Archive for June 2017

Disillusioned And Lost

June 29, 2017

When Senate Leader Mitch McConnell spoke to reporters yesterday announcing there would be no “repeal and replace” vote before the July 4th holiday, the look on his face and the tone of his voice said it all. “How did the Senate get to this point?”

McConnell telegraphed no shame over a bill that gave huge tax cuts for the wealthy, allowed individual healthy Americans to “game” the system by not buying insurance (driving up insurance cost for everyone else), and reduced coverage (via Medicaid) for the most vulnerable Americans. Rather, McConnell was despondent because his Republican majority would not agree to pass the bill.

Several Republican Senators stressed that Medicaid was not being cut but rather would not increase as much as healthcare costs are rising, and about a third of the cost was being transferred to States. In other words, instead of the Federal Government raising taxes from all Americans and distributing this money to those who qualify regardless of where they live, the Republicans are saying, “if your State is willing to raise State taxes, then Medicaid can be offered. It is a State decision to cut Medicaid unless the State agrees to fund.” Hmmm.

There is a legitimate issue around how to fund healthcare (including Medicare and Medicaid). Currently the payroll taxes do not cover the entire amount of Medicare and Medicaid expenditures and the excess is simply added to the national debt.

At the root of this problem is a fundamental disagreement on whether healthcare access is a right or a privilege. There should be no confusion in either case, healthcare must be paid for by someone. The question is what is each persons share and what methods would be used to collect this money.

One party, however, is comfortable with the proposition that you only get as much healthcare coverage as you pay for while the other party is comfortable with everyone getting basic healthcare coverage but it is ok to put the bill on the charge account (Federal Debt).

The greater concern for Republicans seems to be their worry about what voters will do? Rather than looking what other modern countries are choosing for healthcare, Republicans are united only around eliminating the tax aspect of the Affordable Care Act. Republican division arises cruelly on just how many of the ACA benefits should be cut. Hmmm.

Americans are disillusioned and the GOP is lost.

Deeply Held Religious Freedom

June 26, 2017

Hmmm. The Supreme Court has agreed to hear on appeal a case where a cake maker refused to serve a gay couple who wished to purchase a decorated cake for their wedding.

The baker claimed that his deeply held religious views would be compromised because the bible and his religion instructed him not to recognize homosexuality. The Supreme Court will now weigh in on whether religious rights can justify discrimination.

When I think about religion, the first thought that comes to mind is, ”love your neighbor as yourself”. So it seems to me incomprehensible how a serious religion can say, “hold on a minute, the Bible did not mean all neighbors”.

Regrettably, too many religions find it useful to divide and conquer the masses. By assigning “good” to some and “bad” to others, religious leaders can more easily influence the congregation’s direction, and not to be overlooked, the congregation’s gift giving (to the religious leaders). So one might be justified to suspect to any claim of “deeply held” religious views.

If a black person went into any store and when they requested a service, they were told that store does not serve black people, would there be a question that his behavior was illegal? And the same can be said about a Christian denying service to a Jew, or a Jew denying service to a Muslim. So what is it about homosexuals who want to celebrate their marriage?

Mormons were once upon a time excited about having multiple wives. Federal law prohibits that practice and did that Federal law not go against deeply held religious views?

Jehovah Witnesses do not believe in blood transfusions. Yet courts have ordered blood transfusions when medically necessary to save a life viewing the refusal of a blood transfer to be scientifically unfounded and tantamount to committing suicide.

Arguments before the Supreme Court will not take place until the Court’s new term in October. Between now and then, the public could boycott this religious baker and help this religious person reap the benefits of his deeply held views.

Living Ones Priorities

June 25, 2017

The “repeal and replace” saga, brought to America by the Grand Old Party (GOP) clearly underscores the priorities of Party leaders, and dare I say, the big money interests who make it all happen. So why are Republicans against healthcare?

The answer is Republicans are not against healthcare, healthcare just gets in the way of what they seek.

The Affordable Care Act is only a slight variant of what the US has had for decades. Health insurance companies are the same, hospitals are the same, doctors are the same, and drug companies ditto. ACA changed the individual market’s healthcare delivery model by specifying “essential” healthcare services which must be covered for a healthcare policy to be eligible for government subsidies. (No more catastrophic only policies).

ACA defined what “basic” healthcare might be. For non-group policy holders, these individual consumer could purchase one of three types of policies, each differing only in price and amount of co-pay/deductible.

ACA also added a new route to providing healthcare insurance coverage. ACA expanded the eligibility definition for Medicaid and found millions of Americans who previously could not afford basic healthcare and had not qualified for Medicaid.

What could be so wrong about ACA (Obamacare) to drive Republicans to focus so strongly on repeal and replace efforts?

We hear much about the price of individual policies with year over year huge increases in premiums. But for those who earn more than certain amounts and do not qualify for subsidies, that is a problem. Surely, however, there are other means to convince insurers to set more reasonable rates. (Remember these same insurers who are announcing their withdrawal from certain States’ individual policies market are still quite happy to cover “group” plans in the same States.)

We also hear about returning healthcare to “patient centered” insurance and removing “government” from the place between the patient and their doctor. Hmmm. And what is the difference in substituting a for-profit insurance company as the middle person?

The American Heath Care Act negotiations are illustrative. With control of both the House and the Senate and the White House, Republicans have looked impotent in passing a replacement law. Why?

Well, it turns out that Americans overall have found Obamacare a step forward versus what preceded it. As the debate has unfolded. Americans are learning that Republicans are more intent on sharply reducing Medicaid both as an adjunct to Obamacare and as a stand alone program. It is beginning to dawn on Americans that Medicaid is very important program paying for about half of all births.  I wonder why so many Americans cannot afford healthcare insurance with pregnancy benefits? Medicaid is also critical to treating the Opioid crisis and for nursing home assistance for the elderly. And yet the Republicans are pressing on. Why?

Could it be the GOP is single-mindedly focused upon tax cuts?

Replacing Obamacare comes with a $200 million tax cut for the wealthy. The Trump/GOP’s tax reform (code for tax cuts), a separate piece of legislation, will represent billions in savings for the wealthy. Hmmm.

Back to the current Senate AHCA debate. Most Senators are aware that cuts to benefits (like eliminating pre-existing condition coverage) are very unpopular with constituents. They are now learning that critical health services are tied to Medicaid coverage. So, if AHCA keeps most or all of ACA benefits and ends the individual mandate while eliminating the associated taxes, the AHCA will cost the government more than ACA now does. Hmmm.

At this hour, the Washington soap opera is still underway. There are more than enough “no” votes to preclude Senate passage of AHCA 1.5. No matter how many times President Trump tweets that “it’s a great plan”, “people will love it”, or “AHCA is another campaign pledge kept”, certain facts remain.

Any ACA replacement which includes tax breaks for the wealthy will by budget necessity, also bring Americans less benefits at higher costs and fewer insured. Hmmm.

I guess if you number one priority is tax cuts for wealthy individuals and corporations, healthcare doesn’t really matter.

Worrisome People, Worrisome Proposal

June 23, 2017

On June 21, 2017, Dick and Liz Cheney penned an op-ed article in the Wall Street Journal. The subject, “Congress and Obama Depleted the Military”. Catch your breath, the Cheney’s are back and just as sure they are right again.

The article points to 8 years of President Obama and 6 years of Congress’ Budget Control Act as the prime culprit behind a “sagging” US military. One might think there has been a time warp or a cerebral malfunction since the Cheney’s seem unable to recall relevant history and Republican involvement. I wonder why?

The Budget Control Act stems from a partisan budget and deficit standoff. Congress’ inability to pass any budget and facing a Government shut down, prompted Congress to pass legislation which said in the event of budget cuts, these cuts must be done proportionally across all budget items including Defense. Noteably this Act only applied to “discretionary” items omitting Medicare, Medicaid, or Social Security. Conservatives have howled about this agreement for the past 6 years.

We should recognize that US Defense spending amounts to almost $600 billion each year, several multiples of any other country and roughly 1/3rd of the worlds total. Recognize also countries such as China and Russia, combined are only a third of the US expenditure. So assume for a moment, the Cheneys are correct in pointing out deficiencies in the US Defense position, one ought to first ask how is that possible with so much total spending?

The Cheney’s appear conveniently forgetful that it was none other than Vice President Dick Cheney who got the US into nation building in Afghanistan and into a failed invasion and occupation of Iraq.  Most estimates put both of these endeavors’ cost in the trillions of dollars level.  Both of these ventures have yielded none of the promised goals.

The Bush Vice President, more than anyone else is responsible for the wheels coming off the Middle East wagon and creating a power vacuum which is consuming our military’s time and resources. But sometimes people forget those things that don’t support their current agenda.

Today’s world is a different place from 2004 when the US invaded and occupied Iraq. China has become a formidable military force and shows little signs of ceasing its military growth. Russia, also a nuclear country, is stronger and more focused under Vladimir Putin than it was in 2004.

The US should rightly be concerned about security concerning both of these countries. But the answer can’t be simply to rebuild the traditional armory (ships, planes, troops) and think China and Russia will be intimidated.  What about cyber and space warfare? The US must get smarter and while maintaining strength, must use foreign policy, economic influence, and diplomacy to greater degree.

And I wonder if the Cheney’s are aware that the Trump Administration has proposed sharp cuts in State Department funding? Do the Cheney’s realize that the Trump White House has threatened more than once to use trade as a negative foreign policy tool? Trade restrictions, historically, has been one of the fastest ways to generate armed conflict.

The Cheney “op-ed” piece is a thinly veiled attempt to promote Ms Cheney as a tough conservative who needs to be considered for future positions of greater responsibility.

Hmmm.

If this happens, Americans should expect Dick Cheney 2.0 and advance Ms Cheney at their own peril.

Healthcare Math

June 22, 2017

News reports quoting prominent Republicans say Republicans are worried, because the healthcare industry makes up about 1/3 of the entire US economy. Rash cuts might kill the golden “jobs creation” goose. Hmmm.

This is a mind boggling statement for Republicans to admit. The GOP ran in the last election on repeal and replace and previously during the Obama Administration tried to hinder the Affordable Care Act when ever and where ever they could. Now suddenly Republicans are waking up to the broader role healthcare plays?

Now for the math. Total healthcare spending in 2016 came in around $3.2 “trillion”. The US population was about 320 million. That means that on average, each American consumed about $10,000 of healthcare (per capita). In actuality, some Americans consumed little or none and others consumed a lot more.

So, a family of five (mom, dad, brother, sister, sister) represent, if they were average, $50,000 a year on healthcare costs. That would represent $4166 per month from this families budget. So even if the household head earned $15 per hour ($31,200 per year), this family can not buy health insurance.

Most people, especially young and healthy Americans do not consume $10,000 a year in healthcare costs. From an insurance company’s perspective, those who consume less help offset those who consume more. In a somewhat complicated process, insurance companies dial in rates (young and healthy pay less, older and sicker pay more) and there you have it, the American healthcare delivery system.

Let’s consider the pending Republican “repeal and replace” healthcare legislation. What math questions arise?

First and foremost, and unfortunately never asked publicly, is $10,000 spending per capita reasonable? Does the US possess a older or sicker population, or are Americans more prone to serious illness than other parts of the world?

In comparison with the rest of the world, especially other modern economies like the US, the US spends almost twice as much as other modern countries. There are no indicators other than over consumption and inefficiency to explain this difference.

So does the Republican plan tackle this spending issue? Regrettably no. One would assume that cutting Medicaid and individual subsidies is intended instead to simply reduce the number of people seeking healthcare coverage, not increasing the number. Since those without insurance seem to consume a lot of healthcare once enabled to get coverage, cutting Medicaid and individual subsidies would help to keep rates from rising too much.  I suppose this could be viewed darkly as a cost control mechanism.

 

Second, the Republican plan shifts the tax burden away from those who can most afford paying to those who can the least. Estimates show an approximate $200 million tax cut for the wealthy while at the same time making it more difficult for lower income Americans to afford healthcare coverage.  This is an unforced error.

 

Third, pre-existing condition bring a bazaar ingredient to healthcare. The Affordable Care Act required insurers to cover all Americans regardless of pre-existing conditions. Republicans have been all over the map with respect to whether pre-existing conditions would be covered, how long, and for how much.

Covering pre-existing conditions, but charging exorbitantly higher premiums is tantamount to not covering those conditions.

 

Fourth, cutting Medicaid enrollment which provides coverage for the sickest and least able to afford insurance is a prescription for increasing the uninsured rolls. Republicans spin this issue by saying States are better able to determine how to deal with the poor.

What?

The nation’s poor are US citizens who just happen to live in a particular State. Some richer States can afford (at the same tax burden) to provide benefits and other States can not. How can healthcare be viewed as a privilege owing to which State one happens to live in?

 

Fifth, value add of insurance companies? The Republican plan doubles down on the existing cadre of healthcare insurance companies. Each healthcare insurance company demands healthcare service providers (hospitals, doctors, and drug companies) to use specific reporting forms for pre-approval and payment. As a consequence, healthcare service providers have increased their operating costs significantly by necessarily adding “non-medical” staff to process paper work.

 

Sixth, fee for service is alive and well. The Republican proposals are silent on changing the basis for paying hospitals, doctors, and drug companies. Republicans claim that the “free market” will magically pit one insurer against another with the average American coming out the winner. This is a delusion.

Summary. There are gaps in the Affordable Care Act coverage (not everyone is covered) and there are anomalies in subsidies such that some Americans still can not afford to purchase subsidized insurance. And, the real healthcare cost drivers are not addressed sufficiently. There exists a pressing need to improve/reform Obamacare.

The Republican proposal does nothing to address Obamacare defects nor does it portend to deal with reigning in the obscene yearly cost increases. What a shame the country is being lead towards third world healthcare delivery standards (best healthcare money can buy) instead of rivaling the best of the best.

Democracy’s Message

June 20, 2017

When Donald Trump was elected President, the US democratic process spoke loudly. Americans had elected someone inexperienced, uninformed, and some said unqualified emotionally to become President by a narrow electoral college margin (Trump lost the popular vote by 3 million votes). What was democracy’s message?

American democracy approximates one man, one vote but it actually reflects the popular vote in each State times the number of House and Senate members apportioned to that State. Therefore it is possible to win the popular vote but lose in the electoral college. So is that why Donald Trump is President?

There’s more. Along with electing Donald Trump, voters returned the Republican Party to majorities in both the House and the Senate. And with these majorities, GOP leaders feel a mandate to roll back much of what constitutes “entitlements” and “excessive regulations”.

Republicans favor less healthcare coverage, less Medicaid spending, and have proposed large changes to Medicaid and even Social Security. On the regulatory front, Republicans are pro-fossil fuels, less regulations on banking and industry, and anti-labor. How can this type of negative, past looking policies appeal to a majority of Americans regardless of which State they reside in?

As usual, there is another way to see life. Republicans claim that best government policy is that which is originated closest to the people (State and local levels). Therefore by definition, healthcare, tax levying, and regulations should be done at the lowest government level which is practical.  Since the governing process is complicated, this simple explanation has appeal. Hmmm.

Traditionally, two key Republican Party segments have been the wealthy and business/banking leadership. Not surprisingly, lower taxes, more fossil fuels, more dependence upon healthcare insurance companies, and anti-labor policies directly benefit these groups. But strangely Republican policies put far more regular people at risk. So, once again, how did American democracy elected a Republican majority and a President of questionable ability?

Hmmm.

  • Could there have been too many litmus issues? Like is a woman’s right to choose, or the protection of individual rights of other Americans regardless of sex, gender preference, or gender identity.  Are these considerations more important than healthcare, a progressive tax code, or reasonable controls (checks and balances) on banking and industry?
  • Could it be that many Americans choose to believe what their elected officials tell them and do not fact check their assertions?
  • Could it be that too many Americans want it all but do not want to do the hard work of paying for what they receive?

Democrats lost the 2016 election mainly because they could not, and would not tell the voter what the voter needed to hear. Democrats equivocated on the big issues and pander on the social issues.

And by the narrowest of majorities, Americans have gotten what democracy delivers, this time an incompetent President who harbors no agenda, a Congress with a shameful agenda currently split along serious fault lines but teetering on choosing the darkest options, presenting the average America with no reasonable outlook for good jobs, more discretionary income, or hopes for a secure future.

Democrats need to wake up. Rather than stand by and watch Republicans promise the moon and deliver dirt, Democrats need to tell voters what is realistic to expect and why Americans can expect a Democrat to deliver.  That was democracy’s message in the 2016 election.

Loss Of Ethics?

June 19, 2017

Ethical behavior seems at times a much sort after characteristic. Most everyone prefers to think of themselves as “ethical”. All to often, however, individuals confuse ethical with legal (I’m for law and order) and continue to act on the belief that what they are doing is both correct and legal, not considering that while not illegal, their actions may be highly unethical. Hmmm.

In the 1980’s General Motors along with the other major American car manufacturers designed and made automobiles which performed poorly, lacked durability, and were often unsafe, yet were highly marketed, promising the buyer years of great performance. Independent automobile evaluations (side by side comparisons) told a different story and slowly but surely, consumers weighed in favor of competition from Europe and Japan.

In the period 2000 to 2008, financial institutions told clients (such as pension funds) to buy certain securities, especially mortgage backed securities knowing full well that the securities’ credit rating was false. Compounding this terrible behavior, these financial firms used depositors money to purchase credit default swaps betting that the securities they had just sold would subsequently fail.

Now we are looking at a Congress that is determined to reduce healthcare coverage for those who are most vulnerable, yet claiming their plan offers “great” healthcare. This same Congress is proposing to undertake tax reform which will translate into a huge tax cut for the wealthy. Hmmm.

In each of these situations, those involved acted lawfully and as requested by their superiors. In each of these situations, their actions’ consequences were hurtful to others. Their behavior was unethical.

One hears everyday from company X, Y, or Z, or from Chief Executive A, B, or C, that the basis for complaints (even law suits or indictments) were “unfounded”, that their product or service met (or exceeded) applicable standards or regulations, that their product or service when used according to manufacturer’s recommendations, were completely safe, and when confronted with overwhelming evidence that consumer complaints were genuine, these executives and companies claimed “no law” was broken.

One is left with the impression that all types of conduct are “ok” unless specifically denied by law or regulation. Where has the importance of ethical behavior gone? Where has the importance of ones word gone? How can our schools and universities “educate” so many, so highly, yet produce graduates so absent of ethical skills?

The Columbia University Cannon, which requires students to relive history from the perspective of past great minds, at least exposes students to critical thinking. But how many other colleges or universities can say the same?

Other institutions such as churches, law enforcement, and public office holders once provided visible examples of a well lived life. Americans could look to their pastor, their policeman (the policeman is my friend), or their Mayor, Governor, or Congressman for a model of what was right or wrong. No so today.

Church leaders argue over whether certain naturally occurring life styles are acceptable while preaching love they neighbor (but maybe only this type of neighbor). Policemen have morphed into a junior version of soldiering and in the process too many have lost the perspective of the public they serve. (Shoot first, ask questions later). And probably the most devastating has been the self serving, money talks nature of politics. Rare, instead of expected, is the public official who chooses that profession to “serve”.

So, one is left with the question, have our institutions failed us and lead to the apparent loss of ethical behavior, or has a broader, more pervasive cause infected every corner of American life, including our institutions?

What type of pervasive cause could move America to deny global warming or take any responsibility to find a remedy? What would cause Americans to accept healthcare where 25 to 50 million fellow Americans will be unable to access basic healthcare? And, what would make educated and well off Americans push so hard for tax cuts which shift more of the tax burden to those less able to carry it?