About Health Care: I Am Not a Communist, I Just Care About People

There is solid logical and factual basis for opposition to the “repeal and replace” legislation passed by the House and now before the Senate.

Logic first.

Barring accident, taking preventative measures leads to better health and reduces the risk of future catastrophic illness.  Such measures include annual checkups, better diet, exercise and seeing the doctor when symptoms first appear.

Putting off prevention can lead to escalating problems and higher costs, like putting off repairing a few shingles in your leaky roof until the whole roof collapses. The logical result is wider damage and higher costs.

Most people, including me, tend to wait because of cost.

In my case, I could have avoided years of discomfort and permanent damage if I had not had a high deductible plan and put off seeing the doctor.  Rather than spend the money, I lived with the symptoms, with the self-deception that they might go away.

Logically, these tendencies are especially acute among poor working families, who tend to serve more immediate needs — like food and shelter — instead of spending time and money seeking medical advice.

If you cannot identify with this, you must be really lucky.  You should consider volunteering at a homeless shelter.

Now the math.

The data referred to in my last post simply confirms the above logic and puts numbers to the effects of health insurance contraction under the American Health Care Act (AHCA or “Trumpcare”).

If you want to dig into the numbers, look at the data from Idaho that describe the 78,000 uninsured who do not qualify for coverage — because they make too much to fit the narrow qualifications in Idaho for Medicaid and not enough to qualify to participate on the “Your Health Idaho” individual insurance exchange.  This is the estimated number of Idahoans in the “Idaho Coverage Gap”.

Then plow through the reports from the Congressional Budget Office (CBO), which “scored” both versions of the the American Health Care Act (AHCA), H.R. 1628 passed by the House of Representatives and  the Senate version of the bill ironically named the Better Care Reconciliation Act of 2017 (BHRA).

CBO has quantified what is obvious in the legislation: the Senate bill would eliminate coverage for 15 million Americans next year and for 22 million by 2026; cut Medicaid by $772 billion over the same period; next year increase individual market premiums by 20 percent; and, make comprehensive coverage “extremely expensive” in individual markets.

To try to understand the potential impact of the AHCA on poor Idaho working families spend time with analysis published by the Kaiser Family Foundation and at least one of several studies of the impact of coverage expansion (including Medicaid expansion) on general health and mortality rates.

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According to the KFF analysis, an estimated 4.5 million uninsured adults live in the states that did not accept the expansion of Medicaid under the Affordable Care Act (ACA or “Obamacare”).   Of that number, an estimated 52,000 live in Idaho.  These are Idahoans who would have been covered under the ACA, but missed the opportunity because of the Idaho government decisions to not accept Medicaid expansion dollars and to sponsor its own individual exchange.  (Whatever the exact number, it includes some or all of the 78,000 in the Idaho Coverage Gap.)

What are the health impacts?  The study sponsored by the Harvard School of Public Health concludes that the availability of coverage in Massachusetts (the model for the ACA), has had the effect of improving public health reducing mortality rates.  While demographics and health care resources in Massachusetts may differ from those of Idaho, it is significant that a well-constructed, scientific study has concluded that 830 human adults obtaining previously unavailable health insurance coverage could prevent at least one death per year.

The next step is my own analysis of this data and required mathematical extrapolation. It is indicative only (meaning that it is simply an illustration) of the logic at the beginning of this post and my last post.

My analysis assumes that if the AHCA is passed by the Senate after the July 4th recess, its impacts would apply equally across the Idaho population, which represents around one-half of one percent of the total U.S. population.  It assumes that Idaho on its own does not find a way to close the Idaho Coverage Gap. (Efforts so far have failed.)  And, it assumes the Harvard Study results could apply to Idaho across the board to all who lose coverage. With those assumptions:

  • Between 125,000 and 150,000 people will lose coverage in Idaho within the next decade.
  • Between 150 and 180 people are more likely to die as a result.

This analysis has been dismissed as “hysterical.”  Our own Congressman, Mr. Labrador, attracted national and international news coverage when he said that lack of access to health insurance does not result in death.

Paul Ryan has also tried to spin the CBO data by saying that the “loss” of coverage under the AHCA is simply people opting away from buying health insurance in the absence of the “freedom robbing” mandate.

His argument ignores the fact that the largest negative impact on coverage under the AHCA is Medicaid contraction.  His argument is also like someone in the Medicaid gap saying he or she would choose to buy a BMW but exercises the freedom not to do so.

While I am aware that we live in a world of “alternative facts,” please understand that I have done my best to discern and share sound logic and credible facts.

Please encourage others, including our Senators, to do likewise.

 

Call on Idaho Senators to Protect Idaho from Trumpcare

Our Senators must have courage, beginning this week, to resist partisanship and stand up against the devastating effects the Senate version of the American Health Care Act (“Trumpcare”) will have on Idahoans.

Why such a partisan divide on health care?  Why did the House pass a bill that will put health insurance beyond the reach of 23 million people?  Why have Republican Senators scurried off to work in secret on the Senate version of the bill?

Putting aside partisanship and callousness, one significant part of the answer is highlighted in yesterday’s New York Times article about GOP Senator Dean Heller and his opposition to the Senate bill.  About a week ago he said he could not support a measure that would deprive millions of health care and do nothing to lower insurance premiums.

According to the Times, “Now Mr. Heller is facing an intense backlash in Nevada, his home state, where there is talk of a primary race challenge against him next year and a pair of the state’s wealthiest Republican donors are fuming.”

The leading edge of the “backlash” is from President Trump and his rich supporters, in this case, billionaire Nevada casino magnates, Sheldon G. Adelson and Steve Wynn.

Meaning, the health care fight is largely over the taxes imposed on the wealthy to make health insurance affordable for the poor.

Money versus health.  Greed versus individual and societal well-being.

Notwithstanding attempts by Republicans, including Raul Labrador and Paul Ryan, to explain otherwise, if the Senate version of Trumpcare passes, 22 million Americans will become uninsured and people will die.

A Harvard medical study published in the New England Journal of Medicine showed that for the states that adopted the Obamacare Medicaid expansion, mortality rates have declined. Many previous studies support the same, obvious conclusion that with access to health care, mortality rates decline — including for young people.

The Republican-controlled Idaho Legislature has already exposed tens of thousands of Idahoans to higher risk of mortality by refusing to adopt the Medicaid expansion.  The further contraction of Medicaid with Trumpcare will make life even more difficult for tens of thousands of Idahoans.

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Voting for Trumpcare is like voting to strip most of the Boise metro area of health insurance and allowing one whole neighborhood to die as a result.

Because of their disregard for the lives of their constituents, Raul Labrador and Mike Simpson should be ashamed for their votes in favor of the House version of the bill. Senators Crapo and Risch should be ashamed if they support the Senate version.

If you agree, please call or send emails to Senators Crapo and Risch.  The Senate will come back to this terrible bill after their July 4th recess, so email as soon as you can.  Encourage our Senators to follow Nevada Senator Heller’s example.

Mike Crapo, Phone: (202) 224-6142 Email:       https://www.crapo.senate.gov/contact/email-me

James E. Risch, Phone: (202) 224-2752 Email: https://www.risch.senate.gov/public/index.cfm/email

Bodies Were Lying in the Street

One night in New York City, I happened upon a mafia hit, the result of competition for leadership of the Gambino crime family. Current events take me back to that night.

After law school I worked as a corporate finance lawyer at a prominent law firm and spent 10 years in the firm’s New York City office.

My wife and I had both grown up in the West and, to us, the East had always been distant and forbidding.

“It will be an adventure!” I said to her cheerfully. “We’ll spend a couple of years out there, and then move back West.” She glared at me.

I went out ahead to work and look for housing.  For a week or so, I wandered Manhattan in the evenings, searching for an affordable apartment.

On one of those nights, as I made my way back to my humble Lexington Avenue hotel, I passed Sparks Steak House on 46th Street, close to Third Avenue.

It was the night “Big Paulie” Castellano, head of the Gambino crime family, was gunned down on his way to dinner. Police tape closed off 46th street. Lights were flashing. Sirens blared. Bodies were still lying in the street, covered with sheets.

John Gotti, who had ordered the hit, would become head of the Gambino family. Guess he thought he could do a better job than Castellano.

“Better not tell my wife about this,” I thought, as I skirted the crime scene.

This was a dramatic introduction to an ugly part the City at that time. The mafia was distinctly present and projected an image of being above the law, cocky, arrogant and unrepentant.  Just look at this mug shot of John Gotti.

Gotti mug shot

At that time, some in the New York business world seemed to have inherited mafia-like arrogance, rudeness and winner-take-all attitudes. They showed little concern for relationship and trust. In negotiations, I experienced their blatant misrepresentations, threats, verbal abuse and crudeness.  This always injected stress, distrust and delay in the transactional process.

At law school, in my business negotiations class, I had learned that a negotiator will more quickly achieve optimal outcomes with a collaborative approach.  Humility, listening, honesty and respect build trust, foster cooperation and reach mutually beneficial outcomes.

In the face of the belligerent, bullying New York business style, I consistently applied what I had learned in school. My team succeeded in getting hard things done quickly and our practice grew.

This experience keeps coming back to mind (and you can probably guess where I am headed with the story).

I shudder watching from afar the negotiation style of our new President. So far, his lurching administration has left more bodies “lying in the street” than John Gotti.

This approach to “winning” shows little regard for the “other side,” or the greater good, and, with huge arrogance and a small attention span, fails to understand issues, details, process or people.  It is, to me, mafia-like and poisonous to the political setting.

Our governing institutions, with checks and balances, exist to reach collaborative solutions and achieve optimal outcomes for the whole country, without regard to political party, group identity, winners or losers.

As citizens, we must demand collaboration and resist the “me-first” attitudes promoted by the new administration and worse-than-ever partisanship.

Those attitudes are causing our country, and the world, to become more fearful, angry and divided—and more dangerous and dispirited than ever.

Urgent Letter to the Deal-Maker-in-Chief

Here’s the deal of the century! Single-payer, universal health care. You can call it “Tremendous Trumpcare” and be a hero.

May 9, 2017

The White House
1600 Pennsylvania Avenue N.W.
Washington, D.C. 20500

Dear Mr. President,

Here is something that will prove your deal-making ability:  single-payer, universal healthcare.  It will make you an American hero.

Health care expenditures represent more than one-sixth of the national economy.  Fixing the system will have wide-ranging and profoundly positive effects on the whole country.

Put your deal-making foot down. Cut through the confusing rhetoric of “rights” versus “privileges.”  Ignore the callous, anti-government “Freedom Caucus.”

From a business and transactional perspective, a single-payer, universal health care system is just the right thing to do.  Here are some of the main reasons:

Better health. Americans would take better care of themselves.  Attention would shift to prevention and away from last-minute, more-expensive emergency care.

More productivity.  A healthier, more hopeful populace would be a huge boost to national productivity.  As the fight rages over the ACA and the AHCA, lives are lost and families are ruined.  Health care expense is the leading cause of personal bankruptcy. Our national neglect has led to other problems that continue to mount—like mental illness, homelessness and despair—problems that affect all of us directly or indirectly.

Higher efficiency.  A single-payer system would have more leverage to bring down health care costs (especially for pharmaceuticals!) and would eliminate the duplicative overhead of the current, reverse-dog-pile of 1,300 profit-taking insurance companies. There would be an immediate savings of more than $350 billion of duplicative overhead cost, waste and insurance company profit-taking.

Job creation.  A single-payer system will ease the health insurance burden of American employers.  With higher employee productivity and lower corporate costs, profits will rise and more jobs will be created.

Lower, simpler taxes.  Over time, with the elimination of redundant overhead, greater efficiency, lower health care costs and risk spreading among the whole populace, the direct and indirect taxes and costs associated with health care and health insurance will come down.  The tax code will be simplified.

Freedom.  A single-payer, universal system rationalizes pricing and puts health care decision-making back in the hands of health care providers and their patients, and removes it from the profit-driven bureaucracy of insurance company MBAs and administrators.

Apply your vaunted deal-making prowess to eliminating the inefficiency, exploitation and waste of our American health care system.

Time is of the essence.  Among the millions of Americans still without health insurance, at least 120 are dying every day.

Thank you in advance,

JERRYSIG200

“Like Watching the Bombing of a Hospital in Slow Motion”

“Repeal and replace” in the form of the American Health Care Act promises to be a human and political disaster.

The American Health Care Act (aka “AHCA,” “Repeal and Replace,” “Trumpcare,” “Ryancare”) is a human and political tragedy unfolding before our very eyes.  The manner by which it narrowly passed the House this week is an outrage and if you are not angry, you should be.  And if you don’t think you should be, you have not studied the issues and/or you have been misled by the White House and Republican propaganda.

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In summary, a social program popular with the majority of Americans, a program that has helped tens of millions of previously uninsured Americans have access to health insurance and better care and, but for the Republican efforts to defeat it, would continue to do the same, would be replaced by the current administration and 217 Republican members of the House of Representatives with this horrid and inhumane piece of legislation.

It’s like watching the bombing of a hospital in slow motion.

These Republicans were flogged by a President desperate for a victory, although “victory” is a strong word for such a slim margin and such obvious partisanship. 170504144054-ahca-vote-tally-0504-graphic-super-169

This set of heartless Republican Representatives hurtled ahead in the face of opposition by virtually every health care provider–doctors, nurses, hospitals–and even insurance companies. No public hearings. No Congressional Budget Office analysis.

There is no dispute that the AHCA, as it currently stands, will lead to at least 24 million people losing health insurance.  And that is a conservative estimate.

There is also no dispute that the AHCA, as written, promises the already-rich another gift of lower taxes, to further widen the ever-increasing income and wealth inequality in our country.  “Wealth Care.”

AHCA

Sadly, our own Idaho Congressmen, Simpson and Labrador, both voted in favor of the AHCA.  Labrador, not a surprise, but Simpson too. (Mike! Really?)

President Trump will propagandize this victory, but it can only be a victory for him and his rich friends. Newt Gingrich has called it the “art of the deal,” but this is dark art and a bad deal.

The 217 have kicked their rotten can down the road, to the Senate. Pray that our Senators show more wisdom and will reject or fix this mess.

Meanwhile, as we look forward to the 2018 House races, let’s remember the callousness and recklessness supported by these 217 Republican lemmings, including the two from Idaho.

 

Tax Cuts and Drip-Drip Economics

Idaho Trump voters take note:
The Trump tax plan, as announced, is clear proof that a vote for Trump was a vote for making the already-rich richer.

Political issue: 'national debt' concept. Photo realistic sign, isolated

The Trump proposed tax cuts, which promise to add trillions to the national debt, must be putting our Idaho federal delegation in a real bind. They have consistently campaigned on the traditional Republican planks of reducing deficits and the national debt.

Surely, our Idaho Senators and Congressmen will oppose the Trump tax plan.

Rolling out the plan this week was another 100-day trick, supported with the usual marketing hyperbole and unusually-bad economic analysis.

Here are at least three of the falsehoods behind this maneuver.

Falsehood #1: US companies are uncompetitive because of the high US corporate tax rate.

The statutory tax rate may be high compared to other countries, but the actual (or “effective”) tax rate for US corporations is always lower, after the many deductions and loopholes available to American businesses.

More specifically, the statutory tax rate is 35%, but after exclusions and deductions, the effective rate is, more-often-than-not, zero percent (0%). A March 2016 Government Accounting Office (GAO) report shows that most US corporations paid no taxes between 2006 and 2012.

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Falsehood #2: Lower corporate taxes will stimulate economic growth.

This argument is based on the same faulty economic logic that justified the Reagan and Bush era tax cuts. That logic was (and is) that tax benefits for corporations and the rich will “trickle down” to the poor.

However, trickle-down economics has never worked in the real world and would better be described as “drip-drip economics.” Tax savings for corporations and their owners will more likely make their way into bigger homes, private jets and longer yachts, with little if any broad-based economic boost for everyone else.  Meanwhile, the national debt will skyrocket.

In his “Cross of Gold” speech, Democratic candidate William Jennings Bryan proclaimed:

“There are two ideas of government. There are those who believe that if you just legislate to make the well-to-do prosperous, that their prosperity will leak through [trickle down] on those below. The Democratic idea has been that if you legislate to make the masses prosperous their prosperity will find its way up and through every class that rests upon it.”

Falsehood #3: The middle class will benefit from the tax cuts.

OK, sure, this sounds good. Who would not want a tax cut?  But who really benefits?

The already rich population will benefit most. Trump’s promises to the middle class amount to pandering to the non-rich to give greatest advantage to the already-rich.

Among the most-advantaged beneficiaries will be the Trumps, his cabinet members and his circle of super-rich friends and advisors.

Yesterday’s New York Times editorial page summarized it well:

“Regardless of the plan’s fate, Mr. Trump has already sent a strong message about where his sympathies really lie. They lie not with the working people who elected him, but with the plutocracy that envelops him.”

“CSRs, We’re Not Doing That!”

The Affordable Care Act and healthcare for low-income families are held hostage as a Republican-controlled White House and Congress lunge for “victories.”

The newest “repeal and replace” healthcare plan will NOT be voted on today. Hurray! What a relief—for now.

Unfortunately, the Affordable Care Act remains in the hands of its enemies and they have shown they are willing to hold it and its beneficiaries hostage.

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A few days ago, the White House proposed an exchange of payments for President Trump’s wall for continued funding of the Cost-Sharing Reduction payments (CSRs) provided for in the Affordable Care Act. The administration said, in so many words, “For each dollar towards President Trump’s wall, we will not stop a dollar of Obamacare CSR funding.”

Stated otherwise, “we will not make health insurance unaffordable, if you will pay for the wall.”

CSRs are government subsidies provided for in the Affordable Care Act. They are paid to insurance companies to offset the cost of insurance for low-income families. Without CSR payments, health insurance for those families would be unaffordable.

The proposed “deal” (or threat) was met with immediate, negative political and industrial response. As a result, President Trump backed off both wall funding and the withholding of CSR funding—for now.

Republican hostility for the Affordable Care Act remains and the withholding of CSR funding is just one of the several tools in Republican hands to promote their self-fulfilling prophecy of “implosion.”

With the Trump administration, and a Republican-controlled Congress, it is hard to see this ending well for low-income families in need of health insurance. It has been made clear that political victories (and walls) are more important than American lives.

Resistance should remain on high-alert.