Category: Health care reform

The Trump / GOP Budget – Compassion is Nowhere to Be Found

George S LedyardSomehow, in a country in which corporate profits are at an all time high, and wealth accumulation at the very top is greater than at ANY TIME IN HISTORY, Trump and the GOP are trying to sell a budget plan that essentially penalizes the poor.
Remember LBJ’s “war on poverty”? Well, this should be characterized as Donald Trump’s “war on the poor“. The obscenely wealthy, for some reason, seem to deserve getting vast sums cut from what they are paying while the poorest Americans lose some or all of the various programs on which they depend to get by.
Donald Trump war on the poor
Donald Trump’s War on the Poor
The wealthiest corporations maintain that they can’t compete. Well, they seem to have been able to do so just fine. Profits are at record levels. Executive compensation is at record levels and is drastically higher than in any other country, including an economic powerhouse like Germany.
The narrative being put fort by the GOP is that our businesses need to pay fewer taxes so that they can be EVEN MORE PROFITABLE. But none of this profit trickles down to the folks in the middle class. For twenty years, as the rich have become richer and richer, the middle class has essentially been in a recession. And forget the poor. They just sit there, year after year, generation after generation.
How did we as a nation get to the point at which we stand out among all of the most affluent countries in the world as the most hard-hearted, least compassionate? Being poor anywhere is really hard. But among developed countries, the US stands out as the country with the greatest resources that devotes the least to the citizens on the lower end of the scale.
We already imprison a larger proportion of our population that ANY other nation in the world. We have produced a system in which certain segments of the citizenry have been condemned to multi-generational poverty with little or no chance of escape.
Mitt Romney, 47%Mitt Romney’s famous 47% of the public that doesn’t pay Federal income taxes was initially put forward as an example of those folks sponging off the rest of us. But the fact is that they do not pay income tax because they do not earn enough money to do so. That’s almost one half of the country that is underemployed. They work but can’t make a real living wage. If you aren’t paying Federal income tax, you simply aren’t making enough to even cover the essentials.
Think about it. 47% of the populace isn’t making enough to pay income tax. Then we have the fact that over 20%, 50+ million citizens, are actually receiving some sort of public assistance. So, a fifth of the country needs help to just survive. Almost the bottom half of the country is making so little that they are right on the edge. The number one cause for personal bankruptcy in the United States is due to medical costs, something that doesn’t exist in ANY other nation.Poverty in AmericaAnd now, the GOP is proposing a budget that drastically cuts programs for the poor, increases their medical costs by cutting Medicaid, while cutting taxes dis-proportionally for the wealthiest Americans. This is based on the totally discredited notion of the trickle down theory.  If we just give the wealthy individuals and corporations back more money, economic growth will trickle down to the middle class and poor. BUT IT DOESN’T. It’s a myth, yet the GOP still bases it’s entire approach towards tax policy on an unfounded faith in this fiction.
Jeff Sessions, war on drugsTo top it all off, Jeff Sessions, is calling for a return to the draconian war on drugs that has filled our prisons. It has been shown, over and over, that once you put someone in to the criminal justice system, the chances of them ever moving out of poverty are about zero, unless you are Martha Stewart and started rich before you went in. Given the fact that in may states, the right to vote is lost with with a felony conviction, it’s east to see that this push for law and order is a thinly veiled form of voter suppression, especially since it effects people of color even more than anyone else. But it’s disastrous for the poor as a whole.
It is embarrassing and disheartening to see how much of our country has bought into a narrative that so completely lacks any compassion. It actively penalizes being poor while creating circumstances that guarantee that a huge segment of the country remains so. This is an unacceptable and appalling situation. And it can’t possible be sustainable. Something is going to give, probably sooner rather than later.
Poverty in America

The GOP Just Doesn’t Understand Health Care

George S LedyardIt is so abundantly clear that the GOP lawmakers in charge of health care reform simply do not understand the concept of risk sharing or spreading the risk. Asking that people with pre-existing conditions pay more is precisely one of the contributing factors that produced so many people with no insurance that the ACA was designed to fix.
Essentially, what the insurance companies wish to do is sell policies to people that they won’t actually use. Healthy people pay into the system month after month, year after year, and, because they are healthy, they do not use the services. It’s a highly profitable business.
However, folks with chronic health issues use health care services regularly. They require frequent doctors visits, use more expensive services, have much higher expense for meds.
The ENTIRE point of insurance is to spread the risk and the expense. If we had no insurance at all, healthy people would pay virtually nothing and then later in life or with unexpected illness would suddenly be faced with crippling medical expense. Young people would typically need little health care but without exception, they will need those services eventually. So, we are in a situation in which the Baby Boom generation, my generation, are now getting old. In May first I was enrolled in Medicare. After a very active life, I have a number of injuries which need to be addressed. Forty years of martial arts training have made me a “high mileage vehicle” so to speak.
My wife and I have paid a fortune for health insurance every month for years. Yet I have not been able to afford to have my various injuries treated due to high deductibles coupled with insufficient coverage (50% to 80% depending on the condition). And our income as a family is quite a bit greater than that of the average American.
The whole point of national health insurance policy is to have young folks and healthy people “pay it forward”. The younger, healthier segment of the population pays more for coverage than they use thereby subsidizing the folks that have reached the stage in their lives at which they will inevitably need more services. It is precisely at old age, at the retirement stage of life that people end up on fixed incomes and have the least resources to pay for their health care needs.
The right wing of the GOP seems to not understand this concept at all. They keep asking why anyone should be paying for services that they do not use? Why should men pay for women’s health services? Why should the young pay for the old? Why should folks who are healthy pay for the folks that require health care services?
This is a totally “classist” approach. It is a fact that the poor, as a direct result of their own poverty, require more health care support. Since they do not get it under our current system, their general health outcomes are far worse than the general population. GOP proposals would only make this worse.
This is quite simply an application of that Ayn Rand, radical free market, extreme individual responsibility which questions why anyone would do anything that would help anyone else? It’s a sort of radical application of extreme property rights philosophy in which asking anyone to pay anything for something they don’t themselves need is theft and a form of government interference in the rights of the individual.
In reality this is an extreme form of radical libertarian thinking that would love to see health care left 100% in the hands of the market place. Everyone would pay his own way. This would be a return to a Dickensian world in which the poor are not only denied any assistance in health care, housing, food, whatever, but they are actively penalized for being poor. Getting in debt resulted in imprisonment in the work house. It is a world in which any health crisis would simply bring ruination to a whole family. Even with the current system we have, the number one cause of personal bankruptcy is medical costs.
In this world the rich have whatever they need and everyone else is left to their own devices. This is the direction that the Freedom Caucus and the radical right of the GOP wants to take us on health care. We absolutely depend on our Democrats to remain united and hopefully join with the few non-insane, moderate Republicans left in Congress to come up with a fix for some of the issues with the ACA, rather than trashing the whole thing and setting up some libertarian free market program which will throw millions out of coverage and provide substandard coverage for most of the rest of us while the 1% gets the finest health care in the world.
Article: Republican: People With Preexisting Conditions Should Pay More

Hidden Costs – You Are Already Paying for It

George S LedyardToday, Donald Trump and the GOP failed to achieve the single most visible part of their agenda, namely the repeal / replacement of the ACA. This means that, at least for the foreseeable future the ACA remains in place. This is great news but it doesn’t mean we can stop worrying.

There are any number of problems with the ACA. In the short run the Democrats should immediately start proposing legislation to make needed adjustments to the program. At least a few Republicans having seen that their own party won;t produce anything positive, might come along to make the current system better.

But the fact is that we are simply not going to get what we want without creating a single payer system, which I prefer to call Medicare for all. Every other country of any note in the world has a national health care system. Somehow, we as Americans were convinced that anything that came from the government was Socialism and we were terrified of it. The rationale for not having a Medicare for all system is that we can’t “afford it”. If one understands the facts, one can readily see that this is a completely false narrative.

Like many things in American society, we have basically hidden the true costs of how we do things which creates a false impression of what reality is. First of all, the United Sates has the highest per capital health care costs of any major nation in the world. The narrative that says that a single payer system would cost us more is easily disproved by looking at any other major nation. They all spend less on health care than we do. That’s a fact.
Now it is true that a Medicare for all system would increase your taxes. But it is an illusion that you would actually pay more out of your household budget. It would simply be a cleaner system without all the hidden costs. We have what is called an employer based system in which most people get covered through their place of work. For the vast majority this isn’t completely without charge, usually the worker pays a portion of the premium and supposedly the company pays the rest as a benefit.

But the fact is, this is an illusion. Companies do not pay for your health care. The consumers of the products those companies produce are paying for your health care. Companies pass on the costs of insuring their workers, assuming that they do provide benefits, into the cost of the products or services they sell. They have to. That’s how a business makes a profit.
So, in every single thing you buy, every service you purchase is the cost of the insurance that is supposedly being provided as a benefit by the employer. They aren’t really paying for your health insurance, you are paying for it indirectly through the cost of goods and services. It is a hidden cost which artificially creates an illusion of what you are paying for health care.
The fact is that you are paying a whole lot more than you think you are for health care in the US. I’m sure you have already experienced the ridiculously high premiums which seem to go up every single year. I am also sure you’ve noticed those deductibles which also seem to get larger all the time. What many people are unaware of is what they are paying indirectly via the hidden costs that do not get labelled as health care costs when they pay them.
First of all is the cost to the rest of us of every uninsured person. The folks who do not get any health care coverage typically do not have the money to buy their own. So, they end up not getting the preventive care they should, which leaves them less healthy and when they experience their inevitable health crisis, they use our emergency medical system as their health care provider.  This is far and away the most expensive way to provide care and it typically is un-affordable for these people, who then cannot pay, and the hospitals end up writing off the debt. Those losses get passed on directly to the consumers of health care who can pay. You and I are already paying those costs in the prices we are paying.
Then there is the cost of the inadequate insurance that many people have because it is the only thing they can afford. Before the ACA many people’s plans were inadequate to really protect them, especially against catastrophic illness. The ACA had provisions which set certain minimums services that had to be covered in an insurance policy to be considered as adequate. The repeal effort specifically targeted these provisions. The repeal would have put us back to the days when people would have insurance and feel secure only to find that their coverage didn’t come close to covering their real needs in a crisis.
But even with the ACA in place, it is a fact that the number one cause of personal bankruptcy in the United States is medical costs. It is still the case that in our country we have decided that it is acceptable for families to be wiped out financially, a disaster that actually effects multiple generations not just an individual or a couple, due to the cost of medical care. Quite apart from the social cost of family bankruptcy, every time an individual declares bankruptcy, someone, like the banks and their other creditors eat that debt. So. once again, those costs get passed on to the rest of us via increased interest rates, higher service charges, and the increased cost of goods and services. We do not see them as costs associated with health care but they are.

If we can get to a Medicare for all system, we would have none of those hidden costs. We would know exactly what we were paying for. Yes, Federal Taxes would go up. But there could be some relief at the state level as Medicaid, which is administered through the states would not be necessary anymore. The states could save a huge amount.
We wouldn’t have the costs of the uninsured or costs of the bankruptcies being passed on to everyone else. But most importantly, it Medicare for all would almost certainly bring down costs. For profit health care has an automatic built in pressure to raise rates and decrease service. That is precisely how a business increases its profits. Anyone who thinks that competition and market forces are sufficient to bring costs down simply hasn’t looked at the realities of private health care. There is no evidence whatever that this works.

Not having an employer based health insurance system could also drive wages up bu giving the worker more freedom to choose employers. Right now, many folks stay at jobs they hate, or work at pay the is inadequate to cover their expenses simply because they hesitate to lose theior insurance. Essentially, they are held hostage by the employers who offer benefits and don;t feel free to move around. With  Medicare for all system, it would be much cleaner with workers making their decisions about staying or leaving a work place based on wages and work conditions and not on trying to protect the family’s benefits. Over time, this greater choice would create an upward pressure on wages.
Insurance works by distributing or spreading the risk pool. A medicare for all system would mean that 100% of our citizens would be participating in the system. Everyone who pays Federal taxes, either themselves or indirectly via the cost of good s and services they purchase would effectively be paying into the system. Federal income tax is a progressive system so the wealthy would pay proportionally more and the poor might pay very little.
This isn’t rocket science. Every body else has figured this out but us. Are there issues in other countries? Certainly. Every system can be tweaked and improved on. But it is just plain true that the down side of our health care system, which is fast getting un-affordable by anyone but the elites, really outweighs the upside. There is a very good reason that in no other country in the world are they looking at the US system and saying that they want what we have. When you hear any foreigner extolling the US system it is invariably a rich person who can afford to pay whatever the market as asking to get their care. It sure as hell is not the average person. They look at us and think we are crazy.
Let’s get behind Bernie Sanders and make single payer the issue of the day. Help educate the working class folks out there who are being hammered by the current system and educate them why this is in their direct self interest. Help them see through the right wing propaganda and scare tactics. If one gets passed all the BS, it is actually a rather straight forward issue.