Democrats Need to Talk Straight About Health Care

October 16, 2019

By Karen

Though I no longer have a dog in this fight because this month I finally got to enroll in Medicare, my hair still ignites when I hear the Democratic presidential candidates misleading us — whether in ignorance or intentionally, I don’t know — about how to reform health care.

If you’re confused about Medicare for All (a.k.a. “universal coverage”), let me explain the jargon…

Insurance – The crux of the problem. Candidates say “insurance” and “health care” interchangeably, but they’re totally different. Insurance is a piece of paper. Health care is visiting a doctor. The company who sold you the paper may not pay for your doctor’s visit.

Private Insurance – Candidates say this to mean insurance individuals buy for themselves AND insurance that employers provide for workers. Again, two completely different things. When dissing Medicare for All, candidates say, “People don’t want to lose private insurance they love.”

NOBODY loves true private (individual) insurance. It’s expensive because insurers cherry-pick and jack premiums based on age and health. It often has a high deductible, it can be canceled without warning when you get sick, and it can pay little to nothing on claims.

Employer-provided insurance is controlled solely by employers, who can change it, cancel it, or shift its cost onto workers. If you quit or get laid off or fired, you lose that insurance.

To control costs, both types of private insurance may lock you into “provider networks.” You see the doctors the insurer wants you to see, or go elsewhere and pay most or all of those medical bills yourself.

Affordable Care Act (ACA) a.k.a. Obamacare –Obama and Biden managed to pass this in 2010 over Republicans’ dead bodies for people who can’t get employer-provided insurance. It has an online marketplace a.k.a. “the exchange,” where you can buy insurance. Because the ACA didn’t go live until 2014, insurers spent four years royally screwing people (like me) who already had individual insurance by raising premiums astronomically.

ACA insurers on the exchange offer no discounts (see “Subsidies” below). Policies available on the exchange depend on which insurers do business in your area. It’s totally up to the insurers. There may several, one, or none.

Subsidies – Insurance premiums under the ACA are cheaper for people with low incomes because the federal government shovels billions of dollars in subsidies to insurers to make up the difference and keep them profitable.

Public option – Today, the ACA offers insurance only through insurance companies. The proposed “public option” is insurance provided by the government. The easiest way to have that option is to let people under age 65 enroll in Medicare.

Single-payer system – This would create a central federal billing and payment hub (think Medicare) that doctors would bill for providing health care for all Americans (universal coverage). There would be no paperwork for patients and it would have no co-pays, no deductibles, and no surprise bills. England, France, Canada, all of Scandinavia, and many other countries do health care this way because it’s more efficient and cheaper.

Medicare for All – The universal, single-payer system that eliminates insurance and pays for all Americans to receive health care from birth to death.

Here’s where some of the Democratic candidates stood in last night’s debate…

Joe Biden wants to keep the ACA and add the public option. Problem: insurance companies continue getting billions in federal subsidies that could otherwise pay for actual health care.

Pete Buttigieg wants “Medicare for All Who Want It.” He says people should keep private insurance if they like, which is bullshit if it’s employer-provided. He wants to keep subsidies to control costs, still shoveling taxpayer money to insurers to keep their profits up instead of paying for actual health care.

Amy Klobuchar wants to reduce premiums. She thinks punishing Big Pharma will do that. Insurance and drugs are separate industries; they have nothing to do with each other. The only overlap is when your insurance doesn’t cover your drugs and you have to pay full price.

This morning on Morning Joe, Klobuchar complained about Medicare for All kicking “149 million people off of their private insurance.” She’s another one confused about employer-provided insurance that workers have no control over.

Elizabeth Warren wants Medicare for All, but must be unsure of the numbers because she won’t say how she’d pay for it.

The ONLY candidate who fully understands the problem and how to fix it — because he “wrote the damn bill” — is Bernie Sanders. Under his plan…

No American will need health insurance. Instead, we’ll channel what we now spend on premiums, co-pays, deductibles AND surprise health care bills into one system.

A single, centralized billing and payment system will drastically cut administrative overhead and expense for the entire health care industry. This federal system will also have clout to negotiate lower rates for health care services.

You can go to any doctor. Networks won’t exist.

Not a penny from taxpayers will be wasted on subsidies to boost insurance company profits.

I believe, with Bernie, that not only will we all come out ahead financially, but no one will have to go bankrupt from disease or illness.

Check out this publication from the White House from March 2018 called The Profitability of Health Insurance Companies. It says insurance companies have done just dandy since the ACA took effect (emphasis mine)…

“As government policy amplified eligibility and per-enrollee spending, the stock prices of health insurance companies rose by 172 percent from January 2014 to 2018 resulting in improved profitability and outperforming the S&P 500 by 106 percentage points.”

And its conclusion says…

“Despite an initial rough patch in the ACA marketplaces, the ACA Medicaid coverage expansion and subsidies to insurers have resulted in a large increase in health insurer profits. Health insurers’ stock prices more than doubled the impressive gain in the S&P 500 since the law’s main provisions took effect on January 1, 2014. Much of insurers’ increased profitability has resulted from increased Medicaid enrollment and increased payments per enrollee in Medicaid expansion states where the federal government pays nearly all the costs. While insurers initially incurred losses in the ACA marketplaces as they adjusted to new regulations and a relatively unhealthy risk pool, insurers are now profiting on the individual market as well, with higher premiums that are largely covered by federal premium subsidies.

Bottom line: Any candidate, Democratic or Republican, who talks about subsidies, or even insurance, is for squandering our taxes to keep the biggest obstacle to health care — insurance companies — profitable.


What Congress Needs to Learn from Trump

April 30, 2019

By Karen

Robert Mueller finally finished. His investigation ended with a whimper, shocking everyone who believed Mueller was the one man capable of driving a stake through Donald Trump’s black, shriveled heart.

When Mueller failed to deliver recommendations to charge Trump, it seems he, and other misguided souls on Capitol Hill, worship like the 11th Commandment some worthless memo written in the Justice Department during Nixon, which says you can’t indict a sitting president. Rather, the president should face no impediments in continuing to commit crimes in office.

However, Mueller did uncover enough damning evidence to show anybody unlobotomized that if Trump were anybody else, he’d be in prison for obstruction of justice to conceal his obligations to Russia. We don’t know what those are because Trump’s latest flying monkey attorney general, William Barr, redacted the worst parts.

I don’t know what motivates Barr, except perhaps in his dotage he’s become obsessed with turning the U.S. into a Third World dictatorship.

Barr’s been dissing Congress since they let him to slither back in as AG, the same job he held under H.W. Bush I.

Even though Barr has wantonly obstructed and lied to keep Mueller’s facts hidden, Congress wants Barr to testify again, knowing full well Barr’s not going to turn on Trump now that he’s in this deep.

Barr’s balking and trying to set the terms under which he’ll testify.

I say, enough’s enough. Let the punishments begin.

Congress needs to rip the page from Trump’s playbook that Sarah Huckabee Sanders loves to quote, which says…

“When you get hit, you hit back 10 times harder.”

For starters Congress must stop extending deadlines. Tick-tock. Don’t let Trump run out the clock — and run.

If any witness tells the media or tweets that they don’t intend to cooperate, subpoena them THE SAME DAY.

If they say they intend to defy the subpoena, cite them in contempt of Congress THE SAME DAY.

Give them a week to rethink and come around, then get an arrest warrant.

Meanwhile, Trump’s tweets are off the crazy scale. He’s issuing decrees to defy subpoenas and filing lawsuits against Deutsche Bank and Capital One Financial to keep his finances hidden.

His behavior on all fronts is an admission of guilt.

Carl Kline is a former White House stooge who, apparently on Trump’s orders, ignored huge red flags on Jared Kushner and many others to grant top security clearances. He tried to flout his subpoena, but now will testify May 1 accompanied by a White House lawyer. House Oversight Committee Chairman Elijah Cummings says Kline may still face contempt charges if he doesn’t answer all questions.

It’s a good ground rule for every witness, including AG Barr. Come clean or be held in contempt and face jail time.

When Trump sees his closest henchmen dwindling because they’re in jail, maybe his pea brain will absorb that Congress isn’t bluffing.

If Trump doubles down on obstruction — which he’s now committing daily and openly — it’s time for impeachment. The Mueller report contains more than ample evidence for grounds.

Congress must hold open hearings where every Trump associate in Mueller’s report testifies before the American people what they know about their own crimes and Trump’s.

Why is this important? So we don’t repeat the Nixon mistake. He got into a second term before we knew he was a crook.

Tick tock.

If Congress makes it too hot for Trump, he could resign, like Nixon did. Or he could announce he’s not running in 2020.

In an ideal world, the GOP would attempt redemption by abandoning the Trump/Pence ticket at the convention. Nominating Trump challenger William Weld would instantly restore some sanity to campaign season.

But I realize all that’s unlikely to happen and Trump will run again. So, before we vote in 2020, Americans and the world need to know, without reservations, that Trump is an unindicted multiple felon and he must face the consequences — not be granted sanctuary from prosecution in the Oval Office.


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