Category Archives: Affordable Care Act

Trumpcare and Medical Travel: What Will Happen

The following infographic shows what will happen to the US healthcare system when the Senate rams the ACHA down our throats, as many are indicating will occur because McConnell and a group of GOP Men are hiding behind closed doors and won’t even tell their own party what’s in the bill they are writing.

What this will mean for medical travel is not hard to figure out. For some, it will offer an opportunity to seek lower cost medical care due to premiums that will increase and costs rising as well.

This will be especially true for self-insured employers who will want to save money by offering this to their employees.

Here is the infographic:

fa97feb3-c0f5-4fdb-9c79-6cfe82add29e-original

Despicable!

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Winston Churchill

 

Here we have two quotes dealing with the same subject. The first quote is from the father of Scientific Socialism, i.e., Marxism and Communism, and the second quote is from the wartime Prime Minister of Great Britain, who was a staunch anti-Communist.

But what transpired today in Washington, is far from the view of Marx, or the view of Churchill. In other words, it is DESPICABLE!

Never before in the history of the United States, has the government of the people, by the people, and for the people ever taken away something the government gave them in the first place.

Not even the enactment of the 18th Amendment outlawing the sale and production of alcohol, stoops to the level of total disregard for the health and welfare of the American people. Alcohol was never something the government had to give to people, they produced it themselves. Our founding fathers were brewers and distillers of alcoholic beverages.

But the vote this afternoon represents a step towards a society this nation has not seen in many decades. You hear that Republicans want to take the country back. The obvious place they want to take us to is the 19th century, when no one had health care, there was no Medicare or Medicaid, or Social Security, Unemployment Insurance, and Workers’ Comp.

There are specific reasons for this, which I will discuss.

First, pure and simple, it is greed. They want the money dedicated for health care and the other medical plans for a huge tax cut for their wealthy friends.

Second, the health insurance companies can now get to pick and choose who they want to cover, what they will cover, and what they will charge you if you have a serious pre-existing condition or a life-threatening disease. We know this as adverse selection.

Third, they don’t believe in giving “entitlements” to anyone except the military and the wealthy.

Fourth, their libertarian, puritanical, Calvinism teaches them that the poor are undeserving of the benefits that money brings, so let them die, and who cares if they are poor, it is a sign of a moral failing.

Another quote from Churchill says that you can always trust the Americans to do the right thing after they have tried everything else.

Well, after today, we have tried everything else. We have given employers the right to offer health insurance to their employees, we have allowed private insurance companies to sell policies to individuals, and we have created separate health care plans for children, the elderly, the military and their families, members of Congress, and the poor.

But for all the reasons I have given above, and many more, this nation refuses to enact single payer health care, the only thing we haven’t tried, and the one form of universal health care every other Western nation provides its citizens.

One fellow blogger last year during the Democratic Primary, said that while he liked Bernie Sanders, he knew that the health insurance companies were not going to scrape their businesses and start from scratch.

But maybe they should. It is because the capitalist profit motive is at the heart of what, in the words of Walter Cronkite, our health care system really is. “America’s health care system is neither healthy, caring, nor a system.” Too many are profiting from other people’s misery, and driving many into poverty. This is the richest nation on Earth, and this is how we treat our fellow citizens.

It is strange that the Conservative Party of Great Britain believes in single payer, but the American Republican Party does not. The truth is, they are no longer the Republican Party but the Republican Libertarian Party.

Once upon a time, members of their right-wing decried the nation’s drift towards “Creeping Socialism.” With this vote, and with executive orders flowing from 1600 every day, we are witnessing “Creeping Fascism.’ The new Secretary of Labor comes from the fast food industry where workers were mistreated, and still are in some places.

Worker’s rights are being eroded with new overtime rules, wages are stagnant, unemployment is still too high despite what the government says.

One other reason for enacting single payer is that doing so will free employers from having to provide it to their employees, and workers over forty will not have to face losing their jobs and careers they spent their lives in.

We, as a nation, must decide; either we take away health care for millions of Americans, or we make sure everyone has it. There can be no half-measures. Many pundits have said the AHCA (Zombie Health Care Bill) will not pass the Senate, but that is what they said about the House of Representatives.

I hope the Senate will defeat this, but if they don’t, the only option left is single payer.

One More Thing on Health Reform

Could not ignore Joe Paduda’s first post this morning, which is also covered on the Health Wonk Review blog.

He lays out in great detail who would be affected by passage of this zombie legislation, and who would come out ahead,

It’s enough to make you sick, that such people exist who will take away health care from the very people who put them in office, and don’t care that many of them will die because they can no longer get health care.

Comedian Jimmy Kimmel went on his show the other night and confessed to the entire country about his newborn son’s heart disease. What was the response from the Nazi right? Attacks.

Why do these people continue to vote against their own economic interests? There are many reasons for this. The first one is simply, they don’t believe Democrats. And why? Because for far too long, Democrats have engaged in Identity Politics, and have ignored the heartland.

Second, the Democrats have generally avoided campaigning in, or developing their local or state parties in those states most likely to vote Republican, but would benefit from Democratic policies in education, job creation, health care, etc.

Third, Republicans have done a great job of convincing people of an “us versus them” mentality. Republicans sound like “us”, act like “us”, enjoy the same activities as “us”, where “they” do not. You hear the words, “elite”, or “elitist” thrown around, as was done yesterday in response to Kimmel’s plea by an alt-rightist.

Forth, Republicans know how to frame an argument by using simple words and phrases, where Democrats go into long, drawn out lectures on policy. They talk to Americans as if every American has a college degree in political science or sociology. Yex, polls do so that many Americans agree with Democratic policies, but we know that polls are not always accurate.

The last election proved that.

Lastly, the Democrats have been late to the party as to what is happening to working people, both blue collar and white collar workers. In fact, the Republicans know all too well what is happening, as they are responsible for the prolongation of their misery, and will do nothing to stop what is about to happen when jobs are replaced by automation.

Universal Basic Income (UBI)? Not from this crowd of neo-fascist, libertaritards. (Take that, Rush Limbaugh!) Want some more Oxycodone?

As we are witnessing day by day, the US is going backwards. All the way back to the 19th century, the very century the GOP is most comfortable with, because that is when they had complete control of the entire government, and their friends in industry were getting richer and richer, and there were no government programs or laws protecting workers and the poor.

So if this zombie health care law gets passed, look out…there will be more zombies where that came from.

The Zombie Apocalypse and Other Matters

For sometime now, your humble author has subscribed to a health care blog called Health Wonk Review.

Some of their posts are usually out of the scope of this blog, so I very rarely write about these issues, and many times, there are posts from Joe Paduda on subjects I’ve already read, or commented on, so to write about it would be redundant.

But in light of my post yesterday, in which I said, based upon Joe’s post, that the AHCA (Zombie Health Care Bill) was dead, here is the link to today’s Health Wonk Review. I cannot do any more justice to the discussion, so I will let it speak for itself.

Be frightened, be very frightened.

Ding, Dong, Health Care “Reform” Is Dead: A Political View

Time for another rant, but this time it is based on actual facts, plus an understanding of the real reason repeal and replace of the ACA is not going to happen.

There are many reasons for why repeal and replace has failed; some of them have to do with the complexity of the health care marketplace, others have to do with the fact that all the negative things the opposition said about the law did not come to pass, even though some people are paying higher premiums, or cannot find a doctor because there aren’t enough where they live and have to travel long distances to find a doctor (primary or specialist), or the insurance companies have exited the exchanges, thus limiting the number of payers.

Joe Paduda has been conducting an ACA Deathwatch, and yesterday, Joe wrote that ACA repeal will not happen.

This, he says, is due to the defection of one major GOP legislator, Fred Upton, of Michigan.

But what Joe does not say is why the GOP has been so single-minded in wanting to destroy the ACA (besides the obvious reason of tarnishing Obama’s legacy).

The one guiding principal and reason for “repeal and replace” is solely due to the adoption by the Republican Party (or should I say takeover) by out and out libertarians, and rampant libertarianism.

This has nothing to do with the Libertarian Party, although many members of that party were Republicans in the past; case in point, former New Mexico Governor Gary Johnson, who ran for President last year as the Libertarian Party candidate.

To prove to you that this is the case why the GOP has been so one-track minded, one only has to read the response from former GOP Congressman Joe Walsh (you remember him, the guy who yelled “you lie” to Obama during the SOTU speech).

Walsh, not to be confused with the Joe Walsh of rock and roll, said the following in his tweet response to Jimmy Kimmel’s tearful admission that his newborn son had a heart defect that needed surgery, and Kimmel defended the right of others not as fortunate as him and his wife to afford that surgery, which would have been fatal to any other child whose parents could not afford it.

Here is the exact tweet:

Joe Walsh@WalshFreedom

Sorry Jimmy Kimmel: your sad story doesn’t obligate me or anybody else to pay for somebody else’s health care.

At first, you might think this guy is a heartless SOB, but if you read the tweet carefully, and look closely at the word “freedom” after his name, and the tweet itself, you will see that to Mr. Walsh and the rest of his “Freedom” Caucus, it is not that he is heartless, it’s that he is brainless.

Because only a brainless idiot still clings to a political philosophy that time and again has been discredited. He believes he nor anybody else is obligated to pay for someone else’s health care, but I bet he does not feel that way when other people have to pay for his or his children’s public school education, or their ability to have lunch while in school or to even have books to read and pens and pencils with which to do schoolwork with. Or to bring it even closer to home, to have other people (namely taxpayers) pay for his health care when he was in Congress. Do as I say, not do as I do.

Or maybe he sends his kids to private school?

You see, the real reason the GOP is against the ACA is they don’t believe it is the role of the government to do anything for anyone, and that includes providing health care. They are fundamentally opposed to it on philosophical and ideological grounds, and like their Speaker, are slavishly devoted to the rantings and writings of a 20th century novelist and the reactionary views of an economist few have ever heard of.

You know, of course, where the Freedom Caucus came from? It is the legislative part of the Tea Party, founded by former Congressman Tom DeLay (there’s a name for you), and the Tea Party has nothing to do with a hot beverage. It means “Taxed Enough Already”.

But the real impetus behind the Tea Party was not the old folks demanding the government keep its hands off their Medicare. It came from the very wealthy who donated large sums to elect Republicans to office. It started with Howard Jarvis in CA, spread under Reagan and both Bushes, and popped up during the debate over the ACA.

Jimmy Kimmel said the problem with health care was partisanship; however, as written in Salon, the problem is with one party…the Republicans. This by no means lessens the impact of Kimmel’s plea.

The response from President Obama, DNC Chairman Tom Perez, and Senate Minority Leader Chuck Schumer was overwhelmingly positive.

The current occupant continued his insane view that the ACA was dead. Sort of like saying Andrew Jackson could have prevented the Civil War, or that he recently met with Frederick Douglass.

Finally, the defeat of repeal and replace is laid at the feet of those GOP congresspersons who are vulnerable in the next election, and are hesitant to incur the wrath of their constituents, if the recent town hall meetings are any indication.

Like health care itself, the defeat has many reasons, but at the core lies the simple fact that libertarian, free market solutions are more dangerous to the health of the American people than the alleged disaster the GOP has painted the ACA with.

Disaster Averted

Yesterday’s crushing defeat of the so-called “American Health Care Act” or AHCA, signals the end of the seven-year long attempt by the Republican Party to legislatively kill the Affordable Care Act (ACA).

Yet, as was pointed out on one cable news network last night, it won’t stop the health insurance industry from getting the Republicans in Congress to kill parts of the law slowly by eliminating the taxes that go to pay for the coverage.

Call it “genocide by stealth”, since millions of Americans will die, as per the Congressional Budget Office (CBO’s) scoring of AHCA. If they can’t kill the law outright, the so-called “Freedom Caucus”, actually the Congressional version of the Tea Party, will kill it slowly.

Why do you think they keep saying it is a disaster and it is crumbling? It’s because they are dead set against anyone getting health care unless someone else can make a profit from selling a policy.

Then there is the other question, the one usually raised by liberals and progressives, especially those who supported Vermont Senator Bernie Sanders last year in the primaries, as to why we are the only Western country without universal coverage.

The answer is complex, but not complicated (“who knew health care was so complicated?). First, everything the government of the US has ever implemented for the benefit of people has had to pass muster with the Constitution. It either has to be covered by the Constitution directly, or implied through the taxing mechanism.

Second, the Founding Fathers never mentioned or promoted the right to health care, as the prevailing political and social philosophy of the day was concerned with freedom, liberty, and private property. It has been unclear what, if anything, was meant by the phrase, “life, liberty, and the pursuit of happiness”, let alone, the phrase, “promote the general welfare.”

Why they never mentioned health care and why other nations have it, is due to the fact that the US was founded during the first half of the period historians call, “the Enlightenment”, when the right to private property, liberty, and freedom were the topics of discussion on both sides of the Atlantic. Basically, the difference between Classical Liberalism (Conservatism) and Modern Liberalism (Liberalism) is between negative rights (the right not to be killed) versus positive rights (the right to a job, education, housing, health care, etc.)

Canada gained its limited independence from Britain nearly a hundred years after we did, and therefore was influenced by the philosophy of the second half of the Enlightenment, which stressed involvement by government in the economy.

The only time the Founders cared about providing some kind of health care plan was directed towards a particular group of citizens in the late eighteenth century, as I wrote about in this post.

What is now called the Public Health Service began as a government-sponsored, health plan for merchant sailors on ships entering and leaving US ports and on inland waterways. It was never challenged in the Supreme Court as unconstitutional, nor was it ever attacked by members of the opposition party. In fact, it was supported by both Federalists and Anti-Federalist politicians of the day.

The third reason why we don’t have universal, single-payer is because the government allowed employers to provide coverage during WWII to attract women into the workplace when the men went overseas. The UK is often cited as an example for single-payer, but what most supporters of this type of plan do not realize is that because of the devastation the UK suffered at the hands of German bombs, their health care system needed to be re-built from scratch, so the government stepped in with the NHS. Even Churchill supported it.

Fourth, we have always provided health care to certain at risk groups like the poor (Medicaid), the elderly (Medicare), and to children (CHIP), as well as to former service persons and their families (Tricare), etc. Perhaps the way to begin to get universal coverage is to merge all of these programs into one, then expand it to cover everyone else.

But for the time being, a major disaster was averted, but we should not think this is the end of the debate, nor is there victory. The battle lines are drawn, and the enemy is not surrendering. This is not a time for congratulation, but for vigilance and resolve.

 

Integral Healthcare

Doubling down on contentious issues is not just confined to the realm of politics.

An article in Monday’s Journal of the American Medical Association (JAMA) states that single payer for the United States is politically infeasible, and concludes that to achieve universal coverage without single payer, enforcing the individual mandates and assessing real penalties for not purchasing insurance is the best option.

To bolster their argument, the authors, Regina E. Herzlinger, Barak D. Richman and Richard J. Boxer, point to three countries that have a private-sector insurance system. These countries are Switzerland, Singapore, and Germany.

After exploring two other options, creating risk pools for enrollees with preexisting conditions, and pooling costly patients into Medicare, the authors contend that the individual mandate, which the Supreme Court characterized as an annual tax, would be assessed against individuals who did not purchase health insurance within that calendar year.

The authors believe that while it is vilified by some, it is attractive for the following reasons: it is easy to implement, is effective in pooling risk, and reflects the values of individual responsibility (more on values later).

But the authors are mistaken. Many Americans will balk at paying for health insurance, with or without penalties, for individualistic, libertarian reasons. Also, those individuals who are unemployed and who have not filed tax returns for several years, at least under the ACA as it is now enacted, will not be able to get even a subsidy to pay for it. (my own situation that I contacted my Congressman about twice)

Per the authors, Swiss citizens must purchase health insurance, if they do not, the government does it for them. And the insurers can implement debt enforcement proceedings against anyone failing to pay for insurance, collect a penalty and any back premiums.

Singapore has compulsory contributions from employers on behalf of their employees to create medical savings accounts, and it is up to the employee to maintain these accounts for expenses such as health and disability insurance premiums, hospitalization, surgery, rehabilitation, end-of-life care, and outpatient services. Failure to do so are subject to garnished wages and other legal actions. The unemployed, or poor are eligible for subsidies.

Lastly, German insurance is funded by compulsory contributions to private insurers levied as 7.3% of income. Those who are unemployed have theirs taken out of their benefits plus means-based sliding-scale subsidies, and uninsured, self-employed individuals who try to purchase insurance are faced with payment of back premiums for the uninsured period.

Some of the methods described above have been suggested here in the US, or are part of the ACA already, but is not sufficiently strong enough for the authors, or maybe part of the “repeal and replace” packages now stalled in Congress. Therefore, the authors have decided to double down on the one part that the GOP wants to eliminate and that many Americans find onerous, paying a penalty for not having insurance.

But is this really the right way to go, as I mentioned in yesterday’s post, “Damned If You Do, Damned If You Don’t.”

To answer that question, I would like to introduce you to Spiral Dynamics and the next generation economic system, MEMEnomics.

Spiral Dynamics is a biopsychosocial theory of human development based on the research of the late psychologist, Clare W. Graves. Graves was a contemporary of Abraham Maslow, whose “hierarchy of needs” was the first psychology model of a hierarchical nature of human development.

Graves’ framework, called the “Levels of Human Existence”, relates to Maslow’s needs, but Graves realized that Maslow’s model did not adequately express the dynamics of human nature, the process of emerging systems, or the open-endedness of the psychological development of a mature human being.

“Briefly, what I am proposing is that the psychology of the mature human being is an unfolding, emergent, oscillating spiraling process marked by progressive subordination of older, lower-order systems to newer, higher-order systems as an individual’s existential problems change. Each successive stage, wave, or level of existence is a state through which people pass on their way to other states of being. When the human is centralized in one state of existence, he or she has a psychology, which is particular to that stage. His or her feelings, motivations, ethics and values, biochemistry, degree of neurological activation, learning system, believe systems, conception of mental health, ideas as to what mental health is and how it should be treated, conception of and preference for management, education, economics, and political theory and practice are all appropriate to that state.”

Graves proposed that all the forces shaping the marketplace, whether individuals, groups, or cultures, should be looked at from a more integral view that includes the biologic, psychologic, and sociologic aspects, and to examine them in an ever-evolving dynamic culture. He placed these dimensions into eight known hierarchical levels of existence called value systems.

Graves’ ideas would have remained confined to the academic world if it was not for his colleagues, Don Beck and Christopher Cowan, who patented Graves’ work into what they called Spiral Dynamics, taking the name from Graves’ explanation of human psychology. They even wrote a book by that title, which should be read first to gain full understanding of the theory.

When they began their work, they translated Graves’ levels (he used pairs of letters starting from “A” to “H” and from “N” to “U” to represent the life conditions and ways in which humans solved their existential problems) to colors (Beige, Purple, Red, Blue, Orange, Green, Yellow, and Turquoise). This was a way to better memorize the vMEMEs, borrowing the term, meme, from Richard Dawkins, or value systems.

The following table shows the vMEMEs and the percentages found in the population, plus the percentage of power they have in human society. It is important to note that the American population can be found in the last three levels. It is the Blue/Orange vMEMEs that control much of the political, social, and economic agenda of the US, and explains why Green’s values have had a hard time getting accepted, which is why the US is unable to make the leap to the next tier.

sd-population

Colors of thinking.png

Dawkins described memes as “a unit of cultural information that is capable of self-replication and uses the human mind as a host.” For Beck and Cowan, vMEMEs, or value-systems memes begin to shape how individuals, organizations, and cultures think. Along the way, Beck partnered with philosopher Ken Wilber, whose Integral approach was adapted to Spiral Dynamics into Spiral Dynamics Integral.

The following chart illustrates the AQAL model of Spiral Dynamics Integral.

sdi-aqal-1024x690

There are two alternating types; individualistic and expressive, and group-oriented and sacrificial. Both types alternate, and with the passage of time, existential problems arise within each value system that can no longer be solved at the current level. The pressure and energy created by the value system’s inability to solve its problems leads to the emergence of the next level, spiraling upwards and alternating between the types.

So, for example, Capitalism is an individualistic vMEME system, whereas Socialism is a collective vMEME system.

Which brings us to discussing MEMEnomics. MEMEnomics is a composite of the words “meme” as we have been discussing, and economics. The book titled MEMEnomics, by Said W. Dawlabani, is sub-titled, “The Next-Generation Economic System.”

I have read it once, and in the process of re-reading it for better understanding, and explains clearly through Spiral Dynamics why the financial difficulties of the last decade occurred, and guides us to a better, integrated, and holistic future. Dawlabani says that the difficulties the US is facing today (published in 2013) are a result of the evolution from one system to another.

But most importantly, Dawlabani examines the history of the American economy from colonial times to the present day through a memenomic framework, that corresponds to the levels of human existence found in Graves’ work.

These two charts illustrate MEMEnomics and Spiral Dynamics better.

memenomics

memenomicsspiralchart-e1388953833163

Already, there are changes occurring in the economy that signal that there is an evolution. The emergence of the sharing economy found in companies like Uber and Lyft, and Airbnb, are just some of the examples of this emergence. The green economy, as in environmentally friendly, is an example of the healthy side of the Green vMEME, and even exhibits some aspects of Yellow Sustainability.

So where does health care fit in all this?

Health care as it is provided for in the US, is mostly through employers, government programs aimed at specific demographic groups such as the poor, elderly, and children, and through private insurance sold by insurance companies.

The reason for the passage of the ACA was to eliminate some of the disadvantages in employer and private health insurance plans, and to ensure coverage for all by making people purchase coverage. But that has angered many, and is the main reason for the repeal and replace rhetoric in Washington.

The authors of the JAMA article, like many before them, are doubling down on a method of providing coverage that is trapped within the Orange vMEME system. Yet, as Spiral Dynamics and MEMEnomics has shown, there must be an evolution in the way we think about many aspects of human life, health care and its provision included.

We must build the health care system of the future now, not the health care system of the past. Spiral Dynamics and MEMEnomics points us to a future where all aspects of human civilization is integrated and holistic, and health care is a part of that integration.

Any doubling down on the value systems of the past as human development spirals upward is unhealthy and must be avoided. If we continue to require the purchase of a commodity such as health insurance (Orange vMEME – value system) when human development has transcended and included Orange and moved on past Green into Yellow or Turquoise, it would be like Americans living today living like their ancestors did back in Roman times.

I don’t think that is possible, nor is it desirable. And neither is the solution the authors have recommended. We must integrate all our current health care systems into one integrated system, including Workers’ Comp, not because it will save money (which it will), but because human development is headed in that direction.

Not to do so is harmful to the spiral and to human development.