Tag Archives: Democrats

Medicare for All and the Democratic Debates

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For those of you who did not watch the two nights Democratic debate, and those like me who did, one thing is clear. Medicare for All is very popular among the audiences who attended, judging by the applause garnered each time a candidate was asked about their plan for providing every American with health care.

On the first night, the moderator asked for a show of hands to the question as to who supported eliminating private insurance, only two candidates, Sen. Elizabeth Warren and New York mayor Bill de Blasio raised their hands.

The rest of the candidates on the first night supported keeping private insurance or giving people the choice of a public option, and de Blasio and former Congressman Beto O’Rourke sparring over the issue.

This is how some of the candidates responded to the issue:

“I’m with Bernie on Medicare for All,” said Elizabeth Warren

Amy Klobuchar said she preferred a “public option”, “I am just simply concerned about kicking half of America off of their health insurance in four years,”

Former Texas Rep. Beto O’Rourke allowed that the goal should be “guaranteed, high-quality, universal health care as quickly and surely as possible.” “Our plan says that if you’re uninsured, we enroll you in Medicare,” and called his plan Medicare for America.

On the second night, the same question about abolishing private insurance was asked, and again, only two raised their hands, Vermont Sen. Bernie Sanders and California Sen. Kamala Harris.

Former Vice President Joe Biden, who defended the ACA, said that Americans “need to have insurance that is covered, and that they can afford.”

Candidates Pete Buttigieg, mayor of South Bend, Ind., New York Sen. Kristen Gillibrand, and Colorado Sen. Michael Bennet all gave their views on universal coverage, noting the importance of a transition period, and suggesting that a public option would allow people to buy into Medicare.

While the rest of the candidates from both evenings’ debates were divided against their fellow candidates who supported Medicare for All, those who spoke up for it, Sanders, Warren, Harris and de Blasio, won over the audience in the hall. What remains to be seen is how their ideas are received in the primaries beginning early next year.

According to Bloomberg, (the publication, not the former New York mayor), Medicare for All enjoys broad support: 56% of Americans said they supported such a plan in a January survey by the Kaiser Family Foundation. However, when told Medicare for All would eliminate private health insurance, 37% said they favor it while 58% said they oppose the idea.

So, supporters of Medicare for All have their work cut out for them. They need to convince more Americans that sustaining the current system of private insurance, whether they get it from their employers, or they purchase it on their own, is a big part of the problem facing the US health care system.

Another point that is forgotten in the debate is the fact that what is being proposed is not a government takeover of health care, but rather a transition from a broken system to a government financed system of health care. Candidates who support this should explain the difference, and not be led into the trap set by debate moderators or interviews of calling Medicare for All, government-run health care.

It must be made clear that the providing of care will remain private, but that paying for it will not. Sanders’ stump speech line about going to any doctor sounds reminiscent of President Obama’s promise that you can keep your doctor under the ACA, but the reality was far from that.

But the takeaway from the debates indicates that the campaign will be a long and hard fought one, and that Democrats must be very clear what it is they actually want to do on health care, know how to pay for it, and sell it as the best solution to our dysfunctional health care system, or as author Marianne Williamson called it, a sickness system.

Because already, the Orangutan has pounced on one issue raised in the debate, the support by all candidates for providing medical care to undocumented immigrants. In today’s charged political climate where racism has raised its ugly head, and nationalism is on the march, such ideas can be disastrous, especially if rejected by swing voters and independents.

Time and the primaries will tell.

Medicare for All and Its Rivals | Annals of Internal Medicine | American College of Physicians

Richard’s Note: A shout-out to Don McCanne for posting this today from the Annals of Internal Medicine, which is providing the full article for free. The authors, Steffie Woolhandler and David Himmelstein, both MDs, should be familiar to readers as two of the authors I covered in my review of the Waitzkin, et al. book, Health Care Under the Knife: Moving Beyond Capitalism for Our Health. In the spirit of the AIM, I am posting the entire article below with link to the original. It is that important.

Medicare for All and Its Rivals: New Offshoots of Old Health Policy Roots

The leading option for health reform in the United States would leave 36.2 million persons
uninsured in 2027 while costs would balloon to nearly $6 trillion (1). That option is called the
status quo. Other reasons why temporizing is a poor choice include the country’s decreasing life
expectancy, the widening mortality gap between the rich and the poor, and rising deductibles
and drug prices. Even insured persons fear medical bills, commercial pressures permeate
examination rooms, and physicians are burning out.
In response to these health policy failures, many Democrats now advocate single-payer,
Medicare-for-All reform, which until recently was a political nonstarter. Others are wary of
frontally assaulting insurers and the pharmaceutical industry and advocate public-option plans
or defending the Patient Protection and Affordable Care Act (ACA). Meanwhile, the Trump
administration seeks to turbocharge market forces through deregulation and funneling more
government funds through private insurers. Here, we highlight the probable effects of these
proposals on how many persons would be covered, the comprehensiveness of coverage, and
national health expenditures (Table).

Table. Characteristics of Major Health Reform Proposals as of March 2019

Medicare for All

Medicare-for-All proposals are descendents of the 1948 Wagner–Murray–Dingell national health
insurance bill and Edward Kennedy and Martha Griffiths’ 1971 single-payer plan (2). They would
replace the current welter of public and private plans with a single, tax-funded insurer covering
all U.S. residents. The benefit package would be comprehensive, providing first-dollar coverage
for all medically necessary care and medications. The single-payer plan would use its
purchasing power to negotiate for lower drug prices and pay hospitals lump-sum global
operating budgets (similar to how fire departments are funded). Physicians would be paid
according to a simplified fee schedule or receive salaries from hospitals or group practices.
Similar payment strategies in Canada and other nations have made universal coverage
affordable even as physicians’ incomes have risen. These countries have realized savings in
national health expenditures by dramatically reducing insurers’ overhead and providers’ billing-
related documentation and transaction costs, which currently consume nearly one third of U.S.
health care spending (3). The payment schemes in the House of Representatives’ Medicare-for-
All bill closely resemble those in Canada. The companion Senate bill incorporates some of
Medicare’s current value-based payment mechanisms, which would attenuate administrative
savings. Most analysts, including some who are critical of Medicare for All, project that such a
reform would garner hundreds of billions of dollars in administrative and drug savings (4) that
would counterbalance the costs of utilization increases from expanded and upgraded coverage.
Reductions in premiums and out-of-pocket costs would fully offset the expense of new taxes
implemented to fund the reform.

 

“Medicare-for-More” Public Options

Public-option proposals, which would allow some persons to buy in to a public insurance plan,
might be labeled “Medicare for More.” Republicans Senator Jacob Javits and Representative John
Lindsay first advanced similar proposals in the early 1960s as rivals to a proposed fully public
Medicare program for seniors. This approach resurfaced during the early 1970s as Javits’
universal coverage alternative to Kennedy’s single-payer plan and gained favor with some
Democrats during the 2009 ACA debate.
Policymakers are floating several public-option variants, most of which would offer a public plan
alongside private plans on the ACA’s insurance exchanges. Although a few of these variants
would allow persons to buy in to Medicaid, most envision a new plan that would pay Medicare
rates and use providers who participate in Medicare. Positive features of these reforms include
offering additional insurance choices and minimizing the need for new taxes because enrollees
would pay premiums to cover the new costs. However, these plans would cover only a fraction
of uninsured persons, few of whom could afford the premiums (5); do little to improve the
comprehensiveness of existing coverage; and modestly increase national health expenditures.
The Medicaid public-option variant, which many states might reject, would probably dilute
these effects.
Medicare for America, the strongest version of a public-option plan, would automatically enroll
anyone not covered by their employer (including current Medicare, Medicaid, and Children’s
Health Insurance Program enrollees) in a new Medicare Part E plan. It would upgrade
Medicare’s benefits, although copayments and deductibles (capped at $3500) would remain.
The program would subsidize premiums for those whose income is up to 600% of the poverty
level, and employers could enroll employees in the program by paying 8% of their annual
payroll. The new plan would use Medicare’s payment strategies and include private Medicare
Advantage (MA) plans (which inflate Medicare’s costs [6]) and accountable care organizations.
Medicare for America would greatly expand coverage and upgrade its comprehensiveness but
at considerable cost. As with other public-options reforms, it would retain multiple payers and
therefore sacrifice much of the administrative savings available under single-payer plans.
Physicians and hospitals would have to maintain the expensive bureaucracies needed to
attribute costs and charges to individual patients, bill insurers, and collect copayments. Savings
on insurers’ overhead would also be less than those under single-payer plans. Overhead is only
2% in traditional Medicare (and 1.6% in Canada’s single-payer program [7]) but averages 13.7%
in MA plans (8) and would continue to do so under public-option proposals. Furthermore, as in
the MA program, private insurers would inflate taxpayers’ costs by upcoding as well as cherry-
picking and enacting network restrictions that shunt unprofitable patients to the public-option
plan. This strategy would turn the latter plan into a de facto high-risk pool.

The Trump Administration White Paper and Budget Proposal

Unlike these proposals, reforms under the Trump administration have moved to shrink the
government’s role in health care by relaxing ACA insurance regulations; green-lighting states’
Medicaid cuts; redirecting U.S. Department of Veterans Affairs funds to private care; and
strengthening the hand of private MA plans by easing network-adequacy standards, increasing
Medicare’s payments to these plans, and marketing to seniors on behalf of MA plans. A recent
administration white paper (9) presents the administration’s plan going forward: Spur the
growth of high-deductible coverage, eliminate coverage mandates, open the border to foreign
medical graduates, and override states’ “any-willing-provider” regulations and certificate-of-
need laws that constrain hospital expansion. The president’s recently released budget proposal
calls for cuts of $1.5 trillion in Medicaid funding and $818 billion in Medicare provider payments
over the next 10 years.
Thus far, the effects of the president’s actions—withdrawing coverage from some Medicaid
enrollees and downgrading the comprehensiveness of some private insurance—have been
modest. His plans would probably swell the ranks of uninsured persons and hollow out
coverage for many who retain coverage, shifting costs from the government and employers to
individual patients. The effect on overall national health expenditures is unclear: Cuts to
Medicaid, Medicare, and the comprehensiveness of insurance might decrease expenditures;
however, deregulating providers and insurers would probably increase them.
In 1971, a total of 5 years after the advent of Medicare and Medicaid, exploding costs and
persistent problems with access and quality triggered a roiling debate over single-payer plans.
As support for Kennedy’s plan grew, moderate Republicans offered a public-option alternative,
1 of several proposals promising broadened coverage on terms friendlier to private insurers.
Kennedy derided these proposals by stating, “It calms down the flame, but it really doesn’t meet
the need” (10). President Nixon’s pro market HMO strategy—a close analogue of the modern-
day accountable care strategy—ultimately won out, although his proposals for coverage
mandates, insurance exchanges, and premium subsidies for low-income persons did not reach
fruition until passage of the ACA.
Five years into the ACA era, there is consensus that the health care status quo spawned by
Nixon’s vision is unsustainable. President Trump would veer further down the market path.
Public-option supporters hope to expand coverage while avoiding insurers’ wrath. Medicare-
for-All proponents aspire to decouple care from commerce.

Why Are Republicans So Mean? – An Exploration

Revelations this week that the Orangutan Administration is going ahead with plans to repeal the ACA, as reported by myself and Joe Paduda, as well as the announcement by Education Secretary Betsy (I have ten yachts) DeVos, that her budget calls for cutting $18 million from Special Olympics, raises the question, “why are Republicans so mean?” and why do they hate the poor and those not like them?

This article will explore this question from an economic, ideological, political and sociological perspective, citing several previously published articles asking the same question as the title above. It is certainly not definitive, but does suggest some possible explanations.

To begin with, a little history. The Republican Party was formed due to the inability of the Whig Party to deal with the question of slavery and the disappointment many Northern Democrats had with their Southern brethren over this issue, one that occupied a central focus in the second quarter of the first half of the 19th century.

While that twenty-five year period ended in 1850, it is important to note that the GOP was founded in 1854, which is still in the range of the time frame.

After the Civil War, the Republican Party was made up of two wings: the Radical Republicans who favored Reconstruction and harsh treatment of former Southern Confederates (this will have a bearing on our discussion later) and the conservatives who were aligned with the Eastern bankers and industrialists.

In fact, it was the conservatives who, as pointed out in the Spielberg motion picture, “Lincoln”, that made it possible for the passage of the 13th Amendment when they were assured by the President that there were no Southern negotiators in Washington (They were on a riverboat in Virginia being guarded by African-American Union soldiers).

However, after the election of 1876, when Rutherford Hayes became President by promising the South to end Reconstruction, the Radical Republicans were slowly replaced by more conservative Northern Republicans loyal to the industrialists who would dominate the second quarter of the second half of the 19th century, and thus lead to future calls for reform and addressing of the effects industrialization had on the working class.

So as their wealth increased, so too did the misery and poverty of the working class, and this led to the rise within the GOP of a progressive movement, and a likewise movement among the rural population in the Midwest in the form of populism.

With the ascendancy of Theodore Roosevelt to the Presidency in 1901, progressivism took off, and many Republicans led the way for political, economic, and social reform. A brief return to the past in the 1920s under three successive Republican Presidents was followed by the election of FDR and the Democrats controlling Congress for decades to come, making more reform possible, and creating the largest middle class in history.

By the mid-20th century , the Republican Party had three wings: conservatives, moderates, and liberals. Barry Goldwater’s run in 1964, and Robert Taft’s in 1952 sort to change the dynamics in favor of the conservatives, but only meant they lost the battle, but won the war.

Then came Reagan, the first celebrity President. He brought victory to the conservatives and into government. Remember, he said that government was not the solution, government was the problem, and thus, that is how the GOP would operate when they took over.

Turning to the economic aspect of why Republicans are mean, let us look at something written a hundred years ago, Max Weber’s essay, The Protestant Ethic and the Spirit of Capitalism.

According to Wikipedia,

“capitalism in Northern Europe evolved when the Protestant (particularly Calvinist) ethic influenced large numbers of people to engage in work in the secular world, developing their own enterprises and engaging in trade and the accumulation of wealth for investment. In other words, the Protestant work ethic was an important force behind the unplanned and uncoordinated emergence of modern capitalism.

So in this context, Protestantism, or rather its Calvinist form, which influenced the Puritans of New England, formed the moral and ethical basis for the rise of modern capitalism, and while the descendants of the Puritans today in New England are decidedly more liberal than in the past, due to evangelical missionaries in the late 18th and throughout the 19th centuries, in what historians call the Great Awakenings, these values were transmitted to people in the South and Midwest, or were carried with them during western expansion.

As for the South, as mentioned earlier, the debate over slavery has some bearing on why many of today’s Republican leaders in Congress are Southerners, and what that means for the country’s direction these past thirty years or so.

Sara Robinson’s article in Salon.com, attempts to answer why this is so, and sheds light on the difference between North and South. To begin with, despite the rise of Capitalism from Calvinist Protestantism, seen originally among the Puritan settlers, Robinson states that,

For most of our history, American economics, culture and politics have been dominated by a New England-based Yankee aristocracy that was rooted in Puritan communitarian values, educated at the Ivies and marinated in an ethic of noblesse oblige (the conviction that those who possess wealth and power are morally bound to use it for the betterment of society).”

On the other hand, Robinson relates that the New England-based aristocracy is opposed by,

…the plantation aristocracy of the lowland South, which has been notable throughout its 400-year history for its utter lack of civic interest, its hostility to the very ideas of democracy and human rights, its love of hierarchy, its fear of technology and progress, its reliance on brutality and violence to maintain “order,” and its outright celebration of inequality as an order divinely ordained by God.

Robinson cites David Hackett Fisher who,

described just how deeply undemocratic the Southern aristocracy was, and still is. He documents how these elites have always feared and opposed universal literacy, public schools and libraries, and a free press.

In addition, Robinson cites Colin Woodward, who wrote that,

…From the outset, Deep Southern culture was based on radical disparities in wealth and power, with a tiny elite commanding total obedience and enforcing it with state-sponsored terror. Its expansionist ambitions would put it on a collision course with its Yankee rivals, triggering military, social, and political conflicts that continue to plague the United States to this day.

However, Robinson writes that the most destructive aspect of the Southern’s worldview,

is the extremely anti-democratic way it defined the very idea of liberty. In Yankee Puritan culture, both liberty and authority resided mostly with the community, and not so much with individuals. Communities had both the freedom and the duty to govern themselves as they wished (through town meetings and so on), to invest in their collective good, and to favor or punish individuals whose behavior enhanced or threatened the whole (historically, through community rewards such as elevation to positions of public authority and trust; or community punishments like shaming, shunning or banishing).”

Robinson continues,

Individuals were expected to balance their personal needs and desires against the greater good of the collective — and, occasionally, to make sacrifices for the betterment of everyone. (This is why the Puritan wealthy tended to dutifully pay their taxes, tithe in their churches and donate generously to create hospitals, parks and universities.) In return, the community had a solemn and inescapable moral duty to care for its sick, educate its young and provide for its needy — the kind of support that maximizes each person’s liberty to live in dignity and achieve his or her potential. A Yankee community that failed to provide such support brought shame upon itself. To this day, our progressive politics are deeply informed by this Puritan view of ordered liberty.”

Conversely, Robinson states,

In the old South, on the other hand, the degree of liberty you enjoyed was a direct function of your God-given place in the social hierarchy. The higher your status, the more authority you had, and the more “liberty” you could exercise — which meant, in practical terms, that you had the right to take more “liberties” with the lives, rights and property of other people.”

Anytime a Southern conservative talks about “losing his liberty”, Robinson follows with, the loss of this absolute domination over the people and property under his control — and, worse, the loss of status and the resulting risk of being held accountable for laws that he was once exempt from — is what he’s really talking about. In this view, freedom is a zero-sum game. Anything that gives more freedom and rights to lower-status people can’t help but put serious limits on the freedom of the upper classes to use those people as they please. It cannot be any other way. So they find Yankee-style rights expansions absolutely intolerable, to the point where they’re willing to fight and die to preserve their divine right to rule.”

This would appear to not only apply to the justification for the South’s secession from the Union in the 19th century, but for the way Southern politicians, both Democrats (remember, many were Southerners who were promised committee chairmanships by FDR to get the New Deal passed) and Republicans after passage of the Civil Rights Act in 1964 led to Southerners fleeing the Democratic Party for what LBJ said would be for a generation, have acted towards any legislation that would cause them to lose their liberty. Today, we call that White Privilege.

For an ideological perspective, Marc-William Palen, in Foreign Policy in Focus, provides us with a clear understanding that the Republican Party is not merely a party of classical liberalism, but something different from what it was when it was founded.

According to Palen,

From its mid-nineteenth-century founding, the Republican Party was the party of big government, high tariffs, and government-subsidized internal improvements. The exceptions to this rule were the Gilded Age Liberal Republicans. In their vocal calls for laissez faire principles, these Liberal Republicans quickly became the independent thorns in the side of the Republican elephant throughout the first decades following the Civil War. When the big-government Republican majority continued to prove intractable, these Liberal Republicans became known as the “Mugwumps” when they ultimately switched their support to the Democrats in 1884.

Palen writes that classical liberalism was founded on moral sentiments, and that these moral sentiments, “are almost non-existent within the Republican rank and file, especially since the ultra-nationalist party draped itself in the red, white, and blue following 9-11, and led the jingoistic charge into Afghanistan and Iraq.

Nor is morality to be found amid the incessant Republican demands to cut social spending,” he says, pointing out what Grover Norquist, the driving force behind the GOP’s anti-tax, small government ideology when he said in 2001,  he wanted to

shrink government to the point where he “could drag it into the bathroom and drown it in the bathtub.

Palen suggests that if the Republicans current ideology is not found in classical liberalism, then where does it come from? Palen says, Ayn Rand’s pronounced atheism and intellectual elitism certainly does not align with the ideological outlook of most Republicans. And, he says, there is perhaps an element of a Social Darwinian “survival of the fittest” ethos—although no Republican politician is likely to admit to subscribing to anything associated with the theory of evolution.

So where does it come from?

…a large part of Republican ideological inspiration stems from fear. In particular, it is a reactionary ideological response to the turbulent upheavals inherent in an increasingly globalizing world. Such fears—let’s call it “globaphobia”—are frequently expressed on issues such as immigration, global terrorism, global warming, and American participation in international institutions like the United Nations. The massive federal intervention in the so-called free market following the global financial meltdown invariably exacerbated Republican fears that government intrusion in the market— and Keynesian economics more generally—would eventually undermine American individualism, citing Douglas LaBier.

However, Palen says it is not entirely satisfactory. According to Palen,

their fear-driven ideological inspiration dovetails with the philosophy of Thomas Hobbes, who predated Adam Smith by a century and who expounded on an amoral philosophy of self-interested individualism, counterbalanced by acquiescence to authoritarianism. Hobbes believed that a strong state prevented “war of every man against every man,” a chaotic type of warfare that Republicans believe is contained within al-Qaeda’s radical philosophy.

As we have seen, there is no one answer to why Republicans are mean. It seems to be a combination of factors all valid and relevant to today’s political climate in Washington and in the nation at large.

But nothing ever is just as simple as being mean. since we are dealing with human beings and not machines.

For our purposes, health care is just one more “liberty” conservatives are afraid of losing, so therefore, they will deny it to others, so that they can have more of it. Any discussion of universal coverage in a single payer health care system is a threat to their liberty, and therefore must be opposed. Add to that, the economic loss of profit and gain by those in the medical-industrial complex, and you get a clearer picture of the problem.

But to answer the question raised at the beginning, why are the Republicans so mean? It’s because it is in their DNA passed on from one generation of conservatives to another like our genes are passed down from our parents, grandparents, and so on.

Now the question is, what to do about it?

 

Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive

Sound the alarm bells, the health care industry is trying to prevent Americans from having the same kind of health care other Western industrialized countries give their citizens — universal health care; in this case, an improved and expanded Medicare-for-All.

Instead, they want to perpetuate the current system which by all accounts, is failing to provide quality health care at affordable costs, with better outcomes.

And the tactic they are using is fear-mongering of the worse kind, saying that if we move towards a Medicare-for-All system, the people who like their employer-based health care, or the hospitals, insurance companies, pharmaceutical companies, etc., will lose what they have, hospitals will close, and companies go bankrupt; in other words, they will lose huge profits the current broken system generates for them.

As the following article from Healthcare Dive reports, the hospital lobby is opposing this movement towards a more equitable system of health care in this country all for the purpose of protecting their bottom lines.

Don’t let them scare you. Universal health care is a right, not a privilege. We are the only Western industrial nation without such a system. People before profits. Health care for all, not for the few.

Here is the article:

As more Democratic presidential hopefuls embrace the idea, health systems and providers have picked up lobbying efforts arguing it would shutter hospitals.

Source: Hospital lobby ramps up ‘Medicare for all’ opposition | Healthcare Dive

Beware Billionaires Against Medicare for All

This week, the former CEO of everyone’s favorite coffee house and time waster, Starbucks, declared that he was considering a run for president next year as an independent.

This announcement brought immediate response from both wings of the Democratic Party, as they said it would result in the re-election of the current occupant of the White House.

Even former NYC Mayor, Michael Bloomberg, another billionaire, said that he should not run.

However, as this is a blog about medical care, and not politics, I will leave the discussion as to the efficacy of an independent run for president by another billionaire for others.

What I do want to focus on is this overpaid former barista’s belief that the US cannot afford a Medicare for All, single-payer health care system.

Incidentally, this is also Bloomberg’s view as well.

But I do not think their opposition is based solely on the belief that Medicare for All, single-payer is too expensive. Rather, I believe they are afraid that after the results of last November’s midterm elections, the Democratic Party is poised to win back the White House and possibly the Senate, and that Medicare for All, in whatever form it takes, will be enacted.

I have written about the health care industry’s efforts to derail Medicare for All in previous posts. (See the following: https://wp.me/p2QJfz-QIyhttps://wp.me/p2QJfz-Jki, and https://wp.me/p2QJfz-WI5)

While I cannot accuse Schultz and Bloomberg of being in the pocket of the healthcare industry, it does look suspicious that now that the Democrats control the House, they are coming out against a health care plan that many Americans voted for when they voted for Democrats.

But billionaires should not be the ones deciding whether or not we enact Medicare for All. That should be up to the voters (patients and non-patients), their elected representatives, and most importantly, those in the medical profession who believe the time has come for Medicare for All, single-payer.

One such group are physicians themselves, as reported back in August in the magazine of the Physicians for a National Health Program (PNHP), which I was informed of this morning by a high school alumnus who posted the article on another alum’s Facebook post.

The article was originally posted in Jacobinmag.com.

Here is the link to the article by Meagan Day.

One caveat to progressives: Don’t assume that every American voter who is undecided, declared themselves as an independent, or are unhappy with their choice in the last presidential election, and his behavior and actions, will vote for your chosen candidate. That is why Schultz is contemplating running. And he can do a lot of damage to your plans for 2020.

 

 

Establishment looks to crush liberals on Medicare for All – POLITICO

FYI to all Progressives and Medicare for All supporters:

The coalition that fought Obamacare repeal has fragmented as the party tries to follow through on campaign promises.

Source: Establishment looks to crush liberals on Medicare for All – POLITICO

Midterm Mashup

Well, the 2018 Midterm elections are over, and the analysis is beginning as to what this all means.

For those who wanted to send a message to the Russian puppet in Washington, the election meant that the House of Representatives will be controlled for the next two years starting in January by the Democrats.

For the Republicans, it means a greater control of the Senate, with at least one race, the one in my current state of Florida undecided and headed for a recount, as per state law.

However, there were many defeats for the party of Obama, Bill Clinton, Jimmy Carter, LBJ. JFK, Truman and FDR. Andrew Gillum lost to a nobody for governor of Florida who is connected to the Orangutan by an umbilical cord. Beto O’Rourke made a valiant, if futile effort against the worse person to hold a Senate seat, Lyin’ Ted Cruz. And a few Democratic senators lost seats in Indiana, Missouri and North Dakota.

But as far as health care is concerned, the change in the leadership of the House of Representatives means that the ACA is safe for another two years. and Medicare and Medicaid will not be cut, as the Senate Majority Leader has indicated he wanted to do.

Medicaid, in particular, came out of the Midterms a little better than expected before the election, as the following posts from Healthcare Dive, Joe Paduda, and Health Affairs reported this morning.

First up, Healthcare Dive, who reported that Red states say ‘yes’ to Medicaid . Idaho, Utah, and Nebraska said yes to expansion; Montana said no.

Joe Paduda echoed that in his post, “And the big winner of the 2018 Midterms is…Medicaid“. However, Joe stated that results in Montana were not final; yet, they had decided to expand Medicaid two years ago, but the vote was temporary, and yesterday’s vote was to make it permanent.

And lastly, Health Affairs reported in “What the 2018 Midterm Elections Means for Health Care” that besides blocking repeal of the ACA, Democrats may tackle drug prices, preexisting conditions protections, Opioids, Medicare for All, Surprise bills (unexpected charges from a hospital visit). regulatory oversight, extenders such as MACRA, Medicaid Disproportionate Share Hospital (DSH) payments, and Medicaid expansion, especially since gubernatorial wins in Maine, Kansas, and Wisconsin will make expansion more likely in those states.