Names Matter: Patient Protection & Affordable Care Act versus ObamaCare

When I was studying for my MBA in marketing, I had a thoughtful professor, John Philip Jones, a career advertising agency veteran, who wrote one of the earliest books on branding: "What's in a Name". The answer, I learned, is a lot!

Case Study: The Patriot Act

"The Patriot Act", sound Constitutional? Protective? Patriotic? Simple and clear? Easy to understand? Or, does it sound of questionable Constitutionality? Takes away some of our right? Deceptive name? Too good to be true? 

"The Patriot Act", that's an easy one, a no-brainer, especially if you just got attacked on American soil ... and a major population center and national landmark city at that ... the first attack on American soil in 60 years ... you haven't really read all of the details in the actual legislation of the Patriot Act BUT it's been quickly and nearly unanimously passed by both houses of Congress, and signed by the President.












Did you know that "The Patriot Act" is a nickname? 

What if President Bush and Congress promoted "The Patriot Act" by its originally introduced to Congress name ... its real name ... as listed on the official government documents with the Library of Congress,  "Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001"? 

The law's real name is not too inspiring but it more accurately describes the law's provisions. And that could be controversial. 

Perhaps, if President Bush and Congress stuck with the original name "Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act", then then The Patriot Act would have raised the public awareness, concern, and contentious debate among Americans about its Constitutionality.

But no. President Bush and Congress  went with that new promotional name ... wrapped it in the American flag ... The Patriot Act. 

What a perfect name for a law that limits the interpretation of our rights in our Constitution's Bill of Rights! I believe that this is why President Bush and Congressional leaders knew that this law would be controversial, so they wrapped it in the American flag with the name The Patriot Act.

I do not intend here to condemn or assert opinion about The Patriot Act. It's just an example highlighting the importance of law's name. Government leaders select a name for bills that will build awareness and support or suppress opposition and inquiry. 

Here are some other examples: A name like Patriot Act is quite different from a name like Medicare or Gulf of Tonkin Resolution. It's more like Social Security or American Recovery & Reinvestment Act.

Be aware: Every major legislation, especially those that are cornerstones or controversial, are carefully named to establish them as cornerstones and influence the controversy.

Case in Point: The Patient Protection & Affordable Care Act vs Obamacare


... now ... as the American Health Care Marketplace and our feelings about economic security are changing ...















Please, close your eyes and Picture Patient Protection & Affordable Care Act and tell me ... tell yourself ... what this name is trying to say.

... clear your palette ...  

Please, Picture Obamacare and then tell me out loud what this name is trying to say. 

... clear your palette ...

Match these words and phrases to either the name -- Patient Protection & Affordable Care Act or Obamacare: 

• Government run

• No waiting period for pre-existing conditions

• Partisan, political

• No lifetime maximum on coverage

• Selfish

• Premiums prices don't go up so much

• Regulations

• Legitimately, as in passed by Congress, signed into law by President, affirmed by Supreme Court

• Not legitimate, Unconstitutional

• Social safety net, like Medicare and Social Security

• Temporary, political

• Permanent, enduring

• Something I want

• Something more I have to do, tolerate

• Fair, consistent with our rights as citizens

• Unfair, tramples our rights as citizens

• American democracy in action

• American government dictatorship, not democracy

• Good

• Bad

• Right

• Wrong

• I'm for it

• I'm against it

By now you must be getting my point. If not then read "Words that Work" by Frank Luntz because political consultants have been driving the talking points ... and names of Congressional and stat legislative bills since at least the early 1990's. 

The decision by Republicans to label the Patient Protection & Affordable Care Act as Obamacare as a purposeful, pejorative. Republicans and Democrats even argued about whether the term Obamacare could be used communications sent (free) through Congressional franking privilege. And, the bipartisan Franking Commission ruled that Republicans could NOT use it in franked mail. 

Republicans taunted Democrats, daring them to promote the Patient Protection & Affordable Care Act as Obamacare. But most Congressional Democrats saw this for what it is, and opposed its use. Unfortunately, after a while, President Obama adopted the label, perhaps he thought by giving it the context that "Obama cares" he could derail, if not hijack and redirect, the Republican initiative. 

It looks like the Republicans have been successful in getting most media and citizens to adopt the Obamacare label. Democrats fought and won the backstage franking battle but have not fought for the widespread adoption of Patient Protection & Affordable Care Act ... a consequential missed opportunity.

"A rose by another name" ... Kentucky presents an interesting example

Kentucky set up its own exchange for the Patient Protection & Affordable Care Act BUT DID NOT NAME IT anything similar to the PPACA or Obamacare. Instead, they named it with a local, statewide program name of Kynect (sounds like connect) ... and it's been very, very popular!!

News reports that Kentucky residents love Obamacare ... the Patient Protection & Affordable Care Act ... by another name. This rose by another name appears to smell even sweeter.

Nearly 20% ... one out of five ... uninsured Kentucky residents have already signed up for it and, among them, 40% of the enrolled residents are in the highly desireable young and healthy demographic group!!

Names matter. Evaluate the Patient Protection & Affordability Act with this in mind.

Disconnect -- College Cost Inflation vs. Household Median Income Growth in Free Trade Environment

We have known for a long time that the amount of education directly impacts wages, and, as far back as 1994, in light of movement towards free trade pacts,  economists highlighted surging income gap between those with and those without college education:

(See "Trade and Income Distribution Panel: The Debate and New Evidence" delivered by William R. Cline, Institute of International Finance at Yale University Alumni Meeting, 1994)

So it's easy to justify education as one of the best investments a nation can make.

We Americans claim to view extensive public education as essential to healthy democracy, equal opportunity, expanding economy, scientific advancement, and military preparedness ... or so we say. In practice, we no longer make it affordable to every citizen ... only the wealthy.

Back in 2002, professional association research on American public education found unequal funding of education but, most interesting to supporting the value of public elementary and secondary education, is the finding that each time affluent Americans migrate to a new (usually suburban) community, they support highly funded schools.

Education has been the great economic equalizer throughout our history. American founding fathers spoke often and clearly in favor of free public schools. For example:

"If Virtue & Knowledge are diffused among the People, they will never be enslaved. This will be their great Security." -- Samuel Adams (Letter to James Warren, February 12, 1779)

"A Bible and a newspaper in every house, a good school in every district--all studied and appreciated as they merit--are the principal support of virtue, morality, and civil liberty." -- Benjamin Franklin

"I think by far the most important bill in our whole code is that for the diffusion of knowledge among the people. No other sure foundation can be devised, for the preservation of freedom and happiness...Preach, my dear Sir, a crusade against ignorance; establish & improve the law for educating the common people. Let our countrymen know that the people alone can protect us against these evils [tyranny, oppression, etc.] and that the tax which will be paid for this purpose is not more than the thousandth part of what will be paid to kings, priests and nobles who will rise up among us if we leave the people in ignorance." 

                                                         -- Thomas Jefferson (to George Wythe, August 13, 1786)




Remember when NASA selected a school teacher, Christa McCaulif, to be the first civilian as well as the first woman in space?

Now some, such as N.J. Governor Chris Christie, belittle teachers, professors, and universities, belittling the value of learning, of education. 


College costs, including tuition, books & supplies, and room & board (or commuter transportation) have risen far faster than and far higher as a percent of average family income than the costs of other citizen essentials. Also the cost of borrowing for college far exceeds that of other essential costs, such as mortgages, and that which the U.S. government charges banks to borrow. 

The U.S. government should charge college students the same interest rate that it charges banks to borrow -- the Federal Reserve Bank's Discount Rate, which happens to be 0.75%. The current U.S. government "Stafford Loan" rates are 3.86% for undergraduate school and 5.41% for graduate school.  

The interest rate the U.S. government guaranteed loans charge to college students is more than 5 times the discount rate for undergraduate school and more than 7 times the discount rate for graduate school. 

Again, U.S. government guaranteed student loans for college education costs more than 5 times for undergraduate and more than 7 times for graduate school than the interest rate as U.S. government Federal Reserve guaranteed borrowing by banks.

Do you see the wrongness of charging 5-7 times more for a college student loan than a Fed bank loan? Do you see the inconsistency with our stated national values? And, don't you see the consistency argument for all-out government support for college education in a free market global economy?

U.S. college tuition rose more than 10-fold ... more than 1,000% ... during the past 30 years. The consumer index rose about 250%. 



But U.S. median household income only rose approximately 20% during this same period.  



Clearly, a college tuition has been growing out of reach for a long time. The historical tuition prices charts are in nearly every article on the subject of college. That said, I'm glad to hear the issue rising to the top of voters' concerns and, perhaps, getting serious initiatives to eliminate the college cost problem without gutting the college education. 



However, President Obama and Congress's legislation -- to make student loans directly from the government at annual repayment rates that cannot exceed 10% of a student's annual income during the repayment years -- only covers a small share of the total student loans outstanding and, going forward, available to new students and the interest rates are nearly 10-times the rate paid by banks to the FED. Furthermore, these Stafford Loans have annual loan limits that do not cover the cost of college. 

Let's increase government Stafford Loans amounts to realistic college and graduate school tuition costs and charge interest at the same rate that banks pay to the Federal Reserve. Our democracy and free trade global economy demand it.

Let's get real!

Republican Governors' Hippocracy on ObamaCare Medicaid Expansion

In total, only 12 of the 27 Republican state governors have outright rejected any form of participating in an ObamaCare approved Medicaid expansion. That means that 15 of the 27 either have committed to participation or remain undecided.

Specifically, accoding to research by The Advisory Board (30-year consulting company):

Fully 11 of the 27 Republican governors deciding to take ObamaCare's additional Medicaid federal funds and 4 are undecided officially at this point.

Of these 11 Republican governors who definitely will participate in the program, 8 plan to participate with the Medicaid expansion program as-is and 3 support some alternative versions of the plan specifics (which is permitted under ObamaCare if approved by CMS). 

U.S. Companies Profiting From Foreign Forced Labor Not New to Current Generation -- WARNING: Actual Photos

"There is a kind of market determinism in the air, which easily meshes with the techno-determinism of unconsidered speech, a tendency to treat the Market as the Marxists treat History—as a force overriding human choice and responsibility. There is no such thing as "business ethics," Peter Drucker has pertinently observed, only ethics." 

by Jack Beatty, "Hitler's Willing Business Partners", 

The Atlantic Magazine, April 4, 2001

Starting 100 Years Ago

Dangerous, even inhumane, working conditions in American factories first burst onto the national press in coverage of the Triangle WaistShirt Factory Fire (The PBS American Experience documentary video available for free viewing on this tragedy is well worth watching.) on March 25, 1911 killed 146 woman garment workers (mostly by burning or jumping out windows) locked into an unsafe factory floor in NYC. 

The Triangle Waistshirt Company was the biggest, most successful, most profitable women's shirt business in America ... so could have afforded better conditions.

Although the fire led to NYC workplace safety laws, some of America's biggest companies still didn't get the message. But they did start looking outwards.

"NOBODY MADE A GREATER MISTAKE THAN HE WHO DID NOTHING BECAUSE HE COULD ONLY DO A LITTLE" 

(Edmund Burke, 1729-1797)

Yes, that was then. But, as recently as 2001, IBM was sued for its blatant dealings with Hitler in the form of doing profitable business, such as conducting the census that Nazi Germany used to identify Jews. 

UK's Daily Telegraph newspaper reported ("IBM Sued as 100 Companies Accused of Nazi Links", Tony Paterson & David Wastell, February 18, 2001) that as many as 100 American companies did business in Nazi Germany, mostly profiting from forced labor.

The New York Times story "A Fund is Planned by US Companies for Nazi Victims" published (a year earlier) on April 29, 2000 supports the Daily Telegraph report: "The fund, to be set up under the auspices of the United States Chamber of Commerce, is at least partly intended to head off class-action lawsuits against well-known American companies that had subsidiaries in Germany during the war or later purchased companies that had operations there."

THE BUSH FAMILY and NAZI SLAVE LABOR

Even President George W. Bush's grandfather -- and President George H.W. Bush's father -- the late U.S. Senator (and one time Wall Street financier) Prescott Bush was implicated, as a Director of a company using forced labor in Nazi Germany. 


The US Holocaust Museum online resources on all types of Nazi era slave-forced labor.

As reported by UK's The Guardian newspaper "How Bush's Father Helped Hitler's Rise to Power": 
"George Bush's grandfather, the late US senator Prescott Bush, was a director and shareholder of companies that profited from their involvement with the financial backers of Nazi Germany.

"The Guardian has obtained confirmation from newly discovered files in the US National Archives that a firm of which Prescott Bush was a director was involved with the financial architects of Nazism.

"His business dealings, which continued until his company's assets were seized in 1942 under the Trading with the Enemy Act, has led more than 60 years later to a civil action for damages being brought in Germany against the Bush family by two former slave labourers at Auschwitz and to a hum of pre-election controversy.

"The evidence has also prompted one former US Nazi war crimes prosecutor to argue that the late senator's action should have been grounds for prosecution for giving aid and comfort to the enemy."

Perhaps, The Guardian chose to publish that expose in connection to George W. Bush's support for using the Nuremberg Defense to protect U.S. interrogators of suspected terrorists. 

The following excerpt is from a classified report prepared by Pentagon attorneys for Defense Secretary Donald Rumsfeld, as reported in The Wall Street Journal in "Pentagon Report Set Framework for Use of Torture" (by Jess Bramin, June 07, 2004):

" To protect subordinates should they be charged with torture, the memo advised that Mr. Bush issue a "presidential directive or other writing" that could serve as evidence, since authority to set aside the laws is "inherent in the president." 

CLICK for a partial list of companies in Germany using Nazi concentration camp and prisoner of war camp forced labor.

The Nuremberg Defense is defined as:  "Many of those defendants claimed that they were not guilty of the charges against them as they were "only following orders."

IN THE PRESENT. 

Reports had been leaking out since the 1990's about dangerous, callous and un-American workplace conditions in China, Bangladesh, and other outsourcing havens. But they didn't seize the attention of American public until the 2011 exposes by several media sources on Foxconn where Apple outsourced iPhone and iPad production.

Wired Magazine published this story "1 Million Workers. 90 Million iPads. 17 Suicides. Who's to Blame?" (by Joel Johnson, February 28, 2011):

"The nets went up in May, after the 11th jumper in less than a year died here. And they seem to have worked. Since they were installed, the suicide rate has slowed to a trickle.

"Foxconn, the single largest private employer in mainland China, manufactures many of the products—motherboards, camera components, MP3 players—that make up the world’s $150 billion consumer-electronics industry. Foxconn’s output accounts for nearly 40 percent of that revenue. Altogether, the company employs about a million people, nearly half of whom work at the 20-year-old Shenzhen plant. But until two summers ago, most Americans had never heard of Foxconn.

"That all changed with the suicides. ... Some saw the Foxconn suicides as a damning consequence of our global hunger for low-cost electronics. Reports from inside the factories warned of “sweatshop” conditions; old allegations of forced overtime burbled back to life. Foxconn and its partners—notably Apple—found themselves defending factory conditions while struggling to explain the deaths. “Suicides in China Prompt Damage Control,” blared The New York Times."

The Guardian (UK) newspaper published "Mass Suicide Protest at Apple Manufacturer Foxconn's Factory" by Malcolm Moore on January 11, 2012 in which he quoted one employee protest leader:

"We were put to work without any training, and paid piecemeal," said one of the protesting workers, who asked not to be named. "The assembly line ran very fast and after just one morning we all had blisters and the skin on our hand was black. The factory was also really choked with dust and no one could bear it," he said.

The New York Times published "In China, Human Costs Are Built Into an iPad" by Charles Duhigg & David Barboza on January 25, 2012 in which they cited some of the working conditions:

"Employees work excessive overtime, in some cases seven days a week, and live in crowded dorms. Some say they stand so long that their legs swell until they can hardly walk. Under-age workers have helped build Apple’s products, and the company’s suppliers have improperly disposed of hazardous waste and falsified records, according to company reports and advocacy groups that, within China, are often considered reliable, independent monitors.

"More troubling, the groups say, is some suppliers’ disregard for workers’ health. Two years ago, 137 workers at an Apple supplier in eastern China were injured after they were ordered to use a poisonous chemical to cleaniPhone screens. Within seven months last year, two explosions at iPad factories, including in Chengdu, killed four people and injured 77. Before those blasts, Apple had been alerted to hazardous conditions inside the Chengdu plant, according to a Chinese group that published that warning."

The Daily Mail newspaper (UK) published "Real Toy Story: Chinese Factory Workers Forced to Sleep Among Piles of Doll Parts as They Churn Out Christmas Presents"

in which they point out:  "A report in 2009 revealed that 1 million Chinese factory workers suffered industrial accidents in that year alone (among 3.5 million workers in 8,000 toy factories)" And ... "Mostly female workers, aged 18-25, work from 7:45 AM to 10:55 PM, sometimes with as many as 1,000 workers crammed into one 105-foot by 105-foot room." 

The New York Times reported "Report on Deadly Factory Collapse in Bangladesh Finds Widespread Blame" (by Jim Yardley, May 22, 2013) about 1,127 garment workers killed and building owner and tenant factories' owners indicted: 

"The factory owners urged workers to return to their jobs despite evidence that the building was unsafe, the report said. “They compelled them to start,” said Main Uddin Khandaker, a high-ranking official in Bangladesh’s Home Ministry, who led the investigation."

Then, on June 5, 2013, The Guardian Newspaper (UK) published "Bangladesh Police Open Fire on Collapsed Factory Protest" reporting about a peaceful demonstration by former employees and families of the killed with the demand for the government and their employers to make good on promises of care and back-pay. 

COMPLETING THE 100-YEAR CIRCLE

Finally, on July 15, 2013, Reuters could report that the Bangladesh government passed labor laws that ensure the right to form labor unions, and:

"The legislation puts in place provisions including a central fund to improve living standards of workers, a requirement for 5 percent of annual profits to be deposited in employee welfare funds and an assurance that union members will not be transferred to another factory of the same owner after labor unrest."

So nothing has changed, except where American companies locate the factories. And we let them do it. "Out of site, out of mind."

102 years after the Triangle Waistshirt Factory Fire (in 1911), the same horrendous working conditions in Bangladesh and China garment, toy, and electronics factories are suddenly ... but at least ... being recognized with high-profile press coverage. 

"The only thing necessary for the triumph of evil is for good men to do nothing." 

(Edmund Burke, 1729-1797)

Why did I write this post and write it this way ... long, photos, and in red ...? 

I wrote it long and with startling photos so that you look in the mirror. 

Every time we buy one of the products made by forced labor like this, feel the guilt and shame ... because the company executives won't and because your actions are the only way things will get better for these people.

Think about your grandparents, great-grandparents and other relatives who worked in the sweatshops and workhouses 6-7 days per week, 15+ hours per day. This is what you are supporting every time you buy those products ... and remain silent.

I wrote this post in red (rather than my usual teal) to reflect the blood shed for those who likely made this computer and the blood money profits earned from it.

Stand up. Speak up. 

by Steve Reichenstein

Why ObamaCare Makes Sense: Some Different Facts About the Affordable Care Act

I support ObamaCare -- the Affordable Care Act -- because it reduces health care spending without reducing actual patient care and it provides health insurance coverage to include more than 30-million more Americans so that we near universal health insurance coverage. 

My support for ObamaCare is not ideological, it's practical. "This is not personal; it's business." And, healthcare reform clearly is an urgent priority. 

We all agree that the United States spends the largest share of the largest economy in the world on healthcare ... even more than other members of the Organization of Economic Cooperation and Development, a group of developed industrialized nations of which U.S. is a member. More than 10% of American citizens and permanent residents are uninsured.



(Above graphs compare U.S. healthcare spending versus the complete Organization for Economic Cooperation and Development ... of which the U.S. is a member)

Uncompensated Care: Health care for the uninsured and under-insured.


Currently, we pay for the health care of the non-insured and under-insured in our own higher health insurance premiums due to charity care at hospital emergency rooms and lost economic productivity.

In it's healthcare reporting, JustFacts.com : Uncompensated care spending amounted to 6% of hospitals' 2009 total costs. The U.S. Federal Reserve Bank estimated that, in a 2003 bulletin "Overview of Consumer Data and Credit Reporting", that 52% of all collections by agencies and creditors was for healthcare bills.

The 2008 Kaiser Family Foundation (www.kff.org) study "Covering the Uninsured: Key Facts" estimates spending on the uninsured was $57.4-billion -- of which $42.9-billion (or 75%) was paid by federal and state funds, mainly through Medicaid payments to hospitals, and that $14.5-billion (or 25%) was paid by private funds, mainly  physicians and hospitals, and that this $14.5-billion represented nearly 2% of the $829.9-billion spent by insurance plans. 

McKinsey & Company, a major consulting firm as published several research articles on the health care trends and technologies -- here now and emergent -- that support the premises of the Affordable Care Act on continual, significant cost savings through productivity and outcome savings. 

Industry association America's Health Insurance Plans (AHIP) reports that "A 2009 study by Families USA (a health care consumer group) found that uncompensated care costs in 2008 imposed a "hidden tax" on family health coverage of $1,017 (per family)."

The 2009 study goes on to say: "As more people join the ranks of the uninsured, the hidden health tax is growing,' said Ron Pollack, Executive Director of Families USA. “That tax hits America’s businesses and insured families hard in the pocketbook, and they therefore have a clear financial stake in expanding health coverage as part of health reform.”

Together, the point might be made that we already pay for uncompensated care -- health care for the uninsured -- through higher taxes and insurance premiums. Also, the current spending on health care for the uninsured is not cost-effective (inefficient) because it's so heavily weighted on hospital use for primary care and late-stage care for undetected & untreated care.

ObamaCare is not a government take-over of our health care system.

The Affordable Care Act actually is a boon to private insurance companies -- in terms of the numbers of paying insureds and in terms of more efficient application of the basic premise of insurance: Based on the statistical Law of Large Numbers, many people pay premiums so that those among them who happen to need expensive treatment will be able to afford it.

The Basic Premise of Insurance in Health Insurance.

During the Great Depression of the 1930's, physicians and hospitals suffered, as did American families, because most people could not afford to pay out-of-pocket for sick care treatments ... because of the depression. So, Blue Cross and Blue Shield were born: Originally, one for physician insurance and the other for hospital insurance. 

However, a comprehensive insurance system like the Affordable Care Act has to work fully in order to work efficiently ... as soon as possible. 

       

I question why the Obama Administration continually issues waivers and delays implementation of the Affordable Care Act. And this is the central issue of this post. 

Comparison of Implementation Time for ObamaCare vs. Y2K

Compare the ObamaCare situation to the challenge presented by Y2K -- just 15 years ago. every company had to change the dates part of every software from a 2-digit year to a 4-digit year by the year 2000 because, during the 1960's and 1970's, in order to be minimize development costs, software was programmed to accept the last 2 digits of the year and start again at 1900 ("00") after 1999 ("99"). Government feared nuclear launch glitches and companies feared erasing of all their records since 1900!!

Updating for Y2K became a high-profile only 2 years prior to the big day!! The big software investments and rush to prepare for Y2K began in earnest in 1998. 

                                                  

Changing the software for nearly every computer in America (perhaps the world) was achieved in just 2 years!!!!!!!!!!!!! 

Health insurers and employers have had 3-4 years to prepare software and decisions for implementation the Affordable Care Act ... Obamacare ... yet all businesses, worldwide, had 2 years to prepare software for Y2K. Even the governments, like our Defense Department, raised the Y2K issue in 1998 and their 1999 budget requests.    

The Y2K "bug" was a huge issue and challenge!! It dominated the news from 1998-2000. Jobs and spending to repair-prepare legacy systems directly boosted the economy. For example, even supermarkets, like Whole Foods, spent a fortune on it.

So why has 3+ years for health insurers and employers not been enough time for simple, available software programs to be implemented for Affordable Care Act ... Obamacare ... ??

Think about it. Personal health records and physician-hospital-insurer-employer electronic medical records (EMS software) have been around ... and booming businesses for several years!!! 

Healthcare providers have been living with the federal mandate to implement electronic medical records.

Since 2011, the federal government also has imposed penalties as of 2014 but also immediately offered financial incentives ... up to $44,000 for a family medical practice ... to help the millions of physician practices afford to implement "significant use" of electronic medical records EMR.

So what's the real problem?



My opinion

Rescind all of the waivers. The Affordable Care Act ... Obamacare ... should continue to implement as enacted.

by Steve Reichenstein