Tag Archives: medicaid

All Posts, American Foreign Policy, budget, Congress, deficit, donald trump, medicaid, taxes

THE PRESIDENT OF CHAOS

The picture on my computer screen should be better so I tried adjusting it.  That made it worse so I’ll hit it with a sledgehammer and see if that helps.  Unfortunately, that foolish approach is being applied by President Trump to vital national interests like health care,  defense,  immigration, and budgets.

One of Trump’s competitors, Jeb Bush predicted the problem back in 2015 saying,  “Donald, you know, is great at the one-liners.  But he’s a chaos candidate.  And he’d be a chaos president.  He would not be the commander-in-chief we need to keep our country safe.”

Never a dull moment...
Never a dull moment…

President Trump promised to repeal and replace Obamacare with something better: “We’re going to have insurance for everybody…There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”…“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid”.

As President, Trump never proposed a way to provide health care regardless of Americans’ ability to pay for it and he did support cutting Medicaid.  Obamacare has insured about 20 million Americans who had no benefits before the law passed; and at the same time it has slowed the growth of the nation’s healthcare spending.  It’s a success but it needs improvement.  When nothing that he or other Republicans proposed passed, Trump swung his sledgehammer at Obamacare’s most vulnerable spot, the individual markets.  He announced termination of the federal  subsidy to insurance companies for low-income subscribers.  That will damage the already fragile individual insurance markets in some communities – breaking our healthcare system without a plan to replace it.

Trump threatens to withdraw from our agreement with Iran, under which they shut down their nuclear weapons program and gave up 98 percent of their nuclear materials.  The agreement was designed with one goal in mind – don’t let Iran develop  nuclear weapons.  We managed to get Russia, all of Europe and China on the same page because they all agreed with that goal; and it was our combined power that made the deal possible.  Trump can’t persuade Iran to do other things that he wants so out comes the sledgehammer to break the Iran agreement.  If the deal falls apart and if China, Russia and Europe go their own ways, there will be nothing to restrain Iran’s nuclear ambitions.  By destroying the Iran deal without a plan to replace it Trump also tells other nations  that any President can ignore commitments made by his predecessors.  The USA will be seen as untrustworthy.

The DACA program for children brought to the US illegally is an imperfect solution to a problem that congress has been unwilling to address.  Trump promises to hit it with his sledgehammer – forcing law enforcement to round-up and deport children and young adults who have lived most of their lives as Americans.  Again, he has no plan for replacing what he will destroy.  Many young adults will be driven to hide in an underground economy where they have little opportunity for success.  That’s a breeding ground for dissension, hopelessness and crime.

Trump plans to hit your wallet with a sledgehammer too – by cutting taxes, mostly for the wealthy, while increasing military spending and  our national debt at even faster rates than his predecessors.  Americans will have to repay that debt at some future date.  Our ability to borrow money for a true catastrophe or war is already impaired because so much of our debt capacity has been used.  We currently owe $20 trillion.  That is about $62,000 for every American or $161,600 for every American who works at a full or part-time job.

Donald Trump again proposes the sledgehammer approach saying,  “I am the king of debt,”…”I love debt. I love playing with it.”  and “I would borrow, knowing that if the economy crashed, you could make a deal”…”And if the economy was good, it was good. So therefore, you can’t lose.”  When he says “make a deal”, that means refusing to pay our debt, most of which is owed to Americans.  It’s not the same as letting one of his casinos go bankrupt.

If the Republican congress allows President Trump to deliver more sledgehammer blows to our nation, the resulting chaos will belong personally to Donald Trump and each legislator who supported him.  The GOP will own the chaos but the American people (including DACA kids) will pay a heavy price for it.

All Posts, donald trump, health, medicaid

DO YOU HAVE A RIGHT TO HEALTH CARE?

5 Comments

The legendary American philosopher Yogi Berra supposedly said, “If you don’t know where you want to go, you’ll end up someplace else.”  That is the story of American health care.  We have not decided whether health care is a “right” for all Americans or a “privilege” for those who can pay.  It seems that health care is a right for some of the people all of the time and for all of the people some of the time but not for all of the people all of the time.  If you find that confusing, then you’re on the right track.  We haven’t chosen our destination and we have arrived at a place that confuses and frustrates us.

Health care with little or no out-of-pocket expense is a lifetime right for veterans and for prisoners serving life sentences.  I can’t think of any other large groups who have that benefit.  Medicare eligibility bestows a permanent right to most health care for those who pay their out-of-pocket share.  The rest of us have temporary and partial rights that depend on our employment, wealth, personal choices and luck.

Our national debate should be about who has a right to health care, which elements of health care are included, who will pay for it, and how the cost will be paid.  Arguments about whether or how to replace or repeal ObamaCare (the Affordable Care Act) are pointless and counterproductive until we make a firm national decision about whether health care is a right.  Where do we want to go?

Critics of ObamaCare point to extremely high insurance premiums in some of the exchanges where insurance is sold to individuals and small groups.  Some areas of the country have only one insurance company participating in exchanges.  Those problems are real but correctable.  They occur in local segments of the healthcare marketplace and are worst in states that resisted ObamaCare by refusing the Medicaid expansion.

Here’s a snapshot of what ObamaCare has accomplished.  The annual rate of increase in health care spending (both government and private) was 3.3 percent before ObamaCare.  It dropped to 2.7 percent after ObamaCare was implemented.  Simultaneously, the number of uninsured Americans decreased by 20 million.  That is a picture of success.

President Trump’s promises sound amazingly like President Obama’s.  For example, on January 15, 2017 Mr. Trump said, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” …People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”  In the same interview, he claimed that the people covered by Medicaid expansion would continue to have coverage.

A credible replacement for ObamaCare should improve on its performance.  But according to the Congressional Budget Office (non-partisan and under Republican supervision) the bill that Republicans tried to rush through congress would have led to 52 million uninsured (4 million more than before ObamaCare).   Less thorough analysis from the highly respected Commonwealth Fund agrees.   The President and Congressional Republicans dispute the CBO estimates but they have produced no research to support their conclusions.  It’s all based on their opinions.

Two principles of ObamaCare are that basic health care is a right for all Americans and that everyone should be required to participate in the cost.  Those principles are implemented through the individual mandate to purchase approved coverage along with Medicaid expansion for the very poor.  Approved coverage includes  services for prevention and early diagnosis of health problems that often lead to premature death, disability and extreme expenses.  The Republican plan lacked similar features and would produce more late stage diagnoses of illnesses that were preventable but not curable once they occur.

Because there was no individual mandate in the Republican bill, there would be two options for care of those who don’t pay.  Either provide the care and build the cost into the bills of those who do pay or let those who can’t pay suffer or die without care.   The individual mandate is better than either of those alternatives.

What should we do?  I have asked for a meeting with my (Republican) Congressman.  I want to show him the evidence that I’ve found and I want him to show me any evidence that the Republican replacement would produce better results. What will you do?  Your answer will come to you after you decisively answer this question, “If the person that I love most in this world is sick and broke, does she /he have a right to health care?” ___________________________________________________________________________

Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.

This prior column  contains links to references and more evidence.

 

 

All Posts, deficit, health, medicaid

Replacing Obamacare

3 Comments

President Trump and our Republican controlled congress have promised to quickly repeal and replace ObamaCare.  President Trump says that coverage will be better, cost will be lower, and everyone will be covered.

We should consider where we were before ObamaCare and where we are today as a basis for judging proposed replacements.  Using the years 2004 – 2009 as a baseline for how we were doing before ObamaCare and 2010 – 2015 as a measure of its effectiveness, here are some facts.

Each of the following statistics is for five years of change before and after ObamaCare.   All spending is inflation adjusted to 2010 dollars.

Below is similar cost data from a different source and a link that will allow you to browse a wealth of relevant information.

The cost of employer sponsored health plans has been growing slower since ObamaCare.
The cost of employer sponsored health plans has been growing slower since ObamaCare.

Evaluate performance data from the US and other developed nations HERE using tools developed by the Organization for Economic Cooperation and Development.

 

 

Some other changes brought about by ObamaCare are:

  • Before ObamaCare, important screenings like colonoscopies and mammograms were unaffordable for many people.  Now they are covered without deductibles.
  • Insurance companies and employers can no longer deny coverage or charge more for pre-existing conditions.  Previously, cancer survivors, diabetics and others likely to need expensive care were uninsurable on most family budgets.
  • Lifetime limits on coverage were banned.
  • Mental health services are covered on the same basis as other medical and surgical services
  • Dependents can stay on parents’ coverage up to age 26.

ObamaCare is a success compared to what we had before it passed.  But health care costs are still rising faster than our economy is growing and we still have over 28 million uninsured Americans so more improvement is needed.

The ObamaCare insurance exchanges where individuals and small employers should be able to purchase affordable coverage are not consistently working well .  Millions of young, healthy Americans are not buying coverage as required by the law.  That leaves a disproportionate number of unhealthy and older people in these insurance pools.  In markets where that has happened, premiums have risen at double-digit rates and several insurance companies dropped out, leaving meager choices for consumers.

That problem leads directly to critical questions about replacing ObamaCare.  Will congress decide that it’s acceptable for some Americans to have no health benefits?  If everyone is going to have benefits, is there a less expensive alternative than Medicaid expansion?  If so, will it be included in the Republican replacement for ObamaCare?  If not, will it then be acceptable for doctors, hospitals and other health care providers to deny services to those who can’t pay?  To be very clear to free market friends, “There ain’t no such thing as a free lunch.”  If the ObamaCare replacement does not include a way to pay for care of the uninsured then either they will die without care or the cost will be built into your bills and insurance premiums.

There are proven ways to provide more care for less money while covering the entire population.  Every other developed nation has adopted one of them and they are all more cost-effective than ObamaCare.  They range from price controls to “medicare for all” or government operated health care similar to the British model.  All of them require a larger role for government and that seems to be the antithesis of Republican thinking.  President Trump said that no one should be required to buy health insurance.  At present it appears that he intends to provide something (health care) for everyone without requiring anyone to pay for it – a miracle of biblical proportion.

We can hope that the post-election hostility will wane in favor of intelligent consideration of how to replace or improve ObamaCare. It can be done if legislators and the President are willing to forego political rhetoric for what is practical.  If they are not, then both human and economic catastrophes are likely.

All Posts, Constitution, guns, health, lgbtq, north carolina, poverty, public education, taxes, war

What to do on the morning after?

3 Comments

The day after the election will be the first day of the rest of our lives. What should we expect of our elected officials? Will we help or undermine each other and elected leaders?  If individuals, families and communities listen to each other’s ideas and agree on how to move forward together, we can invigorate the idea of “commonwealth”, a society that is organized to benefit all.  Everybody wins.  If, on the other hand, winners kick losers while they’re down in order to maintain dominance and if losers do all they can to stop winners from implementing their ideas then the republic will decline.  Everybody loses.

It’s happened in great societies throughout history and it’s especially clear in the Bible’s Old Testament. When those in power dominate and abuse the powerless, everybody loses and the society fails.  When the principle of commonwealth guides decisions, the society blossoms.

Poverty, income inequality and homelessness are at crisis levels in many places.  Rural America has depended on agriculture and manufacturing to provide family incomes and property tax revenue for local governments.  Both of those economic sectors now produce more goods with fewer people than ever before.  At the same time that rural employment opportunities paying middle class wages have become scarce, the tax revenues of rural communities have stagnated.  Budgets for public education, safety, and human services are under severe stress at a time when they are critical to redevelopment of communities.  The plight of rural America has much in common with high poverty neighborhoods of urban America.  Low incomes and insufficient resources have similar effects in both places.

Will legislatures reconsider how public services are funded and which tax revenues are available at local, state and federal levels?  Will high poverty areas have funding for education, high-speed internet, water, sewer, quality of life, health and other priorities at a level that is proportionate to wealthy areas?  If not, will their future be inter-generational poverty and emigration of successful residents to more desirable areas?  Will legislators work at solving the underlying problems or will they pit urban vs rural and white vs black vs Hispanic for partisan gain?

What about the sanctity of human life?  Will we expect our congress, legislatures and executives to behave as if “all lives matter”?  Does someone who wants a gun have the right to own an assault rifle designed for mass killing?  Does a woman have the right to remove a fetus from her body?  In which decisions should government have a role?

Conflicts between personal and constitutional values will not be fully resolved but can we make progress for the common good?   Could we agree to reduce the demand for abortion by providing free birth control, better access to pre-natal care, simple and inexpensive adoption procedures, and by solving our income inequality problems?   Will we expect legislators to find ways to preserve gun ownership for self-defense and recreation while getting weapons designed for mass killing out of circulation and screening gun purchasers to rule out suspected terrorists and known criminals?  Or will we reward leaders for continuing to insult each other?

The Republican controlled Senate has refused to consider President Obama’s nominee to the Supreme Court.  They hope to win the Presidential election and get a conservative-leaning nominee. Senators Richard Burr and Ted Cruz have made the radical statement that if Hillary Clinton is elected, they will refuse to confirm nominees and let the court shrink.  That abrogation of a senator’s constitutional responsibility would invite similar behavior from Democrats toward a Republican president. Will we insist that senators fulfill their constitutional duties?

Differences of race, wealth, religion and philosophy divide us on a long list of issues: immigration, transpacific partnership, climate change, war, taxes, LBGTQ rights, health care, and more.

We’re not all going to miraculously agree after the election. Continued success for our republic will require two things of us.  First, we must look honestly at facts.  Second, we must engage each other in ongoing conversation (listening more than arguing) about the principle of commonwealth – making decisions and laws that create opportunity and peace for all of us.

Our legislators are capable of that, but they will do it only if they know that we voters expect it, demand it, and that we’re doing it ourselves.

We can start on November 9.

All Posts, budget, Christianity, Congress, deficit, economy, justice, medicaid, poverty, public education, taxes

STICKS STONES AND STEREOTYPES

4 Comments

Election campaigns are under way and the name-calling season is open.  Names, labels and stereotypes can influence our opinions and our elections so it’s important to be aware them. Continue reading STICKS STONES AND STEREOTYPES →

All Posts, health, medicaid, taxes

DOING THAT COULD MAKE YOU BLIND

A South Carolina man is learning that there are some things that feel good at the time but, yes, they can make you go blind.  Here’s a recap of his story, much of it from the Charlotte Observer.  Luis Lang was self-employed with a good income and a 3300 square foot house worth more than $300,000.  He knew that the law (Obama Care) required him to buy health insurance, but it felt good to spend the money  on other things. Continue reading DOING THAT COULD MAKE YOU BLIND →

All Posts, economy, health, medicaid, north carolina

How To Fix Obamacare

If your loved one  is seriously ill or injured and can’t pay for health care, should America provide what she/he needs? If health care costs are beyond the reach of many Americans,  should government take action? If you answer “yes”, the next steps are about how to achieve the goals; and it’s time for fact based solutions to the problems of American health care. Continue reading How To Fix Obamacare →

All Posts, budget, deficit, economy, health, medicaid, north carolina, poverty, taxes

JUST SAY YES TO MEDICAID

The decision by North Carolina’s governing Republicans (every single one of them) to reject Medicaid expansion will cost the state’s residents $37 billion by 2022. That is roughly enough money to run the entire state government for 21 months. They looked at the money and just said “no”. They looked at uninsured people living in poverty and just said “no”. They looked at hospitals and doctors who care for uninsured people, and they just said “no”. And they just said “no” to unemployed workers who would have found jobs in the Medicaid expansion. Continue reading JUST SAY YES TO MEDICAID →

All Posts, medicaid, north carolina, religion

REPUBLICAN SOCIALIZED HEALTHCARE?

The following words are from House Bill 1181, passed by the North Carolina House and endorsed by Governor McCrory. “It is the intent of the General Assembly to transform the State’s Medicaid program from a traditional fee-for-service system into a system that provides budget predictability for the taxpayers of this State while ensuring quality care to those in need.” Translation: Instead of paying for whatever health care is used, they want to budget a fixed amount and make doctors and hospitals absorb any additional costs. They want doctors to save money by keeping patients healthy more so than treating them after they are sick.   If their plan works everyone wins. If it fails, our poorest citizens will bear the burden. Continue reading REPUBLICAN SOCIALIZED HEALTHCARE? →

All Posts, budget, economy, medicaid, north carolina, poverty

MEDICAID AND MANAGEMENT INCOMPETENCE

“What are the most important decisions that you have made in your work?” Ask that question of executives who have been successful in leading complex organizations and a clear majority will give an answer that has to do with choosing the rest of the leadership team. That is a lesson which Governor Pat McCrory is learning in the school of hard knocks while North Carolina taxpayers fund his tuition bills.

Shortly after Dr. Aldona Wos was named Secretary of Health and Human Services for the state, I pointed out that her principal qualification appeared to be the success that she and her husband had in raising money for Governor McCrory’s and President George W. Bush’s election campaigns. In a column at the time, I described her as “…a physician who has not been involved full-time in health policy or medical practice for many years…President Bush rewarded Dr. Wos by appointing her as Ambassador to Estonia. Likewise, the Governor made her DHHS Secretary and she hired a young McCrory campaign staffer, Matthew McKillip, as the Chief Policy Officer of DHHS. At age 24, he has no previous health service education or experience but he has worked for a right wing think tank and now he is leading health policy development for the state.” She proceeded to select others for the DHHS team including Ricky Diaz, a McCrory campaign staffer hired as the top public information officer. He was forced to resign after lying to the press about violations of medical record confidentiality laws.

Wos picked Carol Steckel, another conservative ideologue but one with substantial experience in Louisiana, to re-organize the Medicaid program. Steckel resigned after only eight months. Dr. Laura Gerald resigned as the State Health Director as did Dr. Rebecca King, the state’s top dentist, citing differences with Wos and the administration. Wos and the Governor publicly misinterpreted the findings of the North Carolina Auditor to create the appearance of extraordinarily high administrative costs in the Medicaid program. They used that interpretation to support their goal of privatizing Medicaid. Protests by the auditor and health professionals later demonstrated that the state’s administrative costs are actually quite moderate.

Wos changed the application and enrollment procedures for Food Stamp assistance and her new process takes months for many low income families. It is so bad that the federal government has warned the state that funding for administrative costs will be withheld if improvement is not made promptly. She implemented a new computer system for making Medicaid payments to physicians and other health care providers despite credible warnings that it was not workable, resulting in payment slowdowns that have jeopardized the financial survival of health care providers (doctors, hospitals, therapists and others) who depend heavily on Medicaid.

She is promoting an idea for addressing our troubled state mental health system by merging several quasi-governmental regional agencies into a smaller number without addressing the underlying issues about how and by whom services are delivered to living, breathing patients. Thinking that this administrative re-shuffling will improve mental health services is a bit like preventing the sinking of the Titanic by rearranging its deck chairs. It may appear that something is being done but the ship is still headed for the bottom of the ocean.

The biggest problem in this case is not with Dr. Wos. The major problem is with a Governor who has “rewarded” (punished might be a more apt description) political allies by putting them in highly responsible leadership positions for which they are unprepared. In this case the Governor chose someone who ideologically agrees with him but lacks necessary experience then he offered encouragement as she put other unqualified people in key roles. More recently he has failed to take action as a series of high level staff resigned. The debilitation of DHHS began with the appointment of unqualified personnel and that has demoralized more capable members of the department’s team.

DHHS is by far the largest and most expensive department of state government – comparable in fact to the Titanic. A ship so large cannot turn on a dime and ours is clearly in peril. Unless the Governor acts soon, DHHS will take many thousands of mentally ill and low income North Carolinians down along with some of our health care providers. It remains unclear whether Governor McCrory and Secretary Wos will go down with the ship.