourselves in the mirror, is similar to what the campaign staff attempts to do for each candidate. And, too often, those candidates find it difficult to look at themselves in the mirror. It is the rare person, and the rare candidate, who consistently stays true to the soul he or she sees when they force themselves to look in the mirror. Some candidates seem incapable of soul-searching.


A spate of political ads are out now which feature an individual or family telling us what a great guy Mitt Romney is, describing a specific kindness he has shown, or assistance he has provided. These ads should be comforting and assuring. They are meant to counter the ads by former workers who lost jobs when Mr. Romney through Bain Capital shut down a factory, shipping workers’ jobs overseas. But, is an act of kindness to one person enough to counter the cold calculation which led to huge losses suffered by thousands of workers? Is kindness to individuals enough to counter the threatened loss of social security, medicare, Obamacare, equal pay for women, women’s control over their own health care decisions, PELL grants, veteran’s disability benefits, the post office, Amtrak etc. which the Romney-Ryan budget promises to cut,affecting all of our countrymen?


I am glad to hear of Romney’s acts of kindness. He can look in the mirror and see his goodness as he contemplates these kind acts. But what does he see in the mirror when he contemplates cutting off such kindnesses to the other 98% of us through his budget?


Whom do we know who can look in the mirror with a steadfast gaze? Whom do we know who can look in the mirror with a forward-looking vision of what is possible when we empower the 98% to share in the wealth of America; rather than await and give thanks for the largesse doled out one-man-a-time by the 1%? Barack Obama and Joe Biden.


15 Apr


Louise Annarino

April 15, 2012


In high school, every girl knew where to hang out to attract boys. Parents like mine made certain I was not among those girls. Such was the protective net flung over my head. It was a comfort. It allowed me time to seriously assess what my role in life would be without a man to influence my decisions; and what role men would have in that life. My focus was on education, career and independence. Motherhood and marriage seemed a given, and to be delayed until I could be self-sufficient. Only then, could I make the future secure for myself and some future family.


I deliberately wrote motherhood before marriage in the above sentence. Too many of those young women allowed to hang out with boys, became mothers first and married in haste after. A total loss of freedom and self-sufficiency, only one piece of the price they paid. The cost seemed too high then, and life has shown me it still is thus.


I had imagined university to be different. I expected it to be a community of scholars, where men and women were equals. It was not. Despite living in a coed dorm, rules differed for men and women. Women, but not men, were restricted to their floors after midnight, and had to be in dorm by that time. No late-night runs for pizza. Not even a chance to meet the pizza guy in the lobby to accept delivery. If a women left the dormitory in the evening, she had to write where she was going, with whom, a contact phone number, and expected time of return. The men were treated as adults; women were not.


I wrote a Declaration of Independence for the Women of Lincoln Tower. A group of us detached the sign-out books from the lobby counter, carried them outside and burned them in a bonfire for freedom. Today, we would be arrested. In the 60’s, we had a stern dressing-down from the Dean of Women and the Dean of Men.


It was unlikely that the books could be reordered and delivered before the year was out, so the sign-out system was suspended for the remainder of the year, and never reinstated. While all women students cheered this stand for our freedom, it did not truly reflect the underlying motivation of each woman.Too many were at university simply to find a well-educated husband who could support them. Too many had no interest in maintaining freedom through self-sufficiency. Too many were willing to sublimate their own identity as free women for the ease of being cared for by another.


As graduation approached these women panicked. “The best opportunity to find a rich husband is now! What will I do if I leave here and I am not engaged?” was an increasingly desperate question for them, and for their mothers, whose phone calls became more frequent. This was a new phenomenon to me. My Mother’s instructions were to get as much education as I could so I would never need to depend upon anyone; theirs was to find a rich husband so they would always have someone else to depend upon. This differing world view may explain a current quandary of mine.


That quandary is why any woman would vote for a Republican. But, I think I see how they could. They are the women I knew at university who believe a man will take care of them. Democratic women are those, like myself, who stand independently on their own feet, believe self-reliance brings true freedom, and form relationships with the men in their lives which are free and among equals. Perhaps, I cannot really know, Republican women are simply those women satisfied to be taken care of by a man. To each her own.


It is a free woman who decries anyone’s efforts to replace her decision-making with their own, be they a husband, bishop or a politician. It is a free woman who insists on joint discussion and decision making with her spouse, be their agreement or disagreement. Only when women are free to be themselves, are they free to love and free to share their lives with another. And all women Democratic or Republican seek freedom, even those who avoid expressing it in their relationships with the men in their lives. Even those who listened to their mothers and married up for financial security.


It is ironic that the very women willing to rely on men to take care of them, vote for men who say government has no, or very limited, role in taking care of the poor, the elderly, our health, our job security, our environment. Those men they trust to  care for them, cannot be trusted to care for us. They promise to end ObamaCare.They promise to close the Departments of Education, Environment, Labor, Health and Human Services. They get very confused over which agencies exist and whether they should be closed, but they know they must be gone! They oppose Affirmative Action, an effort to assure African-Americans, and all people of color can stand on their own, and be independent of white largesse oblige.


And these are good men. These are men who take care of their women and children, and believe they deserve respect and loyalty for so doing, for their largesse oblige. They fail to see what is right before their eyes: women and children and people of color who are their equals. By caring for them they deserve no special rank, nor praise. We are all equals, we men and women and children of every color and nationality. We are in this together. We care  for one another. We are our government. Our government is us. That is what it means to live in a democratic republic. Of course government will care for us, since we care for one another as equals entitled to the same opportunity for life, liberty and the pursuit of happiness.


When we Democratic women challenge Republican men, Republican women will of course defend them upon whom the fortunes of their families rely. But, even Republican women now understand that such a paternalistic relationship can go and has gone, too far. Olympia Snowe(R) ME and Susan Collins (R)ME have supported President Obama’s efforts to assure insurance carriers provide women contraception coverage. “The women,” says Maria Cantwell, “are mad.” you don’t feel this is an attack, you need to go home and talk to your wife and your daughters.”1 And Republican women are also speaking out, asking for support for their own contraceptive needs.2  We may be Democratic women. We may be Republican women. We are all sisters. It is time for women to take a second look at the men who would rule our lives. Ask Michelle Obama. She who is an equal among equals, one of us.


1. www.oregonlive.comDavid SarasohnColumns

Apr 7, 2012 – “The women,” says Maria Cantwell, “are mad.” you don’t feel this is an attack, you need to go home and talk to your wife and your daughters.”


2. http://julietjeske.wordpress.com/2012/04/12/on-birth-control-a-plea-to-republican-women/








3 Apr



Louise Annarino

April 3, 2012

I hesitated over the original title of this piece – Want Privacy or Protection? Shoot a Police Officer. I worried some readers might not understand the ironic tone it is meant to impart to my words. The NSA and others may be trolling the internet for just such a word pattern. The following three stories jumped off the page and struck me down today and I believe the title is apt, if absolutely disgusting. But, the thought was so distasteful I could not use the words “Shoot a Police Officer” even though that seems to be where this analysis takes us. Writers should be fearless; but, also responsible.

1.U.S. Supreme Court rules  that jailers may perform invasive strip searches for even minor offenses. In a 5-4 decision, the Supreme Court ruled against Albert Florence, who faced strip searches in two county jails following his arrest on a warrant for an unpaid fine that he had, in reality, paid. “Florence, who is African-American, had been stopped several times before, and he carried a letter to the effect that the fine, for fleeing a traffic stop several years earlier, had been paid.” Nevertheless,officers handcuffed him and took him to jail. Mr. Florence had already passed through  metal detectors, submitted to  pat down searches, had his clothing searched, and showered with delousing agents at 2 jails. But Justice Kennedy insisted being in the jail population, for whatever reason, justified such an invasive search. Further, he stated that the court must defer to the judgement of corrections officers “unless the record contains substantial evidence showing their policies are an unnecessary or unjustified response to problems of jail security.”


2.Indiana Governor Republican Mitch Daniels signed into law Senate Enrolled Act 1 which allows homeowners to shoot police officers entering their home. Proponents argue that the law is meant to keep police safe! But, “Democratic Rep. Linda Lawson, a former police captain, says the bill would create an ‘open season on law enforcement’.” http://www.addictinginfo.org/2012/03/23/indiana-governor-signs-bill-allowing-citizens-to-use-deadly-force-against-police-officers-into-law/

3.The Georgia legislature passed bill criminalizing abortion after 20 weeks with no exception  for rape or incest. “Commonly referred to as the ‘fetal pain bill’ by Georgian Republicans and as the ‘women as livestock bill’ by everyone else, HB 954 garnered national attention this month when state Rep. Terry England (R-Auburn) compared pregnant women carrying stillborn fetuses to the cows and pigs on his farm. According to Rep. England and his warped thought process, if farmers have to ‘deliver calves, dead or alive,’ then a woman carrying a dead fetus, or one not expected to survive, should have to carry it to term.”  Following a firestorm  over this remark, the Act was amended to allow abortion in those situations considered “medically futile”, i.e. one in which a woman’s life or health is threatened. However,  mental or emotional health,including suicide,mental illness etc are specifically excluded. And, “In order for a pregnancy to be considered ‘medically futile,’ the fetus must be diagnosed with an irreversible chromosomal or congenital anomaly that is ‘incompatible with sustaining life after birth.’ The Georgia ‘fetal pain’ bill also stipulates that the abortion must be performed in such a way that the fetus emerges alive. If doctors perform the abortion differently, they face felony charges and up to 10 years in prison.      http://readersupportednews.org/news-section2/314-18/10765-at-11th-hour-georgia-passes-qwomen-as-livestockq-bill

The above decisions are not occurring in a vacuum; they are, in fact, related. Each situation addresses our right to privacy, and our right to feel secure in our own homes and in our own skin. Each involves some form of government intrusion. It is ironic that these decisions are made and supported by Republicans legislators and judges who generally stand for a citizen’s right to privacy and protection from government intrusion. The very group which attacks ObamCare insurance requirements as intrusive, and unconstitutional.

1.In the early 70’s I was a social worker at The Ohio Reformatory For Women, a maximum security prison. I had been hired under a minority recruitment program to address racial issues within the prison, given my field of graduate study. I believe prison officials hired me to avoid hiring an African-American while getting credit for a minority hire. They had no intention of addressing racial issues. I was warned the approved Racial Justice Program I organized was not to be implemented even though it had been officially approved;the approval was for “show only”. Despite this warning, I conducted race relations training for corrections officers, taught a course in Black History at the school, ran racial mediation groups for Black and white inmates, emceed a Black Culture awareness group using local Black achievers once a week, set aside a Black media/book center within the library etc. I was fired 8 months later for “teaching these N*****s they are human beings”.

At Christmas time each social worker was handed a polaroid camera to take a single photo of each inmate which she could then mail home to her family. We were admonished to take a good shot because we were allotted one shot per inmate, no matter how bad that shot was. I warned the corrections officer overseeing the operation that I am a horrible photographer and he could be sure I would screw up at least one photo. “One shot, Annarino! That’s the rule,” he responded. I did fairly well until my camera slipped and I cut off the head of one woman. Let’s call her “Sally”. We looked at one another in horror. She had nothing to send home to her children, no Christmas gift. I explained to the officer, and I took a second shot. I placed the headless photo in the trash can. When the administrator arrived and asked the corrections officer how things went, he informed her I had taken an extra shot, which she demanded I return to her. I had already given the good shot to Sally. She was told she could have only one photo and must return the second shot. I searched the can, but could not find the bad shot, hoping it would be accepted in place of the good shot. Sally insisted she had only the second photo.

The corrections officer was told to take Sally into the bathroom to do a strip search. Sally begged me to do it instead, preferring a woman over a man. Other inmates indicated to me by “sign” that he was not one a woman should be alone with. I reluctantly agreed to do it. I was told to check mouth, throat, anus and vagina. Seriously? How could  a Polaroid hide there?

Once inside the bathroom, Sally went immediately raised and pressed her hands to a wall, feet spread and pulled back. Obviously, this was not her first time. I explained I had never done such a thing, and had no need to do it as I accepted her word.

Sally insisted, “You must do it. They will ask you, and if you say you didn’t they will send him in. Please don’t let him near me. You have to help me.”

“OK,” I replied, but you have to tell me how to do it.”

So, Sally instructed me in the proper way to  do a strip search. I did the pat down along her right and left flank, top to bottom and back up. Then the inside seams of her legs,the frontal cross and down then up. I used as light a touch as possible, apologizing every few seconds. Sally indicating it was OK, not to worry. I thought I was finished, but Sally then advised me I still had to do the internal search. She removed her dress and undergarments over my protests, insisting I had to finish it or “he” would. She opened her mouth so I could peer down her throat. I looked  for a Polaroid photo hiding inside her throat! This was absurd. Drugs? Maybe. Photo? Crazy. Sally then spread her legs so I could reach inside her vagina and anus.

“NO! If that useless photo is so important you would hide it in your vagina or anus, you can keep it! No one deserves this disgrace for a stupid photograph; not you, and not I.”

Outside the bathroom the administrator and corrections officer waited. I snarled at them, “It is done. There was no photo. Never do this to anyone on my caseload again.” I later told the inmates on my caseload to never get into a situation requiring a strip search! I would never do another one.

I know that prison security is always an issue, for protection of both the corrections officers and the inmates. Drugs, weapons, contraband of any kind pose a threat. But, and Justice Breyer would agree, corrections officers ought to have a reasonable suspicion someone may be hiding something which threatens security before conducting a strip search. Reasonableness should be a matter for court review. The 5 Justices, all Republican appointees, have abdicated their judicial oversight responsibility, failing to protect an innocent citizen, Mr. Florence, from jailhouse abuse. We can’t simply rely on the sound judgment of prison workers. Ask Sally.

2.When can a citizen shoot or kill a police officer for simply doing his job? Anytime according to Gov. Mitch Daniels (R), Indiana. The law he signed was passed in response to a recent Indiana Supreme Court decision. “According to the Evansville Courier Press, an Evansville resident fought a police officer who followed him into his house during a domestic dispute call. ‘The state Supreme Court found that officers sometimes enter homes without warrants for reasons protected by the law, such as pursuing suspects or preventing the destruction of evidence. In these situations, we find it unwise to allow a homeowner to adjudge the legality of police conduct in the heat of the moment,’ the court said. ‘As we decline to recognize a right to resist unlawful police entry into a home, we decline to recognize a right to batter a police officer as a part of that resistance.”

In this case, the court acknowledged police sometimes enter a home unlawfully, recognizing those situations where warrantless entry is justified, but expecting that safety of both police and citizen is best served by reducing conflict levels when passions are raised. This is much different than the prior case, where a calm citizen, is in custody and control, within the confines of a jail – not in his own home. In the home setting,police officers are in the dark as to possible weapons and their location. They were responding to a volatile domestic violence situation, the threat to harm someone was the very  basis of their intervention. It was a fluid enterprise. In this case, the court did not abdicate its role. It reviewed the facts and found no police misconduct. It did its job. As did the police.

This was not satisfactory to the Indiana’s legislature, nor its governor. Although Gov. Daniels almost vetoed it because it could lead to killings of police and citizens. This law, like the Stand Your Ground laws in Florida and elsewhere are loopholes for citizens to kill citizens, and for citizens to kill police officers while claiming self-defense. Indeed, in Trayvon Martin’s murder, the killer has not been asked to plead anything, even self-defense. Merely asserting the law’s existence has been enough  to avoid Mr. Zimmerman’s arrest. There are many people out there who think no police officers have the right to enter homes or property, even if there is a warrant. There are people who believe police have no right to  enforce laws designed to preserve safety and security for all citizens, who believe their victims are not entitled to police protection, whose gun purchases or possession cannot be regulated because it takes away their right to bear arms. When did the rights of bullies become paramount? If this case winds it  way to the U.S. Supreme Court, how will it rule? I dread the thought. People have a right to be secure in their homes. Right? Privacy rights are sacred.

3.Republican Governor Mitch Daniels (see 2 above) blames President Obama for the debate over women’s right to  privacy, but admits his party’s response could have been better. In an interview with Reuters, he stated “Where I wish my teammates had done better and where they mishandled it (women’s preventive health care) is … I thought they should have played it as a huge intrusion on freedom,” Daniels told Reuters. Maybe he should talk to Governor Nathan Deal (R) from Georgia, before HB 954 is signed into law. It appears Georgia’s Republican legislators are happy to invade a woman’s privacy. Not so, Gov. Daniels meant health insurance coverage decisions are an intrusion; not health care itself.

While president Obama advocates for women’s right to make their own health care decisions and reminds us in a recent video supporting Planned Parenthood: “For you and for most Americans, protecting women’s health is a mission that stands above politics, and yet over the past year you’ve had to stand up to politicians who wanted to deny millions of women the care they rely on and inject themselves into decisions that are best made between a women and her doctor.” President Obama recognizes something Georgia Rep. Terry England (R) does not, when he reminds us “Let’s be clear here — women are not an interest group…The are mothers,daughters, sister and wives.” He recognizes woman’s right to privacy within her own skin.

Will the U.S. Supreme Court recognize a woman’s right to privacy? that is the basis of Roe v. Wade. A woman’s right is recognized until the fetus is capable of living outside the womb. That time-line is being shortened by neonatal technology. This is why the Georgia law and laws in other states limiting what is considered a legal abortion, require a method resulting in a live birth. Such language is not included to protect women or fetal health and safety, but a political maneuver to challenge Roe v Wade. It is not a medical consideration, but a political one.

If Republicans really believe in privacy rights, how can they not believe in a women’s right to  make a legal medical decision with her doctor; not, with the legislature, nor with the police. Will miscarriages now be subject to court review in Georgia? Will doctors who cannot abort a fetus and maintain its survival be criminally charged?  The law says they  will. Will courts who hear challenges to such laws trust women and their doctors as easily as Justice Kennedy trusts jailers?

ObamaCare: Not a tree, But a Forest

30 Mar

ObamaCare; Not a Tree, But a Forest.
Louise Annarino
March 30, 2012

“The Best Time To Plant A Tree Was Always 20 Years Ago. The Second Best Time Is Always Today.” ~ Old Chinese Saying  

While every other industrialized nation has already assured universal health care for its citizens, the United States has not. Other presidents tried unsuccessfully to enact universal health care. It took President Obama’s pragmatic efforts to get the country this far. We still have far to go. It does not make economic sense to continue hi-tech health delivery system underpinned by a profit motive. A single payer system, removing the profit motive, is more efficient and cost-effective.

Dr. Atul Gawande’s insights caution us to not focus on cost over care. http://www.npr.org/2011/01/19/132931975/lowering-medical-costs-by-providing-better-care . His influence was written into ObamaCare, which offers free preventive care, researches and pays for quality outcome rather than billable minutes. ObamaCare is controlling costs by controlling quality, while extending coverage. An amazing accomplishment.

If allowed to become fully implemented ObamaCare will continue to shift what Evan Falchuk calls our misguided focus. “The misguided focus on saving money over good medicine means we get neither.  The surest way to save money is to make sure that patients get enough time with their doctors, who need to be able to use their training and judgment to help their patients make the right decisions.  It’s a global problem, but America suffers from the most exaggerated version of it.” Warning: Graphic Politics By Evan Falchuk, http://www.seefirstblog.com/2009/12/25/warning-graphic-politics/

Spending more money does not guarantee a better outcome. As of 2009, the “US still shows a dramatic divergence from the other countries, spending more than twice as much for a slightly below average life expectancy.” Graphing The Cost of Health Care by Jon Peltier,December 30th, 2009 Peltier Technical Services, Inc., Copyright © 2012. See chart at:Graphing The Cost of Health Care | Peltier Tech Blog | Excel Charts http://peltiertech.com/WordPress/graphing-the-cost-of-health-care/#ixzz1qceLwkVw. ObamaCare includes on-going reviews to determine what does/does not improve treatment outcomes; assessing quality while reducing costs.

In 2010 an analysis by Drs. Orszag and Emanuel in The New England Journal of Medicine summed up the multifaceted approach which makes ObamCare so promising and so confusing.”The ACA not only will extend health care coverage to millions of Americans but also will enact many policies specifically aimed at reducing the amount we are spending on health care and, by changing the delivery system, reducing the rate of growth in health care costs over time. Indeed, one of the essential aspects of the legislation is that unlike previous efforts, it does not rely on just one policy for effective cost control. Instead, it puts into place virtually every cost-control reform proposed by physicians, economists, and health policy experts and includes the means for these reforms to be assessed quickly and scaled up if they’re successful. By enacting a broad portfolio of changes, the ACA provides the best assurance that effective change will occur. Moreover, by taking a multifaceted approach that includes hard savings plus the mechanisms for creating a dynamic health care system, it enables physicians, hospitals, and other providers to consistently improve outcomes, boost quality, and reduce costs as health care evolves.” http://www.nejm.org/doi/full/10.1056/NEJMp1006571

Whatever the U.S. Supreme Court rules, I am convinced we will have universal health care soon. For reasons both humane and cost effective, we cannot afford not to do so. A single payer system, medicare for all, would best serve both purposes. The second best time to press for universal, single payer health system may be now. We should have planted this tree long ago. The U.S. Supreme Court may uproot or prune the sapling. We will continue to plant. ObamaCare is not a single tree, but a forest.


28 Mar

Louise Annarino
March 27,2012

What is health care? it is more than curing the sick or saving the dying.It is also preventing disease and enhancing wellness. In fact, Medicare has 3 parts: hospitalization, in office medical treatment and preventive care, and pharmaceutical coverage. The oral arguments both sides made today, and the questions of the Supreme Court Justices pivoted about a conception of saving lives through emergency treatment. it is easy to see how this happened. In arguing for the ACA (Affordable Care Act) one might think it best to stress the harm the ACA seeks to prevent in the strongest fashion, i.e. preventing the deaths of Americans. The opposition arguing against would argue that hospitals do not refuse treatment, and no one will die from lack of treatment even if they are uninsured since emergency rooms don’t refuse treatment. Focusing on emergency care is shortsighted.

Justice Scalia engaged in a conversation with General Verrilli who argued in support of ACA,each falling into the trap of distilling health care down to ER care:

GENERAL VERRILLI: No. It’s because you’re going — in the health care market, you’re going into the market without the ability to pay for what you get, getting the health care service anyway as a result of the social norms that allow — that — to which we’ve obligated ourselves so that people get health care.

JUSTICE SCALIA: Well, don’t obligate yourself to that. Why — you know?

GENERAL VERRILLI: Well, I can’t imagine that that — that the Commerce Clause would –would forbid Congress from taking into account this deeply embedded social norm.

JUSTICE SCALIA: You — you could do it.

It is time for a history lesson. “In 1946, Congress passed a law that gave hospitals, nursing homes and other health facilities grants and loans for construction and modernization. In return, they agreed to provide a reasonable volume of services to persons unable to pay and to make their services available to all persons residing in the facility’s area. The program stopped providing funds in 1997, but about 200 health care facilities nationwide are still obligated to provide free or reduced-cost care.” – http://www.hrsa.gov/gethealthcare/affordable/hillburton/

I am familiar with this case, having assisted in enforcing its provisions while a Columbus Legal Aid Society Lawyer,1978-83, when local hospitals were failing to notify eligible patients of the program; denying care to those unable to afford treatment and/or suing them for unpaid charges which should have been covered under Hill-Burton. Is there a societal norm to treat those in need of medical care? Perhaps, but it is not consistently applied; and in the case of hospitals, did not exist under the law until hospitals needed the latest technology and machinery but could not afford it without help from the federal government. The competition between hospitals to have the latest and best drove this bill. Hospitals improved their competitive edge. To get the federal money to do so, they agreed to not turn away those seeking emergency room treatment. They agreed to stop the bleeding, restart breathing, sew up or put in a cast those in need of emergency care. What happens after the emergency is over, i.e. the person will not soon die is not part of the pact. Once one survives the emergency, further treatment is not assured. If one has no insurance, he must pay out-of-pocket. I am concerned the next step will be to repeal Hill-Burton requirements. Justice Scalia would have no problem doing so.

Justice Scalia spoke correctly. Not only could we imagine a system where hospitals and doctors are not obligated to provide health care; we were operating that way until 1946. We still are except for emergency care in the ER, and a percentage of reduced-cost hospital services for income eligible patients. Hill-Burton applies only to participating hospitals (not every hospital participates), and only to hospital costs. It does not apply to doctor’s services.

To focus on emergency care, a saving lives paradigm, and hospitalization needs is too limited a discussion. Health care is so much more.

Justice Kennedy expressed his concern that healthy young persons are mandated to pay for care they don’t need. He assumes more old persons than young persons die. Of course! But health care is about more than saving persons from death. Justice Scalia expressed a belief persons could buy health insurance when they go to the hospital, no need to mandate it beforehand. Again, he focuses on emergency care, hospital care; not health care.

I wonder if the arguments would be better presented by women. After all, we need health care no matter our age. We bear the babies while young, and we take the kids to the pediatricians. We also push the men we love to go to the doctor they strenuously avoid admitting they need to see. We understand health care as much more than emergency care.