When Restaurant Employees Endanger Customers

On Friday, February 5, 2016, my wife and I had one of those rare parental opportunities to go out to dinner. Not a long, fancy, dinner, mind you. No. No time for that. But we had time to go and get a burger together before going to our son’s Winter Drumline ensemble percussion performance.

A few months ago, a Smashburger restaurant opened near us. My son and I have been once or twice, but my wife hadn’t had an opportunity to go. She knows about Smashburger because we’ve eaten there in Louisville a few times (while attending cheerleading competitions) and so she has wanted to try the one near us. So we decided that would work well for us. Grab a good burger and then go to the percussion performance. What could go wrong with that plan?

When it was our turn to order, my wife, as she usually does, asked whether the burger was seasoned. Why did she ask this? Those of you who are regular readers of this blog are no doubt aware that my wife suffers from a rare illness. The details aren’t worth going into other than to say that certain (many) foods trigger what appears to be an allergic reaction (actually anaphylactic shock of differing severities). Thus, she needs to be aware — very aware — of the ingredients of the food she eats.

In response to her query about seasoning on the hamburger, the cashier said, “Just salt and pepper.” Unfortunately, all too often, we’ve seen restaurants where there were “hidden ingredients” in the food, and so my wife said to the cashier, “I have allergies. Are you sure the seasoning is just salt and pepper?” Often, in response to this sort of query, the restaurant employee will ask something like, “What are you allergic to?” and my wife will usually respond with something like, “Too many things to mention; it’s easier if you just tell me what’s in the food”. This is exactly what happened that night, and the cashier assured my wife that the seasoning was “just salt and pepper and a buttered grill”.

So my wife ordered a burger with goat cheese.

But after three bites she put the burger down and told me that something was wrong. Over time, she’s become hypersensitive to ingredients in her food that trigger an anaphylactic reaction. Within moments she had a massive rash on her chest and neck, her cheeks were flushed and warm, and she was beginning to feel very sick.

I noticed a man whose nametag identified him as the Assistant Manager. I called him over and asked him about the seasonings on the burger and explained that my wife appeared to be having an allergic reaction. I don’t think he was taking me particularly seriously at first. He wasn’t ignoring me, but I didn’t get the impression that he thought the situation was dire, either. He told me that he thought that the seasoning was just salt and pepper. I asked if he could check. I think he finally realized the gravity of the situation when I said that I really needed to know what was in the seasoning so that I could explain to the doctors if I had to take my wife to the emergency room.

The Assistant Manager walked back to the kitchen. When he returned a few minutes later, he told us that the seasoning was mostly salt and pepper with some garlic powder and onion powder, two of my wife’s biggest triggers. He apologized profusely, said that he’d been in the restaurant business for many years, and took allergies very seriously. And he gave me two $5 coupons and said that he hoped we’d try the restaurant again. As my wife got up to get some water, he once again told her how sorry he was and asked if there was anything he could do.

We left to attend the percussion performance. Sadly, we had to leave early. My wife was just too sick to stay, especially in that sort of environment (a high school gym). At least we were able to watch the first of our son’s two performances before we left. The rest of the evening was something that we’ve sadly grown accustomed to over the years, as she took virtually all of the medications that she can to help ward off the sort of severe reaction that would have landed her in an ambulance for a trip to the local hospital. Thankfully, since she’s been on her current drug regimen with the freedom to “double up” her dosing when triggering, we’ve managed to avoid what had, for a while, been annual trips to the emergency room (including emergency rooms in both Disney and Maui!). But it was a long, difficult night, that even included bringing our daughter back from a planned sleepover at around midnight (so that if we did have to go to the ER, our son wouldn’t wake up to find everyone gone).

I guess we should feel fortunate that she has learned how to exert some small degree of control over her illness when she triggers.

During all of this, I took to Twitter to both blast Smashburger (@smashburger) and to tell friends what had happened.

By Saturday morning, my wife felt much better, though the extra medicines that she had to take made her feel like she had a bad hangover.

Late on Saturday afternoon, I did receive a call from Smashburger’s Assistant Manager asking how my wife was, offering his renewed apologies, and explaining that there were discussions being held at the restaurant. I also received an email Saturday evening from a person who I believe is Smarshburger’s General Manager:

I want to personally apologize regarding your experience at Smashburger. Our customer satisfaction and safety is our top priority. I have personally spoken to my staff regarding the incident. I truly hope your wife is ok.  I would like to send you coupons and ask you to give us one more opportunity if willing.

If you give me your address I'll be more than happy to mail you coupons.

And, coincidentally, while typing this post (I wrote it last week, but held off publishing so that my wife could review it), I received a response from Smashburger’s Twitter account apologizing and asking me to direct mail them with more information.

But here is the really ironic thing: When I looked at Smashburger’s website, I discovered that they have an entire page dedicated to Nutrition and Allergens, including an interactive allergen menu. When I use that allergen menu and click on a few of my wife’s biggest triggers (onion, garlic, shellfish), the option for a burger tells us “no burger seasoning”! Seriously.

Am I particularly angry that the cashier didn’t know what was in the seasoning? No. I guess not. Though given that the place is called “Smashburger” and hamburgers are their prime focus, you’d think that employees, especially those who deal with customers and orders would know. But the idea that the cashier didn’t know how to handle a customer who made specific reference to allergies is very troubling, especially given that the chain has that interactive allergen menu. How hard would it have been to direct my wife’s attention to that menu (or to read the list of ingredients included in the seasoning that can be found via that interactive menu)? It is also quite troubling that the Assistant Manager didn’t know what ingredients were in the seasoning without having to ask.

I’m also a bit miffed at the notion of trying to apologize via coupons. A coupon is a great way to respond when a customer received poor service or the food isn’t prepared properly. A coupon is a great way to say “sorry” for a minor inconvenience. But when the situation was as serious as this one, when the ingestion of ingredients could have led to hospitalization (or fatality), then a coupon is … um … not the best response. Instead, I’d like to see Smashburger talk more specifically about the sort of training that all employees will receive about allergens and how to deal with customers who inquire about ingredients. I’m glad that the General Manager has “spoken to [his] staff” but I’d like to know what he told them, what he told the higher-ups in the corporate hierarchy (or franchise), and so forth. Perhaps, instead of offering me a coupon, Smashburger could make a contribution to a local hospital to help with treatment of illness caused by allergens (or to The Mastocytosis Society which helps fund research into my wife’s rare illness).

Hopefully some good will come from this. Hopefully, Smashburger’s employees will be more sensitive to allergies and to the problems that exposures to allergens can cause. Hopefully other restaurants and their staff will read about this experience and consider how they handle patrons will allergies. And hopefully, next time my wife — or anyone who suffers from allergies — inquires as to the ingredients in a particular dish, they will get a thorough and complete response.

The Healthcare.gov Website Is Only a Component of Obamacare; Problems With the Website Don’t Mean that “Obamacare Is a Failure”

Ever since the federal government’s Healthcare.gov site went online on October 1, we’ve heard about problems that people are having accessing the site. The sorts of problems being described are inexcusable; there is no reason that the website couldn’t have been designed properly and tested thoroughly before going “live” on October 1. To paraphrase an old cliché: “If we can put a man on the moon…”.

However, there is one thing that is absolutely critical to note about the problems with Healthcare.gov: The website is not Obamacare! Rather, Healthcare.gov is the tool designed to implement one component of Obamacare. But as with so many other things related to the Affordable Care Act, those who oppose it have continued their pattern of lying about the law in order to stoke public fear and anger. So, I found myself feeling the need to remind people what the Affordable Care Act (Obamacare) does, the point of the Healthcare.gov insurance exchanges, and why problems with the website are not evidence of a “failure of Obamacare”.

First, as opponents of the ACA like to remind us, the bill that was passed into law was a thousand plus pages. Ooh, scary. But the point is that the law includes many, many provisions other than the exchanges. Provisions which are designed to, you know, help people. For example:

• The Affordable Care Act provides that insurance companies cannot deny coverage because of a pre-existing condition. Problems with Healthcare.gov have nothing to do with implementation of this prohibition.
• The Affordable Care Act provides that young adults can stay on their parents’ insurance plan until they are 26. Problems with Healthcare.gov have nothing to do with implementation of this requirement.
• The Affordable Care Act provides that insurance companies cannot cap insurance benefits with lifetime caps. Problems with Healthcare.gov have nothing to do with implementation of this prohibition.
• The Affordable Care Act provides that insurance companies cannot terminate coverage when a beneficiary becomes ill. Problems with Healthcare.gov have nothing to with implementation of this prohibition.
• The Affordable Care Act provides that insurance companies must include certain preventive treatment and screenings (such as mammograms) within insurance coverage and without payment of a co-pay or deductible. Problems with Healthcare.gov have nothing to do with implementation of these requirements.
• The Affordable Care Act provides that insurance companies that spend too much of the income earned from premiums on costs other than payment of benefits must provide a refund to those that they insure. Problems with Healthcare.gov have nothing to do with implementation of these requirements.
• The Affordable Care Act gives states the ability to expand Medicaid rolls dramatically, with the cost of that expansion being paid 100% by the federal government for several years (after which the federal government will pay 90% of that cost). Problems with Healthcare.gov have nothing to do with the decision of some states (like Indiana) to refuse to expand Medicaid.

Get the idea?

But there’s actually much, much more at work here, too.

One of the memes that we hear repeatedly from those who oppose Obamacare goes something like this: “If Obamacare [or the exchanges] are so good, why doesn’t ______ [insert “President Obama” or “Congress” or the name of any other public official] get insurance through Obamacare?” The problem is that this criticism completely ignores the very purpose of the exchanges. The Healthcare.gov insurance exchange (or the exchanges operated by the states; more on that in a minute…) aren’t intended to replace existing employer-provided healthcare; rather, the exchanges are designed to provide affordable access to health insurance to those who don’t have employer-provided care and who previously could not afford to purchase individual coverage. Due to economies of scale and increased bargaining power, employers (especially large employers) have been able to get coverage for employees at much less expensive rates than most individuals could obtain when shopping for just themselves or their families. Think of it as the difference between buying wholesale versus retail.

The purpose of the exchanges was to provide a “one stop shopping” site for those seeking to purchase insurance and, due to the nature of the exchange, to use market forces to drive down premiums. Where one individual couldn’t negotiate a lower price from an individual insurer, the hope is that hundreds of thousands (or millions) of shoppers choosing between plans that must provide certain benefit levels will be able to act as a giant group for which the insurance companies will lower premiums when in active and evident competition with one another. In other words, the exchanges exist, not to provide insurance to those receiving it from their employer, but to help the millions of uninsured Americans access affordable health insurance. And the US government, like most other large employers, provides health insurance for its employees. So there is no reason for President Obama or Congress to give up what they have an purchase insurance on an exchange; they are not the intended recipients of the benefits of the Affordable Care Act.

Don’t forget that a critical component of Obamacare is to provide subsidies to allow people to purchase health insurance. So when you hear discussion of what premiums may be for insurance coverage purchased through an exchange, be sure that the premium number that you are hearing includes the calculation of any available subsidy. If the subsidy isn’t included in the discussion, then you’re not really comparing proverbial apples.

There is something else that is critical to remember about the purpose and functioning of the exchanges. Recall that the Affordable Care Act gave states the right to set up their own exchanges. Some did. California, New York, and especially Kentucky (in addition to other states) set up their own exchanges and, by all accounts, are having a quite successful implementation of the exchanges in their states. But many states, like Indiana, chose not to create their own exchanges and, rather, elected to allow the federal government to be responsible for the exchanges for their states. Thus, Indiana could have set up an exchange; it could have been specifically tailored to the needs of Hoosiers. Perhaps it would have functioned as well as the exchange that Kentucky created. But the federal government had to create an exchange for all of the states that didn’t set up their own exchange. Hmm. I wonder which is more difficult: An exchange for a single state or an exchange for dozens of states, each with different insurers?

And let’s not forget that the Republicans made every effort to stop the implementation of Obamacare. Let’s say, just for the sake of argument, that the Supreme Court had ruled Obamacare unconstitutional in 2012. Can’t you hear the screams of outrage from Republicans if the Obama administration had spent significant sums of money creating the exchanges or website for a law that was declared unconstitutional. Similarly, if Mitt Romney had won in 2012 and followed through with his promise to repeal Obamacare, there would have been similar screams of outrage from Republicans about money spent toward the implementation of Obamacare. Keep this in mind when you hear Republicans talking about the administration having three years to create the exchanges. Not really.

I also want to touch briefly on some of the really bad analogies that have been drawn with regard to the rollout of Healthcare.gov and the suggestion that it is a sign of the failure of Obamacare. I’ve seen the rollout compared to the Iraq war and to the Bush administration’s response to Hurricane Katrina. Heck, in response to one of my posts on Twitter, someone made the comparison to a nuclear attack on the United States: “The current #Obamacare situation is more like someone programmed our launch codes wrong & enemy missiles will B here in 5”. Seriously. Let me offer the following response: The failure of a website, designed to allow people to purchase health insurance is not akin to a war or to a failed government response to a natural disaster that led to the deaths of thousands. And it certainly is not analogous to a nuclear missile strike. But those are the analogies that opponents of Obamacare have to stoop to in order to continue their efforts to mislead and frighten.

Think of it this way: We didn’t abandon space exploration when three astronauts died in a fire on Apollo 1; we didn’t surrender to the Confederacy after losing the first few battles of the Civil War; and most importantly, we didn’t abandon President Bush’s Medicare Part D program when its initial rollout was plagued with problems. But those programs weren’t the signature legislative achievement of President Obama. A Democrat. A black Democrat.

I think that the problems with Healthcare.gov are terrible and I don’t know how the system could have been designed and implemented so poorly. But Healthcare.gov is not Obamcare. It is merely a component of Obamacare; it is a component of Obamacare that will be fixed (maybe soon, maybe not, but it will be fixed). In the meantime, all of the other components of Obamacare are functioning and are helping people. And even the exchanges are working in states that adopted their own (and at the federal level for those who choose to register via phone or paper, apparently). One problem in one part of the law does not evidence that the entire law is a failure.

But don’t let truth stand in the way of a good scare tactic; after all, Halloween is just a few days away.

If you hear someone tell you that “Obamacare is a failure”, tell them why they’re wrong. And tell them why. See how they respond.

Todd Rokita Attempts to Defend His Claim That Obamacare is “Insidious”

For the record, I don’t really like using the term Obamacare. I think that it is a loaded term that was coined more as a pejorative than as an honest short-hand descriptor for the Affordable Care Act. However, given that the term has seemingly become the de facto term for the Affordable Care Act and given the public confusion over the terms, I have reluctantly been using the term Obamacare with greater frequency.

So, with that out of the way, let’s move on to Rep. Todd Rokita (R-IN). I’ve was highly critical of Rep. Rokita last week both for his condescending behavior toward CNN anchor Carol Costello, his use of his own child’s illness as a political ploy to reopen certain healthcare elements of the government at the same time that he tries to eliminate healthcare for others, and for his claim that Obamacare is “one of the most insidious laws known to man”. I (and others) have pointed out the evil fallacy of equating Obamacare with truly insidious laws like the Fugitive Slave Act, Nuremberg Laws, Jim Crow laws, Apartheid, and other similar examples of man’s inhumanity to man that were codified into law. But rather than walking back his statement, let alone apologizing for the inappropriate and offensive description, Rep. Rokita decided to double-down and try to defend his claim that Obamacare is “insidious”. To be fair, I’ll reprint Rep. Rokita’s explanation in its entirety:

ObamaCare: One of the Most Insidious Laws Ever Devised

Insidious:

1. Intended to entrap or beguile: an insidious plan
2. Stealthily treacherous or deceitful; an insidious enemy
3. Operating or proceeding in an inconspicuous or seemingly harmless way but actually with grave effect: an insidious disease

The Affordable Care Act is one of the most insidious laws devised. That is because it is built around a series of lies, which are now being exposed. Lies such as Americans can keep the health care they have, and that the law would make health care more affordable.

Lost Jobs:

Hospital systems like Indiana University Health have cut employees and hours due to changes forced upon the system by ObamaCare.

Fewer Hours

Schools – both K-12 and college – are reducing support staff and part-time teacher hours because of new requirements under ObamaCare

Lafayette School Corporation, Hancock and Benton County Schools cut their part-time employees to a max of 29 hours per week.

Morgan, Clay, DeKalb, Floyd, and Marshall Counties schools cut their part-time employees to 28 hours per week.

Indiana University, and Ivy Tech Community College, our statewide community college system, capped part-time hours at 29.  At Ivy Tech, this includes part-time instructors classroom  hours, limiting the access to instructors for some of our students that need it the most.

Lost Insurance:

UPS, one of Indiana’s biggest employers, cut insurance for 15,000 spouses.

Soaring  Healthcare Costs

I’ve had countless letters and emails from constituents who’ve had their insurance premiums and deductibles jump.  For example:

• Larry Cooley in Wheatfield, Indiana reports his 2014 insurance package through Medicare Advantage saw a premium jump 86% and a deductible increase by $500.00.  His prescription costs jumped 25% too and he lost coverage on several drugs.
• Real people like Angie May, who operates a small family farm with her husband in Indiana.  Their premiums jumped 280% from $325 per month in 2012 to $906 per month beginning in 2014.
• In so many cases, Americans are not able to stay on the plan that they liked, despite the President’s promise.

Government Will Have More Control Over Every American:

ObamaCare is forcing millions of Americans on to government run health plans, and therefore putting the government in charge of our health care decisions.

Health care represents 1/5th of our national economy, to bring it under government control is to radically change how our private economy works

Most importantly, as Harry Reid and other Democrats have said, the real goal is to get to a “single payer” system where only the government pays for health care.  When only the federal government pays for health insurance, only the federal government will get to decide what care you receive.

ObamaCare Is A Driver Of Our Exploding Debt:

Over the next 10 years, ObamaCare will spend $1.9 trillion that we do not have.

By the end of the decade, ObamaCare spending will exceed $200 billion annually.

Already every child born today inherits over $55,000 in debt, and according to the Congressional Budget Office, federal spending on major health care programs is projected to increase significantly as a share of the economy in coming decades.

• In 2013, federal spending on health programs will amount to 4.6 percent of gross domestic product (GDP) – by 2038, thanks to ObamaCare, federal spending is projected to rise to 8 percent of GDP.

Note: It appears that Rep. Rokita sourced his definition of the word “insidious” from Dictionary.com. Perhaps because he is a member of Congress he is of the belief that he can simply copy material from another source without attribution.

Obviously, the core of Rep. Rokita’s claim that Obamacare is “insidious” is this statement: “[I]t is built around a series of lies, which are now being exposed”. Oh, really? And what does Rep. Rokita cite as evidence for this “series of lies” that are being “exposed”. First he tells us that “Hospital systems like Indiana University Health have cut employees and hours due to changes forced upon the system by ObamaCare.” But is his statement true? Remember, it is Rep. Rokita that talks about a “series of lies”. Perhaps he needs to look in the mirror before he starts accusing others of lying. For example, a story in the Indianapolis Business Journal about the job cuts at Indiana University Health mentions many factors, but Obamacare is not one of the reasons cited:

After strong growth for years, admissions at Indiana University Health hospitals in the first half of the year suddenly dipped 4.3 percent.

So IU Health executives, who were already looking for ways to cut $1 billion in expenses, decided to give pink slips to 800 employees, according to an announcement Thursday morning.

Meanwhile, however, IU Health's business is stronger than ever, with income from operations shooting up nearly 20 percent in the first half.

“With more than 50 percent of our costs related to labor, and in the face of declining reimbursements and fewer people being admitted to the hospital, we have regrettably concluded that a work force reduction is necessary,” said Jim Terwilliger, CEO of IU Health’s flagship hospital, Methodist. “This is not a decision that we have reached easily or taken lightly, and comes after great consideration.”

IU Health currently had 36,000 employees, although many of those work part-time schedules. It’s full-time equivalent workforce totals 27,000. For all of 2012, IU Health had revenue of $5.6 billion.

IU Health’s decision comes less than three months after Indianapolis-based St. Vincent Health laid off 865 workers in late June, which was part of a 5,000-worker layoff by its parent organization, St. Louis-based Ascension Health Alliance.

Hospitals around the country have been doing the same, as they worry that fewer patients and lower payments will no longer support the expensive operations they built up during a long boom.
“I believe that, as an industry, we have been inefficient,” IU Health CEO Dan Evans said during an April interview in which he announced the $1 billion cost-cutting goal.

IU Health has been able to offset its decline in hospital admissions with an 8-percent price increase and by receiving more patient visits to its outpatient facilities.

Excluding one-time items, IU Health income from operations rose 19 percent in the first half of 2013 compared to the same period in 2012. IU Health pulled in $186.3 million during those six months, compared with $156.6 million the year before.

Inpatient admissions—those that involve an overnight stay—had been climbing consistently throughout 2012. But then, in January, they started to fall.

Total inpatient admissions in the first six months totaled 68,952, down from 72,057 during the same period last year, according to data IU Health released to bond investors last month.

The steepest declines came at IU Health’s downtown hospitals—Methodist, University and Riley Hospital for Children—where inpatient visits fell 6.3 percent.

Even though IU Health saw fewer patients staying overnight in its hospitals, the total days those patients stayed did not fall until the second quarter. And IU Health posted a slight increase in total patient days for the first six months this year.

IU Health outpatient visits—anything that does not require an overnight stay—rose 1.9 percent during the first six months of 2013. At IU Health’s suburban Indianapolis hospitals in Avon, Carmel, Fishers and Tipton, outpatient visits soared 13.4 percent during the first half.

“We think that the future is going to be around population health. How do you keep people healthy?” Terwilliger said. And that means keeping more patients out of the hospital.

Indeed, the federal Medicare program and private insurers are pushing hospitals like IU Health to enter new kinds of contracts in which they can earn bonuses for keeping patients out of the hospital but could suffer penalties if they spend too much to take care of patients.

That’s one factor pushing down hospitalizations nationwide. In addition, persistently high unemployment and the increasing prevalence of high-deductible health insurance plans have left more patients exposed to the high cost of a hospital visit.

What really has IU Health scared, however, is that the federal Medicare program has been reducing payments to hospitals—and private insurers are likely to follow suit. Whereas hospitals for years have claimed that Medicare payments ran about 20 percent below their costs, hospitals now are desperately trying to cut costs to make money on Medicare.

IU Health’s cost-cutting goal of $1 billion would reduce its annual expenses about 20 percent.
“Our foresight is that reimbursement rates will approximate Medicare,” Terwilliger said.

In addition to cutting jobs, IU Health also has been trying to reduce expenses by closing and consolidating programs. For example, it closed pediatric and cardiac rehabilitation programs at Methodist hospital, and now sends patients to similar programs at Riley and at its suburban hospitals.

IU Health also consolidated multiple lab facilities into a downtown facility.

“We continue to root out expenses that do not add value to our patients,” Terwilliger said.

The job cuts will be focused on IU Health's three downtown hospitals as well as its hospitals in Carmel, Fishers, Muncie and Tipton. The 800 cuts will occur in all areas of those hospitals' operations, including clinical and administrative staff.

The cuts will come from layoffs and possibly from some early retirement buyouts—something IU Health has never done before. Laid-off workers will be notified by Oct. 1 and will have their last day with IU Health near Dec. 1.

IU Health officials said they would provide outplacement services, spiritual support and severance. They declined to detail the severance packages.

Hmm. If Obamacare was to blame, don’t you think that Terwilliger might have mentioned that or that the reporter for the Indianapolis Business Journal might have done so? US News & World Report also looked at the broader claim that Obamacare was causing hospitals to cut jobs.

Cleveland Clinic officials announced this week that they would be offering 3,000 buyouts in an effort to cuts costs, citing financial pressures from health care reform as one of the reasons for their decision. More than a dozen hospitals across the country are taking similar measures, due in part to health care reform requirements, but also because of the $9.9 billion in government sequester cuts to Medicare, hospital debt and states’ refusal to expand Medicaid, the government’s health insurance program for the poor.

“For hospitals in general this is kind of the new normal,” says Eileen Sheil, executive director of corporate communications for the Cleveland Clinic. According to most recent estimates from the Bureau of Labor Statistics, the hospital sector lost about 4,400 jobs in July. In May, hospitals shed 9,000 jobs, the worst month for the industry in a decade.

Ron Stiver, senior vice president of engagement and public affairs for Indiana University Health, which plans to cut 800 employees, says the assertion that health care reform is the reason behind hospital cuts is “overly simplified.” IU Health is making cuts partially because of the health law, he says, but also because the state has not expanded Medicaid, the hospital system has fewer inpatient volumes, and payment rates for its services have been declining.

Vanderbilt University Medical Center in Nashville, Tenn., plans to cut 1,000 positions, citing an aging population, lower reimbursement rates, a reduction in National Institutes of Health grant funding and a lack of Medicaid expansion in Tennessee.

In 2012 the Supreme Court ruled that state legislatures could opt out of increasing the number of people who are eligible for Medicaid, and North Carolina is one of 22 states that has done so, a decision that resulted in Vidant Pungo Hospital in Belhaven, N.C., closing down, according to hospital officials.

Democratic Congressman Charles Rangel from New York, the main sponsor of the health reform bill, says organizations have several other tools they could use to reduce costs, and that many businesses are blaming health reform for actions for which they don't want to take responsibility. “U.S. health costs have been the highest in the world, yet our quality measures were middling at best,” he says. “While there is no doubt that [health reform] has helped slow health care cost growth, which is beneficial to both national and household budgets, there is nothing in the law that tells hospitals to reduce staff. The fact is that patients are paying less, not more, as a result of the [health law].”

The Office of the Actuary for the Centers for Medicare & Medicaid Services predicted that decreases like these would occur, stating in a 2010 memo that by 2019 it expected hospitals, skilled nursing facilities and home health agencies would undergo a 15 percent reduction.

For a sector that employs more than 5.5 million people, according to the American Hospital Association, the numbers are likely to get worse. The pattern of layoffs and buyouts has already begun. SouthCoast Hospital Group in Florida cited federal health reform when it laid off 100 employees in mid-September. John Muir Health in California is offering staff voluntary buyouts. NorthShore University HealthSystem in Illinois will lay off 1 percent of its workforce, and Covenant Health in Texas laid off 49 employees.

The requirements that hospitals must meet in order to receive full Medicare reimbursements are having a large impact. Hospitals once were able to bill insurance companies and the federal government for services rendered, but now they have to demonstrate that those services help keep patients healthy.

The government is capping reimbursement rates for specific diagnoses and having hospitals pay to fix their own medical errors, including hospital-acquired infections. The plan is to lower inefficiencies, thereby lowering costs. “We want hospitals to do things more efficiently,” says Dr. Ross Koppel, professor of sociology and affiliate professor of medicine at the University of Pennsylvania. “We don't want to redo tests or subject people to hideous radiation because exam records have been lost, for example. There may be some inefficient practices that were money makers, but with a more efficient system hospitals can't get away with them.”

Hospitals with excessive numbers of readmissions for Medicare patients will face large penalties, and hospitals that serve the poor will be particularly vulnerable.

Still, hospitals are not responsible for a significant amount of the recidivism they see, according to research published in 2011 by the University of Toronto, which revealed that only a quarter of hospital readmissions were preventable.

“Hospitals have very little control over what patients do when they leave the hospital, so in that case there is an unfairness in penalizing hospitals,” Koppel says. “The hospitals may do a good job and tell patients what to do when they get home, but then the patient goes back to drinking, smoking and eating cupcakes all day.”

Sheil said hospitals will be getting paid less and still have to do more. “Nobody is immune to that, not even Cleveland Clinic,” she says.

The news appeared to be particularly devastating to a hospital system that President Barack Obama applauded only four years before for delivering exceptional care at costs well below the national norm. Still, Cleveland Clinic officials were attributing its most-recent cuts to a number of factors, and pointed out that it was continuously developing ways to be more efficient. “There are many factors, and any one isn't going to tip us over,” Sheil says.

“We're not blaming health care reform. We think it is very necessary,” she adds. “Something had to give because costs are going to continue to rise and it's unsustainable.”

I will acknowledge that in the US News & World Report article, an official from Indiana University Health does blame “health care reform” in part (he doesn’t identify either Obamacare or the Affordable Care Act by name…) but he also blames the State of Indiana for refusing to expand Medicaid, fewer inpatients, and declining payment rates. He says that blaming “health care reform” is “overly simplified”. But  not to Rep. Rokita who ignores everything else to blame Obamacare for the layoffs.

So, what do you think now about Rep. Rokita’s claim that “Hospital systems like Indiana University Health have cut employees and hours due to changes forced upon the system by ObamaCare.” Is that an example of the “insidious” nature of Obamacare … or an insidious exaggeration (or outright lie) by Rep. Rokita?

Next, let’s take a look at another one of Rep. Rokita’s claims.

UPS, one of Indiana’s biggest employers, cut insurance for 15,000 spouses.

Well, that one is actually true … kinda. But the omission of an enormously important detail is illustrative of the way Obamacare opponents like Rep. Rokita play “fast & loose” with the facts. So, yes. UPS is cutting insurance for approximately 15,000 spouses — but only spouses who work and are eligible for healthcare insurance from their own employer. It’s probably worth noting the likely source for Rep. Rokita’s half-truth. As Politifact noted in a fact check of the fake filibuster staged by Sen. Ted Cruz [R-Texas]:

Cruz said: “Just a few weeks ago, UPS sent a letter to some 15,000 employees saying, ‘We are dropping spousal health insurance because of Obamacare.’ That is 15,000 UPS employees who had insurance for their husbands and wives, and suddenly those husbands and wives are left without health insurance and being told, ‘Go on an exchange with no employer subsidy.’”

Politifact found Sen. Cruz’s claim to be false:

Cruz said that by dropping spousal health insurance for 15,000 employees, UPS left employees’ spouses “without health insurance” and told them to, “go on an exchange with no employer subsidy.”

But Cruz ignores that the only spouses being kicked off the UPS plan would be the ones who already had access to an employer-sponsored plan in their own job. This means they wouldn’t be “without health insurance” and wouldn’t have to find coverage on an Obamacare marketplace. We rate the claim False.

Rep. Rokita didn’t repeat Sen. Cruz’s false claim in its entirety, but he did omit a critical limiting element. So which is “insidious”? A plan to extend healthcare to millions of uninsured or a lie designed to frighten people into thinking that Obamacare was forcing people to become uninsured?

Rep. Rokita also describes the “countless letters and emails from constituents who’ve had their insurance premiums and deductibles jump” and then he proceeds to identify … two. I know that Rep. Rokita may not be a rocket scientist, but I would have presumed that “countless” would be a number higher than two.* In any event, I’m not going to attempt to fisk this sort of claim; I have no idea what letters and emails he has and hasn’t received; I have no idea if the stories he relays are accurate or if those relaying the stories have their facts straight in the first place; and I have no idea how many other constituents may have encountered completely different results.

Now, before I go any further, I will acknowledge that I’ve made no attempt to fisk Rep. Rokita’s claims concerning schools cutting jobs, insurance premiums going up or how Obamacare will impact the national debt. For one thing, these are very, very complicated issues (especially the debt); for another thing, there is data all of the map on these issues. For example, I’ll acknowledge that just today the State of Indiana and 17 (mostly rural?) schools have sued the IRS over applying the employer mandate to schools. Similarly, some premiums are certainly increasing, but its not clear if those increases are result of Obamacare or a continuation of the rise in premiums that we’ve seen for years (and, for that matter, has Obamacare slowed the increase in premiums?). Similarly, some projections show that Obamacare will add to the debt; yet others show that it will reduce the debt. For example, here is what Politifact said in a June 2012 examination of Mitt Romney’s claim that Obamacare would add trillions to the national debt:

[F]or claims about deficits, we consider the Congressional Budget Office, often called the CBO, to be the standard by which we fact-check claims.

The CBO said this about the health care law back in 2010: It lowers the deficit, by about $124 billion over 10 years.

And in 2011, when Republicans offered a bill to repeal the health care law, the CBO said that increased the deficit, by about $210 billion over 10 years.

In any event, what you need to remember is that Rep. Rokita used the issues of school layoffs, premium increases, and the debt as an explanation for why Obamacare is “insidious”. The issue isn’t whether Obamacare is a good law or a law that should be repealed, tweaked, or fully implemented. The issue raised by Rep. Rokita is whether Obamacare is “one of the most insidious laws known to man”.

Rep. Rokita claims (without citation) that Obamacare will $200 billion annually. Maybe yes, maybe no. I don’t have any idea. But you can’t simply divorce the cost of the program from what that money will be paying for. Obamacare gives states the option to expand their Medicaid rolls (thus offering healthcare to more of those who live in poverty) and the federal government will pay all of that cost for a few years before transferring ten percent of the cost to the states. Is that expensive? Absolutely. But the question is not just cost; the question is whether we the people think that spending that money for the purpose of providing healthcare to the poor is a good expenditure. Similarly, Obamacare will provide subsidies to assist families who are required to purchase insurance. Once again, that is also expensive. But once again, the question is not just the cost; we also have to look at the social benefit of having more people insured. Finally, Rep. Rokita’s discussion of the cost omits any discussion of savings or of increased job creation and the resulting tax revenue. If Obamacare is “insidious” because it is expensive, then I suppose that Social Security, Medicare, the CIA, and Pentagon are also “insidious” — at least by Rep. Rokita’s formulation.

These are all important issues to discuss. And they were discussed when the law was passed. They were discussed in town hall meetings across the country. They were litigated in the 2010 mid-term elections. And, most importantly, they were critical issues in the 2012 presidential elections. And you know what? President Obama ran on Obamacare and he won. By contrast, Mitt Romney ran on a platform that included the repeal of Obamacare and he lost. It’s also worth noting that while Republicans do have a majority in the House of Representatives, they did not win a majority of the votes cast for the House of Representatives. In fact, they lost by about 1,700,000 votes (about 1.9%), but because of gerrymandering Republicans have a majority in the House.

Anyway, Rep. Rokita wants us to think that these cost claims make the law “insidious”.

And that brings me to the last point from Rep. Rokita’s statement that I want to discuss. Remember that Rep. Rokita includes as a part of his definition of the word insidious: “Stealthily treacherous or deceitful” and calls the law “a series of lies”. With that in mind, recall these claims from Rep. Rokita’s statement (emphasis added):

ObamaCare is forcing millions of Americans on to government run health plans, and therefore putting the government in charge of our health care decisions.

Health care represents 1/5th of our national economy, to bring it under government control is to radically change how our private economy works[.]

Does Rep. Rokita really want to talk about being treacherous or deceitful or a “series of lies”? Really? Let’s turn again to Politifact and the winner of the award for 2010 “Lie of the Year”:

In the spring of 2009, a Republican strategist settled on a brilliant and powerful attack line for President Barack Obama’s ambitious plan to overhaul America’s health insurance system. Frank Luntz, a consultant famous for his phraseology, urged GOP leaders to call it a “government takeover.”

“Takeovers are like coups,” Luntz wrote in a 28-page memo. “They both lead to dictators and a loss of freedom.”

The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the “public option” concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan.

But as Republicans smelled serious opportunity in the midterm elections, they didn’t let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry.

PolitiFact editors and reporters have chosen “government takeover of health care” as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats’ shellacking in the November elections.

Readers of PolitiFact, the St. Petersburg Times’ independent fact-checking website, also chose it as the year’s most significant falsehood by an overwhelming margin. (Their second-place choice was Rep. Michele Bachmann’s claim that Obama was going to spend $200 million a day on a trip to India, a falsity that still sprouts.)

By selecting “government takeover” as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy.

The phrase is simply not true.

Said Jonathan Oberlander, a professor of health policy at the University of North Carolina-Chapel Hill: “The label ‘government takeover’ has no basis in reality, but instead reflects a political dynamic where conservatives label any increase in government authority in health care as a ‘takeover.’”

An inaccurate claim

“Government takeover” conjures a European approach where the government owns the hospitals and the doctors are public employees. But the law Congress passed, parts of which have already gone into effect, relies largely on the free market:

• Employers will continue to provide health insurance to the majority of Americans through private insurance companies.

• Contrary to the claim, more people will get private health coverage. The law sets up “exchanges” where private insurers will compete to provide coverage to people who don’t have it.

• The government will not seize control of hospitals or nationalize doctors.

• The law does not include the public option, a government-run insurance plan that would have competed with private insurers.

• The law gives tax credits to people who have difficulty affording insurance, so they can buy their coverage from private providers on the exchange. But here too, the approach relies on a free market with regulations, not socialized medicine.

PolitiFact reporters have studied the 906-page bill and interviewed independent health care experts. We have concluded it is inaccurate to call the plan a government takeover because it relies largely on the existing system of health coverage provided by employers.

It’s true that the law does significantly increase government regulation of health insurers. But it is, at its heart, a system that relies on private companies and the free market.

Republicans who maintain the Democratic plan is a government takeover say that characterization is justified because the plan increases federal regulation and will require Americans to buy health insurance.

But while those provisions are real, the majority of Americans will continue to get coverage from private insurers. And it will bring new business for the insurance industry: People who don’t currently have coverage will get it, for the most part, from private insurance companies.

Consider some analogies about strict government regulation. The Federal Aviation Administration imposes detailed rules on airlines. State laws require drivers to have car insurance. Regulators tell electric utilities what they can charge. Yet that heavy regulation is not described as a government takeover.

This year, PolitiFact analyzed five claims of a “government takeover of health care.” Three were rated Pants on Fire, two were rated False.

‘Can’t do it in four words’

Other news organizations have also said the claim is false.

Slate said “the proposed health care reform does not take over the system in any sense.” In a New York Times economics blog, Princeton University professor Uwe Reinhardt, an expert in health care economics, said, “Yes, there would be a substantial government-mandated reorganization of this relatively small corner of the private health insurance market (that serves people who have been buying individual policies). But that hardly constitutes a government takeover of American health care.”

FactCheck.org, an independent fact-checking group run by the University of Pennsylvania, has debunked it several times, calling it one of the “whoppers” about health care and saying the reform plan is neither “government-run” nor a “government takeover.”

We asked incoming House Speaker John Boehner's office why Republican leaders repeat the phrase when it has repeatedly been shown to be incorrect. Michael Steel, Boehner’s spokesman, replied, “We believe that the job-killing ObamaCare law will result in a government takeover of health care. That’s why we have pledged to repeal it, and replace it with common-sense reforms that actually lower costs.”

Analysts say health care reform is such a complicated topic that it often cannot be summarized in snappy talking points.

“If you're going to tell the truth about something as complicated as health care and health care reform, you probably need at least four sentences,” said Maggie Mahar, author of Money-Driven Medicine: The Real Reason Health Care Costs So Much. “You can’t do it in four words.”

Mahar said the GOP simplification distorted the truth about the plan. “Doctors will not be working for the government. Hospitals will not be owned by the government,” she said. “That's what a government takeover of health care would mean, and that's not at all what we"re doing.”

How the line was used

If you followed the health care debate or the midterm election — even casually — it’s likely you heard “government takeover” many times.

PolitiFact sought to count how often the phrase was used in 2010 but found an accurate tally was unfeasible because it had been repeated so frequently in so many places. It was used hundreds of times during the debate over the bill and then revived during the fall campaign. A few numbers:

• The phrase appears more than 90 times on Boehner’s website, GOPLeader.gov.

• It was mentioned eight times in the 48-page Republican campaign platform “A Pledge to America” as part of their plan to “repeal and replace the government takeover of health care.”

• The Republican National Committee’s website mentions a government takeover of health care more than 200 times.

Conservative groups and tea party organizations joined the chorus. It was used by FreedomWorks, the Heritage Foundation and the Cato Institute.

The phrase proliferated in the media even after Democrats dropped the public option. In 2010 alone, “government takeover” was mentioned 28 times in the Washington Post, 77 times in Politico and 79 times on CNN. A review of TV transcripts showed “government takeover” was primarily used as a catchy sound bite, not for discussions of policy details.

In most transcripts we examined, Republican leaders used the phrase without being challenged by interviewers. For example, during Boehner’s Jan. 31 appearance on Meet the Press, Boehner said it five times. But not once was he challenged about it.

In rare cases when the point was questioned, the GOP leader would recite various regulations found in the bill and insist that they constituted a takeover. But such followups were rare.

An effective phrase

Politicians and officials in the health care industry have been warning about a “government takeover” for decades.

The phrase became widely used in the early 1990s when President Bill Clinton was trying to pass health care legislation.  Then, as today, Democrats tried to debunk the popular Republican refrain.
When Obama proposed his health plan in the spring of 2009, Luntz, a Republican strategist famous for his research on effective phrases, met with focus groups to determine which messages would work best for the Republicans. He did not respond to calls and e-mails from PolitiFact asking him to discuss the phrase.

The 28-page memo he wrote after those sessions, “The Language of Healthcare 2009,” provides a rare glimpse into the art of finding words and phrases that strike a responsive chord with voters.
The memo begins with “The 10 Rules for Stopping the ‘Washington Takeover’ of Healthcare.” Rule No. 4 says people “are deathly afraid that a government takeover will lower their quality of care — so they are extremely receptive to the anti-Washington approach. It’s not an economic issue. It’s a bureaucratic issue.”

The memo is about salesmanship, not substance. It doesn't address whether the lines are accurate. It just says they are effective and that Republicans should use them. Indeed, facing a Democratic plan that actually relied on the free market to try to bring down costs, Luntz recommended sidestepping that inconvenient fact:

“The arguments against the Democrats' healthcare plan must center around politicians, bureaucrats and Washington … not the free market, tax incentives or competition.”

Democrats tried to combat the barrage of charges about a government takeover. The White House and House Speaker Nancy Pelosi repeatedly put out statements, but they were drowned out by a disciplined GOP that used the phrase over and over.

Democrats could never agree on their own phrases and were all over the map in their responses, said Howard Dean, former head of the Democratic National Committee.

“It was uncoordinated. Everyone had their own idea,” Dean said in an interview with PolitiFact.
”The Democrats are atrocious at messaging,” he said. “They've gotten worse since I left, not better. It’s just appalling. First of all, you don’t play defense when you’re doing messaging, you play offense. The Republicans have learned this well.”

Dean grudgingly admires the Republican wordsmith. “Frank Luntz has it right, he just works for the wrong side. You give very simple catch phrases that encapsulate the philosophy of the bill.”

A responsive chord

By March of this year, when Obama signed the bill into law, 53 percent of respondents in a Bloomberg poll said they agreed that “the current proposal to overhaul health care amounts to a government takeover.”

Exit polls showed the economy was the top issue for voters in the November election, but analysts said the drumbeat about the “government takeover” during the campaign helped cement the advantage for the Republicans.

Rep. Earl Blumenauer, an Oregon Democrat whose provision for Medicare end-of-life care was distorted into the charge of “death panels” (last year's Lie of the Year), said the Republicans’ success with the phrase was a matter of repetition.

“There was a uniformity of Republican messaging that was disconnected from facts,” Blumenauer said. “The sheer discipline … was breathtaking.”

So did you get all that? More importantly, do you see what Rep. Rokita has done? In order to defend his use of the word “insidious” — a word that he defines as meaning “stealthily treacherous or deceitful” — and to support his claim that Obamacare is “built around a series of lies” — he repeats a 3-year-old lie. And not just any lie. Nope. That wouldn’t be good enough. He repeats the lie of the year in order to prove that something else is built on a lie.

Still want to talk about things that are insidious?

And it probably goes without saying, but Rep. Rokita focuses only on the cost and perceived downsides of Obamacare to argue that it is insidious. Did you see anything in his statement recognizing that it prohibits insurance companies to deny coverage for pre-existing conditions, prohibits lifetime caps on coverage, prohibits cancellation of coverage when a person becomes ill, permits children to stay on their parent’s plan until 26, requires insurers to give rebates if they overcharge or don’t expend earned premiums to treat those they insure, requires certain preventive care to be included in plans without the payment of an associated deductible, and many other benefits? You see, Rep. Rokita can’t possibly argue that any of those aspects of Obamacare are insidious, especially because he knows that people like those parts of the law (even those who claim to “hate” Obamacare seem to like the things that the law actually does) and because he knows that despite the Republicans’ grandstanding votes to repeal Obamacare 40 or more times, the Republicans have not offered a real plan to replace Obamacare and provide these patient and consumer protections. Rep. Rokita may claim that the law is insidious, but he can only do so by ignoring all of the good that it is intended to do.

One final point. Yes, many Democrats would like a “single payer” system of healthcare. But single payer doesn’t, as Rep. Rokita suggests, mean that “only the government pays for health care”; rather it means that the government pays for healthcare but that doesn’t prohibit individuals from paying additional premiums for supplemental care. In other words, a “single payer” system is essentially the same as Medicare, but for everyone instead of just the elderly. But to Rep. Rokita, adopting an intermediate, market-run plan while still hoping to eventually adopt a more far-reaching plan is insidious.

No, Rep. Rokita. The Fugitive Slave Act was insidious. The Nuremberg Laws were insidious. Jim Crow, Apartheid, and similar laws were insidious. But Obamacare, while it may be controversial and may be expensive, is not insidious. On the other hand, the use of half-truths and blatant lies (including a previous “lie of the year”) to support your argument … now that is insidious.

Rep. Rokita: Your words have brought shame upon yourself and upon the state and constituents you represent.

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*Of course I could be wrong here. After all, then-Secretary of State Rokita testified to a Federal Court that he was unaware of any incidents of in person voter fraud in Indiana but then later testified to Congress that in person voter fraud “does exist” and that it’s “happening in Indiana”. So maybe he does have difficulty counting to numbers higher than zero.

Todd Rokita: Crossing the Line from Offensive to Evil

Look up at the top of this page, right under the title Me Me Me Me Me. Do you see what it says there? “A chance for me to share my thoughts (or, maybe just vent a bit).” Well, please bear with me, but the time has come for some of that venting.

I’m in the process of writing a much longer post debunking Rep. Todd Rokita’s [R-IN] explanation for calling Obamacare “insidious”. But that post will have to wait. Because I’ve just come across something else that Rep. Rokita said that … well … if I said it made my blood boil, it would be an understatement.

First, let’s recall why the government has been shut down. The Republicans demanded that Obamacare be defunded (or, perhaps, delayed in its implementation). That is the core of the dispute. But now that the government has been shut down, Republicans are finding that, gee, some aspects of government aren’t so bad; maybe they’re even good.

So, as reported yesterday by The Huffington Post (emphasis added):

The politics behind the government shutdown reached a new level of absurdity on Thursday as a group of conservative House Republicans — the same ones refusing to fund the government unless Obamacare is delayed or defunded — pleaded with Democrats to pass a bill only funding services for children with cancer.

Dressed in lab coats, members of the Republican Doctors Caucus made the case that pediatric cancer research trials at the National Institutes of Health deserve to be funded, even if the rest of the government is not.

“There are times that the private sector cannot be reasonably expected to do the research and development needed because the issue, the syndrome, the disease, might be so rare that it is economically prohibitive,” said Rep. Todd Rokita (R-Ind.), whose son suffers from Angelman Syndrome, a rare neurogenetic disorder.

“I ask the president himself to stop this nonsense,” said Rokita. “Let us help people. Let us help children. Please.”

I want to make it clear that I have the utmost sympathy for Rep. Rokita’s son and the entire Rokita family. You see, as I think I’ve mentioned before, my wife also has a rare illness; an illness for which the private sector has not done much research and an illness that prevents my wife from getting individual health insurance and causes our family’s health insurance premiums to be very, very high.

That’s one of the reasons that I’ve been a major supporter of Obamacare. I think that it is terrible that people suffering from illnesses can’t get insurance or, if they can, have to pay astronomical premiums. I think that it’s terrible that insurance companies can cancel insurance when people get sick and that many policies include lifetime coverage caps.

But Obamacare does away with those problems.

And Rep. Rokita wants to repeal Obamacare. However, like a true self-sentered asshole with no self-awareness, he’s willing to use his son’s illness to make a political point. He’s willing to plea to “help the children”. But why do the children need help? Because Rep. Rokita and his sociopathic colleagues have shut down the government. And why have they shut down the government? Because they don’t want people — like those children — to have access to affordable healthcare.

Please, please help my child, just don’t help those other children. Government is bad, except when government helps my child. Shut down the government, except the part of government that I like or need. (It’s also worth noting that Republicans spent the first day or two of the shutdown complaining about the closure of the World War II Memorial while people on the left talked about the closure of NIH medical trials; when Republicans saw which of those issues generated more sympathy, suddenly the focus shifted…)

If Rep. Rokita really cared about children, his own or those of his constituents, he could help end the shutdown today. He could join the caucus calling on House Republicans to pass a clean continuing resolution and separate budget and debt issues from their dislike of Obamacare. He could stop trying to blame President Obama and Senate Democrats for his own conduct and do something.

Instead, Rep. Rokita is grandstanding (when he’s not calling Obamacare “insidious” or being condescending to a CNN reporter) about his “concern” for children because his child would benefit from the care. Rep. Rokita wants to use words like “insidious”. Perhaps Rep. Rokita needs to go into a cancer ward and tell the children why he thinks his child deserves medical research but they don’t deserve the opportunity for affordable healthcare. Maybe he could explain to the families of those children why they don’t deserve protection against unscrupulous insurance companies willing to terminate coverage or include lifetime caps. And then he could explain why he was willing to shut down the government only to shed crocodile tears when it might have an adverse impact on his child.

A public servant willing to cry foul because his own conduct puts his child at risk — when that very conduct was designed to put other children at risk — isn’t just stupid or misguided. No. That sort of behavior deserves other words. Words like vile. Or evil. This has gone beyond politics. Rep. Rokita has proven that he doesn’t really understand what it is to be human. Compassion is not a political football and the lives and health of children are not something to use for political gain. Rep. Rokita has shown the true face of many in today’s Republican party; a face that is repulsive and repugnant to anyone with a shred of dignity or decency.

This blog may be called Me Me Me Me Me (it was a joke), but the Republican Party and its billionaire backers have proved that “me me me” is really all that they care about.

Todd Rokita’s Ignorance of History and Reality Is Offensive and Makes Him a Prime Example of Why the Tea Party Is So Detested by So Many

I understand that rhetoric can sometimes go a bit too far and be taken over the proverbial top. But sometimes going over the top is … well, going too far. And while our elected officials certainly have the right to say what they want, sometimes their position as elected officials should require them to, oh, I don’t know … think before they open their mouths and start spouting gibberish. This is especially true when the gibberish coming out of their mouths is both inane and horribly offensive.

Case in point: Indiana’s former Secretary of State and current member of Congress Todd Rokita (R-Indiana).

I understand that Rep. Rokita opposes the Affordable Care Act. I get that. He’s entitled to oppose it (though I’d really like to hear real reasons for his opposition beyond bare talking points, but that’s a discussion for another day). And Rep. Rokita is certainly entitled to his opinion that the Affordable Care Act should be repealed or defunded or whatever. He’s even entitled to think that it is a bad law or a law that will be bad for Americans or for America. He’s wrong, but he’s entitled to those opinions. And if he just said, “Obamacare is bad” or “Obamacare will hurt Americans”, I might criticize his opinion, but that would likely be the end of it.

But that’s not what Rep. Rokita said.

Nope. He took that proverbial step too far in his criticism.

In an interview that aired late Monday night on CNN, Rep. Rokita called the Affordable Care Act (Obamacare):

[T]he most insidious law known to man.

Seriously. Those were Rep. Rokita’s words. “The most insidious law known to man.” Here’s the video (at about 1:00; it’s actually the second time he calls Obamacare “insidious”).

(I could respond to many of the points that Rep. Rokita makes in the remainder of the interview, but that isn’t the point of this post.)

First, let’s recall what the Affordable Care Act does. It prevents the denial of coverage for pre-existing conditions. Insidious. It prevents lifetime caps on benefits. Insidious. It prohibits insurance companies from canceling policies when people get sick. Insidious. It requires insurance companies use premiums to care for the insured, rather than expanding corporate profits unreasonably. Insidious. It allows children to remain on their parent’s policy until they are 26. Insidious. It levels the playing field for premiums between men and women. Insidious. It provides that certain preventative care (like mammograms) be covered by policies. Insidious. It provides subsidies to allow those who otherwise might not be able to afford insurance to buy insurance rather than relying upon (and not paying for) care in the emergency rooms. Insidious. It expands Medicaid so that more of those living in poverty can obtain healthcare. Insidious. And it requires that people have health insurance (either through an employer or obtained individually or through an exchange).

“The most insidious law known to man.”

Perhaps if Rep. Rokita weren’t such a moron, he’d know about laws like the Fugitive Slave Act which provided for the return of runaway slaves to their “masters”. Or maybe he would be familiar with the Nuremberg Laws that revoked citizenship to Germany’s Jewish population and imposed other prohibitions upon the country’s Jews. One wonders if Rep. Rokita is familiar with Jim Crow laws that imposed segregation between blacks and whites and restricted the voting rights of black Americans. Come to think of it, Rep. Rokita should certainly be familiar with that last category of laws given his active involvement in the passage and enforcement of the newest version of a Jim Crow law, in the form of voter ID laws (a law for which Rokita either perjured himself while Secretary of State or about which he lied to Congress). I could probably go on with a list of laws that were, in fact, evil…

But it’s the Affordable Care Act that Rep. Rokita claims is “the most insidious law known to man”.

Which do you think is more insidious: A law that helps people get healthcare or a law that calls a certain group of people non-citizens and subhuman?

Which do you think is more insidious: A law that prevents insurance companies from denying coverage to sick people or a law that requires that runaway slaves be returned to their “masters”?

Which do you think is more insidious: A law that prevents insurance companies from charging higher premiums to women simply because of their ability to get pregnant or a law that prevented black Americans from voting?

Which do you think is more insidious: A law that expands healthcare availability or a law that cuts food stamp subsidies to the poor?

Perhaps Rep. Rokita simply doesn’t know what “insidious” means? Or, more likely, he is simply too busy trying to cause fear and angst among his Tea Party constituents to really care that he is offending millions with his crass claim.

I called Rep. Rokita’s office this morning to see if an apology for this statement would be forthcoming. So far, no apology has been issued.

A statement that far over-the-top, that offensive to those adversely affected by truly insidious laws, cannot stand. And a Congressman who is so ignorant of history, so willing to go beyond the bounds of reasonable dialogue and debate, is not fit to serve in an elected capacity.

Rhetoric like that of Rep. Rokita is wrong. It’s dangerous. In fact, it’s downright insidious. But it’s not the most insidious statement known to man.

Update (October 2, 2013): An anonymous commenter correctly points out that Rep. Rokita actually refers to Obamacare not just as “the most insidious law” but as “one of the most insidious laws”. In listening to the video again, that is correct. I took the quotation that I used from the CNN article linked to above. That said, I’m not sure that the quote is any better. So Obamacare isn’t more insidious than the Fugitive Slave Act, Nuremberg Laws, or Jim Crow laws; it’s just on par with them.

Doctors and the Lack of Courtesy and Attention (Guest Post)

For quite some time I’ve been suggesting to my wife that she should write some posts for this blog. Well, she had an experience earlier today that finally prompted her to take my suggestion. So here is the first (and hopefully not last) guest post on Me Me Me Me Me!

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How many times have you found yourself in a doctor’s appointment with a doctor who doesn’t actually want to listen to you and whose only goal is to give you the quickest answer possible and race out of the room before you can even open your mouth to speak? So many doctors today seem to be in this category, and it is the few doctors in the minority who actually are interested enough to listen to their patient and consider each one independently. Today I encountered yet another doctor who seemed more amused with himself and his own one-liner jokes than in listening to my problem. Had I not known better, I might have thought that I was having a prank pulled on me. Our conversation went like this:

Me: “I have pain on the edge of my heel, not only when I step down but also when I am sitting and my foot isn’t touching the floor.”

Doctor: “Your heel hurts most when you get up in the morning?”

Me: “No, it hurts all day exactly the same. It doesn’t hurt more in the morning.”

Doctor: “So, your heel hurts most in the morning when you get up!”

Me: “No, it hurts the same all day long.”

Doctor: “Where is the pain?”

Me: “On the edge of my heel.”

Doctor: “And the pain is in the bottom middle part of your heel.”

Me: “No, the pain is in the outer edge of my heel.”

Doctor: “Well, based on the fact that your heel hurts most in the morning, and is in the bottom middle part of your heel, you have plantar fasciitis.”

Ahhhhhh! At this point, I had about had it and knew that it was pointless to do anything more except smile and nod … while plotting my escape and wait for an appointment with another specialist who would hopefully listen to my symptoms.

The underlying question that we should ask here is why are the considerate, polite doctors in the minority and the doctors with the big egos in the majority for us patients? If we are willing to pay their hefty fees, then surely they should be responsible for actually doing their job both correctly and politely. Is it polite to ignore what your patient is saying? No. Is it polite to literally be running out the door while the patient is still talking? No. How would that very same doctor like it if he came to us for a service and we behaved the same way?  Not too happily, I imagine…

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I’ve asked her to elaborate on some of her thoughts, maybe talk about why she thinks doctors act this way or what we, as patients, can do. Hopefully, there will be more to add to this post in the coming days. And we’d love to hear from doctors, too. Do you think that what my wife describes accurately reflects your profession? If so, why? If not, what do you think explains her experience?

Is This Why People Voted Republican?

I’d hoped to post more this week, but after my week without Internet, I’ve had to deal with Icepocalypse 2011. I’m still trying to dig out (both literally and metaphorically and both at home and at the office). Thus, this post will be shorter on detail and citation than is my norm.

Anyway, a few weeks before the November 2010 elections, I wrote a series of posts (“Do We Really Want the Insane Right to Gain Control?” and “Do We Really Want the Insane Right to Gain Control? (update)”) in which I briefly examined some of the Republican candidates for office. Well, thankfully, some of the crazier candidates were defeated (Sharron Angle and Christine O’Donnell, for example), but many more were elected. So now that the election is over, let’s take a brief look at some of the legislation being proposed, both in Congress and across the country. And for those of you who voted for Republicans in November, ask yourself these two questions: 1) Was this kind of legislation the reason that you voted for a Republican and 2) how many jobs will this kind of legislation create?

I think my “favorite” (heavy dose of sarcasm…) bill so far (which was thankfully dropped earlier this week) was the effort to redefine “rape”. For those who haven’t followed this story, it is truly mind-numbing. At present, the law does not allow Federal funds to be used for an abortion (e.g., funds from Medicaid); however, there are exceptions in the law for the protection of the life of the mother, rape, and incest. Well, Congressional Republicans (and a handful of Democrats) decided that they didn’t much care for these exceptions because, you know, that might allow for a few more abortions. So they sought to limit the rape exception to cases of “forcible rape” (which was not defined). In other words, Federal funds could not be used for an abortion in a case of statutory rape. Just think about it: A 24 year old teacher has sex with a 14 year old student or a pair of 13 year old kids "experiment". Whoops, not a “forcible rape” (even if state statutes call it rape). Or a sorority girl gets really drunk or us given a date rape drug and "consents" to sex (or is unconscious). Tough luck. And how about sex with a mentally disabled girl who can’t actually give consent? The bill would have also excluded incest if both people are over 21. How about that mentally disabled girl who was “raped” (but not forcibly) by her father or brother? Nope, no abortion funding allowed. I understand that some people oppose abortion, but how many opponents of abortion really want to stop abortions in those sorts of situations? Is this why people voted Republican?

Not to be outdone on the issue of rape, a Georgia legislator (ordinarily, I’d include links, but as I mentioned in the intro, time is short…) has introduced legislation to prohibit rape victims from being called “victims” until the accused rapist is convicted. Until then, the victim is merely an “accuser”. Note that the legislation would not require the same terminology in the case of a murder victim or the victim of a mugging or burglary or any other crime. Nope. Just rape victims — oops, sorry, accusers —would be singled out. Is this why people voted Republican?

Here in Indiana, Republicans want doctors to tell a woman that a fetus might feel pain — even though science doesn’t support that. And Republicans want to be sure that Planned Parenthood doesn’t get any state funding (forgetting, of course, that Planned Parenthood provides many services other than abortion, including birth control). Indiana Republicans also want to prohibit insurance policies from covering “elective” abortions without a separate rider (and who thinks to acquire a separate rider for an abortion, especially if the abortion is necessitated by rape). Indiana Republicans have also sought, once again, to define human life as beginning at conception (see my post “Keep Your Religious Doctrine Out of My State's Laws” from January 2008). And Indiana Republicans have sought to ban all abortions in Indiana unless a doctor certifies that the abortion is necessary to save the mother’s life. Apparently, one of the sponsors of the bill wants this statute to be the test case to take to the Supreme Court of the United States to challenge Roe v. Wade. Is this why people voted for Republicans?

In Congress, Republicans made a big show of trying to vote to repeal health care reform. Note that they voted on the idea of repealing reform before even presenting their own plan to replace the health care law if they could manage to get it repealed. And in states all across the country, Republicans are introducing legislation that would allow their state to “opt out” of the health care reform passed by Congress. Forgot for a moment the Constitutional problems with allowing states to opt-out of Federal laws. Instead, think about what opting out would mean for citizens of a state that opts out (or of the country as a whole if Republicans were successful in efforts to repeal the law without having a plan to replace it). OK, perhaps that would mean that citizens wouldn’t be subject to the mandate to buy insurance. But it would also mean that insurance companies could drop them if they became sick, could refuse coverage on the basis of pre-existing conditions, could drop kids from parents’ plans, could impose lifetime limits, and the list goes on. Note that so far as I’ve been able to discern, none of these opt-out proposals include legislation to extend rights to citizens in the states; rather, they only seek to remove the “burden” of the Federal health care reform legislation. Is this why people voted Republican?

Similarly, Republicans are also introducing legislation in some states to allow the state to “veto” Federal legislation that the state doesn’t like. Apparently, these legislators are unfamiliar with both that little spat often referred to as the Civil War and the Supremacy Clause of the United States Constitution (Article VI, Clause 2):

This Constitution, and the Laws of the United States which shall be made in pursuance thereof; and all treaties made, or which shall be made, under the authority of the United States, shall be the supreme law of the land; and the judges in every state shall be bound thereby, anything in the constitution or laws of any state to the contrary notwithstanding.

Is this why people voted Republican?

Many states are also wasting time worrying about the imposition of Sharia law and passing laws to prevent courts from considering Sharia or foreign laws. (I plan to write more about this later…) It is worth noting, however, that most states have laws specifically incorporating foreign law (the English common law). Moreover, I suspect that the Republicans pushing these sorts of bills have no understanding that following Sharia for a Muslim is not much different than keeping Kosher for a Jew or following the rules set forth in the Bible for a Christian. I guess if we can’t look to foreign laws, then the Ten Commandments will certainly be out. But I digress… And again, I ask, is this why people voted Republican?

Guns are also a favored subject these days. Across the country, Republicans have introduced legislation to loosen gun control regulations. After all, the shooting in Tucson certainly showed that the availability of high capacity magazines and the ability of people who might be mentally unstable to get weapons isn’t strict enough (another dose of sarcasm…). Several states are looking to adopt new provisions regarding carrying concealed weapons, including on college campuses (even in classrooms). Here in Indiana, Republicans have proposed legislation to prevent an employer from asking an employee or prospective employee about gun ownership and to allow a person to carry a licensed weapon onto school property so long as the person isn’t a student. (How comfortable would you be knowing that a parent visiting your kids school might have a concealed gun?) And I can’t help but include the digest of Indiana Senate Bill 506 (emphasis added):

Allows a person to carry a handgun on or about the person's body without being licensed to carry a handgun if: (1) the person is in or on property, or in a vehicle, that is owned, leased, rented, or otherwise legally controlled by the person; (2) the person is lawfully present in or on private property, or in a vehicle, that is owned, leased, rented, or otherwise legally controlled by another person; (3) the person is carrying the handgun at a shooting range, while attending a firearms instructional course, or while engaged in a legal hunting activity; or (4) the handgun is unloaded and securely wrapped.

Read the introduction and clause (2) again and then tell me where the person isn’t allowed to have an unlicensed gun. As I read that digest, a person could have an unlicensed handgun on my property and there would be nothing that I could do about it (other than, I suppose, kick them off my property if I found out). But remember that last year Indiana adopted a law that prohibited employers from declaring their property “gun free” zones. Is this why people voted for Republicans?

And before we leave the subject of guns, it is worth noting the novel idea that has been proposed by Republicans in South Dakota. In an effort to try to show that the Founding Fathers would not have approved of the mandate provision of the health care reform legislation and that the mandate is unconstitutional, South Dakota Republicans have introduced a bill to require all residents of South Dakota to purchase a firearm. Do we really think that encouraging people (let alone requiring people) to have weapons is a good idea? But the funny part of this is that rather than demonstrate how the health care mandate may be unconstitutional, South Dakota Republicans may, in fact, have done just the opposite. You see, in response to this bill, some folks did a little bit of historical research (something that Republicans seem to have a wee bit o’ difficulty with) and learned that — are you ready for this? — while George Washington was President, Congress enacted a law requiring that all citizens own a firearm! Yes, our first President, Father of the Nation, signed into a law a mandate requiring citizens to purchase something! (And don’t forget during Adams’ presidency [I think; maybe it was Jefferson?], Congress enacted a law mandating the 18th Century equivalent of health insurance for seamen.) Hmm. Is this why people voted for Republicans?

In state after state, Republicans are proposing legislation like that adopted in Arizona, to enact racial profiling into their laws in the hopes of stopping illegal immigration. Here in Indiana, Republican legislators want to prevent the State of Indiana from printing documents in any language other than English because, you know, doing so might actually help someone who doesn’t look and talk like the rest of us. Is this why people voted for Republicans?

In quite a few states, Republican legislators have introduced “birther” legislation that would require Presidential candidates to prove that they are natural born citizens. Gee. I wonder why Republicans feel this legislation is necessary? Is this why people voted for Republicans?

Republicans have introduced legislation to protect teachers who want to teach “alternative science” — you know, like creationism, that global warming is a myth, vaccines cause autism, the planets and sun orbit the Earth, the Earth is flat, Jesus was … OK, fine. I won’t go there. But is this why people voted for Republicans?

In Congress, newly elected Senator Rand Paul has proposed eliminating (or nearly so) the Department of Education, the Department of Energy, the Centers for Disease Control, the Food and Drug Administration, and numerous other departments and programs. And remember, he’s a doctor! He also wants to eliminate all foreign aid, including all foreign aid to Israel (he calls it “welfare”). Is this why people voted for Republicans?

And finally, in state after state, Republicans are trying to pass laws or even amend state constitutions to ban same-sex marriage. Is this why people voted for Republicans.

It was my understanding that Republicans were concerned with the economy and job growth. It was my understanding that the Tea Party was concerned with the so-called erosion of individual liberty. Yet across the nation, Republican legislators are introducing legislation to tackle social issues while ignoring the economy, often at the expense of individual liberty. Or, said another way, individual liberty is a good thing, but only if it’s the “right kind” of individual liberty; otherwise, Republicans want to ban it. Finally, consider whether these bills will create jobs or help the economy.

Is this why people voted for Republicans?

If not, let your Republican legislator know that these kinds of bills are not why they were elected. Let them know why they were elected. And remind them that another election is coming…

A Telling Omission From Dan Coats

Unfortunately (or perhaps, fortunately, I’m not sure…), I was unable to watch last night’s first debate among the candidates vying to become Indiana’s junior Senator. However, as I read some of the coverage of the debate in the paper this morning, one thing really jumped out at me. Here’s a portion of former Sen. Dan Coats’ response regarding health care reform:

This is one of the prime examples of what is wrong with Washington. The Obama administration, supported by Nancy Pelosi and by my opponent, as he has just acknowledged, thought that forcing through a 2,000-page, $1 trillion dollar health-care reform plan for this country rather than focusing on getting Americans back to work…. This was a pent-up, 25-year liberal wish dream when they had the votes to push it through. My opponent was one of those very late votes that brought it to fruition. I have traveled this state and talked to dozens of doctors, dozens of nurses, dozens of practitioners, insurance companies, medical providers and found no one who thinks this is the way to deal with legitimate reforms that have to be made.

I’ll come back to the first part of this statement in a moment. But first, focus on who Sen. Coats says that he talked to about health care reform. Notice anybody missing from his list? Sen. Coats talked to doctors, nurses, practitioners, insurance companies, and medical providers. But you know who I don’t see on the list of people that he talked to about health care reform? Patients. The insured. Those who can’t get insurance. Those who’ve been cut by their insurance provider when they get sick. Kids who are kicked off their parents’ policy before they have been able to get out and get a job. People with pre-existing conditions. Kids with pre-existing conditions.

Sen. Coats talked to those who make money in the health care system, not to those who have to spend money or deal with the health care system. Given his background as a lobbyist, is anybody surprised that he seems to have limited his discussions to the business and profit side of the equation? After all, how many patients can afford lobbyists. How many kids with pre-existing conditions can afford lobbyists. By this one sentence in a debate response, Sen. Coats demonstrated, quite conclusively, who he thinks about, who he wants to elicit information and views from, and who he intends to represent if elected to the Senate. And folks, it ain’t you and me.

A few other things to point out about his response: Sen. Coats complains about the Democrats “forcing through a … $1 trillion dollar health-care reform plan rather than focusing on getting Americans back to work”. First, he doesn’t mention that according to the Congressional Budget Office, the health care reform plan will reduce the deficit. Yes, it will cost money, but in the long run, it will reduce what we’re spending. Second, he fails to acknowledge that lowering health care costs will help put people back to work. Third, though I don’t know for sure, I certainly suspect that Sen. Coats, like almost all of the rest of the Republicans in Congress, would have opposed the Stimulus and other plans designed by the Democrats to help put people back to work. Other than lowering taxes on the richest Americans and giving tax breaks to companies who outsource jobs overseas, what does he plan to do to create jobs?

And finally, I’m really sick of the “forcing through” argument. I’m sorry, but I seem to recall the issue of health care reform being a major issue in the 2008 election, being on the front burner of the discussion for nearly a year, being at the heart of contentious town hall debates in the summer of 2009, and then after the Democrats finally got tired of Republican obstructionism, being the subject of democratic votes in Congress. Debating issues for a year and then voting on them is not “forcing through” a policy; rather, it is letting the democratic process work. Or, I guess we could say that the Bush tax cuts were forced through, too.

What we need to worry about is who Sen. Coats will be working for if he gets elected to Congress. When it comes to health care, he doesn’t seem to be very concerned with the issues facing patients and average Hoosiers. Nope. Sen. Coats is concerned with those who work in the medical or insurance fields and those who are probably funding his campaign and the profits of other lobbyists like him.

By the way: Sen. Coats is 67 years old. He’s eligible for Medicare.