Archive for the ‘Healthcare’ category

Speaking About Life

May 12, 2019

On Friday, another pro-life protest broke out in Philadelphia.  The site was the center city “Planned Parenthood” office and as has happened so often in the past, pro-life demonstrators were “praying” and then “calling out” (respectfully they say) to strangers who appeared about to enter the Planned Parenthood office.  A Philadelphia State Senator happened to be present and went into a tirade against a pro-life mother and daughter telling them this was none of their business.  Bad form to be sure and not very smart since his tirade got onto social media and you guessed it, more pro and against people arrived.

Seizing the opportunity the Catholic Archbishop (Chaput), called out for protecting the unborn.  I wonder whether the Bishop was aware of the irony of his words.  The Bishop is someone who has stonewalled the investigations into priest child abuse and yet he feels compelled to speak out on women’s rights.  Hmmm.

There is no question in my mind that many pro-life advocates genuinely feel that abortion is wrong.  To this group the fetus is life and is destine to live in suburbia, go to great schools, and when an adult, saves the world.  Unfortunately, life is not that way.  Planned Parenthood deals mostly with middle class to the very poor Americans who lack the means and knowledge to prevent unwanted pregnancies, or sadly learn that the fetus is defective or likely to be a risk to the mother herself.

The Catholic Church speaks of love yet until very recently shunned LGBTQ community members and still speaks of them in “defective” terms.  Wouldn’t it be far more loving for the Church to welcome pregnant women and if the pregnancy is unwanted, to provide options including moral and accepting ways to end the pregnancy?

There should be no concern that “well to do” women will need the service of Planned Parenthood.  Abortions for the well off are safe and widely available if you have the money.  It seems life of the unborn is only a problem for the poor.  

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Healthcare All Over Again?

March 29, 2019

Like a flash brush fire, the subject of US healthcare has blazed anew.  Dumbing the complex healthcare situation down, the President and loyal Republicans are chanting for the ACA’s elimination and good things will follow.  The President has promised the best healthcare ever, one with “pre-existing” coverage and no individual mandate.  Of course the President wants first the ACA repealed, or ruled un-Constitutional in the courts, and then… “trust me”… the GOP will introduce a beautiful new healthcare bill.  Hmmm.

The silver lining of this “bad dream again” issue is that there are compelling reasons to reopen the healthcare “can of worms” again.  The ACA represented an honorable, ethical, and moral effort to improve upon what existed in 2008 and provide access to basic healthcare for all Americans.  Republicans tell us that ACA is not so. 

The inconvenient truth about US healthcare (the current ACA or the version before ACA) is that

  • healthcare spending per capita is twice that of other developed countries,
  • does not still cover everyone (estimated 20 million more however), and
  • mediocre healthcare outcomes compared to many other countries.  (Healthcare available through institutions such as the Mayo Clinic, Johns Hopkins, Cleveland Clinic and most major University teaching hospitals are as good as there are in the world but those located in the suburbs, depressed inner city areas, and the rural areas across the country are not delivering on the highest standards. And, not to be overlooked, US healthcare is not affordable or not available to too many Americans.)

Affordability, and availability rise above the partisan solutions such as “Medicare For All”, “the replace of Repeal and Replace”, and “keep government out on my healthcare”.  There is no known credible reasons to justify current US healthcare cost and outcomes. 

  • Drug prices are non-negotiable for Medicare.  How is that possible? 
  • A growing number of Americans are learning that they can buy prescription drugs in Mexico or Canada the exact same medications they currently purchase in the US for substantially less.  Why would the Government not demand the best global price? 
  • Republicans have embraced private sector solutions built around private healthcare insurance. Let the insurance companies police costs, the GOP says.
  • Insurance is based upon pooling risks. .  So how can the GOP fight to eliminate the individual mandate? Without the individual mandate the insurance revenue pool will shrink.  In addition, individuals without insurance will go to Emergency Rooms where they will, by law receive treatment.   In essence, no individual mandate means a free pass for those who do not wish to buy insurance, cost everyone more, and makes everyone else a sucker.  How does this make sense? 
  • Estimates put US healthcare spending at 18% of the approximate US $20 trillion GDP (almost $4 trillion).  If the actual spending was on a parr with 20 other major world countries, there could  be $1-2 trillion savings each year extra for investment in infrastructure or paying off the national debt.  What are Republicans thinking?

President Trump and Republicans are disingenuous about healthcare reform.  Democrat candidates who are singularly focused on insuring everyone and overlooking the inexplicable cost differences with other modern countries are destined to make the GDP cost even larger.  The US deficit can not be reduced or brought under control without first dealing with healthcare costs.  Even more dangerous, in the world of income inequality, unless basic healthcare is made affordable for all, there is destine to be social upheaval.

Medicare For All

January 30, 2019

As the 2020 Presidential Campaign season begins to bud early, a few candidates are stepping forward testing the publics reaction to them.  Elizabeth Warren and Kamala Harris have amped their entries with the battle cry “Medicare For All”.  Two unannounced candidates, Howard Schultz and Michael Bloomberg, have dismissed “Medicare For All” as too expensive.  No surprise then that Schultz and Bloomberg position themselves as “centrists”,  Hmmm.

T0 be successful, the accepted theory seems to be the Democrat candidacy must be more than simply “anti-Trump”.  Democrats must be for something, not just against the current President.  Hmmm.

Healthcare is, for sure, a mess and capitalism is stinking up the house.  Morally, it would seem unconscionable that any reputable healthcare insurer could put forth the notion of “pre-existing condition” as grounds for not insuring someone. And the well worn line of “don’t put the government between you and your doctor” seems ridiculous if the other options is putting the insurance company between you and your doctor.  What are people thinking?

The public’s demand for transparency of medical costs touches on another evil.  Hospitals are unable (and unwilling) to put numbers on the table.  Hospitals claim that there are insurance company discounts which means the patient never would pay the hospital full charge (if the hospitals knew what their costs were).  Drug companies use the same thinking to justify their greedy price increases.

What cannot be denied, however, is that Americans spend, without universal coverage, more than twice as much as anyone else in the world.  And if anyone googles healthcare, one can quickly determine that in comparison to other first world countries, Americans pays twice as much and receives only mediocre healthcare outcomes.  (Of course those Americans who utilize the Mayo Clinic or similar world class health care center, pay the high prices but do receive outstanding medical care.  These world class medical facilities serve only a small slice of Americans).

Schultz and Bloomberg’s “Medicare For All is too expensive” reaction may be missing a point.  Health care today is already too expensive for the average American.  Harris and Warren’s off the cuff reply that the rich will have too pay is just as out of touch with reality.  In fact taxing the wealthy is sure fired way to stimulate even higher healthcare costs.  (Free enterprise just loves situations where there is a payer.)

Healthcare systems found in Japan, Canada, Germany, or France, for example, emphasize preventive care, cost controls, and largely a national sales tax to fund the healthcare system, not taxes on a single segment of society.  The national sales tax (value added tax) coupled with negotiated health care services and drug costs keeps “cost control” front and center, and reminds everyone that healthcare is not free.

The 2020 campaign season does not get into full swing until later in 2019.  Hopefully by that time the candidates will have sharpened their stump speeches and gotten real about what’s possible.   

Is Socialism A Real Fear?

January 20, 2019

Recently I got into a discussion with friends over what danger some of the new Democrat Congress members posed.  “Why that woman from New York wants free college education for everyone” one friend said.  “How is the country going to pay for it?”  The person added, “that woman wants to tax the rich to pay for it and that means we are going to have to pay more in taxes”.  Hmmm.

Where does one begin?

The friend making that statement probably lives in the 90th% income bracket which is about $150,000 in yearly income.  The couple probably have a pension, social security, and some income from investments.  They own a home and a vacation house.  They live comfortably but certainly not extravagantly.  Compared to average household income of $61,000, they are doing well.  So why the fear of free college?

My friend did not stop at having to pay higher taxes.  My friend quickly added, free college education would take the US to socialism.  And another friend said, “from socialism, communism was next.  And just look at Russia, Venezuela, and Cuba”  (I guess they had never visited China.)  Hmmm.

These two friends are both educated, well spoken, and otherwise reasonably charitable people.  From where could this disconnect from logic and reality come?  That’s a “foxy” question I think.

I wonder whether my two friends have thought why someone would advocate for free college education in the first place?  I wonder whether they realize that educated people are a resource just like rivers, roads, and electricity.  An educated work force drives prosperity.  In the US, unemployment, average income, and home ownership are all correlated to whether one has a college education or not.

Of course the likely reply would be, “I had to pay for my college education, so should the kids today”.  Hmmm.  I would quickly agree to that if there were options for kids to borrow at no interest the money to pay for their college education and depending upon what profession they chose or where they applied their college education, there were “forgiveness” provisions.  

In many respects, the free college education argument is a red herring with respect to the risks posed by socialistic regulations and laws.  And the connections between socialism and communism are faint if at all.  Socialism arises invariably to counter the excesses of capitalism.     Hmmm.

Most people are surprised to see how much in our daily lives is a form of socialism.  Public roads, libraries, and utilities are starters.  Social Security, the VA hospital system, and the host of consumer protection agencies are socialistic in nature.  All our discrimination laws, rent protection, and FHA loans in some way overcome excesses of unfettered capitalism and are a bit socialistic.

The question of why unfettered capitalism is not dangerous is deceptively difficult to answer.  Unfettered capitalism opens a world of possibilities for those who seek to succeed in business and accumulate wealth.   But given time, the entrepreneur becomes very wealthy and for most everyone else, life can become a little (or a lot) less good.  

In a wealthy country, like the US with abundant natural resources and protection from enemies by the Atlantic and Pacific Oceans, great wealth can be amassed though hard work and intelligence. Question… if all it took was hard work and intelligence, why would these entrepreneurs not go to the Sahara Desert or the North Pole and put their skills to work?  Capitalism’s success has a lot to do with the inherent natural resources, which in some way belong to everyone, and how these natural resources are harvested by the risk taking capitalist.  A hard working, risk taking socialist should be just as successful under similar circumstances, I would think.

But, one might ask, why aren’t socialist Venezuela and communist Cuba successful countries?

Does anyone think that if Venezuela or Cuba simply said “unfettered capitalism” is the way of the future, that life would change?  IMO, history has shown that all that would change is who the rich people were.  The poor would remain poor.  

There is no simple formula for accumulating national wealth.  Clearly abundant raw materials play a big role.  So does motivated entrepreneurs and an educated and skilled work force.  And, don’t forget “guns and butter”.  A country consumed with defending itself militarily will not have the time or ability to concentrate on economic development if it is preoccupied defending its borders.

With Venezuela and Cuba there is another factor which IMO outweigh all the others.  These countries lost their way when they cast aside “democracy”, rule of law, and free speech/free press.  Graft, corruption, and incompetent leader escape the natural consequences of their decisions when free speech and free press are suppressed.

One last observation.   Countries like Japan, Germany, France, the Netherlands, Denmark, or Canada all utilize more socialistic laws and regulations than the US.  None of these countries are teetering on the edge of communism.  And all these countries offer their citizens healthcare costs roughly 1/2 or less that the US with healthcare outcomes uniformly better.  Hmmm. 

The Common Man Quandary

December 16, 2018

“Americans want… (fill in the blank)”, Senator Leader Mitch McConnell and House Speaker Paul Ryan are prone to say.  “Americans have spoken and we are listening”, McConnell and Ryan chirp.  I often wonder just who those Americans are?

“Americans” is a clever way to mask who ever is the object of McConnell and Ryan’s words.  If you are informed and following Congressional debate, then it is clear “you” are the “Americans” McConnell and Ryan are speaking to.  The best part is that even if you have no idea what the debate is about, for example, you are just a “common man”, “Americans” means you for sure.  Most of America’s population resides in the common man category.

A Federal District Court Judge in Texas issued a ruling yesterday pronouncing the Affordable Care Act was now un-Constitutional, null and void.  What Constitution was he referring to since the ACA had already withstood two Supreme Court challanges?

McConnell and Ryan think the 2017 tax cut was just what “Americans” were looking for. The tax cut, however. gave most of its tax reductions to corporations and the very wealthy, and in effect, most “Americans” (who ever they are) were being played for suckers. I guess the notion that corporations and very wealthy people who were getting the tax breaks must be the “Americans” Mitch and Paul were talking about. 

But what about the “common man”?

The “Common Man” for the most part does not pay income taxes.  The “Common Man” earns too little to pay income tax although he pays other taxes like social security, Medicare, and sales and property taxes.  But the “common man” is in for a surprise.

The 2017 tax reductions zeroed out the tax on those who do not have health insurance.  Unbelievably, “Americans” who choose not to buy health insurance (even though they could afford to), and instead game the system by using the Emergency Rooms when they get sick, thereby allowing the rest of their fellow Americans to pick up the cost, have been encouraged and rewarded by the 2017 tax cut.  This bill contained language which eliminated penalty taxes on those who did not have health insurance.

But there is more. The “common man” is in for another treat.  The 2017 tax bill is unfunded.  That means the tax cuts are bringing in too little tax revenue to cover government spending.  Hmmm.  That means the government must borrow money and thereby increase the Federal debt level which at some time in the future, the “common man” or his children must pay back.  Oh, and as the debt grows, interest payments will squeeze out other government spending like fixing roads, bridges, etc and if Republicans have their way, the “common man” will receive less Medicare, Social Security, or any other government safety net benefits.

One need only look to France and the “yellow vest” demonstrations to observe what “Americans” might be in for given the current Republicans views on taxes.

Americans are mostly composed of “common men”.  The wealthy are few, so tax breaks for the wealthy means problems for others.  This makes it imperative that tax policies are carefully considered.  The wealthy can’t pay for everything but paying less than their fair share, especially in an environment of income inequality, catches the “common man” in a vice of rising costs and fixed income.  The “common man” is our society, and when our society breaks, bad things happen.

I wonder whether McConnell and Ryan are thinking this way?

Tax Reform Bottom Line

December 17, 2017

Republicans are predicting that next week the House of Representatives will pass the conference committee’s tax reform proposal and shortly thereafter, the Senate will also vote approval. This outcome is being positioned as a great victory for President Trump and for the Republican leaders in Congress. Hmmm.

For sure it is a legislative victory. But is it in any way a reflection of voters’ best interest? Who wouldn’t want to pay less taxes?

And, is the Republican $1.5 trillion tax cut consistent with long and frequently expressed Republican concerns about annual deficits and the magnitude of the current debt?

This bill is pure and simply a reward to very wealthy Republic donors So, what’s so wrong with this tax reform?

As advertised, “a big beautiful Christmas Present tax cut for the middle class”, it is not. This is a lie or more gently an incorrect projection. Most of the tax savings accrue to the very wealthy and corporations. Even more shameful is that Republicans will now attack entitlements on the basis that the Government cannot afford funding them any longer.

  • One must recognize that tax reform bill is an optional piece of legislation. There is no gun to the heads of Congress members. The US economy is doing well compared to other modern global economies. Changing tax code without severe economic pressure is dangerous.
  • The consequences of lowering both individual and business tax code are unpredictable.
  • The promise of further economic growth, especially in a time of reasonable economic growth, is wildly unsupported with past experience.

The dark side of this “reform” is that it plays to worst of voters’ instincts. Who doesn’t want to pay less in taxes? Unfortunately, America’s growing income inequality makes Medicare, Medicaid, and Social Security even more critical to the well being of so many Americans. Republicans know this and will use the increased deficit to argue for entitlement cuts.

Hmmm. Let me think. Tax cut for the wealthy, pay for it with help from average Americans and the most vulnerable. Wow, what a Christmas present.

The Other Side Of The Coin

November 3, 2017

House Republicans have just released their proposed tax code rewrite. Experts are rushing to digest the proposal and perform the difficult task of assessing how this Republican bill will impact Americans. Wait, wait… if you are wealthy, you do not need to worry. This Republican plan will treat you well and provide opportunities for clever tax advisors to find new ways to save you tax payments.

The bill provides most (but not all) the gifts the rich have been expecting. The top bracket of 39.5% remains although the income threshold has been raised to $1,000,000 allegedly in deference to the “gift to the wealthy” optics.  Carried interest, estate tax elimination, and reduction of corporate taxes (35% to 20%) for private owner businesses will provide the wealthy with plenty of tax relief opportunities while the tax burden is shifted to lower income Americans.  And, for those unfortunate Americans earning $500,000 to $999,999, you will just have to pay in a lower bracket.

The deal is not set yet. Republicans from high tax States will argue for sweeteners in the restoration of State and local tax deductions and full credit for mortgage interest. Lobbyists representing all sorts of industries will go into full court press to preserve other deductions and credits. It is entirely possible that this attempt at tax code changes will stall or fail outright.

But it is entirely possible that this proposal or something substantially the same will pass. What then?

For sure it is maddening that very wealthy people like the Koch Brothers and Robert Mercer will pay less taxes.  It is maddening that as a consequence, the tax burden will shift to less wealthy people (like the Middle Class), or the cost of this tax cut will flow to the national debt, or both.

But that is not the real damage that this tax code change will bring.

A coin has two sides. On one side, heads, is the smiling faces of Americans paying less in taxes. The other side, tails, however, means there will be less government revenue to cover already approved government spending. Let there be no mistake, with lower tax revenues there must be less government spending sooner or later.

Republicans will be quick to assert that there are all sorts of waste and corruption in government spending. Why, Republicans will point out that there are able bodied Americans drawing social security disability benefits who could be working. And look at Medicaid excesses associated with the Affordable Care Act. And, with their faces now reddened, Republicans will bluster about spending in all sorts of other areas. Surely, cutting wasted money can be made.

Maybe. The problem usually boils down to which programs are viewed as wasted spending and what justification makes those expenditures “wasted”.

For example, Republicans have attacked the Affordable Care Act (train wreck, a jobs disaster) even though there were some 20 million more Americans insured with Obamacare than before. And, what have Republicans offered? Their best proposals offer less coverage and insure 10-15 million fewer Americans.

So, when it comes time to submit “post tax cut” Federal Budgets, what makes anyone think Republicans won’t feel that reducing programs which benefit all but the rich will be perfect targets?

The theme which comes up time and again is that there are no free lunches. Republicans are breathlessly trying to sell this tax code change as great for the middle class and the key to unlocking our economy, and best of all, there will be no cost to average Americans.

Really?