September 23 will mark six months since President Barack Obama signed the Affordable Care Act (ACA) into law, signaling a new national effort to save the American health care delivery system as we have known it since World War II.
No, it's not socialized medicine — doctors and nurses have not been turned into public employees, no hospitals have been bought, and the system is still based on the purchase of insurance as a means of paying for care.
It is, in fact, the last best hope of preserving a market-based approach to health care in this country which is the largest industrialized country in the world without a national health plan.
New statistics released this week by the Census Bureau make explicit the logic behind the act and need for reform. For the first time since this data has been collected, the number of Americans with health insurance fell last year. 1.5 million Americans lost their coverage in 2009.
While that is horrible news for those people and their families, it is even worse news for those with coverage. Why? Because the need for care does not disappear just because a person does not have health insurance. They will eventually have to seek care for what ails them and, when they do, it will likely be through an emergency room at a hospital. They'll be sicker than they would have been had they sought treatment earlier and, if they are hospitalized, they won't have the ability to pay the cost.
Who will pay? Those people with insurance. This shifting of costs from those who can't pay onto those who can is at the heart of what has ailed health care costs in the United States in recent decades. Estimates are that the cost of providing care to the uninsured adds about $500 annually to the premium cost of each person with health insurance.
Things are probably even worse in Louisiana, where we have historically been a state where a smaller percentage of employers offer coverage to their workers than in other states. The percentage of Louisiana residents without health insurance has ranged between 18 and 24 percent over the past six years, according to a study done for the Louisiana Department of Insurance (PDF).
Small businesses are said to be the core of Louisiana's economy, yet as of the summer of 2009, 30 percent or less of Louisiana small businesses offered health insurance to their employees, according to a spokesperson for Blue Cross/Blue Shield of Louisiana. Rising premiums are forcing companies to either drop coverage entirely or shift a greater share of premium costs onto employees.
The employment based health insurance system that the United States has used since the end of World War II came into existence when President Harry Truman proposed a national health program here similar to the one Winston Churchill started in England. It is collapsing. The Affordable Care Act is an attempt to save that system without resorting to a single-payer plan.
Under provisions of the plan, adults and children with pre-existing conditions can no longer be denied coverage, caps on lifetime coverage are being lifted and will be eliminated by 2014, small businesses are eligible for tax credits in return for offering health coverage to their employees, health insurance exchanges will allow consumers to shop intelligently for health coverage and be able to choose the plan that best fits them (just as members of Congress do!), and annual health exams will be provided without a co-pay or deductible. All this is happening this year.
If a health reform plan were being designed for Louisiana where we have high poverty rates, low rates of people with insurance, high rates of chronic disease, and health care providers teetering on the brink of financial ruin trying to provide care for that population, the Affordable Care Act would be pretty damned close to being that program.
Enter the Hypocrite
Ah, but Bobby Jindal is governor of Louisiana and he is consumed by his ambition to become president of the United States. Because the plan was proposed by a Democratic president, passed by a Congress controlled by Democrats, signed into law by that Democratic president, Jindal must oppose the plan for political reasons.
And, so he has. First, he ordered (perhaps bribed) Attorney General Buddy Caldwell to join other states in suing to overturn the law.
Jindal stopped the Louisiana Department of Insurance from its preparations to merge the state's high risk pool with the new federal program to provide coverage to people with pre-existing conditions. It's essentially a four-year program that will exist until the full ban on pre-existing condition exclusions takes effect under ACA. As a result of Jindal's decision, 1,700 Louisiana residents are stranded in the state high risk pool paying much higher premiums than would be available to them under the federal plan.
But, Jindal saved his highest form of duplicity for September. Having sued to have the law declared unconstitutional, having acted to block benefits from the plan from accruing to Louisiana residents, Jindal ordered the Division of Administration to participate in the part of the program that provides federal help for insuring early retirees.
That's right! Jindal does not want the benefits of health care reform to flow to Louisiana individuals, families or businesses, but he wants those benefits flow to state government where (just maybe) it will allow him to take credit for those benefits?
Sound familiar? It should. That's exactly the approach Jindal took to the billions in stimulus dollars flowing into the state. He opposed some of it, but made sure that the federal government got no credit for the work that was done with the dollars he accepted. All those poster-sized checks stamped "Office of the Governor" Jindal flew around the state delivering for public works projects in towns across the state were funded primarily with stimulus dollars.
For all the trashing of the stimulus package that Republicans and conservatives have conducted over the past two years, we know with certainty that the spending has done much to save one job in Louisiana — Bobby Jindal's. The money has helped stave off cuts in higher education and health care that would have made the deep, job-killing cuts already made even harsher.
Jindal went apoplectic over the deep water drilling moratorium primarily because it affected the pockets of his donors in the oil service industries along the coast. He claimed "thousands of jobs" would be lost; possibly a few hundred have. Yet, his cuts in higher education and Medicaid are costing thousands of well-educated people to lose decent paying jobs and he flicks aside concern for those jobs as if they are inconsequential.
The consistency between Jindal's approach to stimulus funding and to health care reform reveals more than just his blind political ambition. It also reveals the full extent to which the interests of Louisiana citizens do not figure in his calculations. Jindal has no allegiance to this state. He has no ties to its institutions (other than state government, in which both he and his mother have worked). As far as he is concerned, he could be governor of Nevada, so long as he could use that state to advance his ambitions.
There is a fundamental indifference to the needs of the people of this state and its institutions that sets Jindal apart from all other people who have been elected as governor. At some core level, all other governors of Louisiana loved the state and sought, in some way, to build it up.
Jindal, on the other hand, views the state as something to serve him and his ambitions. The impact of, say, closing colleges and universities does not matter to him. No, it's more important that he not raise taxes in order to protect those institutions because doing so would jeopardize his pursuit of the Republican nomination for president whenever he feels the time is right.
Closing down public hospitals at a time when (under healthcare reform) there will be more demand placed on the healthcare infrastructure of this state does not bother him, because his only interest (and his only option) is to refrain from raising taxes in order to protect his ambition. Whatever happens to the people working in those hospitals does not matter to him; they are just collateral damage resulting from the single-minded pursuit of his ambition.
Narcissism Masquerading As Policy
In his 1961 inaugural address, President John Kennedy challenged Americans "ask not what your country can do for you, but what you can do for your country."
Jindal stands this challenge on its head. His policies and his politics call on us to sacrifice for his political ambition, not for the good of our state.
We are being asked to "pay any price, bear any burden, meet any hardship" in order that Jindal's ambitions not be thwarted.
We should forgo the benefits of healthcare reform. We should acquiesce to the destruction of our higher education infrastructure. We should turn Medicaid into a funnel to enrich the hands of private firms hired to manage care for the poor with less money to do it (how can you add more hands in the till yet provide even the same level of care?). We should allow teacher pay to resume its fall in comparison to other states. We should abandon all hope of educating critical thinkers here because Jindal's friends don't need them in their shops — even though critical thinkers are exactly what we need to get out of the mess that Jindal is leading us into. Our children and their children should resign themselves to having to pursue educational opportunities elsewhere, find good paying jobs in some other state. We should continue sacrificing our coast so that his friends in the oil industry can continue extracting and exporting wealth from our state.
Louisiana should sacrifice all of those things so that Bobby can pursue his dream of running for president.
Sounds reasonable, inside his bubble anyway. This is what he means by the Louisiana Way.
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