Wednesday, June 28, 2017

Choice is a bogus issue in the Senate Trumpcare debate

I just listened to a panel of physicians, on TV, mostly big city specialists, who have the opinion that Trumpcare is better for patients for one reason: choice. I am a widow of a physician. Give me a break. 22 million people will not have health insurance and have no choice of a physician they can afford and will rely on charity care and the ER. Since our family was well heeled by a high earning family head, how easily is it to imagine how a family living of 26K a year affords health care. Even those of us with insurance in the private sector before Obamacare, I had no choice since I was in an HMO and had to stay within the network. In fact, now on Medicare, I have a supplemental that is also an HMO. Even PPO's have preferred physicians. Two of my  over 50 years old children have health insurance provided by an employer and their choices of plans are limited to 3 options picked by their human resources department. Every time they change jobs, their past employer plans are not offered and they sometimes cannot keep the doctors they had or the hospital they preferred. 

None of that would change if the Senate Trumpcare version were passed except that employers would no longer be required to offer employer insurance and there is no guarantee that consumers would not have to pay more to cover pre-existing conditions.  All three have pre-existing conditions and one does not have employer insurance, is over 50, and
is facing being forced out of the insurance market if the Senate version is passed allowing increased premiums for pre-existing conditions and  charging him as much as 5 times more than the younger ones covered. His choice would be not to have insurance because he cannot afford it, not because that is what he would like..
When asked about whether the Trumpcare Senate version would benefit the poor, no hand was raised. However, one physician suggested that the states or townships could pay for it and join together. Denver Health has been an enterprise fund and covers much of the poor without relying of local taxes. The reason, they rely heavily on Medicaid reimbursement and other patient insurance coverage to be self sufficient. Their operating loss due to Medicaid reductions would result in more local taxation. If the states themselves made up the differences in the loss, they too would have to raise taxes because most states are subject to balance budget requirements. A dollar of federal taxes comes just as much out of a taxpayers' income as do local and state taxes. There is a reason there is a bi-partisan group of governors opposing the Senate Trumpcare bills has become public.

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Monday, June 26, 2017

What would happen if the free market ruled health care

(Scheduled for Sky Hi News July 10-12)
One of the hardest to grasp arguments made by those who  opposed the original Trumpcare  Senate bill is that it did not go far enough . The Senate and House versions did not repeal  the structure of Obamacare . Their argument: if you just let the free market work without regulation, then all premiums would decrease  so all could afford insurance, or at least more could afford insurance. It is an appealing theory, but simply repealing Obamacare without a replacement  or even the Senate version would not  have restored the free market to health care because there are other barriers not touched by Congressional action. Besides there is not a profit to be made if patients are unable to pay for their services or the product insurers sell is not worth the cost  to consumers.

Remember what it was like before Obamacare was passed?  An estimated 45,000 people died a year  before Obamacare because they did not have health insurance per a Harvard study.  The number one cause of foreclosure and bankruptcy was the inability to pay for health bills  . By 2026 if the  original Senate version were put into practice, the number of uninsured  would be the same as it was before Obamacare.

Fundamental to a free market is that the business has to make a profit or it closes its doors.  The private market does not make a profit serving those who cannot pay for insurance, or are known bad risks.   For that reason, the least of these will  always be left without insurance unless the paying are willing to shoulder charity care costs  paid for by higher premiums or  make up the losses in higher state, local , federal taxes .

The free market requires  that consumers understand the fine print in insurance offerings and that they have a chance to make an informed , rational decision at or before the time they need insurance or care.  That is a stretch when it comes to health insurance. It is extremely complicated, as even President Trump noted.  

In reality,  most consumers never did  or do have  much of a choice. They  get their insurance through their employers whose human resource departments  give them limited choices of three plans. This would not change  except the Senate bill drops the requirement that large employers even offer health insurance as a benefit.

For a free market to work in theory there must be competition. Unlike every other kind of business except baseball and insurance, it is illegal to fix prices and benefits. However  health insurers  are free to collude to fix prices and benefits with another company since they are exempted from federal anti- trust action.

When Obamacare was scored in 2009,  the Congressional Budget Office noted that cross state insurance sales ( you can buy insurance from another state's provider)  would make insurance more affordable for a few million, a drop in the bucket.  Without required benefits and standards, the cheaper, poorer coverage wins out. The Senate bill removed requirements and standards.   Also, all large insurers have affiliates in other states, you may also be met with an affiliate of that  same company in your home state.

I just listened to a panel of physicians, on TV, mostly big city specialists, who have the opinion that Trumpcare is better for patients for one reason: choice. I am a widow of a physician. Give me a break. 22 million people will not have health insurance and have no choice of a physician they can afford and will rely on charity care and the ER. Since our family was well heeled by a high earning family head, how easily is it to imagine how a family living of 26K a year affords health care. Even those of us with insurance in the private sector before Obamacare, I had no choice since I was in an HMO and had to stay within the network. In fact, now on Medicare, I have a supplemental that is also an HMO. Even PPO's have preferred physicians. Two of my children have health insurance provided by an employer and their choices of plans are limited to 3 options picked by their human resources department. None of that would change if the Senate Trumpcare version were passed.

Much of the pre Obamacare data can be found at and in archives there at that site covering the years 2007-2009.

Saturday, June 24, 2017

What we celebrate this 4th is as important today as it was in 1776.

One fundamental meaning of the 4th of July likely has been lost in the holiday celebrations, fireworks, barbecues, flag waving, and patriotic speeches.  What we should not forget  is why in 1776  we declared our independence from England.  Remember why our founding fathers meeting in Philadelphia  1776 wanted to be free from English rule so much , they were willing to risk being hanged as traitors to the English crown? The issue is of independence from foreign control is as fundamental and relevant in 2017 as it was in 1776 .

Here we are in 2017  when many including President Trump deny or shrug their shoulders that another country, Russia,  has tried to interfere in our elections to give support to the US candidate who would be most favorable to Russia's national interests.

Just publicly revealed there is evidence of recorded Kremlin conversations that their interference, planting fake news stories, hacking, publishing the hacks, and demonstrating the potential to cause havoc in 21 states in voter registration data on election day, was directed by Vladimir Putin himself. His stated purpose was to help Donald Trump and hurt Hillary Clinton. Pres. Obama may have stopped some of this by personally confronting Putin himself and outing the Russian plans. Some measures resulted: sanctions, kicking out 35 of their spies and putting in place for future use retaliatory cyber counter attacks. One can argue if this was enough, but Trump has does nothing but restore the spy property and hinting at ending sanctions.

The reasons our founders revolted were about taxation without representation  and anger with unfair English methods of  controlling their colonies.  After the revolution, the 1789 Constitution was constructed to prevent abuses of our personal freedoms by a government and to balance and check the powers of the three branches, without which they feared would lead to the establishment of another monarchy.

There was also concern that foreign governments would try to take over the US by bribery or financial entanglements. Alexander Hamilton did not even trust the voters or elected officials to stop such attempts. Hamilton expressed his fears in his Federalist Paper 22 “.One of the weak sides of republics..., is that they afford trust too easy an inlet to foreign corruption. ...In republics, persons elevated from the mass of the community, by the suffrages of their fellow-citizens, to stations of great pre-eminence and power, may find compensations for betraying their trust...”  Because of Hamilton’s reasoning  the writers of the Constitution included  the emoluments clause to head off such abuses…” no person holding any office of profit or trust under them, shall, without the consent of the Congress, accept of any present, emolument, office, or title, of any kind whatever, from any king, prince, or foreign state.” Note Congress' responsibility in these matters.

In 2017,  many of the cabinet members, White House advisers, and President Trump , have a  history of financial dealings with Russia.     The significance  is  that some in the administration, in addition to Mike Flynn, may be vulnerable to Russian manipulation to affect policy decisions. If any hid unlawful financial practices known by the Russians, they too are vulnerable  to blackmail. They are compromised. For that reason the various investigations into the Russian connection are following the money.

Thursday, June 22, 2017

The GOP backed Trumpcare bills: like a fat kid taking candy from a baby

A version of this appeared in all editions of the Sky Hi News, June 28, 2017
If you agree with Donald Trump the House Trumpcare bill was mean, the Senate version is even meaner. The GOP Congress bills are  as moral as  the fat kid taking candy from a  baby.
The GOP's sales pitch: These bills are ""patient centered". What they really  are is taxpayer centered, a way to give $600 billion    tax relief to upper income and medical providers paid for by  taking away quality affordable insurance from 22 million (14 million in 2018) middle income and the poor and defenseless  by 2026  The difference is deficit reductions. Timing of the worst impact is after the 2020 election cycle to avoid the wrath of voters who will personally  feel the pain then. Sneaky of them.

The Senate Trumpcare  bill cuts  $34 billion more  deeply  into Medicaid  in removing  expansion and cutting  traditional Medicaid than the House bill's $800 billion slash. To pay for over  a $600 billion tax relief to the wealthy and some medical providers,  the GOP Congress bills take  money for  health care and insurance benefits  from those who  need it the most. Medicaid is the  prime health care safety net:   75 million, or 20% of Americans, are on Medicaid now; 39% of those on Medicaid are kids.The national average is 65% of nursing home residents are on Medicaid.  Nearly half the baby deliveries  in this country are covered by Medicaid. There are 350,000 Coloradans on Medicaid , some whose insurance could  be put in jeopardy .Most rural health hospitals  depend  heavily  on paying patients on Medicaid to cover  costs. This has serious implications for both Summit and Grand county health providers and facilities.

For those not on Medicaid,  patients are getting baited and switched. Secretary of HHS, Tom Price on Sunday talk makes a pitch the GOP Trumpcare bills will be patient centered because patients  can choose the kind of insurance they want. : The 22 million losing their insurance will have no choice of anything. Price  claims consumers will  get lower premiums. How? They bait patients  with lower premiums and switch to them to plans without  some  they required essential benefits but could not afford to include  in their  plan  . Between 2018 to 2020 premiums will rise 20% but there after 2020 falling 20% because the benefits will be cut so much,. This applies to all insurance, including employer insurance.  The logic is similar to if you just paid for the brown bag and small fries without the  usual hamburger,  the cost of a fast food lunch would certainly go down. After 2020, forget the hamburger .

Depending on what box you check for  coverage of  once included essential benefits could mean  you gamble either you or anyone in your family in the future would  not have cancer or get addicted to drugs or end up in the ER,  and you can pay full price  for your annual physical and cancer screenings and prescription drugs.

Another GOP screw to patients  is to restore the lifetime cap on coverage . In the middle of cancer treatments, you could run out of insurance.  GOP's  alleged  coverage for pre-existing  conditions would be meaningless if you do not have paid  for chemo  drug coverage and other benefits.. Older citizens between ages to 65 can be charged 5 times more than  the younger.


Additional comments:

Let the Senators' votes be registered just as the House members have theirs published already.  Then there should be no question then where Colorado Senator Cory Gardner stands in the Trumpcare bills.  The most important question any pollster can ask of voters is does X candidate  or the party care about me. The GOP is making it clear they do not care about either you or your relatives or your neighbors who will be hurt with their Trumpcare legislation. They care more about reducing taxes on the wealthy.

What could happen is that the reaction to the hardships this legislation causes and the burden it puts on state budgets and working near poor families,  alternatives such as Medicare for All will gain popularity.  In the meantime, they can  fix the problem with the exchanges by allowing counties without any health insurer or only one participating in the exchanges inmostly rural counties, by giving consumers  the opportunity to buy insurance either through Medicare or the same federal plan to which Congresspeople subscribe. There also should be a push to require drug companies to compete  for Medicare and Medicaid prescription drug business. .

The hit to both Medicaid expansion added to the Trump budget plans that cut traditional Medicaid, too, come to cutting total Medicaid in half. That observation was made by Steve Rattner on MSNBC June 22,2017

That this is Paul Ryan's dream bill has deep and long history. The last time he tried to cut the safety net, even the Catholic Bishop's called his proposal immoral. From my posting on 4/12/ 2014:

Wednesday, June 21, 2017

The Ossoff candidacy was also a victim of resistance movement that lacks credibility.

The premature nature of the Trump resistance movement was a factor in the Ossoff defeat. The actual outcome of Trumpcare was not yet known, since the CBO score of the Senate's bill had not been released. The resistance movement has also failed to show how they would fix Obamacare. The Russian connection investigation is only about 20% completed, but signs are beginning to point to some very intense effort to understand if there is any financial hanky panky committed by Trump and his associates now or in the past. The financial crimes unit of the Treasury department has just released their tracking of international financial dealings to the FBI and the Senate committee. If, in this course of investigation, truly crimes are uncovered or if Trump is "compromised" and played by the Russians, then this becomes more of an issue in future 2017, 2018, 2020 elections. These are very important "ifs" and the best the Democrats can do is to not overplay their hand,making it look like all truth looks fake or partisan, but to make sure the public is informed and understand the implications and consequences to our national security. At that point, the resistance movement is not just obstructionist, but lacks real credibility. It does not have it yet.

Thursday, June 15, 2017

Trump's troubling love affairs with dictators and despots

This is a step by step analysis of how an aspiring despot can use perversions of constitutional democracies once they get elected. . Our democracy is a special one with strong checks and balances, but even with them, there are ways to destroy them .. I consider this column one of the most important columns I have ever written because I care deeply about our system of democracy and it is being tested,....It is a system for which I have ultimate respect having seen others at work..Democracy as a governing system has its flaws, but for ordinary people, it is still the best governing system in history.. So many democracies have fallen with the consent of their own governed, unaware of what unintended consequences result from good intentions and 
 passionate advocacy. Be careful what you wish.

Column published 6/14/17 in all editions of the Sky Hi News
Donald Trump has now returned to the realities of the political system in the United States. What was noted by many  is that he was not at ease in western Europe, and  refused to confirm US support of  the core reason for NATO, mutual defense without exception, and  was the odd man out on climate change. Lauded as his most successful part of his trip. he managed to score big with Saudi Arabia or  Saudi Arabian absolute rulers treated  Trump like the king he would like to think he deserved.. Given the contrast with his attitude toward the Saudis  with his scolding  messages and standoffishness in Europe it  is  clear is that Trump is much more comfortable with tyrants, whom he considers models of "strong leaders"  than he is with those who believe in Western democracy, so much so he has tried to ape some of their steps to power. Those who have been the most warmly welcomed or invited to the White House in the first months of his administration were the  destroyer of democracy in Turkey,  Recep  Erdogan,  and Rodrigo  Duterte in the Philippines, who had declared martial law rule as he killed thousands without due process or trials.  Trump's bromance with Putin is legendary.

There is a lesson in the rise to power of these autocrats. Unlike  the old days where a military putsch changed regimes,wannabe autocrats now get  into power by a democratic vote and then set about to grab power and eliminate the opposition. Their countrymen have permitted their loss of democracy because of real or trumped up  fear from a threat to national security or lawlessness and crime that begged for a strong arm to lead them. Others saw the emerging autocrat as a ticket to get their shared  agenda enacted.  Once in office,   the creep to autocracy began.  First they  ignored constitutional constraints on executive power, and pushed through changes in  laws, constitutions, that  made it difficult for  anyone to challenge them.   Erdogan even eliminated his legislature by a vote on a new constitution  and Putin filled his Duma with loyalists.

There are many current  examples  of how a democracy fell  to authoritarians.  There is a pattern.  The first step  is to  reduce the power of the opposition press. Unlike Erdogan or Putin, Trump  has not imprisoned opposition reporters or killed them, but he has tried to diminish their power  by convincing many that what  is reported and covered on his favorite TV station is the truth and  the rest spout fake news or make up their stories..   He has called the press the “enemy of the people”, taking a page from the old USSR slogan. The writers of the Bill of Rights  saw a strong, free press as another check  on abusers of power and protected it in  the first amendment.

Another step toward to authoritarian rule  is to diminish the credibility of an independent judiciary. Trump uses   personal attacks regarding the Trump University fraud case’ “Mexican” judge  or the Muslim ban executive orders overturned by “liberal judges”.   The balance of power with an equally empowered independent judiciary is fundamental to the Constitution ‘s rule of law.   One way to get around an independent judiciary   is to stack a judiciary with loyal true believers who have an issue agenda  instead of those who have  demonstrated support of the rule of law as embodied in the Constitution.  Another step is changing rules to make it it easier to get his agenda passed.  Changing  the Senate rules that required 61 votes for approval of a Supreme Court justice to  a simple majority was  the first step. Now he wants the Senate to change their rules so that their simple majority could pass his agenda with out fear of a filibuster or the need to compromise.

Tuesday, June 6, 2017

The Trump mess is up to the GOP to fix themselves

Column published in all editions of the Sky Hi News, June 21, 2017

What to do about  Donald Trump is in the hands of the Republican Party. To deal with this self defeating tweet obsessed President  will be up to  Trump's own party to solve. Failure for them to do so could  contribute to the 2018 election  becoming a referendum on the President, though an  Obamacare replacement that harms so many  may still be the  more important determining factor. Health care affects the daily lives of people; the Russian connection investigations do not..   All members of the House will be up for re-election and will be put on the spot about their stand on impeachment since the House of Representatives controls the process..

Any attempt by Trump's own advisers to change his tweeting  behavior apparently failed. His admissions damaging to his own advocacy, contradicting his own lawyers  and undermining  legal cases are now  on public record in his tweets . In fact, the  judicial rulings against the " Muslim ban", show that tweets can be used as evidence of Trump's state of mind and intent. Tweets will also be used as evidence in the obstruction of justice issues.

Trump has kept his base who still applauds him for making the effort to  carry out his campaign promises and sticking a single finger  in the air at the "elites" . So  long as his polls hover around 36% approval, he believes he is on the right track.  There are signs, however, that in critical  states that swung the electoral vote to him his support is weakening.  However, his core followers are dismissive of the issues of administration collusion with the Russians or obstruction of justice as a left wing conspiracy theories  or not caring much  about the impact on democracy or interference by a foreign government. It will take findings of more  dire substance such as any evidence of  financial crimes yet to be turned up by the special prosecutor  to change this iron clad  support.

The Democrats can  only stand on the sidelines since they  have virtually no leverage to initiate impeachment  processes. They lost both houses of Congress  in 2016 and their  advantage in the popular  vote  was lost in the Electoral College and in state houses and legislative districts. The GOP controls the reins of impeachment  since the process begins in the House.

  While Republicans  have many safe districts with voters who are  true believers in Trump, there are enough districts that are not so safe that could  change the House to blue. Should that happen in 2018.
and impeachment proceedings begun  or Trump resigns as did President Nixon to avoid impeachment,  a President Pence would be able to carry out the GOP agenda. This takes much of the concern about implementing  Republican policy goals off the table.  Republicans  cannot use that as an excuse for standing by a failed president.

Saturday, June 3, 2017

Fruits of isolationism are bitter

published as column in Sky Hi News all editions, June 7 2017
The Trump administration has accomplished little in three months The courts and Congress have become distracted in Russian matters or have found executive orders unconstitutional.  House passed Obamacare repeal/replace is on life support in the Senate. There is  one exception. Trump has succeeded  in making  the United States  isolated.   He has also succeeded in helping to make  Russia, China,  and  Europe great again.

The blow back  will be on the US economy and more.  Political  power and economic vibrancy  are closely  tied. The two  working together  make the trade deals that contribute to our economy and our power to export and to cooperate in other areas such as fighting terrorism and intelligence sharing..What Trump has accomplished is to leave the USA in less control of its own destiny, and  instead having to dance to the tune of others.

In a short three months, Trump’s policies have  effectively  led to US withdrawal from  leadership and influence in the rest of the world.  He ended the TPP (the Asian trade agreement)designed to block Chinese economic expansionism), synchronized  US foreign policy with Russia’s,   and pulled out of the Paris climate accord  that had been approved by every country in the world, except Syria and Nicaragua. Trump  purposefully neglected to confirm the fundamental purpose  of NATO, mutual defense, an attack on one is an attack on all, virtually  inviting Russia to test NATO’s resolve in the Baltics and the Balkans. NATO is the main barrier to further Russian geographical expansion.

Into the vacuum of leadership have stepped Angela Merkel of Germany and Emmanuel Macron of France, willing and able  to lead the Western World. China is aggressively forging trade, military, and political influence in Asia.

The  Paris climate accord  was not a binding treaty, It was a voluntary agreement on goals to be determined on terms and goals controlled by each country,  leaving them to use whatever means they wanted to reduce carbon pollution.   With or without the Paris accord, the world is accelerating a shift to wind and solar and battery power. In the US, less polluting natural gas is taking over coal. In fact, countries will meet their carbon reduction goals ahead of the Paris schedule . The reasons? These alternatives are cheaper due to technological advancement per a recent article in Foreign Affairs.  In the meantime, China is seizing the day and becoming the leading manufacturer of solar panels and other alternative energy technology.
If we want to compete in the world economy, we need to keep pace with the rest of the modernized world. During the 2016 campaign,  Donald Trump’s slogan, Make America Great Again and America First, resonated with those who felt their economic well-being  was victimized by international trade and environmental regulations..   They did know they wanted to return to the good ole days   where a high school diploma landed an assembly line job that paid middle class wages, that coal and oil were king, robotics were science fiction, and there was no competition from foreign imports, What could have helped would have been job retraining, education, re-direction to encourage development of  industries of the present and the future economies in their regions. None of this is funded in the Trump budget blue print.

See: 12/16/16 post: Making Russia Great Again..