ACA Repeal and Replace- Part 5 Gajillion

(Cassidy and Graham–Getty Images)

Congress has one last attempt in them to repeal the Affordable Care Act and replace it with something that will cause millions of Americans to lose insurance. It’s called the Cassidy-Graham Plan….just kidding! Lindsey Graham would never let anyone else put his or her name first. It’s called the Graham-Cassidy plan, and here’s how it “works”. As you can see, much of the plan can be summed up by saying that Federal subsidies for healthcare would be transferred to the states, which can then do what they wish with that money. It’s a States’ Rights approach…I guess. But in practice, it will mean that many Americans will lose healthcare. Why?

Reason One: By removing the Medicaid Expansion and leaving this up to the states, those states that are unable to make up the difference will need to decide whether to cut funding to certain people or find a way to come up with it. That could mean increased taxes, but that seems unlikely. Cutting people out of Medicaid is more likely. I’m not saying that out of pure cynicism. I have personally witnessed several people here in Ohio go through the process of trying to receive disability. The first application is automatically denied; you then go through an appeals process, which can take 6 months to a year. You are then VERY likely to be denied again, at which point you get another appeal. After a year and a half to two years (longer in some cases), you will finally get your verdict. States will do everything they can to deny you, but if you are lucky enough to receive the funding, after two years of waiting, you will need to continuously prove that you still deserve it. That’s under the current system. With less funding, things will be even harder.

Reason Two: The distribution of funds will be up to the states, which will allow them to decide who is eligible and who is not. In practice, this means eliminating pre-existing condition protection as well as federal guidelines for mental health, disabilities, etc. Some states do not recognize certain mental illnesses or disabilities as legitimate. People with those disabilities are very unlikely to have the money to move to another state. They will simply be left behind.

Reason Three: In fact, under this plan, states will be allowed to deny mental illness coverage altogether. There are several provisions of the ACA that specifically define mental illnesses, and even include issues like drug addiction. Under the new plan, the states could ignore those definitions, which in practice will mean that many of the people who now have coverage for mental illnesses will lose that coverage.

This leads me to the main issue that I want to raise here. Graham and Cassidy have defended the bill by stating that it does not remove the pre-conditions clause of the ACA. In other words, insurers will not be able to deny people with pre-existing conditions. When NPR suggested that in fact it would harm people with pre-existing conditions, Cassidy tweeted that this was false (FALSE!). People with pre-existing conditions would still have access to healthcare.

Here is the key point. Whenever you see the word ‘access’ you should recognize that you are being intentionally misled. Yes, intentionally. ‘Access’ is a buzzword among people who want to take something away from others, but don’t want to be caught doing so. In this case, Cassidy is right that the bill will not remove access to healthcare. In other words, insurers will not be able to deny people insurance simply because those people have a condition.

What is misleading here is that ‘access’ refers to a negative liberty that protects us from government interference in our choices. In other words, we will all be allowed to purchase insurance, regardless of existing conditions. However, there will be no controls on how much insurers may charge us for that access. This is a bit like saying that I have access to a yacht. No one is preventing me from purchasing a yacht. Of course, I don’t have the money to buy one; so that access is moot.

We all have access to healthcare at all times—if we can afford to pay for it. We don’t even need insurance. We can just purchase any procedures we need. Realistically, of course, that means nothing. Most people cannot afford the exorbitant costs associated with even minor surgeries, assuming we can even find out in advance how much it will be.

Graham and Cassidy know this. They know that removing government subsidies to offset insurance costs will effectively prevent people with pre-existing conditions from being able to afford the premiums of insurance plans that are unregulated.

Here’s one calculation of what that would mean, based on existing data.  Doctors have spoken out against the bill as well. Let me stress one important part of that last article. Some people, including some legislators, seem to think that healthcare is an individual rights issue, because purchasing it is like purchasing a car for yourself. It isn’t. Having a healthy society benefits all of us, as individuals and as a community. It’s not something we can choose to buy or not buy. When you need it, you must have it. There are no alternatives. There’s no public transportation option, like there is for cars. You can’t carpool on healthcare. Most importantly, you will use our healthcare system. If Republicans are so worried about the free rider problem, they would do well to keep that in mind.

Everyone will use healthcare at some point in life; most likely multiple points. This is as much of a social need as having a police force or fire departments or roads. In fact, it’s more important than all of those things. It’s literally life and death, and unlike the fire department, we will all need to use it.

It’s time to stop messing around with this issue and catch up to the rest of the world, which realized decades ago that a public system of healthcare is a basic right in today’s world, a positive right that should be provided in some way by the government.

The DACA- Is Trump Eliminating It or Codifying It?

(getty images)

This week, Americans are learning another acronym that most had ignored until it became media sensation. The letters DACA stand for Deferred Action for Childhood Arrivals. You can read more about it on Wikipedia, which has some of the history, criticism, etc..  But in basic terms, DACA was an executive order that President Obama enacted in 2012 when the DREAM act failed. Both the DREAM act and DACA aim at providing the children of undocumented immigrants to remain in the U.S. because it has become their home. In other words, the idea is that the children of such immigrants did not do anything wrong, and many (most) of them have become full members of U.S. society, contributing just like other members. Deporting them, according to Obama, would punish them unfairly.

President Trump has announced that he is cancelling the executive action, and this has rightly caused some controversy and confusion. What exactly will happen to the so-called Dreamers (people who were protected by DACA)? Will they be deported after all? Or does Trump really want Congress to pass a law that will ultimately protect them without using the executive order approach that he has often called unconstitutional (in practice, this seems to mean when Obama does it, since he hasn’t really rescinded Bush’s EOs and has made a few himself).

There are certainly some signs that Trump simply wants Congress to provide a permanent solution, which the DACA is not. One reason to be suspicious about this is that Trump has given no concrete path to such legislation. Another is that nothing prevented Congress from creating such a law while DACA was in place. In other words, he didn’t have to remove it in order for such a law to be passed. If anything, removing DACA means that if Congress does not act, then there will be no protection for these young persons.

Why does this matter? Well, there are nearly 800k people who are currently covered by the DACA. The DACA allows them to receive work permits, and almost all of them have jobs. These are not jobs that have been taken from ‘other Americans’ either. Furthermore, in order to keep these permits (and thus their jobs), they must keep a clean record. In other words, they are not criminals. While some might counter that being undocumented is a kind of crime, remember that these are people who were born in America. By law, that should make them Americans. However, since their parents are not documented Americans, they fall into a gray area here.

Still, we should remember that those of us who are Americans by birth have ancestors that weren’t, and that many of our families likely received citizenship basically by being born here. This is not new. What is new is the way that they are being protected in this case. President Trump says that he cares about these Dreamers. But he also campaigned on ending the DACA. This puts him in a tough spot. So tough that many feel that he’s essentially following Democrats here, rather than Republicans.

Whatever his motives, the process is very unclear right now, since there is no direction on how to create legislation. This leaves nearly 800k people facing an uncertain people, and many others are affected by what will happen. If the U.S. suddenly loses 800k employees that will be a huge hole to fill. And it’s not as simple as saying that other Americans can then just have those jobs. The U.S. has a skill labored shortage right now, which is leading to a lot of empty jobs with no one to fill them. So it will not likely provide an equal number of jobs for others. More likely it will simply leave a vacuum in our economy.

One additional piece of information about the process is worth noting. When Jeff Sessions, the Attorney General, made this announcement official, he claimed that it was a correction of the misuse of Presidential authority that Obama had used to create DACA in the first place. He even adds this choice quote:

“Societies where the rule of law is treasured are societies that tend to flourish and succeed. Societies where the rule of law is subject to political whims and personal biases tend to become societies afflicted by corruption, poverty, and human suffering.”

He is correct, of course. However, as the article where I got this quote notes, this is the same person who has fought for a Presidential right to ban Muslims categorically from entering the country. Does this mean that the President has no say on whether people are allowed to remain in the country but has complete power to bar people from entering? That seems like a line that is hard to match with rule of law, which is about following Constitutional authority properly and not making up new rules on the spot. Trump has made up new rules all over the place, and removed existing precedents repeatedly. Personally, I would love to get back to proper separation of powers in the U.S. It’s a critical part of our political system. But having the President force Congress into an action that it doesn’t want to do seems like a pretty big misuse of authority.

On the other hand, if we read this as simply correcting a previous mistake (and forget the ways in which Trump has abused his own authority), then we can try to be generous and see this as an attempt to come up with a better way of dealing with young Americans (yes, Americans) who need more than just a system that allows them to stay but without the full rights of other Americans. If that is the goal of this process, I agree with it. What I don’t agree with is the particular path being taken to reach this goal. It carries too much uncertainty and it certainly smells like an attempt to deport a bunch of people who have done nothing wrong.

Of course, some states are already saying that they will offer sanctuary. In my own state of Ohio, Governor Kasich (a Republican, for those keeping score) has announced that the Dreamers can come here and he will not try to force them to leave the country. However, moving states is not easy, which is why I generally favor a federal solution to a state solution where rights are concerned (perhaps I’ll detail this a bit more in a future article). Many of those affected by DACA live in states like California and Texas, with large populations, both far from Ohio. Relocating your family is difficult, and doing so while under scrutiny of law even more so.

This is complicated by the fact that President Obama collected information from those protected under DACA in order to ensure that they would not be deported. Many worry that this same information might now be used to target people instead, which seems like a reasonable concern. However, if President Trump really does want to protect the Dreamers and is simply pushing Congress to make it an actual law, then they should have nothing to fear. I guess we’ll see soon enough.

Tyranny: Playing as a minion of the Big Bad

So, I’m a sucker for roleplaying games of all sorts; always have been. I played the first Final Fantasy, back when it really seemed like it might be the last one! Now there are 37, I believe….But I also really enjoy the kind of roleplaying games that allow you to make choices in how you pursue the goals of the game, especially when those choices are reflected in some way in the game world. They don’t have to be huge consequences, necessarily, but I want the game to acknowledge things that I have been doing within it. For example, in Fallout: New Vegas, you can help some factions while harming others, and those you help will greet you differently than those you harmed. In Knights of the Old Republic, you play a Jedi in the Star Wars universe, and you can pursue the light side or dark side of the force. The game plays differently, depending on your choices.

Currently, I am playing a game of this sort, which is called Tyranny. Tyranny was developed by Obsidian, which is the same company that made Fallout: New Vegas. They also made Pillars of Eternity, which I discussed in another article. It’s a company that is known for taking story seriously, and I almost always at least give their roleplaying games a shot because of this. In some cases, they take an existing franchise and push it in a new direction. In others, they create their own universe.

Tyranny is the latter sort of game. It takes place in a world where the Ultimate Evil has already won the day. It’s too late to stop him or her (the question of the Big Baddy’s gender is part of the game). In fact, you helped bring this about, as one of the generals serving the main villain of this world! At the start of the game, you get to make certain decisions about the history of the world, and how conflicts were resolved (by you!). These choices come up during the game itself, and people will respond to you differently because of them. If, for example, you decided to burn down a city that challenged your master’s rule, then when you meet up with people from that city they will be angry at you for doing so. Of course, if you meet up with an enemy of that city, that person might thank you. Choices you make during gameplay have similar effects.

While the story itself doesn’t differ dramatically as a result of all of this, it does add some wonderful flavor to the game. Your choices matter. But what makes Tyranny interesting as a gameworld is the fact that you work for the villain. You must decide what that means. Will you embrace being a villain and terrorize the people you encounter? Will you strike them down in cold blood and increase the fear they feel when they hear your name? Or will you be a kind of Schindler, helping people from within the very organization that threatens them? The choice is yours, and it produces some wonderful moral dilemmas.

I don’t mean to suggest that choosing between cold blooded murder and saving the innocent is a moral dilemma. It isn’t. Murder is immoral. A moral dilemma occurs when you are faced with two or more choices and neither one seems very good. This happens throughout Tyranny, even when you are trying to be as good as possible. There is no way to escape the problem of dirty hands in this game. This really separates it from earlier roleplaying games, such as Bladur’s Gate, where one can play a pure good character and basically act heroic the entire time. In Tyranny, you are serving a bad person, and everyone knows it. You can’t back out of this role, either. You can only make the best of it, whatever that means for you.

While I think Obsidian could have taken this a bit further than they do, the world they have created is interesting, and the moral choices you must make often have weight to them. It’s a fairly dark world, which makes it a good choice for Fall playing, if you are looking for an RPG for Halloween (though, if you haven’t played Costume Quest, check that out too! Or Grim Dawn, if you prefer action RPGs…or even Path of Exile!)