Revolted Colonies

U.S. Politics and Culture

Category: Health Care

If You Like the Tax Code, You’ll Love the New Healthcare

There’s an old jibe about legislation: A camel is a horse designed by committee.   At least it’s true when sides are compromising to find agreement. Rarely does the process generate an outcome of equine beauty.  On a positive note, the result may be functional and sturdy, if a bit ungainly.

We long for simple answers: a flat tax with no deductions or customized loopholes. Sadly, it is a creature with the beauty of a thoroughbred but not much horse-sense. America’s a complicated country. We’d all like a one-size fits all plan that’s fair.  At the moment our tax law is complicated but nobody thinks it’s fair. We might be able to write a plan that a four year-old would understand but there will be critics – always- and simplicity does not necessarily result in fairness.

Universal healthcare the presents a simliar challenge. While a single payer plan with the same benefits for all resulting in high quality care is a worthy goal, in our heterogeneous country, One does not want to bear the burdens of the Other – no matter  if One has benefited historically from the Other’s free or cheap land or labors.  So be it.

Our benighted health care plan has absorbed an inordinate amount of attention for 7 years, even more so since the ascendancy of Ubu Trump.  This year’s  several variations had  the virtue of being simple but had nothing much to do with health care. They were about the RE-redistribution of wealth.  They didn’t tackle costs at all. If anything, insurers would have had freer rein to break the insurance market into segments. As for Medicaid, that “problem” would be eliminated first by burdening states with financial and administrative responsibility. The states then could make their budgets by curtailing the program in every different way imaginable.  The result would be Health Care 1.0, a return to the politics and economics of the  past. State by state coverage would kill the possibility of broad, diverse pools, the kind that make universal healthcare viable.

 Trumpcare would have disfavored the old and infirm who, with or without pre-existing condition coverage, would have to bear their own costs directly. The young and feckless could take their chances and ride bareback. Still, the young and feckless should appreciate that even if they eat right, exercise regularly and take good care  of themselves, one day they’ll get sick and die. Don’t bother to ask – the high deductible tolls for thee.  

And that, good people, is why there are horses and camels. While the GOP caucus has been fiddling, Senators Alexander and Murphy  have been trying to put out the fire. They’ve come up with a plan to stabilize the insurance markets, one which appears to have Ubu’s approval as a stop gap, one of those temporary measures that ripen into monuments. At least the future ex-president would not get to pull down the system by unilaterally defunding the subsidies and playing hide-away with the enrollment program, which is his current game plan. Democrats will vote for it. The ball is in the GOP’s court.

 The Alexander-Murray Plan, which is bipartisan (!), starts by accepting that Obamacare is the law and that the subsidies must be restored to maintain it. In turn, states would be permitted to offer a policy variant that affords less care and therefore costs less.  Healthcare lite perhaps, but health care nevertheless.  In a capitalist system, money always holds privilege. That’s an explanation, not an endorsement -and that’s why many of our horses have humps.

Maverick: The Legend of John McCain

  John McCain is the most unusual political character of our time, President company excluded. He has been a conscientious conservative, a rank-and-file Republican, an across-the-aisle kind of bipartisan, and a zombie presidential candidate. McCain was a prisoner of war in Vietnam, withstanding five horrendous years in captivity. He is a genuine hero and an American legend.   This week, after receiving the awful news that he has a fatal brain tumor, he boarded a plane and returned to Washington, D.C., to play assassin to the Republicans’ calamitous effort to unravel the Affordable Care Act. McCain again played the hero in preventing his beloved Senate from shooting itself in the head.  

 McCain is one of the few big-name politicians who keeps things interesting by keeping us on our toes. His willingness to buck party leadership earned him the nickname, “Maverick,” a sobriquet he embraced.  His political story will be an interesting one to tell. Unquestionably, he is a hawk and a fiscal conservative. He also believes in  tolerance and respect for the beliefs of others.  Nevertheless, he caucuses with many politicians who do not.  One of his signature moments occurred in the late days of his unsuccessful 2008 Presidential campaign.  When an ignoramus called Obama an Arab during a town hall event, McCain quickly reclaimed the microphone and extolled his opponent’s decency.  Yet this is the same man who put an obviously unqualified Sarah Palin on his ticket – one long, lingering look from the Bering Strait and  a single heartbeat from the Presidency.  McCain is the person responsible for letting loose the hounds of nativist amateurism on Presidential politics.

After losing the 2008 race and despite his civility toward Candidate Obama, McCain became a constant critic of the President.  In 2012, McCain won a tough race for a sixth term in the Senate, He made the repeal and replacement of Obamacare a prominent plank in his platform.

McCain is the son of a soldiering family, one of whose members fought alongside George Washington.   An Annapolis graduate, he served as a navy pilot in Vietnam.  After his plane was shot down, he was a long-term guest at the Hanoi Hilton, As a high value POW, he had a chance to be released, but he wouldn’t trade on the status  of his Admiral father. He refused preferential treatment.  After five years of physical and mental torture, solitary confinement and abuse that eventually broke him, he was released in 1973. This is the man belittled by Candidate Trump, who prefers his heroes not to be captured.  

McCain held his water, though.  He would never have been a Trump supporter in any normal time but the 2016  election was anything but normal. He threw his support beyond the military school brat who kicked dirt on his reputation, while the only thing to capture the Hypocrite-in-Chief was an Access Hollywood microphone.  

Two weeks ago, McCain flew home to Arizona to have eye surgery, during which it was discovered that he has an inoperable brain tumor, the same type of cancer that killed Ted Kennedy.  The Senate faced the threshold vote on its healthcare bill, a bill so bad it was kept out of sight for as long as possible.  With two certain GOP defections (Collins, Murkowski), an absence by McCain would have doomed the opening gambit, called a motion to proceed.  Earlier this week, McCain returned to the Capitol, struggling physically but resolute to attend the roll call.  McCain joined his party’s vote, ensuring that debate on a bill would take place.  However, Majority Leader McConnell struggled to find common ground between his party’s conservative and alt-right factions.  Two proposals failed to garner enough votes.  On Thursday night, he called for a vote on the so-called skinny repeal, a rollback of Obamacare so marginal that it was only a placeholder to get into a conference with the House over its own odious bill.

When called to vote on the skinny repeal – no replacement, McCain voted no.  He remained consistent with his position that the law was insufficient because it failed to repeal and replace.  But the no vote gave the Maverick the added pleasure of driving  a retaliatory ice pick into the neck of the future ex-president. Trump’s plan to repeal healthcare died with McCain’s vote. He trumped the President at his own game of political theater. To say the President was enraged doesn’t begin to tell the story. The White House Chief of Staff was found the following day floating in the Potomac.

 McCain issued a statement explaining his position.

While the amendment would have repealed some of Obamacare’s most burdensome regulations, it offered no replacement to actually reform our health care system and deliver affordable, quality health care to our citizens.

McCain hasn’t talked about whether he drew any personal satisfaction from defeating one of the cornerstones of the Trump agenda.  But he exhibited the kind of grit that his hosts at the Hanoi Hilton would recognize.

Health Care Costs Top The New President’s Agenda

img_143When the new President takes over the executive branch of the U.S. government in January, she must place health care costs at the top of her domestic agenda.  Considering Hillary Clinton’s  handling of health care reform in her husband’s administration, this would make an interesting parallel. In 1993 President Bill named the First Lady to lead a task force to reach the goal of universal health care.  The only thing universal was opposition to the plan. The new President will face a changed environment but the cast of characters is largely the same.  So, the administration must develop new approaches to succeed this time around.

Insurance Carriers in Retreat

The administration announced that policy holders will receive substantial premium increases on upcoming policy renewals in the Obamacare exchanges. The rate increases are set by state regulation. Thus, they are not arbitrary price hikes. Health care costs continue to increase at a rate that has overwhelmed health care budgeting. United Healthcare, the nation’s largest insurer, is withdrawing from some markets where the company is booking losses. UHC’s action signals that the insurance companies are maxed out.  An insurance company needs policy holders to do business.   By leaving the market, they are saying that they cannot get enough premium dollars to turn a profit after paying legitimate claims.

Causes of Increased Costs

When health care advocates line up the usual suspects, the insurance companies are often first on the list. If the insurers aren’t the cause, what is?  In America’s Bitter Pill, a book on the creation of Obamacare and its shortcomings, Steven Brill pointed out that the Affordable Care Act failed to address the cost aspect of health care. Obamacare expanded coverage without tackling the tougher issue of cost control. The pharmaceutical and biotech industries are the principal engines driving health costs.

Prescription Medicine Costs

The Obama administration agreed not to tackle drug prices in exchange for Big Pharma’s cooperation in expanding coverage. The government has no legal means of holding down prices for specialty or generic drugs.  It lacks an effective bargaining position even in Medicare, where the size of the purchasing unit would compel large discounts. 

The next President must engage the pharmaceutical industry meaningfully if she hopes to sustain Obamacare. There are good strategies available but the White House must be able to form a broad enough coalition in Congress to back its strength in negotiations with the drug lobby.  Consequently, a new approach to control costs must win over Congress. As a result, the administration  must count votes and negotiate with individual Members, not solely with leadership.

Biotech Costs 

Significant advances in genetic and cellular research generate new diagnostics and therapies, broadly described as  Biotech. Some of this research carries the promise of meaningful progress in combatting and preventing a number of cancers, as well as other diseases that are activated at the cellular level.  The cost of these advances is massive. The procedures take enormous time to develop, and there is no assurance that one will result in effective treatment. The rewards of success must justify the attendant costs and risks.  

As these therapies have become available, the cost has become a significant booster in overall healthcare benefits. Therefore, it is unrealistic to place the costs fully on the backs of policy holders  because it will price out people who cannot afford to bear that cost. The expansive nature of the field requires forward-looking approaches, such as public “sharing” in the fruits of publicly-funded research. The technology becomes a public-private asset, in which the ownership of patents  benefits the public in part.  Public participation can result in an overall cost reduction in health-care while providing seed-capital for  education and medical technology. Furthermore, the programs should be able to pay their own way.

Partnering with Providers

Engagement with the drug and biotech industries must be  mutually beneficial to be successful.  Policy holders won’t benefit from a punitive approach or one that threatens to disenfranchise the industries.  

© 2016 The Revolted Colonies

 

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