Michael Berson in a recent post quotes a twitter exchange that asks Rep. Vicky Hartzler (R-4) to essentially put up or shut up when it comes to Obamacare by specifying how she would replace it. Surprise, surprise – Harzler is prepared for just such querries:

West-Central Missouri Representative Vicky Hartzler admits that the Republican party may have spent too much time battling the Affordable Care Act. But now, she’s cosponsoring an alternative bill. It’s called the American Healthcare Reform Act. [i.e.,H.R 3121 (pdf)].

“Our plan would allow more competition across state lines and more individual control over decisions between doctors and patients. It would also allow for some tort reform, which is a real cost driver. It also supervises ways for people who can’t get insurance to access it through high-risk pools,” she said.

Seems to me that I’ve heard these proposals before. Weren’t these the best ideas that John McCain could manage? And, of course there was the three-page alterntive to Obamacare that Roy Blunt and his GOP working group produced way back when, which might have hit the same high (or low) points if I remember correctly. The points Hartzler specifies are simply those every GOP hack flourishes when put on the spot about an alternative to Obamacare.

The most recent of those hacks to pull out the tried-and-true GOP healthcare wish list is Sarah Palin – or at least I think that was what she was trying to do during a typically incoherent interview with Matt Lauer yesterday:

The plan is to allow those things that had been proposed over many years to reform a health-care system in America that certainly does need more help so that there’s more competition, there’s less tort reform threat, there’s less trajectory of the cost increases, and those plans have been proposed over and over again. And what thwarts those plans? It’s the far left. It’s President Obama and his supporters who will not allow the Republicans to usher in free market, patient-centered, doctor-patient relationship links to reform health care.

Hunh? “Less tort reform threat”? At least we now know how Vicky Harzler differs from Sarah Palin. Both espouse the same silly ideas but one of them speaks English.

And the ideas in H.R 3121, which it’s safe to assume Palin would endorse, are silly, especially when presented as an alternative to systematic reform. Some are harmless bits of fiddling that  would have minimal impact on the problems of our healthcare delivery system, others are downright harmful, and some are simply gifts to the insurance industry – purchasing insurance across state lines, for instance. As formulated in HR3121 it seems to me that the point is to permit out-of-state insurers to flout state-based consumer protections in the name of competition.

Consider also the GOP standby, tort reform. HR3121 follows the usual pattern of instituting caps on non-economic and punitive damages. It also allows the court discretion to redirect attorney’s fees to clients in some cases. According to Adam Dawson, who has analysed the results of a similar reform in Texas, “tt’s a terrific plan, except for the fact that it’s a terrible plan.” Some of the most salient results of the Texas experiment:

One of the more optimistic predictions was that doctors would simply stampede to Texas in order to set up practice thanks to Governor Perry’s legal protections. But the latest info from the American Association of Medical Colleges has Texas ranking 42nd in the country in doctors per 100,000 people. […]

Also torpedoed by the facts is the notion that tort reform causes health insurance premiums to drop. Between 2003 and 2010 the average price of a health insurance premium for an individual in Texas went up 46 percent, and the average price of a family health insurance plan in Texas went up 52 percent. As if that wasn’t enough of a sign that tort reform hasn’t helped make health care cheaper, Texas had one of the highest rates of uninsured people in the country in 2010. […]

[…] in McAllen, Texas, Medicare costs per person are actually higher than the median income of the people who live there. While doctors might no longer fear lawsuits, it seems they are also not at all afraid of sending big, fat, test-laden invoices to Uncle Sam or insurance companies. It doesn’t seem to be “defensive medicine” as much as it is an amendment to the Hippocratic Oath: “First, do no harm. Second, daddy needs a new pair of shoes.”

It is absolutely true that medical malpractice cases have dropped drastically in Texas, but doctors and surgeons are making just as many mistakes as they always have. It’s just that now most of the victims have been priced out of the courtroom. […]

HR3121 also, as Hartzler noted, proposes high-risk pools as a way to answer criticisms that our current system leaves those with pre-existing conditions without coverage.  High-risk pools were one of the centerpieces of John McCain’s healthcare proposals and, as I recollect, nobody was too impressed then, nor should they be now, Our experience with high-risk pools in the past has shown that they are not very effective in providing health care; they tend to be prohibitively expensive and often offer inadequate coverage. Many individuals are expected to get better deals by leaving existing state-run high-risk pools and purchasing insurance through the Obamacare exchanges.

All of which brings me back to the difference between Vicky Harzler and Sarah Palin. Their similarities are actually more important than their differences since in GOP circles whether or not one can manipulate English syntax is not so important as being able to get all the buzz words out in public as fast as possible. And when it comes to generating empty noise, both women get a gold star.

*Edited slightly for clarity.

In response to a Twitter post by Representative Vicky Hartzler (r):

Bob Yates ‏@OldDrum

@RepHartzler What is the Republican replacement? Back to having insurance companies denying coverage to people with pre-existing conditions? 11:07 AM – 8 Nov 13

John Schultz ‏@theknobboy

@OldDrum @RepHartzler Auto and life insurance is based on previous behaviors and lifestyle, why not health insurance? 1:19 PM – 8 Nov 13

One of those things is not like the others.

Bob Yates ‏@OldDrum

@theknobboy @jeeastwood63 @RepHartzler I forgot that people born with genetic illnesses are at fault. Thanks for reminding us. 7:21 AM – 9 Nov 13

Uh, yep.

A rather innocuous tweet about University of Missouri football from Representative Vicky Hartzler (r):

Rep. Vicky Hartzler ‏@RepHartzler

Survey: With Maty Mauk doing so well should Coach Pinkel resinstate James Franklin once he’s recovered from his shoulder injury? 11:11 AM – 9 Nov 13

And this response:

carl klopfenstine ‏@Carl23b4

@RepHartzler To hell with you Vicky ,you’re a traitor 12:51 PM – 9 Nov 13

Alrighty then.

It’s their world, the rest of us get to live in it.

Previously:

The good news and the bad news for Democrats in Missouri (November 9, 2013)

Representative Stacey Newman (D) in the House Chamber. [file photo]

Representative Stacey Newman (D) succinctly summed up the prospects:

….Remember those old worn-out legislative themes during election years?  They will be slightly altered for 2014.

Guns, Voting Rights and Attacking Women

These are the new and improved GOP legislative priorities for next year. Coincidentally, they have been my main legislative focus – fighting back against these extreme type of bills since I was first elected in 2009.

Even though the 2014 session doesn’t kick off for 2 whole months, I am preparing now for anticipated bills…policies strictly designed to incite Tea Party GOP base voters in an election year.

Pre-filing of 2014 bills does not officially open until December 2nd.  However, action has already begun

1.  “The Worse Gun Bill in the Country”

It’s back, this time courtesy of Sen. Ron Richard (R-Joplin), one of the 2 senators who upheld the governor’s veto on HB436 in September, causing the “most extreme gun bill in the country”, as referred to by national media, to fail.

Sen. Richard announced last week he plans to file an almost identical bill next session, with the very same title, “The Second Amendment Preservation Act”.

Huh??

[….]

2.  Hang On to Your Voting Rights

Paying attention to the voter suppression efforts in GOP states: Ohio, North Carolina and Texas?  Keep your eyes open because voter suppression is coming back to Missouri. Again.

For the ninth straight year, the GOP in Missouri is expected to file Voter ID bills designed to make it tough (even prohibitive) for elderly, the disabled, working poor, students and women to continue to vote.

It is a two part process.  First we must change our MO Constitution by a vote of the people to allow Voter ID and then we must pass a companion bill which would determine how it would work.

The GOP’s plan is to put the Voter ID referendum on the November 2014 ballot in order to affect the 2016 Presidential Election.  You should know the drill by now. If you can’t legitimately win elections in the voting booth, then you try other measures.  Voter ID proposals are strictly partisan with every Democrat in Missouri and other state legislatures consistently voting against them.

[….]

3.  Attacks on Women’s Reproductive Health

Keep your seatbelt fastened.  Unbelievable restrictive bills interfering with medical decisions that belong between a woman, her partner and her physician are popping up in state houses all across the country.  AND they are becoming more and more extreme.

[….]

I’m ready for our own Extreme Anti-Women bill next session, whichever one Speaker Tim Jones decides to push.

[….]

[emphasis in original]

Uh, yep. The agenda of the right wingnut republican majority in the Missouri General Assembly is nothing if not predictable.

Bill prefiling starts in twenty-four days.

We can’t wait. It’s just like the anticipation of opening those holiday gifts – with the only possible payoff being lumps of coal.  

Duane Graham of The Erstwhile Conservative is disappointed in what he sees as the signs of the times embodied in Tuesday’s off-year elections. He concedes that it’s good that Democrat Terry McAuliffe beat right wing Republican Ken Cuccinelli in purple Virginia’s gubernatorial race, but he’s not too impressed with the margin of victory, 47.8% to 45.3%, especially since the Republican was so extreme that, among other signs of left-brain impairment, he “thought launching a website to help keep Virginians safe from sodomy was a great idea.”

Blue Girl here at SMP is also disappointed about the elections, specifically about the defeat of a sales-tax issue in Jackson County, and I think that she’s getting closer to the reason this election should make progressives uneasy when she attributes the reason for the defeat of Jackson County’s medical tax to “the fact that less than fifteen percent bothered to turn out and vote.”

We now have some verification that the low-margin of victory  in Virginia that leaves Graham feeling worried was the result of the same phenomena Blue Girl laments in Jackson County. As Kos of the DailyKos put it in his analysis of the McAuliffe’s narrow victory in Virginia, “we can’t win big if our people don’t vote.”

Getting Democrats out to vote is the big issue somebody’s going to have to tackle between now and 2014. You’d think it wouldn’t be that difficult. Who wants crazy politicians representing them? And if we’re correct in the belief that Todd Akin handed the 2012 election to Claire McCaskill simply by revealing himself as a radical anti-woman lunatic, it’s equally true that many of the state’s Republican politicians have been working overtime to make the point that there are plenty more like Brother Todd down on the farm. Just ask Vicky Hartzler about what the Chinese are doing with toasters if you doubt me.

There’s certainly no shortage of evidence that GOP lunatics are running the asylum when it comes to Jefferson City. What they have done – or ineptly tried to do – has often served as fodder for the laugh of the day in the national news outlets. A stroll down memory lane dedicated to the last year or so would find such icons of rightwing goofiness as proposed laws dedicated to protecting us from Sharia law and Agenda 21, unconstitutional efforts to nullify federal laws, efforts to suppress access to contraception, goldbuggery, even legislation that would make it illegal to legislate.

What they haven’t done is equally nuts. As the St. Louis Post-Dispatch noted earlier this year in an effort to explain the “party of no” label it had been emphasizing, Missouri’s Republians are nothing if not consistent: “No to health care. No to reasonable gun laws. No to cutting tax credits. No to equal rights. No to ethics reform.”

So, given these high levels of the crazy combined with ineptitude, you’d think 2014 and 2016 would be a waltz for Democrats, wouldn’t you? But maybe not. Democrats will still have to contend with gerrymandered districts made up of those die-hard GOPers who have bought lock, stock and barrel into the story about the Kenyan black man in the White House who wants to take their guns and stick them in concentration camps where they’ll be brainwashed until they’re willing to Sieg heil the communist overlords.

There are, however, sizeable pockets of sanity. I’m willing to bet that sprinkled throughout the state there are lots of reliable Republican voters who may not pay much attention to politics but have stayed with the GOP because it’s a personal or family tradition and they haven’t yet realized or they’re in denial about how crazy it has become. And finally there are all those citizens who would vote Democratic if they only ever made it to the polls. If there’s going to be any changes for the better in Missouri, somebody’s going to have to get the good word out to all these groups in a forceful enough fashion to get them all revved up to trash the crazy by, dare I suggest, next year.

Senator Claire McCaskill and Governor Jay Nixon, the top of the Democratic hierarchy in Missouri, may be fine people and are certainly preferable to their past Republican opponents, but they are, to put it kindly, somewhat lackluster and instead of helping to energize Democrats in Missouri, have concentrated on not poking the Tea Party wingers with sharp objects lest they bite. Good for them, but doesn’t do much to raise the kind of enthusiasm about the issues that brings folks out to vote.

Roy Temple, the new Chair of the state Democratic Party may – just possibly – offer some grounds to hope that a nearly moribund party can get it going again. Word is that he is aggressive and professional with lots of  hard-core experience – although some of it, like the inept Missouri Kerry campaign, may be a bit questionable. He does, though, seem to understand the need to address the dynamics of what he correctly identifies as 20 years of Democratic decline in Missouri.

There’s lots to do. Money to be raised. Effective, targeted, non-stop messaging machines to construct. The unions have worked well with the Democratic party in the state. Are there other organizations where joint efforts can be coordinated better? What about all those Democratic clubs and organizations? I can think of several in the St. Louis area alone – just teeming with Missourians who want to help, but don’t necessarily know how to do it in the most effective way. If Democrats in the state get going now, maybe they can begin to help pull Missouri out of its GOP doldrums. And then we can all sit back and watch pigs soar through the empyreum.

*Slightly edited for clarity.  

Today, at the Missouri Ethics Commission:

C031159 11/08/2013 MISSOURIANS FOR KOSTER Ameren Missouri PAC PO Box 780 Jefferson City MO 65102 11/6/2013 $10,000.00

C031159 11/08/2013 MISSOURIANS FOR KOSTER Operating Engineers Local 101 Political Action Committee 6601 Winchester Suite 280 Kansas City MO 64133 11/6/2013 $10,000.00

C031159 11/08/2013 MISSOURIANS FOR KOSTER RightCHOICE Managed Care, Inc. PO Box 68086 Cincinnati OH 45206 11/6/2013 $10,000.00

[emphasis added]

2016 and beyond.

193,420. That’s the number of uninsured Missourians who would have qualified for coverage if the state’s Republican lawmakers had accepted federal funds to expand Medicaid under the Affordable Care Act (ACA). These jokers turned down the chance to recover a big enough chunk of the tax dollars that we Missourians send to Washington D.C. to pay 100% of the expansion for three years and 90% thereafter – and, no matter what they do in the future, they’ve already cost us the first year’s 100% free ride.  

Put another way, 193,420 is the number of Missourians that we know for sure will pay the price for the Republican anti-Obamacare tantrum. The actual number is probably higher given other aspects of GOP ACA obstructionism in the state – refusing to create a state exchange, attempting to sabotage the “navigators” who have been hired to help people sign up, and, of course, the constant barrage of GOP lies and distortions about Obamacare.

The source of 193,420 number is this interactive map from a TPM report. If you take a look at it, you’ll note that the only state bordering Missouri that has also failed its ACA Medicaid eligible population is Kansas, one of the few states heading to the bottom faster than Missouri. Will somebody tell Missouri’s legislators that this is not a competition we want them to win?

Of course, it’s likely they won’t care. As the article’s author, Dylan Scott, observes:

… it’s the poorest people who make up those 4.8 million [nationwide] who are missing out. Because of a kink in the law’s language, people between 100 and 133 percent of the poverty level will still be eligible to receive financial help to purchase private coverage on the insurance marketplaces that opened Oct. 1.

But those actually in poverty will be out of luck.

And of course, the very poor are the same people our Republicans seem to have been either ignoring or targeting with destructive legislation for several years now.

Nevertheless, you could let your state rep know if 193,420 unnecessarily uninsured Missourians  not only upsets you but leads you to view his or her performance less charitably. Governor Nixon has called a meeting on Nov. 26 with the two legislative committees that  have been “studying” the Medicaid expansion issue (like it needs more study). He framed the meeting as important because Missouri’s health care system “falls short ‘delivering the quality, affordable and accountable care Missourians need and deserve.'” Messages from constituents reiterating that claim, perhaps leavened with a little – polite but righteous – indignation, might help him make that case on the 26th.

 

The retail price of gasoline in west central Missouri this morning:

Previously:

It upsets right wingnuts… (November 4, 2013)

Thank goodness that Keystone pipeline is up and running (October 28, 2013)

We’re on an express elevator to…going down (October 14, 2013)

Water is wet (October 9, 2013)

Rep. Vicky Hartzler (r): we don’t need no stinkin’ objective reality (January 21, 2012)

Rep. Vicky Hartzler (r): not especially prescient (January 9, 2013)

Rep. Vicky Hartzler (r): strange silence, still (December 19, 2012)

Quick, blame Obama! – part 3 – trickle down (December 8, 2012)

Quick, blame Obama! – part 2 (December 5, 2012)

Quick, blame Obama! (December 1, 2012)

Rep. Vicky Hartzler (r): make it stop… (November 18, 2012)

Rep. Vicky Hartzler (r): the price keeps dropping and we’re running out of gas puns (November 15, 2012)

Rep. Vicky Hartzler (r): on an express elevator… (November 12, 2012)

Rep. Vicky Hartzler (r): wait, wait, don’t tell me (November 8, 2012)

Vicky Hartzler (r): it’s so quiet when the price keeps dropping (October 31, 2012)

Vicky Hartzler (r): What’s that? Did you say something? Apparently not. (October 29, 2012)

Vicky Hartzler (r): the sound of silence (October 23, 2012)

The past, the gas, and isms (September 24, 2012)

Rep. Vicky Hartzler (r): let’s pass the gas – part 2 (June 6, 2012)

Rep. Vicky Hartzler (r): let’s pass the gas (May 27, 2012)

We’ve been noticing these contributions, via the Missouri Ethics Commission:

C131133 09/20/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Industry Advancement Fund 3101 Broadway Ste 780 Kansas City MO 64111 9/19/2013 $14,167.00

C131133 09/20/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Industry Advancement Fund 3101 Broadway Ste 780 Kansas City MO 64111 9/19/2013 $12,500.00

C131133 10/08/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Site Advancement Foundation 2705 Dougherty Ferry Rd Suite 203 St Louis MO 63122 10/8/2013 $9,333.45

C131133 10/15/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Associated General Contractors of St. Louis 6330 Knox Industrial Dr St Louis MO 63139 10/15/2013 $17,333.35

C131133 10/21/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Industry Advancement Fund 3101 Broadway Ste 780 Kansas City MO 64111 10/18/2013 $11,166.67

C131133 11/01/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Missouri Construction Industry Advancement Fund Po Box 94 Jefferson City MO 65102 10/31/2013 $26,666.66

C131133 11/06/2013 MISSOURIANS FOR SAFE TRANSPORTATION & NEW JOBS INC Associated General Contractors of St. Louis 6330 Knox Industrial Dr St Louis MO 63139 11/6/2013 $7,258.33

[emphasis added]

Interesting odd amounts. It adds up to a total of $98,425.46.

It’s a new committee, working toward placing a transportation sales tax on the ballot in 2014:

C131133: Missourians For Safe Transportation & New Jobs Inc

331 Madison Street Committee Type: Campaign

Jefferson City Mo 65102

[….] Established Date: 09/16/2013

  Termination Date:

Treasurer Deputy Treasurer

Bill Mckenna Jewell Patek

331 Madison St

Jefferson City Mo 65102

[….]

Ballot Measures Election Date Subject Support/Oppose

Transportation Funding Initative 11/04/2014 Shall The Voters Increase The Sales Tax By One Cent Over 10 Years To Fund Improvements To The State’s Highway System & Other Transportation Projects./Statewide Support

[emphasis added]

From the proposed text [pdf] it looks like it’s about highways, roads, bridges and sufficiently broad language to allow other transportation stuff.