Archive for the ‘Healthcare’ 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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Obamacare’s 9 Lives

September 26, 2017

With Senator Susan Collins’ thumb down, it appears the Affordable Care Act (Obamacare) will live to die another day. This is a victory for decency to be sure, but fiscally US healthcare remains a uncertainty. What does this say about those who govern?

Senator Rand Paul said the GOP bill (Graham-Cassidy) was too much like the Affordable Care Act (too much entitlement), and he said he would not vote for it. Senator John McCain told Senate Republicans to use a bi-partisan approach when Congress deals with 1/6th of the economy. Republicans did not, and McCain said no thanks.  And, Susan Collins announced her “no” following the release of the CBO score indicating millions of Americans would lose coverage with Graham-Cassidy. Others such as Senators Cruz and Murkowski were rumored as “no” but have not spoken out.

The general theme of Republican opposition has been exploding cost. Republicans seem concerned that the Federal Government will pump billions into healthcare and that amount will not be enough as healthcare cost will increase each year. A subset of these fiscal worriers sees Medicaid expansion as the culprit and have selected block grants to States as a way to cap the Federal Government’s financial obligation.  Both of these concerns are reasonable but is it reasonable to take healthcare away from some in order to keep the Federal cost down? Hmmm.

Senator Bernie Sanders has seized this opportunity to hype “Medicare for all”, a single payer system, as the best way to fix Obamacare. OMG, here comes socialism Republicans are crying out.

What an opportunity for someone to articulate in a calm voice that the rest of the modern world provides basic healthcare to all their residents at 1/2 or less what it costs America and these other countries have excellent (better than the US) health outcomes.

If Republicans were really serious about the fiscal aspects of Obamacare, one would think that adopting a healthcare system similar to France, Germany, or Switzerland’s would make sense. Unfortunately, these universal, single payer systems cut out insurance company profits and in turn campaign donations to politicians.
Hmmm.

There might be a tendency to take a deep breath that Obamacare has survived again.  Obamacare’s nine lives are not a forever thing.

Republican’s disregard about pre-existing conditions and even whether everyone, regardless of means, should have access to basis healthcare pose a menace to most Americans.

One might think that faced with a ground swell for Universal, single payer, Republicans might see Obamacare as a preferred alternative.

McCain’s Repeal and Replace

September 23, 2017

Senator John McCain informed Senate Republican leadership that he could not support the latest “repeal and replace” bill (Graham-Cassidy). This placed the proposed legislation one vote away from defeat and would then end a Republican only healthcare action. Was this McCain’s finest hour?

Senator McCain rejected partisanship saying healthcare was too important a matter to not have bi-partisan support. Life could have been much simpler for McCain if he had just chosen to wait and in the end go along. But for the 80 year old Senator afflicted with brain cancer, the future might not seem so endless. For whatever his reasons, Senator McCain made a principled decision without regard to special interest pressure and money.

Hip, hip, hurrah for John McCain.

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.

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?

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?

The Big Fat Lie

July 25, 2017

Exaggeration and Hyperbole are staples of public speaking and popular literature. President Trump, since day one of his Presidency, has added these speech forms to his Presidential Addresses. It appears the possibility of being tagged with multiple Pinocchio’s is not a deterrent for America’s “communicator in chief”.

Yesterday, in a staged photo op, President Trump spoke out over the Senate “repeal and replace” stalemate. Pointing to the gathered group (J Crew looking group), the President asserted that they were Americans who had incurred the injurious nature of the Affordable Care Act (Obamacare). The implication was that here, in flesh and blood, were Americans who were harmed by ACA and wasn’t that proof positive that repeal and replace was necessary?

Maybe, but what about the 22 million Americans who the Congressional Budget Office say will lose healthcare coverage should either the Republican House or the Senate legislation pass. Is that Exaggeration or Hyperbole?

No, Deception or Misdirection would better describe the President’s statements. For someone who appears to have no regard for any statement’s accuracy, President Trump is more complex than just a “truth stretcher”, the President is purposeful and says what ever is necessary, no limits considered, to achieve his goals.

So, as if to say the misdirection statements about how many Americans would benefit from Obamacare were not enough, the President stood before this group and into the camera said, Democrats lied about the Affordable Care Act in order to get it passed, “every single thing they said was a lie, a big fat lie”. Hmmm.

Liar, liar, pants on fire.

The Presidency appears in a race for the bottom. What more outrageous mistruth or magician’s misdirection will President Trump put forth? The larger question might be, how much more exaggerations and hyperboles will Americans accept before deciding to dismiss all statements from our communicator in chief?