Healthcare Math

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

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.

Heated Rhetoric

Following the baseball field shooting of Republican legislators, bi-partisan cries have gone out calling for an end to heated (often misguided and misinformed) rhetoric. “Enough”, cry some of the most practiced in the art of partisan politics. Does anyone really mean those words? Doubtful.

Why doubtful?

While those words calling for a return to civility were echoing through Congressional halls, Senate Republicans were huddling behind closed doors attempting to cobble together a healthcare plan which met the test of reducing healthcare coverage and still keeping a Republican majority to pass the bill. No public hearings, no open discussion, no Democrat input. Do you think that is bipartisan behavior?

Like climate change and the abdication of the Paris Agreement, or the pending “huge” tax cut for the wealthy, or the private sector infrastructure proposal designed to put money is special pockets, Republicans are stacking the deck with intentions favorable to a few, neutral to a few more, and dangerous to the many.

Criticism opposing legislation kept in secret is called heated rhetoric by some. One wonders why?

Special interests?

Our elected officials are called politicians for a reason. Congress members first must convince enough citizens in their districts to choose them over their opposition. Promises are usually part of the bargain and in that lies the seeds for the problems we see today.

Instead of advocating for rebuilding the infrastructure, it is preferred to call for tax cuts. Instead of warning about global warming and taken specific steps towards control, it is easier to question the science and play for time. Instead of calling for basic healthcare availability, it seems wiser to claim (falsely) that America is exceptional and has the world’s greatest healthcare system.

Heated rhetoric could be a “generation thing”. In other words, current public officials inherited a wealthy country have done little or nothing themselves to create national wealth. With no practical experience in what it takes to build a nation, it should not be a surprise that Congress members’ sphere of vision is simply themselves. The role of today is to survive and worry about the future tomorrow. Hmmm.

While there are plenty of examples to support this theory, there is also a more sinister hypothesis. Americans are people. People are by nature greedy. Politicians are people and therefore without adequate checks, are greedy too.

Share that realization with clever and also greedy wealthy citizens and in not too much time, politicians learn to promise one thing but do another (and what they do is what their financial backers want).

Heated rhetoric may simply be the natural end which occurs when politicians make one false claim after another, long enough. Explaining behavior which leads no where can only be done so long before citizens sense dishonesty or incompetence. Raising the tempo, going negative, and if necessary, using “dog whistles” of race, religious, or national origin helps mold the electorate into “we” and “them”. Hmmm.

IMO, Congress reflects middle and upper class American. Congress’ ineffectiveness and willingness to engage in “heated rhetoric” is what any of us would do if public life were our chosen field. Fortunately, most Americans do not seek public office and the power to change government lies in our hands.

Ask the simple question, “what is the problem awaiting a fix”?

The problem is not necessarily that the US is spending too much money as those who say “the Federal Government” is too large. Rather, if there is a problem, one must cite the problem first.

For example, Medicare is often cited as a major contributor to the growing federal debt. Why not collect more fees and taxes to eliminate the deficit? The problem, rather is not the spending amount, it is whether there a need for Medicare at all.

Once there is agreement on why some healthcare subsidy for those on fixed incomes is fair and warranted, then the discussion on how Medicare should be paid for should begin. The same applies to Medicaid, Social Security, and healthcare in general.

Each American can figure out whether the incumbent is interested in the problem or just some special interest outcome (like paying less in taxes). Term limits by voting the incumbent out of office is the fastest way to get Congress members’ attention and to begin to lessen this problem.

I bet, however, that “heated rhetoric” will rule the day until Americans use the ballot box to over come “dark money” and other special interests.

Is There A Difference?

President Trump complained once again that he is being treated poorly (and unfairly) by the news media. The President says that whatever he says is questioned by the press, more so than any other President. Even if the press correctly points out that a Trump statement is literally false (or generously, inaccurate), the President calls the publication of such a finding, “fake news”. Hmmm.

The Washington Post reported this week on a June 15, 2016 gathering including House Speaker Paul Ryan and Majority Leader Kevin McCarthy. Following a session with the Ukrainian foreign minister, when a small group of Republicans were together, McCarthy said to the group he would guarantee Russian President Putin was paying two Americans, one being Donald Trump. A week later, Donald Trump was nominated at the GOP convention.

Fast forward to this week when the Post decided to publish an account of this meeting. The Washington Post approached Speaker Ryan and Leader McCarthy’s offices about the pending article and informed them of what they would quote Ryan and McCarthy saying.

The offices responded that the report was incorrect, it never happened. The Post then went back and said they had a transcript. The offices responded again that the transcript was wrong, if not made up. Finally the Post told the offices they had a recording and the story changed. The offices then said that McCarthy had told a bad joke and there was nothing to it.

Hmmm.

President Trump makes statements which can easily be shown to be inaccurate. Two experienced political leaders make statements which they deny ever making. And they continue to deny making these statements until it is established a recording exists and then a spin is applied. Hmmm. Is there a difference?

Maybe… more like, however, a difference without a distinction.

President Trump says things that are inaccurate, (the kindest interpretation might be stretching the truth). When called for this exaggeration, the President doubles down, repeats the inaccurate statements, and claims unfair treatment.

The Congressmen says something, in private, which they could have believed true. When called up on the statements, this party denies ever having made the statements and avoid providing any proof that their statements might be true.  The Congressmen deny and deny until the evidence is overwhelmingly obvious, and at that point admit making the statement.  Without losing a breath, the Congressmen spin their statements to mean something quite different.

John Q Public hears all this and is puzzled. How could the office of the President say something so outrageously wrong? Why would the President say such things? Press of business? Victim of hateful media?

John Q Public also sees and watches elected officials and is just as disillusioned. The Public has such a low opinion of Congress for good reasons. When a Congressional member denies something, the Public has learned to discount the Congress member’s claims.

So here’s the difference. President Trump is newly elected. His supporters are giving the President wide latitude around what he says (because the Public is still hopeful that President Trump will make “their” American great again.  for Congress members (both Republican and Democrat), the boat has already sailed.   Congress members, on the other hand, may want to think they are not “lying” and certainly will go to extremes with denials and spins.  Congress members are quite comfortable speaking past the question asked, misdirecting the questioner to another topic, and if all else fails, fall back on “I can’t remember the details”.

See the difference?

In truth both President Trump and Congress members are telling John Q Public that honesty, directness, and good intentions are over valued virtues. Rather “not losing” in the case of Congress, and “winning” in the case of President Trump are the goals.

What is worrisome is that enough Americans voted for a person unfamiliar with truthfulness and elected Donald Trump.  If his Presidency becomes unhinged, who will these Americans turn to?  What even more outrageous and unprovable promises will the next candidate be willing to put forward?

John Q Public will be disappointed with President Trump if America is not made great again.  President Trump’s lack of truthfulness may not matter, results will.  If Trump is a one term President, what will the next President have to promise to get elected?

Authority Versus Right

It is only Tuesday and President Trump has already opened another can of worms. In what is becoming a pattern of behavior, the Washington Post reported President Trump revealed to the Russian Foreign Minister, super secret US intelligence. The President’s aides (namely National Security Advisor H R McMaster) denied the Post article. “It” never happened, McMaster told a news conference. Twelve hours later, the President himself tweeted that he had in fact shown the Russian top secret classified material and as President, he had the authority and right to do so. Hmmm.

The Post report indicated that President Trump boasted about how much intelligence he receives daily and pointed to information pinpointing the where abouts of ISIS senior officials. The media speculated that the Russian could quickly figure out where the intelligence came from and most likely the methods used to obtain it. “Means and methods” have traditionally been completely “no-no” when reporting highly classified intelligence information. Hmmm.

President Trump has again conveniently conflated “authority” and “right”. Clearly the President has the authority to declassify any classified information regardless of whether declassifying is prudent or not. Once declassified, the intelligence is legally discoverable through freedom of information requests or through unauthorized “leaks”.

In other words, if the President opens Pandora’s box, what comes next will be what it will be.

In the President’s mind, apparently, authority gives him the right to act as he pleases. President Trump in essence is saying because I have the authority, I also have the right to act regardless of the consequences. IMO, Presidential actions must include reasonable diligence and consideration of consequences as well as gains to be made.

(For example, the President has the authority to use nuclear weapons.  Do you feel comfortable with the President making such a decision without a thorough discussion with senior military and intelligence officials?)

The President claims his purpose was to increase Russia’s engagement in pursuing ISIS. Sounds like a worthy objective especially if the other Country was an ally like Great Britain, France or Germany. One is left wondering when instead the Country is Russia who routinely supports interests opposed to those of the US.

President Trump has the right also to fire (remove from office) the FBI Director and under normal circumstances, the President is given wide latitude in justifying his decision. Obstruction of justice is not an accepted “right”.  Recklessly sharing secret intelligence could be a dereliction of duty.

It could also be brilliant negotiating tactic. Only subsequent events will determine.
Between dereliction and brilliance lies a sea of other possibilities. Ignorance, deceit, mistake, test, quid pro quo, gamble, and instinct to name a few.

As a one off, this release of classified information is unlikely to meet the test of impeachment, “The President, Vice President and all civil Officers of the United States, shall be removed from Office on Impeachment for, and Conviction of, Treason, Bribery, or other high Crimes and Misdemeanors.” (Article II, Section 4).

President Trump had clear authority, but only with more information will Americans know whether the President had the right.

End Game?

There seems to be much reporting and analysis these days concerning how President Trump will become ex-President Trump. For those who were neutral or opposed to his candidacy, the option of an ex-President Trump is tantalizingly attractive. For those who supported his candidacy, somewhat surprisingly over 90% of them still think the Trumpeter is performing well and meeting their expectations. So, why the talk of “ex-President Trump?

President Trump has given his supporters all they could hope for. Reverend Jerry Falwell said this weekend at Liberty University’s Graduation in Roanoke, Virginia that “President Trump is the real deal and unlike previous Republican Presidential candidates (Mitt Romney and John McCain), Trump has delivered” (or words to that effect). (Evangelicals may have an advantage versus the rest of the secular America since Evangelicals believe God is listening only to them.)

One must assume President Trump’s supporters believe there should be immigration and entry barriers for Muslims and see President Trump’s so far failed actions as heroic never the less. (I wonder whether these religious champions have thought about which religious group would be next after the Muslims, or if his Muslim bans becomes implemented, what should the Country do with current lawful Muslim residents and citizens?)

Evangelicals must also cheer when they read about the American Health Care Act which cuts healthcare for the neediest. (Sound like lover thy neighbor?). And I wonder whether evangelicals think about the future. After AHCA, can a re-do of Medicare, Medicaid, and Social Security be far behind?

The Trump proposed tax reform must echo sympathetically amongst their church’s pews. The potential of huge tax reductions for the wealthy (corporate or individual), again overlooking the poorest Americans, must inspire these evangelicals to lift their voices in songs of heavenly thanks.

Of course, evangelicals may be thinking that “god helps those who help themselves”, and surely there is every indication that President Trump, his family members, and his richest supporters are helping themselves and buy into this myth wholeheartedly.

If one is objective about the Trump Presidency, one must admit the President has shown no signs of adjusting his ways despite a hail of criticism and push back. If tweets do not work, then a campaign style rally might. Or, a threat against this person or organization followed by a slam against a foreign country (friend or not) serves to distract the 7/24 news cycle as well as most citizens.

Environmental policy is under attack. Let’s have more oil wells, pipe lines, and even coal fields.  The Justice system has signaled it will be blind to individual liberties (especially voting rights) and instead focus on refilling out Federal prisons. Labor, Education, and HHS are all headed by individuals who are on record of opposing those departments’ previous policy direction. Hmmm.

And let us not forget that the overriding factors that got President Trump elected were two myths, (1) the US economy was flagging, and (2) only President Trump could make it great again.

Both of these myths were and are completely false. With the President’s rants over trade, his stress of keeping American manufacturing jobs in America with one hand and his destruction of jobs with budget and policy decisions with the other, there is more than a reasonable chance that the US economy will begin to slow and soon contract. If that happens, get ready for the wolves to come out.

Today the dark money sources (read Jane Mayer’s Dark Money), conservative and libertarian hedge funds and business owners (plus a lot of wealthy individuals with inherited money) support or at least have welcomed President Trump. These enormously selfish and self centered Americans will turn on a dime if President Trump is unable to provide them the tax reform he has promised and will seek his ouster if the economy fails in such a way as to shrink their personal wealth.

So, back to end game. President Trump is building a public record replete with words, actions, and deeds worthy of supporting impeachment. And, if not impeachment, then not reelections. And if not reelections, then may be not even re-nomination.

Americans, however, need to understand that a President Pence will not change President Trump’s policies. In many regards Pence represents a greater threat than President Trump. Vice President Pence will avoid any public statements if possible which are not fully vetted.  (Pence’s alibiing for Trump’s firing of James Comes is an exception.)   Remember, cutting back on the environment, pushing tax cuts for the wealthy, marshaling aid for religious groups, opposing women’s rights, and suppressing the vote are all bread and butter policies currently supported by Vice President Pence as well as the “dark money” owned Republican party.

Americans must, for their own good, keep an eye on Trump/Republican policies.  Impeachment of President Trump and removing him from office while tempting won’t change the foul wind blowing in Washington.

Repudiation of President Trump by making him a one term President, on the other hand, is that best alternative. Only in cases of severe “malfeasance” should impeachment be considered, regardless of the smell or optics of President Trump’s behavior.  The end game must include the blunting of “dark money” and its stranglehold on the Republican Party.  President is a red herring and not the originator of these top 1% policies.

A TrumpComey-D

This week President Trump fired FBI Director James Comey. One might well say “so what”. Pundits claim the optics are terrible, and others say the White House explanation simply does not pass the smell test. Now, many are asking, “does the firing pass the hearing test”?

At first, sources claimed Comey’s firing stemed from newly confirmed Justice Department second in command, Rod Rosenstein’s review and recommendation. Then the narrative progressed to President Trump’s dissatisfaction with Comey’s listening skills. President Trump is said to have been privately lobbying for Comey’s replacement for a few weeks because Director Comey seemed obtuse to hints to end the alleged Russian investigations. Now in an interview with NBC, President Trump said the decision to fire Director Comes was his alone because Comey was a “showboater”. Why would the President say that?

The White House was quick to remind everyone that the Constitution grants the President those powers. (Sound familiar to words used with the two stayed Muslim travel ban executive orders? No need to provide a credible justification, just claim anything and rely on Constitutional powers.) Apparently the argument goes, “I have the authority and that’s all I need to tell you”. Hmmm.

Several pundits say that Director Comey was fired because he was not loyal to the President (in Trump’s mind), and was prioritizing the Russian investigation too highly (this probably upset both Trump and Sessions). Both of these reasons should be troubling to thinking Americans. Et tu Brute, don’t you remember the system of checks and balances?

In the first 100+ days of the Trump White House, Americans (and especially Congress) are seeing a very worrisome demonstration of executive authority combined with arrogance. Being decisive is no vice. Being decisive in the sense of temperamental outbursts represents a dangerous character flaw, and one that time in the job is very unlikely to improve. Director Comey’s firing, because of its impulsive nature and the lack of “why now” explanation, does not bode well for future decisions.  The firing looks too much like a “sick comedy”.

While it is true that President Trump has the right to fire the FBI Director, he does not have the right, even as President, to interfere with an investigation (obstruction of justice). At this point we must assume that the President was impulsive and not trying intentionally to retard a Federal investigation. What happens next in terms of a new Director nomination, and what steps Congress takes, will give a jittery public a good indication on the real Donald Trump and the real meaning of the Trump Comey-D.