Donald Trump literally knows nothing: The moronic fiction of his “really, really good” health care plan is now obvious

Trump’s idiotic pronouncements on health care can’t conceal that he has no plan and doesn’t understand the details

Donald Trump literally knows nothing: The moronic fiction of his "really, really good" health care plan is now obvious
(Credit: Getty/Saul Loeb/Eduardo Munoz Alvarez/Photo montage by Salon)

President Donald Trump’s ridiculous plan to repeal and replace the Affordable Care Act would be slightly less disgusting if we were confident that he knew what the hell he was talking about. Throughout the past two years, though, it’s impossible to point to a single instance in which anyone, including Trump’s staff and supporters, could say that he totally nailed the nuances of the issue. Not once — ever.

Sure, he’s regularly claimed that the ACA is collapsing, contrary to the recent scoring by the Congressional Budget Office. He’s also mentioned that the ACA is a disaster. Same situation. He’s mentioned that under his replacement plan, everyone will have coverage that he or she loves and will save a lot of money in the process.

Oh, and he said something about keeping the ACA’s language about pre-existing conditions and “children living with their parents.” He noted the latter on a small, seldom-watched show called “60 Minutes,” despite the fact that there’s nothing in the law about covering kids who live with their parents. Yeah, it’s one of the top two most popular aspects of the ACA, and he couldn’t accurately describe it:   The law allows adult children to stay on their parents’ insurance until age 26 — regardless of where they live.

Perhaps Trump’s ignorance about the law is allowed to slide because his supporters know even less about the ACA than he does. Though it’s not just when Trump talks about the ACA that he sounds like an eighth-grader bluffing his way through an essay exam. That describes everything he says about health care in general. The president who chose health care reform as his big legislative goal in his first 100 days doesn’t know anything about how health care works.

As part of his effort to resurrect a major legislative crash and burn, what’s been nicknamed “Trumpcare,” the president fielded a question last week about the status of his negotiations with the House Freedom Caucus, the far-right hotheads largely identified with members of the Tea Party.

During a joint press conference with the president of Italy, Trump said, “The plan gets better and better and better, and it’s gotten really, really good. And a lot of people are liking it a lot. We have a good chance of getting it soon; I’d like to say next week, but it will be — I believe we will get it, and whether it’s next week or shortly thereafter.”

Words have no meaning for Trump.

“It’s gotten really, really good” isn’t the language of a man who’s familiar with the details. In fact, he can’t say anything specific about anything related to health care, for two reasons. First, he just doesn’t know. Generally, the ongoing rule about Donald Trump is that he knows nothing. Second, the details of Trumpcare, at least in terms of what’s being discussed partly in secret, totally undermine his promises for universal, affordable coverage. Discussing those details out loud would expose the game. Oh and incidentally, “gotten really, really good” might sound familiar because it’s the same awkward phrase Will Ferrell once used in a George W. Bush parody video back in 2004 (check the YouTube clip at 40 seconds in). In other words, at least until recently, describing how things have “gotten really, really good” was merely a joke at the expense of stupid people. Now the actual president talks like that. Hashtag Make America Great Again.

Nevertheless, if Trump were to actually tell us what’s in the latest version of Trumpcare, he might have to acknowledge that there’s no legislative text; there’s no actual bill yet. Nothing exists on paper. He’d also have to acknowledge that this new iteration won’t be more affordable and indeed that many more people will be kicked off their insurance policies under the new “really, really good” version of Trumpcare than would have lost insurance under the now-defunct American Health Care Act.

Donald Trump literally knows nothing: The moronic fiction of his “really, really good” health care plan is now obvious.

The Washington Post’s Eugene Robinson called Trumpcare 2.0 “comically bad.” But that language understates the awfulness of what’s being debated. Robinson reported last week that proponents of this new version are claiming it would protect essential health benefits (covering things like “hospitalization, maternity and emergency care” according to Robinson) and protect people with pre-existing conditions.

But here’s the catch. States will be able to opt out of covering essential health benefits. We can assume most red states will opt out, not unlike the way they opted out of the Medicaid expansion, for no other reason than they hate Obama. Smart. (By the way, the new version preserves the slow phaseout of the Medicaid expansion.) States can also opt out of the pre-existing conditions language as long as they create “high risk pools.” Of course this is totally unacceptable because Trumpcare 2.0 doesn’t prevent insurers from charging dramatically higher premiums for people with pre-existing conditions — basically rebuilding the pre-ACA system of gouging and usury against people who need health care the most.

Making matters worse, especially in the near term, it appears as though Trump is planning to use subsidy payments to customers with existing ACA marketplace policies as potential ransom in the forthcoming battle over a potential government shutdown. To put it another way, if the Democrats don’t agree to support appropriations to build Trump’s ridiculous border wall, Trump will withhold subsidies for literally millions of ACA customers. That means Trump haters in blue states and, yes, Trump fanboys in red states, too. Everyone living below 400 percent of the federal poverty level will lose their subsidies unless the Democrats vote for Trump’s pointless wall, which (not insignificant) was supposed to be financed by Mexico.

If both sides fail to agree, the government will be shut down as of Saturday. So Trump is basically saying, “Yeah, I promised Mexico will pay for the wall. But now that I’m reneging on a major platform plank like the weasel I am, I’m going to hold the lives of millions for ransom.” Yes, this is the bargaining position of the chief executive who pledged in his inaugural address to be the people’s president. America first, etc.

Really, really gotten good? You decide.

Again, we have no choice but to wonder whether Trump has even the slightest idea what’s at stake. Does he know how many of his red-blooded MAGA-hat wearing loyalists will lose their subsidies in this ludicrous cash grab for the border wall? Do his loyalists know? I doubt it. Does he even understand how and why the ACA subsidies are distributed? Does he realize how obvious it is that he’s entirely clueless about what will happen in a government shutdown or that his health care plan will lead to far worse outcomes than the current situation — even if the ACA marketplaces collapse, as he has predicted?

Does he know that the marketplaces are only a part of a more comprehensive pair of Obamacare-related bills containing critically important consumer protections, which are supported by majorities of Americans? No way. He knows none of it. It’s worth repeating this maxim because the more we internalize it, the more we embrace the horror, the better: Trump knows nothing.

 

Bob Cesca is a regular contributor to Salon.com. He’s also the host of “The Bob Cesca Show” podcast, and a weekly guest on both the “Stephanie Miller Show” and “Tell Me Everything with John Fugelsang.” Follow him on Facebook and Twitter.

Trump is forcing Americans to participate in an orgy of unnecessary cruelty

Robert Reich:

Trump’s actions violate every ideal this nation has ever cherished — and we have a moral responsibility to stop it

Robert Reich: Trump is forcing Americans to participate in an orgy of unnecessary cruelty
(Credit: Reuters/Jonathan Drake)
This originally appeared on Robert Reich’s blog.

The theme that unites all of President Donald Trump’s initiatives so far is their unnecessary cruelty.

1. His new budget comes down especially hard on the poor by imposing unprecedented cuts in low-income housing, job training, food assistance, legal services, help to distressed rural communities, nutrition for new mothers and their infants, funds to keep poor families warm and even Meals on Wheels.

These cuts come at a time when more American families are in poverty than ever before, including one in five children.

Why is Trump doing this? To pay for the biggest hike in military spending since the 1980s. Yet the United States already spends more on its military than the next seven biggest military budgets combined.

2. His plan to repeal and “replace” the Affordable Care Act will cause 14 million Americans to lose their health insurance next year, and 24 million to lose it by 2026.

Why is Trump doing this? To bestow $600 billion in tax breaks over the decade to wealthy Americans. This windfall comes at a time when the rich have accumulated more wealth than at any time in the nation’s history.

The plan reduces the federal budget deficit by only $337 billion over the next ten years — a small fraction of the national debt, in exchange for an enormous amount of human hardship.

3. His ban on Syrian refugees and reduction by half in the total number of refugees admitted to the United States comes just when the world is experiencing the worst refugee crisis since World War II.

Why is Trump doing this? The ban does little or nothing to protect Americans from terrorism. No terrorist act in the United States has been perpetrated by a Syrian or by anyone from the six nations whose citizens are now banned from traveling to the United States. You have higher odds of being struck by lightening than dying from an immigrant terrorist attack.

4. His dragnet roundup of undocumented immigrants is helter skelter and includes people who have been productive members of our society for decades, as well as young people who have been here since they were toddlers.

Why is Trump doing this? He has no compelling justification. Unemployment is down, crime is down, and we have fewer undocumented workers in the United States today than we did five years ago.

Trump is embarking on an orgy of cruelty for absolutely no reason. This is morally repugnant. It violates every ideal this nation has ever cherished. We have a moral responsibility to stop it.

Robert Reich, one of the nation’s leading experts on work and the economy, is Chancellor’s Professor of Public Policy at the Goldman School of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. Time Magazine has named him one of the ten most effective cabinet secretaries of the last century. He has written 13 books, including his latest best-seller, “Aftershock: The Next Economy and America’s Future;” “The Work of Nations,” which has been translated into 22 languages; and his newest, an e-book, “Beyond Outrage.” His syndicated columns, television appearances, and public radio commentaries reach millions of people each week. He is also a founding editor of the American Prospect magazine, and Chairman of the citizen’s group Common Cause. His new movie “Inequality for All” is in Theaters. His widely-read blog can be found at www.robertreich.org.

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.”

Trump’s Medicaid assault: Now he’s gutting a social program he promised to protect

The White House plans to slash Medicaid funding and kick people off the program — that’s not how Trump campaigned

Trump's Medicaid assault: Now he's gutting a social program he promised to protect
(Credit: AP Photo/Pablo Martinez Monsivais)

For a long time now, Donald Trump has broadcast to the world that he is different from other Republicans when it comes to the social safety net. While most Republican candidates in the 2016 presidential race hugged the party orthodoxy that called for cuts to and restructuring of social programs, Trump positioned himself as a champion of entitlements.

“I was the first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid,” Trump tweeted a couple of months before entering the 2016 race. “The Republicans who want to cut [Social Security] & Medicaid are wrong,” he tweeted in 2015. After joining the race, Trump was similarly outspoken in his defense of government protections for the poor and the sick.

Throughout the 2016 campaign, Trump defended the idea of using government resources to provide low-income people with health care, insisting that he didn’t want to see anyone “dying in the middle of the street.” When asked how he would go about providing that assistance, Trump pointed to Medicaid. “We have to go and help them through the Medicaid system,” Trump said in September, when asked how he would provide coverage to people who can’t afford private insurance. “A lot of people said, ‘Oh, gee, that’s not the thing to say.’ I said, ‘Well you know what? If I can’t say that, I’m not running for office.’”

The casual observer might walk away from all these statements believing that Trump supports Medicaid and has no intention to do any damage to the program. But at the same time that Trump was campaigning as a Medicaid supporter, he was also pushing to fund the program through block grants, which would slash its finances and force people off the rolls. As president, Trump has continued this war on Medicaid.

Much of the violence that Trump plans to inflict on Medicaid will come through the American Health Care Act, the troubled health care reform bill that Republicans have offered as their “replacement” for the Affordable Care Act. The bill, which Trump and his administration strongly support, calls for a halt to the ACA’s expansion of Medicaid in 2020, and it would place per capita restrictions on the amount of federal funding that states can receive for their Medicaid programs.

All told, per the Congressional Budget Office, the AHCA amounts to a Medicaid funding reduction of $880 billion over the next decade. That’s a massive cut, and it would undoubtedly result in millions of low-income Americans either having their benefits slashed or being kicked off of Medicaid altogether. The budget office found that 24 million people would lose their health coverage under the AHCA by 2026, and those losses “would stem in large part from changes in Medicaid enrollment.”

Trump and his administration want to accelerate this process and worsen it. As noted above, the AHCA currently calls for an end to Obamacare’s Medicaid expansion in 2020. But the White House, in its eagerness to win conservative support for the legislation, is apparently planning to pressure Republicans in Congress to move up that date to the beginning of 2018.

This week brought still more bad news on the Medicaid front. As The Wall Street Journal reported on Wednesday, the Trump administration has communicated to governors that it “will work with states that want to alter their Medicaid programs by imposing work requirements, premiums, emergency-room copayments and other changes.” Imposing work requirements on Medicaid eligibility is an excellent way to cut people off from health coverage without doing much of anything to boost employment.

The notion that Medicaid recipients are just sponging off the government is wildly specious. According to the Kaiser Family Foundation, 63 percent of Medicaid recipients are in families with at least one full-time worker, and an additional 14 percent are in families involved with part-time work. The Center on Budget and Policy Priorities noted that Medicaid, rather than discouraging work, can actually help low-income people find jobs: “Research indicates that comprehensive Medicaid coverage can support work and help beneficiaries take advantage of promising job opportunities without worrying about losing their coverage.”

Imposing a work requirement as a barrier to eligibility, as the Trump administration wants to facilitate, makes it far more likely that unemployed people will lose access to health coverage. If those people become sick and can’t seek treatment, they’ll be less likely to find work. Providing “vulnerable populations with needed care can improve their health, help stabilize their housing or other circumstances, and ultimately improve their ability to work,” the center added.

President Trump, however, is hell-bent on hollowing out the social insurance program’s funding and making it harder for low-income people to have access to health coverage. That’s a terrible policy and a broken promise, one that runs directly contrary to how Trump sold himself to the American public.

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

As a Trump Administration Fast Approaches, Cities and Towns Prepare for Political Resistance

Posted on Jan 5, 2017

By Sally Neas / Yes! Magazine

    Members of 350.org and allies recently gathered outside the Trump transition office in Washington, D.C., to protest the president-elect’s choice for secretary of state. Many municipalities, too, are concerned about the Trump presidency, and in reaction to what they see as threats in the incoming administration are strengthening community self-governance. (betterDCregion / CC-BY-2.0)

Back in March, when Donald Trump was facing off with two now-forgotten candidates for the Republican Party’s presidential nomination, the small town of Barnstead, New Hampshire, was quietly protecting its citizens. At their annual town hall, residents voted unanimously for a city ordinance establishing the right to freedom from forced religious identification.

This inconspicuous action was part of a growing national movement for strengthened community self-governance that has found new purpose as the reality of a Trump presidency fast approaches. It came in the form of a community bill of rights, a charter or ordinance that affirms certain rights within a municipality. Similar bills have granted the right to a clean environment, safe and affordable housing, health care, and worker’s rights, among others.

President-elect Trump’s campaign promises, proposed policies, and cabinet appointments offer little confidence that environmentalists, women, people of color, low-wage workers, Muslims, immigrants, and those who identify as LGBTQ will find protection in federal-level policies. In the years to come, community bills of rights are one strategy for cities across the nation to continue to shelter such populations.

In fact, many cities have already begun. At least 10 major sanctuary cities have reaffirmed their position as such, and some, including San Francisco, have released statements or passed ordinances pledging noncooperation with Trump’s policies. Some municipalities, such as Grant Township in Pennsylvania, already have existing community bills of rights.

In Grant, as is often the case, this legislation arose out of environmental battles. “A few years back, the EPA announced a public hearing about an injection well,” said Stacy Long, an elected official on Grant’s Board of Supervisors. “We were horrified, and thought we would simply clue the EPA in on what a terrible idea it would be in our community.”

But residents quickly realized the EPA was likely to issue a permit. Looking for a different strategy, community members turned to the Community Environmental Legal Defense Fund (CELDF), a nonprofit organization that champions community rights through education and legal support. It worked with Grant Township to write a community bill of rights, which, among other things, included a ban on storing fracked water.

“[Communities] can spend years with normal environmental battles, only to find that they do not have much authority to make a decision at the local level,” said Mari Margil, associate director of CELDF. “We go back with them and help them figure out: Why did they end up in this situation they are in, where they don’t have much in the way of local democratic decision-making authority.”

CELDF’s strategy is fundamentally different from that of other environmental organizations. Instead of working through normal legal channels of permitting and suing, where Margil said activists “can spend years, only to end up getting the thing they did not want,” CELDF works to grant communities fundamental rights over their own natural resources, as was the case in Grant Township. Instead of battling with the gas companies, Grant declared “All residents of Grant Township, along with natural communities and ecosystems within the Township, possess the right to clean air, water, and soil.”

The General Council of the Ho-Chunk Nation of Wisconsin went a step further this September when it voted to amend its constitution to grant rights to nature itself. If approved by the tribe, the constitution will proclaim: “Ecosystems and natural communities within the Ho-Chunk territory possess an inherent, fundamental, and inalienable right to exist and thrive.”

The Ho-Chunk made their stand in solidarity with the Standing Rock Sioux and in recognition of the destructive impact of fossil fuel extraction and development. This type of support demonstrates the role that community rights laws could play under Trump, who has pledged to expand fossil fuel extraction and dissolve the EPA.

Environmental battles often pave the way for human rights protections, as was the case with the Barnstead law. It was aimed directly at Trump’s proposed ban on Muslim immigration and followed on the coattails of another community rights law that prevented water privatization.

“Before the election, I was listening to Trump and getting very concerned,” said Kati Preston, who championed the bill. “I am a Holocaust survivor and know that, in New Hampshire, you can pass laws locally.”

New Hampshire’s uniquely independent political climate makes opposing local legislation an unpopular move for elected officials. But in most states, power—and funding—held at higher levels make local legislation a soft target. State governments preempt local governments, and the Federal government preempts the state. CELDF thus makes a philosophical argument that pushes up against preemption.

“Communities are arguing that they have a right to local governance,” Margil said. “We have a fundamental violation of our democratic rights when we have a state legislature that is overriding our ability to protect our communities, protect our people, protect our land. It is a right to community self-governance that is being usurped by industry, by corporations, by state legislatures working hand in hand with corporations.”

Preemption is one of the pitfalls of community bills of rights, as those in Morgantown, West Virginia, discovered. In 2011, the city passed a local ban on horizontal drilling and fracking within 2 miles of town. Within days, a company seeking to drill in the area sued, claiming the city did not have jurisdiction to regulate such activity. A local circuit court agreed, finding cities to be “creatures of the state.”

In 2012, two New York State judges ruled differently. In response to separate municipal fracking bans, they ruled that local governments do, in fact, have the right to set their own environmental laws. These decisions were a victory for local governments on specific issues. But the idea of the right of communities to local self-government will likely be tested under a Trump administration.

The balance between federal, state, and local governments indeed has a long and fraught history that does not necessarily reflect the progressive intentions of CELDF. Calls for local autonomy and states’ rights have echoed throughout history with nasty undertones. Since pre-Civil War America, southern states asserted local control to maintain the institution of slavery, and Confederate states insisted that they were suffering under federal government infringement. Later, the phrase cropped in segregationists’ response to the civil rights movement, and then again in Richard Nixon’s presidential campaign, which used the phrase “states’ rights” to pander to Southern voters.

And local-level defiance certainly has a similar flavor to the obstructionism common during the Obama administration. Five states initially refused to comply with major provisions of the Affordable Care Act, and after the Supreme Court ruled that bans on gay marriage were unconstitutional, many states defied the ruling and maintained such bans. In fact, in his critique of the ruling, Texas Attorney General Ken Paxton said the court’s ruling reaffirmed the state’s “resolve to … return to democratic self-government.”

Despite its speckled past, local self-governance may play an important role under a Trump administration. Although community bills of rights may not have fully sharpened legal teeth, they do offer assurance to a frightened citizenry and direction to cities wanting to protect civil liberties and work toward environmental sustainability. Although they may be barred from executing policies that conflict with state or federal laws, cities and towns can continue to plan for climate change mitigation, offer social services, and fight hate crime. Community bills of rights provide a framework for these and other measures.

Perhaps the most vital role they play is when considering how change happens. It is often iterative: pioneers lay the moral and legal foundation that creates an impetus for broader change. Early desegregationists set the stage for the civil rights movement.

“I think it is a beginning,” Preston said of her community’s anti-religious-persecution law. “If it spreads, it will send a message that we do not want [religious registration] laws. It is simply that: unless you stand up and be counted, bad things will happen.”

Sally Neas wrote this article for YES! Magazine. Sally is a freelance writer and community educator based in Santa Cruz, California. She has a background in permaculture, sustainable agriculture, and community development, and she covers social and environmental issues. She blogs at www.voicesfromthegreatturning.com.

http://www.truthdig.com/report/item/as_a_trump_administration_fast_approaches_cities_20170105

Republican Congress, Trump plan assault on Medicare

committee-hearing

By Kate Randall
26 November 2016

During his election campaign, Donald Trump declared that he had no plans to make “substantial” changes to Medicare, the government-run health insurance plan for the elderly and disabled that covers 55 million Americans. The president-elect’s web site now says his administration will work to “modernize Medicare” and allow more “flexibility” for Medicaid, the health care program for the poor jointly administered by the federal government and the states.

These are code words signaling the readiness of the incoming administration to work with the Republican-controlled Congress to shift Medicare from a guaranteed government program to a plan with fixed government contributions—or vouchers—and to pave the way for the program’s privatization and dismantlement. Medicaid is to suffer a similar fate.

House Speaker Paul Ryan (Republican of Wisconsin) has been explicit about plans to gut Medicare. Under his plan, the government would give those in traditional Medicare a fixed amount to buy insurance. This amount would be tracked to the country’s overall growth rate or another index, plus a percentage increase, but it would not keep pace with rising health care costs. Seniors would eventually pay a larger share of costs, while government costs would shrink.

In an earlier version proposed by Ryan, cost-sharing—where the government currently pays roughly 70 percent of Medicare costs and beneficiaries pay 30 percent—would flip, leaving seniors responsible for 70 percent of costs and the government only 30 percent.

Skimpy vouchers would replace the current government guarantee, leaving traditional Medicare with a sicker, more costly insurance pool, with higher premiums. The New York Times quotes John K. Gorman, a former Medicare official who is now an insurance consultant, who said, “Regular Medicare would become the province of affluent beneficiaries who can buy their way out of” private plans.

The vast majority of working-class and middle-income seniors would be squeezed out of Medicare and left with narrow network Medicare Advantage plans, which are run by private corporations. Such a shift would have catastrophic consequences for the millions of seniors who rely on Medicare. They would see their access to specialist doctors and hospitals, life-saving treatments and procedures sharply curtailed, resulting in unnecessary suffering and death.

The attack on Medicare is part of a frontal assault to be carried out by the Trump administration against all that remains of the social reforms wrested by the working class from the ruling elite over the last century. None of the social programs enacted in the 1930s and 1960s, including Social Security, the government retirement program, will be outside the scope of the social counterrevolution that is being prepared.

Trump is not the initiator of this class war against working people. It has been underway for decades, beginning in earnest with the election of Ronald Reagan in 1980 and continuing under every succeeding administration, including the eight-year tenures of Democrats Bill Clinton and Barack Obama. The colossal redistribution of wealth and income from the bottom to the top of American society reached record proportions under Obama, whose legacy of falling living standards and worsening economic crisis for tens of millions of workers was a decisive factor in the victory of the fascistic demagogue and con artist Trump.

Trump’s victory, however, with its shift to “fortress America” nationalism, signals a sharp escalation of this class war policy.

No one should take for good coin claims by House Minority Leader Nancy Pelosi and other congressional Democrats that they will wage a serious fight against measures to undermine Medicare. In the short period since the General Election, President Obama and the Democrats have fallen all over themselves to pledge support for the incoming administration, maintaining a cowardly silence over the fact that Trump lost the popular vote by millions of ballots. The trade union bureaucracy has likewise signaled its eagerness to work with Trump in pitting American workers against their class brothers and sisters in China, Mexico and the rest of the world.

Trump’s plans for “flexibility” in Medicaid include transforming funding for the program into block grants for the states, in which a fixed and likely reduced grant would be provided to states to administer the health program for the poor. In those states that have expanded Medicaid under the Obama administration’s Affordable Care Act (ACA), including those run by Republican governors, block grants would mean deep cuts to already meager benefits.

While Trump and the Republicans rail against the ACA, commonly known as Obamacare, and vow to repeal many of its features if not the entire program, the Ryan plan for Medicare draws on some of the ACA’s most regressive features. Since Obama’s signature domestic program became law in 2010, the Department of Health and Human Services (HHS) has worked at breakneck speed to transform Medicare’s fee-for-service payments into a system that rewards doctors and hospitals for cutting costs.

HHS projects that nearly every fee-for-service payment to Medicare will be tied in some way to “value” by 2018. A recent estimate by the Congressional Budget Office anticipates a reduction in Medicare spending under Obamacare of $716 billion from 2013 to 2022.

The ferocity of the coming attacks on the basic social needs of the working class—health care, education, decent-paying jobs, pensions—is prefigured in the gang of billionaire parasites being assembled by Trump to staff his cabinet, virtually all of whom have made their fortunes by savaging workers’ living standards and attacking social programs.

Billionaire Betsy DeVos, Trump’s pick for secretary of education, is a leading proponent of charter schools and vouchers and vehement enemy of teachers and public education. Investor and former banker Wilbur Ross, Trump’s likely pick for secretary of commerce, made his fortune through leveraged buyouts of distressed steel and coal companies. He made billions by downsizing firms, slashing wages and pensions, and selling off what remained for a hefty profit.

The incoming administration has singled out the 2.7 million US federal employees for attacks on jobs, employment security and pensions.

Millions of workers are in for a huge shock when they see the reality behind Trump’s promise to “Make America Great Again.” The realization that they have once again been deceived by a capitalist con man will fuel the growth of social opposition.

Democratic Party politicians, on the other hand, who insisted during the election that Trump was “unfit” for the presidency, are now working to accommodate themselves to his agenda. It is not the wealthy upper-middle class that forms the Democrats’ main base of support, beyond Wall Street and the military/intelligence establishment, that will be hammered. Indeed, as the stock market surge since Trump’s election indicates, they stand to make themselves even richer off of the misery of working people and youth.

This party of big business, from Barack Obama and Hillary Clinton to Bernie Sanders and Elizabeth Warren, is a thousand times more fearful of a mass movement of the working class against capitalism than it is of Trump’s ultra-right agenda.

That can be halted only by a political movement of the working class consciously directed against the entire political order and the capitalist system it defends.

http://www.wsws.org/en/articles/2016/11/26/medi-n26.html