The President almost did something good, then…

People need to know that our President is not big into details, nor does he care to be. He is not very conversant on healthcare or the Affordable Care Act, for example. Yet, he almost slipped up and accomplished something good. Alas, he changed his position within 24 hours.

Just last week, he signed two executive orders to help healthcare in the US. Neither order would be very helpful and both will cause premiums to go up under the ACA. In fact, he said if we eliminate the subsidies for deductibles, co-pays and co-insurance on people making less than 2 1/2 the poverty level it would just hurt the insurer’s profits. That simply is not true, as our deficit would go up by $20 Billion per annum and people without subsidies would see premium increases.

But, while this was going on, Senator Chuck Schumer kept telling him about the bipartisan effort of Senators Lamar Alexander and Patty Murray that would stabilize and improve the ACA. Their efforts would restore the subsidies that Trump wanted to do away with. Insurers were pricing 2018 premiums higher sans these subsidies,

Trump encouraged Alexander while Schumer did the same with Murray. The President actually did the right thing, as Alexander and Murray were going about their business in the right way with hearings and committe meetings. This is how legislation should be done, which has been lost on our two Congress chamber leaders.

When Alexander/ Murray announced they reached agreement, the President was supportive. Alexander actually thanked the President for his role in making it happen. Yet, just after Alexander called to thank him, Trump changed his mind and now does not support it. Less than 24 hours had elapsed.

Of course, his support may change and Alexander/ Murray are not done yet, but Trump had a chance to take credit for helping Americans. This could have been a helpful major piece of legislation, which is missing from his tenure. Alas, he realized he would be helping the ACA and he had to destroy it. That is what he promised to his base. While imperfect, the ACA is not broken, but it does need improvements. If it eventually fails, it is on this President and Congress’ shoulders.

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When is the right time?

We should mourn the loss of innocent American lives at the hands of one shooter. We should offer our prayers, thoughts and support to the victims, injured, caregivers and their families and friends. And, we should demand from our lawmakers to act like parents and grandparents and to stiffen our gun governance.

NRA funded politicians, who unfortunately include the leaders of the two chambers of Congress and the White House, say now is not the time to discuss gun control. When is the time? The NRA is likely horse whispering in their ears to stiff arm the gun control proponents until the crisis abates. Then, lip service will be given to the subject as it is defeated once again, given the NRA’s ability to highly mobilize its confederation of zealous followers, even though they are small in number.

Speaker Paul Ryan has noted that it is more than a gun issue, it is a mental health issue. Two comments – it is a mental health issue, but make no mistake about it, access to guns is an issue. As an aside, there is an obvious disconnect between saying it is a mental health issue and supporting legislation that would kick twenty million Americans off their health plans, which include mental health benefits.

Now is the time to address better gun governance. It is actually passed time. Gun homicide deaths per capita in the US dwarf that of other western and non-western countries. When suicides are factored in, we look even worse.

I have written multiple posts over the years about better gun governance. Before summarizing them yet again, let me add what I have mentioned before – it is a mental health issue, it is a civil discourse issue, it is a safe gun storage issue, it is a violent entertainment issue and it is a drug crime issue which has infiltrated places of poverty. On the gun control side:

– background checks on all weapon purchases are essential,

– elongated waiting periods are also key, as this will help with suicide prevention and give time for authorities to track purchases – the Las Vegas shooter bought 33 highly lethal weapons in one year,

– finger printed trigger mechanisms (or the like) would prevent accidental deaths by kids and teens,

– ammunition needs to be coded so that bullets used in crimes can be traced, and

– like the expired Brady Law (another NRA victory), automatic assault weapons (and devices to convert semi-automatic weapons) have no place in non-miiitary settings.

The sad truth is the significant majority of Americans want the first two items to occur. Yet, nothing happens. Not only that, actions have been taken to make it easier to buy guns (if mental health is a concern, why did this Congress take people on Social Security disability for mental health reasons off the watch list for gun purchases?).

Now is the time. And, when you hear people say “guns don’t kill people, people kill people,” the response is no “people with access to guns kill people. No gun, no gun death. No automatic weapon, fewer multiple gun deaths.

My former party does not know much about healthcare

The Graham-Cassidy Bill seems to be on its last legs, but these bills are like Jason – just when you think you kill the serial killer, he remains alive. This latest effort may be the worst bill by my former party, which I left in 2006. It is apparent to me that Republican leaders don’t know much about healthcare and don’t care to know or take the time to know. That includes the man in the White House who just wants to sign something that negates something Obama did. “Who knew healthcare could be so complicated?” he asked earlier in the year. The answer “Everyone, but you.”

Every bill either put forth by the Senate this year or passed by the House has been scored poorly by the Congressional Budget Office (CBO), has been not appreciated in polls and has been denigrated by medical and hospital associations. Not involving women, Democrats, experts and due process in the planning revealed a haphazard approach to legislation.The Graham-Cassidy Bill is the worst of the bunch as it places the burden, and eventually all of the financing, on the states. In a nutshell, the bill says we cannot figure this out, so we are punting it to you.

In addition to the tens of millions of Americans negatively affected by these bills, if passed, the authors make a concerted effort to kick people in poverty and near-poverty in the teeth. Since we have a poverty problem in America, these bills are especially cold-hearted. And, Graham-Cassidy gives states the right to do away with pre-existing conditions, which was incorrectly refuted by Cassidy after being called on the carpet by Jimmy Kimmel. Seeing protestors in wheel chairs at the Senate was telling.

Further, I have shared with Senators, Congressional Representatives and the White House, these bills would be dilutive to the economy. Standard & Poor said yesterday in their global report the Graham-Cassidy would harm the American economy by $240 Billion through 2027 and cause 580,000 job losses. In a nutshell, when people in need no longer have insurance, the trade-off becomes between food/ rent and medicine. So, less is spent in the market place which dilutes the economy.

Yet, let me emphasize one thing that has been raised by more than a few state Medicaid Directors and Governors. Building a new healthcare delivery system will take longer than the time given. In my view, it will take longer than even these folks are thinking about. In business and government, leaders tend to vastly underestimate the complexity to set-up administration of things. As President Obama found out, setting up healthcare exchanges was hard and initially failed to deliver.

This is an important observation about the Affordable Care Act. It is in place. It is not in a death spiral and it is not broken. From the lens of fewer uninsured, it has been successful. Yet, it needs improvements, but first it needs to be stabilized. Part of the reason for the latter is the GOP’s efforts to hamstring its success by defunding subsidies for adverse selection to insurers. Coupled with slow funding of other subsidies, nineteen states who did not expand Medicaid and general naysaying, the law has not been given full opportunity to be successful.

So, this retired benefits actuary, consultant and manager recommends the ACA be stabilized under some version of the bipartisan Alexander/ Murray Bill. Then all members of Congress can spend more detailed and thoughtful time in deciding how healthcare can be delivered going forward. My recommendation is they improve the ACA.

Lyin’ Eyes

The Eagles sang about infidelity in their popular song “You can’t hide your lyin’ eyes. And, your smile is a thin disguise.” I mention these lyrics because of the lack of fidelity to the truth exhibited by various politicians.

The comedian Jimmy Kimmel is being vilified by conservative news sources regarding his calling on the carpet Senator Tom Cassidy about his misrepresentation of what is included in the Graham-Cassidy Obamacare replacement bill. Based on fact checkers, Kimmel knows what is in Cassidy’s bill more than Cassidy does.

This would not be the first time politicians have lied about Obamacare. Obama oversold it saying you could keep your plan, which was at odds with most insurance changes. Yet, the lion share of the lying has been by Republicans. This law is imperfect and needs improvements, but it is not in a death spiral or is broken as portrayed by the GOP. The GOP has also not been forthcoming about their multiple attempts to hamstring the law at the expense of Americans increasing their premiums even more.

But, no US politician can lay a hand on the  greatest liar on record. This man has been measured by Politifacts as telling the complete truth only 5% of the time. When partial truthtelling or more is included, the rate increases to 31%. Saying it differently, this man lies 69% of the time, which is consistent with his rate of lying on the campaign trail. This man, of course, is the White House incumbent.

What I have noticed over the years, when politicians lie, the people who are most harmed are US citizens. The reasons and broadcast success rates for the Vietnam War were packed with lies. The sad truth is the percentages of those who died or were injured were much higher for African-Americans and poorer Americans. They bore the brunt of the lies.

Scrolling forward, when Trump and other politicians lie, people tend to die at higher rates. If the ACA is replaced as planned in GOP bills, more folks will be uninsured and  be at risk. By pretending climate change is not a threat or that governing environmental issues are less important than business leaders’ companies, people will die.

I recognize politicians have always lied, but never before at this rate or with such impunity. Our leaders dishonor the flag when they lie so much. And, they hurt our standing in the world. Right now, other world leaders do not trust Trump. They have good reason.

 

 

 

 

The President and Congress own Obamacare

I have written often about the imperfect Affordable Care Act and ways to improve it. I have written often about the Republicans role in sabatoging the ACA making premiums even higher by not funding promised payments to insurers for adverse selection as well as naysaying the law and not expanding Medicaid in 19 states.

This sabatoge continues under this President who says the ACA is in a death spiral. It is hurting in many areas, but stabilizing in others. He said he wants to let it implode and then fix it.

Mr. President, that is not good enough. You are threatening to cease further promised payments to insurance companies which will harm people. You see, what you and Congress fail to realize is you own Obamacare. If it fails, it is on your watch. And, to be frank the significant majority of Americans and the press do not recognize the role you played in hamstringing the imperfect law.

My strong advice is to do what is necessary thinking of its patients and users. Those Americans out there deserve your best efforts to help them. Watching the ACA fail after you greased the skids is extremely poor form and uncaring. It is that simple. Fix the ACA. That is what is done to laws that need it to help people.

Sunday sermon-ettes, the sequel

Good Sunday morning all and enjoy the day. A few tidbits have been bouncing around in my head, so I will commit them to writing for your review and critique. The tidbits are light on religious tone.

Guns and butter: For some reason, in the US we spend more time discussing protecting the right to own a 34th assault weapon than feeding 34 people. We have far too many food deserts in our country where the closest food is a convenience store. Far too many in our country are undernourished. Yet, pick up any local paper on any day of the week, and you will find multiple gun killing stories. Better gun governance is essential, but it is a nonstarter with the NRA who is more interested in gun sales. I think our priorities are off.

Kicking poor people in the teeth: Along those same lines, our President is pushing the Republicans in the Senate to vote on whether to kick 22 million Americans in the teeth or 34 million, many of whom are in poverty or near poverty. It should be noted the President said he would not touch Medicaid. I guess that detail escapes him in his desire to have a photo op of him signing something.

Brexit is a hard pill to swallow: The word Brexit sounds like one of those new fangled drugs to cure something you did not know you should worry about. I think voters were not told the whole story and many are wishing they had a do over. As foretold, the financial companies who based their EU regional business in London, are making definitive plans to move. Bank of America just announced a move to Dublin, Citigroup is moving folks to Frankfurt and other places, and Japanese banks are doing likewise. While I  understand the desire to fully govern your future, the UK is harming its future growth. That is not just my opinion, but that of financial experts.

Shrinking to greatness is not a good strategy: Speaking of financial growth, limiting relationships with other countries is not conducive to growth. And, a venture capitalist noted that what creates jobs is customers. Plus, when we discuss global trade, we need to reflect the whole picture and that is the foreign owned companies who make things here with American workers. Why? Selling big durable products is more cost effective and less risky if they are not shipped from abroad. Just ask BMW, Toyota, Husqvarna, Michelin, Mercedes, Volvo, Mitsibishi, etc. about their plants here in the US.

The bible says many things: There is a minister who upsets a few applecarts by preaching that the bible should not be cherry-picked to support points of view. His obvious example is in Genesis where God tells Adam and Eve to go forth and multiply and then gets mad at them when they like being naked with each other. The question is how did they know how to go forth and multiply? The minister’s premise is we should take away the overarching messages that are taught therein and remember the context of when the bible was written.

So, on that note, go enjoy your day, whether you choose to practice your multiplication tables or not.

 

Gone to seed

We have a poverty problem in the United States. Too many of our declining middle class did not rise to the next strata, falling instead, to near poverty and into poverty. Yet, we do not talk about this problem enough. We have let their ladders out of poverty, go to seed along with their environment.

Poverty should be succinctly defined, as it is often misdefined along with simplistic diagnoses. Quite simply, poverty is the lack of money. The causes are many and complex, so the solutions must be holistic.

Some like to say it is due to lack of virtue. Some like to say it is due to lack of work ethic, while others may claim it is due to drug use or alcoholism. When I work with people in poverty, I witness hard working, often pious people. I see people with a lesser propensity to do drugs than general society.

If we recognize the simple definition of poverty as lack of money, we can focus our attention on providing ladders out of poverty. We can invest in the communities that have gone to seed, both with economic and social capital. We can start with redeveloping depleted assets. The term coined with a successful program in Atlanta is ABCD – Asset Based Comminuty Development.

ABCD could focus on repairing and not closing a community school, recognizing the during and after school value it offers. Or, it could be redeveloping a gone to seed golf course or empty textile or tobacco mill. Or, it could be repurposing a mall to be a school, church, charity or governmental building. Replacing or refurbishing blighted assets makes a huge difference.

Coupled with these investments must be education and career development, or social investments. Jobs and careers are scarce in too many areas. Opportunities must be introduced and nurtured to make them sustainable. STEM education, apprenticeships, trades skills are part of an all of the above tactical strategy,

But, we must be mindful of four negative trends in areas that have gone to seed – crime, opioids, food deserts  and single families. Community policing by people living in the community is key. Targeted help with the opiod epidemic is important. Better food choices must be available as they may not have a grocery market. And, we must have holistic sex education and access to planned parenthood tools and birth control.

What we cannot have is kicking tens of millions off health care insurance. We cannot reduce an already minuscule food stamps program. We need to think about improving the minimum wage.

These are just a few ideas. But, first we need to address what people in poverty lack – money.