Tag: Trumpcare

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.

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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.

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.