Monday, March 27, 2017

FIRST, DO NO HARM: HIPPOCRATES AND HYPOCRISY



This past week, after hundreds of marches and rallies, after thousands of raucous Town Halls, and after millions of post cards, letters, phone calls and personal contact by millions of concerned Americans across the nation - in Red and Blue States alike, their efforts were rewarded with the implosion of "Trumpcare", "Ryancare", or more generally, the Republican Health Care repeal and replace legislation.  Broadly opposed by every medical association - doctors, nurses, hospitals, and other health care providers, by AARP and other senior groups, by child advocates, and by the 20+ million who would lose their health care had the bill been passed by the House Republicans, the proposal went down in flames last Thursday and Friday.  The current aftermath features finger-pointing and blame casting on many of the players.  These includes failures by House Republican Leaders, especially Speaker Paul Ryan; unhelpful comments from some Senate Republicans that undermined the House debate; a number of Republican Governors who wanted to protect their residents on Medicaid against being set adrift by the proposal in 2018; the 35+ House members of the "Freedom Caucus" - ultra-conservatives who insisted on removing "essential protections" that are provided under the ACA; Trump and his advisors who agreed to strip basic "essential" protections from the health care system to appeal to the Freedom Caucus votes and lost more reasonable, centrist, and moderate Republican House members. Republican moderate voices lost in abandoning "essential care" elements were ALL FIVE NJ Republican House members, including the Chairman of the House Appropriations Committee, Rodney Freylinghuysen, occupying an important leadership position appointed by Speaker Ryan.

This legislation was fatally flawed from the start. Like other versions of the Ryan ACA repeal legislation that the House Republicans voted for and ran on in several elections, this bill removed health care coverage from more than 24,000,000 Americans - first 14,000,000 right away in 2017 and, thanks to yet another amendment, another 12,000,000 in 2018-2020.  In addition, older adults would see their premiums increase from $1700 a year to 12,000 or more a year according to the Congressional Budget Office (CBO) - an age penalty; an $800 billion cost-shift to the states in Medicaid coupled with reduced funding support and a cap on any subsequent cost-growth, and the loss of health coverage by 24,000,000 Americans presently covered under the ACA.  States that had not joined in the ACA through expanded Medicaid coverage would be barred from adding coverage for those not yet signed on for care, leaving them permanently in a fiscal crises and with hospitals awash in red ink.  Yes.... the legislation would save federal tax dollars.... and be given back to insurance companies and the uber wealthy.  That is a far cry from what candidate Trump promised over and over again during the election campaign.  He assured the American people that he would "replace Obamacare with a new beautiful system of health care that would cover everybody with better service and at lower cost.  You will love it.  Believe me." Evidently, many American voters did just that - they believed candidate Trump.  And, last week, the man behind the curtain was revealed to be a liar as he turned his back on millions who took him at his word. HYPOCRISY! For now, the ACA remains in place.  But, round two will arrive at some point.  The clock ticks.

Hippocrates, the "father of modern medicine" and the author of the "Oath" taken by physicians, lived and worked in Greece in 400BC.  One of his most famous statements and one that is included in the modern Hippocratic Oath is a pledge that all doctors take - "FIRST, DO NO HARM."  Perhaps the Republican Members of Congress should have had that oath in mind as they crafted ACA replacement legislation.  The evidence, however, suggests that the only thing that they had in mind was a massive cost shift to the states and a massive tax cut for the wealthy and profits for the insurance companies.  To give money away, you first have to generate some, in this case, from program savings.  And, that's why the Freedom Caucus right-wingers, with Trump and Ryan's support, insisted on "amendments" to the bill as introduced.  I mention them here on the chance that the proposal sank so rapidly last Friday, that their willingness to inflict pain on people and, especially on those who have the least and are least able to defend themselves, have no lobbyists on the Hill, and do not make massive campaign contributions, for the ability to give massive tax cuts to high income earners, large corporations, and to boost the profits of health insurance companies like Aetna, Humana, and BC/BS. (Incidentally, these three insurers' most recent financial statements reveal that they each claim PROFITS of more than $1 billion a year after taxes under the current ACA system.  Can you say, not collapsing?).

"First, do no harm... ."  Hippocrates would have his hair on fire if he observed the pain that the House Republicans were willing to inflict on the public to enrich the already rich.  They did this through a proposed cost-shift of billions of dollars to the states, bumping millions of Americans off of Medicaid, dramatically increasing insurance costs for seniors and older Americans, and abandoning millions of other Americans by permitting prices to rise beyond their ability to pay and/or eliminating "10 essential health services" from coverage under their health plan. So, here are the ten (10) "essential benefits" presently being required under the ACA that would be eliminated as a requirement and become a "choice of coverage" under Trumpcare/Ryancare:

   1. Outpatient care - your typical doctor's office visit with physicians "in network."

   2. Emergency Room Trips - this includes ER visits and ambulance service.

   3. In-hospital care - all care that you receive as an in-patient, including surgery.

   4. Pregnancy, maternity, and newborn care - before the ACA 63% of non-employees coverage
       did not have any maternity benefit, exposing a patient to potentially tens of thousands of
       out-of-pocket expenses.

   5. Mental health and substance abuse disorder services - With the growing threat of opium
       abuse, such coverage is an essential element of a multi-phase approach to a solution. 

   6. Prescription drugs - Insurance companies often negotiate group discounts for 
       medications.  Left on their own, an individual would be exposed to thousands of dollars of
       avoidable expense. 

   7. Rehabilitative services - this includes physical therapy as well as treatments to help those
       with CP, MS, and kids with autism. 

   8.  Lab tests - What with rising malpractice insurance costs, doctors often order a full battery of
        tests to be thorough and accurate in making a diagnosis and crafting a treatment plan. Tests 
        like bloodwork, xrays, MRI or Cat Scans carry high costs that can be out of reach for
        average working families. 

   9. Preventive services - This includes vaccines, cancer screenings, mammograms,
       colonoscopies, and other diagnostic tools commonly used to diagnosis a potential problem
       early on while it is more treatable, curable, less costly, and less lethal.

10.  Pediatric services - including dental and vision care for children. 

Most employer health insurance plans already include these benefits as a matter of course. In fact, fewer than 10% of Americans buy their health insurance on the individual market.  The ACA program REQUIRES that all of these be included in a standard health coverage plan.  The Freedom Caucus, and the amended Republican Health Care Plan, eliminates those requirements and, as a result, exposes those insured to a roll of the medical dice.  And, if they "crap out", leaves the patient, their family, the hospital, and the states in a potentially untenable financial position.  In fact, 57% of US bankruptcy filings list medical bills as the root cause of the financial failure experienced.  Insurance is intended to avoid such pain.  But, not if the insured, because they cannot afford  "Cadillac" plan, have a bare-bones plan that essentially covers very little, resulting in fewer cash outlays by insurance companies, and higher profits for them.  

Let's take auto insurance, for example. Most states require that every driver with a registered vehicle have liability auto insurance in case of an auto accident.  Coverage - liability and comprehensive - is a system of joint risk.  That is, if you have an accident, you are covered.  But, you cannot buy insurance right after you have a crash!  If you could, it would cost whatever the damage total is - say, $40,000, the resulting medical bills if any - say, $20,000, plus 10% administrative fees and another 20% for insurance company profit.  Altogether, that policy would cost you $$78,000!  Not quite affordable.....  

If you don't have a crash, you still have to pay the premiums - no refunds!  So, what happens to your money when you didn't have a claim?  The pooled money goes to where it is needed - those who had the misfortune of having an accident.  That is what shared risk and insurance is all about. Its the same with health insurance.  Those without accidents pitch in for those with accidents on the promise that should they have a need for help in the future, everyone else would be there.  And, that's what the basis of insurance is all about.  It's called "shared risk."  The ACA set up shared risk in health care, and includes "essential health care" elements so that everyone is covered for those standard services, regardless of having an instant need for specific care.  And, also confident that, sooner or later - whether it be lab tests, surgeries, ER visits, ambulance services, or pharmacy needs, all of us will be able to call upon insurance coverage - rather than the bankruptcy courts to help us through a medical crises.

Republicans, and especially the Freedom Caucus - along with Trump and his senior staff - have demonstrated that they care little for the well-being of working and Middle Class Americans and that their entire agenda is driven by reducing taxes on thee wealthy, large corporations, Wall Street traders and firms like Goldman Sachs, and dismantling the protections hard won over the years for our safety (OSHA), the environment (EPA), consumer protection (FDA), and, in this case, health care for those in greatest need and of modest income.  This is not "fake news."  Just a simple fact.

STAND UP!  SPEAK OUT!  MARCH ON!   



THIS IS WHAT DEMOCRACY LOOKS LIKE! FREE SPEECH AND FREE PRESS.....

Famed Broadcast Newsman Walter Cronkite observed, "Freedom of the press is not just important to a democracy, IT IS DEMOCRACY!" And, so it is.  And, that is why that cherished right, among others, is enshrined in the First Amendment to the US Constitution.  And, given the constant assault on free speech and the legitimate press and mainstream media by Donald Trump and his cast of characters - Kellyanne Conway, Sean "Spicy" Spicer, and Steve Bannon, architect of the Alt. Right and White House Alchemist practicing his dark arts in the West Wing and the Oval Office - 500 folks, mostly from the resistance generated during the 1/21 WOMEN'S MARCH ON WASHINGTON - UPSTATE, now known as MARCH ON! NY who traveled from upstate and were joined by others located in NJ and in NYC, assembled at Bryant Park in NYC to Rally and March in support of a FREE PRESS.  The March took us to a Rally in front of the NY Times Building at 41st Street and 8th Avenue where we all again spoke out in support of REAL NEWS and against the FAKE NEWS COOKED UP BY THE CRACKPOTS IN THE WHITE HOUSE and their Chief Alchemist, Steve Bannon.  The following commentary is the speech that I gave on that day just before the March left Bryant Park.  It appears here in its entirety.
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REMARKS BY FORMER DNC MEMBER AND ACTIVIST – 3/25/2017
ROBERT JANISZEWSKI – The Senior Progressive. http://theseniorprogressive.blogspot.com

Our nation was founded on the notion that all were created equal and that we all share – without exception – certain inalienable rights.  And, in the language of the Declaration of Independence, “that among these are life, liberty, and the pursuit of happiness.”  Thirteen years later, in 1789, the new US Constitution expressed these rights in the first 10 Amendments - the Bill or Rights – which further outlined the “inalienable rights” that each American citizen would enjoy. 

Thomas Jefferson, Ben Franklin, Sam Adams, and the other Founders deeply believed that free expression, debate, and the exchange of ideas through the press was THE essential element necessary to preserve a democracy.  Jefferson often spoke of the necessity of a free and unfettered press as the guardian of liberty and enemy of oppression. “Our liberty cannot be guarded but by the freedom of the press, nor be limited without danger of losing it,” said Jefferson.  And, perhaps his most famous comment on this subject was “were it left to me to decide whether we should have a government without newspapers, or newspapers without a government, I should not hesitate for a moment to prefer the latter.”

The legitimate press and the main street media are under attack today – and have been for more than 18 months - from the right wing, and now from the West Wing.  Since the rise of Trump, Bannon, and their allies, we have witnessed attacks on the legitimate press and mainstream media over and over again.  From Alt. Right news sources like Breitbart and others, radio commentators who fudge facts and attack “FACTS” that they don’t like or disagree with, and with a President who has insisted on LYING constantly and then doubling down on each lie while attacking any press outlet that has the nerve to challenge his lie, the assault on a free and unfettered press has never been so severe. Assistant to Bannon, Stephen Miller, famously stated that Trump, “shall not be questioned” when speaking of the Immigrant Ban announced by the White House. Donald Trump was elected with a minority of the people’s votes to the Office of President, not POPE!  Trump, as President, speaks in the public square on public issues, and not on “matters of faith”.  The Donald IS NOT INFALLIBLE.

We gather here together today to celebrate that inheritance and to uphold the value of truth in our public discourse and the right to hold to and to speak out, print, and publish varied points of view in the public square. 

Like all of you, I had a life before Donald Trump.  In the 1950s I was a rock & Roll kid with a black leather jacket flirting at the school dance.  In the 1960, I was awakened by JFK, marched for civil rights, voting rights, and against discrimination.  In the 1970 I marched against the Vietnam War and ran for a seat on my local Board of education and became a union activist. In the 80s and 90s I worked on issues of rent control, affordable housing, the Equal Rights Amendment for women, labor rights, economic justice, funding for AIDS treatment, health care for children and seniors, and worked on numerous campaigns.  I retired 17 years ago, moved to the countryside, live in the woods, and enjoyed retirement – hiking, biking, skiing, reading, and writing. And, then came along – Donald Trump.  And, like the snake oil salesmen before him, Trump came fully equipped with a litany of lies that is ever-present in a never-ending torrent of deception that continues to this very day.  Here is a sample of some of his best whoppers: 

-          Barack Obama is a secret Kenyan Muslim. Why not a Martian?
-          Barak Obama “wiretapped” the Trump campaign. Not according to the FBI.
-          Trump won the election in a “landslide!” Lost by 3 million votes
-          More people attended the Trump Inauguration than at any other time in the history of the nation.  Maybe even in the history of the world??????
-          3 to 5 million illegal votes were cast in the election! Even the Republicans reject this one, though 4 improper votes were found in California. And, they ALL voted for Hillary!
-          Tens of thousands of Illegal voters took buses from Massachusetts to New Hampshire. That would require 500 buses for more for 25000 riders! There are not that many buses there or invisible buses and transparent voters voted.
-          Senator Cruz’ father was a friend of Lee Harvey Oswald and played a role in the assassination of President Kennedy. Maybe he held the rifle? Let’s have a House Committee investigate!
-          Trump said that he knows more about Isis than all the Generals!  What?  From military school? Or from playing Risk?
-          On health care, Trump said that EVERYBODY WILL BE COVERED, TAKEN CARE OF MUCH BETTER, AND AT LESS COST.  Duh?
-          “I never met a Russian or spoke with any Russians,”said Trump.  What?  He held a Miss Universe contest in Moscow in partnership with a Russian Oligarch. Trump maintains that he doesn’t even know where Russia is.  Did he think that he was in France? Or, was he distracted by all of the women around him?
-          And, what of the millions of women who marched in Washington on January 21st for equal justice for all and the millions of others who have protested in sister marches on that day, and the millions who have attended Town Halls in protest since?  Well, they were “all paid professional protesters.”  Spicy Spicer recently said that “protesting is now a career choice for liberals.”  He left out the millions of “gift bags” from George Soros that he alleged were given to the marchers as well as the truckloads of cookies from the DNC.
-          Trump announced that more than 94 million Americans were “unemployed” – WOW! That’s 25 % of the US population!  Yet, the Department of Labor calculated the unemployment rate at 4.7%.  The difference? 88 million children, students, Moms staying at home by choice, and retirees who ummm… are RETIRED and have chosen not to work. Wake up Donald!    
-          Trump recently boasted that his administration was operating like “a fine tuned machine.” During the Republican primaries, Jeb Bush described Trump as “the chaos candidate” who would be “the chaos president”, if elected. And John McCain recently said that the White House is bumbling and chaotic! Hmmm. What do you think? Machine? Chaos? Pick ‘em.
-          Trump criticized Obama for having released “122 dangerous dudes” from Gitmo who went right back to being terrorists. The truth is that George Bush released 113 and Obama released just 9 detainees from Gitmo. Well, he had the total…

It appears that they only “dangerous dude” that poses a threat to our nation and our people is not being detained at Gitmo.  He is presently sitting in the Oval Office.

Kelly Ann Conway described these Trump statements as “alternative facts.” You and I would call them “lies.”  Kelly Ann and Sean “Spicy” Spicer consistently condemn those who dispute these Trump “facts” as the source of “fake news.”  Some media outlets, the NY Times included along with several major networks, have been evicted from official press briefings for challenging the accuracy of these “alternative facts.” Years back, NY Senator Patrick Moynihan famously said during a 1994 debate, “You are entitled to your own opinion. But, you are not entitled to your own facts.” Responding to Kelly Ann’s recent description of Trump’s “alternative facts”, Chuck Todd said, “they are not facts, they are untruths… lies.” Steve Bannon, Senior Counselor to the President, responded to this controversy by charging that “the media here is the opposition party”, and bellowing that the media should “keep its mouth shut…..” Today, we assemble here to say that in a democracy, 

SHUTTING UP IS NOT AN OPTION!
WE WILL NOT SHUT UP!  WE WILL STAND UP!  WE WILL SPEAK OUT!

We assemble here today to stand up for the truth.  We assemble today to speak out for justice and to march against the lies, deception, and propaganda that has streamed across the twitterverse, the internet, and into some print and electronic media. There are no “alternative facts.” And, there are no alien babies in the White House basement.  We call upon those who pollute our public discourse with a constant stream of lies, un-truths, and deceptions to stop the insanity of insisting that falsehoods are truths and truths are falsehoods.

Two hundred years ago, Jefferson wrote that, “The only security of all is in a free press.” 

Sixty-eight years ago (1949), George Orwell published “1984”, and introduced us to “Big Brother”, the “Ministry of Truth”, and the “Thought Police.” Some would say that we are now living the reality of “1984”- a day when thought control would be a result of oppressive propaganda repeated over and over and over again until a set of uniform beliefs would result and “Big Brother’s” words would be accepted as the ultimate truth.  Orwell warned us of a future where liberty would be lost to the growing presence of false “truths.” “Truth” as determined by the government, enforced by the “Thought Police” (Kelly Ann and Spicy), and under the direction of the “Ministry of Truth” (Steve Bannon), would become our “alternative reality” built on “alternative facts.”

And so, today, we – you and I – must become the truth tellers and defenders of speech, of press, of print, and of broadcast media – free to speak, to write, and to publish the fruits of their sourced and vetted research, their points of view, and their opinions, free of fear of arrest, interference, law suits, or reprisals from the “governors” as envisioned in our Constitution.

Forty six years ago, in a landmark Supreme Court Case – “NY Times v. United States” (1971) - the Pentagon Papers case - Justice Hugo Black wrote that the Founders gave “the free press the protection that it must have to fulfill its essential role in our democracy.  The press was to serve the governed, not the governors… and, that only a free and unrestrained press can effectively expose deception in government.” And, so it is.  

Newsman Walter Cronkite observed that, “Freedom of the press is not just important to democracy, IT IS DEMOCRACY.”

In our recent history, President Obama encouraged us saying that “we must uphold a free press … because, in the end, lies and misinformation are no match for the truth.” This is the truth that President Trump has not grasped.  This is the constitutional right guaranteed to the press that President Trump would prefer to weaken or erase.  These are the sources of actual facts, and not “alternative facts” as generated from the unfortunate fantasies of our modern “Big Brother” or from the darkest depths of the Minister of Truth, Steve Bannon.   

So:  TODAY WE STAND TOGETHER FOR THE TRUTH!
        TODAY WE STAND TOGETHER FOR THE BEDROCK RIGHTS
            PROTECTED IN THE US CONSTITUTION.
        TODAY WE CELEBRATE OUR HERITAGE, OUR OF FREEDOM –
            RELIGION, SPEECH, PRESS, ASSEMBLY, PETITION.
        HERE IS WHERE WE TAKE OUR STAND!
        THIS IS WHAT DEMOCRACY LOOKS LIKE!
        THIS IS WHAT DEMOCRACY SOUNDS LIKE!
        THIS IS WHAT OUR DEMOCRACY DEMANDS!   TRUTH, NOT LIES!
         
 STAND UP!  SPEAK OUT!  MARCH ON!

Robert Janiszewski
Former DNC Member (1990-2000)
Served as Municipal Chair, County Chair, and Campaign Chair for the
     Democratic Party from 1988-2000 including Presidential Campaigns in 1992, 1996, and 2000.
Currently author of an on-line progressive blog: http://theseniorprogressive.blogspot.com

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