Tag Archives: health care insurance

Dear Congressman, Why Are You

From the Department of Thanks A Bunch But Don’t Do Me Any More Favors

“Nevada’s premiums on the health-care exchange are likely to increase by about $843 next year as a result of Congress’s repeal of the Affordable Care Act’s individual mandate and a new Trump administration rule on short-term health insurance plans, according to a new report from the liberal-leaning Center for American Progress.

The report, released Friday, found that annual premiums nationwide will increase from an average of about $6,176 to $7,189 for the average 40-year-old, which is about a 16.4 percent increase. In Nevada, average premiums using the same benchmark are projected to rise from about $5,547 to $6,390, or an increase of about 15 percent.” [NVIndy]

All right, I’m not 40 years old and haven’t been for quite some time, but I can empathize with younger people trying to run households, raise kids, pay the bills, and keep it together.  What they don’t need is a 15% increase in their health insurance premiums.  And who does this help?  It doesn’t help promote the best practices of established health insurance corporations.  It doesn’t help those families who are facing rising costs for groceries and transportation.  It doesn’t help young people to sell them junk insurance that won’t actually cover expenses for major medical expenses for illness or injury.  It seems to primarily help the fly by night scam artists who want to sell insurance policies which barely deserve the name.  You can read the full report ?here.

From the Department of Questions to Ask Congress Critters which Don’t Include Why Are You An A–hole?

Dear Congressman ____ why is it impossible for you to vote in favor of a bill to require universal background checks for gun sales and transfers?  (It’s not like this doesn’t have massive support from the American people.  It’s not like this wouldn’t help to keep firearms out of the hands of individuals who shouldn’t have them in the first place.   And while we’re about it, what’s so impossible about limiting the size of magazines, or keeping guns out of the hands of domestic abusers?)

Dear Congressman ____ why, when banks had their most profitable quarter EVER, would you think it important to roll back the consumer protections of the Dodd Frank Act? [MoneyCNN] [Vox] [WaPo]

Dear Congressman ____ in what perverted universe is it considered acceptable to bait bears with donuts and bacon in order to kill them? To kill hibernating bears? To kill wolf pups? [NYMag]

Dear Congressman ____ Just what purpose is served by vilifying a Central American street gang and conflating its members with ALL immigrants to this great nation?  Criticizing a violent gang is laudable, conflating these people with ALL immigrants is inexcusable.  Since I’m not 40 years old and haven’t been for some time, I recall a time when this nation was recovering from a major war against a state which called Jews “vermin,” dehumanized them, and then used the appellation as an excuse to exterminate them.  Perhaps it’s time to have people, especially politicians, read (or re-read) Elie Wiesel’s Night.

Where does this lead?

“Wiesel’s prose is quietly measured and economical, for florid exaggeration would not befit this subject. Yet, at times, his descriptions are so striking as to be breathtaking in their pungent precision. He writes through the eyes of an adolescent plunged into an unprecedented moral hinterland, and his loss of innocence is felt keenly by the reader. His identity was strained under such conditions: “The student of Talmud, the child I was, had been consumed by the flames. All that was left was a shape that resembled me. My soul had been invaded – and devoured – by a black flame.” Night.

When bad things are done by bad people, bad things happen to innocent people.

Or maybe it would simply be easier to ask, Dear Congressman ____ why are you an A-hole?

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Filed under ecology, financial regulation, Gun Issues, Health Care, health insurance, Immigration, Politics

Go To The Telephones

If you are reading this post and you haven’t yet made a phone call to Senator Dean Heller (R-NV) urging him to oppose the motion to proceed on the health insurance bill — whatever health insurance bill — in the US Senate, please take a break and go call.  There is nothing in this post that’s more important than what is going on in the Senate this morning for 1/6th of the US economy, for 1.75 million veterans who rely on Medicaid, and for the Nevada state budget which needs the support of Medicaid reimbursements… and on and on.  It’s time for All Hands On Deck.  This Zombie bill won’t be dead until it’s dead, and reports of its demise are, as Twain really said, “premature.”

Other thoughts of the day —

What the president said to the Boy Scouts probably wasn’t the End of Democracy, but it was highly inappropriate.  Highly inappropriate. In fact, it was a perfectly visible (and audible) impersonation of that guy at the end of the bar who, if given even the most tangential cue, will regale his audience with How He Caught The Winning Touchdown Pass In The Big Game Against Big Rival High back in ’75.  This is the kind of tale that doesn’t even capture the attention of the entire bar crowd, most of whom have moved away from the braggart with a yawn and eye-rolls.  Our braggart in chief misses the point that all he’s managed to accomplish is to further diminish himself with the audience, an audience increasingly aware of his insecurities and ever less willing to tolerate yet another display of them.  It’s also a blatant admission that there’s been nothing else about which to celebrate in our braggart’s life.

The president’s tendency to personalize anything and everything deflects from what ought to be the focus of our investigations into Russian assaults on our electoral system.  Perhaps in his eyes it’s an attempt to de-legitimize his election, but the reality is that the Russians did ‘attack’ us in a cyber-warfare assault, and we need to find out what happened and where we might be vulnerable to future incursions.  How do we cope with ‘weaponized’ data and information?  How do we better secure our voting rolls?  How do we best secure our voting machines and systems?  To get answers we need to look ahead, retrospectives being of some use only in revivals on Broadway and in art museums.

The Election Integrity Commission of zealous, die-hard, vote suppression advocates won’t give us answers to any of these questions — focused as it obviously is on purging voter rolls.  It won’t help us deal with the problem of gerrymandered districts.  It won’t assist in plans to secure our election infrastructure.  It’s just one more panel enlisted in the battle to convince the dwindling bar audience that the score in that last Big Game should have been 6 points higher because the referee should have allowed a score on a play during which the right tackle was clearly offside.

And, now it’s time to get back to the important business at hand — calling our Senator to urge a ‘no’ vote on the motion to proceed into insurance market chaos.




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Filed under Politics

48 Hours: The Health Care Bill

If a person hasn’t found the reason to call Senator Heller’s office and advise him to vote NO on the Republican version of a health care bill, consider the following:

(1)  One in three residents of skilled nursing facilities in Nevada are supported by Medicaid. Now, apply a simple calculator test — if a person was born in 1946 (the beginning of the Baby Boom) he or she will hit 80 in 2026.  In short, the Baby Boomers will be in the age range to need such care just as the major cuts to Medicaid kicks in.  About 65,000,000 children were born in this country between 1945 and 1961.  Cuts to the Medicaid program in this context is essentially create a crisis which we could easily have avoided.

(2) The Republicans are fond of focusing on “premium increases.”  That’s only a part of the story.  Anyone can devise insurance policies with low premiums — raise the deductibles, cut the coverage, increase co-pays,  insert lifetime benefit limits, and Voila! lower premiums.   The problems begin when a person tries to use the insurance — the reason the person bought the policy in the first place — “We’re so sorry, but this policy doesn’t cover immunizations. Or, mammograms, or prostate cancer screening, or the expenses related to the birth of your first child…”

(3) Speaking of lower premiums,  if a person has insurance from an employer then there should be no surprise when the coverage decreases compliments of the waivers included in the Senate bill — “We’re sorry, but we no longer cover wellness screenings for men and women, maternity care, or other elements that used to be included as Essential Benefits.” If a person thought that employer sponsored policies were “safe” from “reforms,” please think again.

(4) This isn’t a health care bill, it’s a tax cut bill.  Those whose income is in the top 0.1% level would receive a lovely $250,000 tax savings gift in 2026. Those earning more than $875,000 (top 1%) would get tax savings of $45,500.  [CNN]  All this at the expense of working Americans.

(5) The buzz word “patient centered” is nonsense.  At bottom, it’s a euphemistic way of saying “You are On Your Own.” A person can “choose” to buy what he or she can afford — and for lower income Americans this means lower coverage and higher out of pocket expenses.  The problem with applying classic market principles to health care is that much of what is covered isn’t a matter of Choice.  No one chooses to be in a traffic accident, any more than a person chooses to get cancer or have a heart attack.   The Republican argument seems to boil down to “live a perfect life and make excellent choices” and you are ‘worthy’ of having insurance.  This argument only works IF a person has no familial risk factors, IF a person isn’t exposed to other people (who might have an infectious disease), and IF a person can afford to build a residence in which there are no places to fall and no way to have an accident with a garage door.  In short, it’s fantasy land.

The next few hours are crucial — that’s right — HOURS. Please call Senator Heller’s office at 702-388-6605;  or 775-686-5770; or 202-224-6244.  Your health care services are at stake.

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

It’s Going to be Fabulous!

If the question is: “What’s going to be fabulous?” The answer is probably nothing.  Thus far the administration hasn’t delivered on much.  Sights! Sounds! Drama! notwithstanding, it’s Shakespearean “Sound and fury, signifying nothing.”

The Muslim Travel Ban met yet another defeat on its way to the Supreme Court.  Supposedly it needed to be enacted Immediately to prevent the Threat of foreign terrorists, but time has passed (along with the time the Muslim travel ban was supposed to be in effect, during a study period) and behold a plethora, a horde, of heretical fanatics didn’t launch an assault.  Nothing there.

The wall seems like a distant memory,  as much fantasy as the idea the Mexican government was going to pay for it — IT, the wall, fence, river boundary, natural obstacles, or whatever.  Nothing there

The President’s first executive order called for the repeal of the Affordable Care Act, and authorized agencies to grant waivers, but pointedly did NOT offer to infringe on “authority granted by law to an executive department or agency, or the head thereof.” Other Executive Orders follow the same pattern. Call for the study of some topic, require a report, and then infer that the report would be fodder for legislation. Perhaps the closest analogy to these orders might be a Christmas List — “Dear Santa, please bring us justification for the following rule changes or legislative priorities.” Lots of smoke and mirrors, without much there there.

An important point to note in terms of the Republican version of health insurance “reform” is that it is far more about tax cuts for those earning over $200,000 than it is about making health insurance affordable for average Americans.  See also: Vox and Atlantic, Forbes.  The median household income in Nevada is $52,431.

And speaking of Nevada — what can we expect?

“371,000 Nevadans stand to lose their health coverage.1

Nevada stands to lose $16 billion in federal assistance to help provide health coverage to its residents.2

Approximately 71,000 Nevadans who currently get financial assistance to help pay for their health coverage will lose this help and will no longer have affordable coverage options. In 2016, Nevadans receiving financial assistance saw their monthly premiums reduced on average $268 thanks to this help.3

The now-historically low rate of uninsured people will spike, with the number of uninsured in Nevada increasing 95 percent by 2019.4 This will reverse the immense progress that has been made to expand coverage. Between 2013 and 2015″

And there’s more:

“187,000 people stand to lose health coverage, most of whom are working.6 The Medicaid expansion has extended health coverage to lower-income Nevadans who hold down jobs that are the backbone of the state’s economy—from fast food workers to home care attendants to construction workers to cashiers. Repeal will leave these hard working Nevadans out in the cold.

Nevada will lose billions in federal Medicaid funding. Over the course of a year and a half alone, Medicaid expansion brought $1 billion in federal dollars into the state economy.7 The impact of that lost federal Medicaid funding will have a ripple effect throughout the state economy, affecting hospitals, other health care providers, and businesses.”

And More!

“The Medicare donut hole will re-open. This will leave Nevada’s seniors and people with disabilities with a gap in prescription drug coverage and forced to pay thousands of dollars more in drug costs.

  • Seniors and people with disabilities in Nevada have saved approximately $123 million on drug costs thanks to the ACA’s closing the Medicare donut hole.14

  • In 2015 alone, approximately 34,000 seniors and people with disabilities in Nevada saved on average $967 on drug costs.15″

Nothing in this truncated list of horror makes it sound like Republican health insurance legislation will be Fabulous.  Unless, of course, we mean “fabulous” in the sense of some gory fable designed to send small children to the floor while checking for monsters under the bed.

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Filed under Health Care, health insurance, Medicaid, nevada health, Politics, Taxation

Let’s Review and Make Some Conjectures

Senator McConnell couldn’t have made himself more clear to the Republican leadership — let’s please have less drama from the White House so we can get along with our agenda.  Less tactfully phrased, McConnell and his myrmidons such as Representative Mark Amodei (NV2) and Senator Heller (R-NV) isn’t going to do anything about the dolt in the Oval Office until after they get what they want.  They want two things: (1) to return the control of the health insurance market back to the insurance companies; and (2) to dismantle the financial and consumer protections enacted in the Dodd Frank Act, and the Sarbanes Oxley Act.  Not sure about this, then please consider the current push for the Choice Act:

“At a time when too many hard-working American families are still recovering from the devastating impact of the 2008 financial crash, deregulating Wall Street’s biggest firms again makes no sense. Yet the Financial CHOICE Act threatens to do exactly that.

It would allow the biggest Wall Street banks to opt-out of significant financial protection rules, while those banks that remain in the regulatory system would be blessed with watered down versions of once-tough protections, like living wills and stress tests. Perhaps most worryingly, the CHOICE Act would cripple two of the most important post-crash reforms: the Financial Stability and Oversight Council (FSOC) and the Consumer Financial Protection Bureau (CFPB).” [the Hill]

Review: The CFPB was the agency which brought to light, and then levied fines against Wells Fargo for egregious violations of their customers’ privacy and financial interests.  Little wonder the banks aren’t happy with those “bureaucrats.” Less wonder why the Republicans aren’t going to do anything about the President who had to fire his National Security Adviser — until the Choice Act is safely delivered to his desk.

We should also recall that the Republican version of the healthcare reform act is much less about health insurance reform than it is about bestowing tax cuts for the wealthiest among us, to the tune of close to $765 billion over the next ten years.  We can easily conjecture that the GOP will do nothing about the man in the office who fired the US Attorney in the Southern District of New York, and then the emissary from the Department of Justice who warned him about the dangers presented by the presence of General Flynn.  At least nothing will be done, until the Republicans can cut Medicaid to the barest of bones:

His (Trump’s) promise would be violated by House GOP bill, as it seeks to freeze Medicaid expansion money for states in 2020 by withhold funding at the enhanced match rate for any new enrollees after that point. Other beneficiaries are at risk with the more long-term transformation that program stands to undergo under the GOP bill. The legislation would overhaul the program—now an unlimited federal match rate—into a per capita cap system, meaning that states would get a fixed amount of funding per enrollee. The Congressional Budget Office, analyzing an initial version of the legislation, predicted out of the 24 million Americans who would lose coverage under the earlier GOP bill compared to current law, 14 million were due to its changes to Medicaid. [TPM]

Given there is no CBO scoring on the current edition, we can’t be certain that States like Nevada which expanded Medicaid enrollment in order to make health care access affordable, won’t be left in the lurch — Congressman Amodei’s tortured logic to the contrary.  So, nothing is likely to be done about the executive who fired the Director of the FBI who was supervising the investigation of Russian meddling in our elections (and possible Trump connections to that meddling) until Medicaid cuts are also tucked into the President’s portfolio for a signing ceremony.

When will Republicans address the Leaker-in-Chief’s discussions with the Russian visitors to the White House?  Probably not until the budget cuts to the Department of the Interior, the Environmental Protection Agency, Medicare, Health and Human Services, and the Department of Education come to fruition.  Do we have a situation in which the following is true?  If the Trumpian honeymoon isn’t over, it soon will be.

That sentiment was echoed by a prominent GOP consultant I spoke to who asked not to be named to offer a candid assessment of Trump and congressional Republicans.
“The question for Republicans is whether this is the straw that breaks the camel’s back,” said the source. “Forty percent approval is not the issue; an erratic, rudderless, leaderless White House is.” [CNN]

The camel’s back may not bend until the Republicans have seen their agenda realized, their Randian Dreams made true, and their Austerity Government imposed on the American people.   The damage of this administration and the Republicans in Congress who enable and excuse him is only starting to come to fruition.


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Filed under Amodei, Comey, conservatism, corporate taxes, financial regulation, Health Care, health insurance, Heller, income tax, McConnell, Medicaid, nevada health, Nevada politics, Politics, public health

Beware The Artful Codger

One congressional Representative for our northern neighbor, Idaho, has a problem in his Lewiston office: Too many artful codgers showing up there around lunch time with complaints about his political philosophy.

“A spokesman for U.S. Rep. Raul Labrador’s office in Lewiston has filed a complaint alleging a threat from a group of local citizens who routinely visit congressional offices.

Scott Carlton reported the issue to the U.S. Capitol Police early last month. Carlton, who works out of the congressman’s downtown Lewiston office, declined to comment when contacted by the Tribune and referred all questions to Doug Taylor, Labrador’s spokesman in Meridian, Idaho.

The citizen group, LC Valley Indivisible, is comprised of mostly older residents of the Lewiston-Clarkston Valley, according to its members. The organization is loosely affiliated with the national Indivisible groups that call for town hall meetings with members of Congress to raise issues regarding President Donald Trump’s administration.” [SR]

The group members recall a civil engagement with Scott Carlton, Labrador’s spokesperson. Carlton told people at a Chamber of Commerce gathering that the group was “aggressive,” and reported that he (Carlton) had contacted Capitol Police who have jurisdiction over congressional offices. [Spokesman pdf]

Not that those in Nevada’s 2nd congressional district can complain about this issue too strenuously, Mark Amodei (R-NV2) hasn’t scheduled a public performance since venturing out to Carson City recently. It is noteworthy that Amodei told the Reno Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, Representative Amodei has a GOP plan before him that does precisely that — reduces health insurance coverage for people in his district, and the amendments to the bill recently announced make the situation even worse, dismantling Medicaid protection for seniors in record time.  However, Representative Amodei doesn’t appear to want to pencil in a town hall meeting in a major metropolitan area in his district — like Reno/Sparks?  Perhaps some of those artful codgers, similar to the Lewiston lunch bunch, might show up?

However, there are other ways to get the attention of elected representatives. I am particularly fond of the Empty Suit Town Hall. Let’s hear it for Lexington, Kentucky:

“…voters in Lexington, Ky., have been clamoring for the state’s congressional representatives — Senate Majority Leader Mitch McConnell, Sen. Rand Paul and Rep. Garland “Andy” Barr — to tackle constituents’ questions in person. They even booked a venue for Saturday and hand-delivered town hall invites to the politicians’ offices.  The legislators were a no-show, but that didn’t stop things. Instead of McConnell, Paul and Barr, organizers propped up three mannequins wearing suits.” [WaPo]

Perhaps not the best optics for a congressional delegation? At least it’s better to be an empty suit than to sic the Capitol Police on office visitors?

There are other ways to contact GOP representatives like Mark Amodei — and this should be done before the vote on the Repeal/Replace bill on Thursday.

For those living in District 2 there’s Amodei’s contact form for quick e-mail messages. Simply scroll down the page to the “e-mail link.”  The page also has the phone numbers for Amodei’s offices in Reno Phone: (775) 686-5760, Elko Phone: (775) 777-7705 , and Washington, D.C Phone: (202) 225-6155.

This is as good a time as any to remind Representative Amodei what he said to the Gazette Journal: “… he would not vote for any plan that resulted in reduced coverage for anyone. “No, I don’t think you can say forget it, we’re going to let them be uninsured because as a practical solution, that’s not an answer and somebody ends up paying in the end anyhow,” Amodei said.”

Now, if only those artful souls in Idaho can get the attention of their Representative…


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

Bits and Pieces: Tesla, Titus, Heller, and Amodei

Jig Saw Puzzle ** It’s a done deal. TESLA’s coming to Nevada, brought to us by $1.2 billion worth of ‘incentives.’ [RGJ]  Meanwhile, watch that multiplier! The state is assuming a 2.5 multiplier for revenue generation, i.e. for every one direct job with TESLA there will be 2.5 ancillary jobs created – that’s a big multiplier. [RGJ] See also [LVRJ]

**  Representative Dina Titus (D-NV1) asked the VA to move its regional office from Reno to Las Vegas. [LVRJ]  Much as it might pain a northern Nevadan to say so, but the Las Vegas metropolitan area does have more of the 246,000 Nevada veterans than those living in the north, [VA] and the northern office hasn’t covered itself in glory. [LVRJ]  I’d not want to hang by my hair waiting for a definitive answer from the new VA leadership.

** From the Department of No Surprises:  Senator Dean Heller (R-American Bankers Association) voted against the cloture motion to consider S.J. Res. 19, a bill to propose a Constitutional amendment to allow the Congress to enact meaningful campaign finance reform.  Senator Heller was one of 42 (all Republican) votes to continue to filibuster any attempt to overturn the decision in Citizens United.  [roll call 261]

Representative Mark Amodei (R-NV2) voted in favor of H.R. 3522, a bill which would allow insurance corporations to offer small businesses group  insurance plans which DO NOT meet the standards for comprehensive health insurance coverage for their employees under the terms of the ACA.  [RC 495]  One organization summed up the problem with the bill:

“This legislation would allow health insurers to continue offering coverage outside of the insurance marketplaces established by the health law even if those plans do not comply with its coverage requirements. In addition, the inferior plans that would be allowed to continue under Representative Cassidy’s bill discriminate against people with pre-existing conditions, force women to pay more than men for the same coverage and impose annual caps on the amount of care received by enrollees.” [NCPSSM]  (emphasis added)

Those three issues, pre-existing condition discrimination, gender discrimination, and junk policies with capped coverage are some of the main reasons the ACA was necessary in the first place.

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Filed under Amodei, Health Care, health insurance, Heller, Nevada economy, Nevada legislature, Nevada politics, nevada taxation, Titus

Bits and Pieces

Jig Saw Puzzle** Interesting the Republicans would keep referring to the unpopularity of the Affordable Care Act, and then report technical glitches in the roll out as people — who supposedly don’t want “Obamacare” — try to sign up. The first day in Nevada saw 3,385 accounts created at Nevada Health Link, and the exchange received 1,536 phone calls.  The executive director of Silver State Insurance Exchange notes this roll out was one massive technical challenge, [LVRJ]and with massive computer projects come glitches and gremlins.  The best advice appears to be the old standard: Be Patient.  At least the Exchange will tell you that the gremlins are being grouchy, and advise you to check back later — unlike a popular  mapping program which leads drivers onto a Fairbanks, Alaska taxi way at their airport.

** Poor Old Rush Limbaugh, telling his listeners that ACORN is providing the navigators for the health insurance exchange in California.  Ole’ Rushbo must be getting his news from the antique magazines in his doctor’s office because ACORN disbanded in March, 2010 and shut down its state affiliates as of April 1, 2010. [Politico]

** One popular line from the Right is that President Obama will negotiate with Syria and Iran but not with the House Republicans, leading to one of my favorite Jon Stewart rants, culminating in a classic line: “If President Obama can make a deal with the most intransigent mullahs in the world but not with House Republicans, maybe he is not the problem.”

** Bookmark this –> GOP’s 21 Demands inserted into the House proposals to keep the government in operation.  Defunding the implementation of the Affordable Care Act wasn’t the only thing on the House Republican wish list.  There were items that didn’t get much media play, but they were hauled out and attached to the Republican banner, and we should expect their flag to be hauled out for the upcoming battle over raising the debt ceiling.

“For a long-term deal, one that gives Treasury borrowing authority for three and a half years, Obama would have to agree to premium support. The plan to privatize Medicare, perhaps the most controversial aspect of the Ryan budget, is the holy grail for conservatives who say major deficit-reduction can only be achieved by making this type of cut to mandatory spending. “If the president wants to go big, there’s a big idea,” said Scalise.” [NatlJrnl]

In short, if the President doesn’t agree to the old Ryan Budget Coupon-Care as a replacement for the current Medicare program, we’re looking at GOP intransigence over raising the debt ceiling later this month.

** If we thought the Citizens United decision was a bad idea, there might be another blow coming, Demos explains:

“A new report from Public Campaign shows what could happen if the Supreme Court deals another blow to campaign finance reform in McCutcheon v. FEC. The case is a challenge to aggregate contribution limits, i.e. limits on the overall amount of money a donor can contribute to federal candidates, parties, and political action committees. Currently, no one person can contribute over $117,000 in total. Given that’s already more than twice the average American’s annual income, the contribution cap is not exactly limiting the ability of people to donate.”

** Meanwhile we have dueling headlines. “GOPers Insist Americans Will Eventually Back Them on Shutdowns,” and “With Traditional GOP Allies Defecting, Big Business Takes Sides With Obama.”

** Highly recommended reading: “The Reign of Morons” from Charles Pierce, Esquire Magazine. “What History Will Say,” Michael Tomasky, The Daily Beast.  “The Captain Ahabs of the House,” Charles Blow, New York Times.

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Filed under Economy, Politics

For THIS we waited 21 hours?

Cruz Vote Enough said?

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Filed under Politics

Suppressed Laughter: Muddling the Medicare Issue

There are those who find the Democratic charge that the Republicans would end Medicare as we now know it risible, but there are some very practical reasons for stifling the guffaw.

Let’s start with the proposition that the current Medicare program is a very popular single-payer system for providing health insurance coverage to individuals in the United States who are over 65 years of age.   Let’s also accept that a single payer system like Medicare has helped reduce the financial strain on our elderly.  [CMS pdf]

Additionally we can find historical data indicating that those elderly citizens who have annual incomes of $40,000 or less spend a higher percentage of their income on health care than those more affluent: [CMS pdf]

We also know that the elderly have moved from a demographic group less likely to have health insurance coverage to the one in 2000 most likely to be covered:

“Prior to Medicare’s enactment, about half of America s seniors did not have hospital insurance. By contrast, 75 percent of adults under 65 had such coverage, primarily through their employer. For the uninsured, needing hospital services could mean going without health care or turning to family, friends and charity to cover medical bills. More than one in four elderly were estimated to have gone without medical care due to cost concerns (Harris, 1966). Today, Medicare covers nearly all of the elderly (approximately 97 percent), making them the population group most likely to have health insurance coverage.”  [CMS pdf]

At this point it ought to be reasonable clear that if (1) we want elderly Americans to have affordable health care insurance, and (2)  especially want those at the lower end of the income scale to secure affordable health care insurance, then by those standards the current program is successful.

If It Ain’t Broke Why Fix It?

Across the philosophical divide:   One important facet of current conservative thinking holds that any government program which offers services to individuals  in the form of a social safety net “creates dependency.”   The proponents of this argument rely on philosophic arguments almost as arcane as the extensions of Anselm of Canterbury’s Scholasticism before Abelard arrived to rescue the scholars.

Theoreticians are invited to weigh in on discussions bounded by such definitional perimeters as the following from the libertarian Cato Institute:

“The central idea behind the theory is that government officeholders, as individuals, have strong incentives to alter important political transaction costs facing the public and facing others in government in order to secure more of what they want with less resistance. As economists use the term, transaction costs are costs to individuals of negotiating and enforcing market exchange agreements, including information costs, negotiation costs, enforcement costs, and the like.”

One is pretty much left to imagine what “and the like” might mean.  However, the message is clear – government office holders have an incentive to promote their programs and to minimize the resistance to those projects.  This assumes that people are naturally resistant to efforts by their own government to assist them, and that all government services must be resisted.  In other words, in order for this argument to work in general terms we’d have to assume that everyone is naturally a radical libertarian.

We’d also have to assume that the populace doesn’t want the government to “alter important transaction costs” on its behalf.   This is a hard point to sustain given that most citizens don’t appear to be enthusiastic supporters of personally negotiating defense contracts — which if we were to extrapolate the localism of the initial argument to its illogical extreme would be required to reduce “Constitutional level political transaction costs.”

Culturing Dependency:   The current arguments from the radical Right, framed philosophically as described above, march to the next milepost — that citizens are naturally “free” (individualistic) and any government programs which provide services to the elderly (or indeed anyone else) create a dependency on government action at the expense of individual “freedom.”

All we have to do to subscribe to this position is to completely ignore the preface to Robert’s Rules of Order:   “Where there is no law, but every man does what is right in his own eyes, there is the least of real Liberty.” (Henry M. Robert)

There are also some uncomfortable questions raised by this proposition.  Does hiring a local police force create a dependency on my part for the protection of my life and property?  Does having a local fire department make me dependent on government for fire suppression, rescue, and EMT services?  Does having a Department of State make me dependent upon government for the implementation of foreign policy?   Does having a Department of Commerce make me dependent upon government for statistical reports on my economic environment?

Splitting Differences:  If the answers to the questions above are equivocal, then it’s probably because there are some definitions of “legitimate” and “illegitimate” government services involved.  If a person defines government as only responsible (legitimate) for national defense and foreign policy, then only government programs in those realms are legitimate.  If, however, we see government as formulated for We The People, life gets a bit more complicated:

 “…of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.”

Now we add “establish Justice, insure domestic Tranquility, … promote the general Welfare…” to the list of legitimate concerns of our government.  It’s time to come back around to the main argument.  If Medicare is a popular single payer system for promoting the availability of health insurance coverage to elderly individuals, and if it is successful in that regard, then why argue that it’s illegitimate?

The Magic Market:  The “market” in whatever form it may take is supposed to be the ultimate form of human transaction — the most efficient, the most efficacious, the most Free.  Except when it isn’t.   We’ve had an unpleasant taste of what happens in unregulated, or poorly regulated, financial markets.  Unfortunately, the after-taste is still lingering.  We are now told by the radical Right that an unregulated health insurance market will meet the needs of elderly Americans for their health insurance coverage.  Probably not.

The first point to acknowledge is that the Romney/Ryan plan for Medicare essentially changes the Medicare program from a single payer system to a voucher plan which “incentivizes health insurance corporations to provide coverage for elderly people.”    This is not “Medicare as we know it,” it is Medicare as the Insurance Corporations would like to have it.

The insurance corporation argument is underpinned by the notion that medical care is a commodity which can be purchased by a consumer from a provider, and this is true up to a point, but it’s a point that is very quickly reached.   The problem, as Professor Krugman points out, is that medical care isn’t bought and sold like a loaf of bread.   A person making up a list of groceries may include bread, but if the price of a loaf is too high then it’s logical to skip the purchase or substitute another commodity.  The market works.  However, if a quintuple  by-pass is needed then price is not the determinant of the “purchase.”  The result of “gee, I don’t think I can afford that right now” is poor health or even death.  The Magic Market doesn’t work in this instance.

The second problem with the Magic Market solution is that no one is shopping in the ambulance.   The victim of a motor vehicle accident or a heart attack, even if fully conscious, isn’t saying “Get me to the cheapest Emergency Room,” he’s saying, “Get me to the nearest Emergency Room.”

The third problem with the Magic Market solution is that the health insurance corporations themselves aren’t subject to it.  Under the terms of the McCarran-Ferguson Act of 1945 health insurance corporations are exempt from anti-trust laws.  This is both good and bad news; the bad news is  they may collude to limit access to their products or divvy up regions as sales territories.   The good news is that they are able to share information which might serve in some cases to reduce premium costs.  [KaiserNews]  Either way, the policy purchaser is dealing with a provider which is not subject to the same “free market” forces as the consumer.

The fourth problem inherent in the current privatization of the Medicare program is that it hasn’t worked.  Medicare Advantage was supposed to be the insurance industry version of the original Medicare program, and IF the free market worked the way the ideologues on the Right predicted, then we’d expect massive consumer shifts to the privatized version.  Hasn’t happened.  Altogether too many Medicare Advantage policy holders are there because their employers, many in the public sector, have been pressured into adopting Medicare Advantage plans.  [HealthBeat]*   If the Free Market worked as predicted, then the pressure would not be necessary.

Finally, the “free market” Medicare Advantage plans can hardly be called “private” when the companies offering them are getting an $8.9 billion subsidy from the Medicare program.  [TP]  Further, if the private market-driven plans can produce lower health care costs, then why haven’t they? [Incidental Economist]

Stop Laughing

If the current Republican calls to eventually replace the original Medicare program with a “market-driven” plan are (1) philosophically dubious, (2) politically questionable, (3) grounded in doubtful Constitutional theory, (4)  and premised upon illogical and indemonstrable market behavior; then why would challenging the practicality of such a plan be laughable?

Arguing that Medicare will still be existent even if privatized into a program run by insurance corporations is roughly analogous to contending that an orange is still an orange after it has been reduced to juice and pulp.   The result may be many things — but it’s not an orange.   Nor, would our original Medicare program be the same Medicare which now serves half of our elderly citizens who live on $21,000 per year or less.  [AARP]  Still suppressing that guffaw?

References: “Medicare – A Profile, 35 years of Medicare,” HCFA, July 2000. (pdf)  Charlotte Twight, “Medicare’s Origin,” Cato Journal, Volume 16, No. 3.   Kenneth J. Arrow, “Uncertainty and the Welfare Economics of Medical Care, American Economic Review, December 1963 (pdf).  Paul Krugman, “Why Markets can’t cure healthcare,” New York Times, July 25, 2009.  *Desert Beacon, “Medicare Disadvantage,” August 22, 2012.  AARP Fact Sheet: Who Relies on Medicare – Profile of the Medicare Population (pdf).

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