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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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?

Are you going to believe me or your own eyes?

The man residing in the White House has basically told his followers that everyone else is lying, only believe me. By itself, that is a pretty audacious claim, yet when the man’s history is reviewed, truthful is not the word his biographers or business relationships would use to define the man. Yet, his fans still follow his lead.

It is very difficult to manage the response to three major hurricanes. Yet, don’t lie to people and tell them everything is going well in Puerto Rico, when it is obviously not. As the Mayor of San Juan said bluntly, “we need to get our shit together.” The better answer would have been for the man in the White House to say we have been slow to get help to people, but here is what we are going to do about it. This same Mayor was ticked off today when a DHS person said Puerto Rico is a “good news story.”

The same man is trying to ram a tax cut through that may offer some relief for middle class families, but who is he kidding? The percentage reductions for the top of the house are substantively more than for the middle class. Abolishing things like the estate tax (which already does not exist on the first $5 million of inherited assets) and the Alternative Minimum Tax (which is what most of these high earners pay) is a windfall. And, let us not look past the comment that a tax cut that will impact the debt by $2 Trillion will create sufficient economic growth to pay for that increase. If we can grow our way out of the problem, let’s cut the taxes to 0%.

The same man has echoed the party line that the ACA has failed, but there are a couple of things he is not letting on. It is not failing, but needs improvement. And, it could be doing even better if it were not for the sabotaging done by the man and his party. Premiums are even higher and carriers are fewer in part due to the efforts of the Republican Party leadership, including the man in the White House. The sad part is most Americans have no clue about this sabotoging role, but it is entirely true.

Finally, just a thought to consider. Why did the man in the White House refer to African-American protestors who civilly made a statement taking a knee during the national anthem as “sons of bitches,” yet made no such references to torch bearing White Supremacists chanting “blood and soil” and carrying Nazi slogans? Then, he said his words had nothing to do with race, yet that is why these men risked their careers by protesting.

On this latter point, my wife shared with me the comments of a third generation soldier. He said he, his father and his grandfather fought people who were not permitted to civilly protest their leadership in WWII, Korea and Vietnam. To him, to see the man in the White House criticize Americans for exercising their rights of civil protest, citing the reason to condemn them so as not to offend the flag or the military, is what this soldier fought against.

 

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.