Of Healthcare and Health Insurance

 

Obamacare was not about receiving healthcare but on how it was to be covered, how it would be paid for. Trumpcare is not about receiving healthcare but on how it is to be covered, how it will be paid for. So, nobody is going to die because they cannot receive treatment because of either legislation. The differences are all about how health insurance will be distributed, paid for and the role of government in this procedure. Another item which is required is the knowledge that there is no such thing as an untreatable patient because by regulations any hospital which receives any form of government money, Medicare, Medicaid, Veterans Reimbursements or direct government aid are required to treat absolutely anybody who comes to them for treatment regardless of whether or not they are capable of paying for the treatment. This includes treating the uninsured, the homeless, the indigent and anybody else who comes to them for care whether through emergency vehicle or simply walking in the front door or the side door marked “Emergency Room.” The hospital I used to work for as a Biomedical Engineering Electronics Technician, the Washington Hospital Center, a thousand bed cardiac care hospital which also has Washington D.C.’s award winning burn center, a top eye and ear clinic, a Cath Lab with a half dozen operating theaters including two Electrophysiology Labs, an EEG department, an entire separate Physical Therapy Hospital attached to them across the entranceway, two separate operating theaters, one with a dozen operating rooms and the outpatient theaters with five operating rooms, one of the areas major Trauma Centers with two medical helicopters and six bays of which two could be used for emergency surgeries, an entire series of outpatient health clinics covering everything from inoculations to chronic treatments plus much more, and was a hospital which provided close to two million dollars in free care back when I was an employee in the late 1980’s through the early 1990’s. So the untruth that people in the United States die on the street because they were unable to receive treatment anywhere because they had no insurance is exactly that, an untruth. In the United States all but a very small number of specialty hospitals and members’ only hospitals, which treat either certain religious groups or select people who belong and pay either a monthly or an annual fee, receive federal funds one way or another and thus are required to treat all who come to them needing treatment. That is the first point that needs to be told as it removes the largest complaint that people are falling dead all over the United States in nearly every city as they are denied treatment because they are uninsured. The claims that we would soon see carts dragged through poorer neighborhoods calling for them to bring out their dead (as seen below) were a bit of an over-exaggeration.

 

 

So, the two plans are all about health insurance, not healthcare. The next truth, which is being used to cast a false accusation, was that the large increases in premiums came since President Trump became President, thus are his fault. The quote that the largest and by far most drastic increases in insurance premiums have been witnessed this year is absolutely true. The claim this makes them President Trump’s responsibility is quasi-valid. That President Trump has caused these drastic increases is false. What is true but seldom mentioned is that all of the statutes and regulations derived from Obamacare came into effect this year as of January first. Now this could all be coincidence, but I doubt this. Many premiums had been seen to increase, in some states almost, if not, doubling, last year as another round of regulations, laws and rules came into effect, but those paled in comparison to those that struck this year. The real effects intended by Obamacare have begun to raise their ugly truths with states such as Iowa fearing the loss of the final insurers pulling from offering coverage in the near future. This was the plan, to so bankrupt the health insurers leading to a panic, which would make a single-payer government health insurance plan acceptable due to lack of alternatives. One by one states would be forced to join Federal Government health insurance. The end result was to be Government Healthcare simply because the insurers who had covered health expenses could no longer make a profit as with the rising premiums people either opted for the Federal coverage or simply ducked from having any coverage. This is what Trumpcare is attempting to prevent and the reason why putting something in place quickly is so important. Unfortunately that also might lead to putting forward a flawed plan which will require patches and modifications before it becomes workable and this would be interpreted as poor planning. Meanwhile, a case being brought before the Supreme Court that would make Obamacare subsidies be limited to those states running their own exchanges threatens to force Obamacare to actually operate as written and not as expanded through broadened but presumed illegal interpretation (see map below). Should this case win it could open the way for more cases of a similar vein leading to strictly limiting Obamacare to the language of the law.

 

 

Emergencies often lead to poorly thought through or otherwise incomplete plans being put into force requiring more attention and an ongoing policy, which causes other problems as changing rules leads to fearful reactions by the affected companies, in this case health insurers. This could in part be the reason for the initial failure of the first attempt at cobbling together a plan and that may prove to have been a saving grace. Now we have Republican Care II, which passed the House of Representatives but now faces review in the Senate where changes will very likely be made and then the legislation, and this is all we have, legislation, will be returned to the House of Representatives. There it may be changed further and this exchange will continue until something more complete and comprehensive which meets the principle concerns of the Senators and Representatives and then will be passed on to the President. This is all depending on one little technicality, the Senate Democrats. The Democrats have sufficient Senators to prevent anything being passed through the Senate through filibuster. The overt civility of the Senate has made the filibuster as simple as telling the President Pro Tempore that a filibuster is intended and the legislation is all too often tabled until sixty votes can be guaranteed to invoke cloture ending the filibuster. No longer does the Senate demand that Senators imposing the filibuster actually talk twenty-four hours a day seven days a week until they tire of doing so or cloture is voted. There was one recent exception when Republican Senator Ted Cruz of Texas read Dr. Seuss’s “Green Eggs And Ham” as part of his twenty-one hour solo filibuster before surrendering as none of his fellow Republicans stepped up to support his attempt at mainly a symbolic statement against Obamacare (seen below). So, out of courtesy, the Democrats will not be made to actually take to the floor and fill the time with endless driveling and possibly entertaining the media with the reading of children’s tales or misquotes. This is also why the filibuster is used so frequently in the Senate as it no longer requires any significant effort or contribution in support of the position taken by the filibuster in opposing legislation. This will also prevent the necessary back and forth between the House and Senate in the manner in which the Congress is supposed to function and also stall any possibility for relief from the impending disasters that will come as a result from Obamacare. This is one time where time actually is of the essence.

 

 

What is certain is that should too many insurers decide to no longer offer health insurance and simply close down this part of their companies, then there truly will be a healthcare crisis in the United States. Many will say that this would be a gift as it would usher in government provided healthcare at long last and the United States could joint the long list of civilized nations. These individuals and groups will leave out the interesting fact that most nations providing government healthcare have a different problem, they cannot provide for their own defense and rely completely on the United States to provide the deterrence, which keeps them safe, relatively and thus far. They will point to particular nations while avoiding numerous others to prove their point that government provided healthcare is completely doable. Those nations they refuse to point to are the reason it will not work in the United States as they found out in Britain when they finally decided that they had to cut back on the amount of healthcare they were providing while other nations approached their problems with price controls.

 

There is a light on the horizon, though most would never point to their success. There is one nation that has universal coverage, a very capable and viable defense force, and a form of government/private health insurance. That nation is Israel. They have a minimal coverage required be provided by all insurers for which each receives a government payout. Then the four insurance companies offer their base plans while the people pay a health tax to cover the base plans offered. Then each of the four insurers operates in areas they feel they can make a profit with at least two operating in each part of the country. Then each insurer offers additional coverages, which they give nice sounding names such as Silver, Gold, Platinum or Palladium, well, OK, not the last one as it is made up. Individual can take the base coverage or they can purchase additional coverages, which vary depending on which of the four companies they choose. This works well for the most part. Yes, there can be problems when a person’s coverage and their particular needs have a failure in coverage, but these are addressed individually. So, nothing is perfect, but it appears to work, at least as far as we have experienced. Where this system may not be perfect, it is a great starting point and with the numbers of insurers currently in the United States, some form of system like this should be capable of being established, perhaps one where the government simply dictates the medial price for the basic coverage and sets up variances for the different markets throughout the nation. That’s our best suggestion if the politicians in the United States are seeking a system that combines a set coverage for all, even to include major medical for unexpected emergencies and hospitalizations, combined with a competitive market where competition is used to reduce prices. In the meantime, let us wait and see what the Congress is capable of producing.

 

Beyond the Cusp

 

What Went Wrong with Trump Healthcare?

 

Trump Ryan combination could not pass Trumpcare to replace Obamacare, and America should be glad, that is if the claims we hear are true. We heard from so many that they wanted Obamacare repealed and their old insurance back, well, with a few niceties left over. They still wanted their kids to be able to remain on their parent’s plans till age twenty-six because college takes half a lifetime you know. They liked that existing conditions should not have to be penalized with higher premiums. Oh, yea, the people receiving high subsidies; got to keep them. So what exactly was it they did not want from Obamacare again? Oh yes, the people who had lost their doctors and their insurance plan or had their hours reduced at work or were simply fired or owned a small business and were afraid to expand past forty-nine employees. So the problem is the same old problem with all Democrat buy vote plans when they replace something that worked with something which really didn’t work but could be patched, smeared, slid along, tweaked, twirled a few times, rewrapped and it would eventually fail tragically and then like the Phoenix some new plan would rise from the ashes to replace it and the entire cycle restarts. That has been the way and the reborn is usually called an overhaul even though much of the new plan appears very similar to the old plan with the debt just tossed aside and we pretend that there had been no problem. So we stand where we always stand, where we have stood on education since the birth of the department of Education, on crime since the War on Crime, on drugs since the War on Drugs, on immigration since the promise to enforce immigration laws in the 1980’s, on you name the federal program since it replaced the church, charity, public institutions, the family, the private sector, or simply replaced people being people and had the government become our teacher, our best friend, our employment guarantee, our minimal income provider (welfare and related programs), our retirement planner, our security blanket, our fair housing guarantor, our fair everything guarantor, our everything over the last three or four generations as government has swallowed responsibility for darn near everything and that they have not they regulate to death.

 

It turns out with Obamacare the same two forces are tugging and we all know which one will win. The forces are those whose lives have been made easy with free stuff against those who know there is no such thing as free stuff because they have to pay for those other people’s free stuff. The people getting the free stuff have more time to make noise while those paying for the free stuff have two or three jobs to pay for the free stuff and no time to make noise or any energy with which to do so. Further, the people paying are seldom around or have the time to take those calls asking their opinion while those getting the free stuff have all the time in the world. End result is the polls show that the people want the free stuff. There really is only one simple answer to the entire situation, a complete and total reset. By that we mean that we take the Constitution and the Bill of Rights and only very delicately tweak things such that we include the additional succession adjustments, the incapacity of a President Amendment, term limits on everything except judges, include the demand that each piece of legislation must include every aspect and enforcement and all the particulars and there can never be anything outside of what the legislation states added or altered by any bureaucrat, administrator, judge or other official without there being legislation stating exactly what is to be altered, added or subtracted passed by Congress and signed by the President. There should be an agreed upon maximum tax rate. And the biggest change is that the government must be precluded from performing any charity, setting a guarantee of minimal income or wages, providing insurance of any nature especially unemployment, any service which can be served by the private sector must be forbidden to government, and the people must be permitted to challenge any legislation passed by Congress and signed into law by the President for a period of ten years through a recall by collecting some reasonable number of signatures not to exceed one-half-of-one-percent of the national population. There are likely a great number of other items which people would like to see incorporated into such a new Constitution and Bill of Rights and as long as they do not diminish any of the rights laid out in the original Constitution and Bill of Rights as taken in their most general and originalist interpretation, then they should be voted upon by the people and those accepted incorporated. The only other modifier would be that these suggestions would need be one of two types, guarantors of rights to the people and the individual states as incorporated by the Tenth Amendment or be a limit on the government starting at the federal level and even including the state and local level if desired also as per the spirit of the Tenth Amendments empowerment of the people themselves. Until something such as this occurs expect more demonstrations and suffocating government laws and regulations, especially regulations.

 

One thing which we found most threatening by the Obama Administration was their positions called Czars who were nothing more than a shadow government replacing the actual power of the Cabinet Secretaries by people who were never vetted by the Senate as they were never required to be confirmed by the Senate as other appointees are required. This permitted a government level within the administration which was unanswerable to the elected representatives of the people which was a way around the confirmation system and placed Obama appointees who were beyond reproach. One such position had no equivalent Cabinet position, the Regulatory Czar Cass Sunstein whose position defined his position as reviewing all previous legislations, laws and even regulations to see whether additional regulations could be derived from these items which had not previously been conceived of and were in line with the desires and goals of the administration. There was no record kept on the numbers of new regulations generated by his position but he remained in this czarist fiefdom for close to the first four years that President Obama was in office. We guess he left when he had run out of things to review and felt that X many thousands of additional regulations should be sufficient to muck up the works of anything anybody in the private sector desired attempting to do without first greasing the wheels of governance. Many estimates place the number of added regulations over the past decade to exceed half of a million pages of new regulations on the books. We do know that the deficit spending through 2010 with 2011 projected in the graph below proves that government is broken and very probably unsalvageable. Without a massive cutting of the size, scope, width, breadth, depth, reach and overall weight of the gargantuan, all-encompassing and devouring behemoth which now threatens the health and welfare of the nation which we call the federal government, the United States will drown in its own swill of regulations, taxes and overreaching programs. This is the sad truth and many know this and still insist on continuing with the same mindset claiming they can spend their way out of this morass.

 

Deficit Spending Through 1980 – 2010 (with 2011 CBO estimate)

 

That is what was wrong with the Trumpcare and Ryan should have realized that and worked to do the right thing. The solution to Obamacare is to hunt down every last single shred of that monstrosity whether it was part of the original legislation or passed as a set-up piece hidden in a defense spending bill, and omnibus bill or an extending government operations bill and nix every last letter and punctuation from the record and then hunt down every single regulation written to enact every scintilla and erase them with equal fervor. The only true solution to the Obamacare nightmare would be to remove it all and if that means that some pieces of other healthcare existing strategies and programs will be cut back, good. Then allow churches and clubs to offer group plans which would spread their care over those who need coverage but cannot find affordable programs and these systems can get group rates which will bring costs down for those in need. Allow charities to pay for healthcare for the people needful of such assistance and do something horrific, require those who are able-bodied to get work and pay their own healthcare. Please pass tort reform, good luck as congress is chocked full of lawyers. Pass limits on malpractice rewards lowering malpractice insurance costs and allow hospitals and health maintenance groups to get group plans for their physicians’ malpractice bringing those costs down. By promoting group insurance for all forms and across state line coverages the prices will become more competitive. There could even be plans made where people residing in a community to purchase healthcare as a group which would offer another means for lower price coverage. Health savings plans should be encouraged and even allow one support from government that money put into a health savings accounts to be tax free along with the interest earned and once an account reaches the set amount, it can then serve as their insurance plan as long as they continue to contribute a minimal amount monthly so that as costs rise with inflation they remain covered sufficiently well plus as they age they will accrue more coverage as it will be necessary. There are ways through private sector to cover almost everybody and almost all who desire coverage, and for those who require care and do not have insurance, there should be a means for loans for such coverage from financial institutions willing to take such ventures under their programs offered similar to vehicle loans and charities for tragic cases as per their discretion. Americans are a people known and renowned for their generosity and are perhaps one of the most giving nations on the planet (we think possibly with an exception except that the exception gives in such ways as cannot be measured as there is no record as much of the charity is through religious institutions where no records as from where their donations came or even how they were dispensed as they were given in quantities and to recipients both of which remain unrecorded for the benefit of all involved and the dignity of the less fortunate. Were the United States to return much of the care for those in need to their religious institutions and charities they might find that would prove to be a superior system and the people who could afford to help would and those who chose not to help would be allowed their greed, in the end it would not matter. Life is funny that way.

 

Beyond the Cusp

 

Republican Distress Self-Inflicted

 

The Republicans appear to be in disarray and acting as if they are completely unaware of the fact that they control both houses of Congress and the White House and are in the catbird seat exactly as the Democrats were the first two years of President Obama’s two terms. They are capable of setting the rules in the Senate such that they would have sufficient votes to ensure cloture by requiring a mere fifty-two votes ending any filibuster. The Democrat use of the so-called nuclear option set the precedent for adjusting cloture to fit your needs when you have the majority in the Senate. Yes, doing so would allow for the Democrats to do similarly when they gain fifty-one seats in the Senate and who does not believe they would do exactly as such anyway. The Republicans instead are fighting with the White House declaring the President’s budget dead on arrival. This is a party in need of better leadership as currently they are wasting their first and possibly only opportunity to prove they are the better option by acting as a whole to enact their vision for the United States.

 

I hear people demanding what we would propose if we think we have the answer. Well, perhaps they could actually get everybody on the same page instead of having a different set of priorities for every twenty or thirty Republicans. They need to have the Senate choose ten Senators and the House of Representatives choose twenty-five or thirty Representatives and have these people meet with the President and each Cabinet member in a series of meetings taking a week out of their schedules. Initially the President on the first day along with his preferred advisors should meet with the delegations and set a general structure for the ensuing week or even two and have the President and everyone else at the meeting express their preferences and ideas and have them discussed in a general sense setting up a framework. Then they should have meetings with cabinet members and the President each morning and then return and meet with the Republicans in the House of Representatives and Senate each with their own chosen delegates such that everybody has some input and in the end they reach a consensus which is acceptable to the President and his Cabinet and advisors. Once this framework has been set, then the House of Representatives and the Senate can begin to work on the enactment of these ideas putting them into action. These agreed upon initiatives should be enacted through the House of Representatives and the Senate in quick order and signed by the President getting a basic set of accomplishments enacted and presented to the public as actual accomplishments in the next election cycle. If their ideas actually capture the minds and match the ideas of the population in the majority of the nation, then the Republicans can reap the rewards and press forward with even more action and accomplish what they promised in the first place.

 

President Trump National Security Advisor McMaster
Speaker of the House of Representatives Ryan
President Pro Tempore of the United States Senate Hatch

 

The first thing they need do is revamp healthcare. An idea we would like to suggest is to keep the choice parts of the current system adjusted to make them include competition between the many insurance companies. Much of healthcare need be taken from the employers and returned to the people such that their demand for the most and best options and the insurance companies need meet their hopes at an acceptable price, this will bring healthcare costs back down within reason. Further, the government need remove most of the regulations, reporting requirements and other unnecessary paperwork which has completely destroyed the concept of a single doctor working from their home in the neighborhood where their patients reside as had been the case before the government needlessly intervened and destroyed affordable healthcare. The government should only require that insurance policies cover major medical allowing people to decide to pay for any minor care out of their own pockets. The one idea which the government should make illegal would be controversial but in the long run would produce lower medical costs, and that is to make group policies illegal such that companies, unions, and other groups such as retirement groups or social groups from offering insurance to their workers or members. Make individual policies the sole type of health insurance allowed and only require minimal coverages. We suggest only what used to be considered major medical which would include emergency rooms treatment with a deductible, surgical procedures, any hospital or clinical procedures again with a deductible, and hospital stays with a deductible. The deductibles would depend on the cost of the coverage with the less expensive coverage having a higher deductible while there could be specialty additional coverages which would cover these deductibles but this should be banned from health insurers offering. Such a system would produce insurance affordable at any level such that younger and healthier people could take the risk of higher deductibles and with people paying for most of their own healthcare we would see prices become lower for most standard healthcare needs. The main way to cut healthcare costs would be to put a cap on rewards for malpractice suits and make one vital change, the lawyers losing any malpractice suit would be responsible for both sides’ court costs and lawyers’ fees within set limits. This would lead to fewer malpractice suits as lawyers would be very careful to only take such cases which they felt quite sure of their case and winning the case, period.

 

There are probably many other means for lowering court costs which we have not included which the Congress could enact. Removing regulations and paperwork would be one of the greatest means to relieve the burden on physicians who have had to form groups to defray the clerical costs imposed by both government and insurance companies who often are demanding additional paperwork simply because the government demands they file paperwork. Government is once again the greatest contributor to the costs of a commodity which they also demand everybody purchase. This is simply something the people’s need should have to accommodate and not employers or government as that is the current system which the people declared broken and becoming overly expensive with far too many forms. The government should never have the power to add costs beyond reason to an industry and then require the people purchase said product. As happened with car insurance, whenever the government demands people to purchase a commodity the price of such commodity will naturally skyrocket reaching the limit of what the people are capable to pay, not the actual required cost of the commodity. Simply ask yourself what would you charge for widgets if the government required every person to purchase one widget every month? You would price them set the highest price the market would bear rather than a competitive price because every other widget salesperson would be doing the same. The highest probability is all widget salespersons would agree to set an inflated price where all would become wealthy beyond what any normal competition would prevail had the government not required people to purchase your product. That is simple reality of life and not rocket science, or advanced economics. The proof of this theory has been the cost of health insurance since Obamacare hit the market. This is why competition must be returned to the health insurance markets and as much government involvement must be removed back to bare bones or less. No government involvement would be the most preferred state of healthcare. But first the Republicans need to unify and find some leadership which can work well with President Trump, both by leading when necessary and following when Trump is leading constructively. We can only hope.

 

Beyond the Cusp