We Keep Focusing On The Wrong Questions and Answers

We are  concentrating all our efforts on who should pay for the rising health care costs instead of asking, “Why are we paying so much?” Right now, Congressman Paul Ryan is rewriting a bill to tinker with raising the eligibility age for Medicare but there is no legislator on either side working on lowering the rising cost of health care. Unemployment is at 8% yet;no committee is working on that problem because all the emphasis is long-term debt instead of where it should be;short term growth job and growth projects..

I’ve read the 24,105 word article written by Steve Brill(Bitter Pill ..Time Magazine) about four times because it’s unbelievable how we just accept that we have to pay more on health care than the next ten highest spending countries combined. Health care in the United States is a seller's market, and we are buyers with very little knowledge of how the system works and we don’t usually have the ability to negotiate. Little Johnny wakes up in the middle of the night crying out with pain, so we take him to the nearest ER and plop down our insurance card, and we won’t realize the cost until we get the bill in the mail. We have no idea if we could have saved some money by comparing the costs of another ER just down the road because that’s not practical. The Hospital takes full advantage of those who do not ask for detail billing and continues their practice of over billing; in fact,  overpayments  are 25% of our bloated health care spending.

Steve Brill has made numerous television appearances saying that Medicare because by law can pay hospitals only the approximate cost of care is the sole program that bends the cost curve. On that basis, he believes people should go on Medicare at a younger age if we are interested in reducing costs but that message is falling on deaf ears, for obvious reasons. He advocates allowing Medicare to competitively price and assess drugs because it would save us billions. Instead of of means testing Medicare recipients, the author thinks wealth individuals should pay a higher co-pays. I guess the idea is not to let Medicare taking the identity of a welfare program.

Health care is the only area where advanced technology has made it more expensive. It encourages more procedures and treatment by making them easier and more convenient. There is also that legal incentive because a doctor can’t be sued for doing too much. Since the same tests are given for a heart attack victim as one for symptoms of a one; new technology in the future may rectify that.

The author hits the non profits pretty hard because they don’t have to pay income taxes or shareholders,  so they funnel all the profits to expansion and CEO pay. A CEO of Sloan-Kettering justified the higher rates because they applied them to [wealthy] uninsured persons from overseas, which allows them to serve the poor. The chargemaster prices are so high (even with discounts and Medicare) that it has allowed them, to become high profile businesses using the charity distinction (1% of its funding) to have the best of both worlds.

Health care costs are over $2 trillion a year, and it will continue to rise unless more hospitals and doctors are aware of their costs. The Cleveland Clinic deconstructed the price of their top three procedures, so they could accurately measure their costs. They tagged all the instruments,equipment,medicines,and even timed the patients stay in post-anesthesia care. They then tagged and labeled their supply cabinets with their costs. They also stressed message of “ Without compromising quality ,consider cost-effective alternatives.”Unfortunately, many hospitals and doctors don’t know or have to know the true costs of their service because they can easily pass them off to their customers.

I hope I never get the displeasure, but if I ever get hospitalized, I will ask for detail billing now that I know what to look for. I will check on the level of room I am being charged for since hospitals charge their ER services by level, depending on the amount of equipment and supplies needed. Level one requiring the fewest.The hospital and doctor's level should be the same. I will question charges for additional reading of tests or scans unless it’s part of a second opinion or consultation. I will also make sure I was not charged for a canceled test due to high blood pressure or elevated blood sugar levels.

The article was packed with endless useful information, and I know that I did not do it any justice in the confines of this blog. I left –out so much because it was repetitive injustices that we continue to hear but don’t do anything to stop.  It reminds of Wall Street surpassing historic highs this week after shaking down America to the tune of $8 trillion, but the emphasis for some is on reducing welfare. The article also took me back to the old days of investigative journalism.

I left out the unlawful and hideous practices of the health insurance companies  and many new proposals that might work if given a chance but there's always manana.

Monday Morning Tidbits

The Sunday talk shows were about the inevitable sequester cuts, which will start Friday. It’s never about a solution it’s always about who’s the blame and the one talking is defending their version of the facts. Spin is what it amounts to. The GOP is now  saying that the cuts aren’t really that bad because proportionately most of the cuts will not affect this year’s spending. I really like what Chris Matthews had to say this morning “ Republicans go to work looking for something they can cut other than defense spending, and Democrats will try to find some way of helping the people who are hurting. The taxpayers are pulling on the apron strings of both parties, so that’s the reason we have so much debt.” Republicans think they can only raise taxes once every thirty years, but that’s a philosophy they’ll all fight for. On the other hand, some Democrats want to reform entitlements, and some don’t. Someone said we could stop the crisis with a one-page bill repealing the sequester cuts, but that’s too easy.

I did see a good discussion Saturday morning about why Democrats and liberal- progressives should care about the continuing degeneration of the Republican Party. The panel on MSNBCs “Up with Chris Hayes “show came up with a conclusion that the Democrats will become complacent and the default party but nothing else, if they’re not pushed by a strong opposition party. There’s a good example of that in my opening paragraph, where we just play the blame game and pay very little attention to the merits of any argument. The GOP will eventually find a leader they can all coalesce around, and the Democrats need to be prepared for that. Right now, the Democrats are aligned, but they need to stand for something and not as just be the party with the most reasonable position at the time because the other solution is way out of the mainstream.

A week ago, a good friend of ours had tears in her eyes, as she told about a recent increase in their healthcare insurance premium. It seems that they were not warned of the $300 a month increase, but she immediately blamed Obamacare. That’s where we are these days; we find the most common villain and just dump our troubles there. If I heard it right, it was a private insurance company that raised the rates, but she never told us the reason why. Her being a good friend, we did what came naturally; we just nodded our heads as if we were in agreement. If we were in another venue and the circumstances were different, I would’ve told her to pick up the latest copy of Time magazine (I'm  still reading all the fine detains of the article for a future blog) so she could see all the waste, fraud, and abuse that’s going on in our healthcare system. I just had a 62-year-old friend of mine, who was fixing to retire, tell me that he was going to stay an additional three years because after this year, his company would no longer offer health insurance.

I was hoping that the “ Pro/Con: Minimum wage thread” would get some interesting comments but the first one I saw was about a city worker getting slammed because he favored a minimum wage increase. It’s one of those “I pay your salary, so I’ll decide if, when, and how much you get” standard answers when you mention public employees.

Get your act together

I'm tired of hearing what the GOP needs to do in order  to start winning national elections again.  I can't get away from it; all the cable channels are talking about it and the Sunday talk shows spend a lot of their time discussing the subject.  You would think that  would give the local yokels a hint.  Instead, they double down and use the most extreme elements in their party to make their case.

A good example of a letter filled with misinformation was printed in today’s letter to the editor that you can see right here. Mr. Allen J. Novosad of Edna is a local right winger who thinks he represents mainstream America. He titled his letter “Irrational voting has put country in trouble” which is based in the truth, but he should have pointed out that the Tea Party was the culprit.

The writer wants the readers to believe that of the 126 million people who voted,  the  65 million people who voted for President Obama were wrong.  You see there were voting for Obama because they were ill informed Democrats who wanted free stuff, and  had other personal reasons that had nothing to do with the betterment of our country because  everyone should know that the GOP are the rightful heirs to that distinction. Oh wait, the voters didn't think so in 2006,2008 and 2012.

Mr. Novosad  evidently thinks that voters have been schooled by the politicians and cannot think for themselves.  I can remember way back in 1974, looking through the Victoria Advocate Sunday Classifieds and noticing that almost all  companies were offering health care benefits.  The company I was working for the time offered healthcare benefits.  Today, you'll find companies  bragging that they will lay off employees before paying for their health Insurance.  One  national pizza chain owner said he would have to raise the price of his (nasty) pizza 15¢ if he had to provide insurance for his employees.  That same pizza owner will probably pay millions of dollars for a 3o second Super Bowl ad. You see Mr. Novosad, back in the seventies tax rates were in the 70% range, so companies reinvested in their employees, and made worthwhile contributions to their community rather than writing out a check to the government.  Wealth distribution in those days was not equated with socialism, and it kept income inequality in check.  A person like you, Allen Novosad, never wonders why the stock market is doing so well, Fortune 500 companies have two trillion dollars in reserve and several are making record profits but benefits to employees are being cut, and their wages have been stagnant for years.

The right wing has been predicting inflation since January 20, 2009.  The writer throws everything into his talking points stew, such as abortion, the rising cost of health insurance, regulations, the Federal Reserve and several other things that are beyond the scope of checks and balances.  It’s as if, the GOP controlled House of Representatives(HR) doesn't have a role to play as the opposition party. The HR makes the tax policies( House Ways & Means) and appropriates the money our government can spend.  When did public schools  stop teaching civics?

Fox News should send their pundits. to a basic economics' class.  Recently there's been a rumor that the treasury might mint a $1 trillion coin send it over to the Fed where they would credit it back to the Treasury in order to avoid the world financial problems that would come by not raising the debt limit.  This artificial notation at the Fed  would not put any new money into circulation; it's merely a trick to avert another trick where the GOP would hold raising the debt limit hostage to more spending cuts. Fox’s financial guru, Neil Cavuto, said the coin would have to weigh tons. No, it doesn’t, in that hypothetical, the platinum coin would not be backed up by the value of platinum.  It's an accounting trick, so we don't have a party jeopardizing the world economy.  Conservatives haven't figured out that money is nothing more than a shared illusion, when it comes the governments.

Perhaps you can take some friendly advice GOP. First, put your first string out there to deliver your message, people like Chris Christie and Jeb Bush instead of the bozos who are hijacking your once great party. According to the latest polls 47% of people identify with the Democrats and 42% with the Republicans, and if you stand a chance of getting any part of the 11% on a more regular basis;your principle should remain, but you need to modify your policies to the times and completely change your rhetoric. Right now, you are doubling down on stupidity like you did when the party denounced the words of Todd Akin, yet the RNC funded his campaign after saying they wouldn’t. Then out of the blue, GOP Rep. Phil Gingrey of Georgia said that Todd Akin was partly right because” I've delivered lots of babies, and I know about these things. It is true. We tell infertile couples all the time that are having trouble conceiving because of the woman not ovulating, "Just relax. Drink a glass of wine. And don't be so tense and uptight because all that adrenaline can cause you not to ovulate." So he was partially right wasn’t he? But the fact that a woman may have already ovulated 12 hours before she is raped, you’re not going to prevent a pregnancy there by a woman's body shutting anything down because the horse has already left the barn, so to speak. And yet the media took that and tore it apart.” I doubt the party leaders will publicly denounce his fund raising words, but they keep the flames of stupidity going. Finally, you need to see someone for your Obama derangement syndrome because being against everything the president wants to do without a plan of your own further discredits your purpose in governing.

I had to bite my tongue

My wife and I had a pleasant journey to Corpus Christi this morning, and it's always a relief to hear the GPS lady say, “you have arrived at your destination." We anticipated some rain but we just got scattered showers on the way up there.

Our company decided to turn over their retiree healthcare plan to a company called Extended Help who will help us with the transition. They even set up a free seminar with the company. I admit that I had a little anxiety because change is hardly ever easy.

As we entered the Holiday Inn hallway, I noticed an old friend  and a couple of other people with him as he was pointing at me and laughing. In the five or six seconds, it took to approach him; lot of things were going through my mind," did I have egg McMuffin on my chin or was my fly open?" It was a relief to hear him say," there is one of those Obama voters who is responsible for us being here." As we were going to our seats my wife asked me “what’s this plan have to do with Obamacare?" I just shrugged my shoulders, sat down and started looking around the room at faces that I recognized but couldn't place a name to. I estimated the crowd to be about 150 to 200 people, but some were from Corpus Christi.

When the speaker said “good morning" you could have heard a pin drop because everyone in the room was anxious to hear every word she said because this was an introduction to a very important decision, we had to make. We all wanted to get all the information we could, before we signed up with the new plan.

As it turns out, we had nothing to worry about because it's a simple choice between a Medical Advantage plan and a MediGap plan. The plans may be less expensive than what I'm on now,  but I will be required to fill more new paperwork. That’s OK because  this company is getting paid by our company to take me through the most economical steps.  She advised us to use a land line or a freshly charged cell  when it came time for the processing because the complete interview would  take one hour or more.

We did learn that the government would not let us be denied for pre-existing conditions, and that the plan will have no lifetime caps... The instructor told us that these plans had nothing to do with Obamacare, which drew a lot of laughs from the skeptics. At the beginning of the seminar, we were handed cards where we could submit our question for the instructor. Three of the seven cards that were submitted asked if this plan had anything to do with Obamacare. On our way out, another old buddy of mind wished us a safe trip and then said, “I don't believe for a minute that this has nothing to do with Obamacare." And that's just it," you can lead a horse to water, even stick his nose in it, but you can't make him drink."

On our way back and as we were approaching I-37N, we could see that it was going to rain, but we never anticipated that we would be driving through a big downpour. For the next 15 miles or so, the cars around us, we're not traveling more than 45 miles an hour. Many cars were parked on the emergency lanes, and I thought of that but looking for a place to exit was more dangerous than remaining in the middle lane and plowing ahead.

We had already forgotten our little excitement until we got into downtown Refugio, when out of nowhere we heard the loudest siren ever. I didn't know what it was, I assumed it was a tornado warning, and I didn't know what actions I was supposed to take, so I just kept driving forward. I wasn't alone, because people were just milling around filling their cars, going into restaurants, and doing their business as if the siren never went off. Refugio needs to go digital.

Up until three years  ago,I didn't think we had that many skeptics or naive people. I used to laugh at the preposterous tales and say to myself “no one will believe that." Oh yes, they will!

Why is health care so expensive?

My monthly Reader's Digest came in yesterday, and as I was thumbing through it, I came across an article titled" Why Hospital Bill Costs What it Costs" by Kimberly Hiss. You old timers know that whenever  we wanted to sound intelligent, we would quote something from the Reader's Digest.

Although I'm clueless when it comes to medical stuff; cost stirs my interest.

The author told a story of a radiologist whose son needed, foot surgery, so he started shopping around for the best prices. The first hospital that he called gave him a quote of $37,000, and then he asked them if that was with his in -network discount and was told, no and they would get back. Someone from the hospital called back later with a recalculated price of $15,000 to $25,000. The radiologist asked a surgeon if he operated anywhere else. The surgeon said that he often used an outpatient center charging $1,515. The radiologists correctly pointed out that with two or three phone calls he saved almost 90%.

We all like our doctor and generally people tend to be pretty trusting of the medical system. When we get our bill, we usually pay our 20%. Sometimes our faith is left in the hands of the medical coders because most doctors cannot explain the complexity of medical billing. For example, the cost of a MRI may factor might be based on buying or leasing the machine, staff salaries. Climate controls electric bill, a competitive pricing, or overhead costs like malpractice insurance. All these coders are trained professionals certified by the American Academy of Professional Coders and  they operate on three sets of universal codes, but the system is so complex that many times it's left to their interpretation. The patient may end up paying for a transposition error.

As technology advances those charges rise. There was a patient from Louisville Kentucky who received a bill for $45,300 for prostate surgery and an overnight stay. Why so much? The hospital used the new robotic procedure, so their bill was structured so that the first users were helping to recoup the equipment's initial costs.

The hospitals are not always the villains because they're usually overridden by negotiated contracts they made with the insurance companies and fixed payments by Medicare and Medicaid. Generally, hospitals will try to shift some of the costs not paid by the government to commercially insured patients.

Then there is the outrageous, or it may be a typical billing charge but I thought I would list an example of some hospital costs that may appear on your detailed billing:

1. The marking pen to mark the right body part for surgery...........$17.50
2. Adult blood pressure cuff.................. $20
3. Charge for the nurse to hand your medicine taken by mouth.....$...87.50
4. Pulse Oximeter Probe (pieces put on a finger to measure oxygen)......$100
5. Warmer air blanket..........$113
6. Operating room..........$200 per minute

I barely hit the surface in summarizing this interesting article which should be read by the skeptics who don't think we need to do anything about the rising cost of health care.

My company made me aware of the rising health care costs 10 years ago, so I knew when health care cost became 18% of GDP, it was not sustainable. I knew it would lead to bankruptcies, under utilization, and eventually death for some who are uninsured. I heard an economist say that the "rising health care cost is the Plutonium inside the U.S. “Debt Bomb.” The government already pays for over half of the medical costs in the United States and 10,000 seniors are moving into Medicare every day.

We're going to have to start using the only weapon left at our disposal; we're going to have to start making criminals of those who abuse our medical system. That doesn’t mean that we can’t do our part by requesting detail billing and reporting discrepancies.

It’s always a Catch 22

I don't think we'll ever be able to prove who the job creators really are. We have always considered our bosses to be the job creators but what would happen if the employees were to take their pay and only bought foreign goods? What if we didn't have enough consumers buying the goods? It's a Catch 22.

That's where we are today. We have two major parties and an element of one party with three different theories on how to get this economy back on its feet. The Republican Party wants to make it easier for big business to hire by lowering taxes and scaling back what they called job- killing regulations. The Democrats want to continue to use Keynesian policies such as a joint venture with the private sector to repair our infrastructure, until our economy improves. The third element, the Tea Party, wants to drastically cut our budget back to 2006 levels, no matter what the outcome. Meanwhile, we are not doing any of the above. We should congratulate Senate Majority Leader Harry Reid and Speaker Boehner for agreeing to fund the government for an additional six months. It still has to be approved by Congress.

We all make assumptions and think it's a truth certain. This morning I was watching Joe Scarborough telling us for the umpteenth time, that he was a small government conservative and praising the likes of Margaret Thatcher, Ronald Reagan, and Adam Smith. He was also praising conservatism as if it was the only economic philosophy that made sense. Joe was on the defensive because the new NYT/CBS poll had President Obama ahead  in 3 key swing states  and in Florida by six points(Scarborough's home state) even thou the state has a Republican governor and the majority of the legislators. It's even more remarkable since our unemployment is still high and showing no signs of coming down before the election. Joe advised the Mitt Romney camp to come out with another ad saying " Obama got his near $900 billion stimulus package, unemployment was at 8.3%, today it's at 8.2% ." This will drive home the point that we spent $900 billion for .1% drop in unemployment. That's the outcome but not the real story.

Mitt Romney is not a good politician, and he showed it recently with his overseas trip. He had to know that his trip was going to be compared to Obama's 2008 trip where he wooed the Europeans, drawing 200,000 Germans at one event. We can argue that Romney's gaffes won't matter in November, but his mistakes are cumulative and the clock is ticking. Joe Scarborough thinks that all Romney has to do is tout the small government conservative message, and it's in the bag but this is 2012 where it's all about the candidate's plan for the future,  money and optics. Romney has the money but nothing else. The people may say," I don't have a job, and neither does my brother-in- law and Obama has been in charge but Romney sounds and acts like the person that fired us."Obama wins the likability factor hands down.No matter how hard he tries Romney will always have a hard time proving that he understands the middle class. 

Today is August 1, 2012, so that means the Affordable Care Act,  will provide women, with the limited exception for those working for pervasively religious employers, to have access to all contraceptive methods approved by the Food and Drug Administration as well as to sterilization procedures and to related patient education. And pregnant and postpartum women will have access to the counseling and equipment needed for breastfeeding -- one of the most effective ways mothers can protect both their children's health and their own.

"Women, with the limited exception for those working for pervasively religious employers, will have access to all contraceptive methods approved by the Food and Drug Administration as well as to sterilization procedures and to related patient education. And pregnant and postpartum women will have access to the counseling and equipment needed for breastfeeding -- one of the most effective ways mothers can protect both their children's health and their own.

Finally, the ACA will ensure coverage of screening and counseling for interpersonal and domestic violence."

This is what Nancy Pelosi meant when she said," we have to pass the bill, so you can find out what's in it." Crudely put and it does take some interpretation, but I understood what she meant.

What does Mitch McConnell think of all this? He said it's time to add an amendment to repeal Obama care. And he wonders why the GOP has been accused of waging war on women. It's no better at the other chamber where the GOP controlled House of Representatives tried to pass yet another abortion bill, yesterday, instead of working on a jobs bill. They're not paying attention to the memo that states that women represent the largest voting bloc, and they vote.

It looks like Texas took the first step to ensure that gridlock will remain the status quo in Washington by voting in Ted Cruz  over David Dewhurst. It was a terrible blow to Rick Perry and the establishment Republican Party in Texas. David Dewhurst was a conservative's conservative but Ted Cruz was to the right of him. Ted Cruz with the help of the Tea Party, and outside influences was able to pull off the upset. This is after; David Dewhurst lent his campaign $25 million and bought a family-size Chick-fil-A just to cover all the bases. The man I voted for, Paul Sadler spent a whopping $132,000 to defeat his opponent. I heard a Republican pollster say that Ted Cruz will win handily in November but the GOP will pay because in 2016, Texas will become a purple state. He said in Travis County alone there are 600,000 unregistered future Democrats who will be courted by the DNC in 2016.

Shame on you,Mitt Romney

I've been pretty easy on Mitt Romney because I think he's a great family man with moral values, and he did a fantastic job reviving the Winter Olympics. I don't resent his wealth because he didn't do anything illegal, and he should run as being a successful businessman.

I do wish, that he would be more forthcoming with his tax returns and business dealings because, if you're going to and call your opponent a liar, I think he should have the facts to back it up. I won't take back my flip- flopping comments because it's very hard for me to believe a person can come from saying, " I'll be to the left but Ted Kennedy on gay rights, and I'll fight hard to retain Roe v Wade" to the position he holds today. It's a complete 180 degrees on fundamental social issues.

I have to give Mitt Romney his props for attending yesterday's NAACP convention in Houston, Texas, unless he was using it for a prop. I'm not a political analyst or a psychiatrist but observing his reaction to the boos, he received, I’ve come to the conclusion that the boos inspired him. It had to be planned because he didn't have the look of surprise; it was more of a look of satisfaction, with a wink and a nod to his base and to the moderates looking for him to pander on that issue. His campaign team knew that repealing health care would be met with resistance, but I don't think they knew why, and I'll give you a couple of examples. The crowd though he used the word Obamacare in the pejorative manner because he doesn't call his health care plan in Massachusetts; Romneycare. The second and most telling is what he said to fundraiser in Hamilton, Montana: "By the way, I had the privilege of speaking today at the NAACP convention in Houston, and I gave them the same speech I am giving you. I don't give different speeches to different audiences alright. I gave them the same speech. When I mentioned I am going to get rid of Obamacare, they weren't happy; I didn't get the same response. That's ok, I want people to know what I stand for, and if I don't stand for what they want, go vote for someone else, that's just fine. But I hope people understand this, your friends who like Obamacare, you remind them of this, if they want more stuff from government tell them to go vote for the other guy-more free stuff. But don't forget nothing is really free." 

It's expected that Newt Gingrich would call President Obama, the food stamp president and Rick Santorum targeting black people by saying he doesn't want to make their lives better by giving them welfare. So far, Mitt Romney stayed away from categorizing black people as food stamp recipients. As you can see from the statement Mitt Romney gave, he is resorting to the same tactics. Shame on you, Mitt,you did nothing to stop the bleeding because your speech drove President Obama's approval in the African- American community from 95% to 98%. Mitt Romney must feel pretty good, thinking he made some points with the base, but it's how he did it. Granted, he was in hostile territory but no one was asking him to pander. He could have spoken about the common ground of wanting better education and jobs, to a community that's lacking in both.

Here I go Again

lEFT-WING LIBERAL PROPAGANDA..:-)

I thought I could turn the page and move on, but this health care issue is still at center stage, and my side doesn't want to defend the Affordable Care Act as much as the opposition wants to destroy it.

It's almost like defending the indefensible because most Americans have health care, and they worry about how we are going to insure 30 million more people, without jacking up their premiums. It's a legitimate worry and the government, regardless of the party, doesn't have a stellar record that instills trust.

The basic idea of consumers paying more for their own coverage to control costs is fundamental in both parties but the Republican plan doesn't expand coverage, so it leaves the market open for free loaders.

Fareed Zakaria, one of my favorite journalists and authors, said what I've been saying all along, “the markets work imperfectly in this realm." He quoted some studies conducted by the pharmaceutical company Novartis and McKinsey and Company showing a difference among countries with regard to a health- care efficiency.

For example: Smoking rates in France are much higher so the French population has a higher rate of lung disease. The French system is able to treat the disease a lot more efficiently and spends eight times less on treatments per person than we do. Another example is Britain, which handles diabetes far more effectively than the United States while spending less than half of what we do. The British System is five times more productive in managing diabetes than the United States.

The United States does better, battling breast cancer because of early screening and easy access to advance treatment, making us one of the most effective places to treat this disease.

What is common in the three examples? You guessed it, a systematic approach that gives all health -care provider's providers incentive to focus on early detection and cost effective treatments, and that makes wellness the goal.

Name me one politician or political party who would tell their constituents the absolute truth? By the truth, I mean, that they must accept the fact that these consumers will never be expert enough to know what product is best. Choosing between hundreds of policies may be a great free market idea, but it's unrealistic. Imagine any politician telling their constituents that they can lower their healthcare premiums by eating less, quit smoking and eating less junk food and seeking preventive care. For more you can read Fareed's article.

I read another interesting article by Donna Dubinsky, businesswoman who played an integral role in the development of personal digital assistants (PDAs) serving as CEO of Palm, Inc. and co-founding Handspring with Jeff Hawkins in 1995. I wish that she would have given the oral arguments before the Supreme Court.

Donna, after the fact, would have answered Justice Samuel Alito argument that most uninsured people either do not want to pay for insurance or cannot afford it, a lot better than the government did.. He said anyone can get health insurance.

Donna Dubinsky said if you're not employed, and you want to purchase insurance in the private market you cannot unilaterally to do so. An insurer  does not have to accept you as a customer. And quite often they do not. Insurance companies prefer group plans because it spreads the risk. Can you blame them? The individual plan is a lot of work, a higher risk, and produces little revenue.

The Government Accountability Office found that on average, 19% of the applicants nationwide are denied. One-quarter of insurers denied more than 40% of the applicants they considered. The reasons were not limited to deadly illnesses. You can expect to be denied if you have asthma, if you take just about any prescription medicine, or if you are more than 15% overweight. Expect to be denied if your doctor has recommended any procedure for you.

The Supreme Court successfully framed what can now be considered the limited conditions of the commerce clause in the constitution.

Donna Dubinsky thinks the government failed in its response because(1) health-care is a service or product that everyone must have at some point in their lives (2) the market for that service does not function if it can turn away buyers.

You might ask, how about burial services? Good question,it passes the first test, but fails on the second because  no seller of those services will turn your away.

Why couldn’t Congress pass a law requiring insurance companies to accept all applications? That obviously would fail because only sick people would seek insurance-because healthy people would wait until they got ill, knowing health Insurance was guaranteed.

The only answer for now is the Affordable Health Care Act because it expands the pool and spreads the risk.

Tax,Penalty,Fee or who Cares?

It shouldn't surprise anyone that we're constantly engaging in the war of semantics, instead of rolling up our sleeves to fix the problems that are keeping us in this rut. The latest battle is finding the proper word to use to describe the Affordable Health Care Act. Is it a tax, penalty, or fee? I'll dwell more into that later, but if my insurance premiums rise, it will be an increase in expenses for my household budget. It could just be that my old company decided to pay a lesser portion, my insurance company decided to raise their premiums for unknown reasons, or perhaps it was part of a fee but I am not one of those who will receive a tax or penalty for not purchasing health care. I am not one of those approximately 4 million folks ,who will decide that just don’t want to buy health insurance.

It's funny how both presidential candidates insist that health care law is a penalty and not a tax for obvious reasons. I tend to go along with their reasoning because, if, in fact, we are using the Internal Revenue for a reference, then the Internal Revenue Service is authorized to assess penalties for various tax violations and deciding to opt out of health insurance(free rider) would fit nicely in the code. For example, if you decide to withdraw from a deferred compensation plan, that taxable portion of that withdrawal would be taxed at ordinary income rates, but you would be assessed a 10% percent penalty if you were not 59 1/2 years old at the time of withdrawal.

I understand why Republicans want to call it a tax; it's in their DNA. They do have a problem because their nominee for president is calling the Act a penalty because, if it's called a tax, the Democrats would say that he raised taxes in Massachusetts; something that Mitt Romney adamantly denies. The Republicans go on and say that it's the largest tax increase in history, but  that talking point draws four Pinocchio's from the Washington Post's fact checking site, Politifact. Mitt Romney does admit that he raised user fees but he is one of those Republicans, who doesn't think a fee is a tax. I remember telling my conservative friends at work that the only difference between parties is how they raise revenue. Back in the day when we used to have democratic governors in Texas; I would say, yes your Republican governor cut property taxes but  he raised fees to pay for them. The democratic governor had to come and raise taxes to repair the neglected infrastructure. Democrats cannot erase that “tax and spend “depiction but my party didn't put in enough effort in tying the label “borrow and spend" Republicans around their neck. Republicans slipped out of that noose because they convinced their constituents that they are the party of fiscal responsibility. I've always said that Republicans are great campaigners, but they can't govern.

The conservatives are still angry at Justice Roberts, but they're saying that he called the whole Affordable Health Care Act a tax. No, he's specifically said that the Act is not constitutional under the commerce clause, but it could fit in the taxing powers of Congress. The first time that Justice Roberts has ever sided with the more liberal side of the court caused a political firestorm of conspiracies. The liberals are cautioning their side to remember how Justice Roberts has voted in the past and how he would likely rule in upcoming and cases such as: affirmative action, voter rights, and DOMA. I can't believe how Republicans overlooked the fact that Roberts made it extremely difficult for future legislation to be included in the commerce clause. He also made it possible for Republicans to gin up their base to get the numbers; they need to repeal the whole Affordable Health Care Act. The court by a 7-2 margin voted against the Federal government mandating the extension of Medicaid. That was huge, because, if the red states opt out, it will mean that 6.2 million people will not be injured. that’s nearly half of those eligible. It's funny how the conservative states that want to opt out for political reasons have the most uninsured people and would be benefited more or as Howard Dean called it “Intellectual Malpractice."

 

Meanwhile, the Affordable Health Care Act will be used by the populace as a dumping ground for their complaints; a lot of them will automatically blame their premium increase on the law, allowing the health insurance companies to scathe free.

Irony or hypocrisy?" According to an analysis by The Huffington Post, dozens of Republicans who want to repeal Obamacare have adult children who are allowed to stay on their parents' health plans thanks to the law, which extended this benefit nationwide. Many of the lawmakers' children are employed and on their own health care plans, but others continue to take advantage of their parents' coverage."

Is it the End of Obama Care?

As early as tomorrow the most conservative court since the 1930s will rule on the constitutionality of the “individual mandate" provision of the Affordable Care Act or to declare the whole Act unconstitutional. I think we can all agree that it will have an enormous economic and political impact.

I cannot sugarcoat the devastating blow it will be to the liberal agenda if ACT gets struck down. It will fall more on them than it will on the Democratic Party. That's unfortunate because liberals only make up 40% of the party and they didn't get the benefit of the pubic option or the single payer, In fact the latter two options did not have a representative at the table. The Blue Dog Democrats (conservative Democrats) did not support the Affordable Care Act and consequently lost their reelection bid; leaving the liberals the only group to blame. Why is this important? It gets down to the basics; the liberal’s reason for expanding heath care is their desire for equality and social justice. The best sign I saw during the Tea Party protest to health care, read “Spread my Work ethic..Not my wealth." Although the “individual mandate" was originally a conservative idea because it's at the core of " individual responsibility" of their beliefs but their civil libertarian side hates the government telling the citizen that they have to purchase anything. I saw a AP poll where 77% wants Congress to redo the legislation and 19% want doesn't want Congress to do a thing. It’s like any huge piece of legislation; it takes a bipartisan effort for it to be successful but the desire is not the same for both parties.

If any part of the Affordable Health care Act gets struck down, the Mitt Romney team will say that the reason for the high employment is that the president spent too much time on health care but that's not true. The Democrats passed the stimulus thinking that it would bring down unemployment but did not anticipate that governors would use that money to balance their budgets, lay off public employees, and that they did not want to start projects which couldn’t be completed without federal funds. The administration over sold the "shovel ready projects." I think the biggest mistake the administration made was thinking that the Republicans would work with them. President Obama was against the mandate during the campaign but was persuaded because he was told that the republicans would support it. The other mistake was not using the "public option" as a bargaining chip and making the deal with Big Pharma instead of having the option to buy drugs in bulk as the VA does. I have to give it to the GOP they won the message war by calling it "government run government health care" and it never was. The political rhetoric will drown out the fact that 30 million people will lose their health insurance if any part is struck down.

Several pundits still say that the legislation is too complicated and the four years it would take for the whole law to be in force was way too long. The reason for the four years was to not go the same path as Romney care. It takes at least four years to get the funding and the clinical and delivery system in place. The administration sent $5 billion to divide between all 50 states to set up temporary risk pools. This was done 90 days after the law was passed. Massachusetts made the mistake of immediately sending out 550,000 insurance cards but did not have the primary care capacity in place; consequently the ERS were always full defeating the cost savings of Romney care since ER care is a lot more expensive.

If the Supreme Court decision is another 5-4, some will see it as upholding the constitution while others will see as partisan politics. President Obama could use the decision to galvanize his base saying " we 've got work to do because the GOP will not take up the mantle." Mitt Romney does not have that option because 5 of the justices are conservative if the unlikely happens.

 What do you think; am I partly right,way off base or somewhere in the middle?

If the Republicans Get their way with health Care

I've read several scenarios about what would happen if the Supreme Court strikes down Obamacare or if the GOP repeals it next year... One report said it would bankrupt our health care system because the bureaucracy would come to a standstill, leaving a lot of procedure and payment questions unanswered. If you remember during the GOP presidential debates, all the candidates wanted to repeal Obamacare, but they never offered, a suitable replacement.

Years and years of skyrocketing health care costs was the only reason the Obama administration took up the measure.

According to Ricardo Alonso-Zaldivar of the AP, “we can’t look for the government to step in.”

Employers and insurance companies will take charge and will probably use some of the good ideas in Obama's care, discard some, but those two entities will push harder to bring down costs...Theirs.

More than likely workers will bear most of their own medical cost with higher deductibles and out -of- pocket cost before insurance ever kicks in. Smokers will probably face financial penalties if they don't seriously try to quit. Overweight employees with hypertension and diabetes will be tagged as health risks and encouraged to get on diet programs.

Some companies will keep the popular provision of coverage, such as the one that allows employees to keep adult children under age 26 on their policies but others will eliminate it

Workers and family members and will be steered to hospitals and doctors who can prove  that they can deliver quality care, and the doctors would earn part of their fees for keeping their patients healthier. This provision is similar to the "accountable care organizations" in the current healthcare law.

Some workers would pick their healthcare provider from an exchange program similar to the healthcare law. They'll get fixed payments from their employers to choose from gold, silver, platinum and bronze plans and pay accordingly.

Obviously, we will go back to square one, where employers were the major drivers in health care plan changes before it became too expensive for them to handle.

One thing is certain; businesses can't and won't take care of the 50,000,000 uninsured.

Careful what you wish for.

Careful what you wish for

I was caught by surprise because I thought the administration would put more of a fight than they did in their recent health care battle with the conservative Supreme Court. They had over year and to come up with better arguments for the individual mandate or at least a plan B. The way it's going, 2.6 million young people might be taken off their parent’s health care plan along with children with pre- existing conditions.

I know my disappointment may be premature because even thou the oral arguments are over for SCOTUS, they will take an informal count sometime this week to see where they stand. It's obvious by their actions that they have disregarded any argument for the individual mandate but perhaps in today's climate, there isn't one. I understand the argument that you can’t compel anyone to buy anything just because the government tells you to but I also see the importance the mandate plays in the commerce clause because health care is 17% of GDP. The official ruling won't be until June but a White House spokesman said that President Obama will not run against a Supreme Court decision in the fall. He hinted that if elected, the Democrats might do some creative additions if the rest of the Affordable Care Act is left intact. They might use reconciliation where it only takes 51 votes to pass and they might submit a "Medicare for All "which they know is constitutional." The opposition will cry socialism but what's new?

If the Supreme Court strikes down the whole ACT, there will be major problems ahead. Justice Scalia doesn't think that the court or its clerks should read all 2700 pages in order to make a decision on what is constitutional and what's not. The court does not want to seen as being a partisan magic wand for the Republican Party. I think if Justice Kennedy allows a good portion of the law to remain intact, Justice Roberts will join him for a 6 to 3 vote. I heard yesterday, that there's about $900 billion that will have to be distributed back to the insurance companies and other entities, if the ACT is struck down. The states will lose the anticipated Medicaid funding and many laws will have to be rewritten. I'm pretty sure the GOP will want to put the $900 billion on the debt and not think twice about the escalating insurance premiums around the horizon. It's my opinion that the court needs to stick to the law and not make judgments that may impact our economy because that role belongs to Congress.

In the meantime senate minority leader Mitch McConnell said that they don’t have any health care plans, not surprising, and the House of Representatives are only interested in passing Paul Ryan’s budget bill with as many republicans as possible. I was surprised that Bowles- Simpson got only 68 votes in the house; proving once again that you can’t believe anything a politician tells you. Legislators in both parties praised Bowles- Simpson on the talk shows but won’t vote for it when it counts. At least they can’t blame the president anymore for running away from Bowles-Simpson.

There has to be a Saturday Vent blog and it’s in the making.

The Complexities of Health Care

I’ve been concerned about the rising cost of Health Care for 10 years or more. One day our company sat us down and told us that our insurance company was merely an underwriter, and that they were paying the actual cost of our health care. Human Resources showed us examples of overcharging and mistakes on some employee's medical charges. They advised us to look over our detail billing and report any discrepancies. It really hit home when it became personal. About a year later, when I was thinking of retiring, Human Resources told us that existing retirees were the biggest drivers of our healthcare costs, and that they were considering increasing the cost of existing and future retiree’s premiums. I don't remember anyone complaining because we understood but lucky for us, they never followed through.

I am not an expert on health care but I am very interested on hearing varying opinions.I even have the entire Act on my iPad and several magazine articles on the subject.

Sunday night CNN's Fareed Zakaia hosted an excellent documentary about how other countries were dealing with their rising cost of health care. Fareed's guest was T.R. Reid, the author of " The Healing of America: a Global Quest for Better, Cheaper, and Fairer Healthcare." Mr. Reid found that government is more efficient at handling healthcare because their overhead is a low 5%, whereas private insurance companies hover around 20 to 25% because of advertising and other costs to satisfy their shareholders. He also said that healthcare is not an ideal product for the free- market because they cannot accurately forecast their costs for the next year. Later in the show, they showed how the free market could work, with conditions.

The fact is, 5% of the people in the United States account for 50% of our healthcare costs, so that information stuck out like a sore thumb. I saw an excellent example how one of the poorest cities in the nation, Camden, New Jersey, took that problem head on. They found out that 30% of the healthcare costs came from one area, so they concentrated on those people and now there are seeing their healthcare costs go down. They found that the average American will go to the doctor or hospital once or twice a year, but these people were averaging about 14 times a year, and one person went 435 times.

Unfortunately, politics wins over economics' in the fight for health care reform. For example, Switzerland had a problem similar to ours where people did not buy insurance and ended in emergency rooms; insurers were screening out people with preexisting conditions and their cost are raising fast. This conservative country barely passed an individual mandate and reformed their system to look like our current Affordable Health Act. Switzerland which has a population of 8 million, healthcare cost is 11% of GDP, and ours is 17% and rising. The country ranks higher than we do on the Heritage Foundation's Index of Economic Freedom. Their healthcare plans are not tied to employers, and their citizens can choose among endless companies and can change every year. The only drawback to that system is these citizens need to be aware of what they are buying.
By several measures, Taiwan has the best health care system in the world. About the time, the Clinton administration was trying to overhaul our healthcare care system. Taiwan sent their experts all over the world to study different plans. Taiwan is a strong free- market economy, but it decided to go with a single private insurer. It's basically a Medicare for all but with one private insurance company. They showed how a “smart card" allowed the insurance companies and government to see that actual cost in real time. Medicare takes about two years to reconcile their invoices with their payments, a reason fraud is prevalent Taiwan spends 7% of its GDP on health care and went from having 41% uninsured to just 8%.By comparison, their clinics stay open 11 hours a day and their doctors sees ~200 a day and gets paid $12 per patient, while their American counterparts get $100 per patient.

The Affordable Health Act is not perfect, but the fact remains we need to stop the rising cost of health care, and we need to insure as many people as possible. Conservatives say that regulations are an impediment in our efforts to compete globally, but they don't mention how companies spend tens of billions of dollars to provide health care to their employees and retirees, while Canada, Germany, Japan, and Great Britain spend next to nothing.

The Democrats lost the message war after they passed the Affordable Health Act, and they are still losing it. I just saw a poll where 52% thought that the Supreme Court had already struck down the individual mandate. The upcoming legal challenges against the individual mandate will be very interesting. Will the five Supreme Court judges appointed by Republican presidents make it partisan, thus angering the Democrats in an election year? Will the Supreme Court to go with the precedent and give broad powers to the “commerce clause" as they have in the past? It will be an interesting case because the Supreme Court might decide to split the issues and leave the Act in place.

I saw a Kaiser Poll yesterday that had 41% for the Affordable Health Act and 40% against and 19% not sure. I would like to know where you stand on the issue. Is it status quo,don’t know enough about the issue,whatever, or repeal the Act and why?

This is what I think. We won’t be able to go with one insurance company because that’s picking winners and losers, and we won’t go with a single- payer universal health care system, where it’s total government because the outcry of socialism will be so load we will all have to wear ear muffs. We won’t institute a system like the Cleveland and Mayo Clinic where the hospital gets a block grant for a procedure and then they divvy that up between the hospital,doctors and other employees.I do know this,we are a hybrid nation,so unless we get a complete domination by a party ,we are either going to have to improve the one we have or take a little from here and a little from there but we will still be saddled with rising costs.

Does the GOP alternative of individual Health Saving Accounts,buying across state lines do the trick? Will you be willing to give up not being turned down for pre existing illnesses or having your children on your policy until age 26?

I'm convinced that  we will never do anything about the high rate of obesity or that we will come to grips that we are a older nation because we are a freedom loving people.  If 30% of the people get all upset because the first lady mentions eating more veggies, I can’t expect for anyone to do anything about contributing factors.

Conservatives Hate the Health Care Act

I think that art of debating is knowing your opponent's point of view. It takes background searches of a poster’s comment history, applying the proper context and looking to see if your opponent is steadfast in their opinion and why.

I'm about halfway through a fascinating book called" The Reactionary Mind" by Corey Robin. The book details the conservative mindset from the French Revolution to modern day conservatism. I'm into the meat and potatoes of the book where it describes the middle class conservative as someone who looks down on those below them because they have a fear of becoming one of them. They were much happier in the 1950s when the average white man was superior to those who were born with darker skin. They hate the government because it's an equalizer that has gone too far. That's why they don't object to the rich getting their tax cuts but will go into a frenzy when someone mentions the word "free."It got its start when President Reagan said “government is not the solution to our problems; government is the problem.” This is just the tip of the iceberg but it does give a little background.

I'm not exaggerating one bit when I say that the conservatives hate the Affordable Health Care Act, I was glued to the television the weekend healthcare was being passed. I saw the anger and the hate of those who opposed the legislation and I saw conservative lawmakers urging them on by waving the Gadsden Flag which bore the words " Don' Tread on Me." We all saw the town hall meetings where it was common to hear the words “I want my country back." Over half of the people protesting were on some kind of government program but they justified it by convincing themselves that they paid for every bit of their government benefits. For the politicians the act was another entitlement that their opponents could beat them on. The protester saw it as allowing those below them getting something” free” which might eventually make them lose a portion of their entitlements. The middle class conservatives saw it as another "affirmative action" like program that would further erode their benefit package and increase the price of their expensive health care insurance premiums.

The next round of anger came from the recent squabble between the church and the government over the “religious conscience exemption" but it was really about the word “free" in the distribution of contraceptives clause. It puts a dent in the church's argument that they will be paying for something that they morally object to. That's hypocritical on its face because many middle class conservative’s insurance policies cover contraception and they have never protested before. The conservative politicians jumped on this and tried to come up with legislation to allow all employees to opt out paying for something that they morally objected to. The politician's goal is to weaken the Affordable Health Care Act (AHCA) so it will be easier to repeal. There's not an accounting trick or language that will satisfy the religious entities who are opposed to this portion of the AHCA because they will always use the 6° of Kevin Bacon logic to justify their reasoning. A ruling by the courts will be the only solution.

The conservatives are not stupid, they know they have a fight on their hands because people like the fact that they can keep their older child on their healthcare policy and that their children will no longer be refused for pre existing conditions. They also know that they don't have a viable plan to replace the current one but their constituents don't seem to care. The only plans they have is the unpopular health savings accounts, tort reform, and being able to buy private insurance across state lines. Their best plan will only bring in 3 million new customers. Conservatives do not pay any attention to intangibles. They need to be able to carry a figure over 12 places, see it on a spreadsheet, or be able to actually touch it and feel it before they will believe it. They do not believe in preventative health care or wellness programs. I guess the 48,000 people that die because of a lack of a health insurance are just collateral damage. They don't believe that people that use the emergency room for "free" will add an average of $1000 to their yearly premium.

The bottom line is that we have to reduce the rising cost of health insurance, so we have to admit that we are an aging, obese, and out of shape country where older people are living longer. We all know that insurance companies are not going to tackle any of those problems, so in order for them to stay in business, they will have to raise their premiums.

As we should all know by now the "individual mandate" was originally a conservative idea because it's based on a conservative concept that everyone should pay something. Today it's a rallying cry for government intrusion, when in reality it's not even in force yet. The enforcement won't come until 2014 and the penalty for not having insurance is pretty vague as it is written. It won't be imposed on many but I know "it's the idea" and we will have that battle in the courts.
 

This is not to say that the American people are happy with the current Affordable Health Care because the USA Today poll, reported that 75 percent of Americans believe the new health-care law's individual mandate is unconstitutional. And if the Court doesn't throw Obama care out, Americans want Congress to do so: Half of voters want the law repealed, compared to 44 percent who want it retained. The conservatives have definitely won the message war but I don't think they can rest on their laurels.

Bottom line if you hate the AHCA; you are a conservative or at least you agree with them. I am not saying that they are right or wrong, I am just describing their mindset.