I get that different political perspectives yield different solutions to problems. I get that in general the Democratic party defaults to a government funded and organized solution to national problems while the Republican party prefers market based and/or local solutions to national problems. I also understand that a lot of what happens in Washington D.C. is political theater meant to keep selected political bases loyal to their respective elected official/congressman/party. I get that bitter partisanship has been a normal part of the American political landscape since the founding of the country. I understand the flaws in our political system that lead to gerrymandered safe districts and a House of Representatives that is always running for reelection, therefore spending more time raising money for, and planning the next campaign, instead of governing. I understand all of that.
But I am a rabbi. I speak to people of all sorts, of all political leanings. Most of them claim a religious affiliation, claiming to have a moral system inspired by that affiliation. Whether they are Christian, Jewish, or Muslim, most of the people I talk to say their works are somehow tied to their faith. So there is a lot I just do not understand, most of it having to do with the current government shutdown and its connection to the Affordable Care Act (Obamacare).
For starters, I do not understand how anyone claiming any kind of religious faith can be opposed to extending access to health care for the poor – especially the working poor. I do not understand how professed believing Jews cannot see providing health care as an obligation to do tikkun olam, “repair of the world,” or simply the directive in Leviticus 19 to “Love your neighbor as yourself.” I just don’t get that. I do not get how any professed Christian does not read the Gospels and come away feeling some measure of the deep concern for the poor expressed by Jesus. Jesus hardly speaks about homosexuality and almost every chapter contains parables or teachings about obligations to the poor. But to hear the Bible as expounded by so many Republican Christians, you would think the opposite is true. I just do not understand that.
I do not understand how the insurance exchanges set up by the ACA are a government takeover of the health care system and an intrusion into the doctor/patient relationship. The government website is a directory to available private insurance plans in your state. It does not tell you which one to buy. Neither does it issue the policy. It merely takes your application and connects it with the company of your choice – kind of like a high tech personal shopper. It is like the security guard in a shopping mall who gives you directions to a store you cannot find. The security guard is NOT telling you in what store you must shop or barring you from entering the mall in the first place. I just do not understand why some people do not understand that.
I do not understand how the states with the largest populations of uninsured poor (e.g. Texas and Florida) are the ones most adamantly against the provision of health insurance to the poor. I do not understand these states’ refusal to set up insurance exchanges to help the most disadvantaged consumers shop for private health insurance. I do not understand why they do not accept the expansion of federally provided Medicaid funds to cover the poorest of the poor. I especially do not understand this when economic experts on health care (e.g. in Houston, Texas) show that such Medicaid would end up saving local tax dollars currently being spent on publically supported health providers – even after the state becomes responsible for 10% of the expanded Medicaid costs (Time Magazine 10/14/13). I do not understand how anyone who purports to a) care about the disadvantaged and b) cares about fiscal responsibility does not support these programs. I do not understand how representatives from these states could call themselves religious.
I do not understand how Republican leaders can lay the shut down of the government at the feet of anyone but themselves. The issue they trumpeted was opposition to Obamacare. It is clear to me after listening for months to Rand Paul, Ted Cruz, and a plethora of Tea Party affiliated House members, that if the President and Senate did not defund Obamacare, they would carry out a shutdown of the government. I do not understand why they think I am not paying attention to their words of the last several months. Their intent has been clear. I do not understand why they think I am stupid.
Even more, I do not understand why these same Republican leaders claim to be speaking for the American people, or even a majority of the American people. Americans are roughly split on the ACA. A Rasmussen poll from Monday, October 7 (Rasmussen is hardly a liberal institution) shows a shifting trend in favor of the ACA – 45% having a favorable view of the law while 49% view it unfavorably. What these polls fail to show is how many of the unfavorables reflect a desire for a single payer system as opposed to any health care reform at all. Other polls show that despite the split views on Obamacare, by a huge margin Americans do not want the functioning of the government or the ability of our government to pay its debt, tied to defunding the ACA.
I know the political answer is that these representatives are from districts that are “safe seats.” I know that they were elected because they agree with or pander to the most conservative segments of their homogenous districts. I know that most of these representatives are relative political neophytes – which is why there were elected. But I do not understand how the responsibilities of being part of a national government have not broadened their views. I do not understand their failure to see an America outside of their home town and I do not understand their failure to feel some responsibility for all the people, not just their voters.
But most of all, I do not understand the blindness. I do not understand blindness to the working poor who need Head Start Centers to care for their children while they fill jobs that provide a meager subsistence. I do not understand their blindness to the well-documented increasing gap between the wealthiest and the poorest, or the erosion of a true middle class. I do not understand the obsession with classifying people as “takers,” who are merely trying to survive. I do not understand their blindness to this reality: for most, the American dream is just an American illusion. And I do not understand how all of us are allowing the destruction of even that illusion.
The Jewish Observer 
Here is an example of one of the big problems with the PPACA, and mind you I am selling it, or will when the Marketplace is actually online with the subsidy: What you call the working poor is a family of four making $94,000/year. That family qualifies for the subsidy if neither spouse receives coverage from his/her employer, while that same family making $60,000/year where one working spouse is under a group plan not only will NOT qualify for the subsidy but will also likely pay MORE for family coverage (this is real and I can show you). So which of these two families are the working poor? The first family is 400% of the Federal Poverty level and the second 250% of the FPL.
The median income for a family of four in 2011 was just over $50,000/year. You and I ask ourselves how anyone could live on this income but are they actually “poor”? We cannot really relate. Does the example above really make sense to you or does it seem broken? Should we put forth a program that we know is broken before it even starts or should we fix it first?
I spoke with a potential client yesterday who is a single mom with three kids and makes $42,000/year in her own business. The best I could do is estimate her subsidy because the Marketplace is not active (I’ll explain later). She currently pays $16 for each child under Florida Kid Care but has no coverage for herself. I estimated her cost under PPACA to be approximately $150/month. She would rather pay the $320 penalty in 2014 and the Florida Kid Care premium than to insure herself. By the way, the PPACA plan was not as good Florida Kid Care. That’s broken!
No one…I say no one has signed up for the subsidy yet. The system is down, not because of the government shut down or because it is overwhelmed but because the subsidy is NOT funded. PPACA cannot function without taxpayer dollars and there are none currently available. Congress will either have to appropriate those dollars from other areas or raise taxes in order to fund it. Premiums have gone up because they had to in order to cover preexisting conditions. Since premiums have increased that means even more tax dollars to subsidize insurance. Keep in mind that everything is based on the Silver plans and the portion of the premium that has to be paid by the individual is based only on income and family dynamic. That means if your premium is $10,000 or $20,000 per year it makes no difference. You will only pay a certain percentage of your income.
If you consider either family above “poor” then your definition of poor is very different from mine. If you see the fairness between family one and family two then our definition of fairness is different. I have spent a lot of time training in order to help people with PPACA and there are many major problems. So many that I would define it as broken. All politics aside, the Marketplace subsidy is NOT ready for prime time. Our politicians are being bitches right now but none of them are focusing on the real problems or successes of PPACA they are just being bitches and are willing to drive our country off a financial cliff in order to show they are right (or left).
If you are interested, I would be happy to tell you what I know about the PPACA subsidy program. I probably know a great deal more than most since I am set to sell it. The point would be to demonstrate that the people you think it is for are not necessarily the people it is for. I would also demonstrate that what Congress is fighting about is not actually the blindness that they have for helping the poor but the struggle for power. And as a student of economics, I can show you why PPACA is not sustainable without tax increases and/or without the demise of some health insurance companies. I can show you the unintended consequences of PPACA that will cost America more than it ever thought. Just ask.
If you understand the issue that Congress claims is using as a pawn your outlook on what they are doing would be a different disappointment. They are using this issue to posture. It has nothing to do with blindness toward the poor. It has to do with blindness to ALL of America. If you do not understand PPACA you will continue thinking, incorrectly, that the fight is a rich vs poor issue. I think Congress and our President are acting in a despicable manner.
Thanks for your comments, David. As always insightful and informed. A couple of responses.
1) You have just made a great case for a single payer system. Research and experience show that Medicare is the hero of our health system now, with 98% of the dollars it takes in going out to patient care. Typically an insurance company is in the 80% to 85% range. A system that allows people to opt in to Medicare (for an income based fee) would be far more efficient and save real dollars in the system.
2) The blindness to the poor is more in the refusal to support the expansion of Medicaid by those states who have the greatest number of uninsured people (e.g. Texas). Even after those states would take on a share of the expanded Medicaid there would be local tax dollars saved as it would reduce the load covered by local taxes (see study done in Houston reported by Time Magazine).
3) Of course the issue is power. In this case it is the power by the crazy wing of the Republican party represented by Ted Cruz. Just see John McCain’s own assessment of these tactics. That is all the proof I need.
This needs to be sent to the Democrat so it has exposure. Maybe when caring folks see it they will contact their representatives and this circus will end!!!.