Profits

Our economy is basically based on profiteering.

Lets be clear, there is nothing wrong with making a profit, it inspires enterprise which stimulates the economy and creates jobs.

However it depends a lot on how many are eating at the trough.

Profit related to value added is productive, but profit related to effectively nothing is a problem.

In one model you might have the producer, say the farmer, who could sell direct to a consumer resulting is a single profit.

That became less possible so we see them selling to middlemen who take the product from the farm to the city say.  A second profit.

Generally they then resell the product to retail outlets who sell to the consumers, a third profit.

This is true for almost all the things we buy with escalating profits.  Of course there is usually some real service provided.

In health care of course we have multiple streams.  There is the delivery of the medical service, the equipment used, and the cost of running the hospital.  We then add the profit stream of the insurance provider.

How to reduce the cost unrelated to the actual delivery of health care would go a long way to making health care more affordable.

We just don't want to.

Health Care for All

The next election is likely to be decided, at least partly, by the issue of Health Care.

No one opposes providing it, although some seem to want to exclude certain people from receiving it, but the major issue is about how to pay for it and how to provide it.

Ultimately the health care we receive is provided by health care professionals, on-line resources, parents, various other providers using traditional or holistic methods, and, ourselves.

A great many things can be self treated or simply get better by themselves.

When something is more serious or traumatic, like a broken limb or bleeding wound, medical care is required.  Still it is more efficient to make using the simplest remedies cost effective.

How to do this and provide a system that assures everyone has access to the care they need is the issue.  Our current system works for a fairly large percentage of the population but not for many others.

A lot depends of whether you have a job with benefits or not and if not how you obtain health coverage.  It also varies widely by where you live.

It would seem that one way would simply be to provide coverage to all those who don't currently have it and work out a transition plan for the rest.

We spend a tremendous amount on health care already and it would seem that an efficient system could reduce overall costs and provide the same or better coverage.

Its the details that are hard.

Fixing Health Coverage?

The number of Americans without health insurance is on the rise.

LA Times Health Insurance

The failure to advertise the open season, the ending of penalties for not having coverage and the attacks on Medicaid have reversed the downward trend in uninsured and started an increase.

Not having coverage leads to failure in many cases to get preventive care and screenings that indicate problems early.

The fallback position for people without health care is normally the emergency rooms where care is most expensive and often conditions have become more dangerously progressed.

We were supposed to see a great new bunch of health plans that would be better, cheaper and more affordable.

We did not.

We do see some plans that offer very little coverage but cost at least as much as the plans that were on the exchange.

They don't receive a Government subsidy so they are cheaper for the Government, just not the user.

In fact we should not lose sight that the goal of the current administration and republicans in general is to protect businesses and wealthy people who object to having tax money help the less fortunate.

We see that in the tax reform that they passed.

The reform was to make our tax system less progressive and allow the rich to keep more of their money.

More houses, private jets, and yachts instead of health screenings for our citizens.

What's not to like?

Politics or Policies?

WE are of to a quick start in the blame game as the Democrats are being blamed for preventing all the great policies the president wants.

Of course, it's debatable a to whether those policies are particularly good or if they are just politics.

Its fairly easy to define objectives that almost all Americans would agree with.  Border Security would be one of them.  The use of this phrase to mean build a wall isn't.  Border Security is the prevention of undocumented crossing but in an efficient and affordable way.

Immigration is not much of a threat to this country, in fact it has always been one of the cornerstones of our growth. Still, almost every American would agree that it should be controlled and regulated.

Similarly, almost all Americans would agree that good affordable health care should be available to all.  How to achieve that is the issue.  Most countries have made this a Government obligation where it is provided at no point of service cost.(there is of course a cost that the taxpayers bear).  It has been shown to bee efficient and effective, but it conflicts with our capitalistic system.  The Affordable Care Act kept the private provider system and overlaid Government subsidies for those who qualified.  It was a compromise that incorporated many republican features, but it didn't win over many republicans as politics became more important than outcomes.  It did significantly reduce the number of uninsured in this country.

Issue after issue could also be addressed in a manner that would win the support of the great majority of Americans is we ignored politics and focused on policies.  Take something like gun control.  We have moved to an all or nothing approach, largely because of the lobbying of the NRA.  Yet throughout our history we had restrictions of who could own a gun and where they could carry it, it just made sense.  No citizen should be prevented from owning guns, if they pass a reasonable background check and take responsibility to control them.  We do this with cars, motorcycles and boats, why not guns?

Its the politics and the great amount of money involved that prevent progress.  We need to demand good policies, not bad politics.

Otherwise not much will happen.

Bipartisan Solution?

On pretty shaky grounds a judge in Texas has ruled that the Tax law of 2017 made the affordable care act of 2010 unconstitutional because it eliminated the penalty for the individual mandate.

What will happen with this is anybody's guess and the logic is very tenuous, but in this country if you find the right judge you can get almost any nonsense.

Now that we see more conservative judges being appointed we may have reason to think this might be upheld, although it is certainly not certain and the law will remain in effect until it winds its way through all the appeals.

It would of course be ideal to simply pass a new law that includes all the things we like but the problem with that is, some conservatives view any interference in the health marketplace as a type of socialism.

Certainly the affordable care act wasn't perfect but it greatly increased coverage, has covered pre-existing conditions and has allowed dependents to stay on coverage longer.

It also mandates that certain preventive services be offered at no additional cost in order to increase the overall health of Americans.

If of course you simply believe that he Government has no role to play here, the good things it does becomes irrelevant.

That is not the view of the great majority of Americans and its time our representatives actually represented us.

This will take a number of years to get to the Supreme Court, its ultimate destination and in two years the American people will have the opportunity to make their voices heard on how they feel.

Its time to have a bipartisan solution.

Unfortunately the odds of that happening are pretty slim.

Health Care, Still Under Attack

You may or may not have noticed that this is the time to enroll in a health plan under the Affordable Care Act if you are eligible.

There is virtually no outreach going on for the Federal Exchange if you live in one of the states without their own exchange.

The current administration was unable to repeal it and instead is doing everything it can to destroy it by other means.

Attempts to repeal it outright are probably over, at least for the next two years if not forever, but attempts to undercut it continue.

As predicted with more experience and with a more stable outlook, premiums have generally stabilized and more providers are joining in since they see opportunities to make profits.

Current attempts to destabilize it include the introduction of low cost do little plans designed to appeal to low risk customers.  If you can get them out of the plans, it will increase costs.

However for many of those, the full coverage plans in the exchange end up being more affordable when you get the income based subsidy that's part of the act.

Now the administration is trying to allow states to apply those subsidies to non qualifying plans outside of the exchanges.

This is of doubtful legality since the coverages and the subsidies are both pretty clearly spelled out, but when you predict it will collapse and try to undermine it without success, well try harder.

Most Americans have come to, if not love, at least accept the plan and most love some of its best provisions like covering pre-existing conditions or allowing dependents to stay covered longer.

We are now going to see some attempts at expanding it even further as many progressives are pushing the concept of Medicare for All.

It will be interesting to watch.

Pre-Existing Conditions

By this time, most of the country has accepted that the Affordable Care Act added some good things to health care.

Not allowing insurers to charge more for pre-existing conditions, allowing children to stay on their parents coverage until 26, expanding health coverage to millions of previously uninsured Americans.

Despite this and even having no replacement plan, the dontard and his cohorts continue to attack it.

The elimination of the personal mandate and certain subsidies to health insurers only served to increase some premiums and since most premiums get subsidized increase the cost to the Government and therefore us.

They have reduced the sign up periods and advertising for the plans being offered.

Despite some dour predictions, we see more states incorporating the Medicaid expansion and the public still trying to get health insurance.

Now the administration has decided to stop defending the benefits of the plan in court as certain states continue to attack it.

The legal arguments are pretty weak, they argue that with the individual mandate tax advantage gone the other provisions such as pre-existing conditions are now unconstitutional.

The administration has decided not to defend the act, so it is now states attacking and other states defending.

The opposition to the law is based mostly on a philosophical opposition to Government health care and a general dislike of some rich people paying taxes.

All Americans have benefited from these provisions and no politician would try to eliminate them, except of course the dontard, who has a twisted sense of reality.

He opposes the act because it was passed under his predecessor.

That's enough to try to strip these benefits from all of us.

Afordable Care Act

Don't hear much about the Affordable Care Act right now.

It is still under assault as a group of states have filed suit calling it unconstitutional, oddly because congress repealed the individual mandate which they argue invalidates the rest of the law.

I think this is more of a stunt but of course we would need to see if it progresses in the courts.

Generally the law continues and while a lot of it cold be improved, the odds of that are slim indeed.

So it will probably just continue in its current form until at least 2020 when w will see if a new administration wants to tackle it.

American all want affordable, available health care if they think about it.

Young people often don't think much about it until they start a family.

If of course you end up needing expensive treatment and have no coverage, it will bankrupt you or leave you in heavy debt.

We are one of the few, if not the only, industrialized countries that treats our citizens that way.

The cost of treatment and medicines is often obscene.

We could certainly benefit from a single payer system, but that seems pretty far off at this point

In addition to being expensive, it also manages to be extremely complex with coverages uncertain, as well as deductibles and co-pays.

Just something else our useless congress isn't going to address.

Health Care and Politics

There is a major disconnect in this country in how much people have to pay for health coverage.  It also impacts the care they receive.

As far as most countries go we are unique in our approach, if you want to call it that.

Most civilized countries recognize that health care is a fundamental right that the Government has an obligation to provide.

We don't.

Not sure if that is a question of our civilized status or simply the fact that we have let wealthy people dictate how the Government behaves.

Even in countries where there were or still are monarchies, the privileged classes long ago lost the fight to control the Government.  Yes there are still conservative parties, but only in this country do we feel that you have to be deserving to get care.

Our politicians are for sale because of the way we conduct elections. 

To run a successful campaign you need money, in some cases a lot of it, and the people who are most likely to help have a lot of it.

So you have to present your issues in a way that is acceptable to them if you hope to get a donation.

Of course even among wealthy people you have certain differences of opinion.

Still, the idea of universal health care and higher taxes to pay for it isn't on most of their lists.

In many ways we have a country where people have learned to blame each other for problems instead of the Government.

So we complain about poor people who get free health care instead of demanding we all get similar coverage. 

Its a sign of success to have a job that pays good benefits now, which is really a sad statement since aren't we all entitled to at least good health care?

Trump Care is less care

The question is how much damage to the health coverage of Americans can the dotard do before everyone wises up?

The general concept of making sure Americans get adequate health care when they need it is pretty much universally agreed to, at least verbally.  The discussion should be about how to do that.

Now, the reason that the clowns in congress weren't able to pass any health care laws is that they ran into a few republicans with a conscience.

Of course the Affordable Care Act doesn't achieve that goal either, but its a step in that direction.

Now by signing an executive order and stopping subsidies, the dotard is taking a step back and increasing the premiums on the people who weren't doing great under the ACA already.

The first one is going to take a while to implement but what it does is attempt to cherry pick healthy people out of the exchanges leaving a sicker pool of people to insure.  The healthy people could pay less but the riskier people will pay more.

This might sound fair except it defeats the concept of insurance.  The idea is that a lot of healthy people and a few sick people pay the same amount and they all are covered against costs that would bankrupt people otherwise.

The second action stops subsidies paid to insurance companies that have to bear high costs for mandatory coverage.  Since the affordable care act mandated that rates for all be capped, certain high cost conditions were not calculated into them since they were unpredictable.  The subsidies served to reduce the premiums for that coverage.

Now without the subsidies those premiums will go up to cover the full potential risk.  This will have a disparate impact since if you qualify for the individual tax benefit you will be protected from the increase.  So people who have to pay the full cost without Government help will be faced with even more cost increases.

Many of these people were the ones who Trump highlights in his criticism of what was Obamacare.  Of course he now needs to take ownership of it as he goes out of his way to make things worse.

Are They Evil?

You have to wonder what motivates some people to act in a manner that is designed to hurt large numbers of people.

If you consider a proposal that will undoubtedly actually take health insurance away form low income people and people with pre-existing conditions you wonder whether the proponents possess any type of moral foundation?

I mean they certainly pretend to be moral but it becomes pretty clear that in the pursuit of narrow political gains and a way to reduce taxes on people who actually have money they are perfectly willing to throw our poorest and weakest under the nearest bus.

It violates the basic tenets of Christianity and pretending that what your doing isn't going to do that means you are either a bald faced liar or really ignorant.

The current proposal takes the money we use for this, reduces it and spreads it out among the States based on a formula.

This formula will help States that didn't increase their Medicaid but will hurt States that did.

Now it also allows States to get exemptions from certain things, like group rating pre-existing conditions, which would mean in those states the cost for those people would go up.

I suppose one way to do this and still pretend to have morals is to say well the States were the executioners, we only passed a law that let them do it.

It should also be noted that the States acted based on commitments in the law that promised a certain level of reimbursement.  So breaking a commitment is another aspect of their moral depravity.

It is primarily a desire to deliver on a promise many made about repealing Obamacare so they can claim in the next elections they delivered on that promise.

Who cares how many they hurt?

Now lets be clear, no one will receive better health care if this law passes.  It reduces the funding and that will reduce coverage.  Now they may argue that the wonderful States are going to find great ways to reduce the cost of Health Care leading to actual better care for all.

Sure, watch our for the flying pigs too.

Working People Health Care

Its amazing how easily the Republican establishment is willing to throw the working class Americans under the bus.

A lot of these people voted for Trump because they have seen their jobs disappear and wages sink.

They need to rely upon two family income and don't have in many cases employer supplied health care.

They have significant health issues ranging from obesity and depression to black lung and other debilitating injuries.

They have been able in many cases to obtain adequate health care under the Affordable Care Act and often the Medicare expansion part.

There are some issues with the ACA but for the people who really need it, it is a god send.

Without it, they wouldn't have any insurance or terribly expensive risk rated insurance.

Now some things people say about the ACA are true but they spin it as a problem when it really isn't.

Take high deductibles.

They reduce the premiums you pay and the idea is that it keeps you from using certain optional health services.

However, the plans cap the total amount you are at risk for and as its designed to do allows people with serious medical conditions get need care without going bankrupt.

So pay a little more each month and reduce the deductible or pay a little less and increase it.

That's a choice each person gets to make under the ACA based on the Bronze Silver or Gold plans.

Now if their was an alternative that promised a low deductible and low premiums that would be great.

However between a high deductible and no coverage at all, I think the choice is pretty clear.

Not to a lot of legislators it seems.

Health Care not Health Insurance

American want affordable health care.  The cost of modern medicine has exceeded the ability of most people to pay for it without insurance.

In an attempt to help the uninsured in this country we saw the affordable care act which was successful in extending care to millions of previously uninsured people.  It certainly wasn't perfect and as certain flaws emerged the congress because of partisan politics wasn't interested in improving it.

Now, I don't want to argue the overall benefits, it helped people who didn't have insurance already but it had some negative impact on people who previously had insurance, at least in some cases.

Statistically it was clearly a net benefit but no one likes to be in the negative part of a statistic.

 Now repealing it has turned out to be a difficult task and as our current president seemed to discover, quite complex.

However, if we simply address the question of how to provide quality health care to all Americans we may see some solutions.

Now the quality care is part of the problem.  Some people with good benefits don't want to see their choice of doctors or hospitals diminished.

For a long time we have had an overall shortage of doctors in this country, especially in certain areas.  Increasing the number of doctors or health practitioners who can take some of the work is something that helps deliver more health care to more people.

Now, our system effectively uses commercial providers to collect money and pay health care professionals, based on the provisions of their policies.  This creates in-network and out of network systems that in some cases are problematic.

People want to be able to go to a doctor to get treated without having to go through a long list of acceptable practitioners.  Further, certain plans can't attracts popular doctors because the reimbursement schedules are too low.

Medicare is a system that works fairly well, although it also has some of the same issues, especially with getting doctors to accept the payment schedules.  So is Medicare for all a viable solution?

It might be.  Remember of course that in this country a lot is determined by who owns the most legislators and the health insurance industry has bought quite a few.  It unlikely that we are going to pass anything that seriously erodes their profits.

Once again its a complex issue that begs for a simple solution, "Quality Health Care for All".

Getting there is the problem.

A Better America

The idea that America has been in some sort of decline is simply not true.  America has been changing and to some extent our post World War 2 privileged status is long since gone, but at no point has America been stronger or in fact more prosperous on the whole.

One thing has happened is that the growth in wealth has been uneven.

This has fueled a certain amount of anger among those who used to have a better share of the wealth, in general non college educated men.

They held a lot of good paying jobs in manufacturing particularly which actually required little more than showing up and doing fairly simple tasks.

Robots are cheaper, don't need benefits and don't show up or stay home because they got drunk.

Now the robots improve the bottom line and that wealth goes to the owners and executives.

So for that group of Americans things look worse, but the only solution is for them to get new skills that are needed, and since it wouldn't be in the same numbers as when unskilled workers were on an assembly line, most of them aren't going to do it.

Even worse, they've been led to believe that the people responsible for their problems aren't the factory owners and executives (although in fairness it is just business) but trade deals, immigrants, the Government, liberals and environmentalists.

So they don't like those people, although clearly none of them were actually responsible to any great extent, it was technology.

Now we aren't going to reverse technology, if we did our companies would be non-competitive but we can improve life for Americans in ways that keep making America better.

These are the progressive goals, a cleaner environment, health care for all, education for all, combat climate change, treat ALL people fairly, and allow individual freedom as long as it doesn't infringe on someone else's freedom.

What job you qualify for or can hold is up to you but whatever it is, you should have air to breathe.

Lets make America better and better.