The GOP's unhealthy obsessions

“The White Whale swam before him as the monomaniac incarnation of all those malicious agencies which some deep men feel eating in them…all that most maddens and torments; all that stirs up in the lee of things…all that cracks the sinews and cakes the brain; all evil visibly personified, made practically assailable in Moby Dick” – Moby Dick by Herman Melville

Obsessions are unhealthy. When Ahab’s obsession ran its course, the Pequod sunk to the bottom of the ocean. Ahab and every member of the ship’s crew, except Ishmael, drowned.  That was certainly not how Ahab saw his obsession resolving itself but obsessions seldom do.

Republicans in the US House of Representatives, including Cynthia Lummis, have stalked the Affordable Care Act since it was enacted. They’ve been obsessed as a crazed suitor and they’ve created an obsession among their base.

Not to be overly dramatic, but their obsession could be seen as a form of “domestic terrorism,” which, by definition includes actions intended “to intimidate or coerce a civilian population and to influence the policy of a government by intimidation or coercion.”

Terrorism involves threats of harm to innocent people in an attempt to get your way over a matter with which your victims have little or any influence. The kind of terrorism with which we are more generally accustomed involves death and bodily injury. This is different. Lummis and her House colleagues have used the threats to seriously harm the economy, put people out of work, reduce the value of their savings, and refuse to pay the nation’s legitimate debts in exchange for getting what they have not been able to get through the democratic process.

The Diagnostic and Statistical Manual of Mental Disorders, a commonly used psychiatric diagnostic system in the US, defines obsession. "Obsessions are persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress...the content of the obsession is alien, not within his or her own control, and not the kind of thought that he or she would expect to have." Terrorism is a tool for satisfying extreme obsessions.

The GOP is diagnosable. They’ve voted 40 times to repeal Obamacare knowing those votes aren’t even symbolic. Their Obamacare obsession includes continual invasive urges, resulting in significant fear, distress, or discomfort. Yet, as with the target of most obsessions, repealing Obamacare is not within their control. Thus, they resort to holding the nation hostage to achieve a result otherwise unattainable by them.

One fellow Republican called them “lemmings with suicide vests.”

Psychiatrists recognize the damage caused when obsessions are not controlled. One of the recommended strategies is to focus on your greater mission. Those who understand the pathology believe if you're able to care about your most important mission you'll find yourself more firmly anchored, upright, and balanced when a wave of obsessive thoughts threatens to carry you away.

Perhaps if these politicians could focus on what is right for the nation rather than what is right for their party?

Professionals urge obsessed folks to accomplish tasks that help put your obsession behind; turn to something you've been neglecting, e.g. your job as a congressman.

Finally the seriously obsessed are advised to listen to what others say. If friends express concern over your obsession, they're probably right. Be open to these messages. Your base isn’t always your best friend. You’ve expended a lot of energy convincing them your obsession is their problem. If you’re going to recover, you’ll have to come clean.

I know what House Republicans are going through. My 3-year-old grandson recently lost his favorite toy, Captain Hook. He became obsessed with locating it. We searched to no avail. We didn’t lose it, had no control over where it was…but he was obsessed with finding Captain Hook. So, Grandpa explained to him that sometimes you don’t get what you want. He was good with that and went on to something else.

But then he’s a three-year-old, not a Republican member of Congress.

Wyoming legislators: All hat and no cattle

Not a week goes by that some struggling Wyoming family doesn’t hold a bake sale or a spaghetti dinner in a futile attempt to raise money to pay medical bills. If Governor Matt Mead and the other governors who joined in the lawsuit seeking the demise of the Affordable care Act have their way, those bake sales and spaghetti dinners may be all that the thousands of uninsured Wyomingites will have left to meet their health care needs.

Wyoming legislators proved they have nothing to offer on healthcare when they defeated the only effort the state has made to address this problem where they claim it should be addressed, at the state level. Despite plaintive calls for the protection of state’s rights under the 10^th Amendment, Wyoming legislators are all hat and no cattle when it comes to crafting legitimate alternatives to federal healthcare legislation.

They created a program called Healthy Frontiers. Its supporters touted it as an alternative to Medicaid. They enrolled 105 families who otherwise had no health insurance. Then they killed the program leaving the Governor scrambling to figure out what to do with those 105 families and what to do about his claim that the state can do it and the feds ought to mind their own business.

Senator Charles Scott, unlike many of his esteemed colleagues, has given it a yeoman’s try.  But the Governor and Senator Scott were forced to admit members of their own party believe the talking points have a priority over actually using state’s rights to do something. “One of the pushbacks on Healthy Frontiers was the notion that government should not be involved in health care,” Mead said.  One of the members of the Appropriations Committee where the program met its demise is Rep. Sue Wallis, who said, “Some Representatives are just uncomfortable with creating a local version of the federal mess.”

As Senator Scott noted, what we are doing now is not free, either of costs or of federal involvement. “Well, we are involved. We have Medicaid and nationally we have Medicare.  You have to be realistic and they aren’t.”

Scott was talking pointedly about the leaders of his own party, a party controlling all but 14 of the 90 seats in the legislature.  Speaker of the House Ed Buchanan, an opponent of Healthy Frontiers, made clear he had his sights set on taking it down though he offered no alternative vision. “Leadership really sent the message that we were opposed to Healthy Frontiers,” said Rep. Rosie Berger, chair of the House Appropriations Committee, turning the term “legislative leadership” into an oxymoron.

If the legislature refuses to take responsibility and exercise the rights they claim under the 10^th Amendment, that leaves only a couple of choices for people. Bake sales and spaghettis dinners or the Affordable Care Act, which those legislators who have no ideas of their own derisively call “Obamacare.” Even Governor Mead understands the last hope may well be the law his lawyers were in court this week trying to kill. “Whether Healthy Frontiers is the answer or not, we still have to look for answers,” Mead said. “We do need to try these things.” According to Mead the other options include a bill he signed into law authorizing state health care exchanges. That, by the way, is a significant element of what he calls “Obamacare.”

There have always been legitimate questions about whether Healthy Frontiers is a viable alternative to real healthcare reform. Yet it was something if nothing more than a legitimate effort at a state solution. The work of conservatives to kill it makes clear they are all hat no cattle on this issue but they don’t care much about those families holding bake sales and spaghetti dinners. Perhaps it is time for those struggling families to look at their own alternatives…at the ballot box this November.

Wyo’s “Healthy Frontiers” pilot program will never replace Medicaid By Sarah Gorin ESPC health policy volunteer

This morning's blog is a reprint of an excellent blog artilce by Sarah Gorin of the Equality State Policy Council with her permission. Thanks Sarah!

Many Wyoming legislators derisively refer to the Patient Protection and Affordable Care Act (the federal health reforms) as “Obamacare.” This would be a humorous addition to the political debate if these same legislators had an alternative proposal, but at the moment the alternative appears to be “No Care.”

Much has been made of Wyoming’s pilot health care reform program, “Healthy Frontiers.” The program was initially funded by the 2010 Legislature, enrolled its first participants at the end of 2010, and received additional funding from the 2011 Legislature to expand to 200 participants.

Currently, Healthy Frontiers has enrolled just under 20 participants from the targeted pool – individuals participating in state job training programs, whose incomes are under 250% of the federal poverty level, and who live in Cheyenne or Casper (where selected medical providers have agreed to begin implementing the program).

Healthy Frontiers is a health care plan. It is important to understand that it is not health insurance. Healthy Frontiers emphasizes primary care and chronic disease management, with the goal of reducing medical costs over time by taking care of conditions before they develop into expensive crises. This logical approach is being implemented in many model programs across the country, and the ESPC has no quarrel with it.

But Healthy Frontiers also requires participants to pay into to a “personal health account” (not a health savings account for tax purposes), based on income. The ESPC has maintained from the beginning that the required contribution is unrealistically high, based on Wyoming’s Family

Economic Self-Sufficiency Standard, which shows the incomes needed to support basic household expenses on a county-by-county basis.

The state also contributes to the personal health account as the client meets certain milestones in the program, such as establishing a relationship with a primary care provider and maintaining compliance with treatment regimens.

Further, the ESPC’s analysis shows that although program proponents hold out Healthy Frontiers as a cheaper alternative to Medicaid, it easily could cost the state more if fully implemented.

The rhetoric from some legislators and Governor Matt Mead about Healthy Frontiers is seriously overblown given the current status of the program. With only a handful of participants to date, and zero data on the workability of the financial requirements or on clinical outcomes, it is wildly premature to talk about this extraordinarily modest program as a substitute for anything.

The problem with the program is a microcosm of the larger health care issue. Americans have made a commitment to providing care to everyone, to not let their neighbors die in the street. But we haven’t yet figured out how to pay for that commitment.

The Affordable Care Act is the first step in that direction, trying to get everyone covered with public or private health insurance so they can pay for their care.

Healthy Frontiers clients earn a painfully low income. Since Healthy Frontiers is not health insurance, if its clients need care above and beyond what is provided by the program, the cost of that care will fall – unpaid – on Wyoming’s hospitals and private providers.

By contrast, Medicaid actually is insurance and pays providers for clients’ care. If you were a health care provider in Wyoming, which program would you like to see behind the consumers coming through the door?

Wyoming’s lawmakers need to lay aside political agendas and focus on solutions that will help our residents access quality health care when they need it and keep our state’s hospitals and providers solvent.