ELIMINATION OF MEDICAL EXPENSE DEDUCTION: CRUEL !

 

After the Republican Congress left millions staggering under bankruptingly high health care costs, the Republican House of Representatives is poised to increase the burden on many of us. If they have their way, we will no longer be able to use the amounts we pay out in our struggle against illness to reduce our federal income tax. Deductibility of these expenditures is a precious benefit to those middle class millions who are forced to part with large amounts in the effort to advance their health. For those of us who itemize our deductions, the ability to further this most vital aspect of our being – our health – would be adversely effected by this proposal.   Elderly folks, with our greater need for medical treatment, would be particularly vulnerable.

Several tax breaks for others would be paid for in part by the lost deductions.

The increase of the personal exemption from $6,000.00 to $12,000.00 for a single person and from $12,000.00 to $24,000.00 for a married couple will provide some tax savings to some lower middle income persons. But the lowering of the corporate tax rate from 35% to 20%, without removing the loopholes that have allowed many to pay even less than 20%, will give these artificial entities an enormous gift. This comes at a time when businesses are making money at the existing tax rates and do not seem to be in critical need this sort of boost. Additionally, humongous benefits will flow to the absolute richest of all, who already have so much more than they could possibly spend in many lifetimes, under other aspects of the measure, including the elimination of the federal estate tax.

Would-be-itemizers of ordinary means, who are locked into punishing, costly outlays by their health needs have been targeted. They have been chosen by the Republican House to provide tax relief to big business and the richest among us. Here’s what this tell us about this arm of the Grand Old Party.

It reveals a callousness to the plight of those who find themselves confronted by the twin challenges of severe illness and the accompanying huge financial demands. Fundamental fairness has not entered into their calculations. Infliction of more financial pain on those already suffering, as a means of benefitting those who do not need it, is unsupported by equitable considerations. The judgement that arrived at the political trade-off to take from the medically/financially challenged in order to give to the opulent is so lacking in humanity as to suggest the work of a malignant heart.

Proposed elimination of other popular deductions is subject to somewhat similar criticism.

Republicans assert that the proposed benefits to business and the wealthy will cause them to invest more and create more jobs. The ‘trickle down’ theory. But if this has ever worked, will it work now? How long will it take ? What are those who will now suffer more to do in the meantime ? Will business actually use the tax breaks to generate additional employment, or will they purchase robots and hire fewer human workers ? “If” and “when” sots of promises by political snake oil salesmen are poor comfort to those who will be adversely effected.

Perhaps the Republican Senate will rescue the House from themselves and millions of Americans from even further financial pain.

I am a lifelong Republican.

 

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Good Medical Care For All: The Best Case

 

Principles underlying insurance should be followed closely in replacing Obamacare, because programs that pay for healthcare are a type of insurance. This calls for spreading risk so widely that only a relatively few will file claims in any one claim period. Generally, the larger the pool, the lower the premiums. Our populace not currently otherwise protected by health insurance who are now at risk – those covered by Obamacare and others – constitute an enormous group. If kept intact they would seem to provide an ideal risk pool to provide the optimum combination of broad coverage and low premiums. There is precedent for this: Medicare. Why not expand that program to include these folks ? Two welcome results would be expected. The newcomers would receive quality affordable broad health care. And the infusion of these younger, likely less claim prone individuals into the existing mostly 65+ Medicare population would provide badly needed reinforcement of this vital and popular program.

Unfortunately, Obamacare divided its clientele, state-by-state, into 50 smaller groups.

Vaunted ‘freedom to choose a plan that suits one’s needs’ is snake oil, as at the time the choice would be made, the needs that are to be insured against will arise in the future. None of us can look into the future and foresee the illnesses or injuries which we will suffer.. Even those with pre-existing conditions can not be sure of the precise nature, extent and timing of the treatment they will need. So, there is much guessing involved.

Any perceived disadvantage to younger persons arising out of inclusion is self correcting as they age.

So, let’s debate the merits of a health insurance plan that most closely adheres to the fundamental principles of insurance. Assemble the largest possible risk pool, with the anticipation of producing maximum benefits for the lowest premium. Reinforcement of Medicare would be an anticipated bonus.

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TUMPCARE: A GAMBLE WITH HEALTHCARE

 

Would you take out an insurance policy on your home that did not cover damage or destruction by common hazards, such as fire, or tornado, in return for a lower premium ? Or that capped its benefits at, say, $20,000.00, or at only a small fraction of your actual value ? Probably not. Your home is likely your most valuable asset. And the shelter it provides is a necessity of life. Of course, cost is important, but this is not a matter about which most of us would gamble.

Who of us considers his home to be more important than his life ? Then why would you consider a healthcare insurance policy with limited benefits, when it is not possible to foresee the maladies and injuries for which you will need treatment ?

Current Republican proposals to replace Obamacare give their blessing to healthcare insurance policies that will turn individual citizens into gamblers over their own health. Insurance companies will be allowed to offer policies that do not protect against serious, expensive medical conditions, or refuse to insure individuals with pre-existing conditions, or limit the amount the company would pay out even though the patients treatment bills are much higher. Presumably such policies would bear lower premiums than broad coverage.

This is the Republican fix for the bankruptingly high premiums coupled with enormous co-pays that have often made Obamacare policies unusable to ordinary folks.

But the only way to provide honest broad coverage at modest prices is dictated by the principles underlying insurance: spread the risk among as many as possible, so that only a relative few will make claims at any one time; and the corollary that the larger the risk pool, the lower the premium.

As applied to this situation, two steps are involved:

1. abandon the fragmented, Obamacare, state-by-state approach and keep the Obamacare congregation together in one, gigantic risk pool;2. Insure that group under a single program.

This could be accomplished by expanding Medicare to include these folks. In addition to providing the newcomers with affordable, broad coverage, the infusion of these younger millions would add badly needed reinforcement for this popular and vital program.

Lets switch the debate away from gambling about our healthcare.

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JUNK POLICIES TO REPLACE OBAMACARE ?

 

Congressional Republicans would now allow insurance companies to issue healthcare policies with only limited benefits, so long as they also offer some policies with the broad Obamacare coverages. Among the features of such plans might be a limitation on the sorts of maladies for which protection would be provided, the right to choose which sorts of pre-existing conditions would disqualify one for coverage and a low cap on the amount the company would pay out. Presumably these low benefit plans would cost less and appeal to those who perceive themselves to be healthy, articularly the young. Older folks with less means to pay would be relegated to more expensive plans.

This will surely be trumpeted as the ‘freedom to choose’ the coverage that suits one’s needs. But it simply ignores the reality that none of us can foresee the maladies or injuries for which we will need medical treatment.

An, as yet missing, honest portrayal of the stark consequences of being stranded with less medical treatment than needed must precede further legislation. How many of us , when stricken with a life threatening health problem, would simply say: “O.K., I did not choose the plan that would provide the treatment that would cure me. Just take me home to die”

“Junk” is a fair characterization of such policies, as these are certain to be worthless to many who would purchase them. In blessing health insurance policies which offer little assistance in this area of bankruptingly high medical costs, the Republicans are foisting a cruel hoax on the public.

Expanding Medicare to include the Obamacare congregation would provide these folks with affordable, broad healthcare coverage. It would also infuse Medicare with this enormous group of younger, less claim-prone insureds and provide badly needed reinforcement for this vital and popular program.

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TWO BIRDS: OBAMACARE & MEDICARE

 

TWO BIRDS WITH ONE STONE: OBAMACARE & MEDICARE

 

For years, the out-of-power Republicans had promised, if elected, to improve the lot of the millions who struggle to pay the sky high pemiums for coverage with unaffordable co-pays under Obamacare. That commitment helped the party win both houses of Congress and the White House. They have thus taken ownership of the healthcare insurance crisis, as well as the capacity to cure it. Unfortunately, internal divisions have so far prevented them from devising a remedy on which the requisite minimum 50 senators could agree.

Republican Congressional leadership may be coming to a realization that future hopes of retaining their dominant position now require them to consider otherwise unthinkable options. I want to suggest that one of these, if viewed from the proper perspective, can be seen as a likely popular, winning strategy of not only fixing Obamacare, but also providing a widely desired solution to another even more important program.

An understanding of the fundamental principle of insurance must be the starting point of any sensible discussion of healthcare: risk must be spread among many, so that only a relatively few will make claims during a given period. As a corollary, the larger the risk pool, the lower the premiums to be paid by those who are insured. A genuine solution to the problem posed by Obamacare must follow these guidelines.

Although apparently not widely recognized, or at least not widely discussed, our nation’s populace that is not already served with health insurance is a ready made, gigantic health insurance risk pool. Maintaining that group intact and insuring its members through a single program would most closely adhere to the design criteria for the most efficient insurance plan. And a working model already exists: Medicare. Why not expand that program to include the Obamacare members? These folks would move from the bankruptingly expensive and often unusable Obamacare to the affordable broad Medicare coverage. Senator Sanders and others, mostly Democrats, have advanced this so called ‘single payer system’, but it has always met knee-jerk right wing Republican opposition.

But there seems to have been a failure to emphasize the apparent benefits that would accrue to the Medicare program from such a move. The addition of the Obamacare millions would infuse the mostly post-65 Medicare congregation with much younger, less claim-prone, participants. Would that not produce the additional bonus of shoring up Medicare ? In recent years there has been much fretting, but little action, directed toward the need for reinforcement of that vital and popular program in order to assure its continued viability.

It should be noted that the currently stalled Republican proposals are the polar opposite of one humongous national risk pool. Instead, these measures follow the fragmented Obamacare state-by-state format. As a consequence the nationwide risk pool is divided into 50 smaller pools. It is certainly fair to ask whether the many unfavorably received features of these plans are the result of the smaller than necessary number of insureds. Or, phrased another way, might not the immensely greater size of the group to be covered on a national basis allow a broad spectrum of benefits at a more affordable premium?

As previously mentioned, the “single-payer system” has been an anathema to the right wing, conservative ‘tail that has so often wagged the [Republican] dog’. But the blame for a continuation of the Obamacare misery for millions of Americans now rests on Republican shoulders.

Perhaps this is the time for the leadership to recognize their situation as an opportunity “to make lemonade out of a lemon”. Provide affordable broad health insurance coverage to those now suffering financially and medically under Obamacare by their inclusion in Medicare, with the attending widely desired and badly needed strengthening of that program. Would not these twin accomplishments be of such magnitude as to be greeted with overwhelming praise ?

Is this not a simple and elegant solution to two seemingly intractable problems ? Our country’s health demands that it receive serious discussion.

I am a lifelong registered Republican.

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Elegant Solution To Obamacare & Medicare

Like many and probably most, I am concerned that the healthcare ‘sausage’ produced by the secretive machinations of the Republican Congressional butcher shop might be bad for our health. Like many, my dissatisfaction with both the process and the results prompts me to object. I join in protesting individual aspects of the measure. Included, by way of example only, are the likely loss of insurance by some 20+ million folks, the watering down of Medicaid benefits, including nursing home care for millions who have exhausted their resources, with the almost trillion dollars so saved providing tax breaks to the wealthiest who don’t need them.

But I also want to challenge what I see as fundamental flaws in the choice of ingredients – basic design flaws. And also point to the little talked of proposal that would more likely provide optimum insurance coverage versus cost. These points will be taken in inverse order.

Any sensible discussion of healthcare insurance must be based upon an understanding of how insurance works. To arrive there, the following questions should be asked: To be successful, must not an insurance plan be able to spread the risk among many, so that only a relatively few will make claims during a given period ? In turn, is it not true that the larger the risk pool, the lower the premiums charged to those protected? Not even the most right wing Republicans are likely to dispute these propositions. Once acknowledged, if brought into the analysis, the most advantageous combination of coverage and price becomes apparent.

Our nation’s entire populace not already served with health insurance is a ready made, gigantic health insurance risk pool. Maintaining it intact and insuring its members through a single federally operated program would be the ideal solution. And a working model already exists: Medicare. Expanding that program to include the Obamacare / Trumpcare members would be quite doable. The addition of this enormous group would infuse the mostly post-65 Medicare congregation with much younger, less claim-prone participants. It would produce the additional, badly needed bonus of shoring up this vital program. A simple and elegant solution to two vexing problems..

However, the Republicans are following the fragmented, state-by-state, Obamacare format as the basis for their program to replace it. The immense, unified national risk pool is thus divided into 50 smaller pools. And they continue down the Obamacare path in breaking up each of the 50 ‘fragments’ by allowing as many insurance companies as are interested – each their own separate risk pool – to ‘compete’ for the business of each individual resident

Two stark departures from the Obamacare pattern further dilute the risk pool.

First, each citizen is authorized to decline to participate, without the Obamacare penalty that had moderated defections.

Next, each state is empowered to allow each insurance company to offer varying levels and types of coverage. This feature is heralded as “freedom to choose the coverage that suits [ones] needs”. Never mind the reality that none of us can foresee the future maladies or injuries for which we will need treatment. Presumably, policies providing more modest coverage would bear more modest premiums. These would appeal to persons who perceive themselves to be healthy and fail to appreciate that they are not immune from costly medical problems – particularly the young. Older folks, who realize they face a wider range of health threats, would need the more expensive broad coverage. In this fashion, the risk pool is further splintered. And, principally on the basis of age.

In so deconstructing the huge segment of society that needs healthcare protection into the young and the old, the Republicans treat us as members of separate categories. In fact we belong to one class, but are participants in a continuum, in a process – aging, growing old. Assuming a normal life span, each of us will be both young and old. Each will participate in the general benefits and burdens of each stage of the process. Any perceived disadvantage to younger persons by placement in the same risk pool as the elderly
is self-correcting as we age. The Republican party has gone out of its way to disadvantage those of us in the later, more expensive stage, when so many have so little ability to cope.

Whatever else, the Republican Congress has not set out to provide healthcare, as and when needed, for everyone, and at the most advantageous price. Conservative orthodoxy has gotten in the way of their ability to do the right thing about healthcare. It has de-sensitized the members to the needs of ordinary folks. It has relaxed their intellects so as to accept contorted theories and overrule rational, experience-proven understandings of how insurance works.
Whether the Republican Congress can succeed in throwing so many of us under the healthcare bus, or other sensible and beneficent forces prevail, will go a long way in revealing whether we actually have a government that is, in President Lincoln’s words, “of the people, by the people, for the people”.

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CHOICE AS REPLACEMENT FOR OBAMACARE BROAD COVERAGE: A HOAX

Apparently the movement to change Obamacare is still alive. Even the law’s authors concede that it needs fixing. In some areas, the cruel combination of steep co-pays on top of sky high premiums  prevent the insured from actually accessing the coverage for which they paid the premiums. But, is it too much to hope that the renewed effort will not in somewhat similar fashion produce a sham ? That was the likely result if the recently failed bill had been enacted.

Sponsors of the withdrawn measure had criticized, as “government mandates”, Obamacare’s requirement that certain specific categories of medical service be provided by each health insurance plan. They went on to trumpet (no pun intended) that their proposal would allow each insurer to offer whatever types of medical care it desired, which would be expected to produce an array of premiums levels. A policy providing more limited care would presumably cost less. This was sometimes characterized as “freedom to select a plan that suits the family’s needs.”

Freedom to choose is the ‘All American’ ideal. But, let’s look at the matter of the need for medical treatment that is to be suited by a plan. If one does not make an accurate determination of that subject, the vaunted opportunity to choose is for naught. This is where ‘push comes to shove’. In order for this ability to choose to be worthwhile, each individual must be able to know what health issues he or she will face. Only with that knowledge would it be possible to select the sort of medical care for which there will be a need. That knowledge would make it possible to review various plans and select one that suits the need.

But, none of us are able to look into the future and foresee what maladies we will face, or avoid. Or what kind of injuries, if any, we will suffer. In turn we are unable to determine what types of treatment we will need.

If enacted, the much ballyhooed opportunity to choose a medical care plan that suits the need would turn out to be a cruel hoax for many people whose needs are destined to be unmet by their uninformed choices. Except to those already sick, those needs are unknowable at the time the right to choose is exercised. And even then, only partly known.

Various aspects of Obamacare need fixing. A removal of the requirement for a broad range of medical services in each plan is not among them.

 

 

 

 

 

INADEQUATE MEDICAL CARE POPULAR: REALLY ?

 

Who of us does not want to receive the necessary medical care when illness or injury strikes ? In my 90 years, I have never known anyone. Do you?

A forthright exploration of this question should be the point of departure in any discussion of the Republican proposed Obanacare replacement. An ability to enroll in healthcare insurance coverage that would leave the ravages of a serious malady untreated is a key feature of their proposal. This glosses over the reality that nobody, not even the young, can foresee, with confidence, that they will be blessed with good health, or which maladies they can avoid.

Perhaps Congressional Republicans believe they have large numbers of constituents who would be willing to forgo treatment that could relieve suffering. Unless this is actually true, they are playing fast and loose with the best interests of the American people.

Unfortunately, they have approached this subject conversely, from the standpoint of cost.  And they have condemned broad coverage as a “government mandate”.  Of course, low priced plans will appeal to those who perceive themselves to be healthy, so that they will need little physicians services – principally the young. So framed, the issue skirts the heart of the matter. An artificial result is produced.

Contrived versions of actuality are the common currency of politicians of all stripes. And too often are the vehicle to achieve a place at the public trough. But, the deception is, in many cases, eventually exposed. Often in the wake of damage and destruction. Currently rampant distrust of government is the unfortunate consequence.

Public reaction to the inclusion of cheaper but limited medical care coverage options in the proposed replacement for Obamacre has not yet been accurately gauged. An, as yet missing, honest portrayal of the stark consequences of being stranded with less medical treatment than needed must precede further legislation. How many of us , when stricken with a life threatening health problem, would simply say: “O.K., I did not choose the plan that would provide the treatment that would cure me. Just take me home to die”?

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CHOICE IN OBAMACARE REPLACEMENT: PUNISHING TO THE ELDERLY

In a previous post I pointed out the adverse effects that would flow to persons of all ages from the inclusion of choice in the replacement for Obamacare. This feature would allow individuals to opt out of comprehensive medical insurance & into a program with cheaper but narrower coverage. In this post I note that choice would consign the elderly into its own high cost ghetto.

Unfortunately, a right to select the extent of one’s medical insurance is a key feature of the Republican proposals to replace Obamacare. Those who perceive themselves to be healthy so that they would need little medical care, particularly younger persons, would likely pick the coverage with the lowest premium.

But, such choice would undermine the fundamental concept that underlies insurance: risk is spread among many, so that only a few make claims at any one time. Each member enjoys a lower cost than to go it alone. The larger the pool of insureds, the lower the premium. If those who perceive themselves to be healthier – the young – may opt into a low premium-low benefit category, the size of the risk pool that includes the elderly – who suffer more health problems – would be smaller. In turn, older folks would pay higher premiums than would be possible. Saddling old folks who are at a time in life when their earning power is lower, or non-existent, would be cruel.

Obamacare itself demonstrates the folly of including choice in a medical insurance program. This well intentioned project is failing precisely because it includes a choice to opt out by paying a prescribed penalty. Too many have chosen this option, thereby reducing the size of the risk pool & pushing the premiums to go sky high and insurers to withdraw. .

Choice is one defect of Obamacare that it’s Republican critics should not repeat in its replacement.

I am a lifelong Republican who is disgusted with the party’s lack of stewardship of the power it has held.

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CHOICE IN OBAMACARE REPLACEMENT: A BAD IDEA

One key feature which the Republicans assert must be part of any plan to replace Obamacare is the right of an individual to choose his or her coverage. Presumably this freedom to choose would allow one to limit some aspects of the coverage, in return for a lower premium. Such a feature would be appealing to those who believe they are healthy, particularly the young, so that they will not need health care. They would likely select the lowest cost policy.

Freedom to decide one’s own destiny is an “All American” ideal. But, when it comes to insurance that would pay for medical care, is individual choice really as good an idea as it sounds ? Financial ruin is the consequence that faces persons of ordinary means – most people – who suffer a serious illness or injury, unless they have adequate insurance. This drastic outcome requires that the wisdom of allowing us to select limited insurance coverage be seriously considered.

Options about healthcare coverage only make sense to the extent one is able to predict the future state of his or her health. Therein lies the problem. Who of us can foresee, with any certainty, a life with little need for medical care ? While younger persons suffer much less illness and injury than the elderly, youth is far from free of serious conditions. It is foolhardy to ignore the reality that noone is capable of determining, ahead of time, whether he or she will be blessed with good health. But that is exactly what the congressional Republicans would mislead us to believe we can do.

Those unfortunates who select a cheaper but more limited insurance benefit and then face serious health problems will be saddled with punishing costs. This, at a time when illness or injury has rendered the burden more difficult to bear. Unpaid costs of the impoverished will fall on care providers.

Any perceived current disadvantage to the young that arises out of the absence of their own low cost insurance pool is self correcting as they age.

Republicams should not encourage us to be foolish.

I am a lifelong Republican who is disgusted with the party’s lack of stewardship of the power it has held.

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