Health care

What's coming with Trump and the Republican congress in terms of health care? I don't know.  As usual he speaks out of both sides of his mouth and probably has no understanding of it at all. Not that Obama understood it when he was pushing for it, but, I doubt Trump has ever really talked about it with anyone who knew the basic plan.  

I still look for some signs that the ACA was a good law and I can't find it, other than for the obvious - some people getting free or actually affordable health care who could not before benefit from it and society benefits from that too.  I've asked a number of people who I think have a clue (that is, not your average person who reads newspaper articles) who support it and I'm still not persuaded by them. It seems to me the following "facts" are true. Correct me with a reference to something I can read (and, um, understand) please: 

- Insurance coverage today is just a few percentage points greater than the pre-recession baseline.

- DHS predicts that less than half the number of people the CBO predicted to be in exchange based plans were actually covered as of last March.

- The large majority of the people signing up will be older and sicker than your average person.

- Premiums, deductibles and co-pays for plans are sky rocketing for many (not everyone - and mine are reasonable - I generally benefit from the law; nevertheless, I am also generally against it). The basis for increases being a "one time correction" is not deductive reasoning but a prediction like any other. And it doesn't seem to include tax increases like the huge Cadillac tax in 2020.

- In 2016, health care costs rose by the greatest percentage since 1984.

- The Commonwealth Fund (which is pro-ACA) analysis found that the CBO initially overestimated exchange enrollment by 30 percent, its costs by 28 percent, and underestimated Medicaid enrollment by about 14 percent. If the CBO has understated the problems and costs, we could be in trouble, because most of the employment issues that will arise were predicted to be coming post 2016.

- About 3/4 of those without insurance still say they cannot afford it.

- Only 5 of the 23 co-ops remain, all failing within 3 years. Of the remaining ones, all posted losses in 2015 and of the few that had gains in 2016, they have to make health risk adjustment payments under the ACA and at least one is suing over it.

- Almost one of three U.S. counties now has a single insurer offering plans.

- Some proponents of the plans are suggesting that we have to double funding. If it is successful, why?

- Last Gallup poll I see, from 8/2016, only 11% of Americans were very positive about ACA and 23% more somewhat positive against 30% somewhat negative and 24% very negative. Asked generally, it is 51 to 44% negative. 29% to 18% thought the law hurt them.

- A  Kaiser Family Foundation poll in 2015 showed of politically independent doctors, 58-42% were negative about it (partisan doctors were pretty much like their political groups). I will add that anecdotally, I haven't spoken to a doctor or nurse that told me they liked it. 

- There is no indication that the "tinkering" that was said to be necessary has helped any of the above.

- A WaPo (generally pro-Obama) article claimed that Republicans are falsely claiming double counting to find Medicare A viable. Here's how they defend it:

"(Note: Some Republicans have argued that the administration “double-counted” the savings from Medicare in order to fund Obamacare. For complicated reasons we've explained before this is an acceptable government accounting practice that both parties have used to calculate the solvency of Medicare. A strong case can be made that there is no double-counting going on at all. It’s simply a case of looking at the same money in different ways. In other words, it is not double counting, but counting different things.)" It could be that I'm just biased but that sounds awfully weak to me.

None of the above includes the usual criticisms about the mandate, unfair waiver provisions, subsidies actually paid for by income redistribution, the admitted lies (you can keep your doctor, your health care plan, etc.) or the political sausage making that led to passage. 

One thing that was clear to me since it was passed. Once you give protection to those with pre-existing conditions and those 26 and under living at home, you are not going to get re-elected by taking it away. I have also thought they were laudable goals if we can find an affordable way to do it (not the way it's being done). Contrary to what I hear, it seems that the Republicans do have a plan or plans. I can't tell you if they are good plans at all. Not being a fan of big government plans in general, I doubt it. We also know that given the huge infrastructure of the ACA, there is not going to be repeal without a replacement.

I don't mind writing these posts without having answers. But I've always floated one on this topic - that we should make a special tax credit (not deduction - credits are better) for those who will pay other people's health care - either one to one - A gives to B or to some type of exchange, that is, A gives to a gov't agency or co-operative earmarked only for health care for those who can't afford it. Perhaps it might even be better than a dollar for a dollar. The usual criticism I hear when I float this is that it cannot possibly pay for the entire health care system. Of course, I never suggested it could. But, I wonder if it would not only pay for those without coverage, but if we would actually have to limit it so that it did not drown out other charitable giving.

I heard another one that makes sense and I am looking for criticism of it. Steven I. Weissman,  who claims to be a former president of a Miami Hospital (which one he doesn't say, but from what I can find online he is a lawyer who ran a acute care facility for a while - doesn't mean it is not a good idea), has a petition on change.org entitled "end predatory healthcare pricing," which calls for an end to hospitals charging different prices depending on what health insurance you have or worse, if you have none. He claims, and I'm not sure that is true, that it is the only service you buy where this happens (I know that is not true of my own profession where attorneys sometimes change price based on who the client is, charging less to those who can afford less or who has referred them, etc.). I think it is largely true. I have twice experienced a medical professional - in one case a doctor and in another case a lab, seek to charge me many times what they would charge an insurance company. Since I hadn't contracted with them (and didn't know they were separate entities servicing me - long stories) I refused to pay more than an insurance company would pay, which was obviously reasonable compensation. He also points out it will end the burden of having a doctor in or out of networks, as they won't be able to vary the price.

I'm not sure what value either his idea or mine will have, but, they are good ideas that will not take a tremendous government network to run. Some people feel that is necessary these days. You'd have to convince me and I haven't been convinced at all.

I had the usual big-government-controlling-our-little-lives nightmare the other day. I am on Obamacare in NY. You don't have a choice if you aren't in a business that has a plan. The plan itself is not bad at all and I do not complain about the cost, which is reasonable. But, I do realize that this is because of other people paying more and everyone paying more taxes and I'm  generally against my having a benefit at other people's expense that isn't available to everyone - and it's not. Someone said to me a couple of year's ago, so you can't complain about Obamacare because you have it. This is a little bit like someone telling you that you can't complain after a shotgun wedding. I didn't have a choice. In NY, you are either on a business plan or you are on an exchange plan. There are no other options.

In any event, my plan, a platinum plan, has automatic re-enrollment. At the end of 2015 after a barrage of emails, I reluctantly took the time to re-enroll, only to be told, as expected, it had happened automatically already. 

This year, I did the same thing - went online to re-enroll after being told I would have no insurance, only to get a response that I was already re-enrolled.

So, I paid my premium before the end of the month as always. It cleared a few days later, meaning it was deposited by my health care company. I also got an email from them in the new year. But, when I went to use it, I was told by my pharmacist it was cancelled. 

So, of course, I called the next day. Well, the agent responded, you were re-enrolled automatically, but . . . the exchange cancelled that plan on 12/31/16 - New Years Eve. Didn't you get an email? No, I said, I just read all my emails.  You have a new plan and it is going to cost you only $31 and change. Okay, I say, first, thanks to everyone for the warning. Great system you all have. Second, there is no way in the world I am going to have to pay only $31. They are going to end up sending me a bill for thousands in a few months. So, I was told to call the exchange.

And I did. Yes, my plan was cancelled as of 12/31. No reason given, but I presume it was not cost effective like so many of them.  They wanted to put me on a cheaper plan. My problem was, I did not think my doctor would accept it - many don't - and that would mean the entire health care organization which has all my med records available for my review and which includes some specialists rather important to me, also would not be available to me. Second, I'm not taking the $31 even though - wow - because first, it would be reprehensible and second, I'm sure I will eventually pay for it. After assuring me that is all I owed per month, after one of the many holds I was put on, she came back and said - oh, maybe you are right. We have you down as having no income last year. I ask, why is that? She answers, because you haven't filed a tax return. Maybe, I say, that is because like most people, I do not file a tax return on New Years Day. We worked it out, and, of course, I have to pay hundreds of dollars a month (still good) but not remotely close to $31 a month.

And, one more thing, I almost forgot - my insurance company - they have been holding on to an over payment from 2015 they forget to tell me about. Frankly, I remember when it happened and it was their fault, but it took so long, I actually forgot about it (no surprise for me really).  That's roughly $555. Then I inquired about the $612 I sent for my premium just before they cancelled me. Oh, sorry, I was told, but since they changed your plan (without telling me), there is a new account number and we won't see your premium, even though we have it. But, we will give it back - in another 6 weeks (I'm sure meaning - if I don't forget). 

And since I wrote that last paragraph, I have yet another surprise. It turns out that not only am I going to be on the very same plan I was on that they terminated because it was supposedly cancelled (no one even understands what I mean when I tell them this at the insurance company because it makes no sense), but it turns out for the month of January, I am on a different plan altogether with a different ID no., but I have my regular doctor listed for primary care physician. BUT - they kicked him off for the new old plan in Feb., even though it is the same plan. Now, I can change it back to him, but, not until Feb., when I will have the old ID number. Get it? I don't. But, what choice do we have?

Bureaucracies have always been heavy to dance with and health care will always be expensive. And I'm sure if the Kingdom of Heaven came tomorrow there would be a software glitch - or ten, and Russia would hack it. Things do take time to work. 

The system should be changed.  I'm for the gov't assisting to standardize record keeping so we can actually have all our healthcare records permanently available. I have always been for a system that allows insurance of pre-existing conditions and like everyone I know, even the most dread haters of Obamacare, I'd like everyone who can be insured and wants to be insured - to be insured. But, the system we have doesn't work. Maybe some of those things are not affordable, period, and are a sacrifice that will have benefits in other ways.

Do I think the Republicans are going to fix it? No. But, maybe it can be improved a little. We will let go for here the whole problem with the federal government controlling healthcare because that ship has sailed. The Republicans obviously think it is a good idea too, just that they can do it better. Regular people will not believe it.

Of course, regular people will not be deciding the fate of the ACA or healthcare. It will be politicians. So . . . .

Who said it 14?

      Round 14 of Who said it?  It's just a stupid game that is one more excuse for me to talk about books. As usual, all the quotes are from my own library. Do your best, and try not to google. The answers are at the bottom.

      1. Our place as a Nation is and must be with the nations that have left indelibly their impress on the centuries. Men will tell you that the great expanding nations of antiquity have passed away. So they have; and so have all others. Those that did not expand passed away and left not so much as a memory behind them. The Roman expanded, the Roman passed away, but the Roman has left the print of his law, of his language, of his masterful ability in administration, deep in the world’s history, deeply imprinted in the character of the races that came after him. I ask that this people rise level to the greatness of its opportunities. I do not ask that it seek for the easiest path.

a. Teddy Roosevelt  b. Adolf Hitler  c. Ronald Reagan  d. Barack Obama

*

2. Here is my creed. I believe in one God, creator of the universe. That he governs it by his providence. That he ought to be worshipped. That the most acceptable service we render to him is doing good to his other children. That the soul of man is immortal, and will be treated with justice in another life respecting its conduct in this. These I take to be the fundamental principles of all sound religion, and I regard them as you do in whatever sect I meet with them

a.     Plato  b. St. Augustine  c. Mohammad  d. Benjamin Franklin

*

3.  In your schooldays most of you who read this book made acquaintance with the noble building of Euclid’s geometry, and you remember – the magnificent structure, on the lofty staircase of which you were chased about for uncounted hours by conscientious teachers. By reason of our past experience, you would certainly regard everyone with disdain who should pronounce even the most out-of-the-way proposition of this science to be untrue. But perhaps this feeling of proud certainty would leave you immediately if some one were to ask you: “What, then, do you mean by the assertion that these propositions are true?” Let us proceed to give this question a little consideration.

a.        Plato  b. Spinoza  c. Einstein  d. Franklin D. Roosevelt

*

       4.  Women really have not much part in all this, though they may use the language of romantic love, since it is so entwined in all our idioms. The sexual impulse makes women (naturally when unspoiled more unselfish) very sympathetic and understanding, or specially desirous of being so (or seeming so), and very ready to enter into all the interests, as far as they can, from ties to religion, of the young man they are attracted to. No intent necessarily to deceive: sheer instinct: the servient, helpmeet instinct, generously warmed by desire and young blood. Under this impulse they can in fact often achieve very remarkable insight and understanding, even of things otherwise outside their natural range: for it is their gift to be receptive, stimulated, fertilized (in many other matters than the physical) by the male. Every teacher knows that. How quickly an intelligent woman can be taught, grasp his ideas, see his point – and how with rare exceptions) they can go no further, when they leave his hand, or when they cease to take a personal interest in him. But this is their natural avenue to love. Before the young woman knows where she is (and while the romantic young man, when he exists, is still sighing) she may actually ‘fall in love’. Which for her, an unspoiled natural young woman, means that she wants to become the mother of the young man’s children, even if that desire is by no means clear to her or explicit. And then things are going to happen: and they may be very painful and harmful, if things go wrong. Particularly if the young man only wanted a temporary guiding star and divinity (until he hitches his wagon to a brighter one), and was merely enjoying the flattery of sympathy nicely seasoned with a titillation of sex-all quite innocent, of course, and worlds away from ‘seduction’.

       a. Winston Churchill b. Sigmund Freud  c. J.R.R. Tolkien  d. Ayn Rand   

       *

       5. As for the people I am accusing, I do not know them, I have never seen them, and I bear them neither ill-will nor hatred. To me they are mere entities, agents of harm to society. The action I am taking is no more than a radical measure to hasten the explosion of truth and justice.

I have but one passion: to enlighten those who have been kept in the dark, in the name of humanity which has suffered so much and is entitled to happiness. My fiery protest is simply the cry of my very soul. Let them dare, then, to bring me before a court of law and let the inquiry take place in broad daylight! I am waiting.

a.   Lord Randolph Churchill on his resignation in 1884.

b.   Emile Zola in his famous J’accuse letter defending Dreyfuss.

c.    Adolph Hitler in his speech on being named Chancellor.

d.   Julian Assange from his balcony in the Ecuadorian Embassy in London.

*

6. I have come to the conclusion never again to think of marrying, and for this reason: I can never be satisfied with anyone who would be blockhead enough to have me.

a. Abraham Lincoln  b. David Henry Thoreau  c.  J.R.R. Tolkien  d. Ayn Rand

*

7. The plain consequence is (and it is a general maxim worthy of our attention), “That no testimony is sufficient to establish a miracle, unless the testimony be of such a kind, that its falsehood would be more miraculous, than the fact, which it endeavours to establish; and even in that case there is a mutual destruction of arguments, and the superior only gives us an assurance suitable to that degree of force, which remains, after deducting the inferior.’ When anyone tells me, that he saw a dead man restored to life, I immediately consider with myself, whether it be more probable, that this person should either deceive or be deceived, or that the fact, which he relates, should really have happened. I weigh the one miracle against the other; and according to the superiority, which discover, I pronounce my decision, and always reject the greater miracle. If the falsehood of his testimony would be more miraculous, than the event which he relates; then, and not till then, can he pretend to command my belief or opinion.

      a. Hobbes   b.  Kant   c.  Spinoza   d. Hume

      *

      8. These people have always been parasites. Lately I do not know, but I have the feeling sometimes that they are a kind of cerebral parasite. They know only too well what is happening in my brain, for instance. Whatever I say today, as I stand before you, they knew of it yesterday already. And even if I myself did not know of it yesterday—they did, these most excellent receptacles of wisdom!

     

      Actually, these creatures know everything. And, even if facts prove their pronouncements blatant lies, they have the nerve to come up with new pronouncements immediately. . . . It keeps the people from having time for reflection. Should people truly reflect on all these various prophecies, compare them to reality, then these scribblers would not get a penny for their false reports. Therefore their tactic is, once one prophecy has been disproved, to come up with three new ones in its stead. And so they keep on lying, according to a type of snowball tactics, from today until tomorrow, from tomorrow until the next day.

     

      a. Hitler  b. FDR  c. Spiro Agnew   d. Trump

v    *

      9.  The age of the world is great enough for our imaginations, even according to the Mosaic account, without borrowing any years from the geologist. From Adam and Eve at one leap sheer down to the deluge, and then through the ancient monarchies, through Babylon and Thebes, Brahma and Abraham, . . . down through Odin and Christ to—America. It is a wearisome while.—And yet the lives of but sixty old women, such as live under the hill, say of a century each, strung together, are sufficient to reach over the whole ground. Taking hold of hands they would span the interval from Eve to my own mother. A respectable tea-party merely,--whose gossip would be Universal History.

      a. Cotton Mather  b. Thoreau  c. Jefferson  d. Will Durant

      *

      

      10.  When we got to the Happy Times Tavern the Madam pulled to a stop. She jumped out and ran for the saloon, desperate for a refill. Over her shoulder she yelled at me to put the horse away.

      The poor beast was lathered with sweat and foam and wheezing like a leaky steam engine. I managed to get him out of harness and into his stall before I started heaving up. I was too sick to move. I went to sleep on a pile of straw.

      

      When I woke up in the morning Christopher Schang was there in the stables crying. The horse was dead. Christopher started wailing at me that this was the best friend he ever had, and I had killed him. How should I know from a horse, that you had to cool him out after a gallop and put him to bed with a blanket on?

      

      A big crowd came that night. Just as the diggers swarmed into the joint I felt suddenly dizzy, like I had during the wild ride the night before. The back room started lifting and sinking and turning around in a circle. I lost all control. I fell off the piano stool. One of the girls helped me up. I fell off again. This time Mrs. Schang saw me. She bellowed at me to get the hell back on the stool and start playing. I staggered to my feet and fell against the keyboard. The Madam grabbed me and sat me straight, so hard that the butt of my spine felt like it was cracked.

      The third time I dropped to the floor she was back in the saloon. Two of the girls picked me up and dragged me upstairs and laid me on the bed, while another girl went to call a doctor. The doctor came. He felt my forehead. He opened my shirt and looked at me closely.

  

       “Measles,” the doctor said.

      When word of my condition was passed downstairs, I could hear Mrs. Schang roar, clean through the floor, “I don’t want no sick Jews in my place! Get him out of her!”

      The next thing I remember I was waiting on the platform of the Freeport railroad station.  The back room girls had chipped in to buy me a ticket to the city, and two of them—my special friends—had brought me to the train.

      The train came. They helped me on board. One of the girls said, “You don’t know how lucky you are, kid, to come down with the measles.” The other girl was about to cry. “I’m going to miss you, honey,” she said. “I’m going to miss that song you play so beautiful.”

      The four whores of the Happy Timers were the first fans I ever had, and I shall always be grateful to them.

      a.   Teller (Penn’s partner)  b. Marcel Marceau  c. Harpo Marx  d.  Billy Joel

  

ANSWERS

      1.     “Our place as a Nation is and must be with the nations that have left indelibly their impress on the centuries. . . ”

a. That was Teddy from a speech in San Francisco in 1903. With a little imagination, it could be Hitler, right?

      2.     “Here is my creed. I believe in one God. . .”

d. That was Benjamin Franklin in a letter to a friend just before his own death, answering a direct question as to his religious beliefs. At one time probably an atheist, or at least an agnostic, he became more religious as he aged, but never took to one sect over another, but preferred, not surprisingly, Christianity.

      3.     “In your schooldays most of you who read this book made acquaintance with the noble building of Euclid’s geometry. . .”  

b.      Einstein – starting an explanation on relativity. The great physicists of the 20^th century were deeply in love with philosophy, which often guided them.

      4.     “Women really have not much part in all this . . .”

c.      Tolkien. Remember, he was born a 19^th century man and his head was in the ancient world. He died towards the beginning of the modern feminist movement and I doubt thought much about it.

      5.     “As for the people I am accusing . . .”

d.     Emile Zola. It was a long, but pretty good letter, lots of paragraphs which began with J,accuse.

      6.     “I have come to the conclusion never . . . marrying . . . blockhead enough to . . . .”

a.   That was Lincoln when he was unsuccessful with women and morose. Could have been Thoreau or Rand, I guess, but not. Not Tolkien who was married for a long time.

      7.     “The plain consequence is (and it is a general maxim worthy of our attention), “That no testimony is sufficient to establish a miracle. . . .”

d.     Hume, in his tract, On Miracles. Not best work. Frankly, isn’t that how we judge anything we hear that sounds outlandish, miracle or not? Either we think the person telling us is lying (or the person who told him/her) or we believe it according to our interests. I raised my daughter to understand that people believe you or not, not based on your honesty, but based on their own interests. Even if they generally think you honest, if it bucks up against something important to them (often religion, their family or sports), you lose.

      8.     “These people gave always been parasites. . . .”   

a.     Hitler. I cheated a little and took out one sentence (the ellipses) which gave it away. But sounds like Trump, right? Although, hate to say it, but Hitler spoke a lot more coherently. No, I’m not saying he’s a Nazi. Relax. Sounds a little like TR too. See no. 1.

9.             9.  “The age of the world is great enough for our imaginations, even according to the Mosaic account . . . .”

b.     Thoreau, my favorite American writer. I wish I could write one line about something significant as sublime as he could about anything – even mud.

10.  “When we got to the Happy Times Tavern the Madam pulled to a stop. . . .”

c.      All four choices are at least half-Jewish, yes, even Marcel Marceau and Billy Joel and the first three with silent characters. But the answer is Harpo, who grew up in NYC and wrote (with help) the best autobiography I ever read, “Harpo Speaks!”

Th-Th-That’s all folks!