Archive for the ‘Democratic Party’ category

Healthcare Math

June 22, 2017

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

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

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

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

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

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

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

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

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

 

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

 

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

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

 

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

What?

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

 

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

 

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

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

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

Democracy’s Message

June 20, 2017

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

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

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

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

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

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

Hmmm.

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

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

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

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

Free Market Health Care

June 11, 2017

When President Obama set in motion steps to expand healthcare coverage, in the wealthiest country in the world, for more Americans than ever before, he and his aides made a questionable decision to build the expansion around traditional healthcare insurance companies, like Aetna, Cigna, Anthem, etc. These cowardly chickens are now coming home to roost.

The Obama White House convinced the legacy healthcare insurers that their margins would be protected when they were presented with new enrollees who might not be able to pay for the entire premium. There would be government subsidies in other words.  That promise was enough to get the insurance companies loyalty.

With this promise (and recognition that there would be another 7 years with a President Obama), healthcare insurers signed on citing the importance of new customers and their dedication to improving Americans’ health.

When the Democrats lost control of Congress, the wheels soon began to come off the Affordable Care Act wagon. Republicans tried their best to outright repeal Obamacare and when not possible, the GOP tried to jeopardize the subsidy streams. Any uncertainties about rate coverage was enough to send healthcare insurer CEOs into orbit.

“Oh my, our shareholders simply won’t accept that”, these CEOs moaned.

In quieter moments, healthcare insurers raised rates and cited the “higher than expected” number of “sicker than average” enrollees. Imagine, these big name insurance companies were finding that previously uninsured Americans were devouring healthcare services at amounts greater than the average American?

After thought (and realization that not much more money was coming from the government), these insurance companies proposed a resolution. They would exit the market!

The Aetna’s of this world would no longer sell policies to exchanges and abandon the exchange market to someone else. So, unless the government renewed its pledge to provide adequate subsidies, these newly healthcare covered Americans would join the ranks of the uninsured again.

So much for these insurance companies’ concern about individual healthcare.

One might fantasize that a Government truly interested in its citizens’ healthcare might say to these companies that they might as well withdraw from the rest of the State’s health insurance business. Cheery picking is not in the publics best interest.

Should that hard ball tactic not convince the insurance company to stay, then employing the “public option” might win the day. Expanding Medicare (with its requirement for paying premiums) would be quick and easy to roll out. Insurance companies might then think carefully on whether they needed to become more efficient or face the creeping invasion of “single payer” insurance.

Republicans might jump up and say “how is the government going to fund the public option?  Of course the answer is through taxes combined with individual payments.  And if the Affordable Care Act is repealed or simple succumbs to the death spiral, how is the cost of the 25 million or so Americans without coverage to be covered?

How about taxes and higher doctor and hospital payments?  Which path seems more humane?  Oh, I forgot the Republicans want to cut taxes, not increase them.  Take a hike you 25 million soon to be without insurance Americans.

Hmmm.

Death Spiral

May 9, 2017

A “go to” line through out Donald Trump’s campaign was to characterize the Affordable Care Act as caught in a death spiral. (House speaker Paul Ryan likes that line too.) The inference was that insurance companies were losing money and would need to raise rates so much that individuals could not afford to purchase coverage. At some point candidate Trump predicted insurance companies would simply stop participating and there would be no insurance available in the exchanges. Hmmm.

As normal for the course, Trump and other Republicans failed to mention that the GOP had consistently opposed any further government aide for insurers, as envisioned in ACA. Now, the use of “death spiral” is serving as a handy crutch to divert attention from the GOP House debacle, the American Health Care Act.

Over the weekend, several GOP Congress members tried to put a positive spin on the House AHCA by pointing out that Obamacare was about to fail (Death Spiral) and AHCA would come to the rescue. When listeners complained about the AHCA’s weakened “pre-existing condition” coverage and huge Medicaid funding reduction, GOP speakers reminded listeners that most Americans would not be in jeopardy of AHCA.

These Congress members said that most Americans had employer provided healthcare (group plans with no denials for pre-existing conditions), Medicare, and Medicaid.
While this is a true statement, I wonder what these Republicans really meant?

  • Does the GOP think Americans shouldn’t worry about the other 20-50 million without healthcare coverage?
  • Does the GOP think Americans are naive enough to overlook the possibility that even if employed today, in a recession or just normal course of business, they might be furloughed and suddenly have no healthcare insurance?
  • And what exactly does the GOP think are “pre-existing conditions”?

Libertarian GOP members are intellectually the most honest GOP faction. Libertarians reject government welfare in all forms and providing at tax payers expense healthcare insurance just doesn’t cut it with real libertarians. Then again, Social Security, Medicare, and Medicaid don’t make the Libertarian cut either. Hmmm.

The GOP is moving into dangerous voter territory. While not of their making, the continued, rise in healthcare costs (greater than the rate of inflation) will not suddenly change if Republicans prevail and pass the watered down AHCA.

The US healthcare delivery system is seriously flawed. EpiPens did not increase 400% in price due to the Affordable Care Act. Mylin’s decision to raise prices was a pure exercise of capitalism in the healthcare market. And Mylin’s actions are not an isolated exception. Almost all drug companies are driving up prices to see what the market will bare. And why is it one can buy the same prescription drugs substantially cheaper in Canada than in the US?

As frustration continues to mount, sooner or later, Americans are going to ask, “do other countries have this same cost problem?” Most Republicans know this, yet many Republicans continue to march further out on a limb, probably blinded by the tax cut appeal associated with the repeal of ACA.

ACA has opened Americans eyes to how precarious their insurance coverage is and how the widening income distribution inequity combined with rising healthcare premiums are putting the American dream further out of reach.

Will the current fight over ACA be a death spiral or a rebirth of hope for universal healthcare?

Should I worry About My Freedom?

May 8, 2017

On National Prayer Day, President Trump signed an executive order instructing the IRS to use “maximum enforcement discretion” when considering a religious tax exempt organization status should the religious organization publicly support a political party or position. In typical Trumpian style, the President boasted of fulfilling another campaign promise. President Trump’s message was a sop to the religious right who complain that they should be able to participate in campaigns without losing their tax exempt status. Hmmm.

Trump’s executive order in effect instructs the IRS to not enforce laws and regulations. Strangely, while as a candidate, Mr Trump strongly criticized former President Obama for not deporting every undocumented alien after then President Obama used an executive order to prioritize deportation. This, of course, is hypocrisy of the most convenient type.

But is the religious freedom executive order a significant threat to my freedom?

Not really at this point. Rather, allowing tax exempt organizations to participate in political activity instead makes suckers out of everyone. The rest of us pay taxes and earn the right to vote. Why shouldn’t religious organizations pay taxes if they want to influence the vote?

A much greater threat emanates from the notion that religious organizations can openly participate in the secular world advocating policies consistent with their ideological or dogmatic views. Sharia law anyone?

Religious organization range from the large (like the Catholic Church) to the small (like evangelical one location mega churches) to the tiny (store front, 100 member or less churches). And in theory, the executive order should apply to any faith even though the same issuer of executive orders has attempted to exclude Muslims from the US. I wonder how much discretion the IRS will use on them?

All Americans are free to hold opinions and are encouraged to use the ballot box to express these opinions. If enough Americans agree, election results reflect these views. Fortunately, we also have laws, supported by the Constitution which drive secular behavior. So, a store cannot choose to sell a product or service to one person (say a white) and deny the same product or service to another (say a black). And no amount of reality stretching can construe religious freedom can encompass this type of discrimination.

Or does this Trump executive order portend discrimination on a wide range of “freedoms”.

Vice President Pence, then Indiana Governor, has past experience in supporting  “religious freedom” legislation. Indiana passed a law, under the cover of respecting “deeply held religious views” of those good Indianians who reject same sex marriage. Had not the sports world promised to abandon Indianapolis financially, Pence was prepared to sign the law.

Religious organizations are just that. They are organization which market a set of beliefs to the public (and collect money from believers. Many, but not all, religious organization peddle dogma which limit or takes away freedom from others in the name of a “deeply held religious view”. Reproductive health, same sex marriage, gender identity, alcohol and caffeine, immunizations, and blood transfusions are a few bans that certain religion would make into restrictive law if they could.

Since no one is required to use contraceptives or have an abortion, or to marry someone of their same sex, or drink alcohol and coffee, or accept immunizations (except in public health situations) or receive a blood transfusion (even in life saving events), religions are better served to sell their beliefs to their members and leave everyone else alone.

Allowing one religion to foster its unique views in an attempt to influence the ballot box is a threat to my freedoms, not to mention a violation of the Constitution.

Seems Obvious

May 6, 2017

In the upcoming Philadelphia District Attorney primary, George Soros has announced he will spend $1.4 million to advance the candidacy of one of seven candidates. In Philadelphia terms, that is a lot of money. The obvious question is why?

The simple answer is George Soros is very wealthy and there is nothing to stop him.  Hmmm.

Actually George Soros is and should be free to “prefer” any candidate in any State or National election and even make verbal recommendations. The real question is why should George Soros, or anyone else who is not a resident of the US, a State, or a local election be able to spend money to influence the election’s outcome?

Most people would find it repugnant that a foreign citizen or country could spend money to influence a US election. Why then should someone living in Michigan or Mississippi spend their money to influence an election in Boston or Los Angeles?

Cynically, the answer might be that the more money spent in any elections translates into more revenue spent in the State and local economy than would have been spent otherwise. Spending loosely translates into jobs, and what’s bad about jobs?

The Supreme Court’s Citizens United ruling called corporations the same as people. With that reasoning, rights accruing to people should accrue to corporations, the reasoning goes. And, spending is an expression of free speech. Hmmm.

So, a large multi-location corporation, flush with money, could support local politicians who espouses certain policies viewed favorably by this corporation, to the disadvantage of local citizens and not to mention smaller, local corporations. The notion of “one man – one vote” just went swishing by, out the window.

Not to complicate this issue needlessly, surely corporations operating in a jurisdiction in question must have opinions on many issues, and would routinely express these views directly or through lobbying firms to elected officials. Why not join the conversation before the candidate is elected?

From my perspective, this seemingly obvious question boils down to what is “reasonable”, and in line with the voice others who will cast a vote (corporations despite being people do not vote) will have. What should be at the heart of this issue is protecting the integrity of the vote. A citizen’s vote should not be drowned out by a voice greatly amplified by money coming from any source, particularly sources outside the jurisdiction whether corporations or by individuals.

The current lack of campaign funding regulations represent cynical attempts to utilize vast sums of money to twist the electoral process to favor certain parties, ideologies, and policies in contempt of the one man – one vote tradition.

George Soros should have no role to play in Philadelphia.

Assessment After The House Vote

May 5, 2017

Yesterday the Republican controlled House of Representatives voted narrowly (217-213) to pass the American Health Care Plan which in their eyes is a “repeal and replace” healthcare option. Amazingly, the House rushed to vote with no “official” (CBO) estimate of the cost or impact.  Hmmm.

When the vote was announced, Republican leaders including Vice President Pence stood before photographers applauding each other. Was it a day of rejoicing or a day which will bring telling consequences?

The AHCA retains much of Obamacare but has reduced its benefits and scope. Senator Rand Paul has aptly called AHCA “Obama-lite”. What the AHCA is not light about is the individual mandate and the mix of revenue offsetting taxes designed to make the keep federal budget revenue neutral, they are gone. I wonder whether that is what the GOP leaders were cheering about?

There will be passionate speeches about what the House AHCA version does and does not do. And, until the bill actually goes into effect, no one can be 100% sure. What can be sure is that without the additional income generated by the individual mandate and the special taxes, is that the GOP replacement will (1) swell the deficit since the government must make the insurers whole in some way, (2) Republicans will be content to allow the marketplace to price some Americans out of the market bragging that these fellow Americans made patient centered choices, or (3) some combination of both.  The AHCA is less coverage for more money for fewer people.  Hmmm.

Do the math. Minimum wage is $7.50 per hour, 40 hours (if one is lucky to find work) per week is $300. Therefore in a year this low wage American is earning $15,600. According to published reports, individual purchased family insurance cost $1021 per month, or $12252 per year. Hmmm, $15,600 before food and shelter, and healthcare of $12,252 which must come off the top. Do you think there will be incentives to offer less insurance coverage in order to get the yearly individual market coverage decreased?

How can a major party sleep knowing that its proposal will treat Americans of limited financial means (which could include full time, minimum wage earners) destine for less basic healthcare than more wealthier Americans? Would anyone think that we should ration basic sustenance for water or food based upon ability to pay?

The House vote marks a dark day for Republicans. All the masterful rhetoric the GOP will surely muster will not change the directional outcome. The American Health Care Act now heads to the Senate where it will meet another test.

Some GOP Senators think the House version is far too rich and would advocate an even stingier act. Others are more moderate and find the House version onerous. Regrettably most Republican Senators are likely to find the House bill as no obstacle to a good nights rest.

With a two seat Senate majority, the outcome is too close to call.