Posts Tagged Health Care

AMERICA IS BEGINNING TO WONDER IF DONALD TRUMP CAN GOVERN—AT ALL!

Following the Presidential Election, there has been an on-again, off-again rally in the stock market, which might have been partially attributed to Donald Trump’s victory, last November.  Generally, the stock market performs best in the first and fourth calendar quarters, most years; however, some investors might have placed too much faith in Trump’s vague promises, raising the seasonal spurt even higher.   Also, some CEO’s seem to have swooned over his proposals:  the corporate tax-rate being halved; escalating depreciation on plant and equipment; eliminating most all regulations; and the “Border-Adjustment Tax”.

As of Friday, the Dow Jones Industrial Average rose 9.3% since Trump won, and the    S & P 500 was up by 8.3%.  There was little in the way of economic activity to have justified such a surge; however, some investors may have just followed the herd instinct.  They wanted to believe!  But like any other asset, when the price rises for no apparent reason, there might come a time where it cannot sustain that psychological momentum.  Did the markets seem to sense that yesterday?

Ever since he announced his candidacy, in June of 2015, Donald Trump has been harping on two primary goals—the worthless Wall, and his vow to “…replace ‘Obamacare’: with something much better, and at less cost.  Just trust me!”  HA! Donald raised the stakes too high, before his American Health Care Act had to be pulled yesterday—for the second time—due to insufficient support from his own Republican Party!

Always the person to find a scapegoat to blame–rather than blame House Speaker Paul Ryan, or the entire GOP–Donald blamed the Opposition Party.  For a self-proclaimed “Negotiator”, how ludicrous was it to have over-sold the “certain” success of his AHCA, as he had often boasted, and then blame the Democrats…but, for what?  He was trying to tear-down a perfectly good (first-step) of a comprehensive plan that could provide Affordable Health Care for all!

Many Americans, including investors, are beginning to wonder if Trump can actually govern! He boasted, before the election, about how many things he would do, beginning “Day One!”  But so far, he has accomplished very little.  On the negative side, however, the list of his idiotic moves is a mile long!

Consider the following problems that he has been entangled in:  the failed raid in Yemen, which resulted in the death of one Navy DEAL and 24 Yemeni civilians; attacking the American Judiciary for rebuking his two Anti-Muslim Bans; his apparent desire to control the Media; threatening a pre-emptive attack on a nuclear-armed North Korea—in China’s back yard; Trump’s potential collusion with Russia, and so on!

A number of Americans who voted for Trump have been on TV stating that they are having Voter’s Remorse.  It’s times like this when I wish that we had a Parliamentary System.  That way, just one “No Confidence!” vote would place M. P. Donald Trump, in a back-bench seat, where he belongs.  Oh, if only…!

When Trump stated yesterday that the GOP’s AHCA Plan had to be pulled, distancing himself from bad news as always, he proclaimed that the next item of business would be Tax Reform.  But there are two problems with that strategy, which he is overlooking:  a number of deep-pocketed conservative organizations, including the Koch Brothers, have come out again Trump’s Tax Plan; and the money that he was supposed to take from ACA customers was necessary to fund his large tax cuts for the Wealthiest two-percent!

Meanwhile, many institutional and individual investors are, no doubt, using this weekend to review Trump’s record—both positive and negative—and to decide what their next financial moves might be.  Additionally, many overseas investors are also considering whether the recent Trump Rally is real, or just a market bubble!  I sure wouldn’t be surprised it there is a pause, at least, in the rally–or perhaps a reversal.

 

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WHEN DID HEALTH CARE BECOME A POLITICAL ISSUE, RATHER THAN A MORAL ONE?

President Barack Obama’s signature legislation, the Affordable Care Act, was designed to provide health insurance for poor Americans who could not afford it.  Many people already have health insurance through employer-sponsored programs, or through Medicare, for Senior Citizens.  Small businesses, however, often do not offer insurance, and minimum-wage workers cannot afford it anyway.  Uninsured Americans were just left to fend for themselves and, of course, private insurance has always been quite expensive.

The Affordable Care Act provide subsidies for poor Americans, including seniors who could not even afford Medicare, and to extend the Medicaid program to more low-income citizens.   Many GOP-controlled states, such as Florida and Texas, have not accepted the Extended Medicaid, even though the Federal Government picks-up most of the cost for the first ten years.

Prior to ACA, cheap health insurance policies, designed for young adults, excluded “pre-existing conditions”, and even maternity was often excluded for young women. For older Americans, the premiums were exorbitant, and out of reach for many.  Policy holders took comfort in being “insured”; however, they didn’t realize how little the policies actually covered—that is, until they became sick or injured!

The total number of previously uninsured Americans, who were able to buy subsidized health insurance, through ACA, approaches 30 million, when the 11 million covered by the Medicaid Extension is included.  Many state Legislatures, that have Republican majorities, have not even allowed their Insurance Commissioners to negotiate for lower premiums, with the insurers.  Basically, those states were working against ACA—and against their own residents.

ACA was assumed to be the first step in providing Affordable Health Care for all Americans.  Like Medicare, some 50 years before, this comprehensive program was expected to need to be amended and modified over time.  But the Republicans, at the Federal and State levels, just fought against the program every step of the way.

TChe Affordable Care Act also required the Health Insurance Industry to meet certain goals:  pre-existing conditions would be covered; contraceptives and maternity must be included for women; equal premiums for males and females; premiums for the elderly could not be more than three times those paid by the younger insured; and no more than 20% of customer premiums would go toward expenses.  Many of these requirements have been dropped, or watered down, under the GOP’s AHCA.

When people do not have health insurance, they only seek medical assistance when they are gravely sick or injured, generally at hospital Emergency Rooms.  By then, the medical condition is usually more aggravated, and the medical personnel are working without any knowledge of the patient’s medical history.   The cost of health care, in this advanced stage, is normally much more expensive, and society and the hospitals bear the expense.

The most humane, as well as the most cost-effective, way to address the need for Affordable Health Care, is to make it available on a regular preventive basis.  Should we ignore the grievously sick, and allow them to die on the streets?  Do we continue to just ignore the overall costs—assuming that they will just go away?   Realistically, we should take pre-emptive action!

Among all of the world’s industrialized nations, American spends the most on health care; but, it gets the lowest return on its investment, by most every metric.  Is this how we wish to continue on?  Should we address the need for providing Health Care for all, in a caring and effective manner?   Or do we, as a Nation, just continue to sink. further and further into the bowels of Humanity.

NOTE:  I was wondering who Donald Trump would try to make the scapegoat when his first foray into major legislation had to be canceled twice, for insufficient support.  Would it be House Speaker Paul Ryan or the entire GOP?  No, he blamed the Democratic Party since they were perfectly happy with the ACA, which they passed seven years ago!   Next stop: Trump’s Tax Scam!

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ARE TRUMP AND THE GOP MORE CONCERNED WITH IMPROVING HEALTH CARE, OR REPEALING OBAMA’S SIGNATURE LEGISLATION?

On Monday, the House Republicans released their Replacement Health Care Plan so they can Repeal “Obamacare”.  Donald Trump jumped at the chance to embrace the Plan.  Also, since the GOP has been so focused on devising, a replacement plan, they seem most ebullient just to mimic George W. Buh’s boast of “Mission Accomplished!”; but, the suitability aspects must have been left back at the conference room.  The reception for the much touted GOP plan, so far, has been anything but favorable, even from within their own party.

Actually, the House Leadership didn’t release it; rather, they seem to have preferred to just have it leaked.  There wasn’t any condemnation for it getting out, just the wiggle room to declare that it was only an early draft and, that way, they could always reel it back in.  Right now, however, the House GOP leadership is trying to put some lipstick, as well as some rouge, on this pig.  But really, this swine is just not gonna fly.

Since the Plan is, no doubt, being analyzed in minute detail, by all of the usual news sources, I will not try to duplicate their efforts.  The NY Times article, linked above, cites various key components of the ACA, and how the House Plan compares.  Specific parts of the ACA are also cited, along with explanatory notes on those being: retained; modified; or eliminated. However,  I would like mention a few key points, which the GOP might have purposely preferred to be lost in the shuffle:

  1. What will happen to those previously uninsured Americans who, under ACA’s Extended Medicaid provision, will lose their health care coverage under the GOP Plan?  Why hide that fact?
  2. Why would reasonably wealthy people be receiving the health care tax credits, rather than just those who need the help in order for them to buy the insurance?  A tax-cut for the wealthy?
  3. When will the American People be advised that they will not be guaranteed to be covered for “pre-existing conditions” if they had not, in fact, already purchased the insurance  coverage?  Why not spell this vital detail out?  Besides, no health care insurer would provide new customers with coverage that include adverse medical conditions!
  4. Block Grants will not insure health care for residents, when given to the states as “flexible dollars”, because the funds may just be added to the state’s General Fund.  In 2009, Republican Governor Mark Sanford, of South Carolina, received Infrastructure money from the Federal government, intended to create “shovel-ready” jobs; but, he used it to pay-down the state debt.  And, Louisiana Governor Bobby Jindal, also a Republican, just refused the much-needed money outright.

The Affordable Care Act certainly can be improved, as was Medicare when it was originally passed, and also the Medicare Prescription Drug Plan (Part D).  The Republican Party has been extremely intent on obstructing President Barack Obama, since the evening of his first Inauguration, and Trump just wants to tear down anything that Obama had accomplished.

But, is that a reason to take Affordable Health Care away form the tens of millions of Americans who have come to rely upon it?  The following Op-Ed, from the NY Times, is co-authored by Dr. Ezekiel Emanuel, a key participant in writing the ACA Legislation.)

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PERHAPS THE REPUBLICANS MIGHT HAVE UNCOVERED MORE THAN THEY HAD WANTED, IN THEIR QUEST FOR AN “OBAMACARE” FIX

As the Republican Party has been delving into alchemy, for almost seven years, in its search to replace President Obama’s Affordable Health Care, it has determined that Americans need to be able to buy health insurance across state lines.  And I agree completely.  But, there’s more to the overall problem, than just where the insurance is sold!

Upon further consideration, however, their search also reveals certain risks in assuming that each of the 50 states already competently regulate the respective insurance operating companies doing business within their states.  The regulatory problems have also become more difficult, especially as the parent companies grow more diverse–and the industry more complex.

Banks and Securities Firms are regulated by Federal Regulators, which enables them to examine, let’s say, Bank of America or Goldman Sachs, both across the nation—as well as across their various product lines.  For Allstate or Nationwide, however, different state regulators examine the individual subsidiaries independently, without any coordination whatsoever—especially with regard to self-dealing among other out-of-state subsidiaries.

The idea of buying Health Insurance in Indiana or Ohio, or Homeowners in Texas versus Oklahoma, would be a simple enough change.  That’s because the insurance risks, for comparable customers, would not change just because they live on one side of the state line, or the other.  If Blue Cross-Blue Shield, for instance, could operate through just one, or perhaps, several subsidiaries nationwide, that would lower some of its redundant expenses, perhaps lowering the premiums, as well.  But, the highest risk is at the Home Office–where the buttons are pushed!

A NY Times article, from 2009, described some issues with AIG, one of the very largest insurance companies, which operated through 71 insurance operating companies, that were spread among 19 states, and additionally in many, many foreign countries.  Eventually, the Federal Reserve and the Treasury had to provide the largest bail-out in American History—some $182 billion.  Otherwise, a collapse by AIG could have brought down the overall American Economy—or even worse!

AIG was playing a shell game with itself: the various operating companies were investing in each other, rather than properly diversifying their similar risks more adequately; some companies were shifting debt to other AIG subsidiaries, making it impossible for the various state regulators to ascertain their respective financial stability; and the parent company (AIG, Inc.) had engaged in “Credit Default Swaps”, the so-called “toxic assets”, whereby it guaranteed Wall Street assets valued at more than its own Net Worth.

But, the final question is:  How far will the Republican Party keep searching, if in looking for a replacement for “Obamacare” (as they call it), they might have the Insurance Regulatory Environment to deal with?

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NO TRUMP BUMP IN THE STOCK MARKET

Following last Tuesday night’s State-of-the-Union Address,  Donald Trump just reiterated most  of the usual things—Jobs, “Obamacare”, Dodd-Frank, Immigration, Terrorism, Regulations, Trade and Tariffs, Education, etc—which he has been talking about throughout his very short political career.   But, after 40 days in office, he has accomplished absolutely nothing, except to infuriate a majority of Americans.

If any of the promises he has made were based on non-practical ideas, Trump would have had people working on his proposals and, perhaps, even submitted legislation to Congress on a few.  For instance, if President Obama’s Affordable Health Care were really so “awful”, we would have seen a draft of TrumpCare by now.  And, if Dodd-Frank, which reined-in the banks, after they took the nation to the edge of the Financial Abyss in 2008, was so terribly bad,  wouldn’t Donald have presented an alternative plan by now?

But so far, Donald Trump seems to be spending his time:  talking and tweeting; holding Command Performance meetings at the White House with people who seemingly would rather be anywhere else; and having his photo-ops boarding and leaving Air Force One, and always with Ivanka and the grandchildren in tow.  I wonder if Trump spends more time at Mar-a-Lago now, since taxpayers are paying for it, than he did before he took office?

Market professionals, who had been expecting a Market Boom; because, Donald Trump vowed to: put people back to work; re-build the crumbling infrastructure; cut the tax rates for everyone; de-regulate all industries; and put more discretionary income in consumers’ pockets.  But now, those investors are beginning to wonder how much of Donald Trump’s agenda is smoke, and how much is mirrors?  They are also wondering if he can even get any of his plans through a Republican-Majority Congress?

When people look at the Trump Regime nowadays, the question most frequently asked is:  Who’s in charge?  Donald Trump has demonstrated that he is certainly not a detail man, whether that means understanding the most important questions facing the nation today, or in directing his staff in carrying out those most important responsibilities.  Trump himself seems to be out more often than he is in, and most of his Cabinet and other key officers seem to be kept out of sight, and few deputies are on-board.  With forty days in, and nothing accomplished: that’s despicable!

The financial markets do not function well with uncertainty.  In fact, Steve Bannon seems to be the only key advisor in the office, and working.   And, that’s like having the fox guarding the chicken coop.  Reports from the West Wing suggest a spirit of: disorganization; disruption, incompetence and disbelief.  Even Reince Priebus, Trump’s Chief-of-Staff, appears to be lost, both in-space and in-time.  Will he be ousted soon?

I believe that this sorry picture of our Nation’s Leadership—without experience, without leadership and without a clue—is why the stock market has paused, and backed-off from the blindly upward track that it had been on for the past couple of months.  There has been more, and more, talk of a stock market pull-back; however, now it might take a “correction”, a ten percent drop, in order to adequately pass some of the false Trump euphoria out off the market.

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DON’T ASK ME TO ORGANIZE MY RECOMMENDED BOOK TAB!

I’m sure that some people would find the “Books that I recommend” list much easier to use if everything were organized into quite distinct categories, such as: Politics; History; Science—or, at least, Fiction and Non-Fiction.  But, that’s not how my mind works.  It’s just too cluttered!

Consider the most recent addition (and yesterday’s post): “Three Days in January”. President Eisenhower left the Presidency 57 years ago; but the real story, I believe, is a combination of:  World War II and Early Cold War History; reflections back to our Founding Fathers, and what their intentions were, with regard to the Constitution; contrasts of the Leadership styles between Ike and JFK, and the lack thereof with Trump. and, lastly, the peril which the Military Industrial Complex might present today, especially in the hands of a Fool.   Now tell me, how would you categorize that NY Times Best-Seller?

“Freeman” is a well-researched historical novel about Racism in post-Civil War rural Mississippi.  That book, not only depicts the reality of how both blacks and whites regarded one another, at the time; but, it also provides some insight as to Racism, as it is today in America today, and particularly, in the rural South.

“Moneybag” is nominally a book about baseball; but, it is really more about the use of statistics in player personnel management.  The Oakland A’s had one of the very smallest budgets in Major League Baseball; however, for a time, they compiled better Win-Loss records than all but a few of the league’s 30 teams.  The A’s realized that some of the more pedestrian statistics, such as: on-base average; total bases and “small ball”, won more games than often considerations: physical looks: home runs and fielding.  For the owners, that approach was more “cost-effective”.

Statistics has also played an increasingly important role in general decision-making theory.  Much of what is pointed-out, by Michael Lewis, the author of “Moneyball”, is based on the insight of the two Israeli Psychologists, who are his main subjects in “The Undoing Project”.  Those psychologists won the Nobel Prize for, get this, Economics, in 2003.  Their research has led to: the creation of the new field of Behavioral Economics; revolutionized Big-Data studies; advanced evidence-based medicine, and helped rationalize government regulation.

NOTE:  If anyone can devise an algorithm, which will organize my “Books That I Recommend” tab, please send me the “For Idiots” version, so that it can install itself.

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NICHOLAS KRISTOFF’S OPEN LETTER TO TRUMP VOTERS

NOTE:  This is an open-letter that Nicholas Kristof wrote, in his regular NY Times column, to awaken all Trump Voters:

Dear Trump Voters,

You’ve been had. President Trump sold you a clunker. Now that he’s in the White House, he’s betraying you — and I’m writing in hopes that you’ll recognize that betrayal and hold him accountable.

Trump spoke to your genuine pain, to the fading of the American dream, and he won your votes. But will he deliver? Please watch his speeches carefully. You’ll notice that he promises outcomes, without explaining how they’ll be achieved. He’s a carnival huckster promising that America will thrive with his snake oil.

“We’re going to win, we’re going to win big, folks,” Trump declared Friday at the CPAC meeting, speaking of his foreign policy.

Great! Problem solved. Next? He then outlined his take on drug trafficking and what will surely be his outcome:
“No good. No good. Going to stop.” Wow! Why didn’t anyone else think of that?

Similarly, all looks rosy for tax outcomes: “We’re going to massively lower taxes on the middle class,” Trump said. But that seems like a classic shell game.

The Tax Policy Center estimated that Trump’s tax plan (to the extent that there is one) would hugely increase the federal debt and give middle-income households an average tax cut of $1,010, or 1.8 percent of after-tax income — while the top 1 percent would save $214,690, or 13.5 percent of after-tax income.

Trump made more than 280 campaign promises as a candidate, and a few — such as infrastructure spending to create jobs — would be sensible if done right. But there still is no infrastructure plan, and The Washington Post Fact Checker is tracking 60 specific campaign promises and found only six cases so far of promises kept.

It’s still early, and Trump has nominated a smart conservative to the Supreme Court and followed his campaign line on issues like barring refugees.

But while you voted for Trump because you put faith in his gauzy pledges, I bet he will do no better with campaign promises than with marriage vows.

Health care will be one of the greatest betrayals. On Friday, he described his plan: “We’re going to make it much better, we’re going to make it less expensive.”

Yet the steps that Republicans seem likely to take on health care will hurt ordinary Americans.

For example, Trump seems poised to weaken the contraception mandate for insurance coverage and curb funding for women’s health clinics. The upshot will likely be more unintended pregnancies, more abortions, more unplanned births — and more women dying of cervical cancer.

The biggest Trump bait-and-switch was visible Friday when he talked about giving Americans “access” to health care. That’s a scam his administration is moving toward, with millions of Americans likely to lose health insurance: Instead of promising insurance coverage, Trump now promises “access” — and if you can’t afford it, tough luck.

This promise of “access” is an echo of Marie Antoinette. In Trump’s worldview, starving French peasants wouldn’t have needed bread because they had “access” to cake.

Many of you voted for Trump because he campaigned as a populist. But instead of draining the swamp, he’s wallowing in it and monetizing the presidency. He retains his financial interests, refuses to release his taxes or explain what financial leverage Russia may have over him, and doubled the fee to join Mar-a-Lago to $200,000.

The greatest betrayal of all will come if, as some of his advisers recommend, he “reforms” and tears holes in some of the big safety net programs like Medicaid, Social Security or Medicare. Medicaid is particularly vulnerable.

Trump howls at the news media, not just because it embarrasses him, but because it provides an institutional check on his lies, incompetence and conflicts of interest. But we can take his vitriol: When the time comes, we will write Trump’s obituary, not the other way around.

Let’s not get distracted by his howls or tweets. What’s most important at this moment is not Trump’s theatrics, but the policies he is putting in place in areas like health care and immigration that will devastate the lives of ordinary Americans.

Trump’s career has often been built on scamming people who put their faith in him, as Trump University shows. Now he’s moved the scam to a much bigger stage, and he boasts of targeting Muslims, refugees and unauthorized immigrants.

Please don’t cheer, or acquiesce in these initial targets. The truth is that among the biggest losers from Trump policies will be you Trump voters, especially those of you from the working and middle class. You were hoping you’d elected a savior, and instead Donald Trump is doing to you what he did to just about everyone who ever trusted him: He’s betraying you.

The sooner you recognize that, the sooner you can fight back and push for policies that will protect your health care and Social Security, defend the integrity of our election system and protect your own interests. You have a false savior, and you will have to turn on him to save yourselves and our nation.

Note from Mr. Kristoff:  I invite you to sign up for my free, twice-weekly email newsletter. Please also join me on Facebook and Google+, watch my YouTube videos and follow me on Twitter (@NickKristof).

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