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March 29, 2012


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What could Obama have done about the economy in lieu of spending a year on health care? Proposed another stimulus? Even if you suppose the president is the mastermind of our economic engine, he had already played his hand. There wasn't anything left to do because Republicans along with a few Blue Dogs would have killed it.

Runaway health care costs will eventually bankrupt us. There is no free-market solution here because the crony capitalists in the insurance industry along with the cartelized medical professionals won't allow it. In effect, we have the worst of both worlds, a hybrid health-care monster, immune to cost containment, and a smugly befuddled citizenry determined to maintain their individual advantages while screwing the less fortunate.

Obamacare is a mess. It was agonizingly assembled by a Congress largely bought off by the health-care industrial complex. It was difficult to explain and the president decided not to even try. Still, it was a start. Politics on this level is always ugly and byzantine. You don't craft transformative legislation without first paying the necessary bribes to the major players. Obama even promised Big Pharma to protect their cost extortion racket in return for not opposing HCR.

Our collective patience with an arduous political process and its decidedly mixed results has never been strong. Still, it's the only process we have. We're not going to leverage better results by dropping out, holding our breath, or demanding unattainable outcomes. It is what it is, warts and all. If it's not good enough for you, consider the alternative. It's staring us in the face and it isn't pretty.

Thats a big 10-4 Soleri

When the "chosen one" was chosen, he was handed a blank check to do anything and everything possible to "fix" things.

After 8 years of Bush and after a decade of bankers being really bad boys, he had a GREEN light and both houses of congress at his beck and call.

He could have shut Gitmo down, completely, vacant, abandoned on day two with overwhelming support.

He could have pulled the troops out of both wars within the first few months. All of them. Leave the middle east bastards to kill themselves off.

Leave Iraq with the understanding that any misbehaving would be met with cruise missiles blotting out the sun.

On day three, start arresting everyone on Wall Street, empty the place out. The only way they get out is by pointing out the ringleaders and the ones who profited wrongly. AIG, Freddie, Fannie, every employee off to jail. SEC and FED bosses, to jail.

He had the approval to do it.

So, what did he do?

As a "Constitutional lawyer", he set about to dismantle every aspect of the Constitution he could get his hands on.

He could have surrounded himself with the guys in the white hats. He went with the ones in the black hats.

Bush took his eye off the ball and went after Iraq.

Obamba took his eye off the ball and went after a 2300 page abortion of a health bill.

After one of the greatest screwups of presidential history (Bush), Obama stepped up and showed us, "heck, I can out do that". And he has.

Word that, AzRebel.

Somewhat OT, but worth reading: http://www.nytimes.com/2012/03/30/opinion/the-gated-community-mentality.html?hpw

I understand the NYT is going to limit non-subscribers to only 10 free views a month, so be forewarned if you're counting.

Does this tie in with health care reform? It helps to look at a nation that thinks it can privatize its public square, from security to the safety net itself. One reason why Obamacare is so controversial is that libertarians appear to be winning this argument even among people who don't live in gated communities. The more government is distrusted to serve as a positive buffer in our lives, the more motivated people become to find their own.


Having read Soleri's excellent post several times, I think it sets an appropriate tone for this discussion. But we're left to worry about where to from here and how we unwind what's already in motion. At 17% of GDP and growing, our healthcare dragon may be too big to slay . . then what happens to US?

While I don't worry about my wife and I, I have real concerns for the younger folks and how well they'll be covered. And I also have concerns about those of any age who are largely clueless about how to navigate within the existing medical morass . . because it promises to grow both more costly, more complex and more restrictive.

Now here's where I may begin to channel Emil's treatises, except with first-hand experience rather than scholarly research. Here goes: buried within the detail is a mandate for Electronic Medical Records (EMR).
When complete, it will give our healthcare providers access to most ALL our data in their computer systems. Example: my primary care doc @ Cigna can call up my last 5-6 years' worth of records covering all orifices and body parts. This means that my Primary Care Physician (PCP) can go online and collaborate/coordinate with every doc I've seen and every diagnostic I've used. For some, this is 1984-like. For me, EMR provides the assurance that my care can be managed and integrated with good data and relatively few suprises. Try this with your docs and tell me what happens . . .

Having dealt with one major health issue for 25+ years, I've seen my share of furrowed brows and fat files with paper records that often required an Easter egg hunt. Fortunately, my late wife was a very proactive nurse who ran interference for me.

Bottom line: I'm wondering NOW WHAT if the Supremes turn into a wrecking crew.

Electronic Medical Records

Ever heard the phrase form the dawn of computers:

Garbage in, garbage out.

Our doctors are all "tied" together.

We have to correct the information every visit.


Reb: Congratulations! You're way ahead of the curve in my opinion! Most patients are far less proactive. Consider also, that without EMR you'd have mainly your paper files to riffle thru . . assuming they'd give you access.

"What could Obama have done about the economy in lieu of spending a year on health care?"

Three years later, we risk forgetting how utterly wrecked the Republican Party was after eight years of W, the recession and Obama's victory. How much hard experience had refuted all their Randian policies and talking points. How fearful people were and open to new leadership.

Obama's position was arguably much stronger than Reagan's in 1981. His party held majorities in both houses of Congress. The opposition was in greater disarray. Here was a man with Reaganesque rhetorical skills, and thus the ability to go over the heads of the established order and get his way, as Dutch did. Unfortunately, Obama didn't have it in him. Reagan had served eight, largely successful years as governor of the second most populous state. Obama was inexperienced and naive. He wasn't a fighter. His enemies smelled his caution and callowness, and the rest is history.

What could he have done? 1) Pushed through a billion-dollar investment in forward-leaning, job-creating infrastructure, bonded with cheap credit. 2) Attacked the foreclosure crisis quickly and effectively. 3) Raised the regular stimulus to a billion, as economists were recommending. 4) Begun a crusade for an orderly remaking of the financial system, including breaking up the TBTFs. 5) Had his Attorney General aggressively prosecute those who had brought on the crash through their criminally risky acts. 6) Used the FDR/Reagan bully pulpit to continuously educate the American people about what their government is doing to help them, and what must be done for the future. Also, to continuously remind Americans what policies caused the crisis, systematically dismantle them by executive order if necessary, and been the middle-class tribune. People were mad and wanted some accountability. They wanted a leader who would show how we were neither down nor in decline. Then, 7) Made some smaller health reforms, such as making big phrama bid for Medicare D drugs and forbidding refusal of those with pre-existing conditions.

I could do on and on. Had Mr. Obama responded with **vigor** there's a chance the right never could have regrouped. AzRebel makes some other excellent points. His success would have let him campaign for a second term on Medicare for all. But the president allowed himself to be rope-a-doped by the right while kinda pursuing HCR, which wasn't really even reform.

Second to Rogue's comment on Obama's cautious nature and lack of fight. The Republicans sensed this about Obama and turned a losing hand into legislative and political jackpots time after time.

The US continues down the right wing path.


Psychopaths (re: Oligarchs) buy the narcissists that run for office and we hope for change? Not gonna happen.

Jon, Let's see if I understood you correctly. President's Obama and Clinton's, wives had more balls than their husbands?

I spent a day down in the Tucson mountains and it was heaven - maybe too warm but the spring flower show was stunning.

I'd like to continue this argument about Obama not to defend his personality or political skills but to push back on Rogue's idea that the Republican Party was in disarray after his election. I don't recall any evidence of this, and if their behavior after the inauguration was any indication, they showed remarkable solidarity in opposing him lockstep on every proposal of his presidency. He spent a lot of political capital making Olympia Snowe his co-president, and one of her demands - and Susan Collins' - was watering down his stimulus bill with mostly ineffective tax cuts. The notion that Obama could have gotten a better deal with his own less ideological caucus (along with the necessity of 60 Senate votes) was unlikely in the extreme.

Now, Obama is definitely not a political street-fighter. His post-partisan instinct didn't serve him well, and he kept going back to that dry well over and over again. But given his limitations, he did what he could do to move the nation in the direction of responsibility. Let's remember who opposed him and why. The Republicans used virtually every racist dog whistle in their playbook demonizing Obama. In return, the MSM sat on its hands in pursuit of its intellectual fetish, the false equivalency. And when Obama acceded to the Republican health-care plan of just a few years earlier, they screamed about death panels and socialism. Given the deep and abiding hostility of nearly half this nation to a black president, he moved forlornly to the right. Let's also remember Ronald Reagan didn't have this problem. What Reagan had was a citizenry more than willng to believe that they themselves were the problem, so it was easy for Reagan to cut taxes on the wealthy while raising their taxes (FICA) significantly. Later Bush 43 would complete the farce by rebating the FICA revenue bulge to the wealthiest taxpayers in 2001-3. Our ignorance is their bliss.

Obama biggest failing was housing policy. He should have insisted on cramdown legislation to let judges move foreclosures to bankruptcy proceedings. He didn't, however, probably because the banks more or less own Congress. Which also explains how Dodd-Frank is such weak tea. Now, we can argue about why liberals such as ourselves are so feckless to elect guys like Chris Dodd and Chuck Schumer in the first place. But we miss the core issue: liberalism itself isn't strong enough to force them to our side and interests. Where are our armies? Where?

We're in the fight of our lives with a well-meaning if irresolute leader in Obama. I'm not one of his fans. His dealings with Republicans during the debt-ceiling crisis and deficit talks were sheer torture for me. But he is, for better or worse, the only leader we have. The real question is what do we do in absence of a dream president. I'd suggest it would be to give Obama our support because not to amounts to feeding Republican nihilism. Yes, it's fun to preen one's moral superiority in front of pols too timid to risk alienating conventional wisdom. But in this case, we're pretty much all that's standing between the nation and the abyss. Or am I being hyperbolic? Do you feel confident we can limit the damage of another Republican presidency, with another two appointments, at least, to the Supreme Court?

Remember, it's not just about you. There are real people whose lives hang in the balance. Maybe they're not clever enough to have gotten to the front of the food chain, but I'd submit we owe them more than our cleverness. We owe them enough respect that we don't turn our frustration into moral collapse.

Now that's down right powerful. I could feel the blood a rising!

Consider the previous Talton post and then think how much better off we'd be if President McCain had appointed two more Supreme Court justices...

Yea verily I say unto you:

It is easy to look back and say coulda, shoulda, and mighta. But Obama ran on the premise and promise of civility. That was his overarching theme: We can disagree without being disagreeable.

And he has tried to deliver on that. He has been a saint in that regards. Like it or not the American people voted overwhelmingly for "not a red America, not a blue America but one America". He was in fact "chosen" to unite the country and bring back civility. He did not fail for want of trying...

The problem of course is not so much with Obama -- he *is* and always was a centrist and an incrementalist -- but with the American people in general (or to use a phrase Jon used to drop a lot: The Duhs and the Ignos and the Republican party in particular.

We are an ignorant country. 38% of the people can't name Biden as the VP. How many Americans do you suppose know that the Republican Party just passed a bill in the House privatizing Medicare away? 38%?

And speaking of the Republican Party, how many of you imagined in 2008 that *four years on* a certain Sheriff in AZ would be leading the charge to prove the President wasn't born in the US?

The answer is none of you. Oh we talked about Crazy going crazy back then. But none of us knew that the media was going to let them get away with it.

And none of us knew that the Kochs et al. were going to spring a Tea Party on America. None of us imagined old people with badly spelled signs marching on DC wanting to take "their country back." And no, they didn't mean "back" to the tax rates of the 50s or 60s or 70s. They meant back to white America.

So to the point:

None of us knew how just how unready America was for a black president. But every day, for four years, right under our noses, the Republican party has worked to deny the president's birthright. Think about that. That is not a trivial slur. That's not akin to calling Clinton a "fornicator". No, they are saying here: Send the nigga to Liberia, he is not even a real American.

No I don't blame Obama for the state of our Nation. Walt Whitman used to say to have great poets you needed great audiences. Well to have a great country you need to have great countrymen.

We don't. We've got tattooed Ignos and over-pierced Duhs. And perhaps soon with President Rmoney calling the shots, we will need a new phrase to describe our condition: Slouchers on vouchers.

Mr. Talton-I have followed you for years as you were one of the few truth tellers in the media.However,you and your followers seem to be straying into cynicism and it does not become you or them.You are better than that,and I hope you are just going through a short phase of depression and will return to your trenchant observations.I suggest you read McCulloch's Truman and will realize that politics was and still is the art of the possible and,like the wheels of justice,grind exceedingly slow,but incredibley fine.

Patience-grasshopper :>)


I"m half way through the "History of the Russian Revolution".

Through most of the revolution there was a vacuum of leadership at the top. Many groups tried to fill it.

It was a messy process.

The vacuum was finally filled, not by the best of folks.

Right now we have a vacuum in DC.

I guess what many of us on this blog are saying is that, it's going to get "messy" filling the vacuum in the swamp that is our capital.

And, it may not be the best of folks who end up in charge.

Cynicism, I would agree to that. Why not? Depression? At 72 I am not depressed I just super happy I got mine? I will tell U cynicism, that’s the kid who got his PHD and is flipping burgers, part time for a living and has no benefits.

The art of Politics has been shelved in America ever since a black man got elected president. As an old white guy I am in a position everyday to hear, “nothing else matters, we got get rid of that”!

How can you not be a cynic with that kind of seek and destroy attitude that exists in America today. And given a few more questionable killings of black youths and you can see the race wars coming. We can’t even convict bunch of old white racists for plotting to overthrow the government (recent court case).

And in Texas they got a Posse Comitatus guy with a warrant for assaulting a police officer that has held up at his ranch, for over ten years and said when you come bring body bags. So four sheriffs later still no arrest. Hell Janet Reno could have solved that problem easier than them badass Texas Lawman.

“Grinding Wheels of Justice” give me a break. As a retired cop I refuse to sit on a jury because justice in American is not grinding to palatable meal. It’s just grinding us into bankruptcy.

I don’t agree that “none of us knew”. Saying the Koch brothers were a surprise is not true. They are just rich Jon Birchers. That’s like saying we didn’t know 911 was going to happen. That’s just blatantly false. We knew we just didn’t believe it because we are so “god” almighty and at the same time complacent After all we got the nukes and hot dogs. No, we knew most this crap. We just didn’t act.

I find it hard to blame Obama for failure as he had very little life preparation for the job. Shooting hoops and doing a little grass don’t cut it. But you would think that for the last four years he has learned to get his hands up and lead with his left and KO them with his right. I would hope so, because if he gets re-elected he is going to need to be down and dirty. No more just floating to the hoop for a little dunk.

Obama like Clinton had a shot at being great presidents. But they can’t even get it in from the free throw line. Too bad this country hasn’t had a real president for 60 years.

The political equivalent of Bonhoeffer's "Cheap Grace" will always be the greatest temptation for the electorate. But voters are also cautious - most wanted Obama to bring different sides together, with the hope of forging something resembling a consensus. What's most remarkable (aside from cowering Democrats)is the complete shakedown of moderate Republicans! The GOP is doing a brilliant job of alienation women and Latino voters - many of whom voted for W. All the money in the world from Romney won't win them back!

Speaking of blood arisin', cal - that was magnificent.

It's cynicism of the practical sort, not the nihilistic variety.

The two parties are dancing with corporate America. We get to cut in briefly during election fever, but they return to the ones that brung 'em in short order.

A "third party" is very clearly a false bromide - I wouldn't be surprised if one isn't engineered soon just to keep everyone distracted from the fact that our government, as it is so constituted, has systemic incentives/disincentives to a true democracy.

Of course, we're preemptively cynical about the wisdom of true democracy, what with all of the "Duh's and Ignos" talk, but it'd be nice if we took it for a drive around the block a couple of times before we turned away from that idea. Keeping in mind that the prevailing "wisdom" of the top of the pyramid has been catapulting the "tyranny of the masses" propaganda meme since the country was founded.

I mean, the strongest indictment against our government's behavior is just how much the majority of the population is being flat ignored on many key issues - take military spending, foreign aggression/occupation, and healthcare as quick examples.

I'm with Jon & AzRebel on Obama's pissing away of an opportunity - it reeks more of his fealty to the financial sector than some reticence to mix it up with the so-called opposition.

All fodder for practical cynicism.

Thank you Professor Petro!

This is the only blog I know where the comments are consistently as sharp and informative as the blogger's posts; and Mr. Talton is very good indeed.

I often fret about the Duh's and Ignos.

I was just at Safeway. As I approached my truck, there was a mother and two daughters standing by their beat up car. Their rear door was open so that it blocked my ability to back up.

Mom: shorts and a tank top, white, 5'5", 250 lbs., every available space of skin tattooed, piercings all around. Smoking like a chimney.

Daughters: so far tattoo free, ages maybe 16 and 18, both smoking like two small factories.

I thought my arrival with groceries would hint to them that their door would need to be closed so that I could leave.


I had to go around and ask if I could shut their door so that I could back out.

Mom: "no problem. we have to smoke out here because they don't allow smoking in the store."


Thanks for the Area 51 update azrebel.
I am going through there Tuesday.

cal, Roswell is where they landed.

They are living and working undercover at a Walmart in Area 51, 120 miles north of Las Vegas.

Obviously, a few have escaped and are shopping at a Safeway in Mesa.


Is there a final solution lurking in that sentence?

What has happened to this blog?

Settle down. Settle down. Settle down.

More like education, contraception, and more education.

Not the other "final solution".

Heck, that's been tried. Even that didn't work. Our species is a virus, we can breed through just about any natural or man-made attempt to wipe us out.

Besides, soleri, you are a fitness freak. Do you condone the scene I mentioned above?

I insist on every American's right to destroy themselves with bad habits, if they so chose, but do you want me to pay for the cost of their bad habits?

I wrecked my body athletically as a youth. Now I'm paying for it. Physically and in cold hard cash. $2,000 just this last week. I paid for it.

We could extrapolate this argument out to include, smoking, drinking, unprotected sex, texting while driving, riding a bike in Phoenix and on and on.

Do we wrap an envelope around all of society and say, go ahead and do whatever the heck you want, we'll step in and take care of you. OR, do we offer help up to a point then if the destructive behavior continues, gently push them out the door and say "you're on your own now, straighten out or pay the consequences yourself.

At some point, we have to let Darwins Theory work its magic.

I'm a compassionate American. I support the local food back and Salvation Army to a great degree.

If a friend or neighbor asks for assistance, I respond, How much do you need?"

If a drunk or a druggie acquaintance comes to me for help, I'll help them, maybe ten times. On attempt number eleven, they cease to exist to me. If they don't have the strength to get their lives back on track, hell with them. There are too many good people out there trying really hard to make good. We no longer have the resources to help those who won't be helped. It's an ugly choice, but as you well know it's an ugly world out there. We're fortunate in this country. We are shielded from the world that most of mankind lives in.

Look at me, I wrote an Emil length post.

Another sidelight: medical issues are rampant among Native American tribes. We don't hear much about the epidemic of diabetic obesity and/or alcoholism. They are sovereign nations, so there's not much transparency. The Great White Fathers also have little to say about the BIA.

We no longer have the resources to help those who won't be helped.

We're the richest nation on Earth - or were up until recently - and we can't provide basic medical care to our citizens? We are also, I believe, the most obese nation on Earth, which is one very strong reason why health-care is eventually going to bankrupt us, particularly if we don't regulate it. Europeans, those elitist snobs who make chocolate and dwell in gulags, tend to live in much denser environments. As such, they walk much more. This is what Republicans want to prevent here: elitists making you walk to your FEMA trailer while enforcing liberal ideas about preventive medicine. That's the menace of Michelle Obama.

Yeah, I'm frustrated by the carelessness of people. But I don't want them to die because of it. If you assume their lives have minimal value, either for aesthetic or moral reasons, you're making a judgment about this nation, too. It's essentially saying we don't have a social compact, that only money makes it worthwhile, and that if you're unattractive and unlikeable, it would be better to die.

We're better than that.

I spend a lot of time online talking to people who call themselves libertarians. They imagine themselves to be completely self-reliant and autonomous. They think everyone else should be like them. Yet, when I probe their stories, it often emerges that their lives didn't spring fully formed from the brow of Zeus. They went to public schools, got FHA loans for their first house, get to deduct the mortgage interest from that on their taxes, and live in a society where the cleanliness of the air and water are guaranteed by the EPA. They get to rely on public safety workers, drive on public roads, drive cars that are much safer than their parents thanks to federal law, and go to public parks and libraries. This is what it means to be civilized. Libertarians don't like that because it's coercive.

This coming election is going to pivot around this debate. Republicans are essentially telling everyone that they're going to be on their own. They want to voucherize Medicare, privatize Social Security, slash taxes on the well-to-do, increase them on the poor, and essentially end the social compact that makes civilization possible in an advanced post-industrial nation.

We need this debate badly because there's so much bullshit coming from the right that says this arrangement is unfair, that there are freeloaders gaming the system (and we know what color they are), that Americans are tired of helping each other because a) no one helps them or b) we don't have enough money. Those are lies.

The lack of realism about modern civilization doubles back on us politically and creates a surreal kind of victimology where prosperous people indulge in ridiculous kinds of self-pity. Even liberals indulge this nonsense when they complain that the president didn't fight hard enough for one program or the other. And the net result of all this is a nation paralyzed by cynicism.

I guess my bad mood comes down to this very human problem. I want people to take responsibility not only for themselves but for their country, too. I don't want to give up because some people are fat and crude, or other people are delusional with the idea of Rugged Individualism. Tell the truth about yourself. Admit who was there for you and how our interdependence is woven so tightly that we don't even notice it anymore.

You carry this compassion everywhere you go. Carry it proudly.


the exhausted national mind turns to every utopian scheme it can grasp to be able to imagine a palatable future. One of those is the libertarian market utopianism (esp. among the younger ones) which is really a belief in a self-organizing optimal equilibrium - quite similar to the environmentalists. 'If we only tried hard enough (dismantling all the shackles) all problems would solve themselves!' is the hope.

The equilibrium doesn't exist. The dreams of a totally free society have already been lived through under a barely disguised feudalism. That kind of society also has the unpleasant tendency to be unstable.

Also, the hope that a hades of extreme Republican governance can knock some sense into people is futile. We have done all that and it didn't work as prescribed! Worse means worse, not better.

Finally, we not only need resources to solve problems but also care and attention. Those two things got lost along the way and now maybe we're just too stressed to find them in us again.

Mr. Talton's post in the comment section was awesomely correct. Obama blew it!!

Now, watch out. DEATH is coming. Yes, I am cynical and depressed. THERE ARE NO JOBS.

There is no way in Hell that I'm going to survive. I'm doomed to starve to death because there are no jobs in the United States.

The Republicans want to eliminate Medicare, Medicaid, Food Stamps, and everything else. WHEN THEY DO THIS, you will see wide-spread death and starvation.

No one can live on a WalMart wage. It isn't possible. The Republicans want those people to live on $120 a week. It isn't going to happen. Americans are going to die, while the Tea Party, the 1%, and the retired folks who "got theirs" laugh and mock them.

Holdomor is coming. The Republicans want Americans to work 90 hours a week for the privilege of starving to death.

"No one can live on a WalMart wage. It isn't possible."

You're right, they can't. They can't even get health insurance. But the 'sustainability gurus' at ASU sure are comfy...

"Walmart chairman, wife donate $27.5M to ASU"



ASU is the perfect echo of unsustainability. They are so blinded by their 'business model' mindset that they can't even see that they no longer create a reflection in the mirror. Hollow.


Oh, I forgot, ASU hasn't glanced at a mirror over oceans of time.

My attitude toward the healthcare legislation is lukewarm, and both Mr. Talton and Soleri make excellent points (from opposite sides of the same coin). So, I'm a bit conflicted.

The requirement to purchase health insurance was originally a Republican idea, and it's perfectly legal for individual states to legislate such a requirement (and some do). The question is, first, whether the federal government can do so, and if the argument it offers for doing so is accepted, whether this opens the door to less wholesome intrusions at a national level; and second, whether if doing so merely feeds the coffers of the private healthcare industry without controlling healthcare inflation: a law socializing costs but privatizing profits is nothing less than a mandate for theft by private corporations beholden to the bottom line and shareholder interests, rather than any public interest.

My primary concern with this legislation is that it seems to do little or nothing to control costs at the source: provider care. Private providers always have a financial motive to charge more for services and to provide more services than are medically necessary, simply to increase profits. The Act does offer tax credits to working and middle-class families, but if costs keep rising then so do taxes, else the value of the credits gets eroded in real terms.

It seems useful to review major provisions of the law.

A useful reference for discussion (quite reader friendly) can be found in this timeline showing the provisions and when they are/were scheduled to take effect:


Before examining major benefits, note that some of the law's finest points aren't mentioned in the government's timeline and seldom receive press attention. The best way to learn about them is to find out what conservatives are complaining about. From an op-ed in the Wall Street Journal, July 11, 2011:

* For the first time, the Affordable Healthcare Act applies Medicare's 2.9% payroll tax (for individuals) to investment income, including dividends, interest income, and capital gains.

* Starting in 2013, the Act adds an additional 0.9% Medicare payroll tax surcharge for singles who earn more than $200,000 a year and for couples making more than $250,000. The surtax is not indexed for inflation, which means that it will eventually apply to (perhaps) the top 10 percent of households before Congress steps in and indexes for inflation.

This means a 3.8% tax hike on the affluent, already passed by a Democrat controlled Congress and signed into law by President Obama. No wonder Republicans hate "Obamacare" -- and Obama.

* Starting in 2018 the Act imposes "a whopping 40% 'excise tax' on high-cost health insurance". Groovy. This is important an important step in keeping consumer costs down, since otherwise costs imposed by the Act on insurers and providers could be passed through to consumers via their insurance premiums.

* A new annual fee on health-insurance providers starting in 2014 and estimated to raise $60 billion by 2019 (though it continues after that).

* The Wall Street Journal also mentions a 2.3% excise tax on medical device manufacturers and a new annual fee on "branded" (non-generic) drug-makers (clawing a little back from Bush's give-away in Medicare Part D), before noting:

"There are numerous other new taxes in the (Act) adding up to some $438 billion in new revenues over 10 years. But even that is understated because by 2019 the annual revenue increase is nearly $90 billion or $900 billion in the next 10 years after that."

Revenues are something to consider when Republicans complain about the law's cost in the period outside the original budgetary window.

In addition to the 40% excise tax on "high-cost" health insurance, there seem to be two basic, additional mechanisms for keeping costs to consumers down.

One is "Rate Review", which means "your insurance company can’t raise rates by 10% or more without first explaining its reasons to your state or federal Rate Review program" according to the government's website.

First, this allows them to increase the rate by 9.9 percent a year and that's far in excess of general inflation.

Second, enforcement will depend on the teeth given to overseers. Note that states can opt to regulate instead of the federal government. Many, including Arizona, already are, at the behest of insurance companies, who seem much more confident in what they can get away with under a Republican legislature and governor than under President Obama and federal staff workers. The federal government can step in if the state oversight program is deemed "ineffective" but that is a recipe for delays, disruptions, lawsuits and behavior by states that is technically compliant but which defies the spirit of the Act.

The Act also contains a provision requiring insurers selling to 50 or more individuals to spend at least 85 percent of premiums on "care and quality improvement". If they don't, they can be made to issue rebate checks to insured who paid premiums in excess of that. There are some loopholes, and enforcement quality remains an unanswered question.

More benefits:

* The Act eliminates both annual and lifetime limits on individuals receiving payments by insurance companies. This means they can't drop your insurance just because you get sick and they have to make a big payout.

* Starting 2014, "the law prohibits insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also, in the individual and small group market, it eliminates the ability of insurance companies to charge higher rates due to gender or health status."

* "An insurer cannot rescind your coverage simply because you made an honest mistake or left out information that has little bearing on your health."

* Starting 2014, "individuals under 65 years of age with income below 133 percent of the federal poverty level (FPL) will be eligible for Medicaid. For the first time, low-income adults without children will be guaranteed coverage through Medicaid in every state without need for a waiver, and parents of children will be eligible at a uniform income level across all states."


* Offers hefty discounts on name-brand and generic drugs for seniors who reach the coverage gap ("donut-hole") in their Medicare Part D coverage. The gap itself is gradually reduced and eliminated by 2020.

See the timeline for other features. Roll the cursor over the white squares and click (check marks indicate provisions already in effect). Note that the Act contains many early, temporary "bridge" provisions that are much weaker than later provisions yet to come into effect, so it's less confusing to read them from the 2015 end of the timeline.

Also, the press reports that the Obama administration has asked the Supreme Court to invalidate the ban denying coverage because of pre-existing conditions if the individual mandate is struck down; supposedly because of concerns that invalidating the mandate while maintaining the ban would make it impossible for the insurers to make a profit and/or destabilize the insurance industry.

Why not just buy a hospital? Then, when your done with it, you can just shut it down, or move it overseas!

"a law socializing costs but privatizing profits is nothing less than a mandate for theft by private corporations beholden to the bottom line and shareholder interests, rather than any public interest."

Yes, just as we daily experience at the very foundation of our technological society: in the energy sector.

Couldn't escape if I wanted to.

Thanks Emil for your patient research. Wish President O&Co. had 'splained the benefits over and over so us common folks could grasp them.

Ironically, I am sick. Will post again ASAP

Hope U feel better soon Jon.

A note from Cuervo NM. I was in town to pickup a tire from a I-40 fatality.
The local news is that the local ranchers and others are suing the oil and gas exploratory drillers. Seems that their drilling dried up all the wells in a 40 Square mile area.

Or in modern, politically correct, legal speak:

Cal, who is allegedly in Cuervo, NM to pick up a tire involved in an alleged fatality heard that local ranchers are suing oil and gas drillers for allegedly drying up wells in a 40 square mile area.

See how much better that sounds.

cal, I hope your alleged trip back home is as safe as our actual trip back home.


Water table couldn't have been in good shape if some holes could drain it!

Get Well Rogue and safe travels cal!

"See how much better that sounds."

According to AzRebel. Allegedly.

Yes, Jon hope you feel better very soon!

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