Different Day, Same Shit.

As of this moment, yours truly is doing his best to navigate through the Healthcare.gov site, but between the constant waiting and error messages (how can your account get locked after you tried logging in for the first time?), it's not going well. The deadline itself is being pushed back for those who got started on their applications. More to come later on.

Health insurance. It's something you might not think you need, until you need it. Then you wish you had it. Or perhaps you want it but simply can't afford it. Either way, it's a critical necessity, despite what many people think to the contrary.

Confused over the ongoing fight over Obamacare? What to know exactly what the hell's going on and how it could possibly affect you? Then take a seat and read on as yours truly attempts to hash out an explanation. Keep in mind this explanation is rather simple and to the point, so there might be a few technical things and other nuances that got thrown out of the boat:

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To better understand Obamacare and people's reactions to it across the political spectrum, it's important to understand how health insurance in works, not just in general, but in this country and elsewhere.

How the hell does this health insurance stuff work?

Health insurance is essentially a large group of recipients paying into a pool of money. When a recipient needs medical care, whether it's preventative care (monthly checkups, etc.) or emergency care, money is taken from the pool to pay for their expenses. Since health insurance works on the principle of there being more healthy people than sick, there's always a relatively large pool of money to tap into.

What's up with insurance companies and their coverages and why does the shit cost so much?

The vast majority of people in the United States rely on private health insurance providers. Here, most folks pay either a (steep) monthly or annual premium out of their own wallets or have a portion of their paycheck deducted to pay for a healthcare plan shared with their coworkers. As a result, there are thousands of different pools that people pay into for their coverage, some more expensive than others, all of them with their own rules and guidelines.

Private health insurance providers also have plenty of leeway regarding who gets to dip into the pool and who doesn't. On the face of it, you can't blame them - thousands of scattered insurance pools are more vulnerable to getting syphoned dry by people with a boatload of health risk factors. That means smokers, the morbidly obese, diabetics and others with a slew of health problems are either told to pay ridiculous amounts of money or get tossed out of the pool. Got a preexisting condition? Good luck. Insurance companies also have their profits to think of. These profits usually average around three percent, but that's been bumped up to around eight percent as of late, accompanied by rising premiums. Ordinary Joes and Janes who are the perfect image of health are forced to pay much more than they should, just to cover both profit margins and the folks who need to dip into the money pool.

And that dip's a relatively deep one, too. Thanks to the high cost of health insurance, approximately 48 million Americans, many of whom are on the wrong side of the poverty line, simply go without. That means they go without preventative care unless they're lucky enough to either pay for it out of pocket or land a job that gives them some form of coverage. A lack of preventative care means that potential health issues go undetected, usually for years at a time. In the end, most people won't go to the hospital until the proverbial shit hits the fan and they need a trip to the emergency room. Emergency room care costs big bucks. So does surgery and treatment for issues that could have been nipped in the bud early on (like, say, cancer). At any rate, the overall cost of healthcare skyrockets.

My health insurance provider told me to go fuck myself with a rusty pipe when I got sick. What's up with that?

Of course, insurance companies absolutely hate paying out hundreds of thousands of dollars to cover medical expenses, hence they'll find any excuse in the book (and a few that don't exist) to unceremoniously drop paying recipients if they dip too deep into the money pool too often. In fact, many companies have panels that review medical requests before signing off on them and those that don't meet their particular criteria are often denied. They'll also stiff hospitals on the bill, which is why they routinely charge insurance companies much more than necessary just in case they get shortchanged. The fight between hospitals, private insurers and their customers can easily be replicated by laying down in the middle of a pack of starving pitbulls with a bloody steak on your face.

Did you know that many private health insurance providers have a network of select hospitals their insured customers can only go to if they're to expect continuing coverage? Stray outside of that network and be prepared to take that second mortgage out on your soul.

So what's this single-payer shit I keep hearing about?

On the other hand, there's single-payer healthcare, commonly known as socialized or universal healthcare. With this type of coverage, there's one money pool (usually administered by a government agency) and every citizen in the country it's enacted in pays into that pool, usually through taxes or mandated fees. Except for the desperately poor, who are given a break and are still allowed to draw out of that pool. The all-inclusive nature of the single-payer system means that 1)there's only one huge pool to pay into and draw out of, therefore 2)there's always enough money in the pool to cover every paying recipient, plus those who aren't able to pay and 3)recipients wind up paying far less in premiums than they had to with private coverage.

Since it's the government footing the bill, hospitals and healthcare providers can rest easier knowing that they'll pay. And since it's the government's dime, the government itself can dictate exactly how much it's willing to pay said hospitals, thereby lowering overall costs.

In short, single-payer saves money. Instead of ignoring that stabbing, throbbing pain in the side for months until you get rushed to the emergency room for a $10k stay and a $100k emergency surgery, your single-payer coverage allows you to go to the doctor to see what that pain's all about. Thanks to that huge pool effectively subsidizing your doctor's visit, the $1k in preventative care costs you zero or damn near close to it.

Other, more respectable countries throughout the world have some form of universal health coverage, provided through public funding sourced from taxes and fees. Some countries combine their publicly funded healthcare with optional coverage from a private health insurer. Other countries leave their healthcare coverage up to these private companies, but strongly regulate how much they can charge and even provide significantly low-cost (or free) health insurance coverage. This is essentially the route that Obamacare's going (but more on that in a minute).

Wait...doesn't that sound an awful lot like Medicare/Medicaid?

It does, doesn't it? In fact, some would say that a single-payer system in America would just be Medicare for All.* As it stands, Medicare is strictly for those over age 65 or anyone with disabilities. Medicaid is for people who are too poor to purchase private coverage on their own - mainly families, women and children. Unfortunately, the eligibility requirements vary among each state. Each year, the federal government disburses a set amount of money to individual states for their Medicare and Medicaid programs. Some states are more generous with the proceeds than others.

Okay...Obamacare.

Once upon a time, President Barack Obama foolishly attempted to bring single-payer healthcare to these United States. The measure was dragged behind the Capitol by conservative legislators and unceremoniously double-tapped in the head. The End.

Said legislators dressed the corpse in a new suit, took out the stuff they didn't really like (like the whole single-payer thing), slapped on a sticker reading "private insurance-friendly" and reintroduced it as the Affordable Care Act, which Congress passed and the president eventually signed in March 2010.

The simplest explanation of "Obamacare" (which is what opponents called it whenever they wanted to disparage it - the name kinda stuck after a while) is that it's a stop-gap between private insurance and single-payer insurance. In other words, all of the private healthcare providers are now part of a regulated "exchange" where they are obligated to insure each and every citizen, regardless of their condition, at something approaching relatively sane premiums.

At the same time, each and every citizen is obligated (hence the term "individual mandate) to sign up for health insurance, so they won't get tempted to sign up for a quick, free dip into the money pool just at the moment they get sick and subsequently screw other paying customers. Those who don't sign up by March 31, 2014 get hit with a penalty, starting at $95 or 1 percent of your taxable income, whichever's greater.

So I lose $95/year if I don't sign up. Big whoop.

$95 or 1 percent of your taxable income. You make $70,000/year? That's $700 you have to pay. And it gets worse. By 2015, the penalty grows to $325 or 2 percent of your taxable income. The year after and subsequent years, its $695 or 2.5 percent of taxable income.

But Mack! I don't even have a pot to piss in, let alone a window. How am I gonna pay for this shit?

You don't. At least if your income's below a certain threshold. In addition to the individual mandate, the Affordable Care Act also expands Medicaid coverage to include individuals age 19 to 65. That means those stuck below the federal poverty line can simply opt for Medicaid coverage. That is, if their state's playing ball.




Thanks to a U.S. Supreme Court ruling that mandated voluntary participation, 22 states have opted out or are leaning close to opting out of the federal government's Medicaid expansion through the ACA. That means if you make more than 100% of the federal poverty level, you can buy your health insurance coverage through the exchange for a significant discount. If not, you're left to the tender mercies of your state's income thresholds for Medicaid eligibility.

In the Great State of Alabama, the Medicaid income threshold for a family of three is $3,221. Per year. Make more than $3,221 but fall short of the $19,530 required to qualify for Obamacare? You're just about as screwed as the folks stuck in the Medicare Part D "doughnut hole".

Speaking of Medicare, the Affordable Care Act also unfucks a lot of what was wrong with it. For starters, enrollees get more preventative services (e.g. mammograms, colonoscopies, etc.) without paying extra. Enrollees stuck in the $2,970- $4,750 drug cost "doughnut hole" also receive a 50-percent discount when they purchase Part D-covered brand-name prescription drugs at the counter.

So why do guys like Ted Cruz treat Obamacare like the spawn of Satan and Grace Jones?

Because Tea Party?

But seriously, that's a good question that can only be answered with yet another lengthy and well thought-out blog post.

*Ba boom tish!

Today marks week two of the ongoing government shutdown, brought to you by the House GOP's refusal to sign off on a congressional budget that included funding for the Affordable Care Act, a legislative act that was already passed and signed into law way back in 2010. For some reason, the idea of mandated private health insurance with subsidies for the poor (which itself was downgraded from a far-superior publicly funded single-payer system) sends most conservatives into epileptic seizures. So much so that it's resulted in a crisis that's only gonna get worse, by all indications.

Everyone has a stake in this shutdown. For the political parties, this whole ordeal can end one of two ways: if the Democrats blink, that means the Tea Party element of the GOP can cherry-tap their way towards favorable legislative action through constant hostage-taking. The Democrat party ends up getting its electoral chains snatched and reverts to being the perpetual weak sister of the two parties.* If the Republicans blink, it'll cause an already-burgeoning schism between the moderate and extremist ends of the GOP to fully break open. It won't kill the party, but it will be a deservedly swift kick in the electoral jewels. Oh, and John Boehner faces the possibility of having his position snatched from under him by a vengeful Tea Party.

For President Obama, the stakes are much higher. If he doesn't bend and the GOP refuses to bend, the shutdown keeps on trucking towards yet another fiscal cliff and the president's own image gets tarnished. There'll also be plenty of fuel for an impeachment hearing, if the GOP so desires (a far-gone conclusion). If he bends, the GOP gains victory, adds cherry-tapping to its repertoire of effective legislative strategies and the president's own image gets tarnished. That means the president somehow has to force the extremist and moderate sides of the Republican party to have their own "come to Jesus" moment and pass a clean continuing resolution, preferably before October 17 rolls around.

For the average Joe working for various government agencies, the consequences of maintaining a government shutdown hit home and hit hard. Example? The United States Antarctic Research Program is the latest casualty of the shutdown, which not only affects the livelihoods and aspirations of the 500 or so people stationed at McMurdo, but also the integrity of various other international Antarctic programs that rely on the U.S. for various logistics and support. Meanwhile, NASA's down for the count, along with the Congressional Budget Office and countless other federal agencies. If things keep up beyond October 17, there's no guarantee of whether people will continue receiving their Social Security benefits.

For everyone else, it's a prime example of how a few actors within the government, led on by a large contingent of people who thinks that hamstringing the government's ability to function properly is the best way to make themselves and their agenda known. It's also an example of what happens when a small group of people with the government's worst interests in mind are able to hijack a party and force it to do its bidding or face total destruction.

Or when a party attempts to use a bunch of rabid extremists as its enforcer wing to effect legislative changes without getting their hair mussed.

Or perhaps when a party gerrymanders the living daylights out of its districts to hold on to as many seats and as much power as possible, only to watch that power slip into the hands of ideological fundamentalists with a hankering for a threadbare federal government and a possible subconscious desire to revive the concept of "state's rights," all with the relative consent of their constituents, most of whom regard "Obamacare" and other federal programs as a giveaway for blacks, illegals and the undeserving poor.

Either way it goes, current events are clearly showing folks around the world how not to run a country, because this way just ain't cutting it.

*But at least the perpetual underdogs will still be welcome in every cocktail party in D.C.

The idea of people demonstrating deference and piety towards their social, moral and financial betters is a universal one, but nowhere in America is that idea more prevalent than in the Deep South. This idea shows itself prominently when it comes to the issue of labor unionization, as all of the southern states are "right to work" and unions have a negligible, if not nonexistent presence.

For instance, the United Auto Workers have made several attempts to organize Volkswagen's Chattanooga, TN assembly plant. IG Metall, Germany’s largest labor union, also has its eye on organizing a "works council" within the plant, as is the norm in VW's German facilities. But the prevailing attitude among most workers in this and other auto plants throughout the Deep South is one of not "messing up a good thing" by any attempts at unionization, regardless of if doing so will actually benefit them. It's the fear of seeing their jobs move further southward and the commonly-held view of unions as lazy, parasitic and overpaid louts that's kept unions a rare breed south of the Mason-Dixon. Most workers in the Deep South are also invested in the belief that if they do good by the company, the company will do good by them in return. In the age of Kochist corporate thought, company leaders are often bemused by the thought of acknowledging or returning such shows of corporate piety.

Truthdogg cracks open a window into this sort of thinking, how it relates to the current government shutdown and demonstrates how toxic it's become to the nation at large:

...the idea of the commonwealth, of something for all citizens, is as foreign to this region as the Russian language. Here, we look to our corporate leaders and wealthy families for table crumbs, for protection & entertainment, and for permission to act.

This flies in the face of our popular ideas of the smartass rebel, glorified by the Dukes of Hazzard and other tv shows and movies. But it makes sense once it’s understood that the smartass rebel is a marginal character here, much more likely to end his life as Cool Hand Luke than Bo Duke, muttering alone in his shack if not prison itself. As celebrated as the lawbreaking bootleggers still are, they exist outside the mainstream, with their romanticization from the ruling class little different than memories of childhood squirrel hunts and canned sardine lunches.

The mainstream is obedient, deferent and possesses a mixture of awe, gratitude and fear toward the fabulously wealthy that is painfully embarrassing to behold. Watch one of our Congressmen apologize to BP executives for the Katrina disaster if you want to scratch the surface of the worshipfulness that is expected here.

I know, I know. I’m describing something that exists all across the nation in many ways. This is certainly not limited to the South, just like racism is not, and I’m not someone who claims the South is full of more bad people than elsewhere.

But here, this idea of a fixed class permeates in ways that are more difficult to escape, with struggling workers admiring the charity of the Walton family, or arguing that development companies should be given free rein to foul their own water. Today they’re arguing that they don’t need health insurance, that they (I suppose) will just wither and die once it’s clear that the church bake sale can’t pay for their future lung cancer treatments, because they know that they’re lower class and don’t deserve anything more. Perhaps one of their libertarian heroes of finance will step in and personally intervene like God himself, but if they do not, His will is being done.

Passions flare over this in no small part because of race. A rigid class structure maintains the illusion of permanent white dominance, and masks the prevalent white working class fear of slipping to an even lower rung in society. Control is the most important issue for the whites I know who fear changes in racial status (or its loss) and the “tradition” of conservative subservience is the path for keeping it. The adoration of the financially successful reinforces it.

The rigid social structure of the long-lost yet seldom forgotten Confederacy provided plenty of benefits for the "right" folks. The ruling class were rewarded with a never-ending and self-replenishing flow of free labor, while the lower orders looked up to them with a mixture of awe, gratitude and fear. Working-class whites were just grateful for receiving whatever crumbs the ruling class deigned to brush aside in their general direction, all the while comforted with the assurance of always having it better than those coloreds, free and slave. No matter how far down the societal rung one slipped, at least your average Joe of the time knew he would always be a cut above a Negro.

Even after the death of the Confederacy, this mindset still reigned supreme throughout the southern states, intermixed with anger at the federal government for infringing on their way of living (except in cases where they benefited immensely). A large number of people were simply comfortable with the rigid social structure of old, as they knew exactly where they stood and what their assigned roles were. People often reacted to any attempts at bucking or demolishing the social structure with a vicious, inflamed passion. That explains why many people treat the idea of universal healthcare like a communist plot (at least until the hospital bills comes due).

It also goes a long way to explain much of the consternation over Barack Obama's presidential election:

The election of a highly-educated black president shattered it. In fact, as with Bill Clinton, his humble origins are the most distressing part of his biography here. If he were born into a wealthy black family, perhaps with a slaveholding ancestry, or even someone who slipped comfortably into a CEO role (like Herman Cain, subservient to the Koch brothers), President Obama’s election may have been easier to accept.

But he wasn’t like either of those things. Barack Obama leapt over many people in his ambitions, drive and focus, and argues for making his path easier to follow, as liberals tend to do. He’s an inspiring figure for anyone inclined to be inspired. He doesn’t claim that his success comes only from his work and ambition, even while that is clearly a major part of his story. But for those who rely upon inequality and fixed social classes in order to maintain the facade that they aren’t the poorest citizens of this country, his biography destroys everything they thought they knew about the world.

The GOP party goals of lower taxes and freer reign for the corporate class and landed gentry, greatly reduced federal social services, sacrosanct defense expenditures, free or greatly reduced-cost labor via public and private prisons and a landscape of districts gerrymandered just enough to insure a permanent Republican majority all echo a desire for a strong ruling class and a populace too enamored with the tradition of conservative subservience to bother with any sort of genuine progress - at least progress that doesn't directly benefit the ruling class.

There's also the never-ending drive to figuratively and legislatively lynch the first (and as conservatives hope, the last) president of color by cutting off as many of his policies off at the knees as possible. Perpetual gridlock, shutdowns and standstills are all a part of paralyzing government to which it'll have no capacity to make any serious legislative changes until a suitable GOP president is back in the Oval Office. That's something to think about as the House Republicans hold the nation hostage over the Affordable Care Act.

If you're one of the millions of unlucky bastards following the U.S. Supreme Court's ruling on the Affordable Care Act on CNN, you probably saw the following:


Turns out the reports of the individual mandate's death have been greatly exaggerated:

Correction: The Supreme Court backs all parts of President Obama’s signature health care law, including the individual mandate that requires all to have health insurance.

Watch live coverage and analysis of the pivotal decision, its impact on you and on the presidential race now on CNN TV, CNN’s mobile apps and http://cnn.com/live

In a race to break the story first, CNN tripped all over its half-tied shoelaces. Looks like it's time to invest in some Velcro slip-ons. H/T to Redeye.

Meanwhile, Jim DeMint is echoing a sentiment supposedly offered by Old Hickory himself:

“This government takeover of health care remains as destructive, unsustainable, and unconstitutional as it was the day it was passed, unread, by a since-fired congressional majority. Now as then, our first step toward real health care reform and economic renewal remains Obamacare’s full repeal, down to the last letter and punctuation mark.

“I urge every governor to stop implementing the health care exchanges that would help implement the harmful effects of this misguided law. Americans have loudly rejected this federal takeover of health care, and governors should join with the people and reject its implementation.”

It looks like states already have a roundabout way for opting out of ACA:

The bottom line is that: (1) Congress acted constitutionally in offering states funds to expand coverage to millions of new individuals; (2) So states can agree to expand coverage in exchange for those new funds; (3) If the state accepts the expansion funds, it must obey by the new rules and expand coverage; (4) but a state can refuse to participate in the expansion without losing all of its Medicaid funds; instead the state will have the option of continue the its current, unexpanded plan as is.

State governors can opt out of Medicare expansion if it offends the sensibilities of their constituents, most of whom are a part of the one in four Americans who are currently without health insurance of any kind.

The next move for conservatives is to convince Americans that ACA, otherwise known as the semi-derogatory "Obamacare," is actually a tax on hardworking middle-class folk, 26,000 whom die annually without having any coverage. This way, conservatives can sell themselves the story of how Justice Roberts pulled off a clever end-run on the Obama administration:

The Supreme Court has upheld the Affordable Care Act. Chief Justice John Roberts has upheld the individual mandate. But not under the commerce clause. Instead, Roberts has said that the law can proceed under Congress’s ability to tax.

It’s a tax. That thing that Democrats were trying so hard not to do so Republicans couldn’t call Obama a “tax and spend” Democrat is now called a tax by the Supreme Court. And now it’s a victory. Until the GOP starts saying that Obama “raised your taxes.”

Americans really have little concept of how they pay taxes in the first place, why they should pay and how the tax brackets actually work. There's also the mostly-unspoken fear of how minorities are gonna steal everyone's tax monies and spend them on rims, fried chicken, lotto tickets and whatever else those people spend their money on. It's how the GOP can convince conservatives to vote against their interests (in the form of tax cuts for billionaires and corporations) and how these folks just can't connect the dots between their ridiculously low taxes and the growing number of potholes and dead street lamps on their block.

These same people want to keep anything approaching universal health from coming to fruition, yet continue paying private healthcare insurance providers thousands of dollars per year on coverage that might get dropped from under them if the provider thinks it'll put even a small scratch in their bottom lines. I don't like having the Emergency Room as my only option because it costs a significant part of my wages to be insured. Or because my insurer unceremoniously drops my coverage over a lifesaving procedure. Or because of "preexisting conditions" no one will touch with a ten-foot pole.

For anyone considering the ACA a sop to the healthcare industry (in the same way state-mandated auto insurance is to that industry), it'll seem that way unless enough people hop aboard the "Medicare for All" bandwagon to make that concern moot or unless the Obama administration finds a way to lower healthcare insurance premiums, the overall cost of healthcare or both.