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Sunday, August 6, 2017

Trump Report Card-Cabinet Actions Midway Through First Year

Trump Report Card-Midpoint Year 1


Donald Trump has been POTUS for half of his first year and this article reviews what his cabinet has accomplished and the direct impacts on you. President Trump’s opinions and omissions do create harmful consequences as this report card illustrates.

What’s at Stake
Cabinet Member
Perspectives
Analysis
Your Health
The Secretary of Health and Human Services controls the following agencies: Centers for Medicare and Medicaid, Food and Drug Administration, administers the Affordable Care Act, and grants more money for medical research than any other agency in the world.
Tom Price, Republican from Georgia, He is an orthopedic surgeon, and represents one of the healthcare sectors with expensive medical devices and lucrative profit margins for health systems. Resentful of the 3% medical device tax his industry pays to fund the Affordable Care Act for low-income Americans.
Wants to get rid of Obama Care and replace it with another insurance based payment system. Questions the value of the Centers for Medicare and Medicaid innovation through Demonstration Projects. He wants to reduce the footprint of government policymaking in healthcare. Though he wants consumers to shoulder more responsibility for their health care, he questions the value of performance assessment as a component of government funding and oversight by government agencies. CMS’s Accountable Care Organization program has been successful and 31% of 2015 participants received bonuses. There are 400 healthcare systems participating in this program.
Would he impinge on medical research by eliminating stem cell research as his predecessor George Bush did?
🔻Price has used HHS money to discredit the Affordable Care Act. It is unclear what will be done to support the open enrollment period which starts in 2 months. 🔻Trump may try to strangle the act by refusing to pay the financial subsidies to insurers who participate in the exchanges, thus causing them to drop out. This ploy would produce a result sought by many Republicans-to kill the ACA. Millions could still end up without healthcare and no public option. 🔻Other death knells may include cutting some of the funding provisions for the act, such as the 3% medical device tax. 🔻The agency may also stop enforcing proof of medical insurance requirements with the IRS, thus gutting revenue from fines for companies and individuals who do not comply.[1] 🔻The proposed federal budget seeks a 20% cut for Health and Human Services, which will hurt medical research and is yet to be approved, but is next on the docket.  🔻
And finally, another legislative rollback-loosening the requirement that religious organizations offer birth control under their medical insurance.[2]
Your Air and Water
The Environmental Protection Agency sets standards for air & water quality, extracts fines from offenders, and litigates as required for compliance with federal and state laws.
Scott Pruitt, Republican, former Attorney General and former senator from Oklahoma, Secretary of Environmental Protection Agency
The EPA was created by the Nixon Administration and is responsible for improvements in air and water quality throughout the nation. Pruitt wants to gut the Clean Water and Clean Air Acts signed by the Obama Administration. Has pledged to dismantle the EPA and is in the back pocket of the oil and gas industry. He has been vociferous in his lawsuits against government regulations. Doesn’t think global warming is an issue. Wants to get out of the Paris Climate Change Accords, which were signed by 95 countries.

🔻U.S. dropped out of the Paris Accords, a nonbinding commitment to cut greenhouse gases, the greatest contributor to global warming and the melting of the polar ice caps. Obama Administration Clean Air Act forces power plants, especially coal powered ones, to reduce particulate emissions. The act established standards for emissions but allows flexibility for states to administer. 🔻The Trump administration has provided a 90-day stay on implementation of the Clean Air mandate. Tough luck for the asthmatics. The OMB’s budget will detail financial impacts of this act and Department of Interior revenues.[3] 🔻The Keystone Pipeline is back to transport earth scorching arboreal forest decimating Canadian tar sand oil to the U.S. for exportation. 🔻Congress also approved exportation of U.S. oil reserves because we are producing more than we need, whereas in normal market economics, production would decline when there is a market surplus. This is a subsidy for the oil industry.
Your Children’s Education Department of Education sets national standards for education (No Left Behind and Common Core), provides funding, and enforcement of standards
Betsy DeVos, former chairwoman of the Michigan Republican Party, is from the Amway family of billionaires and has never attended a public school, nor have her children. She attended Calvin College, a private liberal arts college.   She is the sister of infamous military defense contractor, Eric Prince, founder of private mercenary group, Blackwater.

Wants to deconstruct the agency and give more responsibilities to states, counties, and individual districts to set curriculum. She is a huge supporter of charter schools, which are funded with public funds but operate like private schools. She advocates a school voucher system where the government would essentially provide support for private schools. In Michigan, 80% of the schools are run by private companies. She is does not believe in recognizing homosexuality.
🔻Budget includes a 13% reduction in education funding.[4] 🔻This includes reducing college loans for low-income students under federal loan programs. 🔻Other actions include reducing Title IX enforcement of sanctions for campus sexual assaults. 🔻Relaxing federal standards to comply with Every Student Succeeds Act, for which 12 states have already submitted plans.[5]
🔺Surprisingly she appeared to waffle on the lavatory restriction for transgender folks, crossing AG Sessions.
She still needs to learn to spell.

Your Money
The Department of the Treasury, oversees revenue collection through the IRS, and sets standards for currency and financial management for the nation
Steve Mnunchin, former Goldman Saks executive and Hollywood film financier, is a Wall Street banker insider, who graduated from Yale.
Wants to loosen the Dodd-Frank  reserve standards for banks, created to prevent another financial meltdown due to hedge funders and bad bank decisions. The landmark Dodd-Frank Act, stewarded by Senator Elisabeth Warren,  created liquidity standards for banks to prevent the financial collapse of the nation and the world. If the U.S. government hadn’t bailed out AIG Insurance, General Motors, Fannie Mae, Freddie Mac, and a host of banks the depression would have been much more severe. (ProPublica.org, 2016)
Trump and Mnunchin cannot agree on the budget. 🔻He has identified methods to ease banking regulations without Congressional approval, including bank solvency stress tests, passed after the 2007 banking collapse.🔻 And most grievously, reducing the power of the Consumer Financial Protection Bureau, which has been successful in reducing predatory behavior by lenders.[6] Funding for this agency is not subject to Congressional approval-Trump wants to change this. CFPB has created lending standards for banks to verify income before providing mortgages. Enforcment-27 million Americans have received settlements from banks because of its actions.[7]
Your Liberty
The Attorney General of the United States, oversees the administration of federal laws, court system, and the enforcement of anti-trust and civil rights laws.

Jeff Sessions, Attorney General, is a former Republican Senator from Alabama, and former Attorney General of Alabama. He was rejected by the Reagan Administration for a federal judicial appointment because of racist views.
Has a reputation of being anti-immigrant, anti-Muslim, and anti-gay (LBGTQ). One of the most conservative members of Congress often at odds with his own party. Is a supporter of the stop and frisk ethos.  Widely considered to have racist views.
Sessions has been neutered by Trump and the investigation into the Russian election coupe. 🔻The ill-conceived Muslim travel ban is subject to lawsuits. 🔻He has instigated the war on drugs, wants to remove judicial discretionary sentencing, and imprison more people. Think Opioid abusers in jail not in treatment.🔻 Also revived a federal law allowing government to seize property for those suspected of crimes.🔻 He dumped the National Committee for Forensic Science, which aims to improve crime solving techniques and accuracy.[8]
Your National Parks
The Secretary of the Interior oversees the vaunted National Parks system, national forests, and all public lands, including the Bureau of Indian Affairs.
Ryan Zinke is a Republican freshman senator from Whitefish, Montana who is a former navy SEAL commander.
One of his most alarming views is he considers climate change to be unsettled. We don’t know anything about his governance perspectives. He has friends in the coal and fossil fuel industries, which is why the freshman senator with no regulatory experience was made a cabinet member. Montana has many tribal lands, including the Flathead Indian Reservation, near Whitefish.
🔻Reduced the fees coal companies pay to strip coal from our federal lands.[9]🔻Overturned Obama Administration ruling which stopped coal companies from mining on federal lands.[10] Coal is no longer an economical source of power, especially if the gov. makes them pay fair market rate for leases. Coal is one of the greatest contributors to particulates in air pollution. Much of the coal being gouged out of the earth now goes to China, the largest polluter in the world. 🔻Next up-looking to limit the rules which restrict the greenhouse methane gas production from oil and gas sites on federal lands. In other words, it is back to raping and pillaging public lands as usual.
Your World
The Secretary of State is 4th in line to the presidency and is chief negotiator of foreign policy on behalf of the nation, also responsible for coordination and security of diplomatic posts.
Rex Tillerson, former chief executive of Exxon, has lucrative financial interests in countries which are considered enemies, including Russia.
Tillerson has a fifteen-year relationship with Putin, czar of Russia and advocates loosening of economic sanctions. Unlike other Trump nominees, he favors climate change action, including the carbon cap taxes on emissions. He also favors supporting the 2015 Paris Accords for Climate Change Action. He probably would favor the Keystone Pipeline completion.
The far-flung oil and gas interests of Exon and his personal wealth may be impacted by actions of the federal government. With the Mueller subpoenas, no one is safe from the Russian scandal. It appears Trump does not listen to the Secretary of State, preferring to decide foreign policy with those whom were not subject to Congressional approval, the informal Whitehouse advisers and of course, his children. Tillerson is a micromanager focusing on reorganizing the State Department.
Transportation
The Secretary of Transportation
oversees highway safety and road construction projects.
Elaine Chao is the former head of the Department of Labor and married to Senate Majority leader, Mitch McConnell. In other words, the ultimate insider.
One of Trump’s centerpiece platforms is the rebuilding of America, so Chao will be responsible for contract letting, management, and other infrastructure requirements.
Chao has not accomplished anything of note because the federal budget is not yet approved nor is an infrastructure bill. She is waiting in the wings.
Keeping the Lights On
The Secretary of Energy has oversight of the nation’s nuclear arsenal, also sets policy on utilization of resources to develop and maintain the nation’s energy grid.
Rick Perry, is the former Texas Governor, failed presidential candidate, and middling Dancing with the Stars Contestant. Of note, he was once a Democrat.
The only qualification Mr. Perry has for energy expertise, is his support of wind power in his home state. He has no scientific background and has suggested the Department of Energy could be eliminated.
Perry is on the National Security Committee but he does not appear to have done anything to enhance our security. He did slam the Paris Accords. Important to note, two nuclear power projects were shut down in July in South Carolina because they were not financially viable given other less costly energy alternatives. A list of other nuclear power projects which have been cancelled is included in the footnotes. [11] [12] [13]

Progress
Women’s March✅ Science March✅ Defeating the repeal of the Affordable Care Act✅ It is heartening to see the massive efforts of citizens who are thwarting the Trump Administration regularly.  Hopefully this article will provide some ideas on other policy issues which require attention and action.  Trump has proven himself to be the nightmare we all feared, a global disrupter who does more harm than good. A thriving democracy is an essential component of liberty and I am heartened by the participation of millennials in many of the efforts to resist the Trump Administration’s selfish initiatives. For more information on efforts to curb disastrous environmental policies, read  Geoff Dembicki's, "Are We Screwed-How A New Generation Is Fighting To Survive Climate Change," Bloomsbury Press.  And this is the healthpolicymaven signing off and encouraging you to share this article with all who value their democracy.

Roberta Winter is a freelance journalist who publishes under the trademark healthpolicymaven, which has been in continuous use since 2007. She is a public policy and healthcare book reviewer for the New York Journal of Books, a technical writer, and author. Her consumer guidebook to the U.S. healthcare system was published by Rowman & Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972




Monday, July 3, 2017

How America Co-opted the Future of Generation X and Y and How We Can Fix It-An Examination of Social Security

Bernie Sanders was no fluke, his appeal to the youth of Generation Y and to some extent Gen Xers is marked by real evidence showing how their futures have been muted by financial decisions made by Congress. The President of the nation, theoretically, is elected by us, although recent elections have shown the arcane electoral vote, meant to secure the democracy when many voters were illiterate, has called this into question. It turns out the electoral college is just another version of the “old boys club”. This article examines the contract for Social Security which the United States has made with its working class and what that means for the future of your children and grandchildren, in other words, those whom will be paying the tab.

Social Security
Social Security Taxes Paid by your Grandparents versus Workers of Today

Year
1940
1977
2017
Payroll tax rate is based on wage income and is split evenly between the employer and the employee
1% capped at $3,000; Medicare did not exist then
5.85% of wages, capped at $16,500; Does not include the Medicare tax
12.4% of wages, capped at $127,200; Does not include the Medicare tax, which is separate

When Social Security was enacted, it was meant as a pension for those whom would otherwise be destitute. Retirement age, at which a beneficiary could start to draw benefits was age 65, when the law was enacted on August 14, 1935, by President Franklin Roosevelt. [2] Life expectancy at the time was 62.9 years, so as you can see, only the lucky ones received any benefit. Fast forward to 2017 and life expectancy is dependent on where you live, and other factors, some women will live past 86. But the mean life expectancy for all people living in the U.S. is 79 years.[3] This ranks the U.S. 49th in the world, below all countries with national health plans and at the bottom of all industrialized countries.  South Korea, Jordan, and Hong King residents all live longer than Americans living in the U.S.

Currently, residents whom have met the minimal ten years of contributions under include-able wages are eligible to start drawing Social Security benefits as early as 62, with a reduction, or age 66 ½, depending on their birthdate. The government has an incentive, of 8% per year in increased benefits to delay until age 70.

Income Comparison
Year
1940
1977
2017
Mean income is the earnings amount by which an equal number of workers are above and below this value
$1,368, with an unemployment rate of 18.26% and no unemployment benefits[4]
$12,224, with an unemployment rate of 7.5%, with unemployment benefits
$44,980, [5] with an unemployment rate of 4.3% as of May [6]
Though the unemployment rate is certainly low in 2017, it was just a few years ago when the nation’s banking system collapsed due to junk bond deals packaging subpar mortgages as investments, and provided to people who could not afford them. This fraud was conducted by all levels of banks (Lehman Brothers) and the insurance industry (AIG), many of whom went bankrupt, but not until thousands of American homeowners lost everything first.

Real Purchasing Power Adjusted for Inflation
Year
1940
1977
2017
Purchasing Power-to maintain the same value this is how much you would need
$1
$4.33
$17.47
Earnings needed to maintain equivalent value of mean wage in 1940
$1,368
$5,921.49
$23,893.49

Though gross wages have increased over the years, real purchasing power has not kept up, as this table shows. Americans are only making a little over twice the 1940 per worker mean wage, when you adjust for inflation. The mean wage for all working Americans, which isn’t the average, but the midpoint, with an equal number of workers falling below the standard and above it, is currently $44,980 annually. So, for 77 years, this is not a lot of progress for workers, mainly because they have fallen behind since the 1970’s. Rising productivity of American workers has not resulted in a commensurate rise in wages for most workers, so the Republican trickle-down theory hasn’t worked. Real rise in wages, adjusted for inflation has been stagnant since 1980, the Reagan era.

Change Social Security to a Fairer More Secure System
Currently, a worker in the United States must accumulate forty quarters or ten years with earnings of at least $1,260 a quarter or $420 a month, to be eligible to apply for full social security benefits, depending on their age. Wow, what a deal, all you must do is work for a week each quarter, based on the current U.S. wage and you will have a pension! We can all think of our aunties and grandmas who took advantage of this benefit, by working part-time low-wage jobs, not because they needed to, but for spending money. I can’t think of any other part-time low wage job that comes with a lifetime pension.
Change #1 Social Security Benefits should be based on fulltime earnings for at least 10 years, not part-time. Working part-time does not guarantee you a pension.
Change #2 Social Security should pay more to workers who work longer, for example, workers who work unceasingly for 40 or 50 years, should get a larger benefit than those who work only 10 or 20 years, it is the time value of money. This would change the incentive from “do your bit to get minimum benefits’, to contributing longer for a proportionally greater earned reward.  Though currently, Social Security offers a sizeable benefit increase to those who wait until maximum retirement age of 70, it does not look at the length of service.

Spousal benefit provisions under Social Security allow full benefits to inure to persons who marry multiple times, ala Donald Trump. Though the worker’s tax contribution to the social security fund was capped, apparently the benefits which may be paid out are not. For example, a spouse, either male or female can elect to claim 50% of the partner’s social security benefits. Essentially, this means the value of the Social Security payout has increased by 50%, without paying additional taxes. And here is the real pot sweetener, anyone who has been married for ten years and has not remarried before age 60, gets this extra windfall election. The ex-wife can claim a benefit of 50% of her husband’s social security benefits, years after the divorce, but this doesn’t reduce his take, it is just a bonus to her from the federal government. And, the current wife (male or female) is still eligible to claim her share of the spouse’s social security pay out as well.
Change #3 You are welcome to marry as many times as you can stand, but the government is under no obligation to support your multiple wives/husbands. The total spousal benefit needs to be revised and social security benefits paid to ex-betrotheds should come out of a limited benefit based on the working spouse’s contributions. In other words, if $300,000 is allocated for spousal benefits, that amount must be allocated between all the former “love-of-my-life’s,” not increased exponentially because of salacious decisions.

Survivor benefits can be collected by widows or widowers as early as age 60 and this means, if your spouse has died and was collecting Social Security or was eligible to collect, you can elect to collect full benefits, based on your spouse’s social security. Later, you can decide to switch to your own benefit, if it would pay more money.
Change #4 This seems like gambling against the house and holding the aces; once you start drawing your social security benefits, you don’t get a do-over. If you select your half of his benefits at age 60, that is what you get.

Survivor benefits for children, are only payable for unmarried children until age 18 or 19, if they are still in high school. Children of a disabled or deceased social security participant are eligible to receive benefits if the parent had paid enough into the system, which we discussed, is a mere ten years of earnings. Since it sucks to lose a parent, or to have a disabled one, let’s leave this as is.

Social security taxes have doubled in the last forty years and are not keeping up with the benefits which will be paid out to baby boomers, whom are now starting to enjoy their unreduced benefits. Since the younger generation will most assuredly be expected to pay higher taxes for Social Security and of course, Medicare, we need to shore up their future. It is time to have a national pension or Individual retirement account for those under age 45. Designate part of what they contribute to Social Security to their own private account, ideally 50%, but I will leave that up to U.S. Treasury and Social Security Administration to discern.  The money contributed to Social Security, would not be able to be borrowed against and hence, safe from creditors, could not be used for medical care, and would not be accessible until age 62.
Change #5 Let Gen Xers and Generation Y start their own government protected individual retirement accounts. At least they will have some money for their future and they won’t have to feel so bad about paying those extra taxes for boomer benefits.

It is time for older Americans to wake up to the debt we have left our youth, who will be paying for our bad decisions for a lifetime. If I hear one more senior citizen, enjoying their social security checks and Medicare complain we can’t have socialism, I am going to remove your dentures. And this is the healthpolicymaven signing off encouraging you not to sign blanket releases when you are admitted to a hospital, please add the line, “I agree to pay for services of in-network providers,” as recommended by Dr. Elizabeth Rosenthal in her book, How Healthcare Became Big Business and How We Can Take It Back.”[7]

This article was written by Roberta E. Winter, a freelance journalist and author of https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Sunday, May 21, 2017

Why the Republican Healthcare Plan Won't Save You Any Money

None of the Republican proposals for healthcare include a single cost or quality requirement for payment to doctors, hospitals, or even insurers, which will add rocket fuel to the fee-for-service payment system which is the bane of U.S. healthcare. This payment method, which originated with the founding of Medicare in the sixties, is one of the main reasons why the price for health services is so much higher in the U.S. than any other country. Essentially, there is no budget and all healthcare providers are paid on volume, with the exception of some primary care folks.  You have undoubtedly read the stories of patients being charged for services by surgeons who didn’t even perform the surgery, which reflects the factory mentality of the surgical suite and the outsized incentive to make more money. The delivery of health services or improved health to the patient is often a bi-product. Tom Price is the Trump Administration appointee for Secretary of Health and Human Services, which oversees all policy making for healthcare, any efforts to assess and improve quality, most funding for medical research, and patient safety programs for the country. He is on record questioning the value of Medicare’s Demonstration Projects, whose sole purpose is to find ways to improve health and reduce costs as clinically appropriate. Without the requirements of the Affordable Care Act, for price reporting transparency for medical device companies and other suppliers, as well as mandating that insurers participating in government funded programs spend at least 85% of funds collected on program benefits for enrollees, there will be no incentive for any of these health sector profit-takers to lower their costs or improve quality. Will the Republicans also axe the successful Accountable Care Organization incentives for systems which demonstrate they are delivering high quality health care?
CMS-the Only Agency with Enough Price, Quality, and Enforcement Power to Fix Healthcare
The Centers for Medicare and Medicaid is the only agency with enough regulatory power to enforce both price and performance standards for the national healthcare system. Dr. Tom Price wants to neutralize CMS and loosen oversight for the healthcare industry. As I illustrated in my 2013 book, Unraveling U.S. Healthcare (Winter R. E., 2013), national healthcare when viewed by outcomes is not better here, just more expensive. According to 2017 data from the Henry J. Kaiser Family Foundation, the U.S. now spends $9,451 per capita for health care. (Cox, 2017) Most of Europe spends half of that per person per year. And I am not talking about insurance premiums, but the total, all-in cost of health care. Only three countries spent more than $6,000 in this time-frame, the wealthy triumvirate of Norway, Switzerland, and Luxembourg. How can the U.S. still claim that covering everyone for health care is too expensive when all the industrialized countries are doing that and spending much less?
American Health Is Declining
According to a recent analysis by the Kaiser Foundation, the U.S. is at the bottom of all industrialized countries for life expectancy and we spend 50% more than most of these countries. (Sawyer, 2017) People live the longest in Japan with an average life expectancy of 83.7 years, followed by Switzerland at 83.3 years, and then France at 82.8. The U.S. comes in at 78.8, this despite spending 50% more on health care. In fact, life expectancies are going down in the U.S., which is still one of the richest countries in the world. This should raise alarm bells, yet the ill-informed Republican Congress apparently believe that reducing access to health care by gutting Medicaid, removing basic benefits like maternity care (U.S. also has one of the highest maternal death rates in the developed world), and of course, gutting mental health services will improve the situation. I remember when smoking die-ins were de rigueur, perhaps we need to stage a national die-in to demonstrate the impact of the latest Republican effort to gut healthcare.
Systemic Overcharging Contributes to the High Cost of Healthcare
Why is overcharging tolerated in healthcare? People aren’t willing to spend 50% more for their houses or their autos? Americans are not getting comparatively better health for this 50% higher healthcare spend, but many companies are getting very rich because of it. In 2013, I posted an article on orthopedic surgery for a hip replacement in Belgium, which cost $16,000 versus $60,000 in the U.S. and the entrepreneurial American who chose to fly to Belgium for his uninsured treatment because he still saved money. (Winter, 2013)
Why Increased Private Sector Involvement and Reduced Regulation Won’t Work
As a participant in the Lown Institute’s Right Care Conference this month[1], which focused on educating clinicians and the public about cost effective treatments which improve health, I had the pleasure of listening to Jeffrey Sachs, professor of Health Policy and Economics at Columbia and a United Nations Adviser, the day the Republicans came out with their plan to defund Medicaid. Dr. Sachs has studied microeconomics and unequivocally stated, “Pure market economics in healthcare does not exist. Corporations are not the guardian of public health.” Consequently, the expectation that more uncontrolled private sector involvement will generate a better more efficient healthcare system is ludicrous. The U.S. healthcare system was created for profit maximization not maximum efficiency or efficacy. The idea that market economies are the solution to all public services has been proven false time and again, for national security, the interstate highway system, regulation of drugs and medical treatments, and the safety of our food supply. The scariest weapons in the world are not the missiles of North Korea but chemical weapons, whose carnage the world witnessed in Syria, and even worse, the biological ones. Trump, the anti-globalist doesn’t seem to understand that the World Health Organization provides surveillance and communication of disease and public health epidemics to aid in curtailment. His Budget Director’s proposed 20% cut to Health and Human Services would impact our health safety. Our survival as a species and a planet depend on our cooperation, funding, and heeding the advice from organizations which are providing this front-line work.
Without Price Transparency Patients Are Not Empowered
As the American healthcare system includes a healthy private sector contribution, there is an expectation of a competitive environment, but in healthcare this does not exist. For example, an oversupply of high tech medical technology increases the cost of care and does not lower insurance premiums or hospital charges. The burden of paying for duplicitous equipment is born throughout the health system by the premium payers for insurance and those who use the health services. A healthy marketplace requires symmetrical information, meaning there is equal access to price and quality information for all participants. In the U.S. insurance price information is available, but consumers must go to a lot of work to assess reliable scientific health care quality data. Specious clinical results which do not improve population health are published all the time by drug companies, hospitals, and medical suppliers through direct-to-consumer-advertising. Hospital services are dominated by a handful of huge corporations as is the insurance industry. The profit motive is so enticing in healthcare that the nonprofit Blue Cross Blue Shield entities became for-profit cash machines years ago. This decision did not lower the cost of your health insurance or your health services. Equal access to information, meaning, the healthcare purchasers have access to actual price and quality information is impeded by organizations which are not required to provide this information. At least the Obama Administration required companies to report wholesale and retail price information, as the start toward building a database for price transparency in U.S. healthcare.  Cardiac device companies have successfully fought to prevent the public from learning how much we are overpaying for their heart valves. This phenomenon is very different in other countries, like France and Australia where price lists must be posted. In the U.S. if you ask for the cost of your scheduled procedure and hospital charges, providers will typically not be willing to give you that information. Insurance companies would seem to be in the best position to communicate to their customers what they can expect to pay for a procedure at a facility, because they negotiate price with all their contracted providers. Private sector companies are investing in price detection but their services are not readily available to the public on a national scale. The mega healthcare conglomerates, including medical device, pharmaceutical, and skilled nursing facilities are by and large for-profit entities and they have no interest in delivering unprofitable care. Dr. Sachs also stated, “Anti-retroviral drugs to fight HV cost $25,000 in the U.S. and $160 everywhere else in the world.” Drug distribution and patents are based strictly on profit maximization, not getting the most benefit for the health system.
This Country Is Making You Sick
The U.S. has the highest income inequality in the developed world, which means there is a decreasing middle-class and growing poverty class. About 14% of all people in the U.S. live in poverty, but 25% of all children do. Yet the Trump administration wants to cut school lunch programs, Head Start, public school funding, and access to health care for these children, while the top 5% expands its wealth exponentially.  This worrisome trend is reflected in the ill health of our people as evidenced by the epidemic of suicides and opioid addictions. As I write this column within the past week two teenage boys chose death-by-cop as their suicide method, because in this country, you can have a fake gun, have committed no crime, and still be reasonably certain you will be murdered by the police. In the 1990’s Congress reduced funding for gun violence research, cutting 2.6 million from the Centers for Disease Control and Prevention’s budget. Congress also passed a ban on any research which would advocate or promote gun control, because of alarm over a 1993 study which analyzed risks of keeping a firearm in the home versus the benefit for personal safety. (Sudermann, 2017) Now, gun violence in the U.S. kills as many people as sepsis infections. We treat infections, yet our elected officials lack the backbone to enforce strict licensing and distribution of firearms to protect the public. Under the Trump Administration we can look forward to ever more mentally ill persons obtaining Uzis and the ensuing destruction. Peggy Noonan asserts that societal ills would go away if parents only loved their children more. I can assure you, Ms. Noonan, poor people love their children and it is a herculean struggle for them to make ends meet every day. It should also be noted that the wealthy are just as rife to suicide and drug addiction, so perhaps love isn’t the answer, and informed health and welfare policy making is the solution.
And this is the healthpolicymaven signing off wishing you fully informed consent, and remember, as Dr.  Rosenthal, author of An American Sickness-How Healthcare Became Big Business and How You Can Take It Back (Rosenthal, 2017) recommends, don’t sign generic hospital release forms and do add a codicil which states, “I agree to be responsible for charges for in-network providers.”

This column is completely independent of corporate support and has been since 2007. Roberta Winter is an independent journalist and healthcare writer. She is the author of Unraveling U.S. Healthcare-A Personal Guide, a guidebook to the U.S. healthcare system written expressly for consumers.

References

Cox, C. (2017). How Does Healthcare Spending In the U.S. Compare to Other Countries. Henry J. Kaiser Family Foundation. Retrieved May 21, 2017, from http://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/?_sf_s=health+spending#item-start
Rosenthal, D. E. (2017). An American Sickness-How Healthcare Became Big Business and How you Can Take It Back. New York, New York, USA: Penguin Press. Retrieved from http://www.nyjournalofbooks.com/book-review/sickness
Sawyer, S. G. (2017). How Does Life Expectancy Compare to Other Countries. Kaiser Family Foundation. Peterson-Kaiser Health Systems Tracker. Retrieved May 21, 2017, from http://www.healthsystemtracker.org/chart-collection/u-s-life-expectancy-compare-countries/?_sf_s=life#item-start
Sudermann, H. (2017, March 1). Prevention Revisited-A Harborview-based Center Looks for Ways to Prevent Injuries and Violence. Columns-The University of Washington Alumni Magazine, pp. 38-39.
Winter, R. (2013, August 6). Save Money On Your Health Care By Going To Europe. Retrieved from Straight Talk on Healthcare, healthpolicymaven: http://healthpolicymaven.blogspot.com/2013/08/save-money-on-your-health-care-by-going.html
Winter, R. E. (2013). Unraveling U.S. Healthcare-A Personal Guide. In R. E. Winter, Unraveling U.S. Healthcare-A Personal Guide (pp. 3-15, 31-38). Lanham, MD: Rowman and Littlefield.





Saturday, April 29, 2017

100 days under the Trump Epoch and what it means for your Health

The first 100 days under the Trump reign have seemed like a thousand years of muffled screams and insults, which at times were hilarious because of the inaccuracies and grammatical errors. However, as William O. Douglas, former supreme court justice, once said, "freedom steals away in the night while we are sleeping." This article reviews the thrust of the Trump Administration and the Republican majority's stabs at "healthcare reform." Round deux, dos, or two, depending on your preference, of the attempt to repeal the Patient Protection and Affordable Care Act has slunk away in the night, lacking the requisite number of votes for approval. However, this latest iteration provides a glimpse at the approach the Republicans will apply to future legislation, in healthcare, and many other programs. Essentially, the R's want to shirk national leadership and have the states assume responsibility for more programs and consumer protections. The only area in which they shrink from this is for gun proliferation, where the Trump Administration wants to force all states to accept looser standards for transporting weapons across state lines, including concealed weapons.
Trump Posturing
Right up until the federal government deadline for shutting down, Trump threatened to withhold the tax credits which provide 20 million middle class and low-income Americans with medical insurance. This is of course, an administrative maneuver to choke the life out of the act, since he hasn't been able to gain agreement from his own party. It should be noted however, that Trump has already cut funding mechanisms which flow to the program, including a 3% tax born by the lucrative medical device industry, which will flow directly to their executives and NOT reduce the cost of your cardiac or orthopedic devices. And of course, let's not forget his forgiveness of the "tanning bed" tax, which has zero health benefits and does contribute to skin cancer. 
Regarding the thousands of people who hate the Affordable Care Act, there are exemptions for those who don't want to participate, and about 20 million folks have made this election or paid the tax penalty. Though the Affordable Care Act is not beloved and is flawed legislation, as they all are, it is still a starting point from which to make further reforms. This chart shows provisions of the act which are now being targeted by the Trump goon squad and what the impact may be on your health care.

Provision
Affordable Care Act
Trump Round 2 Health Plan
Protection from Pre-existing Medical Condition Exclusions
Insurance companies are prohibited from denying coverage or reducing benefits to persons with existing medical conditions
The Republicans are proposing that individual states decide how they want to handle insurance offerings to those who need it most-including being able to charge astronomical prices, limit benefits, and deny coverage
Lifetime Limits for Benefits
Insurance companies are prohibited from limiting benefits
The Republicans think states should be allowed to offer restricted programs, contracts with minimal benefits, instead of comprehensive medical insurance
Standardized Benefit Levels Nationally
In the insurance exchanges, participating insurers must offer benefits which adhere to certain benefit designs and guarantees
The Republicans see no advantage in mandating benefit standards and wish to leave this provision up to the states
Protection from Predatory Pricing Based on Age or Need
In the insurance exchanges, there are tiers of rates and people who are in the older tiers cannot be charged more than 3 times the rate of the younger tiers
The Republicans want to allow strict age rating, which means if you are over 50, it will be a long expensive wait until age 65 when you can join America’s national healthcare plan, Medicare
Birth Control Coverage
The insurance exchanges require plans to offer birth control in all plans
The Republicans are opting to use streaming videos of talk show host Alex Jones as birth control
Mental Health Services Coverage
Included under the ACA, as any other benefit
More homeless people, which impacts cities, who didn’t support Trump anyway, so a win for them
Chemical Dependency Treatment
Covered under the ACA, which is critical with the opioid crisis
You are on your own

To all the winners who voted for Trump, stop whining about the millions of engaged citizens who are demonstrating against his horrible policies, the first amendment guarantees their right to free speech, and this is part of a real democracy.
 And this is the healthpolicymaven signing off wishing you all informed consent. Also, TIP OF THE DAY-don’t sign blanket authorizations at hospitals or medical facilities, please add the words,“I agree to pay charges for in-network providers”, which can save you a mint. Those words of wisdom come from Dr. Elizabeth Rosenthal, author of An American Sickness-How Healthcare Became Big Business and How You Can Take It Back. Please do buy and read her book.

Roberta Winter is the author of Unraveling U.S. Healthcare-A Personal Guide, published in 2013 by Rowman and Littlefield.
https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972