Archive for the ‘affordable care act’ category

When People Think Differently

August 8, 2017

The idea of “universal, single payer” healthcare seems so obvious as both the most efficient and least costly method of delivering a nation’s basic healthcare, it seems incredible that there are so many Americans who do not embrace this notion. Why would that be?

Fewer and fewer Americans remember the time before the wide spread availability of insurance company provided healthcare. Yet the US system of “for profit” healthcare insurers is a relatively recent happening. Following WWII, employers began offering health insurance as an employee benefit designed to retain employees in a period of relatively full employment. Health insurance as a benefit caught on and employers have found it difficult to retain workers without offering health insurance. Hmmm.

Also escaping most Americans knowledge is the cottage industry which is necessary to support the multitudes of healthcare insurers. Healthcare service providers (doctors, hospitals and drug companies for example) must carefully keep track of each patient and how much service that patient has consumers, report those services using each insurers different set of codes on each insurers specific form, and then argue with each of these insurers to insure they receive reimbursement for the services already provided. This entails millions of more healthcare workers who do not themselves provide healthcare. Hmmm.

More than two dozen other modern countries (like Germany, France, England, Japan, and Canada) utilize a single payer, universal healthcare service delivery system. These countries all offer “best in class” healthcare services at about one half the total cost experienced in the US. These countries also report excellent healthcare outcomes and boast longer life expectancies than the US. Oh, and these countries provide this healthcare to all residents. Hmmm.

So, why would anyone not be in favor of universal healthcare?

In the US there are many who decry the idea of universal healthcare. They predict unacceptably long wait times to see a doctor or receive treatments. They ask the question “if healthcare is so good in other countries, why do people from Canada travel to the US for medical care?”, and “Why should we put the government between you and your doctor?”, the ask.

The politics of healthcare is even more fascinating and not easy to understand. Progressives are for a universal system and conservatives are not. Conservatives point to Progressive’s record of entitlements and using taxes to fund the cost. Conservatives see creeping socialism behind the call for universal healthcare and the resulting dependency of Americans to look for government to solve all their problems. And worse, universal healthcare will bloat the government making what is already (in their opinion) too big, even bigger. And even worse, conservatives don’t want their tax dollars going to pay for healthcare for someone else. Hmmm.

Hmmm. What could be simpler. Big government, less choice, poorer quality, and offering out of control cost increases, conservatives claim.

Why do conservatives think that way when there are so many examples around the world that prove otherwise? Why don’t conservatives recognize that some Americans already have “universal healthcare”. These Americans, of course, are over 65 and are enrolled in Medicare.

Is this a subject of “the glass is half empty, or half full”? Do progressives and conservatives see the same problem (basic healthcare available to all Americans) or do they see different solutions to different problems (basic right versus small government with low taxes)?

If Americans see the same problem, conservatives may still view the delivery of basic healthcare too difficult a task for “American thinking” and from their perspective, a universal healthcare system must inevitably end up with poorer healthcare and higher costs. Progressives could, alternatively, see no problem too great for Government to solve and therefore discount totally conservatives’ warnings.

The recent Congressional fight over repeal and replace for Obamacare should make conservatives take notice. The conservative sponsored alternatives largely failed because they offered less coverage for the poor, those with pre-existing conditions, and the elderly.   Voters representing those groups made their views known. Progressives and conservatives would be wise to heed this warning.

Healthcare is not free and does require funding. Most other countries employ a “prevention” oriented healthcare philosophy, inhibitions towards uncontrolled price increases, and utilize a consumption tax (value added tax) to fund healthcare along with modest co-pay requirements.

Obamacare could be a starting point were Republicans to acknowledge that Obamacare was based upon Romneycare (Massachusetts) and that was based on a proposal from the conservative Heritage Foundation think tank.

If conservatives can’t agree with progressives on what the problem really is, voters make make the choice for them. The 2016 Presidential elections was a clear sign that the electorate was dissatisfied with both parties and threw its support to a total outsider.

What will voters do next time?

Take A Breath, And Think This Time

July 29, 2017

“Pause and reflect” might be good advice for Republican Congress members. But it is possible pause and reflect may still miss the foolishness of yesterday’s vote on Obamacare “skinny” repeal. The vote confirmed, with little room for argument, Congress is not fully under the control of the Republican Party. There is no Republican Party and Americans had better wake up to that fact.

Those who claim membership in the party in power are not of one mind other than wanting to get reelected. In other words, GOP membership is about winning elections and profiting personally from those elections as best one can. And with the amount of money floating around Capitol Hill, it would take a pretty dumb Congress Member to not increase their personal worth while in office.

For Congress members, unfortunately, there are strings tied to getting elected. Congress members must surrender their right to vote their conscience and instead march to the drum of the big money that financed their campaign. Besides the Congress members’ integrity, the main casualty is the absence of a functioning body invested in the 21st century problems facing America.

Healthcare is a perfect poster child.

Republicans have called out against the rising costs (premiums and deductables) of the individual market. Instead of offering solutions to this problem, Republicans, in essence, have said, if you think the price is too high for a whole loaf, we will offer you a half a loaf at a lower price. Shameful.

The skinny repeal bill took the Republican position even further into the absurd. Republican Senators were asked to vote for a bill which over turned the Obamacare requirements for individual mandate, employer mandated coverage, and certain taxes on makers of medical devices. The bill makes no sense as it would have destabilized the individual insurance market even more and posed the risk of significantly more Americans losing coverage.

Possibly even worse, the skinny bill was never intended to become law. Imagine, grown up elected officials seeking to pass a bill they believed would never become law. Why would that be necessary? Why not try to pass any bill, regardless of how flawed, that was Republicans true intent?

The Republican mysterious behavior has its roots in what basic principles underfoot healthcare. Is healthcare a right or is it a privilege?

Given the opinion polls and most of the nation’s Governors, Americans are trending towards healthcare is a right. (Now be careful and do not confuse, a right and being free.) Healthcare is expensive and the method of paying for it is not straight forward.
The inevitable end point will be a universal, single payer system, as most modern countries have already adopted.

Like most large social changes, US healthcare may still require more baby steps. But other than disgust with the GOP efforts, the defeat of the skinny bill has not brought us closer to any improvement. That work remains.

IMO, there were many Republican Senators who did see healthcare as a government benefit akin to meeting an individual’s right. Regretably, these Senators caved to special interests pressure. There are other Republicans who deny anyone’s right to healthcare unless they can afford it. They seek the best healthcare money can buy. Hence the fundamental schism.

The brightest face one can attach to the failed GOP effort is “some” Republicans working with Democrats could pass modifications to Obamacare which would stabilize the individual nsurance market and return premium costs to real world levels. A necessary fix, but a fix far short of what’s possible and what is ultimately the goal.

“Skinny” option. Hmmm. What will they think of next?

The Big Fat Lie

July 25, 2017

Exaggeration and Hyperbole are staples of public speaking and popular literature. President Trump, since day one of his Presidency, has added these speech forms to his Presidential Addresses. It appears the possibility of being tagged with multiple Pinocchio’s is not a deterrent for America’s “communicator in chief”.

Yesterday, in a staged photo op, President Trump spoke out over the Senate “repeal and replace” stalemate. Pointing to the gathered group (J Crew looking group), the President asserted that they were Americans who had incurred the injurious nature of the Affordable Care Act (Obamacare). The implication was that here, in flesh and blood, were Americans who were harmed by ACA and wasn’t that proof positive that repeal and replace was necessary?

Maybe, but what about the 22 million Americans who the Congressional Budget Office say will lose healthcare coverage should either the Republican House or the Senate legislation pass. Is that Exaggeration or Hyperbole?

No, Deception or Misdirection would better describe the President’s statements. For someone who appears to have no regard for any statement’s accuracy, President Trump is more complex than just a “truth stretcher”, the President is purposeful and says what ever is necessary, no limits considered, to achieve his goals.

So, as if to say the misdirection statements about how many Americans would benefit from Obamacare were not enough, the President stood before this group and into the camera said, Democrats lied about the Affordable Care Act in order to get it passed, “every single thing they said was a lie, a big fat lie”. Hmmm.

Liar, liar, pants on fire.

The Presidency appears in a race for the bottom. What more outrageous mistruth or magician’s misdirection will President Trump put forth? The larger question might be, how much more exaggerations and hyperboles will Americans accept before deciding to dismiss all statements from our communicator in chief?

Don’t Blame Trump

July 22, 2017

The first six months of the Republican Administration has not lacked for fireworks. Most pundits, however, would describe this rare period of Republican control as a “nothing” burger. If so, who’s to blame?

President Trump has blamed Democrats and the “fake news” media. The Republican controlled House has blamed the Republican controlled Senate while the Senate has quietly pointed to the lack of White House leadership. President Trump when not blaming Democrats counters, instead, claims the first six months have been the most successful first six months ever!

What else would you expect the “mistruth commander in chief” to say?

The frightening aspect of this question is that many claim that the Trump Administration and Congressional Republicans could have passed much of their legislative objectives had they approached matters differently. And then there has been that pesky “Russian thing”, the investigation into Russian collusion with the 2016 Presidential election. Hmmm.

For Americans the way things have progressed could be a blessing. Both President Trump and the Republican controlled Congress have been exposed as what they really are, mean spirited, unprepared to govern, and hand maidens of certain wealthy interests.

The center piece of the hopeful Republican legislative program has been the Obamacare repeal and replace. As Congress processed this legislation, slowly but never the less, step by step, it has become clear Republicans lacked a plan and more importantly were clueless over improvements. “Beautiful healthcare Americans can be proud of” instead turned into “healthcare that gamers and the very rich can be proud of”. Replacement legislation passed in the House by a single vote and floundered in the Senate altogether. Not surprisingly, tweak after tweak fell short too. Why?

Each of the Republican healthcare proposals failed in the same way. Each insured fewer Americans, provided less coverage, and benefited the very wealthy. So, how did President Trump get it so wrong?

President Trump is not the architect of this Republican farce. The President is more interested in the pomp that goes with the office, flattering headlines in the media, and a slam dunk reaction win in 2020. There is not much more substance than that.

So don’t blame President Trump for proposing defective healthcare replacement legislation or proposing tax reform which masquerades as (you guessed it) tax cuts for the rich, or for the appointment of Neil Gorsuch to the Supreme Court. Each of these topics is that straight out of the Republican handbook and 100% the responsibility of the Republican controlled Congress.

Troubling is the realization that the Affordable Care Act (Obamacare) is far from perfect legislation and is badly in need of fixes. And who can not agree that the US tax code is more aptly a “jobs” program for accountants than a fair method of raising government revenue. But these goals were not part of any Republican agenda.

The news media has published plenty of reports claiming Trump White House dysfunction and most of it seems well deserved. Never the less, the greater tragedy would be to hold Congress blameless and clear of the ugliness and mean spiritedness of President Trump’s rhetoric.

Democrats had better be taking notice and realize it is not impossible that they will be given the reigns of Congress in 2018. Democrats should be wondering, WWDD?

Repeal, Not Replace, Hmmm

July 18, 2017

The Senate Republican effort to pass “repeal and replace” legislation which would be the successor to Obamacare, ended yesterday with whimper. Pundits have said there were as many as 15 Republican Senators who would have voted against the bill but until yesterday there were only two announced. Following a meeting with President Trump, two more Senators (Jerry Moran and Mike Lee) announced they could not support the Republican Senate bill.

End of story?

Not quite. Senate Leader Mitch McConnell announced he would offer a “repeal” only alternative and expected Republican Senators to pass this bill as they had in 2015. The “repeal” only option has a two year delayed implementation ostensibly designed to allow time for the Senate to find a compromise which could pass.

Does unbelievable come to mind?

What does anyone think is so hard about passing a repeal only bill? Admittedly, passing a replace bill does bring into focus what various factions within the Republican Party and the public think about healthcare. Since there is no consensus (without paying a price at the polls), Republicans will have a tough time finding common replacement ground.

Hmmm.  So why try repeal only?

The fundamental and unstated issue, the elephant in the room so to speak, is whether Republicans think healthcare is a right and they are searching for the most cost effective way to deliver, or whether Republicans see healthcare as a privilege and are seeking the least costly manner to provide minimal coverage and still be able to boast to voters that they are for healthcare.

Hmmm.

An old adage teaches when you are stuck in a hole, the first rule is stop digging.

Republicans are showing in bright, red, white and blue colors that as a Party they are not aligned on principles. Even more so, Republicans are showing that both the President and the Republican controlled Congress, while able to be verbally effusive, are still unfit to lead.

Healthcare Debate Show Down?

July 10, 2017

Republicans have fought mightily to pass legislation which “repeals and replaces” the Affordable Care Act (Obamacare). Divisions within their own party have prevent Senate ratification of a repeal and replace, and now back from the 4th of July holiday, Republican Senators are back to the grindstone. Will they be successful?

Unlikely, unless one counts failure as success.

Medicaid expansion, thanks to Obamacare, has provided many more Americans with healthcare than before. These voters have made it known that they would not be pleased with Republican Senators were this coverage to disappear. Hmmm.

Pre-existing condition coverage is another “must have” option in voter’s minds. Relatively speaking this is an expensive option and Republican law makers are worrying how they can pay for that option and still provide a tax cut. Hmmm.

And the thinking that no one should be required to have healthcare insurance comes also with the freedom for companies to elect not to offer their employees group insurance plans. This “freedom” might have Americans beginning to wake up to the possibility that although they may have health insurance today, tomorrow they might be laid off or their employer may just choose not to offer coverage. In both cases these Americans will be out of luck.

But what seems to have gotten the GOP’s attention is not the impact poor coverage or no coverage at all will have upon Americans, it is the phasing out of Federal Government funding of the Medicaid expansion and the dawning that States would need to increase their contribution to maintain coverage.

What? States would need to raise taxes or become responsible for dropping State residents from Medicaid rolls.

This line of reasoning reflects a morally bankrupt political party. Public shaming has not worked to date in changing Republican thinking. Maybe the political reality and risk of being voted out of office will have a different result.

The Smell Of Coffee

July 5, 2017

Six months does not make a year, and a year does not make a four year term. President Trump (and his advisors), however, are waking up to the reality of governing. Much of President Trump campaign’s boastful rhetoric have already been exposed as misguided myths. Too little time has passed to fairly pass judgement upon what President Trump has done or what he has not. A quick look is not encouraging, however.  Maybe his staff and advisors are saying “pass the coffer”.

On the domestic front, President Trump has continuously blustered about both creating and retaining American jobs. There is little evidence of either, and as important, his budget proposals have circled thousands of current Federal jobs for elimination. I wonder whether the President is using “new math”?

And just in case the Administration has not been looking, internet giants such as Amazon have been marching forward with “job eliminating” new efficiencies. If Trump’s advisors are honest with themselves they should marvel at how resilient the economy they inherited really was.

The Obamacare “repeal and replace” has not turned out to be a “walk in the park”, done, and mark that one off the list type of initiative. Funny but most Americans want the benefits of Obamacare. Further, once fact checked, Republican criticisms melt under a healthy dose of facts and transparency. And best of all, voters have seen what was always there. Republicans are only interested in the tax cut which will accrue for the wealthy. The specific American Health Care Act benefits, if enacted, will be the bare minimum necessary to pass the AHCA.

The campaign’s vitriolic immigration slogans have also been shot full of holes. The top priority Mexican border wall has gone no where after just about everyone involved has declined to endorse the efficacy of addition fencing. Congress has twice chosen not to appropriate money. And, more telling is that there are no indications that illegal immigration has increased.   Even more telling is that business leaders are calling for more temporary labor since they cannot find enough American citizens to fill jobs ranging from technology to agriculture to domestic occupations.

Foreign affairs, probably, best characterizes the Trump Administration ineptness. Trump’s shoot from the hip style has proven to be grossly ineffective. Foreign leaders who possess much less power (ships, soldiers, and planes), have learned to survive employing long term strategies and short term diplomacy. Countries such as Germany, France, Japan, China, and India have over the years cleverly closed large parts of their economies to American companies. These leaders are not going to concede these advantages to President Trump’s taunts and threats.

The President’s decision to withdraw from the TPP and the Paris Climate Accord, both actions were designed to appeal to Trump supporters domestically, simply convinced leaders around the world to say little, work together, and forget about the US until it regains its senses.

His claims of “bombing the S**t out of ISIS and quickly ending the conflict has been shown bogus, but what will he do with what follows ISIS? In Afghanistan, the Trump Administration appears on the verge of increasing troop strength with no known strategy for ending the conflict.

North Korea was to have melted away after President Trump became “buddy-buddy” with China’s President Xi. Today, after North Korea demonstrated ICBM capability President Trump looks to more people, simply a king with no clothes.

There is, of course, plenty of time for future world events to prove President Trump’s blustering prescient.  I wonder whether his staff will up their coffee intake in order to get a real grip on reality?