The Cornered Canine

GREEN EGGS AND HAM: Without Dr. Seuss, there would be ​— ​could be ​— ​no Bob Dylan. Likewise, hip-hop would not ​— ​could not ​— ​ever exist. For my money, Dr. Seuss ​— ​a k a Theodor Geisel ​— ​belongs on the same jammed pedestal of American letters as Mark Twain and Bill Watterson of Calvin and Hobbes fame. For generations, the good doctor ​— ​not really an MD ​— ​provided the subliminal psychic metronome by which so many of us explored the exhilaration of our own twisted syncopations. So when I saw Senator Ted Cruz, the one-man Texas Tea Party, pimping out the Dr. Seuss masterpiece Green Eggs and Ham as part of his faux filibuster against Obamacare last week, I was inclined to grind my teeth a few miles past the gum line. Certainly the ironies overflowed up like a backed-up toilet. In real life, Dr. Seuss was as progressive as they came and would have no doubt winced at the reactionary hysterics of Cruz and his coconspirators. At its core, Green Eggs was a cautionary tale against digging in one’s heels and just saying, “No.” With Cruz and other Congressional Republicans having now voted to repeal the Affordable Care Act no less than 42 times ​— ​each time with no hope of success ​— ​clearly they have not taken that message to heart. In fact, it’s impossible to imagine that the self-proclaimed Texas Tornado ever cracked the book’s spine, let alone ever read it to his kids. Given that the Tea Party members and Republicans in Congress saw fit to shut down the federal government over Obamacare ​— ​on the very first day the health-care exchanges created by the Affordable Care Act were open for customers ​— ​these insults have become mere incidental details to the more profound injury inflicted by the sublime dysfunction of Congress. Little wonder the popularity of that legislative body ​— ​now at 10 percent approval ​— ​has plunged lower than that of a colonoscopy.

For something supposedly so heinous, there was a striking abundance of interest among Californians about signing up for the new insurance exchanges on day one (but the new law doesn’t go into effect until Jan. 1). Most news outlets report there were 2.8 million e-mail hits, causing the system created by Covered California to crash or freeze multiple times. Like many of my knee-jerk ilk, I regard the passage of the Affordable Care Act as a genuinely historic and imperfectly positive achievement. That’s not to say it won’t be a huge mess. It absolutely will be. At least for a while.

Along the Central Coast, an estimated 58,000 people will benefit by vastly improved health care access because of the Affordable Care Act. About 30,000 will now find themselves eligible for Medi-Cal coverage for the first time. That’s because the eligibility rules were expanded to include people who make 138 percent the federal poverty level. Given that the cutoff had previously been no more than 100 percent of poverty ​— ​defined by the feds as $11,000 for a single individual ​— ​we’re talking seriously poor. The other major good news is that 28,000 locals now without insurance will be eligible to sign up for one of the two insurance exchanges set up in Santa Barbara. Yes, insurance will be mandatory. But so is car insurance, and I don’t see the Tea Party going to the barricades because city cops issue approximately 1,029 citations a year to motorists for driving without proof of insurance. Yes, it will cost, but even families earning up to $95,000 a year can get subsidies.

The whole plan hinges on the availability of primary care physicians of which we have a national and local shortage. It came as a huge shock to me to find out that Sansum Clinic ​— ​by far the biggest outpatient care provider in the county ​— ​is not part of this new exchange system. Sansum CEO Kurt Ransohoff told me that he’d always assumed Sansum would be involved, but that as recently as a few weeks ago, Sansum was never approached by either of the two exchange providers, Anthem Blue Cross or Blue Shield. At that time, he said Sansum approached the providers, only to be informed that Sansum was excluded. Sansum, it was explained, had failed to respond in a timely manner to an inquiry the providers had sent out. Ransohoff said Sansum has no records of any such inquiries having been made. Since then, he said Sansum and the exchanges have been talking multiple times a week. But the problem, it turns out, goes well beyond the my-dog-ate-my-homework variety. Ransohoff said the reimbursement rate the exchanges were offering to pay Sansum for treatment provided fell well below the line of economic sustainability. He said Sansum was willing to eat some form of discount but said what the exchanges were demanding was beyond huge. There are many primary care docs outside the Sansum orbit, but many are already booked solid and are likewise leery about the low rate of return offered by the exchanges. Cottage Health System, it should be noted, has signed a contract with the Blue Cross and Blue Shield exchanges, but hospitals are not in the business of outpatient care, despite the intense use of emergency rooms by those without insurance. It’s assumed by many medical professionals that the Santa Barbara Neighborhood Clinics will provide primary care for many of these new patients, and maybe that’s the case. But it’s worth remembering that the Neighborhood Clinics have been bleeding hundred-dollar bills and are currently undergoing emergency intervention. Despite all the optimism expressed over the changes being made, it remains to be seen the extent to which they can shoulder the load. Like I say, there are a lot of bugs still to be worked out. How that happens I don’t pretend to know. I am certain, however, you can’t get from here by shutting down the federal government and voting ​— ​42 times ​— ​to repeal Obamacare. As a start, I’d suggest Senator Cruz and his cohorts reread Green Eggs and Ham. Better yet, read it for the first time.