Any more questions?

For over two years, I have been amazed at how a man, who is so consumed with himself and has given so little regard to the plight of others, can become the President of the United States. He convinced far too many people, whose voice has not been heard, that he was on their side. Unfortunately, they did not pay attention to his history which reveals he has only one cause – himself.

Yesterday, this man decided to kick poor people one more time, stripping subsidies under the ACA for deductibles, co-pays and coinsurance for those who qualify because of low wages. This man owns the imperfect, but working ACA. He has sabotaged it from the get go picking up the baton the GOP Congress gave him, so if the ACA fails as a result, it is on his and GOP leadership’s shoulders.

A few weeks ago, he rolled out the outline of his tax plan that uses sleight of hand with a small tax break for the middle class, while eliminating the Alternative Minimum Tax, Estate Tax above $5 million in value, and the ACA tax on wealthy people, while cutting the individual and corporate tax rates. This is a clear windfall for the “haves” with a little gain for the “have-nots.”

Next, we should consider his proposed defunding of programs to retrain displaced coal miners. At the same time, he was enabling coal owners to invest in digging more coal with fewer workers. An energy expert said, “Trump is not for coal miners, he is for coal owners.” The dilemma is the current and former coal workers don’t know this.

The focus on fossil fuel and attack on environmental regulations is another slap at the disenfranchised. They tend to be the ones who feel the brunt of environmental rollbacks. A rancher in Montana, who has successively fought against the oil companies, notes that he cannot name one western town that has benefited long term after the oil rush abates. He said “all of the money goes back to Houston and Calgary.” The ranchers and farmers are left holding the bag to fix all the environment problems.

Speaking of environmental calamities, after much better responses to hurricanes in Texas and Florida, the response to the hurricanes which devastated Puerto Rico has been slow and fraught with problems. Yet, after pronouncing what a great job he was doing, Trump has continually harangued people in need, actually verbally and physically insulting them when he visited and afterwards.

Finally, the President’s attack on civil liberties, protest and free speech is the coldest dagger of all. He is basically telling everyone to “believe no one else but me.” His actions and words say he will squelch these unpatriotic troublemakers. To me, he is saying how dare they question what is going on in this country or what I am doing?

Well, I dare ask one question to everyone. Do you have any more questions about whose bread is being buttered by this President?

Advertisements

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.

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.

 

 

 

Tuesday’s Gone with the Wind

With a shout out to one of my favorite Lynyrd Skynyrd’s songs “Tuesday’s Gone with the Wind,” here are a few tidbits for this Tuesday.

It should not be lost on anyone that two of the biggest players in wind energy are two of the largest manufacturing companies in the world – Siemens and GE. With Iowa at almost 1/3 of its electricity provided by wind and oil rich Texas at 13% and the largest US wind energy state, this is much more than a breeze and just shy of a gale.

What the ranchers and farmers in the Midwest and in other areas have learned, is leasing their land to wind mills earns annual income and let’s them continue to use the land. In North Carolina, for example, one farmer leased his farm for eleven wind mills for annual income of $55,000. With the variability of profit margin associated with working the land, this adds some stability.

Thinking of a different kind of wind, the Senate leader is a particularly blowhard. Now, that the third effort to revise the Senate ACA repeal and replace has fallen apart, he is still reluctant to take the more appropriate path. Rather than working with all members of the Senate following normal procedure for legislation, he now is talking about a full repeal vote, without replacement. Not only is that malfeasance in my view, it runs contrary to the wishes of most Americans. The fact the President suggested it does not improve the veracity of the idea.

Folks, please pay attention to the good and bad things happening. We can no longer assume our elected leaders will act with the necessary diligence and stewardship.

 

 

 

A few suggestions on ACA Reform

Since the House and 13 Senate Republicans have decided not to listen to the American majority or review actual data, here are a few suggestions on reforming the ACA. The ACA is imperfect and seeing higher premiums than expected in some places, but critics overlook three key things. It has dramatically reduced the number of uninsured, it has introduced positive benefit requirements to all plans including employer sponsored ones and its premiums are even higher due to Republican Senators stiffing insurers.

What should we do about improving the ACA? First, do not pass any variation of the ill-conceived AHCA bill passed by the House. It is obvious the gang of thirteen GOP male Senators are not listening to the American majority. For what it is worth, here is what this retired benefit consultant, actuary and manager suggests for consideration.

– Pay insurers for the amounts promised them under the ACA to take on initial adverse risk (as was done when Medicare Part D was rolled out) and invite them to stay or return to the exchanges. Part and parcel with this change is to restore the risk corridor funding for adverse selection going forward. This will bring premiums down.

– Fully expand Medicaid in the remaining 19 states. The National Governors Association advocates the positives of Medicaid expansion with Ohio Governor and former Presidential candidate John Kasich calling it a “no brainer.” This will help rural hospitals, economies and residents as well as others in more urban settings.

– Reduce eligibility to Medicare to age 62. This will reduce the overall risk profile under the exchanges and Medicare since the added Medicare population is older than the average exchange population it would leave and younger than the Medicare population it would be joining.

– Where competition in the exchanges is nonexistent with only one provider, offer a public option through Medicare or a variation therefrom. The pricing needs to be fair when contrasted to the lone offering as you want provide viable choice, but not drive the lone insurer away

– Finally, I would suggest we evaluate the efficacy of all fee arrangements under the ACA. Which ones make sense to continue, which ones make sense to alter, and which ones should be shelved or replaced?

It would also be helpful for naysaying for the sake of a party position to cease. Some impressionable people have refused to consider the ACA because a politician told them not to saying it was horrible or in a death spiral. People need to be mindful that health care and insurance are complex and politicians are offering advice in areas for which they are not licensed or knowledgeable to do so.

To be frank, I would rather see us go down the path of a national health insurance model. Yet, that is s tough sell in this country. So, improving the ACA is the better course versus what is being discussed. Plus, the strategic expansion of Medicare noted above will permit us to study this option and expand or contract it based on its measured veracity.