Posts Tagged Health Care

DONALD TRUMP PLANS TO EVISCERATE THE STATE DEPARTMENT BUDGET, BY 30%! DOES HE STILL HATE HILLARY CLINTON THAT MUCH?

When Secretary of Defense, James Mattis, heard that the State Department Budget would be slashed by 30%, he said: “I’m going to need a lot more bullets!”   As a retired Marine General, Secretary Mattis understands that the dollars spent by State are worth more than those in the Pentagon’s Budget.  Similarly, 150 retired generals and admirals signed a letter to Mr. Trump, asking him to re-consider this down-sizing; because, they know how State Department programs can partially offset the need for Military action!

Throughout the entire Trump Regime, there are only a handful of key staff positions—Deputy and Assistant Secretaries—that are filled.  Also, since these are political appointments, they would need to go through the often tedious Confirmation Process.
While 200 key positions remain vacant at State, it is expected that the Department might not be up to full-strength, at the key levels, until well into 2018.

Due to the size of the State Department, with some 170 overseas locations, the void at the top is especially debilitating.  Secretary Tillerson must travel quite extensively, mostly out of the country.  Who, then, would be in-charge when the Secretary of State is overseas?  He surely needs several key assistants to keep things functioning properly.

Donald Trump appears to know nothing about Foreign Policy, nor does he seem intent on learning.  Rex Tillerson, his Secretary of State—who should be his Chief Foreign Policy Advisor, was the CEO of Exxon-Mobil Corporation, and is a diplomatic novice, as well.  With both Trump and Tillerson lacking in any form of Foreign Policy experience, who do they call when they need help…NOW?

Secretary Tillerson, in his former career at Exxon, knows that any confident executive would have screamed holy murder at a 30% budget cut.—especially for no apparent reason!  Budget-size reflects relative importance—in government, as well as business. Mr. Tillerson, however, apparently didn’t bat an eye.  What kind of message does that down-sizing send to the world, at large, about how America views Diplomacy?

Besides America’s vast global network of Embassies and Consulates, the State Department provides leadership and financing for numerous vital programs: eradicating illnesses such as malaria and diphtheria; empowering women in combatting rape, incest, honor-killings and sex-trafficking; promoting education and micro-banking; and providing clean water and sewer systems to rural area.  Such programs help enable disadvantaged regions to become more economically aligned with the rest of the world.

Given the Importance of the State Department, as the face of America to the rest of the world, I can only wonder why its Budget was slashed so significantly.  Besides the many geopolitical trouble spots, let’s not forget growing starvation due to Climate Change, and the potential for medical pandemics. Why…WHY is Donald Trump trying to eviscerate the very Department of State?  Does he hate Secretary Hillary R. Clinton that much?

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WHY ARE WE SUBSIDIZING OUR OWN DESTRUCTION?

In 2015, Mark Carney, Governor of the Bank of England, the United Kingdom’s central bank (like our “Fed”), addressed the fabled Lloyd’s of London membership.  Mr. Carney spoke to this consortium of insurers about the future of the financial markets.  Namely, the new threat: Climate Change.   He knew that insurers, much more than other group would understand the risks, and want to be out ahead of what lies beyond the horizon!

As insurers, Lloyd’s members should be aware of the many hidden costs to our society which, either directly or indirectly, they might have to insure.   Economists use the term “Tragedy in the Commons”, which is where any entity uses the communal resources—the air, water, fishing, etc—for their own benefit, while leaving any negative aspects of their actions to society, at large.

Although there are many situations where the Tragedy in Commons may occur, perhaps the best example might be the local electric power utility.  The negative aspects of using fossil fuels—coal, oil and gas—to generate power, are not paid for by the utility that reaps the profits.  Increased health issues, replacing obsolete plant and equipment, and environmental clean-up, are left to the local residents.  And as the air and water flow by, one city’s contagion can spread to other cities—and even continents.

Yesterday, I added a most compelling book to the “Books That I Recommend” tab, on this blog: “Climate of Hope”, by Michael Bloomberg and Carl Pope.  Over the past several decades, the ebb and flow of politics, has caused the commitment of many nations to dissipate, with regard to the various global climate change accords.  Fortunately, many, many cities have stepped-up to fill-in the void!

Michael Bloomberg discusses the fact that much of a city’s needs fall-on the local government.  As the former Mayor of New York City states, when the incidence of asthma spikes, people call City Hall, and not their Congressman.  Besides public health issues, cities assume responsibility for: safe streets; police and fire; functional mass transit; basic utilities; schools; parks and recreation; etc.  And each of these must by budgeted, and paid-for by the taxpayers.

As Bloomberg and Pope point-out, many of these problems are inter-related.  Consider the following: clean air improves health, which provides better attendance at school or work; better-planned cities reduce flooding and expedites the flow of traffic; mass transit improves air quality, and it is cheaper to operate when it is powered by bio- or electric power; updated technology and energy-efficient operations can reduce the business expenses, etc.  And in the end, cities must be vibrant to attract residents and businesses!

In addition to considering many of the concerns we’ve heard for several decades—the air we breathe; over-fishing; auto emissions, etc,—Climate of Hope also describes a number of environmental aspects that we might not even be aware of.  For instance, a chicken dinner has one-sixth the carbon impact as a (similar-sized) beef dinner; there are a number of other toxic gases, besides CO2, that we emit into the atmosphere; and depending on what we import, and from where, we might be encouraging additional climate change.

Working with some 7,000 cities, Bloomberg and Pope have encouraged businesses to join them, rather than as adversaries.  Corporate leaders can better-understand the cause and effect relationship, between up-front investment in plant and equipment, and the long-term stream of lower maintenance costs.  And, once the true costs are included in the analysis, corporate partners want their families, and those of their employees, to live in cleaner, healthier, safer cities, as well.



NOTE:  Welcome to my readers from Panama and Qatar!

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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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