Saturday, August 3, 2019

Health Care Reform, Guns, Becoming a Russian "Asset," Idolizing our Presidents and an Irritating TV Commercial

Good News

Ratcliffe withdrew his name as Trump's new Director of Intelligence.  He recognized that he didn't have enough for the job.  For the time being, we won that one.
Jack Lippman

Bad News – Another Mass Shooting

Enough is enough.  How many more times does it have to happen?  It is time to REPEAL THE SECOND AMENDMENT!  No cititzen is going to be asked to bring their guns along with them when called to serve in a “well-regulated militia.” That was the intent of the Second Amendment’s protection of gun rights and misinterpretations of it by Supreme Court Justices cannot change that.  REPEAL will allow Congress to pass legislation aimed at reducing gun violence and not prevent individual States from passing reasonable laws allowing guns for hunting, sport-shooting and self-protection.  Now is the time for a bi-partisan REPEAL effort!
                                             * * *

Making Everybody HappyHealth Care Reform

Getting Back to Issues

Here’s the bottom line on what will happen in regard to health care if the Democrats win in 2020, regardless of what their ultimate candidate says during the campaign.  This, of course, is my opinion.

On both evenings of the recent “debates” among the twenty aspirants for the Democratic presidential nomination, health care reform was a major topic.   It will continue to be, and if the Democrats win the White House and large enough congressional majorities to get to do something about it, there will indeed be health care reform.  What it turns out to be will be the result of a barrel of compromises among the ideas of the new President and those of the House and the Senate.  It will not be what Joe Biden, Bernie Sanders, Elizabeth Warren, Kamala Harris or any of this week’s debaters precisely had in mind, although their ideas will be part of the mix from which health care reform will come.

Let’s look at health care in this country as it stands right now.  That’s where the starting point will be.

There are exceptions (always including the very wealthy who will pay for the best of everything, including health care beyond what any government plan or insurance company would cover) to these categories but generally here’s how Americans get their health care today.

1.  Most seniors have “traditional” Medicare, which they pay for in part by a modest deduction from their Social Security checks.  The government pays for the rest out of tax receipts.  Some seniors purchase a supplement to “traditional” Medicare from a private insurer to cover what Medicare doesn’t.  Those who don’t may have to pay 20% of their doctor bills and live with deductibles as well.  That 20% can be a considerable amount, considering what major surgeries cost today, even at the Medicare approved charge.  

2.  About a third of seniors have chosen a Medicare Advantage plan from private insurers, for which they usually pay nothing, the cost being covered by the government contribution mentioned above for “traditional” Medicare. While, participants have no doctor bills to worry about, Medicare Advantage plans limit the doctors and hospitals available to those who chose their plans.

3.    Those below Medicare age are left to get their coverage from their employers, either fully paid for or sharing its cost, and the policies from private insurers providing this must meet the standards of the Affordable Care Act, although the present Administration is loosening those standards. 

4.  If an employer plan is not available, individuals can personally buy a range of standardized policies from private insurers, policies which meet the standards of the Affordable Care Act, which can involve significant deductibles and co-payments in their less costly versions.   The present administration is actually encouraging the availability of one-year policies with high deductibles and co-payments, but very low premiums, as an alternative to the policies approved by the Affordable Care Act.  The only good thing about these plans, which were only intended as coverage for folks “between jobs,” is that they are better than nothing at all.

5.    Some unions have provided excellent health care insurance through their own funds, paid for by years of membership dues, to members and to retirees.  Generally, these plans easily meet the Affordable Care Act’s standards.  Veterans are also eligible for health care from the Veteran’s Administration, but the level of care they can qualify for depends on their time in service, their present financial status and whether they were wounded in the line of duty.

6.   Individuals and families below the poverty line are eligible for State-managed Medicaid programs which also are government-funded.  While these are “free,” participants’ choices of doctors and hospitals is limited.

7.    Right now, there are about 27 million Americans who have fallen between the cracks and have none of the above coverages.  An emergency room, the only place they can go, will not turn them away, but the cost of their care is factored into what hospitals charge other patients and insurance companies.  Usually such patients have not had prior routine medical care and often show up with serious health problems resulting in large unpaid bills.   Also, bulwarks of the Affordable Care Act included a requirement that everyone be insured, and that pre-existing conditions be covered.  The first has already been gotten rid of by the present Administration and the second is under its attack in the courts at present.

         *    *    *

Okay.  This is where Congress and the new President will start in their task of accomplishing health care reform.  My guess is that by the end of 2021, if enough Democrats are elected to Congress, and there is a Democrat in the White House, we will end up with a grand compromise looking something like this:

It will indeed be “Medicare for All,” or something resembling it for those who advocate “Medicare for All.”  For those who advocate something less extreme, less of a ‘structural’ change, it will consist of reforms in the Affordable Care Act which will include what is referred to as the “public option.”  But both groups will be talking about the same plan!   

In this “plan,” every American will be given the opportunity to participate in the Medicare Program, either the “traditional” one or the “Medicare Advantage” version explained above.  This will be the “public option,” and for those who choose it, it will amount to “Medicare for All.”  They will pay a premium to do this, just as those in “traditional” Medicare do today if they choose that route.  Most of the cost will, however, be borne by the government through increased taxes. This cost, and the taxes necessary to cover it, will hopefully be less than what Americans are paying today for private health insurance.

As provided by the Affordable Care Act, individuals who have employer-based coverage, union coverage or individual policies, will be allowed to keep them  or purchase them provided that the plan’s benefits are certified as being at least as good as that available under the Act’s new “public option,” “Medicare for All.” Similarly, those covered by the Veteran’s Administration or Medicaid will not be affected.

It is anticipated that private insurance company plans available through the Affordable Care Act which provide as good coverage as that which is provided under the “Medicare for All” “public option” will cost more than the “public option’s” “Medicare for All” plan because they will not be subsidized by taxes to the extent Medicare is.  In the debates, some potential candidates saw this as resulting in the withering away of the private insurance plans, succumbing to the "public option," as taking place anytime from "day one" up until ten years down the road.  That would leave us with "Medicare for All" via the "public option," unless its high cost and resultant tax hikes derail it during that period.

Those who choose either route (Affordable Care Act plans or the "public option") whose income falls below certain levels will be eligible for government subsidization of their share of the premiums, as is the case with plans in the Affordable Care Act today.  Medicare Advantage Plans, as part of the “public option” which do not call for a participant to pay a premium, will be encouraged but not mandatory.

Everyone will have to participate, and there will have to be some sort of penalty for those who do not, despite the Supreme Court’s negative decision regarding the Affordable Care Act’s mandate to participate.  Lawyers will have to find a way to do it.  As for those who reside in the country but are not citizens, they will be included in the plan if they pay taxes.  Those who do not have enough income to pay taxes will be eligible for Medicaid.

That is what I think we will end up with.  Although some would like health care reform to include dental, optical, hearing and expanded assisted living and nursing home care, these benefits will not be part of the initial 2021 package.  

A compromise program like this leaves a niche in the marketplace for private insurance companies to issue supplementary plans which fill “traditional” Medicare gaps in coverage chosen by those who opt for “public option,” as well as to come up with creative ideas with which to provide coverages within the Affordable Care Act which are as good as the “public option” “Medicare for All’ plan for individuals and employers and not cost more.  It will amount to the private sector trying to be more efficient than the public sector in providing health care coverage, in a setting where taxes are certain to rise. 

The ones who will suffer the most under these reforms will be the physicians and hospitals who will be carefully regulated as to what they can charge for specific services.  This is already a problem with Medicare today. It will be even more as Medicare becomes the “public option.”   At the debate, one participant said that a hospital director told him that if they had to bill the Medicare approved charge for everything they provide, they would have to close their doors. 
Campus of Erasmus Hospital in Rotterdam, to which my wife
went for cancer treatment which was not then availablile in this
 country thirteen years ago.  Erasmus is  government-run
with its physicans all on government salaries, and care
there is free for the Dutch.  Prices for us were a fraction
of what it would have cost in this country.
It has been said that when one door closes, another one opens.  That may be what will be happening in health care in the United States.  

Of course, If the Trumpublicans come out on top in 2020, none of the above will come to pass.


                                                 * * *

Irritating TV Commercial Number 4,586

There’s a TV commercial advertising a company which offers to help resolve problems for people who owe large amounts of money to the Internal Revenue Service.   (Incidentally, it doesn’t mention in the ads that any amounts “forgiven” by the IRS become taxable income.) 

Julia is happy!
  Anyhow, I wonder how poor Julia who was losing sleep over the $66,000 the IRS was dunning her for and how grateful Dan who got help in resolving his $102,000 indebtedness to the government amassed those not insignificant amounts of debt.  Obviously, the income they were receiving did not provide for withholding.  

Did they go year after year without even bothering to file a tax return?  That’s pretty dumb, but it’s also pretty dumb not to have a local CPA handle the problem rather than answer a TV ad so my conclusion is that these folks are pretty dumb.  If they did file returns, I wonder if the information they provided was fraudulent, or considerable income was just not mentioned.  That’s criminal.

These people are not to be pitied.  They are to be scorned because when they tried to rip off the government by not paying taxes, or were just too negligent to pay their taxes, you are the people into whose pockets they were reaching.  If Julia and Dan didn’t pay their taxes, you and I eventually made up for it.

Next time around, we’ll get to the lady who tells us “that was the best $150 I ever spent!”
                                         * * *

How to Become (or Choose Not to Become) a Russian Asset 

Carrot  Top
The President still questions the Mueller Report’s documentation of Russian interference in the 2016 election and the our government intelligence community’s confirmation of that revelation and its continuance today.  His blind vanity puts him in this position because it sheds a shadow on the legitimacy of his election.  As a result, he prefers to believe Vladimir Putin when he says that Russia did no such thing.  That makes him an “asset” of Russia’s efforts to interfere with our election process.  Because of his vanity and his lack of intelligence (not the ‘spy’ kind, but the kind in one’s head), his status as a Russian asset is an “unwitting” one, which he refuses to recognize.

Moscow Mitch
This puts Republican legislators, most of whom are far smarter than the President,  in a curious position.  If they choose to back the President, as Senate leader Mitch McConnell does, they become Russian assets as well, and while not recuited by the Russians, their status as their 'assets' is not an 'unwitting' one, as is the case with the President.  They are willing to do this to retain the support of Trump’s firm base of gullible and bigoted believers, which they need when they run for re-election.  

Some courageous Republicans with a conscience have announced that they are not seeking re-election which is their way of saying that while they still are Republicans, they are not Trumpublicans, whose acceptance of the status of being Russian assets begins to approach the borderlines of treason.   

                                                            * * *

Be Careful Whom You Put on a Pedestal

Thomas Jefferson and James Madison had differences.  The Republican Party, even when it was the Party of Nixon or Reagan, which it not longer is, subscribes to some pretty strange ideas.  We should think long and hard before we idolize, and set up as iconic figures,  those of Jefferson's, Madison's  and Reagan's stature.  Do you believe that "The earth always belongs to the living generation."? One of them did.  To read this fascinating article from Esquire magazine, passed on to us by a blog follower, JUST CLICK HERE.

No comments: