Heaping insult on top of injury

FOR MILLIONS of working people, access to affordable health care is a deadly serious matter.

Take Joann King, one of the thousands of people who showed up this year to the Remote Area Medical Clinic in Wise, Va. The event is held every year in the county fairgrounds, providing residents with an opportunity at health care they ordinarily can't afford.

King hasn't had new eyeglasses in seven years, and hasn't been to the doctor for blood work since she lost her job in December. "Today, I'm here to reassure my mind that I'm all right for now," she told the Bristol Herald Courier. "And hopefully I will be, until Medicare kicks in."

King isn't alone in having to make tough decisions between health care and other basic necessities. Nearly 40 percent of patients in the U.S. said they avoided medical care in 2013 because they were worried about affording the cost, according to a study by the Commonwealth Fund. And 62 percent of bankruptcies in the U.S. are related to medical debt, according to the Physicians for a National Health Program.

But the conservative opponents of the Obama administration's Affordable Care Act (ACA) are anything but serious about the health care crisis--as a recent event organized on Washington, D.C.'s National Mall by the billionaire Koch Brothers' group Generation Opportunity showed.

They called it a "Creepy Care-nival." (No, we are not making this up.) It featured a "haunted hospital," with a long lines of people waiting outside, and overworked doctors inside trying to provide care, as skeletons sit waiting. There's a demonstration of a real-life "death panel"--and in another room, the organizers have put up exhibits about the Tuskegee syphilis experiments and forced sterilizations, with the claim that this is what happens when the government involves itself in health care.

The organizers' invitation to the "care-nival" reads: "It's time to expose Obamacare for the freak show that it really is." But if there's something sick on display in Washington, D.C., it's the Republican fanatics and their billionaire backers.

THE KOCH brothers' grotesque pageant premiered the same week as a three-judge panel from the federal appeals court covering Washington, D.C., sided with Republican opponents of the ACA. The judges ruled that people who live in one of the 36 states that opted out of creating their own state-run exchanges for the uninsured to obtain private health care coverage--and who therefore default to the exchange set up by the federal government--were ineligible for tax credits to help pay for insurance.

The case, Halbig v. Burwell, focused in on imprecise wording in the ACA to try to throw health care reform into question. If the ruling stands, people in states without state-run exchanges wouldn't get federal subsidies they qualify for, and therefore would probably not afford to buy coverage. To give a sense of just what this would mean to poor and working-class people, of the 5.4 million people who have been able to sign up for health insurance through the federal marketplace, 87 percent received subsidies.

However, a couple hours later on the same day, another federal appeals court--the U.S. Fourth Circuit Court of Appeals--reached the opposite conclusion on subsidies. The issue will remain in limbo, probably until the conflicting cases get to the Supreme Court.

So what was the conclusion of Republican lawmakers after this debacle? Keep it rolling!

House Speaker John Boehner is pushing for the Republican-dominated House to sue President Obama--over delays in the full implementation of the Affordable Care Act! The suit will reportedly challenge Obama's decision to issue an executive order delaying penalties on employers with 50 or more workers if they fail to offer insurance to their employees.

Meanwhile, conservative groups run by the likes of the Koch brothers are promising more propaganda in their unhinged war against Obamacare--they are financing attack ads, targeted with an eye toward the November midterm elections, as well as local events throughout August while members of Congress are back home for the summer recess.

The Republican creep show doesn't end with their determination to destroy the Obama administration's health care law. They've spent the spring and summer ranting about deporting immigrant children, cutting government help for poor children by gutting the Child Tax Credit--and, of course, impeaching the president.

THE RACIST, anti-"big government" and anti-poor circus is in town in Washington, D.C., with the Republicans as its ringmasters.

But the other side of this sick system is the fact that the political leaders who promised that they would make health care affordable for every American--Barack Obama and the Democrats--have failed miserably to do so.

On the contrary, those who obtain private insurance through the ACA's exchanges are discovering that they have to accept expensive plans with big deductibles and poor coverage--if, that is, they managed to navigate the seemingly impenetrable bureaucracy created with the insurance exchanges.

But the Obama administration didn't fail for the reasons that Republicans claim--that "big government" took over people's health care choices. It failed because Obama's law relies on the same corporate interests that caused the health care crisis in the first place. The same insurance companies that profited from rationing health care for the healthy and denying it to those who needed it most were the ones who called the shots on Obamacare--not the people who actually looked forward to the promise of a national health care plan in the U.S.

For the Obama administration, a single-payer, "everybody in, nobody out" option was off the table from the start. A few long-overdue regulations were imposed on insurers--like a ban on using "pre-existing conditions" to deny coverage--but the core of the new system forced millions of people to buy their overpriced, defective products.

No wonder all the problems of the for-profit health care are exacerbated under Obamacare. The people most dedicated to protecting the health care industry's bottom line designed the law.

As health care activist Donna Smith wrote recently, Liz Fowler was an executive at the for-profit managed care company Wellpoint before she briefly went to work for Sen. Max Baucus writing the ACA. After that, she moved onto the U.S. Department of Health and Human Services, where she helped decide how the law would be implemented. And now, she's made the transition to back to lobbyist for pharmaceutical manufacturer Johnson & Johnson.

Smith, the executive director of Health Care for All Colorado, writes:

Health insurance is not health care. Health insurance is a financial product sold to us to protect health and wealth which may do neither thing very well at all. So we weren't duped by Fowler...as they worked to help the health industry from the inside or as they left to do similar work more directly from outside the public administration of Obamacare.

We patients and private citizens were always the means to an end--higher profits for the health industry and bigger salaries for those who help make it so. As an old adage goes and has ever stayed true, "Follow the money."

IF THE Republicans can get a hearing by raving about big government and its impenetrable bureaucracy, it's because the Democrats gave them a huge, impossible-to-miss target with the wild patchwork of for-profit insurance "options" that make up the Obamacare exchanges.

In reality, the problem isn't "big government"; it's the twisted system that's needed to make sure the insurance industry gets its cut.

Physicians for a National Health Program co-founders David Himmelstein and Steffie Woolhandler compared the Obamacare mess to the relatively easier and less expensive rollout of the Medicare health program for the elderly in 1966:

[C]omplexity is "baked in" to the design [of the ACA], just as simplicity was "baked in" to Medicare. Obamacare's exchanges must coordinate thousands of different plans, with premiums, co-payments, deductibles and provider networks that vary county-by-county; Medicare offered a single, uniform plan...

Obamacare's byzantine complexity reflects the contortions required to simultaneously expand coverage and appease private insurers. And private insurers will exact a steep ongoing toll...To avoid glitches and wasteful expense, design the system right; eliminate private insurers and cover everyone under a single payer program.

People hoping for health care coverage have been left to the whims of the health insurance giants--not to mention the drug companies and hospital industry. And they have the Democrats and their loyalty to the status quo--corporate profit over human need--to thank for it.

The disaster of the ACA is one of the prime reasons why the Democrats are likely to take a beating in the November congressional elections. The Republicans are likely to make gains--possibly even retaking control of the Senate--not because their fanatical policies are popular, but because so many people are disappointed and disillusioned with the Democrats' agenda.

That dynamic will get lost in all the campaign season messaging this fall--the Democrats will pull out all their old "lesser evil" tricks to motivate their supporters to go to the polls to stop the greater evil of a Republican victory.

The stories of people struggling to get basic health care shows the crying need for a better health care system, but neither party looks interested in fighting for it.