Category: Health care reform

“Clean Repeal” / “Repeal & Replace” Proof the GOP Can’t Govern

George S LedyardOK, everyone. Here is the bottom line. We really don’t need any more information than this.
The ACA never managed to cover everyone. The uninsured number of citizens peaked in 2010 at 18.2%. Today, due to the ACA, it is at 10.3%, the lowest rate ever since tracking began 45 years ago. But that is still 28 million uninsured.
The GOP is now considering two options:
1) The clean repeal – according to the CBO, this option would throw an additional 32 million out of coverage. Essentially this option would take us back to a worse situation than our worst rate back in 2010. That’s on top of our existing uninsured. So, we’d go to 60 million uninsured with the “clean repeal”. Who thinks that ‘s an acceptable option, besides Donald Trump?
2) Replace the ACA with the GOP plan – this plan, again according to the CBO, would throw 22 million out of coverage over ten years. That takes us to 50 million uninsured. That’s a couple of million worse than the record in 2010. The reason that the GOP hasn’t been able to pass this option so far, is that a significant segment of the GOP Senate believes that the bill does not go far enough in repealing the ACA. That’s just insane.
The GOP is proving itself to be wedded to ideology rather than reality. Their 7 year propaganda and outright disinformation campaign against the ACA, convinced their base that the ACA is a horrible disaster. Now that they actually have to create a program that works, they find that most of the ACA is working and it’s most important provisions are elements that the voters do not wish to do without.
The tiny group of GOP moderates in the Senate that are also refusing to support their party’s bill, may end up being willing to work with the Democrats to fix the elements of the ACA that are not working. But the rest of the party is facing the harsh reality of either damaging the interests of their own constituents by following through on their promise to repeal the ACA or admitting that their claims about the ACA were pretty much anti-Obama propaganda and retain and repair it.
The GOP is now reaping their harvest of lying to their followers for years. Now that they are responsible for creating a real plan that is sustainable, they can’t and still live up to their promises. So, congratulations to the GOP. They have figured out how to use
propaganda to get elected and have made themselves incapable of actually governing.

Why Republicans Cannot Replace the ACA, Or Accomplish Anything Else

The Truth about the Uninsured Rate in America

 

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“Identity Politics” and the Struggle to Realize the Promise of July 4th

George S Ledyard“We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.”

One of the things for which conservatives have criticized liberals and Democrats is what they call “identity politics”. Some maintain that “identity politics” rather than a focus on the economic realities of the heartland is what cost the Dems the election.

But the fact is,”identity politics” is the on-going struggle for our nation to realize in reality what the Declaration of Independence stated in principles. When the document was written, it didn’t cover women, it didn’t include blacks or native peoples. Over time we have as a society recognized that other groups were not included. LGBT communities weren’t even acknowledged to exist when that document was written. Hispanics didn’t factor in. Large numbers of indentured servants were not equal participants.

When this document was authored, its provisions largely meant white men of property. In the next almost 250 years we have steadily enlarged our notions of who is included in “all men” to actually mean “all people”. At every step, some portion of the previously “included groups’ resisted the addition of other new groups as belonging to “all men”. The have, at every step, have tried to keep the club small and exclusive.

The fact that we, in 2017 are still grappling with women’s issues, racism on a large scale, an anti-LGBT backlash, anti-immigrant hysteria, and so on simply makes “identity politics” inevitable and essential. It is the on-going battle to realize the promise of that original document.

What does the unalienable right to liberty mean in a society which imprisons a higher percentage of its population than any other nation in the world?

What does the right to the pursuit of happiness mean when economic class division condemns a significant proportion of our society to stultifying poverty with little or no opportunity to move up the economic ladder?

The Declaration of Independence set out the ideals of the nation, however imperfectly realized at the time. Later, the Constitution of the United States delineated the legal framework upon which this dream would be based. The provision for amendments recognized that this was a living document, that the future would require that we update the document to deal with realities not envisioned by the framers.

But the dream remains the same. And it is an unrealized dream. The unalienable rights defined in the Declaration of Independence are unequally available to our citizens. Vast economic inequality simply makes anything like an “even playing field” that affords equal opportunity a bad joke in our society.

So while conservatives try to pretend that we are in a post racist society, that no special protections should be afforded vulnerable groups within the larger society, “identity politics” will continue to be an essential part of the on-going fight to realize the original promise of our formation as a nation.

The conservative point of view:

The Declaration of Independence and the case for a polity based on universal principles

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GOP Control of Congress May Be the Great the Opportunity for the Democrats

George S LedyardFrom the Article:
“In the past year, 7 in 10 low-income families experienced at least one civil legal problem, according to a recent University of Chicago NORC survey done for the Legal Services Corporation. Such problems include foreclosures, domestic violence (getting a restraining order, for example), custody disputes, debt repayment or neglectful landlords. The elderly, rural residents and veterans — all core components of the Republican base — are especially well-represented in this population.”
It’s not only Medicaid that’s in danger from the GOP cuts being proposed. Legal Aid is in danger as well.
What is interesting about these budget cuts is the way they reveal a real fault line that runs through the Republican base. It turns out that while socially the base may be very “Republican” i.e. anti-foreigner & Anti-immigration, anti-LGBT & anti-gay marriage, hard core Christian & anti-Muslim, and bigoted against people of color, those very same people, often without realizing it, are very Democratic in their economic / policy attitudes.
The hard core Red States in the heartland are some of the largest recipients of Federal aid in the form social safety net support (often known as welfare). As was the case with so-called Obamacare, often these people, who are not the most sophisticated folks, don’t even understand the details of the support they get. When the find out what’s involved with cutting these GOP vilified programs they are often horrified.
In the case of Obamacare the GOP seven year propaganda effort had the majority of Americans convinced that program was the cause of all of their health care ills. But now that the GOP repeal and replace effort has people looking at the details, it turns out that almost every single element of what they say should be essential in their health care coverage was a part of he ACA and they simply didn’t understand that fact.
The nation’s poor have been relying on Federal assistance in myriad ways. Legal assistance is just another program that benefits low income people who no other means of navigating the legal environment in which all of us live. When faced with losing this support due to GOP budget cuts, the poor and working class folks who have relied on them are not happy.
In most cases these programs exist because Democrats created them and pushed them through the legislative process, sometimes with moderate GOP support and sometimes with no GOP support at all. Now that the GOP is in control of Congress and the Presidency all of these programs are in danger of being either eliminated or drastically cut. And it is the core voter base that is waking up to the fact that they’ve elected leaders who are ideologically committed to destroying the safety net upon which they depend.
This points out  a glaring reality. The Democrats have been and continue to be the political party that has consistently, since the Great Depression, championed the programs that provide a floor to poverty. Programs designed to keep our poor and working class citizens from sinking below the waves and drowning in poverty. And they have been doing an abysmal job of reminding people of that fact.
Why is it that the GOP has such a strong base of support precisely among the folks that depend on these essentially Democratic programs for their survival? One must arrive at he conclusion that, in its championing of the rights of our vulnerable minorities, women’s rights, workers rights, civil rights for minorities, LGBT rights, and diversity as a positive value, the Democrats have done a very poor job of reminding the American public that the programs upon which our nations poor and working class depend for survival, are Democratic programs.
The GOP has mastered the art of playing upon the social biases of the American heartland to convince them to vote against their own economic interests. As long as power seemed to lie in some part with the Democrats, the GOP could blame all sorts of issues on those terrible Liberals in Washington. But now, the GOP is in the position of having to own the whole thing. They control the whole government. And that is starting to wake people up. Voters in the heartland are starting to look at the proposed cuts in the GOP budget & health care bills on an item by item basis.
GOP legislators trying to create the ACA replacement are finding that, in order to keep the elements of health care coverage that the voters feel are essential, they are ending up with something that looks suspiciously like Obamacare 2.0. This is revealing a major fault line in the GOP between those who hesitate to risk losing the support of their base by seriously damaging their economic survival and the hard core ideologues who put their radical libertarian philosophy ahead of the welfare of their constituents.
It is clear that the Democratic Party must figure out how to craft a message that makes this clear to the poor and working class folks who seem to have not understood or have forgotten just what it is that the party does for them. We need to get back to the old Democratic party alliance with organized labor, develop programs designed to deal with the widening wealth / income divide, think forward by working out programs designed to help the work force transition to the jobs of the future as the robotics revolution  destroys traditional work models.
But more importantly, the Democrats need a better understanding of how to sell their program. They need a “ministry of propaganda” that understands the current  neuroscience of how voters make their decisions, how to craft a message the resonates. We  clearly are the party which has the agenda that benefits the poor and working classes economically coupled with an idealistic civil rights agenda of diversity that appeals to the educated liberal elites.
How we develop a sophisticated messaging program to “sell” that fact will determine the survival of the party in the future. The GOP control of the entire legislative process is going to create the opportunity to create a huge backlash against the GOP programs which are now transparently for the benefit of the richest oligarchs at he expense of the common man. But the Democrats have to craft the message and hammer it home. They also need some candidates that are inspiring and charismatic that can get the voters excited about the Dem agenda.
Article on the Threat to Legal Aid in the GOP Budget

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Will the GOP Be Forced to Work with the Democrats on Health Care?

George S LedyardFrom the article –
Second, McConnell will press the argument that if this bill does not pass, Republicans will have no choice but to negotiate over the future of the Affordable Care Act with Democrats. Multiple reports have said that McConnell has privately warned Republicans that failure would mean they must enter into talks with Democrats on ways to shore up the individual markets, which would effectively mean that a chance to pass a partisan repeal bill is gone.”
It is abundantly clear that the GOP has not wanted to work with Democrats on health care. They have seen this chance to dismantle big government programs and cut taxes as a unique opportunity. The battle has revealed fault lines in the GOP between the real ultra right libertarian extremists, who fundamentally don’t really believe that government should have any role at all in providing benefits and protections to private citizens and more traditional style Republican moderates who are willing to support some level of Federal involvement in health care.
While in theory, the GOP has total control of both houses of Congress, the ideological divide between the Tea Party, Koch brothers sponsored extremists, whose goal is to roll back government to pre-New Deal levels and the more traditional moderates is wider than that between the moderates and establishment Democrats.
The ACA, better known as Obama Care, was really a Heritage Foundation, conservative plan created in order to head off Liberal efforts to establish a single payer system. It was successfully put into place in Massachusetts under Governor Mitt Romney. In other words, this was a conservative plan, not some Liberal creation.
President Obama went with is plan, as did the Dems at the time, because they felt it was the best they could do. Anything closer to single payer seemed to be a non-starter at the time. So the ACA was passed with its supporters fully knowing that it had issues that they expected to address as they revealed themselves over time.
What they had not anticipated was the unrelenting, concerted, disinformation attack on the ACA by the GOP. Conservatives made opposition to the ACA the single most important element in their opposition to the entire Obama administration. Republicans met and determined that their strategy would be to block any and all efforts by the Obama administration to do anything. They wished to deny Obama anything that could be considered to be a win and to force him out of office after one term.
Of course that backfired completely and Obama successfully completed two terms. But GOP obstructionism made any tinkering with the ACA to fix apparent issues impossible. Instead, the GOP repeatedly and unsuccessfully tried to repeal the legislation as a way to play to their base. So they publicly excoriated Obama and the ACA while refusing to do anything that might improve it. Their hope was that it would implode and they could replace it with their own legislation.
But now those same Republicans are faced with putting their money where their mouths have been. It is abundantly clear that while they were great at criticizing the ACA for eight years, they didn’t actually have a plan in place that they could agree on to replace it. Their replacement plan floundered in the House and they finally were forced to kick the can down the line by passing a version they knew wouldn’t fly, hoping that the Senate would be able to fix it.
Mitch McConnell decided to minimize public outrage over their developing plan by appointing thirteen GOP Senators, all white males, to meet in closed session to draft the bill. No public hearings, no input from the opposition party, no input from women, no input from the minority community, and no input from the health care provider community.
Even many GOP Senators have been offended by this process, rightly feeling that they had been left out of the process and were being rushed to approve the plan that emerged without really understanding its implications.
Now that the Congressional Budget Office has released its analysis of the draft legislation, it has become apparent that the extremist libertarians in the Senate, the so-called Freedom Caucus, feel it does not go far enough to dismantle Federally supported health care. And the moderates, looking at benefit cuts, rising deductibles, drastic cuts to Medicaid, etc. which will devastate health care for the poor and raise costs dramatically for everyone else, in order to give a tax break to the top 1% are finding that they just can’t go there.
This is REALLY not about health care at all. It is the result on a 35+ year effort on the part of a group of extreme right wing billionaires, like the Koch brothers, to dismantle the Federal government. It’s not just health care they wish to dismantle. It is the entire Federal regulatory structure and involvement on providing the social safety net. Like the Democrats with the ACA, they see this legislation as just the first round. Their eventual goal isn’t just cutting Medicaid. It is dismantling both Medicaid and Medicare. It is the privatization of almost everything we currently view as public goods.
While these extremists have a serious power base within the GOP and have largely, through excellent organization and vast financial support from the radical point one percenter billionaires, like the Koch brothers and Robert Mercer, been able to drive the GOP agenda, they are not the majority. Most of the GOP are not the extreme ideologues that these people are. They are more opportunists. They’ve gone along with the extremists when it seemed politically expedient but now that they are seeing the public reaction to the health bill for instance, they are wavering in their support. And the true moderates, of whom there are still a few, are not willing to follow the extremists in their desire to dismantle government at the expense of their constituents.
The moderates concede that there is a legitimate role for Government in administering areas deemed public goods as well as providing some sort of regulation to protect clean air, clean water, the environment in general, etc. This places them closer to establishment Democrats than it does to the more right wing members of their party. This is a serious culture war in our country and it is reflected within the GOP itself.  Mitch McConnell was barely able to restrain a pro-Trump super pac from running attack ads on one of their own GOP Senators who was refusing to vote for the health care bill as it stands.
So, given the impasse that may result from this ideological battle which may just result in the inability of Mitch McConnell to enforce party discipline and pass the legislation, he has informed his GOP comrades that their failure will force them to do the unthinkable and reach across the aisle and work with the Democrats to keep the current system functioning. It would mean the defeat of the GOP promised efforts to repeal Obama Care and require them to do what they have refused to do, fix the broken elements of the current system.
And the Democratic Party they will be forced to deal with will be a newly energized group. The resistance effort that has been mobilized within the Dem community has actually reinvigorated talk of single payer, Medicare for all proposals. If the GOP is forced to accept a colossal fail on their repeal and replace effort, the reaction from the public may just push health care reform farther in the other direction than it has been. If the GOP is forced to deal with the Democrats, they will be negotiating with a Democratic party newly energized to go farther in expanding Federal coverage than has been the case to date.

George LedyardIf you like what we are doing here, please know that we would be extremely grateful for any support you might provide. We have three levels of on-going support which we have purposely kept extremely affordable. Thanks for helping us keep this effort going.


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The GOP Health Care Scam – All Smoke and Mirrors

George S LedyardGOP Fiction:
The AHCA will reduce premiums.
It will not reduce premiums. Not really. This is a smoke screen. It is a cynical attempt to dupe the public by shifting costs to where they are less obvious.
First, the plan will push tens of millions of people out of coverage. These would be the most expensive consumers of health care, those with chronic condition and the poor. This would result in a return to the pre-ACA days of millions simply using the emergency medical system, as their primary care providers. This is massively expensive and those costs get passed on to consumers one way or another, just less obviously.
Second, the plan ends the very unpopular “individual mandate”. This allows people to forego health insurance entirely if they wish. The GOP justification is that it is wrong to force people to buy insurance if they do not feel they need it. Young people especially fall into the very low risk category and often would rather use their hard earned dollars elsewhere. Sound reasonable?
The cold hard fact is that insurance is about spreading the risk. Period. That’s how it works. If we allow those that are least at risk to opt out, there is only one possible result for those that are still in the system… higher premiums. That was the whole reason that we had the “individual mandate” in the first place. The mandate was essentially about “paying it forward”. You buy insurance when you are young when you need the least care. You are supporting the system for all the others who are older, less fortunate, or have chronic conditions. And then, at some point, you get old yourself. At that point your likelihood of incurring medical costs goes way up. So, it will be the young and healthy who are supporting your own care.
If we allow the young and healthy to opt out of the risk pool. Then the ONLY ALTERNATIVE is vastly higher premiums for the older, higher risk folks. This will be true at precisely the time in their lives when they can least afford it, at retirement when they are on fixed incomes. This is how insurance works. It isn’t magic. It’s a numbers game.
If we decide that we do not want to allow insurers to exclude people with pre-existing conditions (on which American seem to be united), then we have to have some form of broad, blanket coverage requirement. Otherwise people will simply forego buying insurance until they are sick and need it. Then they join the system without having paid into it when they were still low risk. That simply raises costs for everyone else. It has to.
Now, the obvious solution to this is to not “require” people to buy insurance but to “provide” insurance to everyone. A Medicare for all system in which heath care is treated as a public good and would be administered on behalf of our citizenry by our own government. But at this moment in time, with the GOP in control of Congress, that is a non-starter. So, instead, we are talking about trying to stop a plan that takes the country in precisely the opposite direction from where it should be going. It’s tragic but there it is.
The other deceptive piece of the AHCA is the idea that by reducing premiums, we have automatically provided health care to our citizens. But this is just another shill game. For profit insurance companies create lower cost premiums two ways. First, is simply by excluding conditions they do not wish to cover. Things like mental health coverage, prenatal care and maternity services, etc. The GOP bill, which purports to be a free market solution, does not prevent this cynical tactic. People believe they have affordable coverage only to discover that the services they need the most are not included. This was the basis of the substandard policies that the ACA did away with but the GOP plan would once again allow.
The second way is to create lower premium plans by jacking up the deductibles to the point at which the consumer cannot afford to actually use their coverage to get services because by the time they cover the deductible and then add in the percentage of the service not covered by the insurer, it is not affordable any more. In a nation in which half the country exists on the edge financially, with little or no cushion, policies like this mean that they forego routine care, live with conditions that markedly interfere with the quality of their lives, and end up being more likely to have serious and expensive conditions that could have been prevented. It is just another way to kick the costs down the road while creating the illusion that people have coverage. But it is coverage they can’t afford to use.
GOP Fiction:
The Plan Doesn’t Cut Health Care for the Poor and Lower Incomes
It does, and by a lot. It is simply a fact that both the House version of the bill and the Senate versions of this bill will push as many as 23 million Medicaid recipients off the rolls.  These would be the most vulnerable of our citizens, the poor who have little or no other means of getting health care. We know that failure to receive adequate health care costs lives. It’s as simple as that. The GOP plan is a death sentence for tens of thousands of Americans, period. For a party that once screamed about “death panels” it is inconceivable that they now support such a draconian attack on our nation’s poor and low income citizens.
The GOP has come up with a complex set of “tax-free health savings accounts and targeted tax credits” which supposedly help the poor defray the costs of coverage. But wait… think about it. Remember Romney’s 47% of the public that doesn’t earn enough money to pay Federal taxes? What good are tax free savings accounts to someone already poor enough not to be paying taxes? What good are tax credits for someone who will pay zero taxes even before the credit? This is nothing but a cynical sham, a ploy to make it look like the GOP cares about health care for the poor while pushing them out of coverage over time.
Since we as a nation long ago decided that we will not allow bodies in the streets, that we don’t turn away people at the emergency room when they need help, cutting Medicaid is just another way to shift the costs of health care to areas that are less obvious so the GOP can pretend they brought down premiums. Yes, premiums might be less for that smaller group can afford coverage but this is done at the expense of everyone else, and in the end, those people will be for the added costs elsewhere anyway.
The GOP plan either imposes lifetime limits of Medicaid benefits or allows the states to do so. Allowing the states to cap benefits is a sneaky way to allow the poor to get screwed without Congress appearing to be the villains… after all, it was the states.
So, once again, what happens to folks when they hit their lifetime benefit cap? Do they suddenly not require medical care any more? Of course not. The lifetime cap simply pushes people into bankruptcy, period.  Even under our current ACA, medical costs are the number one cause of personal bankruptcy in the United States, one of the richest nations in the world. The Republican plan would magnify this problem by many times. In order to get a short term political win, it kicks the can down the road for tens of millions of Americans who would hit their benefit caps after the political racketeers currently in Congress will be out of office and retired.
Bankruptcies are the number one way that we hide the true cost of our health care.
We allow our citizens to descend into impoverishment due to astronomical care and drug costs. Then we write that off when they declare bankruptcy. It’s a slick way of seemingly making those costs seem to disappear. But of course they do not really disappear. Those losses inevitably get passed on to consumers in other areas where they are less obvious as due to medical costs. And the folks that were wiped out of everything they had are left in poverty and seldom recover financially. Whole families are pushed to the edge of survival this way.
The United States has the highest per capita health care costs in the world. The GOP plan does absolutely nothing to address these costs. It is an attempt to use free market forces to deliver care. Well, free market forces are about profit. If we as a nation decide that the health of our citizens is a commodity meant to be bought and sold for the benefit of the investor class, then we have to accept that the price of profits is crushing poverty, debilitating illness,  and even death for the many millions of Americans that do not have the means to be profitable as consumers of the free market health care product.
And all of this is to allow the GOP to deliver a massive tax cut to the wealthiest Americans. Eight men own the same wealth as the 3.6 billion people who make up the poorest half of humanity, and six of them are Americans. The top one tenth of one percent in America own as much as the bottom 90% of our citizens. This massive and widening wealth and income divide is an obscenity. And to create a health care system that is largely about not providing health care to many millions in order to protect this unprecedented, grotesque, level of inequality is criminal, immoral, unconscionable, and totally unjustifiable.
If any issue were to provide a reason for millions of Americans to take to the streets in protest, it should be the health care issue. This is the single most important issue facing our political system today. Not a single American isn’t effected on some level by this issue. It defines what our nation is to stand for, it is the moral underpinning of our society since it determines how we care for each other as Americans. The first step for us now is to stop this travesty of a plan in its tracks. It cannot be allowed to become the law of the land. It is a national disgrace that one of our two major political parties thinks that this is how we should approach health care.
Then, we have to get serious about real reform. The ACA has been crashing because we didn’t allow it to do what it should have done in the first place. A Medicare for all system is the only solution that would provide coverage for all Americans, remove the burden of insurance costs from our businesses, bring down premiums and give the government leverage to negotiate lower costs for the people. All the alternatives are band aids that will not accomplish what is really needed. Let’s get rid of the incomprehensibly complex insurance system, the hidden costs, the bankruptcies, and go to a straight forward expansion of our existing Medicare system to all Americans. Medicaid can continue to fill in the gaps for the poorest Americans who do not even have the means to contribute to the system.
No caps, no coverage gaps, no pre-existing conditions, just good health care for everyone. Health care should be a public good. It should be seen as a right that everyone in a society supports for the benefit of the whole. It should be the starting point for that level playing field that allows equal opportunity for all Americans. We have to get this right and we need to do it sooner rather than later.

Hiding the True Costs of Health Care – the GOP Approach

George S LedyardFirst of all, the GOP health care bill is about hiding the true costs of health care. Whatever costs it will appear to cut will simply be shifted to areas in which they will be less apparent to the folks who can afford insurance.
By removing the requirement contained in the ACA that everyone be required to participate in the risk pool, this plan will allow people to opt out. That essentially takes us back to the days where millions of Americans simply used the hugely expensive emergency room system for their primary care. The ACA had brought those costs down substantially and now they are likely to rise back up.
The other way that costs for Americans who do have insurance will “appear” to go down is due to the fact that it will push tens of millions of Americans covered under Medicaid off the rolls. The Senate version does this more slowly than the House version, but it still does so. It does so to the tune of nearly one trillion dollars.
So, we allow people to not carry insurance. We push tens of millions of the poor and under employed off the rolls. Now, add to that removing the requirement for larger companies to offer insurance benefits at all. Potentially more people with no benefits. even if they are gainfully employed.
Then the insidious elements that can go below the radar. Remove the essential requirements for policies. That allows companies to go back to offering sub standard policies that appear to cover people that do not in fact cover many of the most important areas like maternity care, mental health coverage etc.
Additionally, think higher deductible policies that simply make receiving basic care, even preventive care, un-affordable for most people.  In the short run, this appears to reduce costs but the reality is that when people do not get the regular preventive and maintenance care they should be receiving. They simply wait until more serious medical catastrophe to access care. That ends up being far more expensive in the longer run.
The bill sneakily shifts many of these considerations to the states. Effectively what that will do is allow the states with the poorest populations, which incidentally tend to be Red States that support the GOP, to push even more people out of adequate coverage. The wealthier states will most likely find ways to work around these issues, thereby going even farther than we are towards two Americas. The haves and the have nots.
The bill contains a bit of money for the opioid epidemic but many billions less than what the experts say is required. Emergency medical services are currently at their limit handling the crisis and the numbers are still on the upswing. So, precisely at the moment when the nation is experiencing a health crisis, this bill is giving tax breaks to the rich, penalizing the poor and working class folks, exactly the people most effected.
This bill is nothing less than a denial that the essential right to health care is a “right” at all. The right wing, Libertarian approach that the GOP seems committed to is quite simply about the rich being cared for and the less well off being either denied access to coverage or receiving inadequate coverage. It really is that simple. Precisely at a time when the income / wealth divide is widening, the GOP is attempting to reduce assistance to the poor in order to reduce costs for the elites and grant the richest Americans a massive tax cut.
This approach is unconscionable, immoral, and unjustifiable. It is a travesty and moves the country in a direction backwards and in exactly the opposite direction that we need to go.

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.