Background Checks Or Banned Assault Weapons? Both? Neither?

Yesterday, Trump contradicted the NRA and congressional Republicans by claiming his party is coming around on background checks. It was an "optimistic assessment, based on nothing but... empty election strategy. Reporters John Wagner and Seung Min Kim could have saved a lot of in, space and effort if they had just written, "Trump is lying about guns again."

The congenital liar, on his way to the fundraiser at the Southampton mansion of Stephen Ross and Kara Gaffney, told the media "I think we can do very meaningful background checks. I think Republicans are going to be great and lead the charge along with the Democrats." He claimed-- falsely "he had spoken with congressional leaders from both parties and asserted that Senate Majority Leader Mitch McConnell (R-KY) is 'totally on board' with his plans to keep 'sick and demented people' from buying guns. In response, a McConnell spokesman said that he had not endorsed any legislation at this point."

Trump and Senate Republicans are under intense pressure to act in the wake of the shootings, which prompted an outcry over government inaction. There has been limited Republican support in the Senate for past legislation seeking stronger background checks for gun buyers.

McConnell has declined to allow the Senate to consider two bills that passed the House in February, both of which Trump has threatened to veto.

Trump’s comments outside the White House echoed morning tweets in which he also said he had been speaking with leaders of the National Rifle Association “so that their very strong views can be fully represented and respected.”

Speaking to reporters, Trump said that the NRA strongly supported him during the 2016 election and said he is hopeful the NRA can be persuaded of the wisdom of “very meaningful background checks.”

“I think in the end ... the NRA will either be there or will be a little more neutral, and that’s okay too,” said Trump, who referred to NRA members as “great patriots.”

The Washington Post reported earlier this week that Trump had repeatedly told lawmakers and aides in private conversations that he is open to endorsing extensive background checks in the wake of two mass shootings, prompting a warning from the NRA and concerns among White House aides.

Early in his tenure, at the NRA’s urging, Trump also signed legislation that repealed an Obama-era regulation designed to prevent certain mentally ill people from purchasing firearms.

Trump’s previous declarations of support for tougher gun controls, including after the deadly Parkland, Fla., shooting in February 2018, have foundered without a sustained push from the president or support from the NRA and Republican lawmakers.

Trump acknowledged that there have been previous efforts to strengthen background checks “that went nowhere.”

“But there’s never been a president like President Trump,” he added.

McConnell said Thursday that he spoke to Trump about the Senate working on legislation to tighten gun laws after the August recess.

In his first interview since the weekend massacres, McConnell specifically mentioned expanding background checks on gun purchases and “red-flag” laws, which would allow authorities to confiscate a firearm from someone deemed a risk to themselves or the public.

“Those are two items that will be front and center as we see what we can come together on and pass,” McConnell said on Kentucky radio station 840 WHAS.

At the same time, McConnell, who faces reelection next year, underscored the difficulty in reaching consensus on a divisive issue. Congress has not passed significant gun-control legislation since the 1990s.

In late February, the Democratic-led House approved the first major new firearms restrictions to advance in a generation. The proposed legislation would amend federal gun laws to require background checks for all gun sales and most gun transfers.

Federally licensed dealers are required to run background checks on people who buy guns, but private sellers who are not federally licensed are not. Under the bill, private parties would have to seek out a federal license to facilitate a gun deal.

The next day, the chamber passed a separate bill that would extend the time for the government to complete a background check on someone trying to buy a gun from a licensed dealer before the sale can go through.

Trump threatened to veto the two bills, saying they do not sufficiently protect the Second Amendment rights of gun owners. Since the weekend shootings, however, Trump has expressed a new openness to considering background checks.

Democratic leaders have urged McConnell to call the Senate back from recess and take up the House-passed bills.

House Speaker Nancy Pelosi (D-CA) sent a letter Thursday to Trump asking him to use his constitutional powers to force the Senate back into session to vote on the two bills.

“Mr. President, we have an opportunity to work in a bipartisan way to pass gun violence prevention background checks. However, Leader Mitch McConnell, describing himself as the ‘grim reaper,’ has been an obstacle to taking any action,” Pelosi wrote.

During the radio interview Thursday, McConnell said the Senate should wait until after its scheduled return from recess to address the issue.

“What we can’t do is fail to pass something, you know, by just locking up and failing to pass-- that’s unacceptable,” McConnell said. “What I want to see here is an outcome, not a bunch of partisan back-and-forth, these shots across the bow.”

As of earlier this week, just two Republican senators-- Patrick J. Toomey (PA) and Susan Collins (ME)-- were on record in support of expanding background-check laws, specifically through a bill Toomey drafted with Sen. Joe Manchin III (D-WV) after the Sandy Hook Elementary School shooting in Newtown, Conn., in 2012.

Toomey told reporters on Monday that he hopes the bill will now gain momentum but acknowledged the difficulty in passing it in the Senate, where there is a 60-vote threshold on most legislation because of the filibuster rule.

“This isn’t going to happen tomorrow,” Toomey said in a conference call with reporters, “and if we force a vote tomorrow, then I think the vote probably fails, and we may actually set back this whole effort.”

Sen Lindsey O. Graham (R-SC), who announced this week that he was working on legislation encouraging more so-called “red flag” laws in states, is traveling with Trump this weekend and said he would discuss his plans with the president.

Graham and Sen Richard Blumenthal (D-CT) are drafting legislation that would provide incentives for states through grants and other methods to enact their own red flag laws, which are also known as extreme risk protection orders. These laws allow family members or law enforcement officials to petition a judge to bar firearms access to people deemed potentially threatening.

“Like the guy in Dayton, if you get kicked out of school for threatening your schoolmates, with a rape list and a kill list, maybe you shouldn’t buy a gun,” Graham told reporters aboard Air Force One. “That’s the heart of the matter here.”

He dismissed the prospects of expanded background check legislation along the lines of a bill that failed to advance in the Senate in 2013. But Graham said he is floating legislation that would potentially require background checks for assault weapons sold at gun shows.

In a bid to bolster Republican support for strengthened background checks, Giffords, a gun-control group founded by former congresswoman Gabrielle Giffords (D-AZ) announced a nearly $750,000 ad campaign Friday in Kentucky and Colorado.

The ads target McConnell and Sen. Cory Gardner (R-CO) for not supporting one of the House-passed background check bill.

John Barrasso is one of two reactionary senators from the most politically backward-- and least populated-- states in America. The idea that Wyoming's declining population of 572,381 people have the same two senators as California's growing 39,747,267 or Texas' growing 29,087,070 is the opposite of democracy. And yesterday Barrasso said even the weak red flag laws Trump and Moscow Mitch might be willing to support are probably not going to pass-- and he'll see to that. "I want to make sure we protect our constitutional rights and whatever comes up will actually help solve a problem. I have a lot of concerns about the due process component of [red flag laws] and I don’t want to punish law-abiding citizens.

As for bipartisan background checks legislation, which he previously voted against and has repeatedly fallen short in the Senate, the Wyoming senator said, “I don’t expect things have changed much.”

The comments from a member of GOP leadership are a reminder of the hurdles to passing legislation that would curb gun violence, despite calls for action from President Donald Trump and comments from Senate Majority Leader Mitch McConnell expressing openness to a debate.

Gabby Giffords' gun control organization endorsed many House incumbents and candidates last cycle. Quite a few who were elected have refused to sign on as co-sponsors of David Cicilline's bill to ban the sale of assault weapons. I wonder if Giffords will endorse them again this cycle. (My guess is yes, for sure!) The malefactors are Tom O'Halleran (Blue Dog-AZ), TJ Cox (D-CA), San Wild (New Dem-PA), Sharice Davids (New Dem-KS), Anthony Brindisi (Blue Dog-NY), Mike Thompson (Blue Dog-CA), Brian Fitzpatrick (R-PA), Lizzie Fletcher (New Dem-TX), Lauren Underwood (D-IL), Kim Schrier (New Dem-WA), Katie Hill (New Dem-CA), Josh Harder (New Dem-CA), Abigail Spanberger (Blue Dpg-VA), Haley Stevens (New Dem-MI), Greg Stanton (New Dem-AZ), Andy Kim (D-NJ), Elissa Slotkin (New Dem-MI), Elaine Luria (New Dem-VA), Conor Lamb (D-PA), Colin Allred (New Dem-TX) and Chris Smith (R-NJ). Today, Giffords began running $750,000 in television ads that oh, so gently chide Senators MoscowMitch (R-KY) and Cory Gardner (R-CO) for not backing gun safety efforts. Here's the Gardner ad:

Lindsey Graham-- who doesn't make a move without Trump's blessing these days-- says he's introducing "legislation to incentivize states to enact red flag programs-- something Democrats may support but also see as insufficient without universal background checks on gun sales." Meanwhile 196 House Dems are co-sponsoring David Cicilline's legislation to ban these of assault weapons again. New York Congressman Tom Suozzi, usually classified as "a moderate," represents the north shore of Long Island, from Suffolk through Nassau and right up to the border of AOC's district in Queens. His suburban communities are exactly the kind that are most adamant about getting military weapons off the streets and Suozzi signed onto Cicilline's legislation to ban sales of assault weapons on the first day it was introduced. Yesterday he told me that "We need to do anything and everything we can to get this epidemic under control. Background checks, red flag, assault weapons ban and any other common sense gun violence prevention we can build a team to support."

Ro Khanna (D-CA), like Tom Suozzi, is one of the original co-sponsors of Cicilline's bill to ban assault weapons. This morning he explained why he backs it in the simplest of terms: "When the assault weapons ban was in place from 1994-2004, we saw a 42 percent reduction in gun massacres. Since then, we have seen an over 200 percent increase in gun massacres. This is about facts and data that saves lives."

Good Source: "Most Of [The Senate Republicans] Have Come To Viscerally Hate The President Far More Than They Ever Hated Obama."

Two dangerous crackpots: Trumpanzee and Prince

Trumpanzee was still smarting from a remark-- "Trump hasn't demonstrated the stability or competence to be successful"-- Senator Bob Corker (R-TN) told concerned constituents back in Tennessee. And, though Corker has announced he won't be running for reelection, Trump woke up Sunday with nothing better to do than go on a deranged Twitter rampage against a senator whose votes he'll need to pass legislation and have appointments approved between now and January 2019. A senator who is both both well-liked a respected by his colleagues in the Senate. A few hours after Trump's outburst, a staffer for a top Senate Republican told me, on condition of anonymity, that more than half the Republicans in the Senate see Trump as an existential threat to the GOP and are hoping for a smoking gun so they can vote for impeachment in 2019. "Trump begged Corker to reconsider and pledged to campaign for him... Most of [the Senate Republicans] have come to viscerally hate the president far more than they ever hated Obama... There's virtually no support in our caucus for the president in his moves against Bob Mueller now, I can tell you that."

I think Wyoming was the Trumpiest state in the country last year. Trump won every one of the state's 23 counties but liberal Teton County. He beat Hillary 174,419 (68.2%) to 55,973 (21.9%). It wasn't just Trump's biggest margin anywhere in the country, it was Wyoming's biggest margin for a presidential candidate ever-- even bigger than they gave Reagan in 1984. Back in March, on caucus day, though, Trump was crushed. Ted Cruz took 71% of the votes. And Rubio, who came in second, had more than double the number of votes than Trumpanzee had. Yes, Wyoming is a blood red bastion of reactionary politics. The state Senate has 26 Republicans and 4 Democrats. The state House has 51 Republicans and 9 Democrats. Wyoming is a political nightmare. Needless to say, both senators and the state's sole House member (Cheney's daughter) are far right Republicans. But not far right enough for the Mercer-Bannon wing.

Sunday morning, the NY Times reported that the founder of the Blackwater mercenary group, Era Prince, the brother of Trump's most hated cabinet member, Betsy DeVos, is being recruited by Bannon to run for the Wyoming senate seat held by very right-wing incumbent John Barrasso. Barrasso is a member of McConnell's leadership team and that's enough to make him persona non-grata in the alternative neo-Nazi universe Mercer and Bannon are creating in the U.S.

If he runs, Mr. Prince would face formidable obstacles in seeking to unseat Mr. Barrasso, a popular and genial but low-profile senator who will have the full backing of Senator Mitch McConnell, the majority leader, and the well-funded political committees loyal to him. Mr. Prince, who has never run for public office, has been a controversial figure for years, as Blackwater faced a welter of ethical and legal problems over its work for the military in places like Iraq, including an episode in 2007 in which its employees killed 17 civilians in Baghdad.

While his ties to Wyoming are thin, the state is attractive to Mr. Prince because it has none of the personal political entanglements he would face in his home state of Michigan. Public records show that Mr. Prince, a former member of the Navy SEALs who has lived all over the world, had an address in Wapiti, Wyo., in the state’s northwest corner, for several years in the late 1990s and early 2000s.

Though Mr. Prince carries some baggage, Republicans have privately said that a primary challenge against a lawmaker like Mr. Barrasso is the kind they fear most: an out-of-the-blue run by a renegade from the right against a senator whose sin is not a lack of conservative credentials, but an association with Mr. McConnell and other party leaders.

...In 1997, Mr. Prince founded Blackwater as a private, for-profit force to aid the military, and he is wealthy enough to self-finance his race. For months this year, Mr. Prince-- with Mr. Bannon’s support-- pushed a plan to replace soldiers with contractors in Afghanistan. The proposal, which would have radically changed the way the fight in that country is conducted, was vehemently opposed by the national security adviser, Lt. Gen. H. R. McMaster, and the defense secretary, Jim Mattis.

...Bannon is also hoping to persuade Ann LePage, the wife of Maine’s outspoken governor, Paul LePage, to run for the Republican nomination to challenge Senator Angus King, an independent who is up for re-election in 2018.

This is about chaos and opportunism-- which Bannon, Mercer and Trump all thrive on and are absolutely dedicated to-- not about ideology or loyalty to Trumpanzee and his agenda of personal aggrandizement. Barrasso's Trump adhesion score is 95.9%, the highest in the Senate. This could well be a turning point for many congressional Republicans who will now feel personally threatened by the out-of-its-mind Trump-Bannon wing of the Republican Party. There is no defense from their insanity-- and not all of them are going to be willing to follow Corker and Dent into retirement without a fight, very possibly a no holds barred fight of historic proportions.  

The Far Right Demands The GOP Push The Economy Over The Cliff

Polls universally show that most Americans will blame the congressional Republicans-- particularly Boehner for his incompetence and the teabaggers for their extremism-- if December 31 comes and goes and the U.S. slips down the fiscal slope. [An aside here, corporate news consumers across the globe have bought into the concept that going over the "Fiscal Cliff" is tantamount to a worldwide recession, which could actually become a self-fulfilling prophecy as people take actions based on the absurd assumptions from China to Europe.]

The Republican strategy is two-fold: you have the far right string pullers demanding that the GOP push the economy over the cliff (and threatening to primary anyone who tries to stop it) and then you have Republican elected officials trying desperately to say it's Obama's fault for not just giving in to all their demands-- which, as we've seen for the last decade, is the way the GOP defines "compromise."

Various Tea Party groups funded by emboldened and arrogant plutocrats like the Koch brothers plus the Club For Growth and the Heritage Foundation, looking for any way to discredit democracy by causing it to fail, are huffing, puffing and cheering on the impending "doom". After killing Boehner's Plan B compromise, "they say Republicans should be empowered to make big demands and stop caving to Obama out of fear. They argue it is Obama who has something to fear if the economy slides into a recession because of tax increases and spending cuts, and the GOP that has leverage." Their perspective is-- as always-- to cause ordinary American families as much pain as possible, hoping that in a blind rage they'll turn against democracy and towards the ideal right wing solution to governance: fascism.

“I think Obama is very mindful of his legacy and is horrified of going over the cliff,” said Andy Roth of the Club for Growth. “Going over the cliff might be a signal that needs to be sent to the president, that he needs to play ball.”

He argued that President Clinton was forced to become a less liberal president after Speaker Newt Gingrich shut down the government in 1995.

“Clinton would not play ball with Newt until Newt shut the government down,” Roth said.

...Conservatives also argue Republicans will see their brand diminished by agreeing to anything that could be labeled a tax hike.

Boehner’s bill would have extended Bush-era tax rates on all annual income under $1 million, but conservatives said it raised taxes since rates on income more than $1 million would have gone up.

“I think it is certainly better to go over the fiscal cliff than to have the Republican party deny the American people to have one party that stands for lower taxes and another party that doesn’t,” Michael Needham of Heritage Action said last week.

Freedomworks initially backed Plan B as a negotiating tactic but reversed course last week and, like the Club for Growth, announced it would score votes on the legislation.

“The worst thing that Republicans can do is raise taxes,” Matt Kibbe of Freedomworks said Friday. “If Obama wants to raise taxes he can do that but Republicans shouldn’t give him cover.

“If Obama wants to go over the cliff, let him own that,” Kibbe said.

Roth argued Republicans should be willing to stretch the fight into 2013. Economists argue the ill effects of allowing tax hikes and spending cuts to go into effect will grow over time as more money is taken out of people’s pockets.

“They could take this into the New Year and extract a lot of very pro-growth entitlement reforms but I don’t think they are willing to go that far,” added Roth.

“The best thing we can do is extend the current rates for six to 10 months while we get pro-growth tax reform. The president is the only one who can propose that,” said Kibbe.

Dan Holler of Heritage Action said that Republicans now need to sell Medicare premium support and other bold ideas to get them into a fiscal cliff solution.

“When is the last time you heard Republicans make the case for Medicare premium support? When is the last time you heard Republicans talking about ending cronyism in the tax code? This is what Republicans need to focus on and commit to in the coming weeks and months. Until they do, no deal will be worth cutting,” he said Friday.

ForAmerica Chairman Brent Bozell on Friday released a plan for the GOP that involves it increasing its demands of Obama in fiscal cliff talks.

“Speaker Boehner, working in conjunction with Senate Minority Leader McConnell, should craft legislation that gets us on the road to fiscal sanity. This agenda must include four key items: cutting the corporate tax rate, abolishing the immoral "death tax," real spending cuts, and serious entitlement reforms,” he said in a statement.

“Bring a united GOP front and challenge the president to support this legislation. Offer him the 'millionaire tax' if he will. If he doesn't accept this, it proves he's not serious. At that point the GOP should walk away, declaring it's the president who now owns the impending disaster,” he said.

And while the neo-fascist thugs work that angle, you have purportedly more "mainstream" rightists, like Wyoming wingnut John Barrasso running to Fox claiming that it's Obama who wants to steer the country over the cliff. There's no real reason to pick on poor Barrasso, although he was on Fox News Sunday doing precisely that, because every Republican Member of Congress has been asked to echo the message whenever they get near a live mic. For low-info voters-- the GOP base and Fox viewers-- Barrasso makes sense babbling nonsense like this: "I believe the president is eager to go over the cliff for political purposes. He senses a political victory at the bottom of the cliff."

Another radical right kook, Mick Mulvaney (R-SC), was on CNN's State of the Union Sunday making much the same point, also trying to claim the Democrats have "no interest at all about not going over the cliff... You cannot negotiate with someone who does not want to negotiate." There's a lot of negative crap you can throw at Obama but not being eager to negotiate and even give in too much to the right is NOT something that will stick. And the American people, for better or for worse, know it. Of course, now we're all waiting to hear what drunken, hypocritical Mormon Mike Crapo (R-ID) has to say about all this. How can anyone be expected to decide anything until we hear what 3-term Senator Crapo says?

3 Progressive Doctors Running For Congress Answer The Questions About What We Do Next

Despite Fox's and CNN's-- and Virginia Foxx's-- idiotic reports that the Supreme Court struck down the individual mandate in the Affordable Care Act, the Court upheld it as a power of Congress to levy taxes. Even as egregious a corporate whore as Chief Justice John Roberts couldn't vote to kill it based on the spurious arguments put forward by the confused Obama-haters who tried to throw it-- and the entire health care reform law-- out. Basically, the whole Affordable Care Act was deemed constitutional other than the ability of the federal government to terminate states' Medicaid funds. AP summed it up like this:

The decision means the huge overhaul, still only partly in effect, will proceed and pick up momentum over the next several years, affecting the way that countless Americans receive and pay for their personal medical care. The ruling also hands Obama a campaign-season victory in rejecting arguments that Congress went too far in requiring most Americans to have health insurance or pay a penalty.

Breaking with the court's other conservative justices, Chief Justice John Roberts announced the judgment that allows the law to go forward with its aim of covering more than 30 million uninsured Americans. ...The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.

...Republican campaign strategists said presidential candidate Mitt Romney will use the court's ruling to continue campaigning against "Obamacare" and attacking the president's signature health care program as a tax increase.

"Obama might have his law, but the GOP has a cause," said veteran campaign adviser Terry Holt. "This promises to galvanize Republican support around a repeal of what could well be called the largest tax increase in American history."

Deranged right-wing extremist Virginia Foxx embarrasses North Carolina again

Wednesday morning I watched reactionary Wyoming Senator John Barrasso, a doctor/legislator, on TV explaining why he opposes ObamaCare. The bill had too many pages and he couldn't understand them. And Sarah Palin says it's death panels so... it must be death panels. Chilling. I spoke to 3 actual doctors, each of whom is running for Congress on a progressive platform and each of whom was largely impelled by concerns over the healthcare reform debate to run. We've written about all three before, Dr. Lee Rogers, who's taking on Buck McKeon in Los Angeles, Dr. David Gill, who has already frightened off the incumbent and is now running for an open seat in east-central Illinois, and Dr. Syed Taj, running for the suburban Detroit seat that was just abandoned by Thaddeus McCotter. Dr. Rogers and Dr. Gill have already won the Democratic nominations. Dr. Taj goes up against a demented LaRouchie running on a platform-- for the Democratic primary-- of impeaching President Obama.

In light of today's Supreme Court ruling I wanted to get into the minds of distinguished medical practitioners who have some kind of an understanding of politics-- and see if we could get behind the rote chant that anyone worth their salt has been asking for all along: Medicare-For-All.

We got the ball rolling by asking each doctor to share a short story from his medical career that illustrates the need for healthcare reform. Working east to west, let's start with Dr. Taj, the Chief of Medicine at Oakwood Hospital in Dearborn, Michigan.

As a physician with 30 years experience in the medical field, I’ve personally dealt with just about every major flaw in our health care system. I’ve witnessed countless patients being denied care because of a cap on total lifetime benefits or preexisting conditions. But while private insurance companies persistently find new ways to deny care to raise their revenues, we’ve always provided care to those who don’t have or can’t afford insurance: the emergency room. Inevitably, these costs are increasingly borne by taxpayers. This is the greatest contradiction and biggest flaw in our health care system.

A system so reliant on emergency care treats only the most severe cases, never with deference to preventative measures. Within this system, I could treat patients but never follow up on their conditions, nor would they monitor their treatment with another primary care physician. Medicaid services like emergency medical cards do little for long-term care for those who can’t afford insurance because there is no follow-up. The problem that brought them to the ER might not be fixed until another emergency occurs.

And speaking of emergency rooms, Dr. Gill is an emergency room physician at Advocate BroMenn Medical Center in Normal, Illinois and he told me he has dozens of stories he could share with us.

The one I tell most often, out on the stump, is this: A few yrs ago, a 39 year old woman, Susan, came in by ambulance, in full cardiac arrest... tried to resuscitate her, to no avail-- she died... She worked at a job that had no insurance, & her hubby was a stay-at-home dad... He was grieving fiercely in the E.R. (appropriately), and he told me that one week earlier, Susan had had chest pains and was seen at a different E.R.... She'd received nitroglycerin, the pain subsided, and it was recommended (appropriately) that she be admitted for further evaluation, including a stress test... But because of her lack of insurance, she & her husband decided that they couldn't afford to have her stay at that hospital... And now, a week later, here she was with me, stone cold dead, leaving behind 2 beautiful daughters (ages 6 & 4)... She had joined the ranks of the Americans who die every 12 minutes just for lack of insurance...

Lee Rogers, a former national spokesperson for the American Diabetes Association is the director and founder of the Amputation Prevention Center at Valley Presbyterian Hospital in Van Nuys, CA. He's also a Contributing Editor of the Journal of the American Podiatric Medical Association. He has a somewhat different perspective on the question:

It's bad enough to be uninsured, and we all have many stories about how doctors try to help the uninsured but can't get access to hospital admission, the operating room, or equipment they need. Some of my more memorable cases illustrating the need for insurance reform actually pertain to patients who have good insurance. I may recommend a procedure to save their leg from being amputated. The insurance company (HMO or PPO) even gives a prior authorization for the procedure. But they always include disclaimer language that "prior authorization does not guarantee payment." I think, what good is it then? We'll go ahead and perform the necessary procedure and then 2 or 3 months later the insurer will deny payment on the claim. It's infuriating to patients and doctors.

Then a question you might think is obvious: How does being uninsured or underinsured affect a patient's access to quality healthcare? This time we'll start on the West Coast and work our way East. So, Dr. Rogers:

I have numerous patients who are uninsured and underinsured. Being underinsured is almost worse. People expect when they have insurance, it will cover whatever the doctor needs to do to save their life, their limb, or just make them better. Not the case. Patients may be insured to have surgery in the OR, but the underinsured patient may not be able to get the latest equipment or products, leaving them with suboptimal care. I find myself compromising my care frequently based on the type of insurance a patient has.

Pretty horrifying, right? Dr. Gill comes to the same point-- ultimately about where the real death panels are:

The uninsured or underinsured simply can't get in to see providers. That's why they come to my E.R.-- we take all comers... What's one of the first question asked by providers' offices when you call? Of course-- they want to know your insurance status,

And Dr. Taj seems to have had the same experiences. He fleshes it out a bit more:

The uninsured or underinsured typically cannot afford coverage, though most needed services are financially impossible to receive without it. Instead, people go to the ER to treat severe conditions and never to the doctor for checkups or preventative care. They simply can’t afford it. Nor can they receive adequate medicine or consultation to conditions they treat at home. Overall, not only do the uninsured receive a significantly lower quality of care, if they receive any at all, but at an astronomical cost that often leads to bankruptcy and/or legal action on behalf of hospitals.

The burden always lies on those healthy people to help to subsidize the sick, the main logic behind health insurance generally. We currently have nearly 40 million uninsured in the United States and, as this number increases, greater costs will inevitably be borne by the insured and/or taxpayers. Smaller insurance pools mean more people in need of care, meaning less revenue for insurance companies and greater prices for the insured. The healthiest that can’t afford coverage then drop out and the system becomes even more expensive. This is a fundamental flaw with our health care system and the reason why the individual mandate at the present time is so essential to the Affordable Care Act.

I wish I could get Barrasso to answer this one too, but the third question tries to get into what each doctor feels is the best type of healthcare system for providers and patients and if there's a system where both win. Alphabetical this time-- so Dr. Gill is up first. He's short and to the point... no frills:

Single-Payer ("Improved Medicare for All") is obviously a system where both patients & providers win... The only losers would be the private health insurance companies who would see their business wane...

Dr. Rogers has come to similar conclusions and he's going from Simi Valley to Porter Ranch to Santa Clarita to the Antelope Valley trying to explain it to nervous voters who don't know what to believe or who to trust. Although, obviously, there's one person most people in the area know for sure they can't trust:


Here's Doctor Rogers:

I'm open to listening to all options, but as I see it right now the only system where both win is a single payer system, like Medicare-for-all. But the big losers would be the health insurance companies. Just the opposite of Obamacare, where the big insurers made out like bandits-- 46 million new customers and no caps on premiums. Many people are afraid of single payer healthcare, thinking it is a government takeover of healthcare. It's not a take over; the government already controls healthcare. Medicare's administrative costs are about 3%, compared with up to 25% for private insurers being profit and going to investors and CEOs. Single payer healthcare would be good for our economy. Business should really be embracing it. The second largest expense for most businesses is health insurance. In 1950, Americans spent 3% of their income on health insurance or healthcare, now we spend 17%. Imagine that cost being shifted to a more efficient system with lower overhead-- where treatments were offered to patients based on their levels of evidence. Imagine no pre-existing conditions, preventative care covered, and prescriptions covered. Single payer can accomplish this. A larger focus on preventative care would improve the economy, because sick employees are less productive. If we reduce obesity, and its related diseases like diabetes, arthritis, back pain, we can have more productive workers.

And Dr. Taj is one of the only candidates I've ever heard-- other that Mitt Romney (see video below)-- actually try to explain why the individual mandate isn't the villainous plot the Republicans-- who first thought it up-- have made it out to be the second they tricked the Democrats into accepting it. Although, in the end, he too senses the inevitability of a single-payer system.

Health care is much more than a consumer good or service. The best system treats access to top-notch medical care as a right of every American. No one should be denied care because of a lifetime limit or preexisting condition, and any successful and ethical health care system should not incentivize providers to deny coverage for those in need. Speaking from experience, the key to an effective health care system is to practice preventative medicine rather than reactive medicine. Prevention is a key to better outcomes for patients. It is also less costly to treat a problem early on than to wait.

I’m encouraged by Affordable Care Act and President Obama’s willingness to compromise. I support the individual mandate as a way to enlarge the insurance-pool to lower costs, treatment of pre-existing conditions, how it lowers overhead costs to focus exclusively on care, and the state exchanges. However, the law is not without its flaws, and as a member of Congress I will advocate a patient-outcome model of health care based on patient outcomes and quality care in conjunction with the ACA. The ACA was the intellectual product of decades of bipartisan research and discourse and I believe political posturing, not a healthy discussion of policy, has unfortunately driven much of the resistance to the law. In the end, the ACA is simply an improvement within an inherently imperfect system. I would like to see us develop and implement protocols and incentives for evidence-based medicine. We should use data-driven medicine focusing on patient outcomes and quality care; reduce costs by implementing electronic medical records keeping and a single billing system that would further streamline health care and reduce costs; work with pharmaceutical companies to reduce the costs of prescription drugs and make generics more readily available.

Overall, studies have confirmed the significant cost savings involved in a “single-biller” system and polls consistently show great public support for it. Such a system would reduce administrative costs, focusing almost exclusively on care, and take away the incentive to deny coverage for increased profits. In Congress I will support evolving our health care system through a range of policies to eventually move our country toward this system.

So, last question, the one everyone is probably waiting for... what now? In light of the Court's decision today, what should be the next steps forward? Dr. Taj kicks it off:

The Supreme Court’s ruling on the Affordable Care Act and the individual mandate means that those of us that support reform of our health care system must now act to build on what has been done and improve it. For one, health care costs are a major contributor to the federal deficit that must be reigned in if we’re to put our nation on a stable fiscal foundation. The individual mandate is the centerpiece of the ACA and projected cost reductions would have been impossible without a larger insurance pool. It would have meant increasingly less take-home pay for middle class families to pay for the same or worse coverage. There's a lot we must do to improve the legislation.

The decision gives us the opportunity to keep reforming and designing a better system. Polls have shown widespread public support for a universal health care system and this is the window of opportunity for our leaders to act. A recent report by economist Gerald Friedman shows that this would “save as much as $570 billion now wasted on administrative overhead and monopoly profits.” While there are costs involved with insuring millions of uninsured and underinsured we’d save much more by eliminating middlemen and simplifying the system as a whole, especially by eliminating the incentive to deny care for larger profits. Even with its virtues, the ACA doesn't do nearly enough to bring down long-term costs or correct the deeply rooted problems of our health care system.

Bingo! And Bingo for Dr. Rogers as well.

I think the whole panel would obviously agree that we need doctors at the table making healthcare decisions. Not bureaucrats or lawyers. This decision draws attention to the good parts of Obamacare and the bad parts. Most of us can agree that eliminating pre-existing conditions to qualify for insurance, allowing adult children to stay on parents insurance, and extending coverage for preventable diseases are good things. Where Republicans and Democrats disagree is how to pay for it. Healthcare is so important for the well-being of our nation, that it should be a high priority. We're wasting a lot of money on a war which we already won, on military aid to wealthy nations, on redundant nuclear weapons systems when we could already destroy the planet multiple times over, on putting nonviolent drug offenders in prison instead of in treatment, giving away billions in subsidies to big oil companies, and many other things that should take a back seat to making sure our citizens have access to quality, affordable care.

The Supreme Court ruled that the federal government has the Constitutional authority to regulate nearly all aspects of healthcare including a provision that requires citizens to purchase health insurance. People who have benefited from the law will continue to benefit. That's the good part. The bad part is that the law still needs to be fixed. No law is perfect, but this one benefits the big insurance companies like no other. It mandates you purchase a product but has no cost controls on that product. We need to put patients first, not big insurance companies.

Dr. Gill sums it up in one short, sweet, easy-to-digest sentence: "We need to once again push for Improved Medicare for All." How would you like to see men like this in Congress rather than partisan imbeciles like John Barrasso-- or Buck McKeon or the psychotic LaRouchie running against Dr. Taj? These 3 doctors have something else in common: the DCCC is ignoring all three races, even though all 3 districts were won by Obama and all 3 races could be easily won if Steve Israel, chairman of the DCCC, hadn't decided to put all his cash behind Blue Dogs like Mike McIntyre, John Barrow and Jim Matheson-- all three of whom oppose health care reform, vote with the GOP and... just to make sure everyone knows where they stand politically, all announced yesterday they would back Darrell Issa's, John Boehner's and Eric Cantor's vicious obstructionist war against President Obama by backing today's effort to find Attorney General Eric Holder in contempt of Congress, a place Mr. Holder shares with between 80 and 90% of Americans. In any case, you can help support Dr. Rogers' and Dr. Gill's campaigns here and Dr. Taj's campaign here.


UPDATE: Manan Trivedi

Pennsylvania congressional candidate Manan Trivedi responded to our questions too late to be included in the post. Dr Trivedi served as the battalion surgeon for the 1st Battalion, 5th Regiment Marine Corps Infantry Battalion in Iraq and when he returned to the U.S. he went on to serve as health policy advisor to the Navy Surgeon General and became a professor at the Uniformed Services University of Health Sciences. Today he's a primary care physician at Reading Hospital and Medical Center and looks likely to defeat Republican hack Jim Gerlach in a southeast Pennsylvania district Obama won with 53% in 2008. He's been a critic of the Affordable Care Act and his perspective on today's Supreme Court ruling takes that into account.

The problem with the ACA was that it was too complicated and did not do enough to rein in healthcare costs or hold the insurance companies accountable.  The SCOTUS decision still allows for an opportunity to pursue a much more simplified system, like a Medicare buy-in, which would provide competition in the marketplace and provide patient consumers public and private choices. This coupled with a much greater focus on comparative effectiveness research, so we can better figure out what works and what doesn't work, would be a system that covers everyone, brings costs down and improves the quality of healthcare for everyone.

His approach speaks volumes to why we need to elect sensible medical professionals instead of just more and more lawyers and multimillionaires to Congress. If we want a reasonable healthcare system in this country, we'll need to embed leaders like Trivedi, Rogers, Taj and Gill into Congress. And... the last word (for now):



OK, the real last word-- El Presidente a few minutes ago:

REPUBLICANS FLIP, REPUBLICANS FLOP-- RUDY, MITT, BARRASSO, HAROLD FORD

Fox faux Democrat Harold Ford, doesn't qualify as a Republican per se-- although he has always voted like one and his stands on all the important issues of the same are the same as Bush's-- but as Chair of the DLC he's pretty much owned by the same interests that own the GOP. DailyKos founder Markos Moulitsas made mincemeat out of a defensive but pathetically exposed Ford on Meet the Press yesterday. Poor Ford is not used to rejection and he was just getting over the fact that he was virtually the only high profile Democrat to lose a Senate race in 2006 when Markos treated his bogus charm offensive with the scorn it merited. Forlorn and depressed over his public humiliation, Ford's press shop is trying to blame his miserable performance on his drunken escapade a few nights before at NYC's most expensive-- and fanciest-- sushi restaurant. Three blondes! Oh my-- but not really and truly a flip flop for Harold, who is a well-known serial philanderer. The flip flop is his claim that he wants to make nice with the grassroots Democrats the DLC has always betrayed and demonized. Not likely to work while he leads a campaign to undermine the Democratic incumbent, Steve Cohen, who won Ford's old House seat in Memphis. It's especially repulsive to real Democrats since the Ford Machine is trying to play on Cohen's support of the Hate Crimes Bill (which all Democrats-- with the exception of the 14 worst reactionary bigots in Congress-- voted for). Ford's allies are pushing a shill, Nikki Tinker, on a platform of reactionary policies and homophobia.

As for the more traditional Republicans, the newly appointed Wyoming Senator, John Barrasso, long rumored to be more than a little light in the loafers, did the ultimate flip flop as he prepares to run for the seat he now holds by appointment: he's announced his engagement... to a woman. That's special-- and it seems to have worked for Congressman McCrery (R-LA).

And speaking of gay Republicans, I mentioned earlier that their hero, Rudy Giuliani, has pulled the rug out from under them. Today's Boston Globe is reporting that Mr. Civil Unions is now in favor of a "much more modest set of rights for gay partners than civil union laws," including the ones he's always favored. Must be getting close to the South Carolina primary. Giuliani also claims he "misspoke when he said he spent as much time, if not more, at Ground Zero" than 9/11 workers. The 9/11 workers didn't appreciate that-- which is why he decided he misspoke. And speaking of misspokes and flip flops, you can't do a story on flip floppin' Republicans without looking into Flip Flop Mitt's latest flip flops.

Yesterday on friendly territory (Fox News Sunday) Romney said he too misspoke. Remember that mornonic remark he made about his sons' doing their duty for America by working for their dad's campaign? And how he equating driving around a $50,000 RV is the wilds of Iowa was roughly equivalent to driving a tank in Al Anbar province? Oops. First he tried the "out of context" defense. But the video showing the context only made it worse-- much worse-- so he switched to the "misspoke" defense. Do you think Fox let him get away with it?

WYOMING SENDS CONGRESS A FOURTH HOMOPHOBIC GAY REPUBLICAN SENATOR-- MEET JOHN BARRASSO

When right wing extremist Senator Craig Thomas (R-WY) died 2 weeks ago, state law dictated that the Wyoming governor, Dave Freudenthal, a conservative Democrat, pick a Republican. The Wyoming State Republican Party submitted 3 candidates and today Freudenthal picked conservative state Senator John Barrasso, an orthopedic surgeon, to fill the Senate until next year's general election. Barrasso is said to have a good working relationship with Freudenthal and isn't considered as much an extremist as most Wyoming Republican officials. In 1996 when he ran for the Senate seat being vacated by retiring Alan Simpson, he ran as a pro-choice Republican (and was beaten by extremist maniac Michael Enzi, an anti-choice fanatic and complete Bush Regime rubber stamp).

Barrasso wrote, "I believe in limited government, lower taxes, less spending, traditional family values, local control and a strong national defense. In the state Senate... I have voted for prayer in schools, against gay marriage and have sponsored legislation to protect the sanctity of life." I guess he learned his lesson about being in pro-choice in the GOP. As for the anti-gay stuff, this is especially interesting because it has long been rumored that the 54 year old doctor is homosexual himself. He doesn't talk about his sexuality but it is pretty well known in Wyoming politics that he has a lover and is only semi-closeted. A Wyoming gay rights organization has rated his voting record on issues impacting gays and lesbians an F- ("extremely anti-gay").

Completely closeted Senate Minority Leader Miss McConnell welcomed Barrasso to the Senate and said he hopes Barrasso can be sworn in as soon as Monday. Now there are 4 gay Republican U.S. senators all of whom opposed gay marriage equality. I should add that one looks like he may be a political goner. Lindsey Graham's approval ratings in South Carolina have sunk to 31%, not because he's a hypocritical closet case but because he favors what extreme right wing elements of the GOP consider an "amnesty bill." Luckily for Graham the right wing extremist who was being pushed by the religious right, State Treasurer Tommy Ravenel was busted for selling cocaine. (He was also the director of Giuliani's South Carolina presidential campaign. Graham, of course, is supporting McCain, whose cabinet he hopes to serve in.)