Archive for the ‘Conservatives’ category

Beautiful Healthcare

October 8, 2017

The Tweet-meister has once again promised Americans “beautiful” healthcare, without the “high premiums” some individual insurance seekers are experiencing. What magic does President Trump have in mind? Do you think he will embrace Medicare for all? Do you think he will recommend the US adopt a single payer system like Australia, Canada, or most of Europe?

Unlikely.

To date, the GOP has been serious about controlling cost exposure for those in the single payer market. Shamefully, the Republicans have chosen various forms of “less coverage”, “fewer insured”, and outright mistruths to portray their proposal as providing “beautiful” healthcare coverage. Why?

Opposition towards the Affordable Care Act (Obamacare) has been mainly a partisan political event. Republicans have never been serious about maintaining (or increasing) the basic healthcare insured rolls. Republicans have eyed the single payer (largely individual owner proprietorships) who could be counted upon to vote Republican.  The rest of Americans were far less important.

The GOP has lamented rising rates and declining insurance company participation in certain markets. Behind these crocodile tears, however, has been (you select which one), either (1) a basic ignorance of how any insurance market works, or (2) a cruel belief that those added by Obamacare were mostly lazy Americans unwilling to do what it takes to work hard.

Why would insurance companies keep raising rates in many markets? Does anyone connect that people who were sick and now have insurance might just be using it?

Does anyone think that many who otherwise reneged on paying doctors and hospitals previously (and by the way, those costs were written off by everyone else paying through insurance), and were now enrolled in Obamacare, were not going to use healthcare?

There have been some commonsense proposals, short of single payer, such as putting all single individuals seeking insurance into a group composed of all other single individual Americans (forming groups like employers do). The idea is that insurance companies could then set rates based upon this much large pool.

This approach might stabilize insurance markets but over all there is no way this proposal will lower healthcare spending. People who are sick or have experienced healthcare coverage for the first time with Obamacare will still get sick and will still want to use healthcare services.

The tweet-meistre might do well if he asked questions about how to lower healthcare costs without reducing coverage or those covered.

Such a line of questioning will invariably lead to where costs are generated, namely doctors, hospitals, and drug companies. This healthcare industry is like no other in the modern world and represents 1/6th of the US economy. If in some magical way, President Trump decreed that the US should adopt a healthcare model like Germany or France, where healthcare spending is about 1/2 that of the US (with equal or superior healthcare outcomes), it would require years to transition to that model without bankrupting many doctors, hospitals, and drug companies, not to mention healthcare insurance companies.

All I can say is that after such a transition, healthcare would be “beautiful” for the average American.

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Repeal And Replace II

September 21, 2017

Republican Senators are marching, somewhat like lemmings, towards a cliff over which they are likely to plunge. The Graham-Cassidy proposal is craftily constructed healthcare (not) bill. As previous GOP attempts, this repeal and replace version eliminates the individual mandate, frees employers from the requirement to provide their workers healthcare insurance, and frees businesses and the wealthy from certain Obamacare related taxes.

Graham-Cassidy also shamelessly bribes the 50 States with a promise of a block grant which can be spent as the States see fit thanks to large cuts to Medicaid.

For some States, Medicaid cuts are unwelcome since when they do the math, these States realize they will receive less money than with Obamacare. For other States, especially those who did not expand Medicaid under Obamacare, Graham-Cassidy looks like new found money.

The vote scheduled for next week represents a wholesale capitulation by Republican Senators to big money interests. The vote is expected to be held without the daylight of any public hearings and without knowledge of the CBO review, both steps Senate Republicans had vowed to provide just months ago.

There is, however, no reason to expect the CBO score to indicate less Americans will lose coverage than in previous GOP attempts.  One must wonder why the GOP insist upon retracing its already discredited path.

At risk once again are the most vulnerable, the poor, those with pre-existing conditions, and the suddenly unemployed. Most Americans gain healthcare coverage through employer provided insurance and will not feel the impact of any “repeal and replace’ legislation (until such time as it becomes fashionable for employers to decline to offer coverage at all). The wealthy, if required, could pay for healthcare personally, and while no one likes paying for anything, healthcare insurance cost for the wealthy represents a tiny percent of their disposable income.

One is tempted to blame President Trump and assign this shameful legislation to him. Wrong.

From all reports the President has tissue paper thick knowledge of healthcare and has applied his learnings to Graham-Cassidy.

There is no doubt the President will praise the bill if the Senate finds the 50 votes necessary for passage (President knows about winning). There is also no doubt that were Graham-Cassidy to become law and the public become disenchanted with GOP governance, President Trump will then disown the legislation and blame the Senate.

Rocket Man Versus Gutter Man

September 20, 2017

President Trump addressed the UN yesterday and disappointed no one. In Trumpian style, President Trump displayed the crudest take on the “ugly American” displaying an unprecedented lack of historical knowledge for a US leader.  The President neither showed he knew how America became a wealthy country nor even a clue of the important symbiotic relationships that have maintained our Country’s living standard since World War II.

For his supporters, President Trump once again “said it like it is”. For his detractors, the President again was the embarrassment many have thought he was.

The red meat crowd (Trump populist supporters) stood up and cheered when the President called the North Korean leader “Rocket Man” and threatened North Korea with total destruction. What are they (the red meaters and the President) thinking? Does the President now endorse other Countries settling for total destruction as the preferred means of settling their differences with their adversaries?

The President also put on display his simpleminded world view. Every country for themselves, or as the President put it, world leaders should act according to their countries best interest. The “Selfish Gene” and the general theory of evolution have long established this as man’s basic motivation. Everyone acts in a way they believe in their personal best interest. But, is that the route to peace?

Does the President think, on a broader view, that the US can continue to prosper if the rest of the world decides not to trade (without heavy tariffs and duties) with the US and for good measure, ignores intellectual property rights of US companies?

A reality of today’s world is that globalization is a fact. If the US or any other country tried go it alone, that country would experience loss of customers and higher costs (due to higher raw material costs and higher labor costs). Whether the country is the US, China, or Russia, without foreign trade, the domestic economy simply can’t keep supporting its current standard of living.

The Trumpian sector may say, “so what, the US can do better than anyone else and eventually the other countries give in to our terms”. Even if this were true, history has painfully shown that those who feel they have been dealt a poor deal will brood until they find a way to get even.

The United Nations is a direct result of a world community tired of turning to war to settle grievances which had marked the world’s history. For the chief executive of arguable the greatest beneficiary of globalization to threaten another country so crudely and to trash a cooperative world community can only reflect a profound misunderstanding of history or a bully more at home in the gutter.

What say Gutter Man?

Another Helping Of Hypocrisy, Please

September 2, 2017

In the coming days, Congress will take up the matter of emergency relief funding for the Hurricane devastation in Texas. There is no question about whether there is unprecedented damage and loss of both personal and public property. There is a question on how large the loss dollar value might be but there is no question that it will be a big number.

And the bank of last resort (?), Who will pay for the damage? Why, of course, the US tax payers.

Frankly, tax payer funded, Federal Government administered, relief is not unreasonable and certainly not unprecedented. Only a few years ago, the Federal Government shelled out $50 billion in the aftermath of Hurricane Sandy for damages in New Jersey and New York. So why shouldn’t those Americans impacted in Texas not expect similar treatment?

Senators Ted Cruz and John Cornyn see Hurricane Harvey differently. These distinguished hypocrites somehow see death and destruction in Texas as a real assault on real people while Hurricane Sandy and its path of destruction in New Jersey and New York as a non-event.

I wonder whether blue States had anything to anything to influence their vision?

Ideological favoritism, and possibly, dependency, however, seems clearly involved. Ted Cruz and John Cornyn pander to ideologues with a voracious appetite.

And votes count, not to mention campaign donations are important. You just wonder how these two plus the other 18 Texas Congress members can look in a mirror and not have their stomachs turn.

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?

Up Next, Tax Reform

August 7, 2017

The President and the Republican controlled Congress agree (for now) that “tax reform” is the next target for action. Tax reform is a umbrella term, and like any good umbrella, tax reform could mean many different things. Soon Americans will know what Republicans have in mind.

There will be two parts to the reform, corporate and individual tax codes. For corporate taxes, there is a rich world of exceptions, exemptions, and deductions which could make anyone dizzy trying to figure out which ones apply to which businesses. Not surprisingly, President Trump has promised to lower corporate rates from 35% to 15% claiming the current US tax rate of 35% is the highest in the world and puts American businesses at a significant competitive disadvantage. Hmmm. (I wonder what the President will propose about the existing dog’s breakfast of loopholes, deductions, exemptions etc which contribute to the current average business tax rate of 14%, far below the starting point of 35%. Which buasinesses will be winners and which one will not?)

An important aspect of corporate tax deals with pass through taxes and carried interest taxes. Both of these options create tax favorable situations for certain wealthy business owners (lowering their overall tax liability). What will the GOP propose for these during tax reform considerations?

For the individual tax code, it is hard to imagine a more complicated set of rules. The individual tax code is used to generate tax revenue on earned income after certain exemptions and deductions are taken into account. When the adjusted income level is determined, individuals fall into tax brackets and the tax is calculated. For many tax payers (but still a minority over all), pass through and carried interest income plays a role in lower the overall bracket.

Some very wealthy Republicans want a straight “flat” tax of say 10% on all income, no exceptions, and no deductions of any kind. Others argue for less deductions and lower bracket rates but, of course, argue certain deductions are still important. Hmmm.

What is normally never discussed under the heading “tax reform” is what would be the consequences. On the plus side, tax reform is often argued as a route to stimulating the economy.  Some even say a tax cut (their idea of a reform) would pay for itself by growing the tax revenue even at lower tax rates.  Yes, believe it or not, a free lunch.

And unmistakably, there are those who plead for tax reform for various purposefully sounding reasons, in truth only seek a tax cut for themselves.

The more insidious consequence resides in what the government will not be able to afford on lower tax revenues.  Will a GOP controlled Congress lobby for healthcare and entitlements cuts too?

The current tax code has something for everyone to find wanting. The tax code seems to complex. There must be something wrong when an average person needs the help of tax experts to file ones income tax.  Corporate taxes are too high we are told yet American business, on average pay about the same tax rate as foreign businesses.  And, the tax code seems unfair to both the wealthy and the average person.  So “reform” seems a reasonable goal.

The mystery is what will the GOP think constitutes reform?

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?