Will The Republicans Replace The Affordable Care Act With Putincare?

Last night-- late last night-- the Senate began the process of repealing the Affordable Care Act by approving, 51-48, a budget blueprint that would allow them-- using a tactic called "reconciliation"-- to gut the health care law without the threat of a Democratic filibuster. Every Democrat voted against it-- even the worst conservatives-- and with the exception of Rand Paul, every Republ;I can voted for it, including fake moderates like Susan Collins (R-ME), Lisa Murkowski (R-AK) and Dean Heller (R-NV). The GOP claims it has a mandate even though they lost seats in both houses of Congress and Trump lost the popular vote by nearly 3 million and probably only won because of Russian tampering with the election process.

The Affordable Care Act has become ingrained in the American health care system, and unwinding it will be a formidable challenge for Republicans. More than 20 million people have gained coverage under the law, though premiums have risen sharply in many states and some insurers have fled the law’s health exchanges.

The budget blueprint instructs House and Senate committees to come up with repeal legislation by Jan. 27.

...Republicans do not have an agreement even among themselves on the content of legislation to replace the Affordable Care Act, the timetable for votes on such legislation or its effective date.

Senator Susan Collins, Republican of Maine, said on Wednesday that she agreed with Mr. Trump that Congress should repeal the health law and adopt a replacement plan at about the same time.

“But I don’t see any possibility of our being able to come up with a comprehensive reform bill that would replace Obamacare by the end of this month,” she said. “I just don’t see that as being feasible.” (Ms. Collins also supported pushing back the deadline to come up with repeal legislation.)

As Republicans pursue repealing the law, Democrats contend that Republicans are trying to rip insurance away from millions of Americans with no idea of what to do next.

What they're trying to do is even worse-- rewrite the entire American social contract they always opposed going back to the progressive strides made by FDR and LBJ to build a strong, vibrant middle class. As Richard Florida explained in a classic tweet storm Thursday morning about Trumpism as the Triumph of Take Capitalism, Trumpism-- not just Trump but the collection of rogues in his administration-- represents the triumph of the Takers (oil, finance and real estate) over the Makers (high tech, innovation, creativity...). "Another way to think about this is that Trump represents the triumph of 'regressive' capitalism over 'progressive' capitalism. Trump himself is a master manipulator of the media-- a product and propagator of the new age of dumbed-down Kardashianized Authoritarianism.

• The contradictions of progressive capitalism can lead to socialism or social democracy or more inclusive capitallism
• The contradictions of regressive capitalism lead to something very different and much uglier...
• On the domestic side, Trumpism is pure oligarchism-- the plundering ("privatization") of all remaining public assets...
•... and reverse robin hood in the largest tax cuts in history. The rich get richer. Most of all Trump himself.
• This combination of racism, sexism, manliness and xenophobia is very powerful, especially for white men who feel they are losing control...

Let's take three states-- New York, Florida and Michigan-- and look, county by county, at how many people will lose health insurance if the Republicans repeal the Affordable Care Act. For each county I've also including the percentage of voters who cast ballots for Trump. First New York:

• Albany- 27,059- 32.5%
• Allegany- 4,396- 68.4%
• Bronx- 338,989- 9.6%
• Broome- 16,290- 49.0%
• Cattaraugus- 8,061- 64.5%
• Cayuga- 7,314- 53.8%
• Chautauqua- 12,293- 59.6%
• Chemung- 9,002- 57.3%
• Chenango- 5,492- 60.9%
• Clinton- 6,878- 47.4%
• Columbia- 6,453- 46.8%
• Cortland- 4,324- 50.0%
• Delaware- 4,675- 61.9%
• Dutchess- 26,657- 48.4%
• Erie (Buffalo)- 80,950- 45.4%
• Essex- 3,504- 48.2%
• Franklin- 5,060- 50.4%
• Fulton- 6,372- 65.2%
• Genessee- 5,536- 65.3%
• Greene- 4,947- 61.2%
• Hamilton- 492- 66.8%
• Herkimer- 6,597- 64.6%
• Jefferson- 10,372- 58.2%
• Kings (Brooklyn)- 524,444- 17.9%
• Lewis- 3,069- 67.1%
• Livingston- 4,499- 61.3%
• Madison- 5,420- 54.4%
• Monroe (Rochester)- 66,981- 40.3%
• Montgomery- 5,792- 60.7%
• Nassau- 125,983- 45.9%
• New York (Manhattan)- 198,650- 10.0%
• Niagara- 19,497- 57.2%
• Oneida- 21,094- 57.8%
• Onondaga- 42,943- 40.8%
• Ontario- 9,423- 51.1%
• Orange- 38,137- 51.2%
• Orleans- 4,150- 69.3%
• Oswego- 12,042- 68.6%
• Otsego- 6,052- 53.4%
• Putnam- 7,653- 57.1%
• Queens- 513,192- 22.1%
• Rensselaer- 12,902- 48.4%
• Richmond (Staten Island)- 56,266- 57.2%
• Rockland- 39,736- 46.1%
• Saratoga- 15,296- 49.1%
• Schenectady- 18,686- 44.2%
• Scholharie- 2,717- 64.5%
• Schuyler- 2,061- 61.5%
• Seneca- 3,017-52.8%
• St Lawrence- 9,502- 52.5%
• Steuben- 10,654- 65.4%
• Suffolk- 166,386- 52.5%
• Sullivan- 10,308- 55.2%
• Tioga- 5,116- 60.9%
• Tompkins- 7,207- 25.6%
• Ulster- 19,851- 42.7%
• Warren- 6,706- 51.8%
• Washington- 7,693- 57.0%
• Wayne- 10,007- 59.9%
• Westchester- 99,835- 32.1%
• Wyoming- 4,284- 73.0%
• Yates- 2,822- 57.7%

• statewide- 3,087,549- 37.5%

Florida:

• Alachua- 11,332- 36.4%
• Baker- 835- 81.5%
• Bay- 8,870- 71.2%
• Bradford- 907- 73.7%
• Brevard- 29,508- 57.8%
• Broward- 189,298- 31.4%
• Calhoun- 411- 76.6%
• Charlotte- 8,954- 62.5%
• Citrus- 7,923- 68.3%
• Clay- 7,907- 70.4%
• Collier- 21,931- 61.8%
• Columbia- 2,766- 70.9%
• DeSoto- 1,165- 62.7%
• Dixie- 543- 80.8%
• Duval (Jacksonville)- 42,163- 49.0%
• Escambia- 10,643- 58.3%
• Flagler- 5,888- 58.9%
• Franklin- 595- 68.6%
• Gadsden- 1,328- 30.4%
• Gilchrist- 603- 80.1%
• Glades- 405- 68.8%
• Gulf- 622- 73.1%
• Hamilton- 450- 63.1%
• Hardee- 927- 69.1%
• Hendry- 2,177- 55.8%
• Hernando- 9,542- 62.9%
• Highlands- 4,213- 64.7%
• Hillsborough (Tampa)- 63,299- 44.7%
• Holmes- 643- 87.9%
• Indian River- 7,905- 60.8%
• Jackson- 1,524- 67.8%
• Jefferson- 490- 51.4%
• Lafayette- 265- 82.8%
• Lake- 17,272- 60.0%
• Lee- 39,539- 58.7%
• Leon (Tallahassee)- 9,503- 35.4%
• Levy- 1,888- 71.0%
• Liberty- 154- 77.1%
• Madison- 678- 57.0%
• Manatee- 16,244- 57.0%
• Marion- 17,616- 61.7%
• Martin- 8,947- 62.0%
• Miami-Dade- 320,461- 34.1%
• Monroe- 5,710- 51.6%
• Nassau- 3,251- 73.5%
• Okaloosa- 7,049- 71.3%
• Okeechobee- 1,442- 68.5%
• Orange (Orlando)- 95,383- 35.7%
• Osceola- 29,254- 35.9%
• Palm Beach- 116,687- 41.2%
• Pasco- 25,211- 58.9%
• Pinellas (St Petersburg)- 50,947- 48.6%
• Polk- 26,826- 55.4%
• Putnam- 2,970- 67.0%
• St. Johns- 9,745- 65.0%
• St. Lucie- 20,450- 49.9%
• Santa Rosa- 5,291- 74.5%
• Sarasota- 21,629- 54.3%
• Seminole- 28,412- 48.7%
• Sumter- 3,251- 68.8%
• Suwannee- 1,672- 76.5%
• Taylor- 490- 74.6%
• Union- 268- 80.2%
• Volusia- 31,427- 54.8%
• Wakulla- 773- 68.5%
• Walton- 3,294- 76.6%
• Washington- 783- 77.4%

• statewide- 1,370,534- 49.1%

Michigan:

• Alcona- 1,044- 68.0%
• Alger- 845- 57.3%
• Allegan- 4,849- 61.3%
• Alpena- 2,180- 61.9%
• Antrim- 2,401- 62.4%
• Arenac- 1,118- 63.1%
• Baraga- 617- 61.9%
• Barry- 4,081- 63.4%
• Bay- 9.174- 53.5%
• Benzie- 1,920- 54.2%
• Berrien- 14,581- 53.8%
• Branch- 3,642- 66.9%
• Calhoun (Battle Creek)- 11,514- 53.6%
• Cass- 4,308- 61.2%
• Charlevoix- 2,470- 59.5%
• Cheboygan- 3,054- 63.6%
• Chippewa- 2,914- 59.1%
• Clare- 3,269- 63.6%
• Clinton- 4,031- 53.3%
• Crawford- 1,504- 63.7%
• Delta- 3,895- 60.2%
• Dickinson- 2,548- 65.3% • Eaton- 6.714- 49.6%
• Emmet- 3,602- 56.5%
• Genessee (Flint)- 42,817- 42.9%
• Gladwin- 2,341- 65.1%
• Gogebic-1,768- 55.0%
• Grand Traverse- 8,347- 53.3%
• Gratiot- 3,198- 60.1%
• Hillsdale- 4,182- 70.9%
• Houghton- 3,527- 54.2%
• Huron- 2,921- 67.1%
• Ingham (Lansing)- 24,471- 33.2%
• Ionia- 4,466 62.1%
• Iosco- 2,760- 62.5%
• Iron- 1,317- 62.2%
• Isabella- 5,208- 48.7%
• Jackson- 13,562- 57.25
• Kalamazoo- 20,530- 40.5%
• Kalkaska- 1,823- 69.7%
• Kent (Grand Rapids)- 47,299- 48.3%
• Keweenaw- 250- 57.0%
• Lake- 1,361- 59.3%
• Lapeer- 7,288- 66.6%
• Leelanau- 2,084- 49.1%
• Lenawee- 7,594- 57.6%
• Livingston- 11,324- 62.2%
• Luce- 552- 68.2%
• Mackinac- 1,024- 61.4%
• Macomb- 79,744- 53.6%
• Manistee- 2,425- 54.9%
• Marquette- 6.126- 44.5%
• Mason- 2,941- 58.0%
• Mecosta- 3,636- 60.1%
• Menominee- 2,310- 62.3%
• Midland- 6.458- 56.3%
• Missaukee- 1,593- 73.8%
• Monroe- 10,319- 58.4%
• Montcalm- 5,666- 63.7%
• Montmorency- 893- 69.8%
• Muskegon- 16,945- 44.6%
• Newaygo- 4,463- 67.1%
• Oakland- 88,341- 43.6%
• Oceana- 2,516- 60.7%
• Ogemaw- 2,539- 65.7%
• Ontonagon- 693- 60.5%
• Osceola- 2,091-69.2%
• Oscoda 894- 70.0%
• Otsego- 2,593- 66.0%
• Ottawa- 15,363- 62.2%
• Presque Isle- 1,465- 62.2%
• Roscommon- 2,738- 62.5%
• Saginaw- 18,335- 48.3%
• St. Clair- 15,196- 62.9%
• St. Joseph- 5,201- 62.6%
• Sanilac- 3,845- 69.9%
• Schoolcraft- 907- 61.6%
• Shiawassee- 5,578- 56.5%
• Tuscola- 5,051- 66.6%
• Van Buren- 7,111- 53.9%
• Washtenaw- 26,096- 26.9%
• Wayne (Detroit)- 208,508- 29.5%
• Wexford- 3,595- 65.4%

• statewide- 885,405- 47.6%

Russians had far better health care under the Soviet Union (communism) than they do today in a country that could best be described as an oligarchy, a fascist dictatorship or, best yet, a Kakistocracy, a country run by the worst, least qualified, or most unscrupulous citizens. Any of these would describe the direction Trump seems to be moving the U.S. in and, of course, everyone is worried about his plans to transform the healthcare system-- privatizing the V.A., repealing the Affordable Care Act and vouchering and gutting Medicare.

When the monarchy was overthrown by the Soviets in 1917, there was virtually no adequate healthcare for most Russians, other than for the rich. Nikolai Aleksandrovich Semashko, People's Commissar of Public Health from 1918 to 1930, had as his first priority controlling epidemics (typhoid fever, typhus, cholera, tuberculosis) and laying the foundation for a real national healthcare system. Under the system he developed, the government provided healthcare for all citizens and all healthcare personnel were government employees. By the 1980s cutbacks in investment in the healthcare system started taking their toll and the the quality of Russia's much-vaunted healthcare system started declining, highlighted by shoddy doctors and severe drug shortages. Two standards began to emerge, one for the elite and one for everyone else. Investment in healthcare was woefully inadequate and spending on patients was about an eighth of what it was in Western Europe.

When the Soviet Union finally collapsed, the healthcare system changed to a mixed model-- everyone was still supposedly guaranteed free healthcare but the reforms led to more and more people (those who could afford it) to seek private health insurance. The free market system introduced into Russia was supposed to promote both efficiency and patient choice; it did neither. No matter how you look at it, Russians' health has deteriorated and growth in life-expectancy hasn't kept up with the rest of the world.

During the period of 1990-2013 it only grew by 1.8 years in Russia, while the global average number increased by 6.2 years, pushing Russia out of the top 100 countries with the highest life expectancy and placing it in 108th position-- between Iraq and North Korea.

The situation will most likely worsen in the years to come, said experts. Economic crisis, lower incomes and deteriorating quality of life in the country will eventually have their impact on health and, therefore, overall life expectancy.

...“[Life expectancy in Russia] started to decline at the beginning of the 1960s, and it has been, basically, doing so ever since. At the end of the 1980s it started to fluctuate-- increasing and decreasing. The latest increase period lasted some eight years, until last year when it had its peak,” [Vasily Vlasov, a professor at the Higher School of Economics’ Center for Health Care Policy] added.

There are factors that influence life expectancy, said Vlasov, but it doesn’t mean that the changes can be easily explained by them. “Serious scientists don’t have a solid explanation for it. It is a mystery to some extent,” he added.

Nevertheless, a bad economy, according to him, was one of those factors-- as well as the latest health care reform. “Expenses on health care are being seriously reduced,” and the government does not have the money to buy necessary medical equipment, which impacts on people’s health, Vlasov said. “It may contribute to the increase of the mortality rate. When people don’t have enough money, there is a whole bunch of reasons for the mortality rate to increase,” he added.

...Heart disease is the number one cause of death in Russia, Vlasov pointed out, and it will be for many years to come. He named smoking as a huge risk factor related to heart illnesses, which often becomes a common bad habit during difficult economic conditions.

“When life gets harder, people become nervous and start to smoke, not thinking about its harmful influence on their health,” and smoking often leads to heart diseases, the expert said.

As surprising as it sounds, slow growth and the decline of life expectancy might be explained by the lack of motivation on the part of the elderly to live longer, said Olga Isupova, senior lecturer at the Higher School of Economics’ Institute for Demography.

It doesn’t mean a person wants to commit suicide, she said, but they care less about their health. “Especially men — when they get older, they simply don’t see a role for themselves in society. Once they quit their jobs and become pensioners, they don’t know what to do with their lives,” while women, at least, can enjoy being grandmothers, she told the Moscow Times in a phone interview.

In general, Russians are reckless about their health, and one of the related problems is drinking-- people consume unhealthy amounts of alcohol, and that impacts their health heavily, explained Isupova.

In addition to that, Russians are not used to planning ahead and thinking about their future life, they prefer living in the here and now. “Life in Russia is unpredictable-- and often people see no point in planning their future,” she said.

...The situation is likely to get worse, said both Vlasov and Isupova. “Either life expectancy growth will continue slowing down, or it will start to decline,” said Isupova.

A report from Newsweek just after the U.S. election, Russia's Bad Health Care System Is Getting Worse, made the point that Trump and "right-wing politicians in Europe may be feting Russian President Vladimir Putin as a strong leader. But the grim reality of Russian provincial state health care often has more in common with Third World countries than a supposed resurgent superpower-- and that’s where it exists: 17,500 towns and villages across Russia have no medical infrastructure at all. “Russia state hospitals and clinics are in a tragic condition, especially in the provinces,” says Gennady Gudkov, an opposition politician and retired KGB colonel. “There is outdated and often nonfunctioning equipment, a lack of medicines and hospital beds, and a shortage of medical specialists. The families of patients are often forced to bring them food. Trump is very wrong if he thinks Putin cares about the Russian people-- he only cares about making his friends richer at the expense of the national budget.”

[I]t’s unsurprising that a mere 2 percent of Russians say they are proud of the country’s state health care system, according to a recent public opinion survey by the Levada Center, a Moscow-based pollster. International experts are also critical. Russia placed last out of 55 developed nations in this year’s Bloomberg report on the efficiency of the national health care systems.

Things are unlikely to get better anytime soon: Russia’s government recently announced plans to cut the budget for health care by 33 percent next year, bringing annual spending down to just $5.8 billion. That’s a level of funding equivalent to spending on health in Latin American or developing Asian countries, according to a recent report by Natalia Akindinova, director at the Center of Development Institute of Moscow’s Higher School of Economics.

...This approach to health care is likewise reflected in the dire deficit of painkillers for terminally ill people. Although the government has taken some steps to improve the situation, Russia’s strict medical bureaucracy means that around a million cancer patients currently lack access to painkillers that would alleviate their suffering, according to official figures. Another 300,000 have already died without receiving medication. For some critics, this inability-- or unwillingness-- to alleviate suffering is the logical consequence of decades of authoritarian rule.

“Russians don’t want to relieve their suffering and the suffering of those close to them for the simple reason that they have been taught to view themselves as replaceable, insignificant screws in the system, whose personal feelings are meaningless,” says Alexey Kascheev, a Moscow-based spine surgeon with a large social media following. “Both doctors and patients are willing to put up with physical and psychological torment. People think, What does it matter if I am in pain, if I am nothing?”

Widespread distrust of state medicine has also resulted in Russians spending millions of dollars every year on so-called magical healers. “It is often the case that people with life-threatening illnesses choose to first turn to alternative forms of medicine. When they eventually visit a doctor, it is already too late,” says Yury Zhulev, a spokesman for the Russian Patients Association. Experts at the Russian Academy of Sciences say there are about 800,000 occult and faith healers operating in the country, compared with 640,000 registered doctors.

If the litmus test of a state health care system is the willingness of members of the political elite to place their own health and that of their loved ones in its hands, then Russia fails miserably. Unlike in many Western European countries, where ministers and other government officials routinely use their nation’s health services, political leaders in Russia often jet abroad for medical care. In 2013, Pavel Astakhov, then Russia’s top official for child welfare, gave a candid answer when asked why his wife had given birth in the south of France rather than in Russia. “I was concerned about my wife and future child,” he replied. “I couldn’t take the risk.”

Will Trump turn to Putin, for whom he professes so much admiration, as a role model as he re-works the U.S. healthcare system? Wednesday, economist Max Sawicky, published a piece in The Baffler asserting that Trump’s entanglement with Russia will pull the United States even further away from providing basic welfare. "[T]oday," he wrote, "kleptocratic, capitalist Russia is among the moneyed interests in the world. It’s tempting but simplistic to see Russian leaders as a fairly narrow species of nationalist interlopers in U.S. domestic politics. More to the point, they are allied with germinating, reactionary forces internationally, if only lately inside the United States."

1. Russia is a new, obnoxious, right-wing participant in domestic U.S. politics, devoted at once to propping up Trump and to dividing his opposition. One form this division takes is support for forces and voices that refuse to distinguish between policies of the two major parties. We have always had such viewpoints, and I’ve been guilty of purveying them myself. Hell, I voted Nader in ’96 and ’00. I can’t attack someone for maintaining that both parties stink and we need a third alternative. But in this case, I do think it’s a mistake. More important, it’s horribly misguided to contend that a Clinton administration would have been just as bad as the incoming one. We can agree to disagree on political strategy, but we ought to agree that opposing Trump & Co. is the priority now.

2. Russia supports rightist formations in other countries. International solidarity, including with immigrants, women, and gays, demands opposition, not least to any Trump administration collaboration with such reactionary forces.

3. Pointing out Trump’s Russophilia and the kleptocratic ties between Trump, his supporters, and Russian oligarchs is a costless way to undercut Trump’s ability to do us harm. Of course, the Clinton people do it to wretched excess, when they are not digging up Keith Ellison’s old traffic tickets or accusing Glenn Greenwald of being a veritable KGB agent, but that’s their problem.

The Clinton/Obama wing of the Democratic Party lives on and has proven its incapacity to deal with the threat posed by the GOP and the Trump movement. In Europe, social-democratic parties are floundering in the face of anti-immigrant politics. In our rigged political system, there is no viable substitute for operating within the constraints of two-party competition. Now, as Michael Walzer asserts, we need to join the center in resisting the right. Does anybody think the Sanders movement in the current constellation of left groups could go it alone?

We also need progressive mobilization founded on programmatically oriented criticism of the Democratic establishment as well as of Republican attacks on the welfare state. So I am not suggesting we temporize on criticism of centrist neo-liberalism on the level of program; quite the contrary.

The U.S. welfare/regulatory state with all its flaws contains many seeds for a better system. Trump, with an assist from a cavalcade of shady backers, including Putin’s Russian oligarchy, threatens to uproot these seeds. It’s possible to exaggerate Putin’s role, but it would be wrong to discount it altogether. Any complete survey of the forces colluding against progressive goals must now include the Russian state.