Archive for the ‘health insurance companies’ category

Public Option?

April 21, 2017

The GOP and the Trump White House are beating the healthcare drum again. The President promises a really good plan for replacing Obamacare. According to a report in the Washington Post, Trump said, “We’re doing very well on health care.” “The plan gets better and better and better, and it’s gotten really good, and a lot of people are liking it a lot.”  “We have a good chance of getting it soon. I’d like to say next week, but we will get it.” Hmmm.

I suspect those Americans who loose their coverage or those who subsequently find out their coverage covers a lot less will not think their health plan got “better and better”.

Republicans are now debating behind closed doors a plan which seeks to bring together conservatives (Freedom Caucus who do not want any hint of entitlements in healthcare and would prefer for the government to not be involved at all), and moderates (The Tuesday Group who fear sharp political retribution if the benefits of Obamacare are rescinded). The Tuesday crowd are offering weasel words that would allow States to opt out of certain Obamacare services. Hmmm.

The overall facts appear unchanged. The American Health Care Act, even as amended, will provide less coverages to fewer Americans than Obamacare and will provide huge tax savings for the wealthiest Americans. The GOP’s embrace of “the best healthcare money can buy” is a sad replacement for the Affordable Care Act (Obamacare). Is that the best we can hope for?

Here’s a dream.  “Medicare for all” could be a next step in healthcare. Compared to the “oh so many” for-profit insurance companies today (which stand between you and your doctor), Medicare, which insures post 65 year old Americans, and fits seamlessly into existing doctors, hospitals, and pharmacies, could offer “a ready to go” alternative.

Of course Medicare is not without some problems, namely how it is funded. Republicans will decry the expansion of government and seek ways to defund Medicare. Cooler minds, however, might see Medicare as the ideal vehicle to determine what is basic healthcare and how to pay for it, especially if Medicare became the standard package for employer provided healthcare.

No sane discussion of healthcare reform should avoid the obvious elephant in the room. Americans spend more on healthcare than any other country in the world and receive mediocre healthcare outcomes in return. The difference in cost is significant (greater than two times).

An additional revelation is that balancing the Federal Budget can not be achieved unless there is a fix for Medicare and Medicaid, both of which collect less in tax revenues than they spend on healthcare benefits. With “Medicare for All” there is one program providing basic coverage with significant negotiating power with healthcare providers. Existing insurance companies could continue to “administer” Medicare benefits but would be unable to set different conditions around services.

Most likely efficiencies associated with a single payer would be insufficient to assure Medicare would be solvent. Consequently tax reform coupled with healthcare reform could be seen as reforms aimed at serving all Americans and not as ploys to pass on huge tax breaks to the already very wealthy.

Despite wrong headed GOP motivation on both tax reform and healthcare, Democrats, unfortunately, appear willing to simply play for a tie (defined as thwarting the American Health Care Act thereby keeping Obamacare) and rejecting tax reform unless the proposal is revenue neutral or positive.  Hmmm.

The can is poise for another kick down the road.

Republican Healthcare Secret

April 6, 2017

Today there were reports that the unofficial  second effort to repeal and replace Obamacare had collapsed. It appears that potential changes to the initial failed repeal and replace (American Health Care Act), while encouraging to the Freedom Caucus was unacceptable to moderate Republicans. In other words original no votes that were willing to change to yes votes were offset by original yes votes who would now vote no. Hmmm.

These healthcare deliberations speak volumes about the Republican Party. For the better part of seven years the standard Republican Obamacare line has been “job killer”, “a disaster”, and “we will fix healthcare”. Through the buzz of political speak, one can see that there never was a Republican Plan. Many different Republicans may have had plans but as a Party there was never agreement on anything other than the value of insinuating that the Affordable Care Act was in someways defective and by association, Democrats were also defective. Hmmm.

Republicans are now revealing (1) they are not a party of one mind, and (2) the Freedom Caucus hold views which are mean spirited, ill informed about basic healthcare, and really represent a third party, not a faction of the larger Republican Party.

Around the world, other modern countries have settled on healthcare models which provide basic healthcare to their residents. These countries have found that preventive care and reasonable controls on healthcare provider’s profit incentives produce superior health outcomes for their residents and much much lower costs to boot.

The Freedom Caucus is claiming they won’t agree to any Obamacare changes unless there is a reason to believe healthcare premiums will decrease. On the surface this sounds reasonable. But when one considers the Freedom Caucus approach (eliminate Federal mandates over what services healthcare policies must cover), one suddenly realizes that the Freedom Caucus is comfortable with insurance companies reestablishing pre-existing condition limits and embracing stripped down policies (like catastrophic care only) which provide no access to basic preventative healthcare. The Freedom Caucus has written the book on “the best healthcare money can buy”.

The Republican Healthcare Secret is much more about the party itself than healthcare. The Freedom Caucus would also seek to not just roll back (or moderate) recent gains in civil rights, human rights, and environmental protections, the Freedom Caucus would seek to deny there is any basis for these rights to exist or protections to be implemented.

One might think the right thing for Republicans to do would be to expel the FC from the Party. But the Freedom Caucus has been beneficial to the GOP also. Caucusing with the Republican Party, the combination has been able to “control” Congress, and thereby chair the major committees. While the GOP was the Party in opposition, there was always a greater danger than ideology, the other Party. Now the Republican Party has control of the executive and Congress and can no longer ignore the role of responsible governance.

Damn that Freedom Caucus.

A Week Of Eye Opening

March 26, 2017

This past week has been an eye opener for what a new Republican Congress stands for. How about “for everything” and “for nothing”? Or, maybe “for effective government” and “for ineffective” government? Or, maybe “for sincere government” and “for insincere government”? Hmmm.

This first revelation was striking. Republicans had passed legislation to repeal Obamacare about 80 times during the past 6 years and had campaigned in 2016 for the complete repeal and replacement of Obamacare. Yet when the opportunity was there, Republicans had no replacement plan.

The GOP had many plans, all disingenuous, but there was no one plan Republicans could agree upon. Hint: do you realize GOP candidates lied about their intentions?

The most popular refrain the GOP used was lowering the premium costs which “Americans” are experiencing. To some degree, in some places, this claim seems justified but Republicans were happy to leave this claim unclear. Americans receiving healthcare coverage from their employer, Medicare, or Medicaid, received no staggering premium price increases. These Americans were shielded from the increases some individuals in certain areas experienced.

So why would Republicans make such a claim? Could it be that most all Americans experience some form of uncontrolled healthcare cost increases (as they did yearly before Obamacare) and don’t understand why hospitals, doctors, and drugs cost so much?

Few, if any of our politicians called out for a universal, single payer system to replace Obamacare. Shamefully, Republicans instead called for changes to Obamacare which were designed to reduce cost increases pressure by insuring less people! How do those politicians sleep at night?

But simply reducing coverage was not good enough for some Republicans. The “Freedom Caucus” members sought to change Medicaid from an entitlement for the most needy to a capped block grant which would become the sole responsibility of States in a few years.

The “Freedom Caucus” wants to deconstruct the Federal Government and healthcare seemed an opportune way to begin the process. “Freedom Caucus” members represent a clear and present danger to modernity.

Most Americans have little skin directly in the healthcare game. Next up on Congress’ docket is likely to be “tax reform” where almost all Americans have an opinion.

While there is much good that can be achieved (like eliminating or vastly reducing the number of tax loopholes, exemptions, and deductions), changes which will lower the overall tax revenue or the progressive nature of the tax code, are sinisterly designed to reward the wealthy and to starve the Federal Government and its ability to function.

With tax reform, even more than with healthcare, it will be critical to study what any proposed changes might accomplish before voting upon any bills. The devil will almost certainly be in the details.

This past week revealed a White House and a Congress whose intentions are hidden.   On one hand, the Republicans seem unfit to govern and on the other hand, seem not a friend to the average American.

I wonder whether this GOP leadership will have learned anything that might restore faith in their intentions? I really wonder whether the White House or the Freedom Caucus care?

Free Market Health Care

March 23, 2017

The Republican sponsored “American Health Care Act” is floundering in Congress. The replace portion (as in repeal and replace Obamacare) is in trouble for curious reasons given that Congress and the Presidency are both in Republican hands. The political farce which is unfolding casts a sharp light on the undeniable fact that there is no Republican Party united around a core set of principles. Rather today’s Republican Party is a party of convenience which unite around not being Democrat or progressive.

The shallowness of this union shows through in the Republican argument over repealing Obamacare and trying to agree upon a replacement. Maintaining “no pre-existing condition” or “no life time benefit limits” exclusions along with keeping children on parent’s policies until age 26 showed the world Republicans were caring and compassionate (or so they said).

But doing away with the individual mandate and dropping certain taxes has brought into focus the difficult task of how to pay for these benefits and keep the same number of Americans on the insured roles. The inescapable GOP conclusion is that insurance costs will not come down unless, Republicans say, the free market kicks in. If this mysterious free market does not bring down the cost of insurance, then individuals and Medicaid will see large increases in cost.

The most conservative Republicans, true believers in everyone should have access to the best healthcare they can afford, are now proposing to eliminate the 10 healthcare benefits mandated in Obamacare. Hmmm.

  1.  Outpatient care—the kind you get without being admitted to a hospital
  2. Trips to the emergency room
  3.  Treatment in the hospital for inpatient care
  4.  Care before and after your baby is born
  5.  Mental health and substance use disorder services: This includes behavioral health treatment, counseling, and psychotherapy
  6.  Your prescription drugs
  7.  Services and devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8.  Your lab tests
  9.  Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10.  Pediatric services: This includes dental care and vision care for kids

It shouldn’t take a genius to realize that without some requirement like these 10, insurance companies can price policies high and steer customers to stripped down version such as  catastrophic coverage. Moderate Republicans, especially those representing poor or inner city districts, see a huge backlash coming in the next election if the ultra conservatives prevail.

Conservatives are quick to counter, “doesn’t everyone have the right to buy only as much insurance as they want? Why would a single young man want to pay for pre and post natal coverage if he is not married?”

That strikes right to the heart of the matter. Healthcare costs, are generated by hospitals, doctors, and drug companies and don’t change simply because of insurance changes. The number of pre- and post natal visits will be the same regardless of whether a young man chooses to carry broad coverage or just a stripped down policy. The implication, however, should not be lost, everyone else will pay more if the young man is allowed to buy stripped down policies. That is the definition of insurance.

Republicans are ringing their hands over this dilemma. Conservatives say they will vote against the American Health Care Act if the bill looks too similar to Obamacare and Moderates say without certain coverage and federal assistance (like tax credits and Medicaid) they will vote against it.

Congress members appear to be living in a make believe world. If somehow Congressional leaders along with President Trump can work out a compromise and pass the American Health Care Act, then just looking at the reduce insured numbers and the fewer services many Americans want (and need), Republicans will lose in 2018.

“Americans” Expect Us To Act

March 22, 2017

How many times have you heard GOP leaders repeat ad nauseam the mantra “the American people elected us to X or Y”, or “the American people want this or that”? The correct terminology  would be “Some American people…” with emphasis on “some”.

This type of honesty and absence of hyperbole would diminish the pomposity and self importance GOP elected officials want to present. (I fear this is a Republican disease today simply because Republicans are in the majority and in truth, Democrat leaders might fall under the same spell if roles were reversed.)

No better example of the misleading nature of “Americans expect” is the current healthcare debate. Republican Congressional leaders are moaning about those Republican Congress members who are threatening to vote against the American Health Care Act (the replace plan for Obamacare). “Americans expect us to pass this bill” leaders cry while all sorts of non-partisan studies point out that the replacement bill will maintain some popular Obamacare benefits but at the end of the day provide less coverage and insure fewer people.  No more appropriate subject does “some Americans” apply than here.  “Most Americans” are not impacted as a benefit recipient by Obamacare

For some Republican Congress members, the AHCA does go far enough in rolling back entitlements and for others, it goes too far. Hmmm, I wonder what Americans really want?

Senator Rand Paul elaborated today on his proposal which could gradually eliminate Medicare expansion and streamline the individual market. Paul has proposed creating a pool of all uninsured and the allowing the “free market” to drive down price through competition amongst insurers.  As lower policy prices emerged,  government supports would decrease until they disappeared. Hmmm.

Paul deserves credit for proposing a clever way out of the box Republicans have created for themselves. His proposal, of course, has it own set of pitfalls, the most obvious of which is whether “for profit” insurance companies will want to offer policies at prices the pool will demand and people can afford. None the less, Paul proposal deserves a careful review.

The irony of the current healthcare repeal and replace drama is that greedy Republicans are far more interested in diving into “tax reform”. We will hear again that “Americans expect us to lower taxes” when in fact “some Americans”, like the top 1 or 2% wealthiest Americans will alone reap huge benefits. Most American will see little impact and no benefit. More insidious will be the knock on effects of such a large tax cut. Where will the Government get revenues to pay its expenses?  Think there will be more cut in government services?

The Republican tax reform odyssey will make “searching for a free lunch” dinner time conversation.

Is The Free Market The Answer?

March 20, 2017

The “repeal and replace” gang have been telling Americans for a long time that healthcare needs to be about choice, that the high cost of healthcare is because the free market is not working, and things will get better when Government no longer comes between the patient and the doctor.

Admittedly, supporters of Obamacare have been handicapped because healthcare spending is still high and rising annually. How can one speak against what Republicans are saying when what Republicans are criticizing is not working well either?

Whoa. Let’s slow this down and review some inconvenient facts.

The Affordable Care Act (Obamacare) is about insuring more Americans, not directly dealing with how much healthcare costs. So right away if voters don’t want to pay (via subsidies and expanded Medicaid) for more insured, than it is entirely unnecessary to put forth misinformation about more choice and better healthcare, just admit that as an American one feels no need for universal healthcare coverage. Full stop.

Now if one wishes to invest energy and tinker with the Affordable Care Act, let’s consider a few popular Republican myths.

  • Get the Government out from between you and the doctor. Is the implication that I should accept (for profit) insurance companies making better decisions on what treatments are covered or what drugs are acceptable? At the very best of possibilities, how are these two options different? And, with insurance companies public corporations with a requirement to make a profit, how can insurance companies not be more costly?
  • Competition is the answer to lowering healthcare costs. The suggestion is that with more policies available (selling insurance across State lines) natural free market principles will drive down costs. Insurance prices are related to real healthcare costs which are generated by hospitals, doctors, and drug companies, not insurance companies. Insurance companies simply hitch a ride on basic costs.  Insurance premiums assumes usage and underlying costs PLUS insurance company profit. If insurance companies guess wrong, they just raise the price of their policies.
  • Patient centered Healthcare puts the individual in charge. This “wordsmith” slogan “Patient Centered” has no connection with underlying costs. “Patient Centered” is about providing the patient with information about their health status and suggested medical treatments and services tailored to improve health outcomes. Is this not what we have today?
  • American Healthcare is the best in the world. This myth is put forth whenever there is a suggestion that other countries have better healthcare delivery systems and surprisingly achieve that superiority at substantially lower costs. There is little to be gained from disputing how good the Mayo Clinic, the Cleveland Clinic, or Johns Hopkins might be, or for that matter many other large teaching hospitals across the country. Most Americans, however, only read about these institutions and do not receive medical treatments from them. Life expectancies, percent of residents receiving basic healthcare, and treatments for serious illnesses rank American healthcare well down the list of modern, developed countries.

The number one problem with America’s healthcare delivery system is cost. Americans spend twice as much as most other modern countries (with healthcare outcomes equal to or superior to America’s). The number two problem is that America’s healthcare delivery system does not include all Americans since cost puts it out of range for poorer, sicker, and older Americans.

These are not myths, these are facts. So all the smoke and fiery words about repeal and replace the Affordable Care Act miss the primary targets as did Obamacare.

Given all this, is the free market even remotely likely to improve a fundamentally flawed healthcare delivery system?

Access Versus Coverage

March 14, 2017

The ideological and philosophical differences over America healthcare got clearer yesterday with the Congressional Budget Office scorecard report on the GOP “replace” healthcare plan.  Hmmm.

Access means if you have enough money an American should be able to get coverage.

Secretary of HHS, Tom Price readily confirmed that those who do not want coverage should not be forced by Government to have healthcare insurance. Hmmm.

Price was a little less clear on the future for those Americans who cannot afford the new, reduced subsidies (in the form of tax credits). The best he could say was the CBO numbers were wrong. Other law makers pointed out that when Federal Medicaid support went away, States could pick up the tab. Hmmm.

The GOP’s animosity towards the individual mandate while clear is never the less hard to understand. These insurance deniers are plain and simply “free loaders”, playing the system for their personal advantage. How Republicans can line up and staunchly defend an individuals right to NOT purchase insurance is difficult to comprehend. Similar arguments has been waged around motorcycle helmets and auto insurance and the side of reason has prevailed. When someone without insurance gets sick or injured, it the rest of us who foot the bill for the free loader’s medical costs.

As in most political rhetoric, even the most disingenuous, there is often a thread of truth. Republicans have pointed out cases where Americans (some) purchase healthcare insurance and find that the deductible or co-pay are so high that it makes use of the insurance very limited and not helpful in providing basic, preventative healthcare.

Republicans have also pointed out that in some areas, individuals with Medicaid coverage find doctors have refused to accept Medicaid because the reimbursement amount is too low. Hmmm.

Both of these are straight forward fixable if one was sincere about providing real access to healthcare (both affordable and with dignity). Hmmm.

The current healthcare debate is about the “fringe”. Most Americans obtain their healthcare insurance through their employer or through Medicare, Medicaid, or the VA.

Prohibiting the immoral and unethical practice of denying coverage due to pre-existing conditions or other discriminatory practices which price people out of the market potentially could apply to everyone but in practice apply only to about 10-15% of Americans. So, why should anyone worry about this current debate?

I wonder whether this Republican argument could be applied to Medicare, Medicaid (pre-obamacare expansion roles), and Social Security? I wonder whether Republicans are thinking seniors, low income Americans and retirees actually need government assistance (that in theory Americans have paid for through wage taxes) or would they be better off investing in the private sector? I wonder whether “access” through subscription to investment plans during ones working life would obscure the need for Medicare, Medicaid, or Social Security?

I wonder.