Conservative pundit David Brooks – How Democrats Won the War of Ideas

As an independent and former Republican (and Democrat), David Brooks is one of my favorite conservative pundits and authors. He is a regular participant on PBS Newhour’s Friday recap show with the more liberal Mark Shields. Like other key conservative pundits, MIchael Gerson, George Will, Ross Douthat, Eric Erickson and Max Boot, he is hoping that America votes out the incumbent president.

In his usual articulate and even-handed fashion, Brooks penned the following editorial last week called “How Democrats Won the War of Ideas.” The link is below, but I will highlight a few paragraphs for your review and comment.

“Over the last 100 years, Americans have engaged in a long debate about the role of markets and the welfare state. Republicans favored a limited government, fearing that a large nanny state would sap American dynamism and erode personal freedom. Democrats favored a larger state, arguing that giving people a basic economic security would enable them to take more risks and lead dignified lives.

That debate ebbed and flowed over the years, but 2020 has turned out to be a pivotal year in the struggle, and it looks now as if we can declare a winner. The Democrats won the big argument of the 20th century. It’s not that everybody has become a Democrat, but even Republicans are now embracing basic Democratic assumptions. Americans across the board fear economic and physical insecurity more than an overweening state. The era of big government is here.”

Brooks cites a few survey facts from last week’s New York Times/ Siena poll.

2/3 of Americans support allowing people to buy health insurance through the federal government

2/3 support Joe Biden’s $2 trillion plan to increase renewable energy and build efficient infrastructure

72% of likely voters and 56% of Republican voters favor another COVID-19 relief package

59% of Americans think government should do more to solve problems

2/3 think government should do more to fight climate change

60% support increasing the minimum wage and providing tax credits to low income workers

82% of voters and 70% of Republicans would like to expand requirements for paid family medical leave

Brooks also cites a study by the Mercatus Center which notes that Republicans are also moving left, just not at the pace of Democrats. This is contrary to what is believed by the media.

I have long said that more than 1/2 of the Republican voters are voting against their economic interests and do not know it. This survey indicates many do favor policies that would help them, but are sold a bill of goods packaged to woo their votes, but mask the purposeful deterioration of rights and opportunities.

A great example is the Affordable Care Act. When people are surveyed about the features of the act, the features receive high marks from all, including Republicans. The only feature that did not was eliminated – the mandate to buy coverage. Ironically, this elimination is the basis for 25 Republican Attorney Generals who have case to declare the ACA unconstitutional in front of the Supreme Court after the election, which should not occur as the case is not solid, but one never knows with these things. Sadly, the White House chose not to defend the law, which affects expanded Medicaid, exchange and employer-provided benefits.

Please read Brooks article below. It is very well done, as per usual.

Just a quick refresher on the ACA animosity in the Republican Party

Our friend Scottie asked me why the Republican Party detests the Affordable Care Act (ACA) so much and wants to kill it. I have written many posts about this, but here is quick refresher.

The Republican party has spent about ten years nay-saying the ACA. This is in addition to actual efforts to sabotage it by Senator Marco Rubio and President Donald Trump and the fourteen states who still have not expanded Medicaid. Rubio and Trump’s actions caused premiums to increase. Blue Cross and Blue Shield of North Carolina (BCBS of NC) said it was geared to have a 0% increase in 2018, but after Trump de-funded reimbursing insurers for co-pays/ deductibles for people making less than 2 1/2 times the poverty rate, BCBS of NC said it would have a 6.6% increase. Not only did Rubio’s action cause premiums to go up, it drove some insurers out of the exchanges lessening competition which also hurt consumers. *

So, to me the Republicans are so far down the path of killing something that is working pretty good (it still needs improvements), they cannot stop. And, it is apparent that Trump has an Obama obsession that he must kill everything that Obama did regardless of its level of efficacy. As a retired benefits consultant and former actuary, what the GOP came up with in 2017 to replace the ACA was god-awful. It was throw-against-the-wall planning. The fact the Republicans did not follow due process was a key reason Senator John McCain voted it down. Mind you, I fault Obama for the terrible roll out of the exchanges in 2013, but he at least involved Republicans in the planning process in very public sessions (although they were told not to vote for it).

And, here is the rub. The reason the GOP does not have a plan is the ACA is largely based on a Republican idea set in motion by Mitt Romney for Massachusetts, when he was governor. It worked so well, that Senator Jim DeMint, the leader of the Tea Party, advocated its national use in writing to President George W. Bush. And, DeMint politicked with Romney on stage in 2008, Romney’s first run for president. I recognize the ACA is not exactly the same as Romneycare, but there are a number of similar constructs.

Everything I mention above, including the DeMint piece can be found by Googling. But, here is the major concern I have. Employers have been going to more part-time and contract work forces even before the pandemic. Why? – to avoid providing subsidized health care benefits. So, to survive in this gig and part-time employment world, the ACA is essential.

Plus, the ACA imposes requirements on employer based plans as well that may go away if SCOTUS rules unwisely with the court case. Those include pre-existing condition protection, guaranteed renewability, no deductibles on wellness visits, and limitations on insurer margins in pricing, e.g. So, a bad SCOTUS ruling could impact over 200 million Americans not just those in the exchanges and Medicaid.

* Note: The reason for the premium increases are complex, so I will mention them here. Rubio led a Republican move to defund 89% of the payments to insurers for adverse selection (pent up demand for new policy holders) for the first few years, a process used when Medicare Part D was rolled out. Insurers were forced to increase premiums and some left the market with the US owing them money that was promised. The Trump change is more complex. By stopping the reimbursement to insurers for this extra benefit for low paid policyholders, the insurers still honored their commitment to the policyholders. This drove up premiums. Trump said this would only impact insurer profits, but that was not true. The CBO said it increased the annual deficit by $10 billion because the premium subsidies went up as well. The people who ultimately got screwed were those who did not get a full subsidy.

Letter to editor – health care actions speak loudly

I have written longer posts on the actions of Donald Trump, Marco Rubio and Republicans to sabotage the Affordable Care Act. What many do not know, after the election, a court case will decide its fate, brazenly brought forward by several Republican state AGs after Congress stripped away the coverage mandate during a budget vote. The following is a brief letter I sent to my newspaper.

The truth matters. Actions matter. Four years ago, Trump said we had to wait and see his healthcare plan. None existed and still does not. Three years ago Trump cut payments to insurers to fund their payment of co-pays and deductibles for ACA members making less than 2 1/2 x the poverty rate and then lied about its impact – it actually increased premiums and the deficit per the CBO.

After the election, SCOTUS will be hearing a case to rule on the constitutionality of the ACA premium subsidy after Republicans stripped away the coverage mandate, which would severely hamper the law and may lead to its end. The White House chose not to defend the law. The ACA impacts both exchange and employer benefits, three key provisions of which are allowing pre-existing conditions, requiring guaranteed renewability and requiring wellness doctor visits not be subject to deductibles.

Sadly, beyond the nay-saying, there has been more sabotage of the ACA which increased premiums (Google Marco Rubio and risk corridors), repeal and replace efforts which were fortunately defeated, and fourteen states (including NC and SC) who still have not expanded Medicaid, a key part to help people in poverty. Health care coverage access is a major issue this coming election so says this retired benefits consultant, benefits manager and former actuary.

Eliminating the ACA which which may impact over 200 million Americans  (including the ACA requirements on employer plans) is unwise in my view, in general. But, doing so in the middle of a poorly handled pandemic by the White House with over 200,000 and growing American deaths, is plain asinine and mean-spirited.

Please feel free to adapt and use. Actions speak louder than words and my former party, the GOP, has purposefully sabotaged the right for Americans to have access to health care coverage. This is why your vote matters.

Help me define the best (or worst in this case) metaphor of the Trump presidency

After the most recent incredulous statement by the US president about ingesting disinfectant as a possible cure for COVID-19, I felt this Marie Antoinette moment might be a metaphor for his presidency. Yet, there are truly many contenders for such a distinction.

Below are twelve top of mind statements or actions that could be considered. Sadly, there are more to choose from. So, readers please let me know your top three, including others I may have overlooked.

1. Ingesting disinfectant – he has to tried to explain this away as sarcasm, but to see Dr. Birx trying to avoid eye contact when he asked her what she thought is telling.

2. Sharpie gate – this is when the president played meterologist and scared the state of Alabama by drawing on the map the hurricane may hit them. This was an unforced error thst aides spent a week trying to diffuse.

3. Firing Comey without telling him – for a person who liked to say “You’re fired” on TV, the president cannot bring himself to fire soneone in person. James Comey found out he was fired via TV news. But, Trump failed to tell his Communication team, so Sean Spicer was hiding in the White House bushes with staff to plan what to say.

4. First travel ban – Trump likes to use the word disaster to define anything he did not do. The first travel ban was so disastrous, it waa pulled after two days. The president failed to vet the change with various stakeholders including the people who would need to conduct the ban. So, people did not know what to do and the lines were long.

5. India/ Pakistan brokering peace deal – this faux pas did not get much air time, but the president announced in front of the Pakistani leader the India prime minister asked him to broker a peace deal between the two countries over the Kashmir conflict. Within the hour, India put out a press release saying no such request was made.

6. Tariffs paid by China – the president has said this at least a dozen times, so it may be a good candidate because of its staying power. Trump likes to say China is paying the tariffs. Economists correct him each time saying US importers pay the tariffs which are passed onto the consumers. So, we pay the tariffs.

7. Extorting Ukraine – after watching a parade of reputable public servants testify under oath at a great risk with such a vindictive president, Trump was impeached over extorting Ukraine for personal gain. He likes to focus on one phone call, but if that call was so “perfect,” why did his staff try to bury it?

8. Siding with Putin over CIA – in Helsinki, standing side by side with a man who is KGB trained on disinformation, Trump sided with Putin over the advice of his intelligence people. Senator John McCain wrote an op-ed piece to blast the president’s words as “traiterous.”

9. Pulling out of Paris Climate Change Accord – the president’s stance on climate change was my worst fear going in. So, he announced pulling out of the Paris accord on June 1, 2017, the day following Exxon shareholders voting for management to tell them what Exxon is doing to address climate change. When we exit, the US will stand alone in the world.

10. Transgender in military – the announcement to ban new transgender people in the military got the press, but the decision process is the metaphor. Per the book “Fear” by two-time Pulitzer Prize winner Bob Woodward, the president announced his decision by two tweets around 10:05 one morning saying the Joint Chiefs of Staff and he had decided to do this. Problem is they had not. The time is important as the Joint Chiefs waited downstairs to meet with the president to go over four options and the pros/ cons of each. The president was told of this and asked when would be a good time to meet. This is a key reason DOD James Mattis abruptly said that a tweet is not an order.

11. Wandering alone at G20 – this was a sad to watch as the president wandered the tables looking for someone to talk with after dinner at a G20 meeting. He finally wandered over to meet with Vladimir Putin alone, a very scary situation with a very informed leader and Trump, who does not study history or issues. Plus, it is a metaphor that he would gravitate to Putin’s table rather than an ally of our country.

12. Bragging on fixing the economy – this is the most relentless of topics and, until the virus hit, was his claim to fame. The problem is he did not fix the economy. Yes, economic growth continued under his watch, but when he was sworn in on January 20, 2017, the US GDP was in its 91st consecutive month of economic growth (that is seven plus years), the stock market had more than doubled under Obama, and unemployment was under 5%. Presidents get too much credit and blame for the economy, but for Trump to say he fixed the economy is untrue – it was not broken He has added both short term tailwinds and long term headwinds.

So, that is a dirty dozen, so to speak. I wanted to limit them twelve, so leaving off Charlottesville, his rallies, his ignoring the early warnings on COVID-19, or just his litany of routine, daily untruthfulness or beating up on the press, etc. proved difficult. Let me know your top three choices. Please feel free to add any others. It is funny, depending on how I want to focus my attention, I could pick a different three – is impact, continuity, or inanity the best measure?

Supreme Court rules against a GOP effort to renege on owed payments to health insurers

On Monday, the US Supreme Court ruled against an effort of several years ago led by Senator Marco Rubio to shortchange health insurers money owed to them for accepting higher risk claimants early on under the Affordable Care Act. In essence, Rubio led GOP Senators to eliminate 89% of the funding under a risk corridor agreement to tie insurers through initial adverse risk (due to pent up demand from folks who were not previously covered).

The following excerpt from an article called “Supreme Court rules government must pay billions to Obamacare insurers,” by Susannah Luthi of Politico, may be of interest.

“The Supreme Court on Monday ruled the federal government owes health insurers massive payments from an Obamacare program shielding them from financial risks after the companies accused Washington of reneging on its funding promises.

The 8-1 decision could open the floodgates for federal cash to the insurance industry. Insurers who accused the government of a ‘bait and switch’ claimed they’re owed $12 billion from the Affordable Care Act program.”

The lone dissenting vote was from Justice Samuel Alito who said the insurers were getting a “windfall.” No, Justice Alito and Senator Rubio, they are getting what was promised in writing.

People could easily dismiss this as a fight that does not concern them. That would be a misjudgment. The Republican Senators led by Rubio screwed Americans to win a political argument in attempt to sabotage the ACA. Why do I say that? As a consequence, these insurers had to raise premiums that impacted unsubsidized folks and caused an increase to the offsetting premium credit under the ACA for the subsidized folks. That subsidy increase in turn increased our budget deficit. It also forced some insurers to exit the ACA with the US government owing them money, which hurt competition.

Sadly, all of the efforts noted above, which the Supreme Court just overturned, are true. That is a reason for the near unanimous vote. I encourage you to Google “Marco Rubio and ACA Risk Corridors” and read as much as you like. What frustrates this retired benefits consultant, manager and actuary is very few people know they got screwed. The following links to this article and one of my many pieces on shoring up the ACA are below.

https://www.politico.com/news/2020/04/27/supreme-court-rules-government-must-pay-billions-to-obamacare-insurers-211184

https://musingsofanoldfart.wordpress.com/2019/07/19/please-stabilize-the-affordable-care-act-now-to-help-americans/

Wednesday wanderings the first week of March

Well, March Madness will be thrust upon Americans later this month, so everyone get ready for the various brackets for the NCAA basketball tourney. Madness may be the operative term for the world these days, but please note things are usually not as bad as reported, as good news is vastly underreported and does not have as high a bounce as a negative news.

Here are few thoughts as a wander this Wednesday.

The Coronavirus will be more prevalent than first thought, but it seems not as deadly as other viruses. Still, those who are not in good physical shape with breathing issues, circulation issues, obesity issues, etc. should be prepared to more abruptly deal with symptoms. Sadly, since the US president has made this a personal political issue, listening to politicians talk, whose first mission is to protect the Trump brand, is not reassuring. I want to hear from experts.

Many financial people have forewarned that using stimulus tools to prop up an economy and stock market when it is going pretty well is not the best time to deploy them. When they are used now, what will you use later? The economy is still doing pretty good, but has been softening for more than a year. And, the stock market has been in need of a downward adjustment for some time. But, the president views the stock market as a key barometer, so he takes it personally when it falls, even though, he has little ability to control it long term. Yesterday, the market did not react very well to the Federal Reserve lowering interest rates 50 basis points (1/2 %). To me, it was seen as a panicky move, but smarter people than me will have to judge this (note, the market got a bump today in reaction to Biden’s success in the primaries).

While I like Bernie and will vote for him if he is the nominee, America breathed a sigh of relief yesterday with former VP Joe Biden’s rebound performance. As an independent and former Republican and Democrat, I am fiscally conservative and socially progressive. I very much believe in helping people with opportunities and to climb a ladder when disenfranchised. But, we need to pay for things. Right now, we have $23 trillion in debt and it is projected to increase to over $35 trillion by the end of the decade. We must deal with this obstacle, while we do other things – pay for infrastructure improvements, shore up the ACA, Social Security, etc. With this in mind, while both are good people, Biden will be better positioned to bring folks together to do that – Democrats, independents and even some Republicans.

If Bernie wins the nomination, I hope he pulls in a more moderate Democrat as his VP candidate. If Joe wins, it would be great if he tapped someone a little more progressive than he is. One of the dilemmas is the Democrats need to think about the future, as neither person is a spring chicken. I like listening to folks like Pete Buttitieg, Andrew Yang, etc. as they have a well-considered ideas, even if you don’t agree with every thing they say.

Whatever happens, Democrats need to vote for their candidate as four more years of the most corrupt and deceitful president in my lifetime, including the corrupt Richard Nixon, will not be good for America. I have said and written this to Senators and my Congressman, but regardless of party, we cannot have a president who acts the way this incumbent does. He is a national security risk and quite simply, America is no longer trusted as before, because the president is not trustworthy. Plus, we cannot lose sight of more aggressively addressing climate change and environmental degradation that have been made worse and would deteriorate more on his continued watch.

Near universal health coverage achieved in six states and DC

An article by Michael Rainey of The Fiscal Times (see link below), called “How six states achieved near universal coverage” noted the success of covering at least 95% of their people. These six states are Hawaii, Iowa, Massachusetts, Minnesota, Rhode Island and Vermont. The District of Columbia also fits the bill. Per the article:

“A half-dozen states and the District of Columbia have health care insurance rates of over 95%, achieving near-universal coverage. Three researchers at the University of Pennsylvania — including Ezekiel Emanuel, a key architect of Obamacare — said Monday that the Affordable Care Act has everything to do with those results.

Here’s how the states achieved such high insurance rates, according to the authors:

Expanding Medicaid: States that expanded their Medicaid programs as allowed under the ACA had about half the uninsured rate (6.6%) in 2018 as states that did not do so (12.4%). ‘Nearly 5 million people would gain health insurance if the remaining 14 states expanded Medicaid,’ they write.

Extending enrollment periods: High-coverage states countered the Trump administration’s efforts to shorten enrollment periods and reduce informational assistance.

Lowering premiums: States enacted additional subsidies and reinsurance programs to keep premiums low, a crucial factor in maintaining insurance coverage from year to year.

Simplifying options: Some states limited the number of options available to counteract “choice overload,” which can reduce signups through consumer paralysis.

Maintaining individual mandates: Five low uninsured states maintain some kind of individual and employer mandates, which may help persuade healthy people to sign up.

The lesson, the authors say, is that near-universal health coverage can be achieved without national legislation. ‘While it is easy to dismiss the ACA and focus on the promise of Medicare for All, there is a more straightforward path to universal coverage,’ they write, ‘adopting a handful of relatively simple policies and programs at the state level can ensure health insurance coverage for nearly all Americans.’”

This article echoes what can be achievable if Medicaid is expanded and the other above steps are taken. The three states who drag the results down for the country – Texas, Florida and Georgia – did not expand Medicaid nor run their own Healthcare exchanges. Of the six states over 95%, it should be noted Iowa and Hawaii use the federal Healthcare Exchange, while the other four run their own exchanges.

I have long said Medicare for All is something to be explored, but it requires detailed analyses (and time) of its costs and impact. In the interim, I have strongly advocated improving the Affordable Care Act. The goal is access to care, in my view. The employment paradigm has been changing for some time, where fewer full-time workers are being used than before. We are seeing several industries move to a largely part-time workforce, such as in the retail, restaurant, and hospitality industries. We have seen contractual employment continue as well as the growth of gig economies. Health care access needs to come from somewhere.

What I do not care for is the hyper-politicization of this topic. Republicans (including the president) have actively sabotaged the Affordable Care Act, cutting funding to insurers, not mentioning the negative talk about it. It has still survived. Some Democrats choose to throw progress out and go full bore with Medicare for All. Again, that is a detailed undertaking and no candidate can accomplish this without buy-in from both parties.

So, let’s improve what we have. States who have not expanded Medicaid have been economically short-sighted and harmed their citizens. I have argued for repaying insurers who were harmed by the reneging on funding commitments, inviting them back into markets. Where choice is not available, introduce a Medicare option. I would also lower the eligibility for Medicare to age 60 or 62.

These are practical options that may move the needle upward like in those six states. Let’s talk about that.

https://finance.yahoo.com/news/6-states-achieved-near-universal-224827646.html

Former Arkansas surgeon general brags on Medicaid expansion

I have written often about the Affordable Care Act not being fully implemented since 15 states have not expanded Medicaid. Rather than repeat my arguments, let me reference the attached editorial written by Dr. Joe Thompson, the former Surgeon General of Arkansas, which I read in Friday’s The Charlotte Observer. The reason for their interest is North Carolina has a Democrat governor working with a Republican majority General Assembly and the issue of Medicaid expansion is of importance. The editorial is entitled “Medicaid expansion works in deep red Arkansas. It would work in North Carolina too.”

“My home state of Arkansas is unusual among Southern states in having adopted Medicaid expansion early and in our own fashion.

I was Arkansas’ surgeon general in 2013 when the state first faced the question of whether to expand Medicaid. Like North Carolina now, Arkansas then had a Democratic governor and a Republican-controlled legislature. Fortunately, we avoided an impasse; lawmakers on both sides of the aisle came together to approve an innovative alternative to traditional Medicaid expansion that provides private health insurance coverage to about 250,000 people earning up to 138% of the federal poverty level.

The effect on Arkansas’ uninsured rate was swift and dramatic. A 2015 Gallup report showed that since Arkansas’ Medicaid expansion program took effect in January 2014, the state’s uninsured rate had been cut roughly in half, dropping from 22.5% to 11.4% ― the biggest reduction in the nation.

According to the U.S. Census Bureau, Arkansas’ uninsured rate was 8.2% in 2018. North Carolina’s was 10.7%, the ninth-highest rate in the nation. Arkansas’ reduced uninsured rate led to a 55% reduction in uncompensated-care losses at hospitals. This has been especially important for rural hospitals, which treat many low-income patients.

Since January 2010, only one rural Arkansas hospital has closed for financial reasons. In the five neighboring states that have not expanded Medicaid, more than 50 rural hospitals have closed, according to the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

Expanding Medicaid also has helped stabilize Arkansas’ health insurance market, improve competition and control premiums. Since 2014, at least three insurers have offered plans through the Health Insurance Marketplace in each county in the state. The competition encourages low rates: In 2014, 38 states had marketplace premiums lower than Arkansas’; today, only six states have lower premiums.Medicaid expansion has brought billions of new federal dollars into Arkansas’ economy: $1.7 billion between January 2014 and June 2015 alone, according to the Kaiser Family Foundation. Arkansas also is saving money because some individuals previously covered under traditional Medicaid, which in Arkansas is 30% state and 70% federally funded, are now covered under Medicaid expansion.

The federal government currently is paying 93% of Medicaid expansion costs and will pay 90% in 2020 and thereafter. A consultant told a legislative task force in 2016 that Medicaid expansion would save Arkansas $757 million between 2017 and 2021.Thirty-six states have now decided to accept Medicaid expansion.

Arkansas has become a firmly red state, but it has reauthorized its Medicaid expansion program with a supermajority vote every year because of the demonstrated benefits to the working poor, the economy and the health care infrastructure. Last year, Arkansas added a work and community engagement requirement that currently is blocked by a federal judge’s order, but however that issue ultimately is resolved, it is clear that Medicaid expansion has had tangible, positive results. There’s a reason the number of states rejecting it continues to shrink each year.

Joe Thompson, MD, MPH, is president and CEO of the Arkansas Center for Health Improvement. He was Arkansas’ surgeon general under Republican Gov. Mike Huckabee and Democratic Gov. Mike Beebe.”

In spite of efforts to naysay it, hobble it and kill it, the Affordable Care Act is stabilizing some. It needs more stability and Medicaid expansion would help in the remaining 15 states. I have also advocated the US government paying back the money they withheld from insurers causing some to leave the market, inviting those companies back to the market. I have also advocated the reduction of the Medicare eligibility age from 65 to age 62 or even 60. And, where options don’t exist, Medicare could be offered as an option for younger adults.

What frustrates this retired benefits manager, consultant and actuary is the fact people getting harmed by decisions to harm the ACA is not a major factor. There is too much focus on winning an argument that people getting screwed does not seem to matter. Please help make it matter. Even as we speak, the eating away at the edges of the ACA could lead the Supreme Court to rule it unconstitutional. If this occurs it would be a damn shame.

Medicaid expansion is needed for NC says this retired benefits professional

As North Carolina continues its stalemate on Medicaid expansion, it might be interesting to heed the words of former Ohio Republican governor John Kasich. When Ohio moved forward with the Medicaid expansion, he called it a “no brainer.”

Now why would he say that? Kasich noted Medicaid expansion would not only help people, it would bring $13 billion to his state over several years. George Washington University did a study that said Medicaid expansion would help a state’s economy, help a state’s rural hospitals and help people. We should also remember NC Republican Mayor Adam O’Neal of Belhaven walking to Washington seeking the expansion of Medicaid after his colleagues in Raleigh turned him down as he tried to save his town’s hospital.

Rather than offer stale arguments, it would be nice if the Senate and House leaders figure out a way to get this done. Let me add the voices of The Commonwealth Fund, RAND Corporation and Economic Policy Institute that echo the results of the GWU study. NC is already in the minority on this. Please let’s find a way to help people.

Let me close with a truism about health coverage to think about. Those with coverage will see doctors earlier and will have access to prescription drugs to avoid future train wrecks. Preventive care and health maintenance are better paths forward for people and healthcare financing.

Note: The author of this post is a retired benefits professional who is a former actuary, former benefits consultant and benefits manager for a Fortune 500 company

The most realistic path to ‘Medicare for All’ says a former Insurance CEO

I said back in 2010 to a healthcare consulting colleague, we will eventually need to consider national health insurance, but it won’t happen. When he asked why, I responded the “Healthcare industrial complex is too powerful.” People forget the reason we have the Affordable Care Act is CFOs were tired of rising healthcare costs to their bottom line.

Healthcare is a complex topic and the ACA added to that complexity. It has since gotten better, but we need to shore it up to stabilize it more, rather continue to allow it to be diminished as its opponents have down for several years.

But, national health care under the banner of “Medicare for All” is worthy of consideration with data and analysis. This retired actuary, benefits consultant and benefits manager supports data driven analysis to improve what we have and consider more substantive changes. JB Silvers, a former health insurance CEO and professor of health care finance at Case Western University, penned an article called “The most realistic path to ‘Medicare for All'” in The New York Times earlier this month. Here are excerpts from the article:

“Much to the dismay of single-payer advocates, our current health insurance system is likely to end with a whimper, not a bang. The average person simply prefers what we know versus the bureaucracy we fear.

But for entirely practical reasons, we might yet end up with a form of Medicare for All. Private health insurance is failing in slow motion, and all signs are that it will continue. It was for similar reasons that we got Medicare in 1965. Private insurance, under the crushing weight of chronic conditions and technologic breakthroughs (especially genetics), will increasingly be a losing proposition.

As a former health insurance company C.E.O., I know how insurance is supposed to work: It has to be reasonably priced, spread risks across a pool of policyholders and pay claims when needed. When companies can’t do those fundamental tasks and make a decent profit is when we will get single payer.

It’s already a tough business to be in. Right now the payment system for health care is just a mess. For every dollar of premium, administrative costs absorb up to 20 percent. That’s just too high, and it’s not the only reason for dissatisfaction.

Patients hate paying for cost-sharing in the form of deductibles and copays. Furthermore, narrow networks with a limited number of doctors and hospitals are good for insurers, because it gives them bargaining power, but patients are often left frustrated and hit with surprise bills.

As bad as these problems are, most people are afraid of losing coverage through their employers in favor of a government-run plan. Thus inertia wins — for now.

But there’s a reason Medicare for All is even a possibility: Most people like Medicare. It works reasonably well. And what could drive changes to our current arrangement is a disruption — like the collapse of private insurance.

There are two things insurers hate to do — take risks and pay claims. Before Affordable Care Act regulations, insurance companies cherry-picked for lower-risk customers and charged excessive rates for some enrollees…”

There is only one solution: pooling and financing many of the risks related to chronic and acute health care issues. A study by my former company noted generally 15% of participants drive 80% of the claims costs in any given year. It may not be the same 15%, but with major chronic issues, some could continue to be in the mix. The principle of insurance is to pool those risks, so that good risks can moderate the higher risks.

The ACA uses the private insurance system, exchanges and expanded Medicaid. Unfortunately, there are about 15 states who still have not expanded Medicaid. Medicare for All would consolidate the risk into one place, eliminating the profit load and reducing the relative administration cost of insurance companies. I have suggested for several years to do a pilot and expanded Medicare eligibility from age 65 to age 62, or even lower. This would let us measure the impact of such a change.

Yet, what we don’t need is this to become political. What people do not realize is the ACA has been sabotaged on several occasions by my former party which drove some insurers out of the market and increased premiums for everyone else more so than they otherwise would have been.

So, let’s cut to the chase and study options. And, politicians should let people who know what they are doing do the analysis. The ACA was made too complex and the exchange roll out was botched. On the flip side, what the GOP did in 2017 was sloppy and poorly staffed, so what was voted on woulf have been harmful to many.