Tag Archives: health care

Trumpcare in Two Images

Say what you will about Donald Trump and his new health plan, there are a few things that are just so true that if you are going to argue with them, you seriously should consider putting down that crack pipe. What are these two truths?

  1. The “American Health Care Act” has about as much of a chance of passing as the “Make Squirrel Montana Queen of the Country Act,” which does not exist.
  2. The only people who will really be helped by this legislation don’t really need any help.

Let’s start with 2. The Kaiser Family Foundation has a great tool. It shows how the tax credits put forth by the GOP will impact people based on their income. If you are 40 years old and you make $20,000 each year, this is what kind of help you will get:

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If you are 40 years old and you make $100,000, this is what you can expect:

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Seriously. Wow. The bottom line is that the more you make, the better off you will be under Trumpcare.

Next, you can probably skip worrying too much about this bill because everyone hates this bill. Democrats hate the fact that it will be sure to drive costs up, rather than down, that it relies on tax credits, which do nothing to help people living near or at or under the poverty line and it offers less in the way of services provided. The conservatives hate it because they think it is “Obamacare lite.” Because it is a bill that cannot be dealt with in the Senate via the reconciliation process, it will need more than 60 votes and that just is not going to happen.

Donald Trump may be a lot of things and he may be a good deal maker (I doubt it but let’s just pretend he made money by being good at that and not on the backs of working people all over American) but he sucks at dealing with Congress.

 

The inexplicable Donald Trump

…or “Then they were down to two.”

Even Larry King was intrigued by the Donald's do.

First Newt Gingrich sais he would happily participate in the debate Donald Trump is hosting with NewsMax on December 27. Then the Donald did a round of interviews proclaiming himself the ultimate king-maker and representative of millions (Millions! Check his web sites if you don’t believe him!Note to Mr. Trump, oer your standards the cast of Jersey Shore is qualified to pick the nominee for a major party for the most important job in the country.) before things began to unravel. Rick Santorum agreed to take part but then, one by one, Jon Huntsman, Mitt Romney, Ron Paul, Rick Perry and the also inexplicable Michele Bachmann declined the invite. Reince Priebus, perhaps the first adult to emerge in a while, said that his support of this train wreck would amount to “malpractice” on his part. Well put, sir.

And for the record, Jon Huntsman was the first to decline and for someone with as much experience dealing with criticism and being in the public eye, the Donald has an amazingly thin skin. Trump called Huntsman’s comments that he “will not kiss his ring or any part of his anatomy” “offensive.” Yeah, Donald, your circus is offensive. That you are still harping on President Obama’s birth certificate — after you said you would drop it once you saw the ‘long form’ version — is offensive. What’s really shameful (and I am part of the problem here but watching him crash and burn twice is truly delicious) is the attention you continue to get and the fact that you are using the job interview to be leader of the free world just another way to get publicity for your reality show. Even the Situation has more class (not much).

All of this leaves me a little perplexed.  Why do we care what the Donald thinks about anything?  We know he likes himself a lot.  A lot more than anyone should.  His official bio describes him this way:

“Donald J. Trump has become the most recognized businessman in the world, and the Trump brand is readily acknowledged as representing the gold standard around the globe. As the pre-eminent developer of quality real estate, his acumen is unrivaled, and the diversity of his interests has set a new paradigm in the world of business. His commitment to excellence is legendary, and his work as a philanthropist is an integral part of his ethos. He is the archetypal businessman, and an icon of New York.”  You can read more of this brilliant rewriting of history here.

I don’t dislike the Donald but when I was growing up in NY, his life was a sideshow for the bulk of the time I was there.  First of all, he didn’t start his business, he inherited a successful one from his family.  He has a remarkable talent for self-aggrandizement but inflates his net worth an downplays his failures (to his credit, a Trump bankrupcy looks very different from most other people’s).  He is great at self-promotion but does that make him qualified to do anything but promote his reality show?

 

Seriously, when did this start bothering you? Yesterday?

Wow.

This used to be one of my favorite photos of myself. Today? Not so much.

 

 

 

 

 

 

 

 

 

If this Congressman Anthony Weiner situation had happened at a different time, I would have felt differently.  (I should point out before I continue that I have been pretty merciless in my criticism of John Edwards, someone I supported and worked for and when I started doing stand-up used to say “Every time I think this story cannot get any douchier, it does.”  That joke is as true today as it was two years ago when I wrote it).  The calls from the right for Weiner to resign and the “outrage” they have been falling over themselves to express sickens me.

You see, I have a few other scandals kicking around in my head making me put this in perspective.  There is neither rhyme nor reason to the order I am using.

America’s Mayor, Rudolph Giuliani.  The cheating really isn’t what bothers me.  He and his then-wife – Donna Hanover – were having very public problems.  This is none of my business.  Not until this happened; Ms. Hanover was doing an interview where she told of how they were “trying to work things out.”  As she says this, the channel goes to a split screen with the mayor giving a press conference that he was in the process of serving her with divorce papers.  Yes, that’s how she learned she was getting a divorce.  Ouch.  Where is he now?  Considering a second run for president.  Oh, he was a crappy mayor, too.

The GOP “ideas” guy, Newt Gingrich.  Three marriages and countless pieces of Tiffany’s jewelry later, everyone’s favorite “intellectual” and serial adulterer, divorced one of his wives while she was recovering in the hospital from cancer.  Doonesbury ran a cartoon of this at the time with Newt telling her to “Press hard, woman, you’re making three copies!”  Where’s this family values former Speaker?  Again, running for president.

The Governator.  Known for decades as groping women on film sets and press junkets around the globe, Arnold Schwarzenegger’s “recent” antics should shock no one (not the LA Times who reported on this when he ran for governor).  Think it gets worse than fathering a child with your maid, who continues to work for you and bring her son who looks just like you to the house you share with your wife and children?  Oh, it does.  Reports have indicated when confronted with his – is it indiscretion at this point? – situation he told Maria Shriver that she had to move out.  Oh, and the premise of his new animated series (from the press release issued the week this story broke) is that a governor is living a dual life – as governor during the day and super hero at night – he even keeps a separate and secrete home under the home he shares with his wife and family that he doesn’t even tell them about.  And where is he?  Right, starring in a new Terminator movie.  He said he would be back…

David “Acorn shouldn’t get funding because they support prostitution and only I am allowed to do that” Vitter.  In 2007, the world learned that Senator David Vitter was a client of the “DC Madam.”  He had been a “client” from 1999-2001(he was in the House of Representatives where he was serving in the seat vacated when Bob Livingston – at the time Speaker – resigned following his own adultery scandal, for which Vitter praised him saying “This is what Bill Clinton should have done.”  If that doesn’t make your head spin, what does?).  The main difference between Vitter’s support of prostitution and Acorn’s is the latter was investigated and found to be false while the only standing between Vitter and a  criminal prosecution for his crimes is the statute of limitations.  Where is he?  The US Senate.

Henry Hyde – my personal favorite.  This is an oldie but goodie.  Congressman Henry Hyde – one of the chief prosecutors of the Clinton impeachment – admitted he cheated on his wife but explained it as being a “youthful indiscretion.”  He was 51 when that happened.  I have tons of time to do dumb stuff and claim it was all because of my youth.  The former Congressman has passed – at 83 after retiring with a full pension and some pretty sweet health insurance.

What people do in their private lives – no matter how public they have made their lives – is private.  None of what I wrote about is any of my business.  I was never going to vote for any of them (except John Edwards).  When Eric Cantor – Minority Whip and lead “you need to resign, Weiner!” point person – was asked about Vitter, John Ensign (affair with employee that was covered up with payments to his best friend and her husband) and Mark Sanford (flew to Argentina with state funds to have an affair) he said “We are a party of ideas, not personalities” – it makes my skin crawl.

So, no, I don’t think Anthony Weiner should resign.

All these cheaters deserve to live (but not work!) here.

Beware of wolves who look like sheep

I may look like a sheep but I am really a wolf

The Democrats are looking a bit like the boy who cried wolf.  They have seen threats to all of the social safety net programs (Social Security, Medicare & Medicaid) in every campaign and Republican proposal.  The real problem is that when someone comes along with a plan that will end these programs, they have less credibility.  The real wolf has finally arrived.

Paul Ryan, you are that wolf.

Congressman Ryan’s plan offers a strange study in contradiction.  It is bold and honest. It is equally timid and dishonest.

This plan shows some bravery in that he does talk about some of the entitlements – the so called “third rail” of politics – Social Security and Medicare – two incredibly popular programs.  These programs are so popular that even members of the Tea Party like it – remember their signs that read “Government stay away from my Medicare!” Granted, these signs miss the point but people like knowing that when they get old they will be cared for.  So yes, Mr. Ryan, kudos for talking about them.

The bravery ends there.  While this ‘Roadmap for America’s future’ goes into detail about how we should deal with all three of these, this plan will dismantle all of them and yet it fails to deal with the fundamental problems with Medicare and Medicaid (I reject his premise that Social Security is insolvent).  He refuses to take on insurance companies and change the real status quo of health care – one person at a town hall meeting with the Congressman put it well when they said “How do you expect seniors to take on the insurance companies when you will not?”

The problem is that the costs associated with our health care system are spiraling out of control.  In this area, Congressman Ryan and I agree but we soon part ways when his plan says “At the heart of this problem is the Federal tax exclusion for employer-provided health coverage.”  His solution is to give people $2,300/year for individuals and $5,700/yr for families in the form of a tax refund – this is not for people who will be enrolled in Medicare or Medicaid but speaks to the point about lowering medical costs – this plan would require people to be responsible for any costs above the tax refund amount.  I challenge anyone to find decent health insurance for that.

There is a great piece on this in the New Yorker.  Basically, our problems can be summed up this way; our current system incentivizes cost and more care does not equal better care.  Dr. Atul Gawande, in the piece above, has this to say about it: “Americans like to believe that more is better.  But research suggests that where medicine is concerned it may actually be worse.”  He describes how we incentivize costs this way:

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”

The last part of that is particularly important because pointing out that the cost of care will not change if we change the party who pays for it because that is all the Ryan plan does.  It shifts the costs from the government back to the patient.   On this point I turn again to Dr. Gwande, he and Congressman Ryan express the argument for having patients pay the bulk of the expense is that when they do (and this is put the same exact way in the article and the plan itself) they will have some “ skin in the game.”  This will do nothing for the costs of treatment:

“When it comes to making care better and cheaper, changing who pays the doctor will make no more difference than changing who pays the electrician. The lesson of the high-quality, low-cost communities is that someone has to be accountable for the totality of care.”

 

Now would be a good time to point to a different resource for asking – do we get better care in the United States that other countries? – the Congressional Research Service (CRS) found that we do not.  You can read their report here.  In it they assert that we spend more on health care than any other country but do not get better care.  In fact they found “research comparing the quality of care has not found the United States to be superior overall. Nor does the U.S. population have substantially better access to health care resources, even putting aside the issue of the uninsured.”  The people at CRS concur with Dr. Gawande on the point of incentivizing costs, they cite the Organization for Economic Cooperation and Development (OECD):   “there is no doubt that U.S. prices for medical care commodities and services are significantly higher than in other countries and serve as a key determinant of higher overall spending.”

The cowardice does not end there; there is one entitlement that this plan leaves alone and that is defense spending.  Nowhere in this plan does he mention the military.

The “Roadmap for America’s future” is both really honest and really not.  It claims to protect and preserve Social Security, Medicare and Medicaid while simultaneously blaming them for many problems the county faces.  Congressman Ryan blames the New Deal and Great Society programs for causing government to control people’s lives, destroying the American character, removing any incentive for innovation and killing the entrepreneurial spirit that has defined us since our founding.

This is the fundamental difference between Republicans and Democrats – and is the reason the Democrats have been crying wolf for so long.  Republicans have been trying to dismantle these programs since they were enacted.  Congressman Ryan doesn’t beat around the bush on this topic.  He comes right out and blames these programs for destroying America’s character.  This idea is repeated often throughout the introduction.  It would take pages and pages to cite every example of this intent.  In one section he states: “Americans have been lured (emphasis added) into viewing the government – more than themselves, their families, their communities their faith – as their main source of support.”  He says in another section that “More ruinous in the long run in the extent to which the “safety net” has come to enmesh more and more Americans – reaching into middle incomes and higher – so that growing numbers have come to rely on government, not themselves, for growing shares of their income and assets.  By this means, the government increasingly dictates how Americans live their lives.”  That last bit is particularly interesting when you remember that some Republicans in Congress have proposed making welfare recipients take drug tests.  There is a clear irony there.

I welcome the opportunity to have the conversation about what we want our government to do and be.  I believe government exists so that we can do the things collectively that we cannot do individually.  When Congressman Ryan blames the social safety net for destroying our innovative nature, he shows just how vast the ideological gulf is between the right and the left.  When you look at growing economies and societies – Asia, I am looking at you – you see countries investing in their people.  I see a great parallel between what makes employees stay with company (hint: it’s not money) and how countries see their people.  Companies and organizations that see their employees as their greatest asset treat them better – give them the tools and resources to do their job.  Similarly, countries that invest in their children’s education, for example, are going to be the future super powers.

I am a Democrat. I do not want Social Security, Medicare and Medicaid to be turned into voucher programs: that’s the antithesis of what they were meant to be.  However, if Congressman Ryan’s plan leads to a real, productive conversation about these programs and the role the federal government should play, I welcome this as an entrée into that.  If this is the ending point, though I think ending these programs, which are infinitely more popular than any politician right now, it would not show the world that we are recapturing our entrepreneurial spirit but that we are reneging on the promises we made to our own people.

A number of people (Churchill, Ghandi, Truman, others) that “The measure of a society is the way it treats its weakest members.”  We should remember that as we move forward.