Archive for the ‘medicaid’ category

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?

Advertisements

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?

Don’t Blame Trump

July 22, 2017

The first six months of the Republican Administration has not lacked for fireworks. Most pundits, however, would describe this rare period of Republican control as a “nothing” burger. If so, who’s to blame?

President Trump has blamed Democrats and the “fake news” media. The Republican controlled House has blamed the Republican controlled Senate while the Senate has quietly pointed to the lack of White House leadership. President Trump when not blaming Democrats counters, instead, claims the first six months have been the most successful first six months ever!

What else would you expect the “mistruth commander in chief” to say?

The frightening aspect of this question is that many claim that the Trump Administration and Congressional Republicans could have passed much of their legislative objectives had they approached matters differently. And then there has been that pesky “Russian thing”, the investigation into Russian collusion with the 2016 Presidential election. Hmmm.

For Americans the way things have progressed could be a blessing. Both President Trump and the Republican controlled Congress have been exposed as what they really are, mean spirited, unprepared to govern, and hand maidens of certain wealthy interests.

The center piece of the hopeful Republican legislative program has been the Obamacare repeal and replace. As Congress processed this legislation, slowly but never the less, step by step, it has become clear Republicans lacked a plan and more importantly were clueless over improvements. “Beautiful healthcare Americans can be proud of” instead turned into “healthcare that gamers and the very rich can be proud of”. Replacement legislation passed in the House by a single vote and floundered in the Senate altogether. Not surprisingly, tweak after tweak fell short too. Why?

Each of the Republican healthcare proposals failed in the same way. Each insured fewer Americans, provided less coverage, and benefited the very wealthy. So, how did President Trump get it so wrong?

President Trump is not the architect of this Republican farce. The President is more interested in the pomp that goes with the office, flattering headlines in the media, and a slam dunk reaction win in 2020. There is not much more substance than that.

So don’t blame President Trump for proposing defective healthcare replacement legislation or proposing tax reform which masquerades as (you guessed it) tax cuts for the rich, or for the appointment of Neil Gorsuch to the Supreme Court. Each of these topics is that straight out of the Republican handbook and 100% the responsibility of the Republican controlled Congress.

Troubling is the realization that the Affordable Care Act (Obamacare) is far from perfect legislation and is badly in need of fixes. And who can not agree that the US tax code is more aptly a “jobs” program for accountants than a fair method of raising government revenue. But these goals were not part of any Republican agenda.

The news media has published plenty of reports claiming Trump White House dysfunction and most of it seems well deserved. Never the less, the greater tragedy would be to hold Congress blameless and clear of the ugliness and mean spiritedness of President Trump’s rhetoric.

Democrats had better be taking notice and realize it is not impossible that they will be given the reigns of Congress in 2018. Democrats should be wondering, WWDD?

Healthcare Debate Show Down?

July 10, 2017

Republicans have fought mightily to pass legislation which “repeals and replaces” the Affordable Care Act (Obamacare). Divisions within their own party have prevent Senate ratification of a repeal and replace, and now back from the 4th of July holiday, Republican Senators are back to the grindstone. Will they be successful?

Unlikely, unless one counts failure as success.

Medicaid expansion, thanks to Obamacare, has provided many more Americans with healthcare than before. These voters have made it known that they would not be pleased with Republican Senators were this coverage to disappear. Hmmm.

Pre-existing condition coverage is another “must have” option in voter’s minds. Relatively speaking this is an expensive option and Republican law makers are worrying how they can pay for that option and still provide a tax cut. Hmmm.

And the thinking that no one should be required to have healthcare insurance comes also with the freedom for companies to elect not to offer their employees group insurance plans. This “freedom” might have Americans beginning to wake up to the possibility that although they may have health insurance today, tomorrow they might be laid off or their employer may just choose not to offer coverage. In both cases these Americans will be out of luck.

But what seems to have gotten the GOP’s attention is not the impact poor coverage or no coverage at all will have upon Americans, it is the phasing out of Federal Government funding of the Medicaid expansion and the dawning that States would need to increase their contribution to maintain coverage.

What? States would need to raise taxes or become responsible for dropping State residents from Medicaid rolls.

This line of reasoning reflects a morally bankrupt political party. Public shaming has not worked to date in changing Republican thinking. Maybe the political reality and risk of being voted out of office will have a different result.

Healthcare, A New Take?

June 5, 2017

Former Oklahoma US Senator, Tom Coburn, gave a genuinely heartfelt argument on how to fix healthcare. Coburn’s solution  –  total free enterprise. Use the free market, Coburn said, where millions of Americans could seek “great quality” healthcare at the lowest prices. The former Senator used the Amish as an example of price shopping with the outcome – great coverage at low cost. Hmmm.

Tom Coburn is a doctor (MD) by education and should know something about healthcare. Senator Coburn is a conservative and has a history of concern over healthcare cost.  Senator Coburn, needless to say, was not a fan of the Affordable Care Act (Obamacare).

And to be sure, there are situations with our current healthcare delivery model ripe for abuse.  Fee for service, Medicare payment for unneeded services, and non-negotiated drug costs in Medicare Part D are a few examples.

Most Americans are largely divorced from healthcare’s actual cost. Most Americans are covered by group health plans (paid for by employers) or for those over 65, Medicare. While there are deductibles and co-pays, these costs are nominally small compared to the overal healthcare cost. Consequently most Americans are content with and expect their employer and their insurance provider to fight with doctors, hospitals, and drug companies and manage these healthcare services prices.

Do you think insurance companies, who have built into their policy prices their earning would welcome a lower premium cost which would in turn lower profits for their shareholders? Hmmm.

In addition to employer provided and Medicare, there are Medicaid (for those who qualify) and the single payer market to make up the rest. (I am excluding the VA system for reasons of simplicity.) It seems ridiculous to believe that Americans on Medicaid roles, who can not afford to buy their own healthcare policies now because they are too poor would suddenly be able to find their way through the medical and insurance maze and buy adequate healthcare insurance.

The individual market could be different however, since the members might have the financial means. But, does anyone think that suddenly insurance companies will welcome Americans with pre-existing conditions and charge them the same low rates as healthy young Americans? One might wonder what Senator Coburn has been smoking?

The free enterprise system, instead of being healthcare’s savior, is actually its devil. Our free enterprise, capitalist system honors the concept of maximizing profit. American healthcare costs have risen at two times the rate of inflation for years.  No better recent example is the American drug industry where prices have escalated at unprecedented rates. Disgracefully, one can buy in Canada the same US produced drug for substantially less. Hmmm.

Americans are regularly reminded about innovation and increased productivity from competition in a capitalist system. We are asked, “do you want to give that up”?

Americans, instead, need to ask a simpler question, “are there other healthcare delivery models around the world that cost less (say one half what the US spends) and are associated with better health outcomes”?

Senator Coburn’s proposition might work if all Americans had the same health prospectus and the same capabilities to make a deal. Buying an automobile or an airplane ticket are examples of where the free market is working. Americans pay widely different prices for essentially the same goods or services. Americans can, however, chose not own a car or use an airline to travel with no life or death consequences. Healthcare is different.

Over two dozen countries around the world have adopted healthcare delivery systems which cost half that which Americans spend and achieve better outcomes for all their citizens. Broadly speaking these healthcare delivery systems emphasize “prevention” and “ease of use”. These plans insure everyone (universal coverage) and employ a “single payer” administrative model. There are no “negotiations” between citizens and healthcare providers.  The role of doctors, hospitals, and drug companies are to serve the customer while earning a fair but modest profit.

Insurance companies may, if they wish, participate as a “plan administrator” facilitating payments for healthcare providers. Their profit is negotiated with the national healthcare agency (a government organization) so there is no temptation for insurance companies charge “what the market will bear”.

So in countries like Germany, basic healthcare is available to all residents at the same low co-pay cost (a national value added tax pays for most of a German’s healthcare cost). Socialism?

There is no effort or thought, however, that all Germans should be driving a BMW instead of a Volkswagen or  having no car at all.  What type of car a German buys and how much he/she pays for it is a free market event.   Germany has a capitalist economy but treats healthcare as an individual right.

Why is this such a foreign idea in Washington?  Why are Republicans so dead set about reducing healthcare in a land where healthcare costs are two or more times the level of other modern countries?

Are Republicans seeking the best healthcare delivery system money can buy?

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.