Tag Archives: ACA

Things That Go Bump In The Night and Things That Are Making More Noise Than Sense

Another week of the Trumpster Fire, another week of news from a fire hose, and another week during which we, as news consumers, are required to filter wheat from chaff, and the relevant from the nearly irrelevant.  What things bumping in the night should be attended to? Which can be set off to the side and safely ignored for the moment.

Bumps With More Noise Than Significance

Preliminary public polling results.  The Press/Media is enamored of the latest rendition of The Great Blue Wave.  This is one of the least informative ways of filling one’s air-time.  First, national preference polling is interesting, but all elections are local.  While some members of the punditry are beginning to mouth the words “vote suppression,” and “gerrymandering,” not enough information and analysis has been shared about the effects of these GOP efforts to maintain control of the Congress, and of state elections. Secondly,  there are no national elections for Congressional seats — to state the perfectly obvious.  Those elections will be determined by candidate recruitment and quality, personnel and monetary resources, and campaign competence.  None of these, with the possible exception of shared mailing lists and big donors (monetary resources) is national in scope.  Third, some campaigns will be assisted by the efforts of third party groups. For example, are Union members out canvassing? Are students out doing registration drives?  Are small groups of activists providing services like rides to the polls? The extent and nature of these ancillary groups and their activities will have an impact, we just don’t know the extent to date.  None of this will be “news” to anyone who’s been paying attention to American civic life for the last few decades.

Just because it’s on the news doesn’t necessarily mean it’s important.  The occupant of the Oval Office and some members of the media are still playing the DC parlor game, “Who is Anonymous?” Or anonomus or anamonomous or whatever.  I’m still working on why this might be important.  For my money we still have staff in the executive branch who are willing to explode the national debt in service to tax cuts for the top 0.01% of American income earners, at ease with putting 12,000 children in “detention” facilities for an indefinite period, and quite pleased to allow health insurance companies to charge people with pre-existing medical conditions more for their premiums.  That these people will occasionally arise on their hind legs and proclaim the Great One has gone too far doesn’t impress me.  What would impress me?

How about more attention paid to this nugget:

“Besides family, one of the only people Trump continues to trust is Stephen Miller. “The op-ed has validated Miller’s view, which was also Steve Bannon’s, that there’s an ‘administrative state’ out to get Trump,” a Republican close to the White House said. “There is a coup, and it’s not slow-rolling or concealed,” Bannon told me. “Trump believes there’s a coup,” a person familiar with his thinking said.”

And thus our Oval Office Occupant (Or Triple Zero if spelled 0val 0ffice 0ccupant) is more heavily reliant on a blatantly racist, far right wing conspiracy fabulist, who stokes the Occupant’s most divisive tendencies?  This seems to call for more analysis, and yet the punditry still grasps the Who-Done-It? segment, or pontificates upon the “effect” of the infamous Op-Ed on the President’s “mind set.”  Clue number one a White Nationalist was influencing the 000 might have been the initial Muslim ban?  More clues — no DACA agreement  by Congressional Democrats was ever going to be satisfactory — no one ‘would care’ that there might be children separated from their parents at the southern border — it’s considered acceptable to move funds from FEMA and the Coast Guard to pay for more ICE detention facilities —  it’s supposed to be all right for asylum seeking families to be kept in these detention facilities indefinitely?

Things Not Making So Much Noise But Nevertheless Important

Health care and health insurance.  There is nothing the GOP would enjoy so much as repealing the last semi-colon and comma of the Affordable Care Act.  We’ve heard the “more competition” argument currently coming from the House Speaker before.  It doesn’t make any more sense now than it did then.  Health insurance is not a product analogous to purchasing a motor vehicle or any other consumer product.  One doesn’t choose to get hit by a bus, or hit with a cancer diagnosis, or hit with a complicated pregnancy — or even an uncomplicated one for that matter.

Consumer protection.  While the great fire hose emits its inundation of noise about all things Trumpian, consumer protections enacted to prevent yet another Wall Street melt down are under attack.  The student loan market is being “deregulated.”  Not a good thing.  The smaller issues involved in the Dodd Frank Act have been resolved with some bipartisan legislation, but the administration wants to go further — and the assortment of Goldman Sachs alums in the administration are being ever so helpful in this regard.  Left unchecked we’re going to see another round of de-regulation, which didn’t work out so well for us the last time.  Caveat Emptor American consumer — be careful before voting for any candidate who vows to cut red tape and diminish the “burdens” of regulations — like those preventing the next melt down in the Wall Street Casino.

It’s the Stupid Economy.   Yes. Wall Street has been doing quite nicely thank you very much. I maintain my position that the worst business news is readily available on most broadcast networks.  If a person believes that the DJIA represents the state of the American economy then they’re in for more surprises like the ones which emerged in 2007-08.   Information like real median household income trends is available from FRED, but before we get too excited note median household income numbers may be obscuring other figures like wages adjusted for inflation for full time employees.   Further, what’s being added in to the mix as “income?”  All income includes everything from unemployment benefits to returns on investments.  It’s those returns on investments that have made some very nice progress over the last ten years…wages maybe not so much.  We’re on our own to dive more deeply into the wage issues and income distribution data.  There’s some good news, some bad news, and some news to think about like the 16 straight quarters we’ve had of increasing domestic household debt.  So, it’s time for the question:  Are we seeing candidates for Congress who acknowledge the need for common sense controls on Wall Street casino operations? Who are aware and concerned for wage and salary workers and their economic security?  Are we getting more noise from the highly generalized pie in the sky theoretical visionaries who want us to believe that those with great wealth are going to buy all the homes, cars, washing machines, shoes, movie tickets, and restaurant meals necessary to keep the US economy rolling on?

I could use a little more light on these subjects, and perhaps a bit less bump in the night stuff about a “crisis on the border” (manufactured by the current administration) or “The Press Is Out To Get Me,” from Orange Blossom.   And, I’m looking for Congressional and Senate Candidates who will speak to me about how to fix problems, rather than shout at me about how to fix the blame for them.  I’d like for political discourse to make more sense than noise.

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Filed under anti-immigration, banking, Economy, financial regulation, Health Care, health insurance, Heller, Nevada politics, Politics

Heller on the Slipface?

angle of reposeLet’s assume for the moment that much of the goings-on at the Residence on Pennsylvania Avenue have less to do with governance, and ever so much more to do with a tender ego, thin skin, and a perfectly illogical, nay irrational, sense of reality.  Further, we might also assume that Senator Dean Heller (R-NV) has calculated a return to his seat in the US Senate predicated on keeping the Trumpian Base happy.  After all, Heller was pleased to support Orange Blossom’s Muslim Ban [RGJ] after expressing some initial “concerns.”  The senior Senator is good at this, i.e. expressing initial concerns prior to caving in faster that a pile of  dry sand with a 35° angle of repose.   So, we shouldn’t be surprised to find he’s caved again.

Thus much for all that opposition to turning Nevada into the nation’s nuclear waste basket (Yucca Mountain), Senator Heller is willing to forgive and forget all that to tell us he has NO reservations about supporting the nomination of Mr. Kavanaugh to the US Supreme Court. [RGJ]  How convenient for the Orange Occupant of the Oval Office?  To have a Senator support the candidate most likely to declare the decision in US vs. Nixon a mistake. [WaPo]  Indeed, how very helpful!

Once having aligned himself with the Orange Occupant’s selection, Senator Heller may have to explain to his audiences (should he decide to have any with living people in them) how he is serving ALL the good people in the Silver State.

People who don’t necessarily believe the decision in Roe v. Wade should be overturned?  People who don’t necessarily believe that gun dealers have more rights than gun violence victims?  People who don’t necessarily believe that people with pre-existing medical conditions should be priced out of the health insurance markets?  People who don’t believe that ICE agents should be arresting and detaining victims of domestic abuse? People who don’t necessarily believe that the function of immigration enforcement agencies is to rip young children away from their parents, and then to be so incapable or incompetent as to make reuniting them nearly impossible — subsequently resorting to the ruse of declaring the un-reunited children as “ineligible” for a return to their parents.  What a cold and miserable calculation that categorization must be?

But, please, Senator Heller, do run as if this were still primary season.  Do cling to the increasingly disjointed, illogical, and downright cruel rantings of the Oval Office Occupant.  Do revert to the wedge issues of the 1980s and 1990s.  I’m sure your opponent, Rep. Jacky Rosen will be pleased to talk about —  offering affordable health care for all Nevadans, promoting women’s health and family well-being, advocating for employment opportunities and equal pay for all Nevada families.

“President Trump is trying to pull up the ladder behind him, leaving the middle class stranded while his super-wealthy buddies turn the federal government into a source of enrichment for themselves. Trump ridicules women, people of color, the LGBTQ community, immigrant families, and anyone who challenges him.” [Rosen]

So, while Senator Heller is clutching the banners on Trump’s bandwagon, Rosen would rather we take our own ride.  We can’t guarantee that the media will do much more than it did in 2016 — spend more time interviewing Trump and the Trumpians than discussing issues raised by Democratic candidates. Therefore, it will be up to Democrats to tell friends and neighbors about Rosen’s (and other Democratic candidates’) position on issues.  Rosen’s are here.

We know we’re about Health Care, Government Reform,  a Clean and Safe Environment, Education, a sane and humane Immigration Policy,  advancing the interests of Senior Citizens, attending to the Security of our Nation.   However, we can’t count on much help from a mass media which treats Republican candidates and their voters like the audience for Duck Dynasty — interesting, intriguing, anomalies who attract their attention.   If Democrats can’t be shiny objects for press and punditry, perhaps we can be loud and proud.

We don’t disparage the different and the disabled. We don’t find it necessary to call the cops on kids selling lemonade, hot dogs, and candy.  We don’t find it uncomfortable if someone who has a “natural tan” is in the swimming pool, or lives next door.  We The People buy up the candy the young lad was selling when the broad beamed bigot decided to launch her verbal assault.  We The People know how to make life a misery for the intolerant who call the cops to barbecues and college common rooms.  We The People know how to identify and shame the shameless. And, if some members of Congress don’t share our values of common decency, concern for the well being of others, or improving the lives of as many of our fellow citizens as possible, then We The People can always change the members of Congress.

The Trumpians, for all we care, can slide down the slipface of history.

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Filed under Heller, Nevada, Nevada politics, Politics

Thank You: A List for 2017

thank you cardAs youngsters we were admonished to acknowledge gifts during the holiday season, and not to delay thanking Auntie for bestowing such “creative and unique” items.  That said, this isn’t an obligatory thank you — it’s a Thanks! with a capital letter to those who’ve been an inspiration this year.

 

Thanks to the ladies of the Women’s March!  Prior to that event I’d contacted my Senators and Representatives, but never with any regularity, and certainly never with multiple phone calls in any given month.  The idea of sending post cards hadn’t occurred to me.  I listened to the speakers advise more contact, more persistent contact, more urgent contact — and I bought some postcards.  I also bought a small pocket notebook.  I recorded my calls and post cards in the notebook — at first just to keep track of the topics, and then it became a habit.  The little notebook is half filled now, and I even had to add a piece of ribbon tied on as a bookmark to keep track of my place.  Perhaps I’m gaining a reputation as a pain with a couple of members of the 115th Congress. I don’t care.  They won’t be able to say they’ve not heard from anyone about protecting DACA, or the ACA, or the Consumer Finance Protection Bureau, or the EPA, or women’s reproductive rights, or the rights of workers to organize.   My new year’s prediction is that the little notebook will be filled by this time next year — at least I sincerely hope so.

Thanks to the people who attended town hall meetings!  Those who are dependent on the individual health insurance market to secure health plans need our assistance.  Those on employer  group plans need to know that the provisions of the ACA will require  they have real insurance, as opposed to junk policies with outrageous co-pays, high deductibles and limited benefits.  Those who buy policies need to know mental health treatment is on par with physical health needs, and immunizations are essential services.  And, since as they say “it takes two to tango,” everyone is in the pool — men and women, meaning maternity care is also essential.  To those people who put real faces on real problems — Thank You.  To those people who supported the people testifying to those very real issues — Thank You.

Thanks to the organizers of Indivisible!  Should I run out of ideas on a given day concerning what to say and to  whom to say it, there’s Indivisible online to assist me.  I appreciate the tweets and notices from Nevada Indivisible groups, Indivisible Lake Tahoe, Indivisible Reno, and Indivisible Las Vegas.  You are doing good work, and it’s appreciated.

Thanks to the professionals working on the Special Counsel’s investigation!  I understand those investigators aren’t the total solution to the problem of foreign interference in our elections.  However, they are a key facet of the issue and they’ve endured enough flack from partisan hacks for a lifetime already.  They can’t tell us how to protect our election systems in the future, nor can they tell us what actions our state and local officials can take to prevent future assaults — but they can, and I’m sure will, give us an accurate picture of anything prosecutable.  Their efforts are appreciated.

Thanks to the independent members of the press and media!  There are reporters and broadcasters who are not allowing lies and mischaracterizations from the current administration to go unchallenged.   Not all editors are spiking stories about corruption, maladministration, and mismanagement.  Not all reporters are playing the role of stenographer for government issued blather.  Now, more than ever before in my lifetime, we need FACTS.  Good old fashioned FACTS, and good old fashioned news — the kind wherein we learn not only who is supporting a particular policy, but what the implications of the policy proposals are in real life.

Thus, the little notebook continues to sit beside the phone, the post cards are at the ready, and there’s no shortage of topics upon which to comment.  For this, I say THANKS.

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It’s Official: GOP Hates Women — Scamcare Edition

In case there’s anyone left who thinks the Republican Party is representing the needs of women in this country, the contradiction is right in front of us in the form of the Graham-Cassidy+Heller (tagging along) bill.

Amy Friedrich-Karnik, senior federal policy adviser at the Center for Reproductive Rights, pointed to a statistic from progressive think tank the Century Foundation that estimates 13 million women will lose access to maternity care services if the ACA is repealed. Friedrich-Karnik explained that the bill also blocks Medicaid patients from using Planned Parenthood, which bars access to essential preventative care like birth control, cancer screenings, and STD testing and treatment. “It also slashes Medicaid overall and into the future, and so really impacting particularly low-income women and women of color who rely on Medicaid broadly for their health care,” she said. According to the Kaiser Health Network, Medicaid pays for nearly half of all births in America and covers family planning services for 13.5 million women. [Jez]

Not only is the bill a golf ball shot to the back of the head for Nevada women, it could cost the state some $250 million in funding:

Specifically, the proposal would eliminate the marketplace subsidies and federal dollars that states that chose to opt-in to Medicaid expansion under the ACA, like Nevada, currently receive, replacing them with block grants to be doled out to states, which would be left with the responsibility of deciding how to spend that money. It also converts almost the entire Medicaid program to a per capita cap, under which the federal government would set a limit on how much it reimburses states per enrollee, and allows states to waiver certain provisions from the ACA that require insurance companies to cover certain services and bars them from placing annual or lifetime caps on coverage. [NVInd]

Got that? Nevada gets a per capita cap, AND insurance corporations could refuse to cover pre-existing conditions, maternity care, family planning, women’s health care services, AND the corporations could revert to that wonderful old scam — the lifetime limit on coverage.  This isn’t as bad as the former “skinny” bill — it’s worse.

Senator Heller might have wanted to give this version some thought before he inked his name on the paperwork to co-sponsor the bill, but he didn’t.

It’s understandable that Nevadans are tiring of calling, writing, and sign making, but if Republicans are nothing else they are persistent.  They’re counting on public apathy, ignorance, and fatigue.  Not this time. Not on American health care. Not on our watch.

Senator Heller’s Washington DC office number is 202-224-6244.  Calls are tallied, and at some point the number of calls opposing this iteration of scam-care needs to impinge on the amount of money Republicans are counting on from the Koch Brothers and other right wing radicals.

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Filed under Health Care, health insurance, Heller, Medicaid, nevada health, Nevada politics, Politics

Thanks Mr. Trump: Anthem Pulls Out of ACA market

This from Fortune magazine on Anthem’s decision to pull out of the Nevada health insurance exchange:

“In its announcement, Anthem said it had spoken with state leaders and regulators, but the deteriorating market, paired with uncertainty at the federal level, led the company to make a “difficult” decision. The Senate recently failed to make good on the GOP’s years-long campaign promise to repeal the law known as Obamacare, and insurers say Trump has added to instability in the markets with threats to stop paying so-called cost-sharing reduction subsidies.”  (emphasis added)

The administration has several ways to sabotage the Affordable Care Act and failure to support the cost sharing reduction subsidies is one of the prime one.

Thanks Mr. Trump.

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Filed under Health Care, health insurance, nevada health, Nevada politics, Politics

Rest and Repair: ACA and market stabilization

Senator Dean Heller (R-NV) might have wished for a kinder, gentler, headline from the Reno Gazette Journal, but he got this one: “After weeks of waffling, Heller votes ‘yes’ on failed ‘skinny repeal’ of Obamacare.”  Rest assured, he’s promised to work on health insurance reform as part of his duties on the Senate Finance Committee.   This would be as good a time as any for him to demonstrate his knowledge of the insurance sector.

Heller Plays the Bail Out Card: Game One 

Let’s track back a couple of paces in time to review how Senator Heller presented his ‘moderate’ credentials on economic concerns.  While Nevada was in the throes of the Great Recession brought on by the Wall Street Casino machinations, Senator Heller was touting his opposition to the Dodd-Frank Act to insert some common sense regulation of the banking industy, casting it as follows: “Heller mentioned he was the only member of the Nevada delegation to vote against the bank bailout. He called the Dodd-Frank bank regulation bill “cover for those who voted for the bank bailout.”  In short,  that “cover” was the regulation of some of the practices that caused the collapse of the investment banks in the United States.  Senator Heller calculated that the use of the phrase “bailout” would be sufficiently negative to thoroughly obscure his support for the deregulation of the banking sector and the Wall Street Casino players therein.  There’s little reason to doubt he’ll try this play again in 2018.

McConnell Tees Up the Bail Out Card: Game Two

After the “skinny bill” failed, Senate Majority Leader Mitch McConnell provided the framework for the next time Senator Heller might want to play the Bail Out card:

“Now, I think it’s appropriate to ask, what are their ideas? It’ll be interesting to see what they suggest as the way forward. For myself I can say — and I bet I’m pretty safe in saying for most on this side of the aisle — that bailing out insurance companies with no thought of any kind of reform is not something I want to be part of. And I suspect there are not many folks over here that are interested in that. But it’ll be interesting to see what they have in mind.”  (emphasis added)

If Senator Heller didn’t mind obfuscating the purpose of the Dodd Frank Act (by calling it a bail out), he’ll certainly not mind playing the same game with the attempts to improve our health insurance system.  It would be very tempting for him to try this play one more time to cover his opposition to the very proposals that would stabilize the individual health care insurance markets in this country.  For the record, I’m assuming that if a proposal helps an insurance corporation, then Senator Heller will be sure to call it a “bail out.”   Or, in the immortal words of President George W. Bush, “There’s an old saying in Tennessee—I know it’s in Texas, probably in Tennessee—that says, ‘Fool me once, shame on…shame on you. Fool me — you can’t get fooled again.’

Making Mountains from Mole Hills

There are justifiable questions about the stability of the individual health insurance market, but before we launch major proposals in this direction it’s important to note that for all the palaver about the collapse, demise, descent or whatever of the Affordable Care Act, that individual market has been stabilizing on its own.  The Kaiser Family Foundation released its report on this market:

“Large premium increases, typically granted by state regulators, in 2017 contributed to the improved financial performance, as insurers adjusted for a sicker-than-expected risk pool, the analysis finds. However, data on hospitalizations suggest that the risk pool was not getting progressively sicker as of 2017, supporting the notion that the large increases were necessary as a one-time market correction.

Slow growth in claims for medical expenses also played a role in insurers’ financial improvements, according to the analysis.”

So far so good, but there are issues to be faced.

“Although the analysis finds the market is stabilizing, it notes that ongoing uncertainty over payment of cost-sharing subsidies to insurers and enforcement of the individual mandate could lead insurers to leave the market or charge higher premiums in 2018.”

We can now safely assert that when Senator McConnell (and perhaps Senator Heller) speak of “bailing out” insurance companies they may be referring to proposals to provide more certainty to the insurance corporations that the administration will, in fact, make good on those promises to come through with cost-sharing subsidies.  That’s truly stretching the definition of a bail out, but it may prove a highly convenient hook on which to hang Republican rhetoric.

The previous post mentioned the Three R’s — risk adjustment, risk corridors, and reinsurance.  Here’s one proposal for the last on the list:

“Senator Kaine and Senator Tom Carper of Delaware on Wednesday introduced legislation to create a reinsurance program to help insurers offset the cost of covering older, less healthy customers. That type of program—which provides payments to insurers that enroll high-cost individuals—was originally part of Obamacare until it expired last year, and Republican legislators in Minnesota and Alaska have embraced the idea as a way to stabilize insurance markets in those states. “That’s something that should have some bipartisan appeal,” Kaine said. [Atlantic]

Reinsurance was in place until 2016 in order to ease any problems with corporations insuring a high number of risky policy holders, such as those with pre-existing medical conditions.  Re-establishing it would serve the same stabilization purposes today.   The Kaiser Family Foundation provides an explanation of risk adjustment and risk corridors which don’t require an MBA to understand. Neither of these constitute any form of “bail out.”

Conflation Projection 

Conflation is too often a vehicle for obfuscation.  For example, one of the Republican objections to the ACA continues to be the incantation: Socialized Medicine!  There’s no hint of socialized medicine in the ACA, it’s a full bore market based system of encouraging  affordable health insurance policies sold by PRIVATE companies to PRIVATE CONSUMERS for use to pay PRIVATE HEALTH CARE PROVIDERS.  However, this doesn’t prevent Republicans from speculating on the ulterior motives of Democratic advocates of expanding access to affordable health insurance policies.

“Soon, they’ll want a public option!” And, then they’ll want Single Payer…and there you have it Socialized Medicine.

Let’s stop here before the fog gets too thick, and explore other options for improving health care access in another post.

*Thanks to @Karoli and Mark Stufflebeam for suggestions and references. 

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Filed under Health Care, health insurance, Heller, McConnell, Medicare, nevada health, Politics

Rest and Repair: Going Forward With The ACA

Breathe, regroup, and re-enlist in the movement to #Resist the egregious GOP agenda to dismantle the 20th century.  The health insurance bill was the first fight, but it won’t be the last.

First, expect the GOP to repeat ad nauseam all the old talking points about the Affordable Care Act, and to keep working in the background to eliminate key elements of health care assistance, and we need to be prepared to counter them.

“Premiums have skyrocketed”Counter: While there are some states in which premiums for health care insurance have increased dramatically, there are others like Indiana and Rhode Island in which premiums have actually decreased. Nevada’s increase was a modest 8% when compared to pre-ACA rate increases.  [See KFF chart for all 50 states.]  Counter: Premiums are only part of the consumer costs.  If an insurance policy offers low premiums, but includes higher co-payments and deductibles then it really isn’t “cheaper.”

“Democrats want to bail out the Health Insurance Corporations.”  The Republicans used this line when attacking the legislation to get ourselves out of the Great Recession, the product of unfettered financialism on the part of investment banks. This line has served them well, and Senator Dean Heller (R-NV) utilized it almost constantly to impress Nevada voters with his “independence” when bragging about how he voted against “bank bailouts” in the Dodd Frank Act, legislation which applied common sense regulation to investment bank practices.

A much better frame for this argument from the pro-ACA side would be that we want to stabilize the insurance markets.  Including a re-insurance element to the ACA would be helpful.  There is a way to introduce these topics without resorting to protracted arcane discussions about the nuances of the insurance market:  Explain the Three R’s.  Risk Adjustment. Reinsurance. Risk Corridors.

Government is forcing people to buy insurance they don’t want.”  I’m fond of hauling out my auto insurance — even though I’m fully aware of the fact that this is far from a good analogy.  I have one vehicle which works and one that doesn’t.  For the one that works I have a comprehensive policy, and for the one that doesn’t I have a basic policy.  What the ACA does is require a “basic policy.”  The old rig isn’t going to hit anyone or anything unless a tornado picks it up and moves it — but I still have some liability insurance for it. The policy pools all car owners, and basic is basic, so there’s liability insurance on a vehicle that isn’t moving and isn’t going to without a tow truck.  (Please don’t ask why I still have it…the answer is irrational.)

Individual mandates and employer mandates aren’t popular.  That’s fairly irrefutable. However, those mandates are an essential part of creating a widening POOL of policy holders, which in fact serves to help contain health care cost increases.

But everyone has access to health care…in the emergency room.”  No, all this means is that everyone has access to EMERGENCY health treatment, which, as we all know is the most expensive place to receive care.  Further, “having access” is not the same as being able to pay for it — thus the pre-ACA misery of personal bankruptcies and hospitals with disturbing amounts of uncompensated care on their books.

Secondly, have a plan.  A plan to address specific needs for specific problems.  If health care costs are rising faster than other consumer needs, then address this directly.  (1) Allow the government to negotiate prescription drug prices for Medicare the same way the VA negotiates prices for veterans’ medication. (2) Incentivize prescription drug research while limiting excessively high prices.  This sounds impossible, but really isn’t.  A paper from the Brookings Institution (pdf) explains how this might be accomplished.   If about $1 out of every $6 spent on health care is related to prescription drugs, holding the line in this realm would be helpful.  (3) Allow the importation, or re-importation, of medication.  This probably isn’t as efficacious as some of the other proposals, but it, too, could be helpful.

(4) Encourage practices which yield better health care outcomes.  Thus far we have a system which pays for services rendered — as it should — however, efforts to study and promote best practices.  This is a component of the ACA and one that should be publicized more effectively.  (5)  Emphasize preventive medicine.  This, too, is an element incorporated into the ACA, and deserves more attention.  It’s far better for all concerned to promote annual health check ups, healthy lifestyle and nutrition programs, and vaccinations than it is to cover the costs of heart attacks and preventable diseases.  The insurance corporation doesn’t have to pay out the claims for the heart attack, the hospital doesn’t risk providing uncompensated care, the physician doesn’t run that same risk, and the person who avoided the heart attack in the first place is working and continues being a productive member of society.

(6) The slippery slope message is already in the public domain.  “What the Democrats really want is ‘single payer.’” Yes, some do.  The Republican cognitive dissonance hits the surface when some conservatives decry socialized medicine while famously exhibiting their “Get Government Hands Off My Medicare” signs.  However, this argument is both accurate and speculative at the same time.  Some Democrats are, indeed, in favor of single payer. Some are more likely to support a public option where private corporations are reluctant to enter the private health insurance market.  Others would simply prefer to sustain the present health insurance exchange marketplace system under the current provisions of the ACA.  There’s no monolithic, lock step, Democratic position on this issue, which is both a political problem for massing support for a specific proposal, and a political opportunity to let local voters select the candidate who best represents their views.

Third, we need to recognize that “repeal and replace” was never a serious proposal in the first place.  Had it been serious, then surely in the seven years since the passage of the ACA the Republican party would have come up with something more substantial than cutting Medicaid, limiting jury awards for malpractice, defunding Planned Parenthood, and giving tax breaks to the ultra-wealthy among us.  They were perfectly happy to vote in favor of complete repeal of the ACA until the burden shifted to their own backs, then the GOP controlled Senate couldn’t come up with 50 votes for a sham bit of legislation no-one wanted.

Slogans are effective public relations, but they are woefully inadequate policy proposals.  No, the ACA isn’t “socialized medicine.”  If it were then the Heritage Foundation wouldn’t have provided the framework of the plan as a response to Hillary Clinton’s health care proposals back in the ’90s.’  Granted, the Heritage Foundation didn’t include increasing Medicaid coverage, and it did include ‘tort reform,’ but the other similarities are striking even if hard-line Republicans in 1993 opposed the bill based on the framework, and it never came to a floor vote.

The GOP Zombie Bills may be gone, but the fight isn’t over.  And the obese ladies who would do better to follow the advice given by their doctors (covered as part of the ACA mandated insurance) aren’t yet singing.

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Filed under Health Care, health insurance, Medicaid, Nevada politics, Politics