Tag Archives: republican party

Interstate Health Insurance?

If the Republicans win the general election in the fall and Obamacare is repealed, what happens? Several common threads run through the various strategies from Republican front runners.

The most odious feature of the the Patient Protection and Affordable Care Act (PPACA) among conservatives seems to be the mandate, so it will go. If you don’t want to buy insurance, you don’t have to. If for example you get pneumonia from an untreated infection, you can go to the hospital and get free care. For the hospital to remain in business however, they have to cover the cost of the “free” care with higher costs to the paying customers – the insurance companies. And remember that emergency care is the most expensive way to deliver care, bar none. The cost to those who buy insurance will go up to subsidize the uninsured. This doesn’t do anything to lower costs, it’s what we had before and it is a silly way to keep everybody healthy.

So everyone, republicans included, realizes that steps need to be taken to bring down the cost of healthcare and one thing you hear constantly is that allowing the purchase of insurance across states lines will increase competition and thereby lower costs. Will it work? It works with widgets. If someone in another state sells widgets at a lower price than that can be bought here, then go there to buy where the price is lower.

The story with health insurance is quite a bit more complex. The PPACA includes provisions that already allow the purchase of health insurance across state lines. The difference between the PPACA compact provisions and earlier interstate sales provisions are that the PPACA requires all states to comply with a minimum level of insurance coverage. But interstate sales is not happening, so why?

Insurance companies make money by negotiating prices for “healthcare commodities” – doctors fees, hospital costs, laboratory costs, drug costs etc. All these costs are negotiated to control costs to the policy holders. The nature of the policies sold in a state are regulated in the state.

Georgia, Maine, and Wyoming are states that have taken the step to promote interstate sales. The problem is not that regulations prevent it, but rather no insurers are interested. In none of the aforementioned states, has an out of state insurer expressed interest in selling in those states. This is partly due to the fact that out of state insurers will still have to abide by the rules in the states where they sell.

Eventually it may happen. There is a case to be made that costs are lower the bigger the pool of insured, and crossing state lines could expand the pool for a given insurer. In some markets such as large metropolitan areas that cross state lines, this could happen sooner rather than later, but the development will take time. How how much will this lower the cost to a consumer?

Experts cite the fact that insurance costs depends on how healthy a given group of policy holders are. Arkansans currently have the highest obesity rate in the country, Colorado the lowest. If an insurer from Colorado wanted to sell in Arkansas, the policy costs would be base on the obese Arkansas pool, not the fit Colorado pool. Consequently what cost savings may occur would be small.

In a final irony, a catch-22 of sorts, interstate sales of insurance means federal regulation, anathema to generally states rights conservatives.

Torture Doesn’t Work

If all it took to stop ISIS was enough bombing or troops on the ground, then we should be in command, but we are are battling an asymmetric war. The enemy is smaller and weaker but fighting in a way that is difficult for superpowers to address. They have a considerable grasp of social media to attract adherents, they are absolutely free of any respect for the “rules of engagement” such as the Geneva Convention, and distribute their form of terrorism world wide.
So what is our next president to do?

It appears that many of the republican candidates are ready to follow the enemy’s lead into an unethical, immoral, even illegal battle plan. Basically many of the republican candidates are ready to become exactly what we are trying to stamp out. Consider the issue of torture.

Donald Trump has commented “Would I approve waterboarding? You bet your ass I would – in a heartbeat, and I would approve more than that.”

Ben Carson has suggested that not employing torture is equivalent to “fighting a politically correct war.”

Marko Rubio said “ I do not support telegraphing to the enemy what interrogation techniques we will or won’t use.” He doesn’t want to deny “future commanders in chief and intelligence officials important tools for protecting the American people and the U.S. homeland.”

Jeb Bush feels that the torture techniques employed by his brother were effective in producing intelligence, even though an Senate Intelligence Committee report said that the techniques previously employed were more brutal than previously described, and ineffective at producing any useful intelligence. He suggested there may be occasions when brutal interrogations are called for to keep the country safe.

The real question is does torture really work? The short answer is most likely no. In spite of a history of many, many years of use the only evidence of efficacy is anecdotal, and frequently that is wrong. The scientific community has never established that coercive interrogation methods are an effective means of obtaining reliable intelligence information. Before we undertake what is obviously unethical and even illegal activity in the name of national defense, the burden of proof ought to be on those who wish to torture.

The only real argument for torture is inevitably the “ticking time bomb” scenario. Suspects are being held that know the whereabouts of a bomb which if exploded will kill lots and lots of people – you pick a number. Torture till they talk and stop the bombing. But there are so many assumption here as to be preposterous. How do you know there is a bomb? How do you know the suspects you torture are actually knowledgeable? How do know that they won’t just say what they think you want to hear to avoid more pain?

What little science which has been applied in considering torture is negative. Human memory is not all that accurate and it gets even worse under stress. Even without stress, people are poor eye witnesses as just one example. People may not have any useful information and no amount of pain can create it.

Lastly there is evidence that lasting harm comes to those who do the torturing. It is not good for the human psyche to purposely inflict pain on others. Torture has not been shown to be effective, it is harmful to both the torturer and the tortured, it sullies our image as a moral leader in the world, and ultimately makes us less safe.

Military Preparedness and Global Warming

Arkansas Pols in particular and the Republican dominated congress more generally don’t seem to think much of the risk of global warming. Jim Inhofe, the ranking member of the Environment and Public Works Committee in the US Senate famously said something to the effect that global warming is the greatest hoax ever played on the American people. Actually he said this hoax was second only to the separation of church and state, but we’ll save that for another discussion.

The Environmental Protection Agency begs to differ. After years of planning they have released a clean power plan aimed to curb the release of Carbon Dioxide from the burning of fossil fuels. This will not only reduce the risk of global warming but also clean our air of a number of pollutants harmful to health.

Another agency that disagrees is the Pentagon. They think global warming is real and in fact have released a report ”2014 Climate Change Adaptation Roadmap.” Secretary of Defense Chuck Hagel, in an address to the Conference of the Defense Ministers of the Americas said that “Rising global temperatures, increasing sea levels and intensifying weather events will challenge global stability and could lead to food and water shortages, pandemic disease and disputes over refugees and resources.“

Secretary Hagel went on: “The loss of glaciers will strain water supplies in several areas of our hemisphere. Droughts and crop failures can leave millions of people without any lifeline, and trigger waves of mass migration.”

Without claiming that the troubles in the near east are due directly to global warming, it is true that climate change can only make a regional problem worse. There is no doubt that severe weather such as floods and droughts further stress difficulties in any society.

US military flood relief, Colorado 2013

US military flood relief, Colorado 2013

This report is only the latest is a number of reports addressing the risk of global warming. The report is however noteworthy in that for the first time the pentagon recognizes global warming as a real threat now, rather than something to be dealt with in the future.

US National Guard provied search and rescue for Hurricane Sandy

US National Guard provied search and rescue for Hurricane Sandy

The pentagon report has indicated that a number of consequences must be addressed. Coastal military installations that are vulnerable to flooding will need to be altered, humanitarian assistance missions will be more frequent in the face of more intense natural disasters, and weapons and other critical military equipment will need to work under more severe weather conditions.

Obviously there is considerable disagreement between the views of the senator from Oklahoma and the leadership of the mightiest military in the world concerning the real risk of global warming. When such dissonance occurs we each have to decide who to believe. On the one hand we have congress, with an approval rating near single digits and on the other the military, sworn to protect us. It’s your call.

Affordable Care Act

Disincentivizing Work

The Republicans have a bright and shiny new word they’re using to bash the Democratic Party in general and Obamacare in particular — Disincentivize. As in Obamacare disincentivizes Americans to work.

This characteristically disingenuous attack on The Affordable Care Act (ACA) comes from a purposeful misinterpretation of a recent Congressional Budget Office report titled “The budget and Economic Outlook: 2014 and 2024.” About 30 pages out of 175 addressed the ACA.

The point the Republicans tried to exploit was a couple of lines that said “The ACA will reduce the total number of hours worked, on net, by about 1.5 percent to 2.0 percent during the period from 2017 to 2024, almost entirely because workers will choose to supply less labor — given the new taxes and other incentives they will face and the financial benefits some will receive.”

See, ensuring access to healthcare takes away jobs! No, not really. What the report said is some people who previously had to keep a full-time job just to be insured may not need to. The ACA ensures that affordable insurance is available to individuals regardless of pre-existing conditions or income.

People who can now get insurance on the open market can decide to work less, or retire a little earlier than they would have. If a person retires early, this opens up a job for another worker — a far cry from taking away jobs.

Once it was clear that jobs weren’t being taken away, the Republicans switched to the disincentivise mantra. This is their argument: If a person doesn’t have to work to maintain access to expensive health insurance, then they won’t work. Access to affordable healthcare makes us lazy. Really, that’s what they think.

Republicans have traditionally resisted just about everything which contributes to the quality of life. People are lazy because they would like to be able to spend more time with their family? People are lazy because after working long and hard, and saving their money, would then like to retire a little earlier? People are lazy because they would rather not work two jobs if they didn’t have to? Really?

Americans already work the longest hours among workers in the industrialized world. That means we have less time to be with our families, less time to enjoy time with friends, less time to volunteer for our church or club. What is wrong with this picture?

You know what else disincentivizes people to work? Those things that contribute to the enjoyment of the American dream — the 40-hour work week, overtime pay, Social Security, Medicare, Medicaid, and now the Patient Protection and Affordable Care Act.

Should we get rid of the mortgage deduction for home ownership and the dependent allowances on our income tax? Saving money disincentivizes work? Meanwhile, the Republican controlled House of Representatives will be taking the next two weeks off, on our dime. What’s that about disincentives to work?

ObamaCare

Republican Irresponsibility

The real irony of Republican pique over Obamacare is the fact that it is a Republican idea. The final form of the Patient Protection and Affordable Care Act (PPACA) relies on Americans to take personal responsibility for their healthcare. It is not a complex formula; buy insurance that covers for the eventualities we all face, be it accident or illness. For those who can’t afford it, costs are subsidized by tax payers according to a sliding income scale.

What conservatives now seem to be saying is that personal responsibility is an onerous burden and purchasing insurance which covers the full cost of accidental injury or illness shouldn’t be necessary. Conservatives think that cheap policies with limited coverage, high deductibles, large co-pays or caps on payments are just fine.

But what happens when these inferior policies fail to pay the cost of care? Then who pays? Currently very close to half of all bankruptcies involve medical costs. That’s no way to run a healthcare system. And conservatives know it, at least knew it. Even before President Clinton proposed a single payer “medicare for all” type of healthcare system, the Heritage Foundation proposed an individual mandate for the purchase of insurance, just like Obamacare. It included a minimum standard of coverage, just like Obamacare. It even included a mandate to insure those with pre-existing conditions, just like Obamacare.

Whether we’re talking about Romneycare, Obamacare, or the Heritage Foundation policy, they all keep the private for profit insurance market alive. They all reduce costs because greater coverage increases access to preventive care, the cheapest and most effective expenditure. And they all mandate that personal responsibility is the centerpiece for healthcare in the United States.

We collectively provide for our national defense, isn’t our national health just as important? We have a single payer military, where everybody, through income taxes, pays their share. We don’t get to choose just how much defense we want, we are mandated to buy the same military. And single payer courts, and single payer disaster relief, and on and on and on. It’s the personal responsibility to our general welfare. E Pluribus Unum – from many, one.

The focus of the Republican party has been to avoid any collective action on healthcare. Democrats since at least the Truman administration have tried to make healthcare more inclusive. To the point of adopting a Republican approach. They’re still not happy.

My Fifteen Minutes of Blame

My fifteen minutes of blame

Blame the Republican house, blame the Republican party, Blame the Republicans. Yesterday evening Steve Womack – Republican representative for the third congressional district came to Russellville, Arkansas for a townhall meeting. A small crowd of about thirty folks listened quietly for about a half an hour as he politic-ed. From the nature of his presentation it was obvious that he worried more about his right flank.

He explained how shutting down the government over Obamacare was a bad idea. Not because it would harm the public welfare, but rather because it was politically unwise – it would turn the public away from the party. He staked out the traditional republican position, railing against spending, the Affordable Care Act, and the senate position on immigration. This kind of republican is actually more dangerous than the buffoons of the tea party.

A couple challenges from his right, shutting down the government and deporting all 12 million undocumented people were deflected. The real fun came from his left. A local pastor who happened to be sitting next to me made an eloquent and sensible argument for passage of the senate immigration bill. She spoke of how two of her parishioners, brothers, risked their lives (and their mothers life savings) by riding on the tops of trains for three weeks to get to the United States for a job. She was taunted somewhat by the crowd about lazy Mexicans, even though she had previously said that they had traveled for three weeks and risked life and limb FOR A JOB. I suspect those brothers have a stronger work ethic than most of the people in the room.

Then I got a few bites at the apple. On one of his slides (there’s an anachronism) he included a bullet on health savings accounts. [ME] OK, consider a guy with a health savings account who gets really, really sick; cancer, heart attack, or stroke with extended hospital care. He runs up a tab that is twice his savings. Who picks up the remainder of his costs? Somebody needs to pay for the drugs and reimburse the nurses and aides and janitors who cared for him. Bankruptcy is about his only alternative. I’ll tell you who pays, we do through our insurance premiums! [HE] ummm. He gave no real answer, he just went off on how if you have this savings and you don’t use it for healthcare, then you have this nice little savings account to use for other purposes. The long and short of it: he wouldn’t or couldn’t answer the question.

Probably my favorite encounter of the evening is when I asked another simple question: [ME] I understand why we all have an obligation to our common national defense, why not a similar obligation to our common national health? [HE] uhhh. Then he gestured by holding his hands in the air as if he were trying to measure the relative weight of a couple of objects. [HE] The two aren’t the same, providing for the national defense is in the constitution! [ME] So is providing for the general welfare! Then he said something about having skin in the game, but provided no real answer. He tap danced around the subject for a while, only to make his case worse.

He said something which I still don’t understand about do I pay to get my teeth cleaned. Maybe he was leading to a discussion of preventive care. [HE] I’m proud that while mayor of Rogers, AR we built a taxpayer-funded Adult Wellness Center. A lot of people benefit because of the center, why one gentleman I talked to said that he paid over 2000 dollars a month for some medication but since he started coming regularly to the center, his costs for the medication have been cut in half!

My jaw-droppingly obvious answer: [ME] My point exactly. If we taxpayers act together we can save ourselves some money. If we provide preventive care for the poor we will save money overall. Ten cents a day spent on the front end for a generic blood pressure drug can save us hundreds of thousands dollars in the prevention of just one hear attack or stroke. And that is a big part of the Affordable Care Act! [HE] We’ll just have to agree to disagree! He made my point, what else could he say?

One final egotistical riff. Another participant there who knows me commented on something about caps on payments for physical rehab. He said “as Dr Allen said…” while gesturing towards me. Womack swung his gaze at me and his eyes got just a little bit bigger. I guess titles still impress some people. It was just a funny moment.