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Tag: "health care"

The Horror

[ 59 ] July 30, 2017 |

I see it’s the anniversary of the end of American freedom.

This is why only President Trump can MAGA. When will my mom have the freedom to die many years too young?

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What Might Single Payer Look Like?

[ 102 ] July 26, 2017 |

I am definitely not the LGM health care wonk, but I wanted to point out to you all this proposal about how to get to single payer. The left always says, “Let’s have single payer!” but the conversations rarely go into any depth at all. What would that look like? How would we get there? What about the insurance industry? Etc. So I won’t really comment on the overall quality of this proposal, but rather want to point it out so that commenters can work off some kind of proposal in order to hone their ideas.

Our plan, the Medical Insurance and Care for All program (MICA), is a public health insurance program based on Medicare but open to all individuals. Employers will be required to buy their employees MICA or equally good private coverage. If one does not receive employer coverage, they will automatically be enrolled in MICA and charged for it in their taxes.

ny serious move toward a more rational universal health care system will face strong opposition from hospitals, doctors, drug makers, and insurance companies. That’s because they rely on the byzantine nature of the health care system to charge significantly more than providers and insurers in other highly industrialized countries.

There is no way around this financial reality. Consequently, for any plan to be politically viable, it must aim to reduce opposition from outside the health care sector as much as possible while still achieving universal affordable health care.

The Affordable Care Act (ACA) was designed as a large transfer of wealth from the rich and a segment of healthy middle class individuals to the poor, the sick, and importantly, the health care industry. MICA is primarily a transfer of wealth from the health care industry to everyone else.

The guiding political principles behind this plan are intended to make it politically viable by minimizing disruption, making the transition feel voluntary, and ensuring everyone outside the health care sector is noticeably better off (and at least not worse off).

There are two primary approaches to transitioning to single-payer that minimize disruption and the number of losers outside the health care industry.

The first is to slowly lower the Medicare age and/or slowly add specific groups to Medicare. The second is to find a way to transition our current employer coverage system towards single-payer-like health insurance.

This plan does the latter by strongly encouraging the private dollars currently spent on health care to be redirected toward a new, much cheaper, and better quality government program. MICA will be an attractive option for all companies, as the program should cost 20-30% less than what employers are currently spending on insurance.

The existence of a universally better government program will compel the remaining private insurance industry to perform better.

The reasons for this approach over slowly lowering the Medicare age are multifold. First, is the issue of financing. Lowering the Medicare age would need to be combined with a new tax structure while this plan relies on mainly redirecting employer current spending on private health insurance.

This route is also quicker and more difficult to reverse. MICA would be available immediately to all companies and they would steadily start choosing it.

Additionally, one fear with lowering the Medicare age slowly is that opponents could simply freeze it when elected, ending up with our same system—except Medicare now would start at age 59.

Lowering the Medicare age is likely to be disruptive. There might be some point, for example, when the eligibility age reached 45, where larger companies might stop dropping employer coverage en masse, creating a need for an emergency fix.

There’s a lot more detail at the link.

Finally, the Poor Will Have the Freedom to Die

[ 46 ] June 25, 2017 |

While officiating Secretary of the Treasury Jay Gould’s third wedding, Vice-President Torquemada found time to tweet a picture of the wedding of a bunch of millionaires (sitting at the distant tables no doubt) and billionaires and use this as the message:

Class war, indeed. Anyway, what’s the kind of personal responsibility the party of mass murder is talking about?

Senate Republicans are expected to revise their health bill early next week, adding in a provision that could lock Americans out of the individual market for six months if they fail to maintain continuous insurance coverage.

Miss a payment, no health care for 6 months! Sounds like freedom to me!

Our Qualified, Intelligent Political Leaders

[ 19 ] May 26, 2017 |

Mark Meadows, (Lunatic-NC) and critical player in TrumpCare passing the House:

Freedom Caucus Chairman Mark Meadows (R-N.C.), — who played a pivotal role in including state waiver options in AHCA — hadn’t read the full report yet, but initially said he saw it as “good news.”

When reporters pointed out the portion of the CBO report saying individuals with preexisting conditions in waiver states would be charged higher premiums and could even be priced out of the insurance market — destabilizing markets in those states — under AHCA, Meadows seemed surprised.

“Well, that’s not what I read,” Meadows said, putting on his reading glasses and peering at the paragraph on the phone of a nearby reporter.

The CBO predicted:

“…the waivers in those states would have another effect: Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

Republicans insisted in the days after AHCA’s passage that the health care bill would not weaken protections for preexisting conditions, citing the plan’s high-risk pools for sick people.

Critics argue those high-risk pools are not adequately funded, though. The Center for American Progress projected, before House Republicans passed AHCA in May, that its high-risk pools “would fall short by at least $19.7 billion per year, or by about $200 billion over 10 years.”

The CBO analysis was likewise adamant that AHCA’s current high-risk pool funding isn’t enough to cover sick people if states use the mandate waivers.

After reading the paragraph, Meadows told reporters he would go through the CBO analysis more thoroughly and run the numbers, adding he would work to make sure the high-risk pools are properly funded.

Meadows, suddenly emotional, choked back tears and said, “Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

He continued:

“In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.”

Meadows indicated he would support less-conservative changes to provide more funding for high-risk pools in the Senate, if needed.

The man literally has no idea what it is his own bill or how it will affect people, despite people talking about this ever since this horrible idea began. But, hey, those people were liberals. And so are those CBO hippies so I’m sure the magic math behind TrumpCare will totally work. That’s Jesus math right there.

Calling Republicans

[ 56 ] May 4, 2017 |

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Marshall makes sense here on how to deal with Republican representatives on this vote to kill millions of Americans, whether they vote yes or no.

It matters just as much if your GOP rep is voting against this bill. To call and say “Hey thanks”? Not remotely.

If your Republican Rep is voting ‘no’, it’s still their vote and their seat which makes Paul Ryan the Speaker. That’s making this possible. If their seat was held by a Democrat (and obviously a number of seats more, not just that one) this wouldn’t be happening. So it’s not just about their vote. They make the majority possible. And that’s why this is happening. So really, they are just as responsible as the Republicans are voting “yes”. That’s true as a factual matter. As a matter of political strategy, if you want to protect the coverage of those 24 million people, you should let them know that you plan to hold them responsible for this. The heat on them will matter a lot because they have little real incentive to try to stop the train if they think they’re off the hook because they voted “no”. This is very important.

I guarantee you there are many conversations between ‘no’ voting Republican Reps and House leadership in which it’s a very straightforward arrangement. “I wish you guys the best but I need to vote ‘no’. It won’t fly in my district.” For a certain number, the leadership says, “We understand. We’ll give you a pass. We have the votes.” So the “no” voting Rep thinks he or she is covered. I’m in the clear. They shouldn’t be for the reasons I’ve stated above. In many cases, they are perfectly happy to see the 24 million go to the butcher block. Because it’s not on them. Or they don’t think it will be. It’s important for constituents to let them know that is not how they see it.

If your Rep is a diehard “yes” in a safe district, you should still call. Why? First, no one is ever that safe. But the more important point is that when people in safe seats hear more than they expected, they will rightly get the sense that other people in their caucus might go down to defeat. So they may no longer be in the majority. Especially today, parties operate as units. No representative is an island.

Another point to consider is that this seems likely to pass by maybe as little as one or two votes. What does that mean? That means that every Republican “yes” on their own could have made the difference. Let’s say this literally passes by one vote. That means your Republican Rep, alone, could have saved coverage for 24 million people. And so could that other Republican Rep who represents your cousin in other state. Funny how that works, isn’t it? But it’s true. That’s powerful. That’s the making of 30 seconds ads.

I could rattle off a list of other scenarios. But the point is that you should call basically no matter what. The utility and impact may not be as obvious. But often, the impact is almost as great as it would be if you were calling someone who was actually wavering. Sometimes greater. The over-arching point is don’t fall for the silliness of vote count literalism. Call. It matters.

The main takeaway from this horrid bill is this tweet from last night. And the central point that I have made over and over–the threat this nation faces is at most 20% Trump. The threat is at least 80% the Republican Party and what it stands for. And I don’t know really know if our freedoms can survive decades of this.

Drain That Swamp!

[ 45 ] April 26, 2017 |

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Congressional Republicans are really going to sell the public on keeping themselves on the ACA while they continue attempting dooming millions of Americans to early and painful deaths.

House Republicans appear to have included a provision that exempts Members of Congress and their staff from their latest health care plan.

The new Republican amendment, introduced Tuesday night, would allow states to waive out of Obamacare’s ban on pre-existing conditions. This means that insurers could once again, under certain circumstances, charge sick people higher premiums than healthy people.

Republican legislators liked this policy well enough to offer it in a new amendment. They do not, however, seem to like it enough to have it apply to themselves and their staff. A spokesperson for Rep. Tom MacArthur (R-N.J.) who authored this amendment confirmed this was the case: members of Congress and their staff would get the guarantee of keeping these Obamacare regulations. Health law expert Tim Jost flagged me to this particular issue.

A bit of background is helpful here. Obamacare requires all members of Congress and their staff to purchase coverage on the individual market, just like Obamacare enrollees. The politics of that plank were simple enough, meant to demonstrate that if the coverage in this law were good enough for Americans than it should be good enough for their representations in Washington.

That’s been happening for the past four years now. Fast-forward to this new amendment, which would allow states to waive out of key Obamacare protections like the ban on pre-existing conditions or the requirement to cover things like maternity care and mental health services.

If Congressional aides lived in a state that decided to waive these protections, the aides who were sick could be vulnerable to higher premiums than the aides that are healthy. Their benefits package could get skimpier as Obamacare’s essential health benefits requirement may no longer apply either.

I appreciate wanting to keep your staff healthy. Too bad it doesn’t apply to all Americans. I guess being a College Republican who gets a staff job out of college with a fireeating Republican makes you the member of a superior class, unlike those people.

Meanwhile, the Trump tax plan sure looks great!

Reduction of the corporate tax rate from 35 percent to 15 percent, a cut which sounds like it will indeed apply to “pass-through” companies like the Trump Organization.

Reduction of the top individual tax rate from 39.6 percent to 35 percent and reduction in the number of individual tax brackets from seven to three.

Doubling the standard deduction.

Repeal of the estate tax.

Repeal of the Alternative Minimum Tax.

Repeal of the “Net Investment Income” tax that helps pay for Obamacare.

It would also eliminate nearly every deduction except for mortgage. Among many other things, this would effectively mean the end of freelancing as a career choice.

How would this affect Herr Trump? Secretary of the Treasury Jay Gould:

How will the president’s own tax bill be affected by the plan? “I can’t comment on the president’s tax situation since I don’t have access to that.”

I’m sure that Trump will make this clear soon enough by releasing his taxes!

The Next Step in the Health Care Debates

[ 57 ] March 25, 2017 |

Cartoon-Socialized-Medicine

Above: Hells yeah!

Yesterday was a great day. But let’s be clear–Trump and Ryan will treat the ACA as well as they treat any other part of the government, which means trying to undermine its effectiveness. And given how insurance companies are dropping out of the exchanges, there are real problems that need to be fixed. It’s not really on Democrats to defend the ACA as a static program because they originally passed it. What they should be saying is that the ACA was the best that could be in 2010 and yes it does have problems that need fixing. And they should be saying that the way to fix those problems is universal Medicare. And while I get that single-payer has been simplified on the left as the only possible solution for health care when in reality there are many possible roles, expanding Medicare into a single-payer type system does have certain advantages.

It also makes an excellent organizing signpost. Medicare for all is simple, easy to understand, and hard to argue against or distort. Most people know someone on Medicare who can testify to the generally good care, or who is counting the days until they can enroll and have the peace of mind that comes with quality coverage. Fabricated agitprop like the mythical ObamaCare “death panels” will be a much harder sell.

As Republicans do their level best to make sure as many poor people as possible go bankrupt from medical debt or die of preventable diseases, a single-payer counter-offer makes perfect policy and political sense. Even if you think it’s a bit hasty on the merits, it’s still a splendid way for the Democrats to demonstrate, loudly and clearly, that they are for quality health care for all.

That makes plenty of sense to me.

Also, organizing works. Keep doing it. If you flooded congressional phone lines for everything like for this bill, or even 10% of like this bill, we would have a far better nation.

Dumbasses of America

[ 323 ] March 19, 2017 |

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The genre of “let’s talk to idiotic white voters who support Trump even though he will decimate their lives” is already more stale than bread baked on November 8. However, it does lead to the occasional special anecdote that truly sums up the stupidity of many white people.

Blake Yelverton is taking a break with a burger that doesn’t cut any corners. Cheese and bacon and everything. He’s 23, a burly young man with a big red beard, and he works on his father’s cow farm.

“I don’t believe it’s the federal government’s job to provide health care,” he said. “It’s communism, socialism anyway.”

Yelverton hopes Trump trashes the whole thing, and he’s not too fond of the GOP plan being discussed in Congress either. “They’re doing a lesser evil of Obamacare,” he said.

His insurance?

“I’m on my parents’ plan,” he said.

So, Yelverton, it turns out, benefits from Obamacare. That’s because the law allows parents to keep kids on their insurance until age 26 — a widely-popular element of Barack Obama’s signature health law that Republicans intend to keep in their replacement plan.

Confronted with that information, he pauses for a moment.

“I haven’t been to the doctor in four or five years,” he said.

Smart kid.

Who Knew?

[ 211 ] February 27, 2017 |

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The last person to understand a basic fact is of course our president.

President Donald Trump told a bipartisan group of governors at a White House reception Monday morning that GOP tax reform would have to wait for lawmakers to move on repealing Obamacare, cautioning that, “Nobody knew that health care could be so complicated.”

“I have to tell you, it’s an unbelievably complex subject,” Trump said.

OK.

Who Uses the ACA? Trump Voters.

[ 216 ] February 6, 2017 |

1in4WA

As this story on Washington demonstrates, one of the many sad ironies of the election is that the counties most reliant upon the ACA for health care are also the counties most likely to vote for the fascist Trump.

The ACA and the Republican War on the Arts

[ 145 ] January 19, 2017 |

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Repealing the ACA would decimate the lives of musicians who rely on it to stay healthy. This is of course part of the point for Republican “governance” that is launching a head-on attack on the arts.

For much of his life, Andrew Savage, the 30-year-old singer-guitarist for New York indie-rock band Parquet Courts, went without health insurance. The musician suffers from epilepsy and suffers two or three seizures a year, the most severe of which have resulted in head trauma. He quit his day job six years ago to tour with the band, which was just starting to take off, but that meant no insurance to pay for his daily medication. He spent years shuffling payments on credit cards; once, he openly wept when a pharmacist told him a generic drug was available for $40 instead of $400.

The ACA would have helped, but by the time it took effect in 2013, the members of Parquet Courts were big enough, like most successful bands, to form a Limited Liability Company and purchase group insurance. “We were worried that if we got Obamacare, there would be a lot of limitations — the bill, when it was first conceived, was very different from the one that made it through because so many things got taken away from Obama and his original vision of the plan,” Savage says from his Brooklyn home. “Of all the cynical things promised by Donald Trump, this has got to be one of the most scoundrel-ish — this is taking things away from people who definitely need it.”

Even musicians who haven’t purchased insurance through the exchanges have benefited from Obamacare. Insurance companies can no longer raise rates for customers who have pre-existing conditions. That means sick people have an easier time than ever getting coverage.

Members of Drive-By Truckers, the veteran southern-rock band, run an LLC and share a group health-insurance plan. But 52-year-old Patterson Hood, one of the band’s lead singers, says the central Obamacare provision that prevents insurance companies from raising rates due to members’ pre-existing conditions has helped his family immeasurably. His wife and 12-year-old daughter have scoliosis, or curvature of the spine, and his 7-year-old son has growth hormone deficiency that requires an expensive shot every day for the next decade.

“My son’s shots are in the thousands per month. I mean, it’s a lot of money. And we do not have it,” he tells Rolling Stone just before a Conan appearance in Los Angeles. “We’re paying $2,000 a month as it is just for the insurance. I’m lucky I’m gainfully employed — my band, we’re not stars, but we’re successful enough to where I can make ends met. But it terrifies me. It literally woke me up in the middle of the night last night.”

You ain’t the only one Patterson. You ain’t the only one.

But hey, I bet Pat Boone has the best health insurance. And that’s all the music we need in the new White Christian America.

Repeal and Replace…With Manly Suffering and Life Lessons

[ 136 ] December 19, 2016 |

scott-walker-repeal-and-replace-plan-explained

GOP health care in a nutshell:

A Republican congressman outlined the way he would like to see the health care system operate if Obamacare is repealed, as GOP lawmakers are promising. It is a brave new world in which parents would wait and think about it before bringing in their sick or injured kids for costly treatments.

The example Rep. Bill Huizenga (R-MI) gave in an interview with MLive.com was from his own experience when he waited until the morning after to take his youngest son to the doctor with an injured arm, because he did not want to waste money on an expensive emergency room visit. The arm, it turned out, was broken.

“We weren’t sure what was going on. It was in the evening, so I splinted it up and we wrapped it up, and the decision was, okay, do we go to the ER? We thought it was a sprain, but weren’t sure,” Huizenga said, adding that he and his wife “took every precaution and decided to go in the next morning.”

“When it [comes to] those type of things, do you keep your child home from school and take him the next morning to the doctor because of a cold or a flu, versus take him into the emergency room? If you don’t have a cost difference, you’ll make different decisions,” he said.

Explaining to your kid that you could relieve his pain immediately, but then poor people would have health coverage and become horrible welfare slackers driving around in their Cadillac after ordering their t-bone steaks is simply good parenting. Preventive care? Well, that’s preventing our kids from being losers as adults by simply not treating their illnesses.

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