Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die

With the AHCA, the Republicans have put a price tag on the lives of America’s working class: $300 billion

Trumpcare, Ryancare, Trashcare: While the GOP celebrates its found money, the poor will get sicker and die
(Credit: AP/Susan Walsh)

Trumpcare, Ryancare, Trashcare — whatever you want to call it, the American Health Care Act is nothing more than a cheap stab at Barack Obama, a petty attempt on the part of grudge-holding Republicans, including President Donald Trump, to try to diminish Obama’s legacy. They can try, but that will be impossible — Trump’s follow-up act has been so bad so far that he’s making George W. Bush look practically Lincoln-esque. But let’s set legacies and agendas aside for now and focus on health care.

“We have come up with a solution that’s really, really, I think, very good,” Donald Trump has said. “It’s an unbelievably complex subject. Nobody knew that health care could be so complicated.”

I’m not a president or a billionaire. I could never afford the kind of routine checkups that Trump has access to from award-winning physicians with platinum stethoscopes and solid gold scalpels — or even a state-of-the-art Viking fridge stocked with spare teenage hearts and kidneys, all plump and ready to be inserted when Trump’s conk out. He’ll probably live to be 360 years old as a result. Most of us don’t have that experience, and the president, just like the congresspeople and senators who are aimlessly playing with the lives of their constituents by threatening to kill Obamacare, is taken care of. They have amazing health care coverage that we, the taxpayers, fund. Strangely, that never makes it into the conversation.

Is Obamacare perfect? Absolutely not. But it has already saved the lives of millions of people. People who would have never voted for Obama are calling him a hero, even as some die-hard right-wingers praise the Affordable Care Act for saving their loved ones, not realizing that it’s the same as Obamacare.

Trump loves his catchphrase, “Make America great again.” Obviously he doesn’t understand that “great” is a process that we must constantly work toward. Greatness is edited, nurtured and achieved after recognizing what works and what doesn’t. Scrapping Obamacare and replacing it with a trash plan that will leave millions of people who were born without the luxury of being Trump-level rich uninsured is not making anything great. It’s evil. According to the CBO analysis, the AHCA would “reduce federal deficits by $337 billion over the coming decade and increase the number of people who are uninsured by 24 million in 2026 relative to current law.” And every Republican is running to the cable news networks, bragging about saving $300 billion. What does that mean to the person the Wall Street Journal described, a 62-year-old person who makes $18,000 a year who will now face premiums of up to $20,000?

Imagine a sickly elderly woman running home from work to her family to share with pride that the government just saved $300 billion. There is nothing more important than that to the government, even if it means that you’re broke, your granddaughter is pregnant because she couldn’t get birth control, and your grandson overdosed and died because he couldn’t be treated for his prescription drug addiction, which he developed to self-medicate his depression over the factory jobs that Trump promised never coming. We should all celebrate because the government saved $300 billion? That’s $300 billion that regular people will never touch.

People will not be treated for their illnesses. Many will suffer, and some will die. But at least the GOP beat Obama!

D. Watkins is an Editor at Large for Salon. He is also a professor at the University of Baltimore and founder of the BMORE Writers Project. Watkins is the author of the New York Times best-sellers “The Beast Side: Living  (and Dying) While Black in America” and “The Cook Up: A Crack Rock Memoir.”

US health care debate: A bipartisan drive to lower life expectancy

16 March 2017

The new overhaul in the US health care system that is being prepared is a highpoint in a war against the working class in the United States. The debate in Washington and the media obscures the basic motivation guiding both big business parties: to restrict access to affordable health care and sharply reduce the life expectancy of American workers.

The divisions between the Democrats and Republicans are over secondary and tactical questions. Far from “repealing and replacing” Obamacare, the Republican proposal builds on its basic framework while driving up the number of uninsured workers, making health care unaffordable for older, lower- and middle-income workers, and accelerating the destruction of Medicaid and Medicare.

The aim is to free up resources for a massive increase in military spending, while funneling even more money to the stock market and the financial aristocracy. It is a continuation of a decades-long social counterrevolution, pursued regardless which party controlled the White House and Congress.

According to the Congressional Budget Office report released Monday, 21 million Americans will lose coverage by 2020, and 24 million by 2026. How many of these people will die as a consequence?

Under the Republican House plan, a 64-year-old worker earning $26,500 will see his or her premium increase from $1,700 to $14,600 by 2026 due to the disproportionate cuts in tax credits for older consumers. A 21-year-old earning the same amount would see his or her premium drop from $1,700 to $1,450.

In so far as overall premiums drop, this is because older workers—whose health care costs are higher—will simply leave the market because they can no longer pay for insurance. The result will be a sharp increase in mortality and fall in life expectancy, which is already on the decline in the US due to the rise in suicides, drug abuse and other social ills.

These changes are only a prelude to raising the eligibility age for Medicare to 67 and beyond and transforming it into a voucher program. At the same time, the Republican plan would slash funding for Medicaid—the federal entitlement program for the poor—by 25 percent by 2026, reducing the number of Medicaid beneficiaries by 17 percent, or 14 million people. Trump’s appointee to head the Center for Medicare and Medicaid Services (CMS), Seema Verma, has already tested out work requirements for Medicaid and health savings accounts in Indiana.

When Medicare was passed in 1965, a byproduct of a powerful wave of social struggles, the average life expectancy of a male in the US was 66.8 years, and for working class men it was even lower. At the time, the government program was designed to provide a couple of years of health care. But to the growing horror of the American ruling class, increased access to health care and major advances in science and medicine led to a significant increase in life expectancy, with the government paying out benefits for a decade or two longer than had been anticipated.

The mid-1960s was also the period when many workers secured pensions and won retiree health care benefits, which enabled them to live many years after they stopped producing profits for corporate America.

This has provoked ever-greater anger and bitterness in the ruling class. By the 1990s, there was a chorus of complaints about the aging population, and how out-of-control health care costs were undermining the global competitiveness of US businesses. In 2005, Delphi CEO Steve Miller complained that “people are living longer these days.” He declared that employer-paid benefits made sense only in an era when “you worked for one employer till age 65 and then died at age 70…”

Obamacare was the first significant effort to reverse this trend by undermining the system of employer-paid health benefits and shifting the costs of medical care from the corporations and the government onto the backs of workers. The plan, drawn up by insurance and medical business interests, rationed care and dumped low-income workers into barebones plans.

In opposition to all of those who claimed Obamacare was a progressive social reform, the WSWS explained that it was the opening shot of a health care counterrevolution aimed at stripping the working class of access to affordable and decent coverage, and substantially reducing life expectancy. This assault is now being vastly expanded.

The war against the working class in the US is inseparable from the criminal wars being fought abroad. In a major article in Foreign Affairs magazine in 2016, entitled, “Preserving Primacy: A Defense Strategy for the New Administration,” House Armed Services Committee Chairman Mac Thornberry and national security strategist Andrew F. Krepinevich Jr. concluded that expanding US military operations against China, Russia, Iran and preserving US military domination would require taking on “the expanding cost of entitlement programs.” The main confrontation the next administration would have would be on “the domestic front,” they wrote.

The assault on health care, like the attack on jobs and living standards, the attack on immigrants and democratic rights, and the drive to war, will provoke enormous social opposition. The fight against Trump requires a fight against the bankrupt capitalist system and both big business parties, which laid the groundwork for the most reactionary government in US history.

This requires the building of a revolutionary leadership to unite every form of social opposition in mass political movement of the working class for a workers’ government and socialism. This is the only way that profit can be taken out of health care and high quality medical coverage established as a social right for all.

Jerry White

 

http://www.wsws.org/en/articles/2017/03/16/pers-m16.html

Is Health Care Doomed?

PERSONAL HEALTH
The Republicans’ new plan to replace the Affordable Care Act is worse than many expected. John Marty has a better idea.

Doctor Discussing Records With Senior Female Patient
Photo Credit: Monkey Business Images/Shutterstock

As Donald Trump and the Republicans aim a bulldozer at the Affordable Care Act, supporters of the ACA are making a strong case for its successes. One of them is Jonathan Cohn, who has covered health care for years. In a long and persuasive essay, he calls on witness after witness to show that “real people with serious medical issues are finally getting the help they need.”

Cohn interviews a number of people who fell victim to “the old system at its callous, capricious worst” (before President Barack Obama took office) when “roughly 1 in 6 Americans had no health care insurance, and even the insured could still face crippling medical bills.” The ACA was an effort to address their problems, and after seven years, he reports, the list of what’s gone right is long:

– In states like California and Michigan, the newly regulated markets appear to be working as the law’s architects intended, except for some rural areas that insurers have never served that well. Middle-class people in those states have better, more affordable options.

– It looks like more insurers are figuring out how to make their products work and how to successfully compete for business. Customers have turned out to be more price-sensitive than insurers originally anticipated. In general, the carriers that struggle are large national companies without much experience selling directly to consumers rather than through employers.

– Last year’s big premium increases followed two years in which average premiums were far below projections, a sign that carriers simply started their pricing too low. Even now, on average, the premiums people pay for exchange insurance are on a par with, or even a bit cheaper than, equivalent employer policies — and that’s before the tax credits.

– The majority of people who are buying insurance on their own or get their coverage through Medicaid are satisfied with it, according to separate surveys by the Commonwealth Fund and the Henry J. Kaiser Family Foundation. The level of satisfaction with the new coverage still trails that involving employer-provided insurance, and it has declined over time. But it’s clearly in positive territory.

Overall, Cohn concludes, the number of people without health insurance “is the lowest that government or private surveys have ever recorded.”

Yes, there are problems. Cohn acknowledges where the Affordable Care Act has failed and why. Mostly because the president and his allies were so determined to succeed where those before them had failed, “they made a series of concessions that necessarily limited the law’s ambition:

They expanded Medicaid and regulated private insurance rather than start a whole new government-run program. They dialed back demands for lower prices from drug makers, hospitals and other health care industries. And they agreed to tight budget constraints for the program as a whole, rather than risk a revolt among more conservative Democrats. These decisions meant that health insurance would ultimately be more expensive and the new system’s financial assistance would be less generous.”

Cohn gives critics their due, especially those who focused on the law’s actual consequences: the higher premiums and out-of-pocket costs that some people face.

“The new rules, like coverage of pre-existing conditions, have made policies more expensive, and Obamacare’s financial aid frequently doesn’t offset the increases. A ‘rate-shock’ wave hit suddenly in the fall of 2013, when insurers unveiled their newly upgraded plans and in many cases canceled old ones — infuriating customers who remembered Obama’s promise that ‘if you like your plan, you can keep it,’ while alienating even some of those sympathetic to what Obama and the Democrats were trying to do.”

But remember: “When the Senate passed its version of the legislation in December 2009, then-Sen. Tom Harkin (D-IA) described the program as a ‘starter home‘ with a solid foundation and room for expansion.”

Yet the Republicans, many of whom reject the whole concept of health care as a right, are determined to rip it all up. Giving scant attention to what’s gone right, they claim the Affordable Care Act is “a disaster.” Their now-leader, President Trump, turned directly to the camera Tuesday night in his address to Congress and announced that he still wants the ACA “repealed and replaced.” If Trump and his fellow Republicans could, they would end it altogether, but they are nervous about the political consequences of depriving millions of Americans of coverage and raising deductibles. As longtime health policy experts Steffie Woolhandler and David Himmelstein — both physicians — point out in the current Annals of Internal Medicine, proposals by House Speaker Paul Ryan and the new HHS Secretary, Tom Price, both Republicans, would slash Medicaid spending for the poor, shift the ACA’s subsidies from the near-poor to wealthier Americans and replace Medicare with a voucher program. This would likely lead to their rout at the polls in 2018 and 2020. The vast majority of Americans want to keep their health care coverage.

We are at a stalemate. Opponents of the ACA have no viable replacement and supporters have no power to stave off the Republican bulldozer.

Is the situation hopeless? In Washington, probably — at least for now. But there are alternatives. As I noted above, two longtime advocates for universal health care, Drs. Woolhandler and Himmelstein, have renewed their campaign for single-payer reform, which candidate Barack Obama applauded when he was campaigning and then rejected after his election as part of those compromises he made to win support from conservative Democrats and the medical and insurance industries. In their Annals article, the two reformist physicians offer evidence that single-payer reform could provide “comprehensive coverage within the current budgetary envelope” because of huge savings on health care bureaucracy. It’s worth reading.

So is a plan put forth by Minnesota State Sen. John Marty. Often described as “the conscience of the Minnesota Senate,” Marty has been an advocate for universal health care since he was elected 30 years ago. He has served as chairman of the Senate Health Committee and now serves as the ranking minority member of the Senate Energy Committee. Often ahead of his times, Marty introduced and eventually secured passage of the country’s first ban on smoking in hospitals and health care facilities. Long before public support had materialized, he worked to ban mercury in consumer products, create a legal structure for public benefit corporations and bring about a “living wage” for workers. In 2008, when he introduced legislation proposing marriage equality for LGBT couples and predicted it could pass in five years, colleagues dismissed him as a Don Quixote. Five years later Minnesota passed marriage equality legislation.

So this lifelong progressive has earned the right to chide his fellow progressives for “merely tinkering” with problems. He writes that “If 21st-century progressives had been leading the 19th-century abolition movement, we would still have slavery, but we would have limited slavery to a 40-hour work week, and we would be congratulating each other on the progress we had made.”

This timidity, Marty acknowledges, might be partially explained by decades of defeat at the hands of powerful financial interests and politicians beholden to those interests. But as a result, many politicians who espouse progressive change have retreated from a “politics of principle” to a “politics of pragmatism.”

Sen. Marty crisscrossed Minnesota to talk directly with citizens about what they need and want in health care. He has now proposed a universal health care system which he calls the Minnesota Health Plan. He’s distilled it into a small paperback book — Healing Health Care: The Case for a Commonsense Universal Health System. I asked him to write an essay for us summing up the plan’s basic principles and the case for it.

— Bill Moyers

A CALL TO ACTION
By John Marty

Our health care system is broken.

We have some of the best health care available in the world, but one of the worst systems for accessing that care. We squander outstanding health care resources — providers, clinics and hospitals, medical research and technology — on a broken system that makes it difficult and expensive for many people to get the care they need.

Our health outcomes, including life expectancy and infant mortality, are worse than most other industrialized countries.

President Obama provided hope during his 2008 campaign, saying health care “should be a right for every American.” Unfortunately, he never proposed universal health care, though the Affordable Care Act (ACA) was a big step forward. It reduced the number of people without health coverage by almost half. It made a (in some cases, literally) lifesaving difference for millions of Americans.

However, even if the ACA were beefed up, it would always leave some people without coverage. In addition, health insurance does not equate to health care — millions of Americans who have insurance still cannot afford the care they need due to exclusions in coverage, copays and deductibles. And because it added even more complexity to our already convoluted insurance system, the ACA is easy to attack.

Republican attacks during the 2016 campaign were wrong; the ACA is not the cause of the problems in the system. Nor is it the solution, despite the good it did for many people.

Now that President Trump has blurted out that “nobody knew that health care could be so complicated,” we will watch the ironic efforts of Republicans to replace the Affordable Care Act — an insurance-based plan, largely modeled on former Massachusetts Republican Gov. Mitt Romney’s “Romneycare,” which, in turn, was largely based on ideas from the conservative Heritage Foundation. We have Republicans attacking a Republican concept. It might be bizarre to watch, but lives are at stake.
We are headed in the Wrong Direction

Most of the health care “reforms” in recent decades aimed at saving money by making sure people don’t overuse health care, putting barriers in their way. These reforms included use of restrictive “networks” of providers, requiring “prior authorization” by the insurance company before treatments could be provided, copays and higher and higher deductibles. The Republican proposals this year head further down that path of adding barriers to care, especially when they cut Medicare and Medicaid.

After four decades of putting barriers between people and medical care, we do make fewer visits to the doctor than people in most other countries.

But it is hard to call this a success. About a third of Americans report that they fail to get the care they need, because they cannot afford to pay for it. Yet even after all those “reforms,” we are spending nearly twice as much as people in most other countries spend. That raises both an ethical and an economic question:

Why would any society make it difficult for its people to access health care? And, if our attempts to make health care less expensive through barriers to care isn’t working, shouldn’t we try a new approach?

Fixing these problems requires fundamental changes in our health care system. We need a new model.
Health care should be covered like police and fire

We could start by looking at other public services. Nobody goes without police and fire protection — nobody has to apply for new “police and fire coverage” each year, nobody has to worry that they may no longer be qualified, nobody has to worry about a $3,000 deductible before the fire department will come. Nobody has to worry that the local sheriff won’t accept their “police insurance” plan. And nobody gets a letter informing them that their police or fire coverage is being terminated, for any reason.

A civilized, humane society that takes care of its people with universal police and fire coverage needs to do the same with health and dental care.
Designing a new system

Before leaving on a trip it is important to know where you are going: Focus on your goals and where you are headed. The same is true for designing a health care system.

Here are some basic principles that need to be followed if a health care system is to serve the public well. The health care system must:

  • ensure all people are covered;
  • cover all types of care, including dental, vision and hearing, mental health, chemical dependency treatment, prescription drugs, medical equipment, long-term care and home care;
  • allow patients to choose their providers;
  • reduce costs by cutting administrative bureaucracy, not by restricting or denying care;
  • set premiums based on ability to pay;
  • focus on preventive care and early intervention to improve health;
  • ensure there are enough health care providers to guarantee timely access to care; and
  • provide adequate and timely payments to providers.

These principles offer an entirely different approach to health care reform. Instead of trying to design a health care system that restricts care, we design a system that keeps people healthy and helps them get care when needed.

Perhaps counterintuitively, that logical health system actually saves money. To illustrate why a system focused on health is less expensive than one based on insurance, consider an analogy between schools and hospitals:

If schools were funded the way we fund hospitals, each teacher would need to spend a half hour or more each day calculating and reporting how much time was spent with each student, along with the amount of supplies each student consumed. Those calculations would be forwarded to the school’s billing office, where a portion of janitorial costs, facility costs, and administrative overhead would be allocated to each student.

The billing office would bill each student’s “education insurance plan,” at a highly inflated price (Hospitals call it a “chargemaster” rate.). Each education insurance plan would negotiate with the school, ultimately reducing their cost by about two thirds. Those families who don’t have any “education insurance” would be liable for the full, inflated “chargemaster” price. Many families would struggle to pay. As a result, the school would also need a collections office.

Would this improve education? No. It would make it worse, shifting teacher and administrator time from education to billing.

Would it save money? No. It would cost much more, adding these significant administrative duties.

We would never want to fund schools the way we fund hospitals.
Our proposal — A Minnesota Health Plan

I have introduced legislation to create a Minnesota Health Plan (MHP), a proposal designed to meet all of the principles mentioned above. The MHP would be governed by those principles, setting it apart from other health systems in its focus on public health and well-being instead of profit or politics. While this plan is designed for Minnesota, a similar model could be used in other states.

The MHP would be a single, statewide plan that would cover all Minnesotans for all their medical needs. Equally important, it would reduce the need for costly medical care through public health, education, prevention and early intervention. It would be governed by a democratically selected board that would be legally bound to those governing principles.

Under the plan, patients would be able to see the medical providers of their choice without network restrictions, and their coverage by the health plan would not end when they lose their job or switch to a new employer.

Dental care, prescription drugs, optometry, mental health services, chemical dependency treatment, medical equipment and supplies would all be covered, as well as home care services and nursing home care. Consumers would use the same doctors and medical professionals, the same hospitals and clinics, but all the payments, covering all of the costs, would be made by the MHP, and everyone would be covered.

There would be no filling out of complex application forms, no worrying whether a provider is “in network” or not, no worrying about whether the treatment was covered or how you are going to pay for the drugs.

The MHP would be prohibited from restricting or denying care to save money, but would lower health care spending through efficiency, the elimination of billing and insurance paperwork, and through public health prevention.

The MHP would restore medical decision-making to the doctor and patient, removing health insurance companies from making treatment decisions. The plan would end not only access problems caused by cost, but also access problems caused by an inadequate number of health professionals and facilities around the state, because the health plan would be required to ensure sufficient providers to meet medical needs around the state.

The plan would be funded by all people, with premiums based on the ability to pay, and a payroll tax on employers, along with existing state and federal funds that have been committed to health care. Those payments would replace all premiums currently paid by employees and employers, as well as all copayments, deductibles and all costs of government health care programs. The premiums paid by all but the wealthiest would be less than the premiums, copays and deductibles they currently pay.

Although the MHP is not cheap, it is significantly less expensive than our current system, and it would provide a full range of health care services to everyone, improving the health of Minnesotans.
The politics of health care reform in 2017

Republican gains in recent years show that progressives need to spell out solutions that would actually fix our problems. We cannot win policy battles by negative attacks against the other side. We will win when the public realizes that our solutions will improve their lives. Thus, when fighting against Republican efforts to eviscerate Medicare, Medicaid and the ACA, saying “no” isn’t enough. We need to articulate a solution.

Republicans typically describe health reform proposals they don’t like as “government health care.” But that is not an accurate description of this plan. The MHP is a patient-directed health plan. It lets people choose the providers they trust, and medical decisions are made by patients and their doctors, not government or insurance companies.

The MHP is publicly governed, which means that it is more accountable to patients than insurance companies. It encourages competition and innovation among doctors and hospitals based on an efficient financing system in the background.

Finally, let’s not forget the ethical dimension. What does it say about a society that allows some of its people to suffer from untreated health crises? Should profit and individual wealth continue to determine who gets care, or should health care be available to everyone?

The proposed Minnesota Health Plan and the principles that underlie it are nothing more than what any caring society would desire in order to ensure good health for all of its people. It is time to replace health insurance for some with health care for all.

 

Bill Moyers is the managing editor of Moyers & Company and BillMoyers.com.

Sen. John Marty has been a Minnesota state senator since 1987. He is former chair of Minnesota’s Senate Health Committee and is currently the ranking member of the Energy Committee.

http://www.alternet.org/personal-health/health-care-doomed?akid=15289.265072.-2n41U&rd=1&src=newsletter1073670&t=30

The Republican House of Horrors Offers a Terrifying Health Care Vision

Republicans have exploited the repeal-and-replace meme with paybacks to some of their wealthiest friends.

NATIONAL HARBOR, MD – MARCH 6, 2014: Congressman Paul Ryan (R-WI) speaks at the Conservative Political Action Conference (CPAC).
Photo Credit: Christopher Halloran / Shutterstock.com

Halloween arrived early this year featuring the Republican house of horrors seeking to fulfill their long lust to repeal the Affordable Care Act.

While there are legitimate criticisms of the ACA—notably the 28 million still uninsured and its failure to limit escalating out-of-pocket costs—the coverage gains made through the ACA, through Medicaid expansion and the crackdown on insurance abuses, are largely eviscerated by the GOP plan.

Instead we have a plan that again fetishizes a market-based health care fundamentalism that saw the U.S. plummet in a wide array of health care barometers, including infant mortality and life expectancy rates and people skipping needed care due to cost compared to the rest of the developed world, especially before the ACA.

With the hodgepodge plan hurriedly released Monday night, the House majority attempts to straddle growing public support for a government role in establishing health security for the American people and approval of the Tea Party crowd that views any fingerprints of public protection as akin to Satanism.

The bill fails on both counts, while also betraying promises made by candidate Donald Trump that “we’re going to have health care for everybody” that is “far less expensive and far better.”

The principal effect of the new bill will be the loss of existing health coverage for tens of millions of people, without any restraints on health care industry pricing practices that add up to massive health insecurity for the American people.

Pretending to retain popular components of the ACA, the bill offers refundable tax credits to replace the ACA subsidies to buy private insurance, temporary continuation of the ACA Medicaid expansion, and requiring insurers to sell insurance to people with pre-existing conditions. But it’s like fools gold, each component sabotaged by the not-so-fine print.

Some lowlights:

  • Medicaid expansion, the mechanism of most of the ACA expanded coverage, is temporarily retained, but open ended federal funding would be ultimately replaced by a cap on federal payments that would encourage financially strapped states to slash eligibility of those covered and sharply cut covered services.
  • Refundable tax credits would provide less financial support than the current ACA subsidies, and by most initial analyses provide far less help for low and moderate-income people.
  • A 30 percent premium penalty surcharge on people who allow their “continuous coverage” requirement to lapse completely undermines the false promise that the bill retains the ban on insurers denying coverage for people with pre-existing health conditions. Even through the ACA health exchanges, insurers routinely change plan designs yearly in ways to increase out of pocket costs and limit patient choice through narrower networks. The surcharge will increase insurer incentives to engage in these practices.
  • Cuts in minimum covered health benefits, services now required by the ACA. Those would expire in 2020.
  • Elimination of funding for Planned Parenthood is a significant attack on women’s overall health care. Planned Parenthood clinics provide a wide array of needed health services.
  • Reduced funding for public health. Elimination of the ACA’s Prevention and Public Health Fund will disproportionately harm low-income people and patients with chronic illnesses like diabetes and heart disease that will worsen the health of communities and facilitate the spread of infectious diseases. As reported today by Vox, affected programs include the federal vaccines program, and programs to reduce heart disease and hospital acquired infections.

The architects of the new bill have exploited the repeal and replace meme with paybacks to some of their wealthiest friends and donors.

The draft bill includes a roll back of most corporate and high income taxes used to pay for the ACA, and, “as Rep. Keith Ellison has noted, a tax cut for wealthy people’s investment income and tax deduction for health care CEOs making more than $500,000 a year.”

If you follow the rhetoric of the repeal-and-replace crowd, they pay a lot of lip service to restoring “freedom” and “liberty.” But their approach to health care restricts freedom in the most personal aspect of our lives: health care.

Freedom to choose junk insurance has nothing to do with getting the care we need. In fact, it is the false choice of a faux freedom. This bill lets insurance shape what procedures doctors do, what drugs we take, and even which doctors we can see.

Nurses know there is only one real fix for our broken, dysfunctional, profit-focused health care system—an improved Medicare-for-all system, much as the rest of the developed world assures health care for its people.

NNU’s California affiliate, the California Nurses Association, is sponsoring a bill in California that could become the national model as an alternative to both the ACA and the fraudulently named GOP American Health Care Act.

http://www.alternet.org/economy/aca-replacement-terrifying?akid=15277.265072.oPECsp&rd=1&src=newsletter1073557&t=8

12 Glaring Omissions, Contradictions and Lies Bernie Sanders Spotted in Trump’s Address

NEWS & POLITICS
The Vermont senator slammed the president’s speech in a video response.

Former Kentucky governor Steve Beshear issued a formal Democratic response to Trump’s address to Congress Tuesday. But the most blistering reply may belong to Vermont Senator Bernie Sanders, who took to Facebook shortly thereafter. “I wanted to say a few words about what [Trump] didn’t say, because when you analyze the speech sometimes what is more important is what somebody does not say as opposed to what they actually say,” he began.

Below are 12 glaring omissions, contradictions and lies Sanders spotted in Trump’s address.

1. Social Security and Medicare

“At a time when over half of all older Americans have no retirement savings, I did not hear President Trump say one word, not one word about Social Security or Medicare,” Sanders pointed out.

“During the campaign, as we all remember, President Trump promised over and over and over again that he would not cut Social Security, Medicare or Medicaid. But in his first address [to Congress], he didn’t even mention Social Security or Medicare once, not a single time.”

While Treasury Secretary Steven Mnuchin insisted the programs would not be touched in an interview this past weekend, President Trump’s budget director, Mick Mulvaney, has defended such cuts.

“I urge President Trump, keep your promises, tell the American people, tweet to the American people that you will not cut Social Security, Medicare and Medicaid,” Sanders said.

2. Income and Wealth Inequality

Trump’s speech to Congress briefly touched on poverty in America. However, Sanders “did not hear President Trump mention the words ‘income and wealth inequality’ or the fact that we now have the widest gap between the very rich and everyone else since the 1920’s.”

3. Campaign Finance

“I did not hear President Trump mention the fact that as a result of the disastrous Citizens United Supreme Court decision, a five-to-four decision, we now have a corrupt campaign finance system that is allowing billionaires to buy elections and undermine American democracy,” Sanders said.

To the first-time politician who has repeatedly boasted about funding his own campaign, Sanders asked, “How could you give a speech to the nation and not talk about that enormously important issue?”

4. Voter Suppression

In his speech, President Trump used the phrase “guided by the well-being of American citizens.”

“[But] not only did President Trump not mention the issue of voter suppression, what Republican governors are doing all over this country to make it harder for people to participate in our democracy, but the truth of the matter is his administration is now working, working overtime, with Republican governors to make it harder for young people, low-income people, senior citizens and people of color to vote,” Sanders explained. “That is an outrage.”

5. Climate Change

Perhaps most astoundingly, at a time when the scientific community is virtually unanimous in telling us that climate change is real, that it is caused by human activity, that it is already causing devastating problems in our country and all over the world, I did not hear President Trump say one word, not one word, about the need to combat climate change, the greatest environmental threat facing our planet,” Sanders hammered.

Not only did Trump not mention climate change, “he pledged to increase our dependency on fossil fuels,” Sanders added.

6. Criminal Justice

“At a time when we have more people in jail than any other country on earth, disproportionately African American, Latino, Native American, I did not hear President Trump say one word about how he was going to fix a broken criminal justice system,” Sanders pointed out.

“Yes, we must support the hard work of men and women in the police departments, in the sheriff’s departments all over this country, but we must also end the disgrace of having more people in jail than any other country on earth,” he added.

7. Higher Education

“At a time when we need the best-educated workforce in the world to compete in a highly competitive global economy, I did not hear President Trump say one word, not one word, about the need to lower the cost of college and to do what countries all over the world are doing, and that is to make public colleges and universities tuition-free,” Sanders said.

8. ‘Drain the Swamp’

“During his campaign, President Trump told us that he was going to take on Wall Street and ‘drain the swamp,'” Sanders reminded viewers. “Well, the swamp, big-time, is now in his administration, which has more millionaires and billionaires than any presidential administration in history.”

“Amazingly enough, for somebody who was going to ‘drain the swamp,’ who’s going to take on Wall Street, his chief economic adviser, Gary Cohn, is the former president of Goldman Sachs, one of the major financial institutions that pay billions of dollars in fines for their illegal activity,” Sanders added.

9. Glass-Steagall Act

“I did not hear President Trump say one word about another campaign promise that he made to the American people, and that was to reinstate the Glass-Steagall Act.”

In his speech, President Trump proposed a $1 trillion investment in American infrastructure, “but the specifics of the financing plan that he has provided us with so far are absolutely wrong,” Sanders concluded. “We cannot rebuild our infrastructure by providing billions of dollars in tax breaks to Wall Street and large corporations.”

10. Clean Water Rules

“Donald Trump said tonight that we need to ‘promote clean air and clean water.’… I had a difficult time not laughing out loud when he said that,” Sanders admitted, since, “On this very, very day, he signed an executive order rolling back President Obama’s clean water rules and has appointed the most anti-environmental EPA administrator in our nation’s history.”

11. Military Spending

“President Trump said [Tuesday night] that he wants to substantially increase funding for the Pentagon,” Sanders recalled. “What he didn’t say tonight is that he will come up with that $84 billion in increased funding for the Pentagon by slashing programs that benefit the working people of this country, that benefit the elderly, that benefit the children, the sick and the poor.”

12. Prescription Drug Costs

“As he did during his campaign, Donald Trump claimed that he would bring down the cost of prescription drugs,” Sanders told viewers. “A few weeks ago, he even said that the pharmaceutical industry was ‘getting away with murder,’ but if Donald Trump really wanted to take on the pharmaceutical industry, he would have told his Republican friends in the House and the Senate to pass legislation, which I [re]introduced today with 20 senators allowing Americans to import safe low-cost medicine from Canada.”

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6 Diseases That Could Skyrocket or Become Far More Deadly If the Affordable Care Act Is Repealed

PERSONAL HEALTH
Bernie Sanders may have been underestimating when he said 36,000 per year will die if the health care law is dashed.

Photo Credit: Shutterstock.com

When senators Bernie Sanders and Ted Cruz debated the merits of the Affordable Care Act of 2010, aka Obamacare, on February 7, Sanders had a dire prediction: “We are moving into an era where millions of people who develop terrible illnesses will not be able to get insurance, and God only knows how many of them will die.” The Vermont senator, who favors a single payer or “Medicare for all” system, was right to be concerned. It remains to be seen when or how Republicans in the U.S. Senate and the House of Representatives will repeal the ACA; Sen. Rand Paul has been complaining that repeal is taking much too long and that fellow Republicans don’t appear to be in a hurry to repeal it. But the Urban Institute estimates that if and when Republicans do repeal the ACA, “The number of uninsured people would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people”—and Sanders has predicted that “36,000 people will die yearly as a result.”

Sanders is not exaggerating about the potential death toll; if anything, he is being optimistic. In 2009, a pre-ACA Harvard Medical School/Cambridge Health Alliance study found that almost 45,000 Americans were dying annually due to lack of health insurance. Shortcomings and all, the ACA—according to Gallup—has reduced the number of uninsured Americans aged 18-64 from 18% in 2013 to 11.9% in late 2015. And that includes millions of Americans with pre-existing conditions such as diabetes, heart disease and asthma. The ACA has not only made it illegal for insurance companies to exclude people due to pre-existing conditions, but it has also emphasized preventive care and screenings, which can prevent chronic conditions from developing or at least treat them after a diagnosis. Without those protections, it stands to reason that diabetes, heart disease, cancer and other potentially life-threatening illnesses will be on the rise.

Here are several diseases that are likely to increase or have much worse outcomes if Republicans succeed in abolishing Obamacare and render millions of Americans uninsured.

1. Diabetes

According to the American Diabetes Association, 30 million Americans suffer from diabetes, while another 86 million have prediabetes. For those 116 million Americans, access to health care is crucial; diabetes, if not managed and controlled, can lead to everything from amputations to heart disease, stroke and blindness. And when prediabetes is managed, patients have a much better chance of avoiding full-blown diabetes. Bearing those things in mind, the American Diabetes Association sent members of Congress a letter in December warning them how dire the consequences could be for Americans with diabetes or prediabetes if the ACA is repealed without a suitable replacement.

“The ACA,” the American Diabetes Association told Congress in the letter, “ended fundamental inequities in access to adequate and affordable health insurance that separated Americans with diabetes from the tools they needed in the fight against the horrific and costly complications of diabetes, including blindness, amputation, kidney failure, heart disease, stroke and death. Repealing the ACA will create huge access barriers for millions of Americans, especially if no fully defined replacement is put in place immediately to meet the health care needs of individuals with chronic health conditions like diabetes.”

In 2016, medical researchers Rebecca Myerson and Neda Laiteerapong examined the ACA’s possible effects on diagnosis and treatment of Type 2 diabetes. The physicians found that 23% of American adults, aged 18-64, with diabetes lacked health insurance in 2009/2010, but said it was “likely that a significant fraction became insured in the subsequent years due to ACA provisions.”

2. HIV/AIDS

Jennifer Kates, director of HIV policy for the Kaiser Family Foundation, has described the ACA as a “watershed moment” for Americans living with HIV, and the Centers for Disease Control called it “one of the most important pieces of legislation in the fight against HIV/AIDS in our history.” Kaiser research has indicated that 200,000 HIV-positive Americans may have gained coverage through the ACA, and according to the AIDS Foundation of Chicago, the ACA brought insurance to 12,000 HIV-positive Illinois residents.

With HIV treatment, one of the goals is avoiding full-blown AIDS. In a recent article for The Advocate, Carl Schmid, deputy executive director of the AIDS Institute, warned that ACA repeal could be devastating for Americans living with HIV and that access to treatment can be a matter of survival.

“If Congress repeals the ACA without simultaneously replacing it with programs that ensure comprehensive health coverage for the same, if not more, individuals, the private insurance market will become unstable—and people with HIV and others would lose access to the care and treatment that they rely on to remain healthy,” Schmid said. “People with HIV, who depend on a daily drug regimen, cannot risk losing access to their health coverage—not even for a single day… We cannot afford to go backwards by eliminating or destabilizing the health care that the ACA provides.”

3. Cancer

In January, Gregory Cooper and his colleagues at University Hospitals’ Cleveland Medical Center in Ohio released a study that compared access to cancer screenings before and after the ACA, which they found was making it easier to obtain mammograms but needed to do more to encourage colonoscopies. Cooper, reflecting on GOP plans to repeal the ACA, stressed that the U.S. needs more cancer screening, not less, saying, “If you take away people’s health insurance and they’re going to pay out of pocket for health care, are they going to get a mammogram, or are they going to buy food? People are going to do what gives them the best benefit in the short term, which is food and shelter.”

Amino, Inc., researching 129 insurance companies, has offered some estimates on possible out-of-pocket costs for cancer screening in a post-ACA environment; in Alaska, for example, the costs could be almost $500 for a routine mammogram or $2,565 for a colonoscopy. And as Cooper pointed out, Americans will put off or avoid potentially life-saving tests when they become cost-prohibitive.

4.  Blood Pressure and Hypertension

In 2015, researchers at George Washington University School of Public Health released a study on the effect the ACA was having on hypertension, a major factor in heart disease and stroke. The researchers reported that 78 million Americans suffer from hypertension and that “lack of insurance coverage is a critical barrier to better treatment of hypertension,” and they predicted that if ACA expansion continued, it “would lead to a 5.1% increase in the treatment rate among hypertensive patients.”

5. High Cholesterol

In 2015, the Harvard T.H. Chan School of Public Health published a study that linked the ACA with better outcomes for three conditions: diabetes, high cholesterol and high blood pressure. The study found that uninsured people suffering from any of those conditions were much less likely to find out they had a problem, whereas insured people had a 14% greater chance of finding out if they had diabetes or high cholesterol and a 9% greater chance of finding out they had high blood pressure. And for those who those who were diagnosed, the Chan School found, being insured greatly improved one’s chances of controlling blood sugar, total cholesterol or systolic blood pressure.

Joshua Saloman, a senior author of the study, said, “These effects constitute a major positive outcome from the ACA. Our study suggests that insurance expansion is likely to have a large and meaningful effect on diagnosis and management of some of the most chronic illnesses affecting the U.S. population.”

But instead of insurance expansion, Republicans could significantly reduce coverage. Even John Kasich, right-wing governor of Ohio and one of the many Republicans who lost to Donald Trump in the 2016 GOP presidential primary, sounded a lot like a Democrat when he said that while there is “room for improvement” with the ACA, he was worried about what would happen to “these people who have very high cholesterol” if it is repealed without a solid replacement.

6. Asthma

Before the ACA, the term “pre-existing condition” as defined by health insurance companies was far-reaching; anything from multiple scleroses to kidney disease to anemia was grounds for rejecting an application for coverage. For people with asthma, obtaining health insurance was difficult or impossible. 17.7 million adults, according to the Centers for Disease Control, suffer from asthma in the U.S., and when asthma is not treated or controlled, it can become life-threatening (in 2014, CDC attributed more than 3600 deaths annually in the U.S. to asthma).

In 2013, a Harvard Medical School study cited lack of health insurance as the main reason asthma care for young adults deteriorated when they turned 18; emergency room visits became more frequent, and medications often became cost-prohibitive. But with the ACA’s implementation, young asthmatics could stay on their parents’ health plans until 26—and asthmatics, regardless of age, could not legally be refused coverage because of their condition. With full ACA repeal, however, it could once again become legal for insurance companies to deny coverage to asthmatics. And even partial ACA repeal could make asthma care cost-prohibitive.

While ACA repeal is likely, it remains to be seen what, if anything, Republicans would replace it with. Rep. Steve King has made it clear he couldn’t care less if the ACA is repealed without a replacement. However, Rep. Tom Price, President Trump’s nominee for secretary of the U.S. Health and Human Services Department, has proposed replacing it with a plan that would eliminate Medicaid expansion, thus making coverage more expensive for Americans with preexisting conditions. And President Trump has promised that after the ACA, Americans can look forward to more comprehensive coverage at much lower prices. But it’s an empty promise because he has yet to offer any specifics.

In other words, Republican plans for an ACA alternative range from terrible to woefully inadequate to nonexistent. To make matters worse, Rep. Paul Ryan is still pushing for Medicare privatization, meaning that Americans who suffer from ACA repeal could be facing additional hardships if they live to see 65. With Republicans going out of their way to make access to health care difficult or impossible for millions of Americans, the future looks grim for anyone suffering from cancer, HIV, hypertension or other potentially deadly illness.

Alex Henderson’s work has appeared in the L.A. Weekly, Billboard, Spin, Creem, the Pasadena Weekly and many other publications. Follow him on Twitter @alexvhenderson.

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Milo Yiannopoulos isn’t ready for “Real Time” and it shows

Bill Maher’s public service:

Most people have no idea who Milo is, except that he claims to be “Dangerous.” Friday night, Bill Maher showed them

Bill Maher's public service: Milo Yiannopoulos isn't ready for "Real Time" and it shows
(Credit: Getty/Drew Angerer/HBO/Salon)

When it was announced that this week’s episode of HBO’s “Real Time with Bill Maher” would feature so-called “right-wing provocateur” Milo Yiannopoulos, some people freaked out. Many seemed to believe that bringing Yiannopoulos on the show would legitimize a noxious professional troll, as if that horse hadn’t already escaped the barn when America elected one president.

Journalist Jeremy Scahill, co-founding editor of The Intercept, canceled his own booking in protest. In his one-on-one segment with Maher at the top of the show, Yiannopoulos called that approach out: “If you don’t show up to debate, you lose.” On one hand, not every debate is worth sitting in the makeup chair for. (I’ve seen the Milo show; I’ve seen better.) But Yiannopoulos isn’t leading a political movement; he’s an attention-seeking troll. They don’t feed on legitimacy, but rather scandal and outrage, which Scahill helped deliver. For my part, I was irritated that I’d have to sit through an interview with this guy before getting to Leah Remini’s Scientology Dirt Bag, so it’s not like I had a high horse to climb off of.

It’s easy to forget, if you don’t live on the Internet, that most people in America — and quite possibly most “Real Time” home viewers — likely have no idea who Milo is or if they should care about him at all. (Third *NSync alum from the right?) If their first up-close exposure to Milo Yiannopoulos, C-Lister Famous for Something or Other, was last night’s “Real Time,” I can’t imagine they now understand what all the fuss is about.

Yiannopoulos came out quite saucy and self-satisfied — ain’t I a stinker? — so Maher, ever the comedy veteran, heckled him right out of the gate: “You look like Bruno.” Milo pouted, and then turned his exaggerated frown into a smirk after a beat. “You know I told [the make-up artist] to dial down the contouring.”

Despite their flirty greetings, Maher didn’t let Milo off easy. They agreed on a few things, like how liberals are too easily offended, but throughout the interview, Milo seemed squirmy, a bit flustered and obviously outmatched by his host. Maher wasn’t interested in gossiping about Lena Dunham, Amy Schumer and Sarah Silverman, whom Milo lamely joked were funny before they “contracted feminism.” In fact, he dismissed most of Milo’s low-hanging outrage-bait as just kind of stupid.

Maher’s challenge here was not being cast as Principal Skinner arguing with Bart Simpson, and for the most part, he succeeded. “You’re wrong about certain things,” Maher tells him flatly, giving examples from Milo’s own spiels: “Black Lives Matter is a hate group. There’s no such thing as white privilege.”

Maher, a consistent atheist, also dinged Yiannopoulos for “bullshit stupid thinking” when Milo gave Catholicism a pass he doesn’t extend to other religions.

Yiannopoulos insisted that he’s funny and that his jokes “build bridges.” All he cares about, he claimed, is free speech and free expression, which he described as “now a conservative position.”

“I’m the guy who always defends jokes, right up to the point where they pointlessly hurt people,” Maher said, bringing up the campaign of vicious harassment against “Ghostbusters” star Leslie Jones that got Yiannopoulos banned from Twitter.

Milo’s defense was a mess of facile talking points. “I like to think of myself as a virtuous troll,” he said. He also claimed, “What actually hurts people is murder, violence. Mean words don’t hurt people.”

“Which some people would say you’ve incited,” countered Maher, though he didn’t give any concrete examples.

“They would be idiots,” said Yiannopoulos.

For a couple of years in the 1980s, my family lived in Germany, where Nazi symbols were, for very understandable reasons, forbidden. As an earnest 7-year-old who read a lot of children’s literature set during World War II, it freaked me out to see swastikas scratched and inked into naughty graffiti, presented with as much gravity and political intent as butts-and-boobs doodles were back home. Little kids test social boundaries all the time. They’re drawn to the illicit — like giggling over Nazi symbols, which they know are bad but don’t quite understand — because that which is frightening for abstract reasons can also be thrilling, even titillating. Part of growing up — as I hope the kid at my Catholic school who was responsible for that graffiti did, eventually — is learning how one kid’s abstract illicit thrills can be another person’s concrete and dangerous threats, and adjusting your behavior accordingly.

Yiannopoulos is an intriguing conundrum because even though he’s an out gay man in his 30s, not a doodling child, he refuses to connect his own flippant denigration of gay people as hyper-sexed, druggy and untrustworthy — abstract jokes he’s in on — to the concrete threat of discrimination or even violence that LGBT people face from those who may feel emboldened or justified by those attitudes. Maybe he feels those fears are idiotic. Most of his fans are likely in it for the dark thrill of an illicit giggle alone: the permission to laugh at a gay joke because a gay man made it. But how grotesque of a spotlight-chaser does one have to be to ignore the possibility of the fan that isn’t? And how narcissistic is it to forcibly extend that “in on the joke” intimacy to those who haven’t issued an invitation first, like women, black people or Muslims?

On one hand, it’s a pity Maher didn’t have time to delve that deep into a discussion of the philosophy of “j/k lol” with Yiannopoulos. On the other hand, it’s not like Milo said anything on “Real Time” that indicated he’d be up for a challenging intellectual discussion about where the line is, and what it’s used for.

Throughout the segment, Milo demonstrated that as far as provocateurs go, he’s nowhere near Maher’s level. You can disagree with Maher’s positions on politics and religion, but he’s a pro who can back a gag or a flat statement up with reason and consistency. Milo’s a snarky brunch friend on a second round of Bloodies for people who don’t have snarky brunch friends. (Get off Gab once in a while and buy a round, fanboys! You can get your fill of Lena Dunham jokes in person.) He’s managed to build a public speaking and publishing career on little more than being shameless, disgusting and reasonably attractive at the same time. America, land of opportunity!

Maher closed the segment by scolding his audience. “Stop taking the bait, liberals!” he cried. “You’re all freaking out about this fucking impish British fag! You schoolgirls!”

Maher’s using his words as a blunt instrument here, but the sentiment’s not wrong. Exposing Yiannopoulos as a lightweight “famous for doing nothing” vacuous Twitter celeb on TV — as Maher just did — is likely going to be more effective at limiting his cachet and influence than inadvertently building up his illicit, underground cred through outrage. Pushing a malignant thing like Milo Yiannopoulos out into the spotlight isn’t necessarily normalizing it. Sometimes the cliché is true, and sunlight really is the best disinfectant.