Medicare for All: Give Me Healthcare or Give Me Death
by Donna Smith - Common Dreams - April 5, 2017
Where are the screams about those death panels now? As Trump-Bannon-Ryan and friends craft their healthcare path forward with the leaders of the swamp team, no one is crying “foul” about the bold, proud creation of those famed death panels. I found it almost fitting that some of the latest negotiations happened on the golf course with the tweeter-in-chief and his close pal and darling of libertarians everywhere, Sen. Rand Paul (R-Ky). And the American taxpayers paid for all of this fun on the links.
The Republicans are ready to move forward on allowing insurance companies to charge more if you have any health conditions requiring your use of insurance and also if you are older than 50. I expect my premiums to be so much because of both issues that I will be effectively sentenced to death – but by God, my friends, let’s tank the Affordable Care Act/Obamacare.
The art of the deal on healthcare is exactly the same as the art of the deal on every other topic in the United States under this regime: Does Trump look good and does he take credit? Is Pence kept sort of “clean” just in case the Donald has to be removed? Do Ryan and McConnell look like they knocked off enough Dems in the process? Are the Koch brothers happy? Do we slap around enough lousy, urban liberal people who failed to vote for Donald? There are absolutely no goals in their top ten that reflect healthcare access or quality.
Follow the money right on over to the death panels, and your next big investment should be in Trump-branded final arrangements like pretty caskets and upscale soirees to say farewell to some of the regime supporters and voters who will, of course, be caught up in the collateral damage. Sadly, we will bury and burn a few folks who were needed in red states too, but the far left ought to be pleased to see some of their weaker links removed in this way too. I have reached out to find out about assisted suicide, and I have already priced what cremation costs. One of my children offered to set up a healthcare guardianship for me, but there really is no need to try to do that. Like so many Americans, my family—even the ones who are doing OK financially—do not need to divert their resources to pay an insurance company to deny most of the care I would need.
Millions of us keep waiting for the uprising on behalf of patients among us who have been stressed and terrified since November 8, 2017. So far, the resistance pushed by most Democrats has not been enough for the Republicans to care. The deal is all that matters. And more specifically, all that really matters to the Republicans led by their standard-bearers Trump and Bannon is making a deal—any deal—no matter what it does to the human beings who are to be most injured. Some Dems have used patients as props to say it’s terrible to see what the Rs are doing; some Repubs have used patients to say premiums are too high under the ACA/Obamacare. There are no more patient rescues by groups coming to the defense—the real defense—of patients being harmed. That all died long ago. The money and the political power is all that matter to most in power now.
I will admit that on some days since November 8, 2017, death does not seem like the worst scenario for me, but I expect lots of other people do not agree. Children, moms, dads, neighbors, friends and even many Republican voters will be caught up in this American, Republican culling of the wheat from the chaff.
It would be so revolutionary if we would hear someone—anyone—say it is unacceptable to even discuss any healthcare plan that threatens the lives of this many Americans. Who will filibuster for us? If this were an ISIS attack on this many people, even a threatened ISIS attack, we would be seeing something very different in response from every elected official. Apparently lives are worth less when they are ended through political deal-making.
Here is the deal I will make with all of my elected officials: If you do what you are promising and pass some selfish, greedy Trump deal for healthcare that threatens my life and the lives of so many people, we will bear witness before we die. We will take names. We will know you avoided passing improved Medicare for All—the plan supported by a majority of Americans and the only one that is a centrist solution for this nation. Medicare for All takes a good idea from the right (in private and public delivery of actual care) and a good idea from the left (with a single-pool public insurance model) and blends those into one centrist plan that covers everyone and saves money for individuals, families, business and the government. Centrist. A deal that values every life and values fiscal responsibility. (As an aside, has anyone noted just how much money the insurance industry, big Pharma and other health business interests know they will make under an extension of Medicare to every American? Hmmm. Why not?)
Even those who support Medicare for All legislation in Congress sometimes remain silent. But, and I am sorry, you cannot do that anymore without being complicit in my suffering and death. No political dance will keep you from that. Asking for us to vote for change in 2018 is too late. We are suffering now. We are stressed now. We are in the streets, on the phone and in your offices now. I will not beg you. You are on notice. My life, and the lives of many of your constituents, are at stake. Rise up and demand Medicare for All and see how quickly the country’s mood changes. I know I could stop planning for my final days, and perhaps a few political fortunes would be significantly changed. It is my belief that the American people would forever honor those who extended Medicare to everyone.
Ceding to One Side on Health Bill, Trump Risks Alienating Another
by Robert Pear and Thomas Kaplan - NYT - April 4, 2017
WASHINGTON — The White House stepped up its push on Tuesday to revive legislation to repeal the Affordable Care Act by placating the most conservative House members, but the effort risked alienating more moderate Republicans whose votes President Trump needs just as much.
Vice President Mike Pence met for about two hours on Tuesday night with lawmakers, including leaders of three groups of House Republicans. But lawmakers leaving the conclave in the basement of the Capitol said that no deal had been reached and that talks would continue on Wednesday.
“It was a very good exchange of ideas, with concerns that represent the broad spectrum of our conference,” said Representative Mark Meadows, Republican of North Carolina and the chairman of the conservative House Freedom Caucus. “There were no agreements tonight, and no agreements in principle,” he added.
Mr. Pence has been meeting continually with House Republicans this week to rework and resuscitate the repeal bill that collapsed on the House floor on March 24. But the House speaker, Paul D. Ryan, acknowledged that changes intended to gain support on one side of the House Republican Conference could lose votes on another.
“It’s important that we don’t just win the votes of one caucus or one group, but that we get the votes and the consensus of 216 of our members,” Mr. Ryan said.
In negotiations with members of the Freedom Caucus this week, administration officials have discussed allowing states to opt out of two bedrock requirements in the Affordable Care Act. One requires insurers to cover a standard minimum package of benefits, known as essential health benefits. The other generally requires insurers to charge the same price to people of the same age who live in the same geographic area, with a possible surcharge for tobacco users. Under this provision, known as community rating, insurers cannot vary premiums based on a person’s health status, insurance claims history or gender.
Mr. Meadows said earlier Tuesday that he was pleased the administration was willing to eliminate more of the mandates in the Affordable Care Act, which Republicans have been trying to repeal ever since it was signed by President Barack Obama in 2010.
“Lower premiums have to be our first and only priority,” Mr. Meadows said. “By repealing community rating and the essential health benefits, it allows for lower premiums across the board.”
But Mr. Meadows said Freedom Caucus members wanted to see the language that would be added to the repeal bill before promising to vote for it, and no such language was made available at the meeting on Tuesday night.
At the same time, more moderate Republicans were expressing concern for other reasons. Administration officials say they want to preserve one of the most popular provisions of the Affordable Care Act, which bars insurers from denying coverage to people with pre-existing medical conditions. But without a requirement for some form of community rating, insurers could effectively do that, simply by increasing the cost of policies for sick or risky customers.
“I don’t think we will have something that eliminates community rating,” said Representative Tim Murphy of Pennsylvania, a member of the caucus of moderate Republicans known as the Tuesday Group. “That just can’t be.”
Mr. Murphy, a psychologist, has successfully championed legislation to improve treatment for mental illness and drug abuse, including opioid addiction. He said he wanted to be sure that any changes to the bill protected mental health care and treatment for substance abuse disorders, as well as maternity care — benefits that are guaranteed under the Affordable Care Act.
Mr. Ryan and the White House tried to play down expectations of a breakthrough, saying the talks on a new health care bill were at a preliminary, conceptual stage.
Sean Spicer, the White House press secretary, said the vice president and the chief of staff, Reince Priebus, were “very optimistic” about the possibility of developing a health care bill that could win a majority of votes in the House.
“The president would like to see this done,” Mr. Spicer said. “If we can get a deal and it gets to those votes — which, again, I’m not going to raise expectations, but there are more and more people coming to the table with more and more ideas about how to grow that vote.”
New York adopted community rating under a state law in the 1990s, and the policy caused serious problems in the individual insurance market, but state officials have come to accept it.
Representative Tom Reed, a New York Republican who supported the original version of the repeal bill last month, said on Tuesday: “Community rating is one of those things that is a very significant reform in the Affordable Care Act. I appreciate the states’ rights argument, but recognize that there is a reason behind community rating and the benefit that it brings to the insurance reforms.”
Democrats say that relaxing federal standards for benefits and rates would, in effect, eviscerate protections for people with pre-existing conditions.
And some Republicans appear to share that concern. Allowing states to opt out of the federal requirements for minimum benefits and community rating “could greatly erode the safeguards Obamacare put in place for those with pre-existing conditions,” said Representative Leonard Lance, Republican of New Jersey, who opposed the earlier House repeal bill and has not moved from that position.
Representative Chris Collins of New York, a Trump ally and member of the Tuesday Group, said he too was concerned about allowing states to obtain waivers from the community rating requirement.
“It’s one thing if you have car crashes and you pay higher car insurance,” Mr. Collins said. “Health is a different animal.”
The version of the repeal bill that went to the House floor last month died after Republican leaders, in a bid for conservative support, agreed to eliminate federal standards for minimum benefits. Under the proposal now under consideration, states could obtain waivers from the federal requirements.
Trumpcare 2.0
Republicans for Single-Payer Health Care
by David Leonhardt - NYT - March 28, 2017
Without a viable health care agenda of their own, Republicans now face a choice between two options: Obamacare and a gradual shift toward a single-payer system. The early signs suggest they will choose single payer.
That would be the height of political irony, of course. Donald Trump, Paul Ryan and Tom Price may succeed where left-wing dreamers have long failed and move the country toward socialized medicine. And they would do it unwittingly, by undermining the most conservative health care system that Americans are willing to accept.
You’ve no doubt heard of that conservative system. It’s called Obamacare.
Let me take a step back to explain how we got here and how the politics of health care will most likely play out after last week’s Republican crackup.
Passing major social legislation is fantastically difficult. It tends to involve taking something from influential interest groups — taxing the rich, for example (as Obamacare did), or reducing some companies’ profits or hurting professional guilds. Those groups can often persuade voters that the status quo is less scary than change.
But when big social legislation does pass, and improves lives, it becomes even harder to undo than it was to create. Americans are generally not willing to go backward on matters of basic economic decency. Child labor isn’t coming back, and the minimum wage, Social Security and Medicare aren’t going away. Add Obamacare to the list. “Americans now think government should help guarantee coverage for just about everyone,” as Jennifer Rubin, a conservative, wrote.
Trump seemed to understand this during the campaign and came out in favor of universal coverage. Once elected, though, he reversed himself. He turned over health care to Price, a surgeon and Georgia congressman with an amazing record, and not in a good way.
Price had spent years proposing bills to take away people’s insurance. He also had a habit of buying the stocks of drug companies that benefited from policies he was pushing. Preet Bharara, the federal prosecutor, was investigating Price when Trump fired Bharara this month, ProPublica reported.
Price and Ryan were the main architects of the Republican health bill. They tried to persuade the country to return to a more laissez-faire system in which if you didn’t have insurance, it was your problem. They failed, spectacularly. Again, Americans weren’t willing to abandon basic economic decency.
But Price may not be finished. This weekend, Trump tweeted that “ObamaCare will explode,” and Price, now Trump’s secretary of health and human services, has the authority to undermine parts of the law. Here’s where the irony begins: He can more easily hurt the conservative parts than the liberal parts.
Obamacare increased coverage in two main ways. The more liberal way expanded a government program, Medicaid, to cover the near-poor. The more conservative way created private insurance markets where middle-class and affluent people could buy subsidized coverage.
The Medicaid expansion isn’t completely protected from Price. He can give statessome flexibility to deny coverage. But Medicaid is mostly protected. On Friday, after the Republican bill failed, Andy Slavitt, who ran Medicaid and Medicare for Obama, was talking on the phone to a former colleague. “Virtually the only words either of us could say,” Slavitt relayed, “were ‘Medicaid is safe.’ ”
by Jennifer Steinhauer and Robert Pear - NYT - April 5, 2017
WASHINGTON — The new bill to repeal the Affordable Care Act is dead, killed off by House Republicans who never actually read the legislation — because in fact, it never actually existed.
Conservative groups moved quickly on Wednesday to shift the blame for the failure of a seven-year promise to repeal the law onto some not-as-conservative Republicans, after a small but powerful group of hard-line House conservatives failed again to come to a meeting of the minds with the Trump administration over how best to repeal and replace President Barack Obama’s signature achievement.
“The left wing among House Republicans doesn’t want to compromise or keep their pledge to voters to repeal Obamacare,” David McIntosh, the president of the Club for Growth, a conservative free-market advocacy group, said in a statement. “They’ve rejected deals that would give Americans more choices for cheaper health insurance, and now they won’t even allow states the chance to scale back Obamacare’s costliest regulations.”
The accusation — echoed by other conservatives — represents a remarkable turnaround in the blame game. The group and its supporters have opposed much of the major legislation considered by Congress in recent years.
Last month, a House Republican bill to repeal the Affordable Care Act failed to get enough support to bring it to a vote. About 30 of the most conservative members of the House rejected the bill as preserving too much of the existing law, but as they pressed to dismantle ever more provisions, they pushed away more moderate House Republicans who were leery of leaving 24 million more Americans without health insurance.
The effort was left for dead, until Vice President Mike Pence and other Trump administration officials raced up to the Capitol this week to cobble together a new agreement with the most conservative Republicans, the House Freedom Caucus. The revived measure, stirring in its grave, was known informally on Capitol Hill as Zombie Trumpcare.
According to several members, Mr. Pence had proposed allowing states to obtain waivers from two provisions of the Affordable Care Act. One provision requires insurers to cover a standard minimum package of benefits, including maternity care and emergency services. The other generally requires insurers to charge the same price to people of the same age who live in the same geographic area.
By allowing insurers to increase the cost of premiums for sick people, the waivers would effectively gut the Affordable Care Act’s most popular provision: mandated access to insurance for people with pre-existing medical conditions. But members of the House Freedom Caucus were pushing to allow states to compensate with “high-risk pools,” where sick people could buy subsidized policies. Many congressional Republicans and President Trump viewed that option as morally and politically toxic.
The proposals never made it into a bill, and members never gave the ideas a full unadulterated blessing. The entire exercise appeared to melt in the midday sun on Wednesday, as members prepared for their two-week recess, set to begin Thursday afternoon.
Conservative groups were quick to attack the more moderate members of the Republican conference, particularly a group of lawmakers known as the Tuesday Group, as the reason the plan failed.
“The Tuesday Group is opposed because they do not want to repeal Obamacare,” said Michael A. Needham, the chief executive of Heritage Action for America, a conservative group that opposed the original House Republican bill but remained supportive of the Freedom Caucus’s efforts. “They do not believe in policy innovation from the states. They do not believe in the basic premises of the Republican Party.”
Representative Charlie Dent, Republican of Pennsylvania and a leader of the Tuesday Group, agreed that making the plan less palatable to governors — who were major opponents of the plan — and trimming benefits further were not helping to win his vote.
“What they were talking about was not going to get me to yes,” he said, noting that the plan was untenable to many governors, Republican senators and the vast majority of health care groups and representatives even before efforts to make it more acceptable began. “This is just another gratuitous attack from the self-designated chiefs of the purity police on an issue of great consequence,” he said.
In fact, the entire effort never really had the scent of veracity. Any effort to appeal to the hard-right members of the House Freedom Caucus was always going to repel Republicans in swing districts, especially those won in November by Hillary Clinton.
The objections to the House outline went far beyond the most moderate corners of the conference, and included people like Representative Christopher H. Smith, Republican of New Jersey and one of the most active anti-abortion members of the House, and Representative Don Young, Republican of Alaska, who objected to the way his state, with particularly high health care costs, would have fared. “The congressman isn’t one to often label himself,” said Matthew N. Shuckerow, a spokesman for Mr. Young. “He is Alaska first.”
If the most conservative House Republicans were blaming moderates, the moderates, for their part, were just as critical of the conservatives.
“The Freedom Caucus continues to play Lucy with the football and keeps moving the goal posts,” said Representative Chris Collins, Republican of New York and the first member of the House to endorse Mr. Trump. “I believe they are less than genuine in trying to get to yes.” The suggestion by Heritage Action and the Club for Growth that moderates were to blame was “ridiculous on its face,” Mr. Collins said.
In reality, there was probably never time to pass the measure. House Republicans have been operating under somewhat arcane budget rules to avoid a Democratic filibuster in the Senate. At some point, Republicans hope to adopt a new budget resolution for the fiscal year that begins in October. They plan to use that budget resolution to focus on tax cuts, not on health care.
As conservative members prepared to return to their districts for the two-week spring recess, they desperately wanted to be able to tell their base voters that they were still trying to do away with the Affordable Care Act.
“We are going home tomorrow without a deal,” Mr. Collins said. “The Freedom Caucus says they want to get to yes, but their actions don’t show that. The irony is, the very things they campaigned against will now be locked in because of their stubbornness.”
Health care in the US is an expensive mess. How does Canada do it?
by Joan Wickersham - Boston Globe - April 6, 2017
My friends — let’s call them Tim and Richard — live in Toronto. In their wallets they carry cards issued by the government, entitling them to health care.
Last April, Tim, who is 58, got a bad cold. Because he has asthma, developing pneumonia could be dangerous. He went to a neighborhood walk-in clinic, above a supermarket right near his house. He didn’t need a referral. He showed the card, waited an hour, and saw a doctor who prescribed prednisone.
He showed the card again in July when he was taken by ambulance to the emergency room. He’d been feeling dizzy, and had suddenly vomited blood and become too weak to stand. The doctor suspected a Cameron ulcer, a relatively rare condition in which the lower esophagus gets tangled with the upper stomach. An endoscopy confirmed this diagnosis. Tim was given a blood transfusion and admitted to the hospital. After three nights, he wanted to go home; by then his blood count was in a low-to-normal range and they reluctantly agreed to discharge him with some ulcer medication and a prescription for more. They also scheduled a follow-up appointment for him with a gastroenterologist.
Meanwhile, his husband, Richard, 59, was preparing for double hip replacement surgery in August. The surgeon was skilled in a relatively new procedure that went in from the front, rather than the back, eliminating the need to cut through muscle and speeding recovery time. All through the surgery, Tim was getting texts from Richard’s surgical team updating him on how things were going. The nurses and physical therapists had Richard walking that same afternoon. By the next morning, he was climbing a few stairs and that afternoon he went home.
Tim opted to cancel the appointment with the gastroenterologist because his yearly physical with his internist was scheduled for October. At that check-up the doctor ran a battery of tests. The ulcer medication was working, but a new concern surfaced: Tim had an elevated level of prostate-specific antigen. The doctor scheduled a follow-up test in three months.
A month later, Tim used his card again in the emergency room, where he’d gone with severe abdominal pain, which he assumed was related to the ulcer. The surgeon in the ER believed it might be his gall bladder, a diagnosis confirmed by ultrasound the following morning. Tim was told he could have surgery in the next few days, but he was about to sing in a concert so the operation was scheduled for three weeks later. It was done in a different hospital — one dedicated to ambulatory surgery — by the same surgeon whom Tim had seen in the ER, and who remembered him and spoke reassuringly to him before the procedure. “I had a snarky anesthesiologist,” Tim told me. “That stood out: the one person in this entire year of medical stuff who was anything other than nice.”
He told me this on the phone. I had called and asked him what health care was like in Canada — not in general policy terms, but how it felt to use the system. I had said, “Tell me about every time you and Richard have seen a doctor in the past year.”
He admitted that the year had been atypically intense for them; they’d seen doctors a lot. Each time, they showed their health care cards, and that was it. He felt the care had been excellent. I asked how much it had cost them. He said that outside of Richard’s crutches and some $10 charges for prescription drugs, it hadn’t cost them anything.
We both knew that what we were really talking about was US politics.
“I like knowing that every person I see when I walk down the street in Toronto will be taken care of, and it doesn’t matter what’s wrong with them or how much money they have,” Tim told me. “If you need help, you get it.”
No ‘Death Spiral’: Insurers May Soon Profit From Obamacare Plans, Analysis Finds
by Reed Abelson - NYT - April 7, 2017
In contrast to the dire pronouncements from President Trump and other Republicans, the demise of the individual insurance market seems greatly exaggerated, according to a new financial analysis released Friday.
The analysis, by Standard & Poor’s, looked at the performance of many Blue Cross plans in nearly three dozen states since President Barack Obama’s health care lawtook effect three years ago. It shows the insurers significantly reduced their losses last year, are likely to break even this year and that most could profit — albeit some in the single-digits — in 2018. The insurers cover more than five million people in the individual market.
After years in which many insurers lost money, then lost even more in 2015, “we are seeing the first signs in 2016 that this market could be manageable for most health insurers,” the Standard & Poor’s analysts said. The “market is not in a ‘death spiral,’ ” they said.
It is the latest evidence that the existing law has not crippled the market where individuals can buy health coverage, although several insurers have pulled out of some markets, including two in Iowa just this week. They and other industry specialists have cited the uncertainty surrounding the Congressional debate over the law, and the failed effort two weeks ago by House Republicans to bring a bill to the floor for a vote.
The House G.O.P. leadership went home for a two-week recess on Thursday, unable to reach a compromise between conservative and moderate members over the extent of coverage that should be required for the very sick.
If the markets were to falter without a resolution in Congress, the risk of eroding public opinion before the midterm elections next year is bound to increase. The latest monthly Kaiser Health Tracking Poll by the Kaiser Family Foundation showed that more than half of Americans now believe that the president and Republicans own the health care issue and may shoulder the blame for any failings. The survey reported that more than half now support the Obama health care law.
The S.&P. report also buttresses the analysis of the Republican bill by the Congressional Budget Office, which said the markets were relatively stable under the current law, contradicting some Republican assessments of volatility.
“Things are getting better,” Gary Claxton, a vice president at the Kaiser Family Foundation, said of the insurance markets. The foundation has been closely tracking the insurers’ progress.
Although it took longer than expected, the insurers appear to be starting to understand how the new individual market works, said Deep Banerjee, an S.&P. credit analyst who helped write the report. The companies have aggressively increased their prices, so they are now largely covering their medical costs, Mr. Banerjee said. They have also significantly narrowed their networks to include fewer doctors and hospitals as a way to lower those costs.
In 2016, the number of companies whose medical costs exceeded their premiums fell by half, to nine of the 32 Blue Cross companies included in the S.&P. analysis. The improvement signaled the potential for profit margins to increase. A few plans, notably Florida Blue, are already profitable. The report released on Friday did not include Anthem’s for-profit Blue Cross plans, which span 14 states.
Mr. Banerjee warned that the market is still fragile, and he said insurers needed more time to figure out how to make the business work. While the market is very much alive, he said, it is “still in critical care. It still needs time to improve.”
The S.&P. report represents some good news in a market that has proved more than challenging to the health insurers. Most insurers have struggled to make money, and several companies reported losses that ran into the hundreds of millions of dollars.
News media have reported on insurers that are giving up. Aetna and UnitedHealth Group were among the first major insurers to largely pull out, but, early this year, Humana announced it would stop selling policies in 2018. That could leave parts of Tennessee without any insurers, an outcome that some senators on both sides of the aisle are trying to address.
Just this week, two of the three largest insurance companies in Iowa, Wellmark Blue Cross and Aetna, said they would stop selling individual policies in the state next year. That could leave nearly all of Iowa with only one carrier.
The insurers’ latest withdrawals are helping to fuel Republicans’ arguments that they have no choice but to repeal the law. Mr. Trump has continued to proclaim that he believes the market will collapse without a new law.
LePage Calls for State Health Insurer
by Mal Leary - Maine Public - March 28, 2017
Gov. Paul LePage is blasting Republicans in Congress for not supporting House Speaker Paul Ryan’s bill to repeal and replace the Affordable Care Act. Speaking on Bangor radio station WVOM, LePage called for a new state-chartered health insurer to make sure Mainers have access to coverage.
LePage said the failure of Congress to come up with a replacement to the ACA could leave Mainers in the lurch, with no health insurer left in the state.
“What’s the federal government going to do, I mean they sit, they go hide. They don’t want to do anything. We have to take care of our people. The people are No. 1, and if Congress can’t see that, shame on them,” he said.
Instead, LePage said he’s considering a health insurance model similar to the Maine Employers Mutual Insurance Co., set up in 1992 to provide workers comp insurance.
“What I am suggesting is, go to the Legislature and see if they won’t create an insurance company like we did with MEMIC and workers comp,” he said.
But he offered no details about how the new health insurer would be set up or whether his plan has the Democratic support it would need to pass.
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