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:

Screen Shot 2017-03-09 at 12.28.21 PM

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

Screen Shot 2017-03-09 at 12.28.02 PM

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.


We deserve better

Screen Shot 2014-04-22 at 9.47.38 AM

Conventional Republican wisdom is that the fewer taxes people pay and the simpler the tax code is, the happier and wealthier we all would be.  In fact, our economy would soar and it would be utopia. Thomas Piketty’s recent book, Capital in the 21st Century  claims the opposite.

Piketty, a French economist known for studying inequality, argues that progressive taxation reduces it.  Psychologists find that people are most satisfied, not when they have the most of something (like money), though some probably are, but when they don’t see a huge difference between themselves and the people around them.  The Organization for Economic Development and Cooperation (OECD) puts out a yearly list rating the quality of life around the world.  They rank: 1. Australia, 2.Sweeden, 3. Canada, 4. Norway, 5. Switzerland, 6.the United States, 7. Denmark, 8. the Netherlands, 9, Iceland and 10. the UK.  Of the countries on the chart, only the UK follows us.  Everyone on the list pays higher taxes.

The 2011 paper , Progressive Taxation and the the Subjective Well-being of Nations (Dr. Shigehiro Oishi from the University of Virginia) found, “Respondents living in a nation with more-progressive taxation evaluated their lives as closer to the best possible life and reported having more positive and less negative daily experiences than did respondents living in a nation with less-progressive taxation.”

When Bill Clinton was president, some on the right claimed that he was destroying our way of life because he was making “taxation acceptable.”  His argument was that people would start getting something good in return for their taxes and not mind paying them.  According to the right, this would lead to the apocalypse.

The right doesn’t hate President Obama just because of the Affordable Care Act, they hated him long before that, but it is one reason.  Obamacare is a tangible way people can see their taxes in action.  In the same vein, they aren’t trying to cut education funding for just that reason, they just think the only things our tax dollars should go to is the military and investigations into the Obama administration.

Republican Supreme Court Justice Oliver Wendell Holmes said, “Taxes are the price we pay for a civilized society.”  Maybe we need to stop demonizing taxes and wonder why making things essential to life such as health care, an education, shelter, etc. is so bad.  The citizens of such a great county as this one deserve better.

Enhanced by Zemanta

Memo to Democrats: Embrace Obamacare

Although it is only March, the post mortem has already been written for the Democratic performance in November’s term elections.  CNN’s John King said the situation is “bleaker than bleak.”  A Democratic strategist said the numbers portend a “tsunami sized loss” for the party.  Whichever party controls the White House usually does poorly in off year elections and this president approval rating is at an all time low.  Having said all of that, things can get better for the party and embracing Obamacare may be the way to do that.

Thus far, the GOP strategy on the Affordable Care Act or Obamacare has been pretty effective and was helped by the disastrous rollout last fall.  When David Jolly defeated Alex Sink in this month’s special election, the GOP claimed this was because the anti-Obamacare message works.  The Democrats have been trying to spin this as not a loss but a near win as Sink got so close in a swing district that been held by a Republican for more than four decades.  Both sides are partially correct.

First of all, voter turnout won the day in Florida.  This was a special election in an off year and fewer people vote in these types of elections.  Moreover, the people who tend to show up at the polls are older, whiter and more conservative.  Also, anger is a big motivator for most people.  So, yes, running against Obamacare helped the GOP here because it got more people to the polls.  And yes, their message works in places like this because it is simple: you don’t like Obamacare and neither do we, vote for us.

The takeaways from this are pretty clear and the Democrats can turn this around if they really want to.

Own Obamacare.  Running away from the health care law helps no one.  So far the GOP has won on this issue because supporters of the law have let opponents define it and set the rules for how we talk about it.  This has to stop.  The trick is to start talking up the law NOW.  The best time to talk about the benefits of Obamacare is not during a campaign or on a 30 second ad, people need to hear about how it helps them NOW.

Obamacare will be more popular in the fall.  The law is very unpopular now.  A recent USA Today/Pew Research Center poll put its approval rating at 42 percent.  Having said that, Gallup did a poll earlier this year that showed that 56 percent of uninsured Americans plan to use a government exchange to get coverage.  So far, five million people have enrolled through the plan.  As more people use (and like) the new system and as memory of the horrible rollout fades (it will have been over a year since implementation), people’s anger will dissipate.  One reason the GOP was so opposed to implementing the law was that once it is in place, it will be impossible to repeal.

Obamacare will not end our way of life.  The GOP is fond of saying that this is going to end our freedom.  Well, they said the same thing of Medicare.  Ronald Reagan once said, of the now popular program, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.”  That didn’t work out that way and neither will this.

Obamacare is not socialism.  If anything, it is forced capitalism as it mandates people buy something from a private company.  The idea of the individual mandate came from the Heritage Foundation.  This is from their 1989 report:

Mandate all households to obtain adequate insurance. Many states now require passengers in automobiles to wear seatbelts for their own protection. Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness. Under the Heritage plan, there would be such a requirement. This mandate is based on two important principles. First, that health care protection is a responsibility of individuals, not businesses. Thus to the extent that anybody should be required to provide coverage to a family, the household mandate assumes that it is the family that carries the first responsibility. Second, it assumes that there is an implicit contract between households and society, based on the notion that health insurance is not like other forms of insurance protection. If a young man wrecks his Pors c he and has not had the foresight to obtain insurance, we may commiserate but society feels no obligation to repair his car. But health care is different. If a man is struck down by a heart attack in the street, Americans will care for him whether or not h e has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services – even if that means more prudent citizens end up paying the tab. A mandate on individuals recognizes this impl i cit contract. Society does feel a moral obligation to insure that its citizens do not suffer from the unavailability of health care. But on the other hand, each household has the obligation, to the extent it is able, to avoid placing demands on society by protecting itself.

Obamacare is not a “job killer” nor will it “discourage work.”  This are common themes among opponents of the law.  Congressman Paul Ryan told the Conservative Political Action Conference (CPAC) that Obamacare will discourage people from finding jobs and there are too many quotes from his party about how it will hurt the US economy and job creation.  None of that is true.  In 2011, the Rand corporation did a study on the impact of health insurance on job creation.  They found the high cost of health insurance is a deterrent to entrepreneurship and small business creation: people stay in jobs rather than strike out on their own to keep employer offered coverage.

Obamacare is not perfect but it is a real step forward.  Our businesses have long been hurt by the requirement that they provide health insurance and have to compete globally against companies who do not.  Our citizens have been hurt by a system that is costly and ineffective. Some 45,000 people die each year in the United States because they lack access to health care.  It’s time for Democrats to stop running from the president’s signature law and start embracing it.


Enhanced by Zemanta

Healthcare reform, three years later…

English: President Barack Obama's signature on...

English: President Barack Obama’s signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

The Affordable Care Act (ACA), otherwise known as Obamacare turns three today.  Read more here.

#HCR and you

President Barack Obama's signature on the heal...

President Barack Obama's signature on the health insurance reform bill at the White House, March 23, 2010. The President signed the bill with 22 different pens. (Photo credit: Wikipedia)

On the second anniversary of  the Affordable Care Act, I am reminded of a conversation I had with a reporter from The Daily Caller who likened the legislation to something from Nazi Germany (seriously).  He went on to say that no insurance company had ever dropped anyone for becoming ill.  He challenged me to find someone this happened to.

As luck would have it, I didn’t have to look very far because it happened to me.

In 2003, I left my job to go back to school.  For some reason I didn’t think I could get Georgetown University’s student plan for the summer session so I bought my own personal plan.  In the fall, I had planned to cancel the personal plan and just go with the student insurance but I forgot to cancel it and had both.  The effective enrollment date of this plan was June 1, 2003.  (It was a good thing that I kept both because a decent chunk of my care was received when I was not eligible for the student insurance.)

Prior to 2003, I had been pretty healthy.  I have always been a bit anemic but I used to donate blood and platelets on a regular basis.  My only real complaint was my knees, which suck and both have been operated on.

In November 2003, I started feeling really crappy.  I was taking organic chemistry and physics.  I was terrified of physics and orgo is just hellish (though it is the best class, in retrospect, that I have ever taken, it really improved the way I process information and every college student should have to take it).  My symptoms were stomach pain and nausea, things I could easily dismiss as being related to the course material and all the coffee I was drinking.  I am very good at ignoring things I do not want to deal with.

By mid-December, I could not ignore it anymore because I started throwing up blood.  A lot of it.  When I was seen at the GTown ER, they put in a naso-gastric (NG) tube to flush out my stomach to determine if there was any active bleeding but were pretty sure there would not be.  They were wrong. They found a bleeding ulcer which kept me there for the next week.

Over the next few months, the ulcer did not respond to treatment.  At least not in a good way.   It was growing and by late winter it was one of the biggest they had ever seen at Georgetown Hospital  (Go big or go home as I always say).  They recommended surgery to remove it.  So I had laproscopic surgery to remove just the ulcer.

A few days after I got home from that operation, I became really sick.  Had a high fever and was back in the ER.  An infection had developed and I needed a drain inserted.  (Side note: my insurance did not want to pay for the anesthesia used to insert said drain until I described, in as much gruesome detail as I could come up with, the procedure and then they did pay.)  Spent another week in the hospital.

Several weeks after that, a blockage formed and I couldn’t eat anything so back to the hospital I went.  My only option was an open partial gastrectomy.  This was much more invasive and serious a surgery than the first.  They removed the bottom (distal) third of my stomach.  This is called a Billroth II.

The next phase of my medical drama is at least partially my fault.  If you ever have major surgery, give yourself more than two weeks (once you are home) to go work on a national, political campaign.  You’ll thank me later.  I ended up in the cardiac care units of two different hospitals that summer.  That was because my healing stomach was still bleeding.

Meanwhile, back at the ranch, my personal health insurance had stopped paying.  By this time, the tab for my care for 2004 hovered around $450,000.  They were claiming this was a pre-existing condition and refusing to pay for any claims that had been submitted and any that were coming in.  My coverage had been pretty much suspended and I advised against going to the doctor until this was resolved.  In this area, I was lucky because I didn’t need to for a few months but things could have easily gone the other way.  It took several months but they finally agreed that this was not “pre-existing.”

Note:  It may be worthwhile to treat medical records like a credit score of sorts.  I had trouble getting Georgetown Hospital to send my records to the insurance company — there were hundreds, if not thousands, of pages of them.  When I went through them I found an injury I never had (one of the few!).  On on ER visit, subsequent to all of this, the nurse who triaged me asked me if a certain physician was my doctor.  When I told her I had no idea who that was, she replied “He delivered your twins.”  She really thought I was out of my mind until I told her I didn’t have any children.

In a sense, that reporter was right.  Insurance companies don’t come out and say, “We’re dropping you because you are sick.”  They do, decide to call something pre-existing, and it doesn’t have to be for them to call it that and get away with it — at least until now.

I wrote this detailed account of my medical problems to show how rapidly things can go very wrong.  As I stated, I was healthy when I purchased the private insurance.   I was working out at least five times a week.

The United States stands alone in a number of areas.  Our approach to health care incentivizes costs, not care.  Moreover, while we pride ourselves of having the best system in the world, if we prevent access to it, what good is it?   Dr. Atul Gawande wrote an excellent piece for the New Yorker on the current status of our health care system.  You can read that here.  We are also exceptional in terms of how bankruptcies caused by medical bills.  That isn’t a problem in other countries but is huge here.  In economic times like these, far too many of us are one emergency away from bankruptcy.  That is unacceptable.

Personally, I think we need to do more with health care reform.  We need a single payer system.  I do not, however, think “Obamacare” is a vast overreach by the federal government.  I think it is a good start.