Is there, really, anything as exhausting, futile, as trying to follow a Washington DC Bill of interest to the general population being debated in the Highest popular court of the Country…How many years have I hoped for something intelligent and nonpartisan to emerge from the DC Swamp…to my own exhaustion and despair.
This AHCA (American Heath Care Act, Trumpcare, Obamacare 2.0, American More Of The Same Act, etc…or wathever else you name it) is just really the indication that there is absolutely no solution to hope for amongst the great lawmakers universe which compose the Hill.
A farce…a REDiculous and BLUBBLEitious walk of fame towards the same holes of fiscal suicide.
Why can’t neither of the richest political elites belonging to each party come to grasp that if Obamacare could not survive…AHCA cannot either.
According to the wittiest minds on the hill defending AHCA, this time, the Republicans will make it work because we can trust that if Health Insurance Companies don’t pay anymore federal taxes, that they expenses even costs they never incurred, they may show incredible good faith and suddenly lower premiums…Is that the best they can come with. Because lowered premium is the only sales pitch that could sell this nightmare.
How come the greatest economists on wall street can’t figure out that if government has less revenues to pay for an even more generous proposal, DC will go bankrupt in a few hours after implementation of this New Health Bill.
I mean…really, in this case, a five years old, could do the math…and I mean even a non “savant” 5 years old could figure it out; don’t need to be Asperger here.
I guess the US is the only country where everyone believes that you can get health care for free, and no one has to pay for it.
It reminds me of this ridiculous Micheal Moore moment where this great Hollywood Docu-genious affirms, to an audience all mouth open and drooling :..”look…in Canada, health care is free…you don’t have to pay anything”. Well I guess you don’t Micky, and your docu american friend using a canadian health venue either…but we Canadians had to pay for your American friend’s visit..with our personal income taxes, our product and services sales taxes and all other Canadian Federal and Provincial taxes oriented to subsidize a public heath system…how ridiculously rhetorical can you be Micky…Hollywood educted, obviously…maybe you could join Franky on the “Hill”…
It appears, that increasingly, Americans believe that if the Nasdaq, or the Biotehc and Pharma indexes go up enough….Healthcare will become free because of all these “wonderful” innovations…
Did delusion really build America? Sometimes I really wonder…Its great to believe…but then again, even if cell phones are great tools, we are far from teleportation, yet, the Captain Kirks of the world of politics would have believe otherwise. It’s true that we now do have these great “Retard” watches that can make people believe they are super heroes because their watch told them they climbed 10 stairs today and that this should have them loose at least 10 pounds of their extreme obese fat.
But while the “great brains of Apple, Google, Facebook, Wall Street, Washington DC” work hard at curing all of our ills, I am not sure a cell phone can even venture into taking a glycemic plasma measure, yet.
So can’t we start working on a quality and decent (yes, you have noticed, I did not say the BEST and Most INCREDIBLE) health coverage for All Americans that won’t drive the State to go bankrupt in a whiff.
For those “billions” of readers that frequent my blog….please read this proposition first, its about creating regional clusters through limited consolidation of health markets…then come back here.
Now, I am not unhappy that lawmakers finally backed down from dis-regulating the Health Insurance market…it would have been a disaster. On the other hand, some markets lack the capacity to consolidate economies of scales enough to attain critical levels of population density that may be more fitted for the evolution of the Health Care Services.
Market structure is important, and in this case, market structure of those offering services, before those covering their costs, yet both are intertwined since money dictates.
I still prefer a State limited Health Care Insurance Market against a national one. But still, one must consider that over the past 20 years, health care has developed deeper knowledge with the effect that we have noticed clustering of specialised centers for treatment. Treatment for cancers, for diabetes, for neurodegenerative conditions, for heart disease…etc. In this context, it is very difficult for smaller economies to keep pace and hope for their respective state to see in the near future these kind of clusters grow spontaneously. by allowing some smaller States to regroup in small unions (on the landscape of healthcare only), would give them opportunity to make benefit from critical population mass that would allow for specialized clusters to take foot.
But most importantly, is there not a way to figure out how the governments can participate in HealthCare without turning it bankrupt? The first stept is to make the country understand that there is no single road you can travel where suddenly HealthCare will become “free”. Some people may pay more, others less, some very little…but heathcare cannot be free.
What good is it if they create a HealthCare solution that cannot survive in the long run, will we have the current scenario repeat itself at every regime change?
Yesterday, march 20th, they added an amendment to the AHCA which they believe will allow the Bill to pass both chambers. It adds 150 Billion to the ten-year federal budget forecast. That is an extra 15 Billion in annual deficit to the already 37 Billion of new HealthCare unfunded average annual future liabilities of the AHCA as analyzed the CBO report (Congressional Budget Office Cost Estimate of the American Health Care Act).
Adding to this fiscal whole, the New Congress is already drooling at the fiscal upcoming holiday they may start enacting before July, which may even include retrospective fiscal measures.
So, if the AHCA is already less funded than the ACA it replaces, and this, from the onset…when you factor in the Fiscal Gifts to the Rich and Famous, to these modern Financial Holocaust victims, DC’s faith may take the same direction as Detroit’s municipal administration, and will have to declare bankrupcy…what god will have been the AHCA under this “hospice”?
But, as many overly educated analysts explained this past weekend, we should not worry because Health Insurance Companies only have to lower their Premiums by 50% and everything will work fine…you see, it’s what the CBO forgot to consider, and what those who promote this Bill are claiming: if Premiums go down by 50%, everything will work fine.
It is surprising that with such a window of opportunity, State governors don’t request that from now on, Medicaid should become a strict State sponsored program. No, instead, most of them beg that DC do more. When everybody knows the principal problem we face as a country is that DC wants to do everything.
One of the reasons the Federal government got involved with Medicaid in the first place, was to minimize the differential of wealth between the different States in the barriers it created in allowing all Americans to have somewhat equal access to Healthcare services.
When will Americans have governors that will understand that political clout comes from the money you gather. Let’s have States charge the Medicaid Individual Income Tax portion, and let them administer their own program. By collecting their own Medicaid taxes, they could allow the Federal government to simply become responsible for exercising some form of moderate equalization as to contain excessive wealth spreads between the different states. Then maybe states can start offering and structuring services in a manner more proper to their constituents needs and desires. This should allow a better balance of power politically in their dealings with the Federal government, not only in health care, but in other manners. And aren’t the states the best positioned to understand the market organization their constituents need, instead of these distant Lawmakers from DC?
As for the current AHCA and ACA…I always believed that it is the wrong hybrid approach. The federal government subsidizing net margins of private corporations doesn’t make sense.
My whole view for a solution is far away of any proposition we have heard yet, but it may,
in the long run, offer a better chance at long-term coverage of the maximum amount of Americans, which the current proposition, by setting us back to the pre-Obama levels of uninsured, surely doesn’t fix, but ACA did not either, despite the much wishful thinking.
I believe that the best way to discipline the Health Insurance industry in offering truly competitive pricing is if government competes with it. Since most hospital anticipate that the Republican proposal will hurt their capacity to offer proper services to their clientèle because many hospital depend on Medicaid dollars to cover fixed costs, eliminating anticipated future revenues from ACA policies may have for effect of bankrupting many of them.
This is the reason I believe it would be less costly for government to collect from taxpayers the amounts paid to insurers as the maximum premium amount, and pay the remainder of what is needed to hospital and service providers to support this demographic.
For example, if we take the example from the CBO report on ACHA cost estimates, this is what it could look like:
As I mentioned, the House has just amended the current proposition to modify the Tax Credit Limitations (from page 89, line 23 of the original leaked document, section 36C (c) Limitations) applied only to singles and adjusted for age brackets (limitations amounts) of less than 30 ($2,000), to 30-39 ($2,500), 40-49 ($3,000), 50-59 ($3,500) and 60 to 64 ($4,000).
These limitation increased the out of insurance holder premium portion he had to pay. It is what in fact creates this 14900 premium portion that a 60 years old has to pay from a projected $1,700 under ACA in 2020 to $14,900 under the un-amended AHCA.
But, for the purpose of demonstration, lets look at the 21 and 40 years old individuals in the upper part of the table. Their premiums would be 3,900 and 6,050 respectively. They would incur $1,450 and $2,400 in their share of premium costs. This amount would be collected by government. It would become their share of pay to participate in Medicaid services delivery. The government would then fund the remainder of Medicaid programs to cover the cost between this contribution and the cost incurred for delivery of service.
Since Medicaid delivers cost at a discount over Private coverage, and there is no net margins, the direct and indirect cost to government would be a lot less that the portion of premium they would pay through the Premium Tax Credit, which is a subsidy to Insurance companies, more than to the insured.
This would allow a better consolidation of services for the whole Medicaid programs and guarantee survival of Hospitals. This would effectively create a competition between the public and private sector, requiring private insurers to either concentrate on product differentiation or pure bottom line price competition. Either way, by giving the choice to consumers of which market they want to participate in, you give them choice, and you could then easily require that people are required to have insurance, therefore maintaining the universal mandate.
This approach has a better chance of offering a survival of the funding mechanism as well as a healthy consolidation of the Service provider network that delivers Medicaid services.
It is therefore a Participation Extension of Medicaid, up to 138% under the Federal Poverty Line (which if states repatriate Health Authority, could become each respective States Poverty Line), it is free save for the marginal co-insurance and co-pay amounts, over 138% you gradually pay more following the current tables proposed by the AHCA but measuring the Maximum Medicaid Insurance Premium amount.
The following table taken from the original AHCA proposal would now be entitled:
Maximum Medicaid Insurance Premium amount
Now, obviously, with such a proposal, I will immediately be accused of being a socialist because I support big government…but if government pays less for a better service, how can it be bigger government than subsidizing net margins of private corporations. Or, again, for the same critics…why is government serving people earning less than the median income socialism, but subsidizing families earning more than the median income becomes genuine capitalism.
What the Republicans are proposing is as socialist as the ACA, my solution may be less corporate finance friendly, but it sure has a better chance of long-term survival. Government is already in this business through Medicaid and doing a respectable, and sometime better, job at it than pure private service oriented venues…
Obviously, I make abstraction of people over 64, who are in long-term care, and are on Medicaid. This is purposefully, because they are a different problem which needs to be addressed separately. But one must consider that when analyzing Medicaid costs, often the average per patient cost includes these patients, which makes understanding the true cost government would face in the preceding proposition hard to figure out.
Much of the costs of Medicaid come from these patients. So, by allowing ourselves to only concentrate on the remainder of patients, we get a better picture of how affordable and cheap is my proposition. On this, I suggest: (Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries
Robert L. Kane, Andrea Wysocki, Shriram Parashuram, Tetyana Shippee, Terry Lum).