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

 

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

 

Social Fabric is Being Torn Apart

 

The social fabric since the urbanization caused by the industrial revolution has taken the majority of mankind out of a rural setting and thrust us into a more urban environment. The question which should be occupying a large part of those pondering the future is how will our society adjust the social fabric when approaching one third initially and within this century well over three-quarters of what we consider now as the workforce not only not having gainful employment but no opportunity for employment as more and more occupations are performed by robotic systems. In a recent study Oxford University researchers have forecast that machines might be able to perform half of all jobs in the United States over the next two decades, and by implication the same will be true for the rest of the Western and Industrial nations and beyond. Once robotic workers are capable of executing an occupation, that occupation will be on a fast track to making the human employee a luxury, no employer will be capable of wasting further investments and instead will automate or perish before the competitors who have automated their workforce. Our societies throughout the world will need to adjust to a permanent unemployable class which will far outstrip the active workforce projecting sufficient tax revenues no matter what the taxation rate to support the remainder of society. But do not fret as the price of production and delivery of most goods will be delivered at a great savings which will continually become more efficient and less expensive to produce.

 

One example I recently read of compared the human workers to a former workhorse which powered much of our production either by providing the raw power or was at least required to bring the products to the public. This power and transportation utilized animals such as plowing with an oxen or mule, horse drawn wagons transporting goods from production to the consumers and any other animals mankind once relied upon. In our modern age the sole use for animals is recreation or as a raw material such as sheep for wool and food, cattle for food, dogs and cats as pets and so on with the animals no longer being used as a source of power within modern and industrialized societies. Where the horse drawn wagons and carriages were commonplace on the city streets of New York, Washington D.C, London, Paris and across the world; now a horse within the city limits for transportation is relegated today as some form of recreational use normally reserved for tourists such as carriage rides offered around Central Park in New Your City or central tourist areas in London and Paris and so on. This has caused a drastic drop in the horse population where they have become something that relatively wealthy people keep for their own use and the noble steed has passed its use-by date. The most telling replacement was made painfully obvious when at the start of World War II some of the finest cavalry troops saw their last in the Polish Army until January 27, 1947, when the 1st Warsaw Cavalry Division was disbanded. The initial breakout of World War II saw the attempt to use horse cavalry, as pictured below, in the field against German tanks; one can guess the end result was not too good for the cavalry.

 

 

The use of machinery initially to aid and augment human workforce was the driving technology of the industrial revolution. Power was initially provided by draft animals or water powered systems some of which have been found dating back well before the Industrial revolution to the Roman Empire. Eventually animals were replaced with steam engines followed soon thereafter by more efficient engines such as the internal combustion engine and also the use of electricity to power the factories using electric motors. Whatever the use in the modern factories of the industrial revolution it could be traced back to either hydropower or petroleum and natural gas powered electrical generators or direct use of fossil fuels as in trains, planes and automobiles. The terminology often used to describe the current stage is the information age though one could make an argument for the full utilization of programmable mechanisms. Such systems can trace their history back to the card operated weaving machines which often were water powered used in the making of cloth fabrics. With the development of the microchip we have seen an explosion in the variety of automated machines and had their size drastically reduced and made more agile and adaptable. These robotic units can be programmed or taken through a routine by a skilled operator and then allowed to simply repeat the process it was ‘trained’ to perform. Electronic automating has taken leaps forward to a point where virtually any manual task can be performed by an automated system even to the point of self-driving automobiles, buses, trains, trolleys, trams and other conveyances. Modern airports have installed moving floors to remove the necessity of having to actually walk to your terminal to board or disembark your flight. The exacting standards can and will be facilitated, and will only become more versatile in material and intricacy, as 3-D printing continues to be developed and integrated into the modern, fully-automated factory with robotic employees and a minimal human presence to basically monitor operations and hit the ‘stop’ button in case of, what will be made less common, an emergency or breakdown. What is frightening is there are robots being developed which would facilitate the repair of such a breakdown.

 

One thing I can attest to from my own work experience is that the printed circuit integrated boards have reached a level of sophistication and the manufacture of the integrated circuits made so affordable that the vast majority of these boards, or even modules, are less expensive to replace the entire part of the unit and send the malfunctioning board to be recycled or even destroyed (in an environmentally sensitive manner, of course). One industry which has turned to automation in a big way has been the automotive industry, both in their products and the assembly of the product (pictured below). The muscle of a robot is one of its major benefits as it never tires of doing its assigned tasks, never takes a break, is rarely ill or out of commission, does not complain and is very efficient. The latest addition to the productivity and versatility of the robotic assembler is that the software is almost to the point where a robot will be fully capable of replacing the majority of service jobs as well. In the future there may well be some upscale stores which will offer their patrons a level of service advertised as the most personal service one could expect, and such a boutique would actually have real flesh and blood people. What will be amazing is those people may even approach the efficiency, attentiveness, level of service and any other category except for speed and acute knowledge of the entirety of products available but otherwise just as good service as one can get from an automated shop. The basic for such a machine requires a special set of electronics which will have a microprocessor board which will contain any number of required CPUs (central processing unit), Memory ICs (both read/write and worm, write once-read many), support data ICs holding the AI (Artificial Intelligence) and the various switching, logic gates, and drivers (all of which look a lot alike to the chip displayed below). The current form of Artificial Intelligence in a robot can take many various forms each with their own special abilities and limitations. Some you might choose to have around the home to do the cleaning and be a walking-talking data base to provide information or even take your selfies and post them on Instagram, Facebook or whatever is the latest and greatest once we all have our personal assistant. (see below)

 

 

 

 

 

The predictions are that humans as a part of the workforce will be limited to personal touch niche and specialty markets but manufacturing will be fully automated within the next fifty years. Some of the effects of just sending many manufacturing plants overseas have had a huge debilitating effect of employment and pay scale of average incomes. Additionally, the United States has faced this drain in particular and it is not simply the income of the workforce which has driven many manufacturers overseas but rather the additional restraints and extra costs of making many products which drove them from American soil. The cost of pollution controls are quite stringent by comparison to the near nonexistence of such laws and restrictions in China and other markets. Taxes are another driving force pushing these jobs overseas. One has to realize what the extra costs with compliance with all the labor laws, inspections, building codes, noise limitations and the additional costs of employees with the new addition of the Patient Protection and Affordable Care Act (PPACA) which in and of itself has produced an expected quirk as far as new hires in the United States. Where part-time work for people employed from twenty to twenty-nine hours per week has increased measurably, some estimates place it as high as twenty-five percent with the average assessments placing it at approximately twenty percent but on the other end. Full-time employment figures have not only not increased as well but in most assessments has dropped approaching five percent. College graduates can expect lower starting wages with many even working in their field starting at below fifty-thousand dollars a year. This is after at the minimum of four years at an average cost of over one-hundred-thousand a year for room, board, books and other supplies and fees. There are also a record number of college graduates who have been forced to accept employment in other fields and at positions which do not require a college degree, and we are not talking about those who majored in Renaissance French Sonnets of the Sixteenth Century.

 

The coming explosion in robotics will be from two perspectives. The first will be the rapid advancement of AI (Artificial Intelligence) to levels where one would have some degree of difficulty determining if they are speaking with an actual person or a computed employee, basically a telephone operator robotic unit. There is work being done now that has computer programs that write the codes for use in robotic systems. There are cad/cam software programs which enable the computer to design the systems to meet specifications using modular designs which are becoming as complex and intricate as anything produced previously by human beings. The truly frightening thing is that we may soon have robots designing and programming their own improved models and able to implement the manufacture and production of their improved design. This also implies that robotic systems in the not too distant future will also be capable of rewriting their own software and improving themselves for their own purposes. Once the machines begin producing more powerful and more capable machines and are capable of writing the programs allowing these improved robots the ability to supercede the level of competence of the initial robot we will have, as the human race, made ourselves superfluous placing us beyond the cusp and onto the endangered species list as we will have just as much relevance to robots speaking their own invented language and, who knows, inventing their own programming language which will completely shut human kind out of the formula. Let us hope the robots of the future find us to be cute little humans and get a good laugh at the humans posting their exploits on the internet. The robots are coming, the robots are coming and many of them are here already and they are assisting the government in watching you.

 

Beyond the Cusp