Friday, October 13, 2017

Introducing America's new health care system: Trumpcare

Updated 10/15/17
Introducing America’s new healthcare system: Trumpcare.  Donald Trump just  broke the old one; he owns the new one.   He can no longer blame Congress that  also tried to break it and failed.  He is the one who broke it all  by himself with his own executive orders. It gives some the choice of cheaper policies, but their new choice is between bad, worse and useless. All premiums in and out of exchanges will rise. The financial impact will be felt immediately in everyone’s pockets. Trump has opposed any  suggested fixes that would make his orders unnecessary.

However, facing 2018  Congressional elections, he claims he is ready to make a deal with Democrats , it appears . No wonder. The political repercussions will be felt in time for the 2018 midterms when the  millions of lower income and middle class voters will feel the pain in their pockebooks and realize  in real time  they  just  been taken to the cleaners by Trumpcare. Given insurance policies fine print, most will only learn the consequences when they get sticker shock, paying full price for needed services not covered by terms, deductibles, and lifetime and annual caps. The most affected are red states that use more of the subsidies he just halted and who voted for Trump Alternatives such as single payer and Medicare for All will begin to look better and better to more. If Trump blames greedy insurance companies, then single payer solves that problem: it cuts out private health insurance participation.  Congressional  Democrats in the short term are united in support of fixing Obamacare in contrast to Trumpcare. Deal with Trump? Chuck and Nancy have already been bitten with DACA's deal with him over that. They were double crossed later . Don't blame them if they do not take him up with his offer.

Trump’s  threats to stop payments to insurance companies who help low income pay insurance premiums (not to prop up their stock prices as Trump claims)  have already caused exchange premium prices  to rise 20-25% in some states since  insurers anticipated his move. October 12 he made good on that threat with his order.  Per a recent Congressional Budget Office score , the impact on all  premiums  of the payment stop will  be an average increase of  20-25%..  An estimated seven million who buy insurance through the insurance exchanges  will find premiums hiked, but so will the subsidies increased to help them pay.  This order   will raise the deficit by $194 billion over ten years since the government will make up the difference in subsidies and insurance companies will pas on costs to everyone else in higher premiums, or the insurance companies will just drop out of the program.
Trump’s order includes a creation of a parallel system of  cheap association plans. There  will be no  requirements for  them  to cover anything so essential to many: prescription drugs, hospitalization, low co pays or affordable deductions, maternity care, cancer screenings including prostate and mammograms,  annual physicals,  pre-existing conditions, mental health care and drug rehab. Consumers buying into association plans  wanting  to make up the the unanticipated loss of uncovered benefits  would pay extra  from their pockets at  full  market price or go without. That is Trump's definition of "great care".

Currently fourteen million buy their insurance through the exchanges. The only ones who benefit from Trumpcare will be the two million  buying  insurance through the exchanges who make too much money now  to get subsidies. Even then, Trumpcare  will  bait and switch them  to accept his "great care"  association plans that resemble  a hamburger with   two buns but with  little meat and condiments .

The eventual   financial failure  of Obamacare is not the death spiral caused by Obamacare,  but it a death spiral engineered by the Trump administration on purpose as part of their plan to de facto repeal  it.  In time, the entire  Obamacare private insurance  based exchange system will collapse as the  parallel  association system will destroy the ACA’s “pool” comprised of  both those  with the healthy  who lightly place claims and  those with pre-existing conditions or with health problems.The  healthy will be  lured into cheaper stripped down plans. The result will be virtual high risk pools left to the sicker who   will see their premiums soar to become unaffordable.

This executive order  is such a fundamental change to the intent and financing of Obamacare, that it is the mother of all executive overreach.  resulting in court challenges which will further drag out uncertainties and  will cause continued premium increases  for everyone as the market is destabilized. ______________________________________________________________________________

"Blog posting: 9/271/17 Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives

Thursday, October 12, 2017

Why Trump's order to allow cross state health insurance sales won't work

Trump's executive order to change Obamacare today is a hamburger bun without the beef, no condiments,  laced with  no taste and  a chunk of poison.

Obamacare has already allowed cross state insurance sales.
It never took off and there are many reasons for it.There are many reasons for it and those same reasons would apply with Trump's executive order.

There is a dirty little secret as well: allowing  small business  and  associations to join together  offer insurance is a sneaky way to offer employees empty insurance without including essential benefits.  The purpose of his plan is to knock the props out of pool of both healthy and the sick and leaving the pool full of the sick.  It is a nasty way to exploit employees as well, leaving them without essential benefits, prescription drug coverage, annual physicals, cancer screenings, blue and pink pills, etc.  This is an executive order that does more than extend cross state purchases.  It is an attempt to change the purpose of the ACA (Obamacare), jacking up the cost of premiums for everyone else who needs it since who would be left are the ones expensive to treat.  It is such a fundamental attack on Obamacare's structure, expect law suits to fly.

The cross state sales portion will probably not be challenged since it is already permitted in Obamacare.  It just won't do much. From a Forbes opinion piece, the industry itself wants to narrow networks and not expand them.

From my prior blog posting:

 " Buying insurance across state lines is a mirage. The CBO has already scored it as only helping 3 million people more to afford insurance under Obamacare. . Furthermore, under Obamacare, multi- state group plans were permitted, and they never took off. There are reasons. Consumers lose easy appeal if they have a complaint about of state insurers since they would have to register and fight for appeal in the insurer's home state. . Furthermore, big insurers with affiliates in many other states like Blue Cross and United can collude to set prices across state lines since insurance companies are exempted from federal anti trust laws. They could hike prices in other states . Without essential benefits being required, there would be .a full out race to the price bottom of useless, deceptive insurance with few benefits.Expect, too, that the political problem of doing end runs around each state insurance commissions may create another potential opposition group. State Insurance Commissions are long, old political plums and state by state control would be lost. "

Blog posting: 9/271/17 Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives

Saturday, October 7, 2017

How Trump plans to reboot coal jobs will have little effect

Donald Trump is trying to make good on a campaign promise: to reboot  coal mining jobs by rolling back  the EPA regulations  that favor other fuel sources for  power plant electrical generation.. Does that mean back to dirty air and dirty coal? Not as much as Trump would hope  for jobs  or many  fear for the environment. The horse is mostly  out of the barn. Coal mining technology advancement uses fewer miners.  Market forces are a driver since the cost of natural gas has fallen.  States have their own regulations, such as Colorado, that favor converting plants to gas and increasing wind, thermal, and solar alternatives. Nationally nuclear is nearly 20% of generation. Gas is  already generating more electrical energy (34%) than coal. (30%) That is good news for the environment since natural gas emits 50 to 60% less carbon into the atmosphere than does coal. 1400 local and state government entities, including Colorado,  are pledged to uphold the Paris environment agreements so  policy goals for clean air will continue regardless in parts of the US.

 States such as Colorado,  with a 2010 plan  and regulations that favor  converting plants from coal  to gas, are already  well on their way to completing their plans. Whether  the lifting of regulations  on coal to bring down the cost  will be significant enough to make much of a difference is the question, given the investments already made in the  switch  to gas and alternatives.  Switching back is an expense in itself.  Colorado is unique since it produces both coal and natural gas. within the state,  which reduces transportation costs  of both, unlike other areas of the country .  60& of Colorado's electricity is generated by coal and a quarter is natural gas.   Front range mega cities such as Denver  fueled by Public Service  have already switched  their plants to natural gas.  

The human cost  of loss of coal jobs is not minor,  but it can be  mitigated by retraining skills  for  employment in manufacturing, truck driving, and alternative energy. Coal jobs in Colorado are already down 36% in three years and the state has launched retraining programs for jobs in alternative energy, though such  jobs pay much  less than coal miners once earned. In Appalachia and the west,  mechanized strip mining is replacing labor intensive deep mining. Job retraining may be the key to families at least earning a living wage, if not returning to the glory days of deep coal mining.

FYI: In 2016, the US electricity generation was 4079 TWh (billion kWh) net, 1380 TWh (34%) of it from gas, 1240 TWh (30%) from coal-fired plant, 805 TWh (19.7%)nuclear, 266 TWh from hydro, 226 TWh from wind, and 117 TWh from other renewables (EIA data).

Nuclear Power in the USA - World Nuclear Association

Thursday, October 5, 2017

Speaker Ryan is living his immoral dreams

Paul Ryan must be feeling good: he passed out of the House a budget that gave tax cuts to the rich while gutting Medicare and Medicaid. Speaker Ryan had another House victory: he passed from the House an Obamacare repeal/replace bill that left 30 million without affordable health insurance. His first dream to cut welfare that came to public attention was in 2012. Catholic bishops called the budget "immoral". From my blog and published column Aug. 29, 2012
" "The Catholic bishops passed judgment on the Ryan budget. Wrote the Bishops, …' deficit reduction and fiscal responsibility efforts must protect and not undermine the needs of poor and vulnerable people. The proposed cuts to programs in the budget reconciliation fail this basic moral test.'
Some believe drastic cuts to the safety net are, to the contrary, a moral act because we are doing recipients a favor by keeping them from being dependent on government. So who are they doing such a favor? Mostly kids and the elderly. It is not the adults such policies impact the most. It is the kids who benefit from “welfare.” Three-quarters of food stamp recipients are families with children. Of the nutrition programs for the poor (8.7 million recipients), 4.3 million are women with children, 2.2 million with infants. National school lunch programs: 30.5 million kids benefit. Children's health programs (CHIP) keep them healthy enough to go to school and Head Start gets them ready to enter first grade. Ryan would cut these programs deeply, guaranteeing they will not have good nutrition and early education needed, or to be prepared to qualify for jobs later"

Note: CHIP was not refunded in 2018 but attempts are being made to save it:

Tuesday, October 3, 2017

Evolving thoughts on gun control

Updated October October  8, 2020   A version of this was published in the Sky Hi News Oct.11, 2017

The Las Vegas massacre is another sad opportunity to refocus national debate about gun control. A near massacre of GOP Congressmen practicing for a baseball game and Rep. Steve Scalise’s emotional return to work the week before Las Vegas  was another reminder.   I am beginning to re-evaluate my thinking on regulating assault weapons.. At minimum, we need a serious national and Congressional discussion. The question we must ask ourselves as a nation is whether the price of deaths of these innocents is too high to pay for our very permissive gun laws.

I am in general a supporter of the 2nd Amendment.  I live in a rural county where every kid on a ranch or the offspring of a hunter is taught to shoot and to  learn gun safety. My grandfather in the eastern plains of Colorado taught me how to shoot a tin can with a shotgun when I was youngster..  A gun rack is often on the back window of local pick up trucks.  Big game hunting is big business here. Sometimes weapons are needed for defense of human life or livestock or a pet threatened by a predatory beast, a coyote, a mountain lion. I know gun collectors and in my family I have gun club sportsmen NRA members. I get all of that.  What I do not get is why semi automatic and automatic assault weapons are needed for any of these purposes. Semi-automatic weapons converted to nearly automatic machine guns and equipped with large clips are geared to kill many  people without a shooter needing  even minimal aiming  or rapid fire skills, or pause to reload. This enables one person to cause more carnage than even using the deadly unmodified semi-automatics. Due to Las Vegas reports, we have learned more about how easily semi-automatics can be converted to automatics and to skirt federal regulations with bump stocks and digital methods readily and legally available.

We seem to be hung up on dealing with killers’ motivation and what we can do to detect or stop  a wannabe mass killer in advance. Pursuit of those goals is worthy.  However, the enabler common to single gunman mass killers  is often an assault weapon. If there is to be a debate inspired by Las Vegas and an accumulated list  of other such tragedies where assault weapons were used, reducing access to them and means of modification need to be a part of it.   Reinstatement of  banning assault weapons, a buy back program, or requiring licensing and registration of semi automatics to accommodate collectors should be on the table. An NRA supported bill to make silencers legal was temporarily tabled by Speaker Paul Ryan as it became obvious the rat-a-tat noise was the only tip off that the Vegas shooter was not fireworks, alerting more to take cover. The non-sense response from gun rights groups is that a determined, cunning, and evil person can always find a way to kill, limiting the effectiveness or availability of these weapons would at least reduce the casualty count.

Motivations and techniques to kill masses vary from incident to incident so that there seems to be as many possible preventative solutions as there are incidents. Gun right advocates always respond to with more nonsense that the the most current incident would not have been prevented by such and such regulation and laws or proposed solutions or profiling personality types; therefore no solutions will work. There are copy cats and you can take it to the bank that the next mass killer now knows how to modify and use their weapons to do as much damage as possible it they did not know it before.

The Republican party has responded to calls for bringing gun control discussions in Congress with "now is not the time", refusing to set up a select committee on gun safety, and claiming "Democrats are using Vegas to politicize the issue". Shame on Democrats if they are, chimed in Colorado's Senator Cory Gardner. There seems to be some bi-partisan agreement however that bump stocks sales need to be outlawed.

Another response from gun rights advocates is that the single acceptable measure is to fund mental health services better . The Vegas shooter had no mental health red flags, which illustrates one limit of that approach. That we have a woefully inadequate mental health system is true, and intercepting wannabe mass killer patient is valuable and should be supported. However, as psychologists know they can predict who may be capable of doing it 50% of the time. Even if they do, we learned from the Aurora shooter history, a warning from the psychologist went nowhere. Protection of individual privacy rights trump the duty to warn as well in the rules and ethics of mental health professionals.

The GOP in control of Washington since January already tried to undermine access mental health services. The attempt to repeal and replace Obamacare with no required essential benefits overlooked the fact that insurance coverage of mental health was one of the benefits they tried to remove. In February, Donald Trump signed an executive order reversing an Obama era attempt to identify better those with mental health problems. Trump killed a regulation that would have required Social Security Administration to submit records of mentally disabled to the FBI database as part of the background check that would deny those the ability to buy guns. GOP reasoning: Some people who were "adjudicated as mental defective" were competent to own guns. In addition, the NRA lobbying has effectively scotched uniform background checks even though 74% of NRA members favor them. Stupid is as stupid does.

Peggy Noonan, a thoughtful columnist with  the Wall Street Journal, suggested one reason on MSNBC's Morning Joe why assault weapons are so popular. Her comment triggered  my  remembrances of things past. There are those who fear the government or hate its power.  They are preparing for a physical assault on their freedoms and they want the firepower to defend or to take a revolutionary initiative against what they see as their enemy,  government.

Early in the 1960’s and 1970’s my physician husband had a colleague. His wife and he were often dinner companians as well. John was an active member of the John Birch Society, the forerunner of the radical belief and ideology movements we see today.  His vacation time was often spent training with like minded people in “militias”.  It was easy to dismiss him as a paranoid or an anarchist, but it led to some interesting dinner time discussions and hearing his rationale,  to say the least. I had faith in the democratic process and the ways it provides to solve conflicts and government change without violence. Later when the Michigan “militia” tried  to  kill off  law enforcement and state police, I stopped looking at this movement  as just a matter of certain  personality traits carrying out  fantasies. I realized there was a darker side, especially since I was a part of the District Attorney’ s staff at the time, working side by side with police, whom I respected a great deal..

There is a bit of irony in  the  argument assault rifles are needed for protection against government. It does not have a  practical meaning today. The militarization and equipment of domestic police now gives police the firepower to outgun even assault rifle armed militias or blast through steel  doors, employing  the same techniques and  same equipment  used  on Afghan  battlefields. Many of those who take the side of law enforcement when it comes to dealing with racial issues and  stopping rioting. are the same voters  who support remilitarizing of domestic and local law enforcement with surplus military equipment . They are also  the  most likely to interpret  the 2nd amendment to mean the least regulation, the better.

As the Mayor’s liaison to Denver City .Council in the late 1980’s, I sat through many a debate on assault weapons, listening to the plea of police that they were outgunned by the criminals they were trying to arrest. The question centered around the firepower of ammo clips.  As the years passed, the police got the firepower they needed, the SWAT teams, the armored vehicles, and the military-like might  of equipment and training. Some of that was curtailed during the Obama administration, since there was a  feeling that militarization  created more problems with the minority community than it solved and it was a visual picture of police overreach.  However, the Trump administration recently reinstated  giving local police the military equipment they wanted.

The NRA’s push to legalize silencers is another extension of gun rights they advocate. Watching  TV reports of the Las Vegas massacre, it was the rat-a-tat noise that alerted the audience to bolt and seek shelter.  I wonder how many more  would have been killed on the baseball field or at the Las Vegas concert  if the shooter had used silencers. We need a very strong dose of common sense about that piece of legislation. Speaker Paul Ryan agreed and tabled the NRA silencer bill indefinitely.

Building better rat traps to catch Russian election meddling

A version of this was published in the Sky Hi News  Oct 4, 2017 and the blog was updated Oct.5 to reflect information released by the Senate Committee investigating Russian meddling. 

During the summer of 2016 a friend of mine who follows politics called me and said “did you hear? Hillary Clinton……” and she relayed the contents of an ad that popped up on her computer that appeared to give “proof” of Hillary’s   deviant  life” .  What was the source of that ad?  I asked. Who paid for it? In  political ads in traditional media  there is regulatory requirement for  a disclosure of the name of some political committee who paid for for it.  There was none, she said. I smelled a rat and told her she should, too.   Thanks to Congressional Committee investigations into Russian election meddling,we are learning  rats were running  rampant in 2016. We may  need to build some better rat traps.

What has been revealed so far  by both Senate and House committees investigating Russian interference in the 2016 election and the testimony from Facebook executives is that social media advertising had been bought by Russians or related entities. A Twitter account was  even paid  in rubles. In one Twitter account,  the sender neglected  to remove the location of the organization placing posting tweets, which was Vladivostok, Russia.   That is only a tidbit  released to the public of what the Committees have learned  so far. What they have disclosed,  ads were carefully  targeted to those  voters Russians  believed  were gullible enough to accept them as truth since they likely  fortified their existing suppositions.   The subject matter was not always about negative, fabricated   stories that made Hillary Clinton look bad, but also the  ads  were  about issues which would intensify existing partisan feelings about immigration and  racial hatred..

Whether a large enough  number of voters who fell for the Russian disinformation campaign to swing the election to Donald Trump, we will never know because there were so many factors that led to his electoral victory, if not the popular majority but Oct 4, the Senate Committee had no evidence Russian meddling swung the election to Trump. What we do know so far, the Russians were actively engaged in helping Donald Trump get elected, but that most of their ads were to intensify anger about issues such as racism and immigration and were targeted with sophistication.  Collusion and conspiracy of the Trump campaign may or may not be proved.   What is more important is that voters need to become educated about warning signs and  learn  how they can tell  that some foreign  force is playing with their heads.  The best public education service those Congressional committees can provide is to let the public hear and see  the actual  contents  of ads which were traced to Russian funding and to point out the  disinformation techniques they were using.  It would be an effective  wake-up call for the yet unconvinced that interference  happened.

Public education is not enough. It is only human that people  believe what they want to believe, but still  healthy, informed  scepticism works for more than a few. As the Committees learn more, an outcome is likely to be regulation of social media advertising.. Neither Twitter nor Facebook nor other social platforms have been put on the same  regulatory footing as other media advertising. Ads placed by foreign entities on US based social media should be  forbidden by regulation just as they are
on other media.     Social platform political advertisers  should be required by regulation  to  know and publish the source of all  ads and  need to coordinate  with our intelligence agencies as part of their vetting process. US social platforms must  take responsibility to  self police posting contents and  their sources, too,      Non- partisan, non -profit fact checkers   can play a very important role in helping the public sort truth  from disinformation that is not put in  paid ads  and they deserve higher profiles and media exposure of sources and facts.