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.

http://www.denverpost.com/2017/03/13/denver-health-other-hospitals-worry-about-newly-uninsured/

http://www.politico.com/story/2017/05/03/obamacare-repeal-health-care-237948

https://www.forbes.com/sites/brucejapsen/2017/06/26/ama-says-mcconnells-trumpcare-bill-violates-do-no-harm

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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.

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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 www.mufticfrom.com and in archives there at that site covering the years 2007-2009.

http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/#_=_

http://smallbusiness.chron.com/cost-shifting-23849.html

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.

http://www.kansascity.com/news/nation-world/article159682299.html

https://www.theatlantic.com/politics/archive/2017/05/trumps-company-isnt-tracking-all-the-money-it-gets-from-foreign-governments/
https://www.brookings.edu/blog/order-from-chaos/2017/06/27/trump-russia-and-sanctions/ https://www.washingtonpost.com/graphics/2017/world/national-security/obama-putin-election-hacking/

https://www.nytimes.com/2017/06/21/us/politics/jeh-johnson-testimony-russian-election-hacking.html

http://www.independent.co.uk/news/world/americas/us-elections/obama-says-he-personally-told-putin-to-cut-it-out-on-hacking-a7480576.

https://www.nytimes.com/2016/09/08/world/europe/defense-secretary-warns-russia-to-stay-out-of-us-elections.html

https://www.reuters.com/article/us-usa-cyber-congress-idUSKBN19C1Y3?il=0

http://www.nbcnews.com/news/us-news/report-putin-russia-tried-help-trump-discrediting-clinton-n703981

https://www.rferl.org/a/cia-told-obama-august-2016-that-putin-ordered-election-interference/28575911.html

http://www.npr.org/2017/06/02/531269090/trump-administration-made-secret-efforts-to-ease-russia-sanctions
http://www.cnn.com/2016/12/29/politics/russia-sanctions-announced-by-white-house/index.html

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.

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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. .

http://time.com/4833408/american-medical-association-mitch-mcconnell-healthcare-bill/

https://www.ncronline.org/blogs/distinctly-catholic/immoral-senate-healthcare-bill
https://www.nytimes.com/2017/06/22/us/politics/senate-leaders-unveil-bill-to-repeal-the-affordable-care-act.htm

https://www.theatlantic.com/business/archive/2017/06/ahca-senate-bill-preexisting-conditions/531375/

https://www.benefits.gov/benefits/benefit-details/1621

https://assets.aarp.org/rgcenter/il/fs10r_homes.pdf

 www.medicaid-help.org/Eligibility/Colorado

http://khn.org/news/deep-cuts-to-medicaid-put-rural-hospitals-in-the-crosshairs/

http://www.npr.org/sections/health-shots/2017/06/22/533942041/who-wins-who-loses-with-senate-health-care-bill

https://www.usnews.com/news/best-states/articles/2017-06-07/gop-medicaid-cuts-hit-rural-america-hardest-report-finds

http://www.latimes.com/business/hiltzik/la-fi-hiltzik-senate-hidden-20170623-story.html

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:

WHO SPEAKS FOR THE POOR