Showing posts with label ObamaCare. Show all posts
Showing posts with label ObamaCare. Show all posts

Friday, July 7, 2017

The Potential For A Real Health Insurance Debate

This might be a bit dense for some readers.  If I had anything to say about my concerns about President Trump on the world stage, I would.  But literally what can you possibly say about this incompetent individual.  He is incapable of developing policies or of having a vision for an end goal and how to get there in a political process.  Yes, he won the election, but he didn't have a real set of policies or buy-in from his governing support to implement them.  The import tax was the only real thing that would have helped him help his supporters eventually, but Walmart has killed it before it even got to the point of being debated.

Anyway, after reading this morning's paper, I have a vision of what a real health insurance debate between the Democrats and Republicans would look like if the GOP would leave tax cuts out of the equation and simply focus on trying to build a consensus that the people could vote on through the 2018 and 2020 election.

What the Democrats are moving towards is Universal coverage through a Single Payer Plan.  It might require some increase in taxes, but most of that would be netted against what is currently being paid by employers and individuals in their group insurance plans so the net increase would potentially not be very much.  The Democrats need to do some work with the people who really know this type of  data and figure out just what this math would really look like.

One key to the Democrat's argument is the need to separate in the voter's minds what the cost of Medicaid is to cover people under 65 from the cost of Medicaid for people over 65, who for the most part are people with dementia in long term care.  I think most voters want Medicaid to pay for that long term care since most voters do not want death panels and know they cannot take care of demented granny in their home.

I paid $130,000 to cover long term care for my wife and myself.  The issuing company is so unsure that that was sufficient that they stopped issuing further policies even with that steep upfront cost.  I don't believe that 98% of Americans can afford long term care policies, so something needs to be done about insuring this catastrophic cost and yes, it needs to be means tested somehow; perhaps as it is currently through the spend down process to meet Medicaid requirements.

Now what would a real GOP plan look like.  Well, we know ObamaCare was originally designed by the Heritage Foundation to be the GOP alternative to a Single Payer Plan and keep the private insurance industry involved in controlling costs. But the private insurance industry was not successful at controlling costs before ObamaCare nor is it within ObamaCare.  Now interestingly, somehow Medicare Advantage Plans which are basically privately insurance HMO's within Medicare have seemingly been able to perhaps control costs somehow for the elderly.  But these HMO's are subsidized by Medicare directly so we don't have a clear picture of the real effectiveness in controlling costs.  But Medicare Advantage Plans are supported by the GOP as the fix for Medicare and are basically ObamaCare for the elderly.  So Paul Ryan supports ObamaCare's design for people over 65, but not for people under 65.  No wonder the GOP is having an internal fight to repeal Obamacare, their only preferred replacement is the ObamaCare construct.

What prompted this blog was an op-ed by the Features Editor at Reason Magazine.  This is a libertarian magazine.  I have never heard of it, but the Chicago Tribune named it as one of the 50 best magazines about 10 years ago.

The writer offers a set of principles that the GOP needs to use as guidance for their solution to the fact that the Heritage Foundation design for ObamaCare has certain aspects that are unworkable in the minds of the GOP.

For starters, he says no universal coverage.  Otherwise, the GOP would end up negotiating on the Democrat's terms.  That is a non-starter for him.  It also offers up a very stark political campaign between the GOP and the Democrat's if they go down this path.  I would like to see an election campaign on that issue, as a supporter of Universal Coverage.

The 2nd principle is unification, not fragmentation.  But what is unification, if not a single payer plan.  He didn't touch upon that point.  Our current system is fragmented between Medicare, Medicaid, the private employer paid market, and the private individual paid market.  The result is that people view health insurance as a means of prepaying for health care, not as insurance from catastrophic risk.  And the primary cause of this view by people is the reliance upon employer paid health insurance which is promoted by the tax deductibility for employers and zero taxable income for employees for the value of health insurance.  No politician, be they Ted Cruz or Elizabeth Warren, wants to change that tax subsidy because it is an entitlement enjoyed by a huge percent of the working age electorate.  That can be changed only as part of a huge overhaul of the entire health insurance scheme.

The 3rd principle is separate heath insurance from health care.  Insurance is a financial product to protect against catastrophic risk.  People need insurance because they do not want to worry about financial ruin from a catastrophic medical condition.  What the GOP needs to focus on is making routine health care affordable through supply side innovations as well as demand side reforms.  He is a little vague exactly what needs to be done here and whether it would be effective, but this is after all exactly where Obama/Romney/HeritageFoundation Care has failed.

His 4th and final principle is that government assistance always be focused on the poorest and the sickest.  Now it is focused on "subsidizing workers with six-figure salaries and wealthy retirees, while sidelining the poor and sick in Medicaid, a system in which many doctors will not participate in because of low reimbursement rates.

So, what would his system look like:  Expanded Health Savings Accounts, a broad comprehensive system for catastrophic health insurance, cessation of the tax subsidy for employer paid health insurance (making it income to the employees), means testing Medicare, and other things that no one has thought of yet.

It is the last point that convinces me that a Universal Single Payer Plan is the answer.  Hospitals and Doctors will not be government employees.  Leaving capitalism at work.  No doubt, the wealthy will get concierge service, but everybody else will be fine too.  After all, if people need to think of things that no one has thought of yet, when health care is a basic human need and there are literally millions of people thinking about this issue, what great insight can be found?  That is not to say someone could not think of something new, but since many countries have moved in the direction of a Single Payer Plan, a case can be made that somewhere within that construct, there is the best design to minimize the % of GDP that is spent on health care.

And I would separate long term care from that cost calculation.  That is not health care, it is resident care for people who cannot take care of themselves. I would call it specialized subsidized housing for the elderly.


Friday, March 10, 2017

David Brooks further Outlines the Battle Lines

I'm going to have to reread this to try and have an idea of what campaign themes the Democrats can use to keep the base mollified while attracting back rural FDWVFT.

FDWVFT:  Former Democrats Who Voted For Trump

Link to Brooks "The GOP Health Care Crackup"


Tuesday, March 7, 2017

Fatal Flaw in House GOP Health Insurance Proposal

In my mind the biggest problem with the ACA, aka Heritage Foundation/RomneyCare/ObamaCare, is that for people who are not on Medicaid/getting a subsidy to pay for health insurance, it is expensive for most people who do not have employer paid health insurance.

But remember the old system wasn't inexpensive.  When I last worked in 2011, I was paying roughly $400 a month for health insurance with a 3,000 or 4,000 deductible and a higher max out-of-pocket.  My friend, RedStateVT, was in the individual market paying roughly $200 a month for a family policy, but with a 25,000 deductible/max-out-of-pocket.  And the Federal Government was paying $billions to hospitals to compensate them for providing health care to people with no health insurance, while they jacked up the price to insured people for the same reason.  In our economy, everyone needs to cover their costs at a minimum.  That remains true today.

So, now we see the House GOP plan.  People with pre-existing conditions get health insurance at the same price as everybody else if they have maintained insurance coverage.  And people without pre-existing conditions can go uninsured with no penalty and sign up for health insurance when they are good and ready at no penalty if at that moment they do not have a pre-existing condition.  Do you really think people will not game this system to sign up for health insurance when they know they have something coming up?  Do you really think the Hospitals will not have to deal with uninsured patients who come in after an accident?  Do you know that cancer can strike anyone of any age at any time, potentially, and where will they go for treatment?

I know the GOP thinks the later group should suffer financially for their folly, but lets get on to the fatal flaw.

Tax Credits are only a benefit if you work and occur in the 1st 4 months of the year following the year in which you are seeking health insurance.  In the current system, with the requirement that everybody have health insurance, where the insurance company can make a profit in NY costs a full paying individual $500 a month with a $6,000 deductible, max-out-of-pocket.

How is a $4,000 tax credit in April following the year of cash out-flow going to motivate a low/middle income person to pay $6,000 (individual) to $12,000 (family) plus deductibles when they make $40,000 a year pre-tax, 28,000 after-tax and have to pay for rent, food, car, clothes?  No one will pay 40% of their take home for health insurance no matter what the tax credit is.

And once you have uninsured who is going to subsidize the hospitals for their treatment?

And what happens when the tax credit expires in 2020 or whatever the House GOP stuck in the bill?

Their plan is not a functional plan that will maintain coverage for everyone who has it today nor will it lower the price of health insurance for those who are full payers today.

To quote King Donald, "Health Insurance is unbelievably complicated."  My reaction to that was, where has he been if he just figured that out?  And he calls himself the smartest person he knows.  He is delusional, but any more ranting on that point will have to wait for another time.

Wednesday, February 15, 2017

The balance the GOP Leadership Wants in Health Insurance Reform

"Now that they’ll be held accountable for the changes they make, Republicans aren’t all sure they want to get rid of all that. Republicans might want to kill the taxes, but that would mean they’re going to have trouble paying for a replacement. Republicans would like to convert those subsidies to refundable tax credits, but it’s not yet clear how Republicans would design them. Many Republican states took the Medicaid expansion — and saw their uninsured rates plunge. They like the flexibility involved in Republican plans to turn Medicaid into a block grant, but they don’t want to give up the money they’re getting from the federal government."
"In short, this stuff is complicated, especially if you want to avoid the enormous public backlash that would increase exponentially if you just repealed the law. There may be no way to avoid that backlash, particularly since everything Republicans are considering is guaranteed to produce more uninsured people, higher out-of-pocket costs, and enormous disruption to the system (and that’s if it works as planned). But Ryan and other GOP leaders are hoping to finesse it all with a carefully constructed Jenga tower of a bill that minimizes the political damage they’ll suffer. Some parts of the ACA (the popular ones) will likely be kept in some form, and the whole thing will be rolled out gradually, perhaps with a delay that pushes the most dangerous parts of the transition past the 2018 midterm elections (or even the 2020 elections). And it’s already clear that Ryan doesn’t want to rush into anything when the political stakes are so high."
From WAPO column by Paul Waldman 

Thursday, February 9, 2017

Might Obama Still Win the Health Care Legacy Fight, It IS NOW Looking Possible

I don't want to jump the gun on this, but after seeing Paul Ryan blabber his way though another interview on many issues and then reading the column I will link to below, I think the headline is true.

I would rather be skiing today in the semi-blizzard that is hitting us right now, but I wasn't up for driving 2 to 3 hours through it both ways to do so.  So here is one day when I would rather be living in BTV.

Anyway, despite Paul Ryan saying the GOP was working on a replacement for ObamaCare, it turns out that are not even talking about it quietly.  I have gone into these reasons ad nauseum in prior posts, but I will do so again for any new readers.

The ACA, aka ObamaCare, was designed by the Heritage Foundation, a right wing think tank.  It was designed to keep the private health insurance market solvent so it would be a viable alternative to Universal Health Insurance provided by the Federal Government, while controlling the aggregate cost of health care in the economy, which in the U.S. is close to 20% of GDP vs 10%-12% of most of the rest of the Industrial World.  And of course, the 1st Governor to implement this design was Gov. Romney the 2012 GOP candidate for President.

So, the ACA is the best design the GOP has for controlling the aggregate cost of health care while not adopting a single payer health insurance plan, or even a public option for people who don't have health insurance through their employer and have too much money to be on Medicaid, the state run national plan for providing health insurance to the poor.

Of course, the key is forcing younger healthy people to buy health insurance so those who get cancer or some other horrible illness can be treated in a timely manner and are covered and older people who have even more go wrong sometime and with frequency can afford to buy health insurance.

And while I think all of this is an argument to offer Medicare for All as an option, the GOP doesn't want to do that and they don't want to require everybody to buy health insurance, except that is the only way the ACA can work.  You have to require that healthy people share in the risk pool financially because they will end up in the risk pool eventually.  It's the same risk sharing principle behind every other kind of insurance and even why we pay taxes to support the public safety system, the judicial system (to protect our rights) and to pay for national defense.

Link to WAPO column that prompted this



Saturday, November 5, 2016

This Election is Costing Me Sleep, because Donald Trump will implement certain policies if Elected

I have not slept soundly through the night for some time now. I wake up between 3 & 4 or 5, relieve my prostate system, put buds in my ears and listen to the BBC.  There is nothing better to put me to sleep than the phrasings and tonality of a British accent.  I thank my 80+ year old friend Ed in BTV for turning me on to this.

But of course this morning they were discussing the U.S. election and my fears of what a Donald Trump win would mean overcame any inclination to return to sleep.  So I got up and began to type.

A speaker, unidentified to my brain said that Donald Trump does have 3 policies that you can count on him implementing and that is the basis for much of his support which has captured 3 groups of supporters:  Private Sector Union Workers, Tea Party supporters and America First/Isolationist types.

1.  Lower taxes and Reduced Free Trade

2.  Stop immigration

3.  No more promotion of democracy and nation building in Foreign Policy

That is what in my mind allowed Donald Trump to be nominated.  To that I would add the following which has allowed Evangelicals and Business types to get in line behind Trump even if they don't agree with #'s 2 & 3 or parts of #1.

4.  Do nothing about Global Warming & reverse Obama's Executive Orders

5.  Repeal ObamaCare

6.  Appoint Supreme Court Justices who will overturn Roe v. Wade and support prior decisions on Guns and Corporations have a Right to Free Speech and money is a form of speech.

Now what can you say for sure about such policies and this is why I could not sleep anymore.

Donald Trump's policies will end the America that represents Hope and that is the basis upon which so many Americans take pride in their country.  And why so many in the world want to be here if they could.  So basically Trump's policies are aimed at killing the founding premise of this country.

Why do I say that?  Well look at what each of these polices will actually accomplish.

1.  Lower Taxes will result in less government spending on defense and Human Services because Trump has said he will not touch Social Security or Medicare.  If he stops paying interest on our debt, which he has said he might do, there will be a financial crisis and my ability to support myself from my investments will be harmed.  Tearing up Trade Agreements will reduce corporate profits because business flows are build upon the rules that exist and changing them is not a positive.  We could have a depression from Trump's economic policies if he balances the budget.  That will crush hope.

2.  Removing 11 mm people from the U.S. will reduce GDP and cause a recession.  It will also require a police state apparatus that Trump can use for his own purposes as President.  That will crush hope.

And when doing #1 & #2 won't return the jobs to the Americans who support Trump because America doesn't have a manufacturing crisis.  We produce as much today as we did 30 years ago with far fewer workers because of technology advances and Trump cannot roll that backwards.  So that will crush hope when those avid supporters realize there is no change for them in Make America Great Again.

3.  Allowing Authoritarian Governments to operate unchallenged will crush the hope for those people who are subject to them.

4.  Doing nothing about Global Warming will depress anyone who cares about this issue and that will crush hope.

5.  ObamaCare needs to be adjusted but Trump has not said what he will do to replace it, only that he will repeal it as his 1st act of legislation.  So what will repeal actually result in.  Insurance companies will go back to discriminating against people with pre-existing conditions.  People who cannot afford their health insurance without subsidies will go uninsured again.  There will be chaos in hospital finances as the uninsured who cannot pay will flock to emergency rooms when they must get medical care.  The hospitals will seek to get reimbursement from those who can pay just like they used to and everybody's health insurance will cost more.  Unless, in the repeal, the Congress repeals the requirement that passed under Ronald Reagan that hospitals must provide care to anybody who shows up at their door (not to mention that the Hippocratic Oath might require them to do that also).  Anyway, this will destroy hope.

6.  Overturning Roe v Wade will be a slow moving issue.  We don't know what states will be allowed to do vs. what Congress might pass as national policy once the Supreme Court rules.  But we do know at least that if states are allowed to do their own thing, women in some states will be allowed to make their own decisions.  But women in other states will not have that choice and if they don't have the money to go to another state, they will bring into this world a child that may be unloved, may be brought up in unfortunate circumstances, may have physical and mental challenges, or may be an orphan at birth because the mother could not be saved because of new laws forbidding an abortion even for the safety of the mother's health.  That will destroy hope.

So that is what the Republican Party stands for today and it is depressing to me that 40% to 45% of Americans can support that vision.  That is not a country I want to live in because there is no hope.

How can there be hope when a person's unrestricted right to a gun is more important than my right to not be shot by someone with a gun?  How can there be hope, when the police state has the right to take or shoot anyone who fits a profile?  How can there be hope, when access to health insurance is dependent upon an employer being able to afford to help workers?  How can there be hope, when women are second class citizens if they don't comply with Evangelical views of how the world should operate.

I was raised in a small town which took pride in every way about the story of immigration and hard work in a society that rewarded effort.  It was quietly religious, but private about religion and didn't care what a neighbor's religion was.

My brain says how do I deal with this if Trump wins, but my heart cannot contemplate this eventuality.  My brain says maybe I should just commit suicide because I know I will be depressed and fearful about this loss of hope, but my heart cannot go down that path.  I have things I still want to do in this life.  I will probably need lots of Asian medical treatments to reduce my stress which my anger will create.  I am angry that so many people can support policies that destroy hope.  Hope has been the basis of my being from my earliest days.  I didn't really realize that until the end of this election.

Thursday, February 4, 2016

Newt Gingrich (R) and Tom Daschle (D) Propose a Middle Ground for Health Insurance

And the legal basis is already in the Affordable Health Care Act, aka Heritage Foundation, Romney, ObamaCare.

At last an idea to put some acrimony behind us, hope springs eternal.

Link to Op-Ed Piece



And meanwhile, we find out in this mornings paper that even Tea Party politicians lie.  Ted Cruz apparently is happy to take money from conservative gay people saying he doesn't care what states to for gay marriage.  But what happens to a gay person in Texas if they can be legal in Vermont or NY or California and they work for the Federal Government in Dallas?  Is their spouse entitled to benefits or inheritance in the same manner as heterosexual couples?

And of course, Marco Rubio is all over the place on immigration depending on the moment.  He is even both radical and floppy floppy on taxes and the notion of balancing the budget, something he has never seemed to accomplish in his personal finances.

It seems like the only person who is consistent is The Donald, who is the closest thing to a Fascist I have ever seen in my lifetime.  I was born when McCarthy was having his way.