Affordable Care Act

Morning Ethics Warm-Up: 6/25/17

/ Jack Marshall / 19 Comments

1. On the same New York Times front page (June 21) that announced the Georgia 6 result, surrounded by Times’ agenda-advancing stories with slanted headlines (climate change, North Korea, the Obamacare overhaul,  the “divided GOP,” and Michael Flynn) was the kind of story that once made the Times’ reputation. It was headlined, “Haven for Recovery Becomes A Relapse Capitol,” Will this story be discussed today by the Sunday talking-head shows? Of course not. The implications of it are not friendly to progressive mythology.

The story explains how Delray Beach, Florida has become a Mecca for drug addicts and a bonanza for treatment centers and “sober houses,” group living facilities for addicts. Some quotes will provide a sense of the report, but you should read it all:

Unlike other places in the United States that have been clobbered by the opioid crisis, most of the young people who overdose in Delray Beach are not from here. They are visitors, mostly from the Northeast and Midwest, and they come for opioid addiction treatment and recovery help to a town that has long been hailed as a lifeline for substance abusers. But what many of these addicts find here today is a crippled and dangerous system, fueled in the past three years by insurance fraud, abuse, minimal oversight and lax laws. The result in Palm Beach County has been the rapid proliferation of troubled treatment centers, labs and group homes where unknowing addicts, exploited for insurance money, fall deeper into addiction.

…

Hundreds of sober homes — some reputable, many of them fraud mills and flop houses for drug users — sprawl across Delray Beach and several surrounding cities. No one knows exactly how many exist because they do not require certification, only city approval if they want to house more than three unrelated people. Hoping for a fresh start, thousands of young addicts from outside Florida wind up here in places that benefit from relapse rather than the recovery they advertise.

…

…the proliferation of fraudulent sober homes was in part also the result of two well-intentioned federal laws. First came a 2008 law that gave addicts more generous insurance benefits; then the Affordable Care Act, which permits adults under 26 to use their parents’ insurance, requires insurance companies to cover people with pre-existing conditions and allows for multiple drug relapses.

The result was a whole new category of young addicts with access to insurance benefits. This gave rise to a new class of abusive operator, as painstakingly chronicled in The Palm Beach Post: the corrupt sober house owner. Many drug treatment centers — which also treated inpatients — started paying sober-home owners “bonuses” from insurance money and fees for referring outpatients to their centers while they underwent therapy, according to law enforcement, a grand jury report and court records.

…

Sober homes, which are not covered by insurance, can get thousands of dollars a month for each recovering addict, in large part from treatment providers, law enforcement and city officials said. Much of it goes into the owners’ pockets. But it is also used to pay rent so patients can live free and to provide perks that lure patients from other sober houses: manicures, mopeds, gym memberships and, worst of all, drugs. Relapses are welcome because they restart the benefits clock.

To increase profits, many treatment centers and labs overbill insurance companies for unnecessary tests, including of urine, blood and DNA. Some have billed insurance companies thousands of dollars for a urine test screen. Patients often unnecessarily undergo multiple urine tests a week.

Ah, glorious compassion! So those of us who managed to not break laws and cripple ourselves while doing so get to pay for not only the self-inflicted problems of those who did, but also get to enrich  the scam-artists who live off of their addictions, protected by compassionate, expensive insurance guarantees that require no personal responsibility or accountability. Meanwhile, “federal disability and housing anti-discrimination laws offer strong protections to recovering addicts who live in them.”

This is the better “treatment” alternative to the “war on drugs” that the compassionate people harangued us about for decades. Continue reading →

No, Insurance Companies Treating People With Pre-Existing Conditions Differently From Other Customers Is Not “Discrimination.”

/ Jack Marshall / 63 Comments

Here is a prime example of how the news media’s intentional or careless use of words warps public perception and policy.

Yesterday, the New York Times front page story about the GOP House’s health insurance bill noted in its second paragraph that the bill wouldn’t do enough to prevent “discrimination” by insurance companies against those with per-existing conditions. I have seen and heard that term, discrimination, used over and over again to describe the per-existing condition, and I apologize for not blowing the whistle on it long ago.

Using the term, which is usually used in other contexts to signal bigotry, bias and civil rights violations, is misleading and virtually defamatory. Insurance companies are businesses. They are not charities. They are not public resources. If an automobile company turns down an offer of half what a car costs it to make, it is not discriminating against that customer who made the offer. If a restaurant customer says to a waiter, “I have just four bucks, but I want you to bring me a dozen oysters, a steak, and a nice bottle of wine,” the establishment isn’t discriminating against the diner for sending him to McDonald’s.

Insureds with per-existing conditions want to pay premiums that are wildly inadequate for the coverage they know and the insurance company knows they are going to need. Insurance companies are portrayed as villains because they don’t eagerly accept customers who they know will cost them money, often a lot of money. That’s not discrimination. That’s common sense, basic business practice, fiscal reality,and responsible management. The news media and the under-cover socialists among us want to create the illusion that a company not wanting to accept customers who lose money rather than add to profits is a mark of corporate greed and cruelty, hence the use of “discrimination” as a falsely pejorative term, when the fair and honest word is “problem.” Continue reading →

The False Lesson Of The GOP Failure To Replace Obamacare

/ Jack Marshall / 25 Comments

“They called off the Charge of the Light Brigade, the incompetent fools!”

Ethics Alarms feels obligated to state what should be obvious, but increasingly is not, as abuse is heaped on the Republican House and President Trump for failing to be able, for now at least, to agree on a replacement/repeal/fix for the Affordable Care Act, “Obamacare” its close friends….enemies too, come to think of it.

The headlines on stories all over the web describe the lack of a GOP bill are brutal:The failure of the Republican health care bill reveals a party unready to govern (Vox)…Republicans Land a Punch on Health Care, to Their Own Face (New York Times)…Inside the GOP’s Health Care Debacle (Politico). Those are the nicest ones. The conservative media’s headlines are even more contemptuous. This only reflects how much the prevailing delusion on the Left and by extension the Left’s lapdog media and punditry, has infected political common sense, leaving a Bizarro World* sensibility about what ethical governing is about.

It may be futile to point this out from this obscure corner of the web, but hell, I’m a fan of quixotic endeavors: the House health care bill was a bad bill. Virtually everyone who examined it thought so. If the thing had somehow been passed by the Senate (it wouldn’t have been, so this meltdown just got all the abuse and gloating out of the way early) and signed by the President (who admits that he has no idea what a “good” health care system would be), it would have thrown millions of lives and the economy into chaos. It isn’t responsible governance to pass bad laws. (Why is it necessary to even say this?) It’s irresponsible. The Republicans wouldn’t show they were “ready to govern” by passing an anti-Obamacare bill that made a bad mess messier; they would have shown that they were fools, reckless and incompetent.

You know: like the Democrats when they passed the Affordable Care Act. Continue reading →

And The Obamacare Ethics Train Wreck Rolls On…

/ Jack Marshall / 48 Comments

Barack Obama’s legacy is a series of ethics train wrecks of remarkable and depressing longevity. The oldest of them, the Obamacare Ethics Train Wreck. may never stop rolling, leaving destruction in its wake forever..

Observations:

1.   It is clear that the Republicans will not be able to repeal, undo, repair or reinvent Obamacare, aka The Affordable Care Act, consistently with their rhetoric and the wishes of the thoroughly messed-up law’s abundant critics. The many bills passed by the GOP-controlled House to that end during the Obama Administration were grandstanding only: they passed because there was 100% certainty they would be vetoed. Now that such bills actually risk becoming law, Republicans are, reasonably enough, not willing to take the leap into the void.

2. The President has told Congress that if they are not prepared to deal with the repeal and replacement of the ACA now, he will move on to other priorities.  This is entirely responsible, both politically and pragmatically. Passing a sweeping law in haste that will affect millions of Americans would be irresponsible.

3. This means, of course, that the President’s campaign pledge to repeal Obamacare and replace it with something “great” “on Day One” was nonsense. On one hand, it was reasonable for him, or anyone, to assume that after seven years of complaining the party’s legislators had a viable plan ready to replace the affordable Care Act. On the other, it was dishonest to make such a pledge without ascertaining with certainty that what Candidate Trump was promising was within the realm of possibility. “Day One” is obvious hyperbole, but anyone making such a statement must assume that it will  be widely interpreted as “before the next Ice Age,” and thus should not be uttered unless the pledge can be fulfilled eventually. Continue reading →

KABOOM! Unethical Quote Of The Month, And Maybe Hypocrisy Of The Century: Nancy Pelosi

/ Jack Marshall / 33 Comments

I’m stunned. I honestly did not think it was possible for  Nancy Pelosi to surprise me any more, as my expectations for her utterances are so low as to be subterranean. I certainly didn’t think she could make my head explode again. Pelosi accomplished the impossible, however, by including this astounding line in a letter to Paul Ryan regarding a GOP replacement for the Affordable Care Act. She actually wrote…

“The American people and Members have a right to know the full impact of this legislation before any vote in Committee or by the whole House.”

KABOOM!

1. This is the same woman whose most famous quote, regarding the ACA, is “We have to pass the  bill so that you can find out what’s in it….” 

2. The law the Republicans want to replace with something the “American people and Members have a right to know the full impact of … before any vote in Committee or by the whole House” was one that almost no Democrats read before voting for it, so even they didn’t understand its “full impact.”

3. The ACA passed in this manner included a mandate that Pelosi and her party swore was not a tax but a penalty, and then when the law was challenged argued to the Supreme Court that it wasn’t a penalty, but a tax.

4. The President of the United States who signed the ACA materially misrepresented the impact of the law repeatedly by stating that it allowed Americans who wanted to keep their current health plans to do so.

How dare Nancy Pelosi make that demand? How astoundingly hypocritical, overflowing with gall, and immune to self-awareness can any human being be? This is like Bill Clinton lecturing Donald Trump about avoiding intimate relations with subordinates, but worse.

Of course she’s right, but Pelosi is the last person on earth, literally the last person, entitled to demand transparency regarding health care bills. How can she say something like this? Is she senile? Is she trying to look ridiculous? Is she so completely devoid of integrity that she can advocate the exact opposite of her own conduct and that of her party without a twinge of irony or shame? Does she believe that her followers are so blind, stupid an unable to hold a memory in their heads that they won’t see how offensive this is, coming from her?

Are they that blind and stupid?

Why Health and Human Services Nominee Price’s Smoking Gun Ethics Breaches Won’t Disqualify Him

/ Jack Marshall / 11 Comments

smoking-gun

There was good news on the Trump Administration Ethics Train Wreck, still just pulling out of the station. Despite the ethically-challenged reaction fro the Trump transition team when it was revealed that Monica Crowley had plagiarized in her latest book, somebody, somewhere, persuaded the conservative radio talk-show host to resign her new White House post. Good. But as many—most?—predicted, the muck is just beginning to bubble to the surface.

CNN reports that Rep. Tom Price,Trump’s nominee for Secretary of Health and Human Services who will have much of the responsibility for dismantling Obamacare  without triggering a health system crash, appears to have engaged in a flagrant instance of using his position for financial gain.  Last year, Price purchased shares in Zimmer Biomet, a medical device manufacturer [Full disclosure: I have one of their artificial hip joints, setting off metal detectors at airports all over the world] right before he introduced  legislation that would have directly benefited the company.

Price bought between $1,001 to $15,000 worth of shares in the company last March, and then, less than a week after the transaction,  introduced the HIP Act (Clever!) to delay until 2018 a regulation that industry analysts believed  would significantly hurt Zimmer Biomet, one of two companies most affected by a regulation that limits payments for joint implant procedures. Not only did Price have a financial stake in the regulation he tried to stall,but after Price introduced  his bill, Zimmer Biomet’s political action committee donated to the Georgia congressman’s reelection campaign.

Merely a coincidence, I’m sure.

Price is scheduled to appear before the Senate Health Committee this week, and the Senate Finance Committee later. He should withdraw, or failing that, Trump should pull the nomination. Price’s purchase of the Zimmer Biomet shares isn’t the first time he’s used inside information (the inside information being “I’m going to propose a bill”) to buy shares in a company. The Wall Street Journal reported last month that he traded roughly $300,000 in shares over the past four years in health companies while pursuing legislation that could affect their bottom lines.

Yeccch. Continue reading →

Obamacare’s Epitaph: “Live By The Rationalization, Die By The Rationalization”

/ Jack Marshall / 46 Comments

obamacare-gravestoneRemember in 2010, when the Democrats ensured that the Affordable Care Act would clear its final hurdle to passage this way?

Democrats will finish their health reform efforts within the next two months by using a majority-vote maneuver in the Senate, Majority Leader Harry Reid (D-Nev.) said. Reid said that congressional Democrats would likely opt for a procedural tactic in the Senate allowing the upper chamber to make final changes to its healthcare bill with only a simple majority of senators, instead of the 60 it takes to normally end a filibuster.The move would allow Democrats to essentially go it alone on health reform, especially after losing their fillibuster-proof majority in the Senate after Sen. Scott Brown’s (R) special election victory in Massachusetts.

Republicans have protested the maneuver as a hyperpartisan tactic to ram through a health bill, and have said that plans to use the reconciliation process make moot a bipartisan summit at the White House this week, where both GOP and Democratic leaders are supposed to present their ideas on healthcare.

At the time, Republicans, as is their wont, over-stated their objections to the maneuver, calling it unconstitutional and a breach of rules. No, it wasn’t quite that, nor was it as unusual as the GOP claimed. It was within Senate rules, but still the first time it was ever used to amend a bill that had already passed the Senate via cloture, and under such contentious circumstances.  Reconciliation was legal, all right, but since the Affordable Care Act was so revolutionary and controversial, its passage needed to be seen as democratic, and it wasn’t. Democrats ignored the Golden Rule, and extended the acceptable use of reconciliation by using a number of rationalizations, as well as “the ends justify the means.”

Let’s see: “Everybody Does It” wouldn’t work, because the problem with using reconciliation was that everybody didn’t do it, at least not very often.  So Democrats opted for 13. The Saint’s Excuse: “It’s for a good cause”…23. Woody’s Excuse: “The heart wants what the heart wants”…#24. Juror 3’s Stand (“It’s My Right!”)…25. The Coercion Myth: “I have no choice!”…28. The Revolutionary’s Excuse: “These are not ordinary times.”…31. The Troublesome Luxury: “Ethics is a luxury we can’t afford right now” …40. The Desperation Dodge or “I’ll do anything!”…59. The Ironic Rationalization, or “It’s The Right Thing To Do”…and perhaps a few other rationalizations on the list. Continue reading →

“If That Was Transparency, Then I’m A Kumquat” And Other Reactions To Josh Earnest’s Multiple Unethical Christmas Quotes

/ Jack Marshall / 13 Comments

This morning, Obama Administration paid liar Josh Earnest spoiled my Christmas mellow by telling CNN’s alleged news media ethics watchdog Brian Stelter that there’s really “no constituency in American politics for transparency in government beyond journalists,” as he deflected Stelter’s accounts of journalists complaining about administration foot-dragging on Freedom of Information Act requests. Then he really curdled the ethicist’s eggnog by saying,

“If this constituency of journalists are gonna be effective advocates for the issue that they care about, they need to remember that they have a responsibility not just to criticize those who are not living up to their expectations. Any activist will tell you that the way that you get people to support you and to support your cause is to give them credit when the credit is due, to applaud them when they do the thing that you want them to be doing.”

Finally, Earnest molded my mistletoe by claiming,  “President Obama has been the most transparent president in American history.”

Stelter, of course, being an incompetent, biased and unethical news media ethics watchdog, did not interjection with the mandatory, “WHAT??? You’ve got to be kidding! HAHAHAHAHAHAHAHAHA ACK! ACK! ARRRGH! and drop dead in shock.

That statement is fake news if anything is, rivaling the news media lie that that the Obama years were devoid of major scandals. Before we begin shooting fish in a barrel and deal with that brazen-beyond-belief spin, let’s pause to consider the other stunner in Earnest’s Christmas morning performance:

1. What does Earnest mean that journalists are the only constituency for transparency? Does the Obama administration, and by extension Democrats, really believe that the public doesn’t mind being lied to? If so, that explains a lot, including the nomination of Hillary Clinton.

2. Journalists are not supposed to advocates and activists at all. They are supposed to be devoted to communicating facts and the truth.

3. Is Earnest saying that when a President generally defies a pledge of ethical conduct, he should nonetheless be praised when he doesn’t defy that pledge, and that journalists should highlight the Administration’s rare examples of  transparency while ignoring the overwhelmingly more copious breaches? It sure sounded like it.

That brings us back to the mind-melting quote that this has been a transparent administration by any definition of the word other than “not transparent at all.”

This episode from 2011 nicely encapsulates the issue:

“President Obama was scheduled to receive an award from the organizers of the Freedom of Information Day Conference, to be presented at the White House by “five transparency advocates.” The White House postponed that meeting because of events in Libya and Japan, and it was rescheduled…That meeting did take place – behind closed doors. The press was not invited to the private transparency meeting, and no photos from or transcript of the meeting have been made available. The event was not listed on the president’s calendar…Nor is the award mentioned anywhere on the White House website, including on the page devoted to transparency and good government. Were it not for the testimony of the transparency advocates who met secretly with the president, there wouldn’t seem to be any evidence that the meeting actually took place.”

That’s right: Obama wasn’t transparent about a transparency meeting. That same day, Obama went on TV  and tried to explain why he hadn’t been transparent to the U.S. Congress about his military plans in Libya.  Shortly after that, news leaked that the Fed had secretly sent billions in loans to foreign banks during the financial crisis.

Ah, memories! On his second day on the job, January 21, 2009, that…President Obama famously pledged, in one of his first memos to federal agencies

“We will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration. Openness will strengthen our democracy and promote efficiency and effectiveness in Government.”

He may be right about that last part, or maybe he discovered that it was naive and impractical dream. Under no circumstances, however, can it be said that Obama’s administration was transparent. An exhaustive list is impossibly, long, but here is an incomplete  sample just from the posts in Ethics Alarms: Continue reading →

Irony: The Self-Proclaimed Child Advocate Who Will Become The First Woman President Will Be Preventing The First Child President….

/ Jack Marshall / 37 Comments
Superman vs Batman is isn't...

Superman vs Batman is isn’t…

Donald Trump’s ridiculous, embarrassing—but typical!—“let’s see if we can lower the shameful level of rhetoric in this campaign even lower” statement at a campaign stop in Florida yesterday:

“Did you see where Biden wants to take me to the back of the barn? Me. I’d love that. I’d love that. Mr. tough guy. You know, he’s Mr Tough Guy. You know when he’s Mr. Tough Guy? When he’s standing behind a microphone by himself.”

He’s a child.

The news that the Affordable Care Act is falling apart exactly as it’s Republican opponents predicted would be potent ammunition for any competent and focused Republican candidate. Instead, he blathered briefly and inaccurately about the program, and allowed himself to be drawn into a silly hypothetical. time-travel fisticuffs challenge from Joe Biden.

Peggy Noonan observed last week that a sane Donald Trump—speaking of hypotheticals—would have beaten Hillary Clinton in a landslide, but that unfortunately the one who is running is nuts. Here we had another demonstration of that. In a real campaign, the looming collapse of the Affordable Care Act, passed without bipartisan support, sold with lies, and taken to the finish line using Parliamentary tricks, would have been a major issue in the campaign, dominating the debates, and providing a crisis for Democrats with this late campaign development. This was, after all, supposedly the “signature accomplishment” of the Obama administration: an irresponsibly complex law that its supporters didn’t understand or even read, triggering much of the middle class anger that created Donald Trump’s disastrous candidacy. Never mind. Trump, as always, didn’t bother to do his homework or get his facts straight, wouldn’t think through his comments sufficiently to be coherent, and finally couldn’t resist reacting the goading by Biden, who had said he wishes he was in high school so he could take Trump “behind the gym.” Thus Trump handed  the media yet another excuse to focus on something other than the real issues, and the failure of Barack Obama.

Well, I guess the fact that the GOP’s candidate for President is an idiot qualifies as an issue, but there are others.

I look forward to “fact-checkers” pointing to the Trump “lie” that Biden said he wanted to take him to “the back of the barn,” when he really said “gym.” That’s got to be worth at least four Pinnochios, right?

Observations On Donald Trump’s Anti-Judge Rant (And The Selective Outrage Regarding It))

/ Jack Marshall / 23 Comments

donald-trump

If I was still doing an “Unethical Donald Trump Quote Of The Day,” it certainly would have qualified. Here is Trump, blathering on, as usual,  at a rally about the case that is currently pending in federal court regarding the alleged charges that Trump University was a scam:

The trial, they wanted it to start while I am running for President. The trial is going to take place sometime in November. There should be no trial. This should have been dismissed on summary judgment easily. Everybody says it, but I have a judge who is a hater of Donald Trump. He’s a hater. His name is Gonzalo Curial. And he is not doing the right thing. I figure what the hell? Why not talk about it for two minutes. Should I talk about it? Yes? [cheers and applause] so we should have won. . . .

I am getting railroaded by a legal system, and frankly they should be ashamed. I will be here in November. Hey, if I win as president, it is a civil case. I could have settled this case numerous times. But I don’t want to settle cases when we are right. I don’t believe in it. When you start settling cases, do you know what happens? Everybody sues you because you get known as a settler. One thing about me, I am not known as the settler.

And people understand with this whole thing, with this whole deal with the lawyers, class action lawyers are the worst. It is a scam. Here is what happens. We are in front of a very hostile judge. The judge was appointed by by Barack Obama – federal judge. [Boos]. Frankly he should recuse himself. He has given us ruling after ruling, negative, negative, negative. I have a top lawyer who said he has never seen anything like this before. So what happens is we get sued. We have a Magistrate named William Gallo who truly hates us.

The good news is it is a jury trial. We can even get a fully jury. We are entitled to a jury, and we want a jury of 12 people. And you are going to watch. First of all, it should be dismissed. Watch how we win it as I have been treated unfairly. . . . So what happens is the judge, who happens to be, we believe Mexican, which is great. I think that is fine. You know what? I think the Mexicans are going to end up loving Donald Trump when I give all these jobs. I think they are going to love it. I think they are going to love me. . . .

A lot of people said before you run you should settle. I said I don’t care. The people understand it. And they use it. So when I have 10,000 people, and when we have mostly unbelievable reviews, how do you settle? And in fact, when the case started originally, I said how can I settle when I have a review like this? Now I should have settled, but I am glad I didn’t. I will be seeing you in November either as president. And I will say this. I have all these great reviews, but I will say this. I think Judge Curiel should be ashamed of himself. I think it is a disgrace he is doing this. I look forward to going before a jury, not this judge, and we will win that trial. We will win that trial. Check it out. Check it out, folks. You know, I tell this to people. November 28. I think it is scheduled for. It should not be a trial. It should be a summary judgment dismissal. . . .

It is a disgrace. It is a rigged system. I had a rigged system, except we won by so much. This court system, the judges in this court system, federal court. They ought to look into Judge Curiel because what Judge Curiel is doing is a total disgrace. Ok? But we will come back in November. Wouldn’t that be wild if I am president and come back and do a civil case? Where everybody likes it.

Ok. This is called life, folks. . . .

Now, we are told, “legal experts” are concerned that this rant “signals a remarkable disregard for judicial independence.” Freaking out entirely, Washington Post writer David Post (I guess he’s the paper’s son?) wrote..

“No, this is called “authoritarianism.” It’s what Berlusconi sounded like, what Chávez sounded like and what Perón sounded like — for that matter, it’s what Sulla and Caesar and the others who helped destroy the world’s first great republic sounded like: I am bigger than the law, I AM THE LAW.”

I have searched and I have searched, and darned if I can’t find Post expressing similar horrors when President Barrack Obama attacked the Supreme Court of the United States while misrepresenting its decision in Citizens United to its face, during the televised  State of the Union address in 2010.  The New York Times Adam Liptak, however, wrote at the time, Continue reading →