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 Happy –
Health 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.
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.
 |
| 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. |
Of course, If
the Trumpublicans come out on top in 2020, none of the above will come to pass.
JL
* * *
* * *
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! |
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!”
JL
* * *
JL
* * *
How to Become (or Choose Not to Become) a Russian Asset
 |
| Carrot Top |
 |
| Moscow Mitch |
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.
JL
* * *
* * *
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.
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