Another GOP “Leader” Demonstrates His Lack of Concern for His Constituents.

David Perdue parroted the now familiar GOP line that passing any Healthcare Regulations is more important than passing bad healthcare regulations.

Specifically he said,

“What happened today in Washington was a failure…There is a complete lack of congressional leadership and no accountability to get results. From the get go, three Republican Senate chairmen failed to support our efforts to repeal and replace Obamacare as we have all promised to do.”

Hopefully he did not pick his wife the same way.

 

Can the New Activist Passion of Suburban White Women Change American Politics?

This story is important and I agree completely.

And, let me add that, as someone that lived through the 60’s, I think the fact that women are so engaged reminds me of how it felt during the 60’s. Because their boyfriends and husbands were being shipped off to Viet Nam, women drove the anti-war movement.

What do you all think?

“No matter the outcome on Tuesday, the real story of this campaign is the story of women organizing, standing up, fighting,” Jon Ossoff tells me from his campaign’s Chamblee office two days before the runoff.

“There’s something of a renaissance of civic engagement and political activism afoot, and it’s being led by women.”

Majority of voters in Georgia 6th have unfavorable view of GOP healthcare bill: poll

© Greg Nash A majority of likely voters in Georgia’s sixth congressional district hold an unfavorable impression of the Republican plan to repeal and replace ObamaCare, according to a new poll by The Atlanta Journal-Constitution . While 62 percent hold an unfavorable impression of the legislation, 25 percent hold […]

GOP Healthcare Plan Struggles to Win Over Experts

Conservatives Want to replace Obamacare.  They’ve published a  policy paper on dismantling the Affordable Care Act (ACA) from House Speaker Paul Ryan (R-Wis.).  The current GOP proposal, “Obamacare Repeal and Replace: A Policy Brief and Resources,” was released on February 16.

A post by Shannon Firth, Washington Correspondent for MedPage Today suggests that health policy experts, from both sides, “are not impressed.”

“It’s a repackaging of ‘A Better Way’,” said Kavita Patel, MD, a nonresident fellow in economic studies at the left-leaning Brookings Institution, referring to the alternative ACA plan Ryan released in June 2016.

Joe Antos, PhD, of the conservative American Enterprise Institute in Washington, agreed that the new document was “largely the same” as the previous one. However, he did note one difference — “The word Medicare doesn’t appear at all” in the current policy paper.

“Medicare has always been the piggy bank for health policy,” he pointed out.

Shannon reports that “Patel, who is also a primary care physician at Johns Hopkins Medicine in Baltimore, suggested the impetus for Ryan’s policy paper was the House Freedom Caucus’ push for the speedy repeal of the ACA; Ryan felt compelled to stake his claim, she hypothesized”  I agree with Shannon’s conclusion here since the Freedom Caucus put forth its own plan for a fast-tracked repeal on February 15.

“It would be nice to have more details, but what details are there are troubling,” particularly for vulnerable populations, such as low income families that depend on subsidies and on the Medicaid expansion, Patel added.

When people begin to talk about turning health insurance purchase into a tax credits, it’s highly likely people will lose coverage, she added.

“How many of the 21 million people who have been insured since the ACA started would lose their insurance?” Patel stated. “We don’t have that answer.”

Another expert

Antos said the lack of mention of Medicare doesn’t mean that there won’t be changes to program, but they will likely involve financing any reforms.  As for “voucherizing” Medicare, that’s “a dead issue,” he said.

As for the plan put out by the House Freedom Caucus, led by Rep. Rand Paul (R-Ky.) and Rep. Mark Sanford (R-S.C.), it recommends repealing Medicaid expansion, de-linking health insurance from employers, and offering a $5,000 tax credit which beneficiaries could invest in HSAs, according to the Washington Post.  The Caucus wants “a clean repeal” of the ACA, and has suggested using the budget reconciliation bill that President Obama vetoed last year.

“What exactly is in a clean repeal?” Antos said. “[Republicans] are all speaking at a level of generality that doesn’t lock anybody into anything yet.”

The GOP Plan suggest that their proposal would “ensures more choices, lower costs, and greater control over your health care.”  I strongly disagree.

Here are the key points in the GOP Plan and my comments:

  • The GOP Plan says it “Moves health care decisions away from Washington and to where they belong: with patients, their families, and their doctors.”
    • The key for me is that there is no mention of Insurance Companies in this comment.  They say they want to move decisions from Washington (Washington is always the bogieman/whipping boy/scapegoat for conservatives) to patients, families, and doctors.  But they leave out Insurance companies.  I don’t decide what I care I get the Insurance companies get to decide.  Which may not be a bad thing if there is competition between insurance companies and transparency of the doctors and insurance companies.  But, since there is no transparency, consumers cannot make the decisions the GOP Plan says we should make.
  • The GOP Plan says it “Provides coverage protections and peace of mind for all Americans—regardless of age, income, medical conditions, or circumstances.”
    • No it doesn’t.  Any evaluation of the plan leads to the reasonable conclusions that their plan will “guarantee” none of those things.  
  • The GOP Plan says it “Gives patients the right tools, like Health Savings Accounts, to make their health insurance more portable and affordable.”
    • This is laughable on its face.  HSAs do nothing to make insurance more portable or affordable.  I could be wrong here, but I don’t think so.  The supporters of this bill need to provide the details of how HSAs make insurance more portable and affordable.
  • The GOP Plan says it, “Allows those who don’t receive insurance from an employer or government program to have access to quality coverage.”
    • Again, this is laughable on its face.  They need to explain what they consider “quality coverage” and how the plan provides more access to the plans.  Plus, and I love this one, in their first bullet they talk about doing away with government, yet in this bullet they talk a government program.  It confuses the hell out of me.
  • The GOP Plan says it, “Breaks down barriers that restrict choice and prevent Americans from picking the plan that is best for them and their family,
    • Name that tune!  How does your plan do this.  This is a great example of what Dr. Patel says is a lack of details.  
  • The GOP Plan says it, “Modernizes and strengthens Medicaid to protect the most vulnerable.”
    • From my perspective this is simply a lie.  And they hope no one calls them on it.  They do not want to strengthen Medicare or Medicaid.  They believe that Socialized Medicine is a bad thing.  They believe that poor people abuse these benefits and that the only way to stop the abuse is to stop the benefits. The new policy paper actually states that the enhanced match rate for Medicaid expansion states — the ratio of funding states receive from the federal government for the expansion population — will drop to the regular match rate at “a date certain,” Antos said.

 

My reading of this policy paper is that it is not a true plan, but has elements that will become a plan.

Here are some of the questions about the policy paper that need answers:

  • What will the refundable tax credits look like?
  • How does the refundable tax credit increase with age?
  • At what point will employer sponsored insurance be taxed and at what rate?
  • How will the plan affect gender rating, the practice of charging men and women different prices for healthcare based on their gender?
  • If you cannot afford to pay will you not get treatment?
  • Is pregnancy a preexisting condition?

 

 

To Improve Health Care We need to Change the Incentive From Making Money off of Sick People to Improving the Health of the Patient

To Improve health care and reduce costs we need to change the incentive from making money off of sick people to improving the health of the patient.

Tom Price has a plan for Health Care.  His plan is to reduce transparency, reduce standards, and increase freedom to exploit the sick.

Of course he would describe his plan differently.  If you ask Tom Price what his plan is, he would say that he advocates empowering individuals with their doctors so they can make their own health care decisions free from community interference.  And he is trying to pass laws in Congress and is encouraging the States to enact patient-centered, market-based programs to do this.

As a Doctor, it is clear why Rep. Price would like a system that frees him from any transparency and community interference.  He wants a lot of sick people that have no information so he can charge them as much as he can so he can make as much profit as he can.  He says, he wants patients to make their own decision in a free market system, just as one might when they by a car.  However, clearly, unlike buying a car where the buyer could know more about cars than the seller, Dr. Tom Price will always know more about what is wrong with the patient than the patient.  This places the patient at huge disadvantage.  In economics it is called “Information Asymmetry.”  Dr. Tom Price makes a lot of money on sick people.  And he wants to change the rules so he can make more money.

I had hoped the passage of Obamacare would put this debate behind us.  But, sadly, Obamacare did not solve the problem.  In fact, health care costs continue to ballon much faster than inflation.

So, what is the answer.  I came across an interesting study by Prof. Grayboyes.  The Title of the Study is “Fortress and Frontier in American Health Care.

Here is a short video Prof. Grayboyes put together to explain his view.

While I understand his view, I see the problem differently.

The problem is that, while every cell phone is exactly the same, not every hip replacement is exactly the same. While every Model T Ford was exactly the same, not every heart bypass is exactly the same.

Professor Graboyes comparison of health care services to technology is not a good comparison because you can gain huge cost savings through standardization in technology, but there is no such cost savings improvements in standardizing health care. In fact, by standardizing health care we would actually reduce quality care.

As long as the incentive is to make money on people getting sick, the sick will continue to pay more because those making money on people getting sick will continue to want to make more money.

We need to change the incentive of our health care industry from making money to making the patient well.