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By Tom Cushing

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About this blog: The Raucous Caucus shares the southpaw perspectives of this Boomer on the state of the nation, the world, and, sometimes, other stuff. I enjoy crafting it to keep current, and occasionally to rant on some issue I care about deeply...  (More)

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“These are our friends. These are our families. These are our neighbors.”

Uploaded: Jun 25, 2017

“These are folks who are worth fighting for,” Gov. Sandoval said of the 210,000 Nevadans who obtained Medicaid coverage under the Affordable Care Act.

Granted that Mr. Sandoval is not a US Senator from the Silver State, so formally he only counts as just another voter. His viewpoint, however, has motivated his Republican colleague Sen. Dean Heller to oppose the Senate’s copycat version of the House of Reps.’ reprehensible bill seeking to gut the ACA, or ObamaCare.

By way of a small digression, I have been poking around the ‘net, seeking background for a blog on ‘tribalism’ as a working model of contemporary American politics (yes, on both sides of the aisle). It turns out that quite a bit has been written in terms of diagnosis (e.g., when you see political claim, do you decide how you feel based on the source – and then go looking (in your chosen media) for justification? You're in the tribe.). There’s a lot less out there on ‘cure’, unfortunately, but I’ll keep looking.

Mr. Sandoval’s quote is a fascinating turn of phrase, as an example of a pretty inclusive tribalism. It expresses empathy for those close by (families, neighbors, friends – who are numerous, even in sagebrush country), thereby rejecting the ‘Othering’ of Medicaid recipients. It’s a recognition that these Nevadans are not Those Other People – they are Us. Indeed, Medicaid assistance is a godsend for fully 1-in-5 Americans. Ironically, that fraction is even higher (1 in 4) in more rural, and redder states.

It also reveals the wretched cruelty of the Senate offering. Billed as a rebuild of the House-passed version (which even the Prez called ‘mean’), it is instead a simple variation on the theme. As such, it registers familiar GOP themes of pushing responsibility out to the states, and massively cutting taxes on the wealthiest among us. Much has been made of the facts that it was drafted in secret, by an all-male cast of characters *, but one might also ask: if this is It, what were they Doing in their man-cave, all that time - watching ESPN?

Congressional Budget Office numbers are due out shortly, and they are not likely to reflect much less ‘meanness.’ You can tell this because loyal GOP Senators have been busily pre-throwing dirt on the projections. It’s what you do when they’re going to be awful. Early estimates are that upwards of 18 million of ‘our friends, families, and neighbors worth fighting-for’ will lose health insurance coverage. That may be down a bit from the 24 million in the House version, but how many vulnerable, beggared neighbors is acceptable?

I’ll wait while you do the calculations.

Besides sexist drafting secrecy, the other pillar of the GOP strategy has been to rush this stinker to a vote, with nary a single hearing – a chance to be heard by all the many relevant professional organizations who oppose it. The ACA, by contrast, had fifty hearings - in public - over six months.

With the Dems solidly opposed (but without an alternative ACA improvement plan, because Dems are bad at politics), the bill can only afford to lose two GOPers. So far there are five – and those objectors come from both ends of the left/right spectrum. Therein lies the rub – to mollify the righties, you have to offend the moderates, or vice versa.

May I ask that anyone opposed to this inhumanity consider taking a few minutes today or tomorrow – to express email support to the several GOP moderates who are opposed or wavering? They are easy to google, and include the following: Cassidy, Collins, Murkowski, Capito, Heller, Portman, Corker and maybe Alexander. The forms will ask for your address, but it’s most likely that they are primarily keeping count of pros-and-cons.

This is a Defining Moment for those Senators.

It is so for all of us, too.

* Item: GOP Sens. Susan Collins and Lisa Murkowski are members of the Health Education & Labor Committee, but were excluded in favor of Ted Cruz, who is not even on that Committee. No medical doctors, either, although GOP Sen. Cassidy is an MD. Hmmm.
What is it worth to you?


Posted by Michael Austin, a resident of Pleasanton Meadows,
on Jun 25, 2017 at 5:45 pm

Michael Austin is a registered user.

Wander if the Koch brothers will be twisting arms of Rand Paul - Kentucky, Ron Johnson - Wisconsin, Ted Cruz - Texas, Mike Lee - Utah, Dean Heller - Nevada.

After all, the Koch brothers contributed millions of dollars to all five of these republicans that have announced their opposition to the health bill replacement for Obama Care.

Posted by Tom Cushing, a resident of Alamo,
on Jun 25, 2017 at 6:01 pm

Hi Michael:

The Kochs and their political organization 'Americans for Prosperity' (they needn't say whose) are among the right-side critics who don't think either bill goes far enough to dismantle the social safety net: Web Link

"Colorado Springs (CNN) As growing opposition imperiled passage of the Senate version of the healthcare bill, leaders of the conservative Koch network voiced sharp criticism of the legislation at their donor retreat here -- stating that the bill needed dramatic changes before they would support it.

The Koch network announced Saturday that they plan between $300 and $400 million on their political and policy objectives during the 2018 political cycle as Democrats wage an intense battle to win control of the House. The network has made the repeal of Obamacare a central focus of their political and policy work. They believe that neither the House, nor the Senate version achieves that goal."

Posted by Michael Austin, a resident of Pleasanton Meadows,
on Jun 25, 2017 at 8:26 pm

Michael Austin is a registered user.

There is another brother combination.
Farris and Dan Wilks contributed $15 million to Ted Cruz Super Pack.
I did not look deeper to learn where else they placed their money.
But, $15 million has an agenda!

Posted by Tom Cushing, a resident of Alamo,
on Jun 26, 2017 at 10:38 am

Sen Cassidy lays out his criteria:

June 26, 2017

Dear Mr. Cushing:

Thank you for inquiring about my thoughts on health care reform. It is good to hear from you, and I appreciate you taking the time to write to me. Having served uninsured patients at hospitals and community clinics for decades, I too am concerned with the problems facing our healthcare system.

As a physician, I have witnessed firsthand the inequalities in access and quality of care faced by the uninsured. Finding solutions that allow healthcare providers to deliver quality, affordable care to their patients is one of my primary goals in Congress.

As your Senator, I am working to achieve these goals and provide an alternative to the government-run system set in place by President Obama. I recently introduced the Patient Freedom Act of 2017. You will be pleased to know that I actively sought out my current position on the Senate Committee on Health, Education, Labor, and Pensions in order to more effectively develop such changes.

The Senate released a working draft health care bill that is still being worked on. Crafting legislation of this magnitude is always a multi-step process. This or any health care bill should continue adequate coverage for people, protect those with preexisting conditions, have fewer mandates, and lower premiums; the measures by which any bill must be assessed before being voted upon. This publicly available draft still must be scored by the CBO, given opportunity for amendments and debated on the Senate floor all before a vote.

I will continue to represent the views of my state and do so through hearing from constituents like you. Please continue to reach out, either by phone or by email, when you have another question or concern. You can reach my office in Washington DC at 202-224-5824 or submit an email at Web Link


Senator Bill Cassidy, M.D.

Posted by Tom Cushing, a resident of Alamo,
on Jun 26, 2017 at 6:06 pm

Some further knowledgeable background from writer Atul Gawande, published today: Web Link

"To understand how the Senate Republicans' health-care bill would affect people's actual health, the first thing you have to understand is that incremental care�"regular, ongoing care as opposed to heroic, emergency care�"is the greatest source of value in modern medicine. There is clear evidence that people who get sufficient incremental care enjoy better prevention, earlier diagnosis and management of urgent conditions, better control of chronic illnesses, and longer life spans. ....

Conservatives often take a narrow view of the value of health insurance: they focus on catastrophic events such as emergencies and sudden, high-cost illnesses. But the path of life isn't one of steady health punctuated by brief crises. Most of us accumulate costly, often chronic health issues as we age. These issues can often be delayed, managed, and controlled if we have good health care�"and can't be if we don't. ...

These bills are, in many ways, Medicaid-repeal bills masquerading as Obamacare-repeal bills. And Medicaid, remember, is not a program that the public is complaining about. It is immensely popular and works well. It provides coverage for sixty per cent of disabled children, and maternity coverage for half of pregnant women. Two-thirds of nursing-home residents end up relying on Medicaid coverage after their savings are spent. Among adult Medicaid recipients, sixty per cent work, and eighty per cent are part of working families."

Who is Atul Gawande? "Atul Gawande ... has won the Lewis Thomas Prize for Writing about Science, a MacArthur 'genius' fellowship, and two National Magazine Awards. He is also a surgeon at Brigham and Women's Hospital, in Boston, and a professor in the department of health policy and management at Harvard School of Public Health, and in the department of surgery at Harvard Medical School."

Posted by Resident, a resident of Laguna Oaks,
on Jun 26, 2017 at 10:25 pm

Is the blogger a resident of California or Nevada?

Posted by Tom Cushing, a DanvilleSanRamon.com blogger,
on Jun 26, 2017 at 10:33 pm

Tom Cushing is a registered user.

Both, at different times, FWIW. And you?

Posted by Soveletsky, a resident of Walnut Creek,
on Jun 27, 2017 at 12:39 am

From Cushing:

"Conservatives often take a narrow view of the value of health insurance: they focus on catastrophic events such as emergencies and sudden, high cost illnesses."

Conservatives take a narrow view regarding health care coverage? Interesting. Interesting because the previous administration did not appear interested that thousands of people would lose their health care coverage; which in fact they did. Another fact: Obama said no one would lose their coverage. Looks like the former commander in chief fibbed a bit, eh?

Whatever the case, I hope the folks in DC actually read this bill; which of course was not part of the required reading from Obama's syllabus last time. Oh, and the little thingy about the Repubs working on this bill behind closed doors? Well.... The Dems did the same thing too.

Meanwhile... The supreme court ruled in favor of the travel ban. Also, three so-called "journalist" from CNN walked out over their phoney news story about... The Russians! Of course! And... Nancy Pelosi is in hot water with her party due to the Dems losing the special elections. But wait! There's more!

Emerging from the bull bleep out there regarding Trump and the Russians, is the pending investigation of former Attorney General, Loretta Lynch. What goes around, well... It really comes around, doesn't it?

Tick tock tick tock, Mr. Cushing.

Posted by Resident, a resident of Laguna Oaks,
on Jun 27, 2017 at 8:13 am

The question wasn't where you live, the question is where you legally reside.

I legally reside in California fwiw.

Posted by Tom Cushing, a resident of Alamo,
on Jun 27, 2017 at 9:09 am

As a rule, I believe I do not owe my legal particulars to readers or anonymous commenters. I am not hard to find; you are free to draw your own conclusion.

You might also provide any smidgen of relevance to the topic, or some other reason why the rule is not a good one for me to follow. Otherwise, it's just a distraction from the issues raised in the blog.

Posted by Resident, a resident of Laguna Oaks,
on Jun 27, 2017 at 9:22 am

You make a fair point on relevance to the particular subject at hand.

Your answer to the question is sufficient to draw my own conclusion.

Thank you.

Posted by MichaelB, a resident of Pleasanton Meadows,
on Jun 27, 2017 at 10:08 am

<The Kochs and their political organization 'Americans for Prosperity' (they needn't say whose) are among the right-side critics who don't think either bill goes far enough to dismantle the social safety net>

I'll take their version of prosperity (free markets/more opportunities) over the left wing (equality of outcomes) one.

Income/wealth are not "rights" in this nation, nothing is "free", and getting more people dependent on social safety net programs is financially unsustainable. Barack Obama's regulate and redistribute("you didn't build that") economic policies didn't deliver the growth rates and incentivized employers to hire fewer workers. You needn't say it was the fault of the "1%" or "greed" for things not working out well.

Posted by Tom Cushing, a resident of another community,
on Jun 27, 2017 at 11:19 am

Hi Michael: I know you want to get into this, but it's not really on-point for this edition of the RC. I'd welcome a blog from your perspective - I used to have that kind of faith in the unfettered economic system.

Let me just give you something to think about - what if you take a System view, instead of one that frets about presumed givers-and-takers (with all those bad assumptions built-in). There's very good evidence that laissez-faire capitalism does not self-correct, but leads inevitably to the inequality of the present, and the past (think Gilded Age). That's unsustainable and ultimately anti-democratic. (read, for instance, Piketty's "Capital in the 21st Century," or Reich on "Saving Capitalism").

I'm no socialist; I do believe that capitalism has to be good for everybody who wants to get ahead - and that's just mythology at present. We, the People must harness the raw power of capitalism to serve the People's interests, through Our government. I agree with this depiction: Web Link

So, write it up. If you want, I'll publish it verbatim as a guest blog. But THIS blog is about health care.

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