Archive for the ‘affordable care act’ category

Healthcare All Over Again?

March 29, 2019

Like a flash brush fire, the subject of US healthcare has blazed anew.  Dumbing the complex healthcare situation down, the President and loyal Republicans are chanting for the ACA’s elimination and good things will follow.  The President has promised the best healthcare ever, one with “pre-existing” coverage and no individual mandate.  Of course the President wants first the ACA repealed, or ruled un-Constitutional in the courts, and then… “trust me”… the GOP will introduce a beautiful new healthcare bill.  Hmmm.

The silver lining of this “bad dream again” issue is that there are compelling reasons to reopen the healthcare “can of worms” again.  The ACA represented an honorable, ethical, and moral effort to improve upon what existed in 2008 and provide access to basic healthcare for all Americans.  Republicans tell us that ACA is not so. 

The inconvenient truth about US healthcare (the current ACA or the version before ACA) is that

  • healthcare spending per capita is twice that of other developed countries,
  • does not still cover everyone (estimated 20 million more however), and
  • mediocre healthcare outcomes compared to many other countries.  (Healthcare available through institutions such as the Mayo Clinic, Johns Hopkins, Cleveland Clinic and most major University teaching hospitals are as good as there are in the world but those located in the suburbs, depressed inner city areas, and the rural areas across the country are not delivering on the highest standards. And, not to be overlooked, US healthcare is not affordable or not available to too many Americans.)

Affordability, and availability rise above the partisan solutions such as “Medicare For All”, “the replace of Repeal and Replace”, and “keep government out on my healthcare”.  There is no known credible reasons to justify current US healthcare cost and outcomes. 

  • Drug prices are non-negotiable for Medicare.  How is that possible? 
  • A growing number of Americans are learning that they can buy prescription drugs in Mexico or Canada the exact same medications they currently purchase in the US for substantially less.  Why would the Government not demand the best global price? 
  • Republicans have embraced private sector solutions built around private healthcare insurance. Let the insurance companies police costs, the GOP says.
  • Insurance is based upon pooling risks. .  So how can the GOP fight to eliminate the individual mandate? Without the individual mandate the insurance revenue pool will shrink.  In addition, individuals without insurance will go to Emergency Rooms where they will, by law receive treatment.   In essence, no individual mandate means a free pass for those who do not wish to buy insurance, cost everyone more, and makes everyone else a sucker.  How does this make sense? 
  • Estimates put US healthcare spending at 18% of the approximate US $20 trillion GDP (almost $4 trillion).  If the actual spending was on a parr with 20 other major world countries, there could  be $1-2 trillion savings each year extra for investment in infrastructure or paying off the national debt.  What are Republicans thinking?

President Trump and Republicans are disingenuous about healthcare reform.  Democrat candidates who are singularly focused on insuring everyone and overlooking the inexplicable cost differences with other modern countries are destined to make the GDP cost even larger.  The US deficit can not be reduced or brought under control without first dealing with healthcare costs.  Even more dangerous, in the world of income inequality, unless basic healthcare is made affordable for all, there is destine to be social upheaval.

Medicare For All

January 30, 2019

As the 2020 Presidential Campaign season begins to bud early, a few candidates are stepping forward testing the publics reaction to them.  Elizabeth Warren and Kamala Harris have amped their entries with the battle cry “Medicare For All”.  Two unannounced candidates, Howard Schultz and Michael Bloomberg, have dismissed “Medicare For All” as too expensive.  No surprise then that Schultz and Bloomberg position themselves as “centrists”,  Hmmm.

T0 be successful, the accepted theory seems to be the Democrat candidacy must be more than simply “anti-Trump”.  Democrats must be for something, not just against the current President.  Hmmm.

Healthcare is, for sure, a mess and capitalism is stinking up the house.  Morally, it would seem unconscionable that any reputable healthcare insurer could put forth the notion of “pre-existing condition” as grounds for not insuring someone. And the well worn line of “don’t put the government between you and your doctor” seems ridiculous if the other options is putting the insurance company between you and your doctor.  What are people thinking?

The public’s demand for transparency of medical costs touches on another evil.  Hospitals are unable (and unwilling) to put numbers on the table.  Hospitals claim that there are insurance company discounts which means the patient never would pay the hospital full charge (if the hospitals knew what their costs were).  Drug companies use the same thinking to justify their greedy price increases.

What cannot be denied, however, is that Americans spend, without universal coverage, more than twice as much as anyone else in the world.  And if anyone googles healthcare, one can quickly determine that in comparison to other first world countries, Americans pays twice as much and receives only mediocre healthcare outcomes.  (Of course those Americans who utilize the Mayo Clinic or similar world class health care center, pay the high prices but do receive outstanding medical care.  These world class medical facilities serve only a small slice of Americans).

Schultz and Bloomberg’s “Medicare For All is too expensive” reaction may be missing a point.  Health care today is already too expensive for the average American.  Harris and Warren’s off the cuff reply that the rich will have too pay is just as out of touch with reality.  In fact taxing the wealthy is sure fired way to stimulate even higher healthcare costs.  (Free enterprise just loves situations where there is a payer.)

Healthcare systems found in Japan, Canada, Germany, or France, for example, emphasize preventive care, cost controls, and largely a national sales tax to fund the healthcare system, not taxes on a single segment of society.  The national sales tax (value added tax) coupled with negotiated health care services and drug costs keeps “cost control” front and center, and reminds everyone that healthcare is not free.

The 2020 campaign season does not get into full swing until later in 2019.  Hopefully by that time the candidates will have sharpened their stump speeches and gotten real about what’s possible.   

Essential Services

January 15, 2019

Under the Affordable Care Act (Obamacare), employers must provide a basket of “essential women’s health services” including birth control (family planning) methods.  The Trump Administration, in an open nod to fundamentalist and evangelical religious groups, put forth new procedures which would allow employers, who claimed deeply held religious beliefs which prohibited birth control, to simply not provide this service to their employees.  The States of Pennsylvania and New Jersey filed suit and US District Judge has issued an order temporarily banning the Trump Administration from enforcing these new rules.  

Pundits predict this case will land shortly in the Supreme Court.

These “deeply held” religious views represent a theme running freely within conservative circles.  Cynically, IMO, this assertion serves as a “get out of jail” card for those wishing to discriminate or exert their personal beliefs beyond what is their right to free speech.  These arguments have politicized views that do not belong in the public square.

The judge ruled that the new guidelines would disadvantage far more than would be satisfied and the essential services played an important role in women’s health.

No problem with that obvious rationale. 

But what about the even more obvious aspect: 

  • Providing essential services does not in any way require the employer or any employee to use them. 
  • Almost as obvious, eliminating essential services hurts only the poor and most vulnerable because anyone with average or higher income can afford to obtain these essential services on the open market.

For those conservatives, claiming deeply held religious beliefs, to stand up and claim injury (to their beliefs) while professing to be christians, is hypocrisy at its best.

Reading Election Tea Leaves

November 8, 2017

Today is the morning after. Yesterday an off year election was held which featured two high profile governorships at stake. Democrats won both (Virginia and New Jersey) and surprisingly across the country, Democrats picked up previously Republican held offices. What was behind this Democrat resurgence?

Money was not a factor even though there was plenty of money spent. Performance in office did not seem to be a factor either, both governor’s races were open since the incumbents were term limited and could not run. So what provided the spark for Democrats?

Some pundits are saying yesterday’s races represented a repudiation of President Trump and his policies. Interestingly, Republican spokespersons disagreed and claimed instead that voters were dissatisfied with the lack of legislative action on the President’s campaign promises.

In other words, had Congress passed the Affordable Care Act “repeal and replace”, and pushed through a huge Middle Class tax reform, then voters would have rewarded the Party with victories. Hmmm.

Reality, however, is more likely different. According to news reports, women played a big role in Republican candidates’ defeat. Women came out to vote and did so in what might be record numbers. Overall voter turn out was unusually high for an off year election across the country.

Rather than conclude Republicans lost key elections because the White House and the Republican controlled Congress did not accomplish what they promised in 2016, it might be wiser to think Republicans lost because of the mean spirited, wrong headed ways the President and Republican controlled Congress conducted themselves.

Trying to cheapen healthcare many women depend upon, backing away from the Paris Climate agreement potential leaving a more severely damaged world for our children, and attempting to pass a tax cut which blatantly passes out billions to the very wealthy and puts the tab on our children and their children charge account (the Federal Debt) has not been missed by a growing number of voters.

Voters, especially women voters, see what’s going on, and are beginning to recognize that  the outlook is not promising in the Trump/GOP teapot.

The Other Side Of The Coin

November 3, 2017

House Republicans have just released their proposed tax code rewrite. Experts are rushing to digest the proposal and perform the difficult task of assessing how this Republican bill will impact Americans. Wait, wait… if you are wealthy, you do not need to worry. This Republican plan will treat you well and provide opportunities for clever tax advisors to find new ways to save you tax payments.

The bill provides most (but not all) the gifts the rich have been expecting. The top bracket of 39.5% remains although the income threshold has been raised to $1,000,000 allegedly in deference to the “gift to the wealthy” optics.  Carried interest, estate tax elimination, and reduction of corporate taxes (35% to 20%) for private owner businesses will provide the wealthy with plenty of tax relief opportunities while the tax burden is shifted to lower income Americans.  And, for those unfortunate Americans earning $500,000 to $999,999, you will just have to pay in a lower bracket.

The deal is not set yet. Republicans from high tax States will argue for sweeteners in the restoration of State and local tax deductions and full credit for mortgage interest. Lobbyists representing all sorts of industries will go into full court press to preserve other deductions and credits. It is entirely possible that this attempt at tax code changes will stall or fail outright.

But it is entirely possible that this proposal or something substantially the same will pass. What then?

For sure it is maddening that very wealthy people like the Koch Brothers and Robert Mercer will pay less taxes.  It is maddening that as a consequence, the tax burden will shift to less wealthy people (like the Middle Class), or the cost of this tax cut will flow to the national debt, or both.

But that is not the real damage that this tax code change will bring.

A coin has two sides. On one side, heads, is the smiling faces of Americans paying less in taxes. The other side, tails, however, means there will be less government revenue to cover already approved government spending. Let there be no mistake, with lower tax revenues there must be less government spending sooner or later.

Republicans will be quick to assert that there are all sorts of waste and corruption in government spending. Why, Republicans will point out that there are able bodied Americans drawing social security disability benefits who could be working. And look at Medicaid excesses associated with the Affordable Care Act. And, with their faces now reddened, Republicans will bluster about spending in all sorts of other areas. Surely, cutting wasted money can be made.

Maybe. The problem usually boils down to which programs are viewed as wasted spending and what justification makes those expenditures “wasted”.

For example, Republicans have attacked the Affordable Care Act (train wreck, a jobs disaster) even though there were some 20 million more Americans insured with Obamacare than before. And, what have Republicans offered? Their best proposals offer less coverage and insure 10-15 million fewer Americans.

So, when it comes time to submit “post tax cut” Federal Budgets, what makes anyone think Republicans won’t feel that reducing programs which benefit all but the rich will be perfect targets?

The theme which comes up time and again is that there are no free lunches. Republicans are breathlessly trying to sell this tax code change as great for the middle class and the key to unlocking our economy, and best of all, there will be no cost to average Americans.

Really?

Governing Part II

November 2, 2017

The Republican Party now holds the reigns of government with control of the Presidency and both houses of Congress. Despite this apparent political control, Republicans have been relatively impotent. Governing Part I offers the thought that the Republican Party is a collection of disparate factions whose inherent policy goals are in conflict externally with a majority of voters’ interests, or conflict internally with other Republican factions’ policy demands, or both.

Implementing the Republican majorities has become surprisingly difficult and fraught with potential unwelcome blow back at the next elections.

Does this imply that Democrats would govern better?

Maybe… but at the very least, the Republican dysfunction speaks to the outsized influence mean spirited conservative big money (“dark money” per Jane Mayer) plays.

Democrat governance would speak to different financial interests. IMO, progressive views, characterized as “center, slightly left”, would be far more pragmatic and directionally sensitive than the current regressive Republican policies.

Contrary to Republicans’s notion that America’s future is destined to look like its past, “Make America Great Again” is on the wrong side of history.

  • Globalization is a fact from which retreat is not possible… and still have America grow in economic terms. Low cost manufacture will chase low cost, high quality labor. High cost manufacturing will reduce Americans’ standard of living. Free and fair trade are a must.
  • Growing income inequality is not a sign of globalization, but rather a greedy, thoughtless, and selfish product of wealthy Americans. Labor regulations and a creative tax code are needed to share the fruits of capitalism more productively.
  • Global warming is real and will drive dislocations in energy supplies. Attempts to favor oil and coal over natural gas or renewable energies denies the science behind global warming, increases the atmospheric carbon, and brings on the destruction associated with rising seas.
  • Digitalization (computers, internet, wifi, artifice intelligence and automation) has changed labor’s definition of “good jobs”, basic skill requirements, and the training and education needed.
  • Population growth rates in developed countries has slowed to below replacement rates and has placed a new value on immigration. Comprehensive US immigration reforms is a far wiser approach than building a wall.
  • Most of the developed world see basic healthcare as a citizen’s right and a necessary government/private sector service. Often over looked is that basic healthcare as a right helps center a person’s thinking around the value of government.
  • Retirement protection is an emerging need. With most companies no longer offering defined benefit retirement plans, and 401k savings plans subject to changes in the tax code, a national retirement pension fund would seem wise. The general notion is that retirement with dignity should be a right for everyone but how to fund such a program must be identified.

So, how does the Democrat Party stack up against these realities of our changing world?

  • Dark Money – Democrats have accepted campaign donations from a wide range of sources, dark money conservative sources excepted.  Reasonable limits and full transparency has been a Democrat position.
  • Globalization – Democrats have reluctantly embraced free trade including NAFTA and the TTP despite the objections from organized labor.
  • Global Warming – Democrats have openly embraced the science behind global warming theory and have endorsed policies which restrict carbon dioxide emissions. Democrats have given only lip service to dislocated labor (like coal miners).
  • Digitalization – Democrats have proposed a wide range of training and education programs but as in many other programs, have not told Americans what it will cost to implement their ideas nor what it will cost the Country if these ideas are not implemented.
  • Immigration and a diverse work force are solid Democrat principles, again if these positions can be sold to the Unions.
  • Basic healthcare – Democrats supported the Affordable Care Act but only a few Democrats strongly spoke out for single payer, universal healthcare for all (like that found in Europe).
  • Retirement Support – Democrats support the government’s role in assuring workers the dignity of a social security-like payment which makes retirement “livable”.

Are you ready to sign up for the Democrat Party?

Remember how Democrats acted after the majority Democrat Party passed the Affordable Care Act.   When election time rolled around, however, many Democrat candidates were silent and tried to change the subject when their Republican opponents criticized Obamacare. Democrats did not campaign on the idea of repealing Obamacare, as did Republican candidates, nor did Democrats vigorously defend Obamacare.

Lukewarm, would you call it?

Great leaders come along every so often. FDR, JFK, LBJ, and to a lesser extent, Bill Clinton were effective in passing important legislation. Barack Obama, when Democrats controlled Congress did get through healthcare reform but not much else (except by Executive Order). Obama will be more remembered for what he urged Congress to do as well thwarting what a mean spirited Republican Congress tried to do.

In this age of sound bites and tweets, will Democrats portray themselves in proactive terms? If Republicans are the Party of small government, low taxes, and individual initiative, what are Democrats?

Party of Opportunity, Security, and Leadership (for all Americans) in the 21st Century might be a place to start.

Hmmm.

Governing Part I

October 29, 2017

There has been much written about the inability of the 115th Congress, one with Republican majorities in both Houses, to pass meaningful legislation. In the 113th Congress, Elements within the Republican Party orchestrated a Government shut down squabbling over an ideological but relatively pointless issue. The question is why are current day Republicans so inept when at the Ship of State’s helm?

Could it be there internal inconstancy among policies Republicans claim they hold dear such as:

  • Federal Debt – “Massive, out of control, and an unfair burden for our grandchildren”. In fact, US Federal Debt is about average for all the countries in the world. US Debt is higher than Switzerland, about the same as Germany, and lower than Japan. The real underlying problem with US Federal Debt is that it results from the Congress’ inability to make rational decisions on spending and taxation.
  • Tax Reform – When Republicans mention “Tax Reform”, the are really voicing a free lunch message around “tax cuts”. Republicans claim tax reform will lower (big time) Middle Class tax burden when in fact the tax cuts are premised on lowering the tax for the wealthiest of Americans. Oh, and what about the Federal Debt? This is a shameful policy and consequently Republicans must use all sorts of misdirection and misinformation to keep the voting public from seeing through their scheme before tax cuts are enacted.
  • Healthcare – In the past, Republicans were mainly agnostic about healthcare. Since the enactment of the Affordable Care Act (Obamacare), Republicans have been like a dog chasing after a meat wagon. Not surprisingly the Republican mantra overlooks the fact that some 20 million more Americans have healthcare access with Obamacare than before, or that the US pays twice as much for healthcare than other modern countries. It would appear that the national Republican Party goal is to reduce Medicaid involvement and to eliminate taxes which the wealthy pay, and in return Republicans are willing to see millions less Americans receiving coverage. Hmmm.
  • Medicaid – Even if there was not a broader fight over healthcare, Republicans support only a much smaller application of Medicaid. Many Republicans see Medicaid as “an entitlement” (something Americans do not earn) and a naturally growing government handout.
  • Social Programs – Republicans use this broad terminology to imply that Government aid for specific social programs is a wasteful and wrong headed idea. Surprisingly, the tone was different this past week when President Trump declared an emergency around the growing (predominantly white population deaths due to overdosing with opioids. Hmmm.
  • Environment – when it comes to government policy towards issues such as smoking, industrial discharge into rivers, land, and the air, and most recently global warming, most Republicans have been unusually skeptical on the “science” demanding controls. Could campaign contributions drive Republicans to favor businesses and overlook the welfare of its citizens?
  • Immigration – One of the most convoluted arguments Republicans have made is the danger posed by Mexican undocumented workers. The approximate 11 million illegal workers has been labeled as the cause of most violence, a huge drain on social programs, and “line breakers” who are trying to gain citizenship by not following the rules. Mexicans are mostly church goers, family centered, and extremely hard workers who make model Americans if given the chance. Could it be that Mexicans, if given the vote, might vote Democrat?
  • Faith Based Issues – Probably the most shameful and hypocritical position Republicans candidates have taken lie around the issue of god and religion. Republicans stand firmly by the Constitution when they pander to gun owners but are willing to twist the Constitution and accept discrimination based upon ethnicity, gender, or sexual orientation (if the discriminator is motivated by deeply held religious beliefs). This is akin to one Bill of Rights phrase, overriding all other rights if it is favored by a large number of bible totting voters.

The reality of this boils down to who elects Congress members and which issues are the most important. Distorting the otherwise democratic process is the unparalleled amounts of campaign donations coupled with the “legal” and huge amounts of “issues” money.   Mostly all of this money has emanated from the wealthy, and has driven the political conversation to elect a majority of RINOs (Republican in name only). This group, depending upon where in the country they represent, bring a range of intensity to the issue mentioned above.

If instead of keeping the single name “Republican”, each member chose a more applicable name like Christian Republican, No-tax Republican, Big Business Republican, etc, then the current Republican Party would not hold the majority and power would shift to others. So, banding together, even with vastly different depth of feelings around specific issues, makes the Republican brand the majority.

Republicans, however, are showing that being the majority and providing effective governance are two different matters. This year’s Republicans are hopelessly compromised owing so much to so many (tax cuts to the wealthy contributors, discrimination rights to bible thumpers, anti-immigration action to the xenophobes, anti-science policies to short sighted business leaders, and second class and hugely expensive healthcare policies to ignorant (uninformed) Americans.

Republican Congress members are complex and thinking people. Most, if not all, know the real nature of this Post’s issues. Unfortunately too many are willing to “go along”, thereby making unbalanced choices which are setting in motion collisions between common sense and prejudices or flatly unsupportable policies. In such an environment, facts are not important, and democracy suffers while governance becomes problematic.