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healthcare reform

Make America Sick Again!

March 16, 2017 by Mighty Casey Leave a Comment

boudica image
clown trump image
(c) Salon

The Insane Clown Car Posse (hat tip to my buddy Robb Fulks for that lovely turn of phrase) that’s currently at the helm of the ship of state here in the good old USA has started to give us a peek at their plans for US healthcare. The phrase “shit show” seems to have been invented just so it could be used to describe the excrescence that’s emerging, inch by fetid inch, under the banner of the AHCA, full title “American Health Care Act.” [Personally, I call it “the new National Eugenics Plan,” since the savings the legislation’s backers crow about are clearly gained from sick folks just dyin’ quicker.]

Maybe we could tag it as GOTCHA, “Government Out To Cut Healthcare Access?” Asking for a friend.

“Make America Sick Again!” seems to be the sales pitch here. After the gnashing of teeth, rending of garments, and fisticuffs that marked the passage of the Affordable Care Act in 2010, the ACA haters – we’ll call them “the entire Republican Party, and all who sail in it” – spent the rest of Obama’s Presidency voting to repeal the law, while doing very little else.

What the ACA, or “Obamacare,” accomplished was to finally put the theory of universal healthcare access on the table for Americans, who had spent the 20th century watching pretty much every other developed nation on the planet create either single payer (a la Britain’s NHS) or insurance-based universal access (in Germany and Switzerland) healthcare delivery systems for their folks.

I say “theory of universal access” because, like all Congressionally-ground sausage, it’s a mix of top cuts of awesome (10 Essential Benefits! Tax Subsidies on Premiums!) with awful offal from the abattoir floor (too much power concentrated in the hands of AHIP, ridiculously narrow networks, uneven Medicaid expansion). But it was a start, after every President since FDR trying, and failing, to get any kind of national healthcare access plan in place.

After trying to throw Obamacare from the train, on a loop, lather/rinse/repeat, for years, once Cheeto Voldemort (I refuse to say, or type, his name – work with me here, people) took up occupancy at 1600 Pennsylvania Ave., the ACA-haters wasted no time in getting their “repeal and replace” dance of the seven veils started. They need at least seven veils to hide this mess, but they’re starting to run out of cloth.

Here are the Greatest Hits (to humanity, and human life) brought to us so far by GOTCHA-care:

  • Instead of getting direct tax subsidies to help pay health insurance premiums – currently, individuals earning less than $47,520, or families of four earning less than $97,200, are eligible for those subsidies – people who need to buy health coverage for themselves and their families will get a following-year tax credit for their coverage. Which sounds great, until you realize that, say, you’re a 58 year old human living in central Virginia who’s a freelancer, making $40,000 per year. You’ll have to shell out around $600 per month (annual total = $7,200) for your individual Silver plan, or $1,000 per month ($12,000 annually) for your family of four’s Silver plan, and then get a munificent … $3,000 per year. The tax subsidies under the ACA, for the same coverages: $3,200 for the individual plan, $10,000 for the family of four.
  • The myth of “choice.” All the messaging coming out of the push for the American Health Care Act is about “giving Americans choices about their care.” What those choices reveal themselves to be are:
    • “Go naked” – no individual mandate to buy insurance coverage. Combined with the hockey stick trajectory of health insurance premiums over the last 30 years, this is an actual “choice” that many people, including me, were forced into before the Affordable Care Act.
    • “Buy a plan you can afford.” – this is code for “buy a craptastic plan that covers nothing.” I know people who had plans like this before the ACA. The ones who got sick after buying these plans are no longer alive if they didn’t survive long enough to get on an ACA plan.
    • “Buy a plan that covers you pretty well, and then live in your car.” With a maximum tax credit of $4,000, for people over 60 years old, those who qualify for AARP membership will find themselves pretty broke-ass if they buy a plan with any kind of comprehensive coverage. Which is why the AARP is flaming Congress over this proposed “replacement.”
  • After improving access to healthcare (before the ACA, 18% of Americans – 47 million people – were uninsured; that number as of January 1, 2017 was down to 11%, 36 million), and starting to see incremental signs of overall public health improvement, the Clown Car now seems to think that throwing 24 million people off the insurance rolls by 2026 is a great idea, while bloviating about a $337 billion deficit reduction. Which sounds great, until you realize that the US spends upwards of $3.35 trillion-with-a-T on healthcare annually, of which up to $1 trillion is estimated to be waste. That’s $1 trillion PER YEAR, making the overspend between now and 2026 close to $10 trillion dollars. That figure makes a $337 billion deficit reduction over ten years look like a bar tab.

The people who put Cheeto Voldemort in office are the biggest losers here, which just proves that low information voters can wind up the punchline in a joke they *thought* they were in on. Our 45th President’s broad promises to “cover everybody” at “lower cost” is laughable in the face of the numbers out of the CBO, and the language in the AHCA itself.

As I said at the outset, this is a shit show. People’s lives are on the line, but the jerktastic folks defending this mess are outright lying about its impact on working class and middle class Americans. My own Congressional (un)representative, Dave Brat, answered my question about rural hospitals and uncompensated care at his Town Hall in February 2017 by pointing at the community clinics that hospitals are setting up to help people who can’t access care … THESE ARE PROGRAMS MADE POSSIBLE, AND PAID FOR, BY THE AFFORDABLE CARE ACT.

Sorry, was I shouting? <deep breath>

Tom Price, the “healthcare is a privilege, not a right” orthopedic sawbones now at the top of the US Dept. of Health and Human Services, outright lied on “Meet the Press” on Sunday, March 12, when he said “nobody will be worse off financially” under the American Health Care Act.

He prevaricated again, at a CNN Town Hall on Wednesday, March 15, when colon cancer survivor Brian Kline asked him point blank, “Why do you want to take away my Medicaid expansion?” Price said, “The fact of the matter is we don’t. We don’t want to take care away from anybody. What we want to make certain, though, is that every single American has access to the kind of coverage and care that they want for themselves.”

Price is fronting that myth of “choice” I mentioned above. They’re lying, they’re ginning up one of the biggest tax bonanzas for the already-wealthy in modern history, while simultaneously reducing access to care for the average American Joe and Jane.

Oh, and if you’re reading this, and thinking, “HAH! You losers, I have coverage through work!” … don’t. Employer sponsored insurance – which I have been saying needs to get clubbed on the head and buried in the woods for a while now – is on the bubble, too, since the Republican plan eliminates a key penalty on employers who don’t offer their employees health coverage.

The American Cancer Society hates this thing. The American College of Physicians hates this thing. Consumers Union *really* hates this thing.

We’ve got to get the insane clowns out of their car before they grind us under that car’s wheels. Time to start taking up some figurative weapons, folks. If the pen – or the keyboard – is mightier than the sword, start swinging that QWERTY blade at your Congressional representatives, now.

Your life is on the line.

Really.

boudica image
image credit: David Paget | Happy_Mutt

Filed Under: Crisis communications, Healthcare, Politics, Social media Tagged With: health care, health insurance, Healthcare, healthcare economics, healthcare reform, healthcare system, Obamacare, politics

World on fire. Film at 11.

April 13, 2015 by Mighty Casey 5 Comments

bluebutton mockingjay mashup image

I wasn’t lucky enough to get a press pass, or a scholarship, to HIMSS15 this year. Given events of the last few days, I’m really sorry I can’t be on the ground in Chicago for what feels like a grassroots revolt brewing in protest of the Centers for Medicare and Medicaid Services (CMS) dropping an announcement, on Friday late afternoon, that they were thinking of gutting the rules for patient access to their own records under the “Meaningful Use” criteria of healthcare reform. You know, the one where we spent something like $6B of taxpayer money. Which was supposed to make care easier, safer, cheaper.

There are phases and stages of Meaningful Use. We’re in MU2 right now. Originally, by the end of the MU2 period (running through 2020), a practice or facility had to demonstrate that 5% of the people/patients cared for in that practice or facility viewed, downloaded, or transmitted their personal health information (PHI) to a 3rd party. That was the criteria for a healthcare provider seeking stimulus $$ for EHR technology deployment [updating: and Medicare reimbursement].

Here’s the “new” rule (clue train: instead of 5%, it’s 1. No, not 1%, one patient) being proposed:

mu2-gutting

I know, right? Friday afternoon, everyone in the industry is heading to Chicago for HIMSS15, who’ll care? Sorry, CMS, but you are totally busted. Here’s data access rights activist Regina Holliday, who’s at HIMSS and whose hair is now on fire:

Speaking of “hair on fire” … so’s mine.

Seems like the Empire is trying to strike back. Or the Capitol (the big-money healthcare industry players who drop money on K Street lobbyists like snowflakes in Boston in the winter of 2014) thinks it’s run over all the Districts (patients, caregivers, families) and has little to fear from our powerlessness. I think they’re wrong. Dead wrong. And they’re about to find out just *how* wrong. Expert, activist patients, along with savvy clinical folks whose hearts are truly in their work, are now assembled in District 13.

My take can be summed up in this image [updated on Tuesday, April 14]:

bluebutton mockingjay mashup image

We are coming for your silos. Because it’s OUR data, and OUR lives.

Filed Under: Business, Find the funny, Healthcare, Media commentary, Politics, Social media, Storytelling, Technology Tagged With: #bluebutton, CMS, e-patients, health care, health care reform, health IT, Healthcare, healthcare reform, HIMSS15, Hunger Games, meaningful use, mighty casey media, politics, revolution

The Story on Healthcare Reform…After 11/2/2010

November 8, 2010 by Mighty Casey Leave a Comment

I attended a great Disruptive Women in Health Care event last week: Health Reform After the 2010 Election – Assessing the Viability of Health Insurance in the Aftermath of the Mid-Term Elections.

A big title, but it’s a big topic.

In a series of panel discussions, a varied group of healthcare policy wonks and a smattering of journalists offered their perspectives on what the future of healthcare payment & health insurance reform is, given that control of the House is now in Republican hands, and the Senate super-majority won by the Democrats in 2008 is history.

With the economy in the tank since before the 2008 election, and little to show for the massive injection of federal money to bail out the financial markets and the auto industry (other than a continuing 9+% national unemployment rate), it still seems quixotic that the Obama administration picked healthcare reform as its first big policy project.

Dan Gerstein, a Forbes columnist and former legislative aide to Senator Joe Lieberman, said during the first panel discussion, “this was a perfect storm of bad execution on the part of the Democrats.” With the economy and jobs a much larger, and more personal, issue to most of the electorate, the 9 months it took to push the healthcare reform act through Congress took a big toll on the public’s perception of the Obama administration.

Which, in turn, took a big toll on the Democratic Party’s results on Nov. 2.

Now, whither healthcare reform? It seems that the watchword will be replace, not repeal.

Nancy Johnson, who served 24 years representing Connecticut in the US House and is now a public policy advisor at Baker Donelson, said, “people are beyond parties now. Two things have gone fundamentally wrong: endless use of credit, which has led to fiscal collapse.” That translates to an unwillingness, particularly on the part of the states, to fund healthcare reform as it currently stands.

Now that the President will have to deal with a much less amenable Congress, Jim Slattery, a six-term Congressman from Kansas and now a partner at law firm Wiley Rein, said, “the President has a tough choice to make, and only a few weeks to make it. Confrontation or cooperation?” He noted that in a democracy, “compromise is a great substitute for violence,” but I wonder how much of a figurative beating the desire for systemic healthcare reform will take in the name of compromise.

Stay tuned on that one.

The second panel discussion spoke directly about the issue of health insurance: access/availability and affordability. One of the central issues facing the health insurance market is this: if the government is mandating insurance coverage, redefining the role of insurance agents and brokers will be an interesting battleground.

David Reynolds, President & CEO of Coventry Health Care in Maryland and Delaware, thinks that those agents and brokers would be ideal navigators of the new system. But how will they be remunerated for serving as navigators, particularly on the lower end of the market?

Slattery said that moving healthcare toward a utility model, where public utilities are private companies operating under public regulation on price and access, might be the right answer. Add to that the idea of moving the healthcare delivery system from an illness-treatment to an illness-prevention model and we might see some actual bending of the cost curve.

The session wound up with a discussion of what the insurance market might look like with the new Congressional landscape. Janet Trautwein, CEO of the National Association of Health Underwriters (NAHU), which represents more than 100,000 employee benefits and health plan management professionals across the US,  echoed Reynold’s statement that agents and brokers were valuable advisors to companies working to understand the impact of the healthcare reform act. She also noted that the staggering $1Trillion-with-a-T price tag of reform was just the government share of the financial impact of healthcare reform.

Leslie V. Norwalk, who served as Acting Administrator for the Centers for Medicare & Medicaid Services (CMS) in the George W. Bush adminstration, observed that companies might elect to pay the $2,000-per-employee fine for not offering healthcare coverage to their workers, since coverage typically costs between $3,000-$8,000 per employee per year. Even if they pay the fine, and offer their workers $1,000 each toward buying their own insurance, they’d at least break even – and they might save a significant amount of money.

Think of it from the perspective of a Fortune 50 who employs more than 100,000 people – get my drift?

Did the folks drafting the legislation even think of that possibility when structuring it? Were their calculators broken?

My take-away from the morning’s discussion – which I have to say I was delighted to have been in the room for – was that both sides of the aisle believe that the healthcare payment system in the US has fallen, and it can’t get up. The issue at hand now, with the new Congressional balance of power, is how to tweak/replace/re-tool needed reform without increasing the federal debt, and while simultaneously creating a system that truly offers access to all.

I’m a believer in the consumer-driven model, with HSAs for everybody. Encourage people to be active consumers, not passive meat puppets, when it comes to their health and healthcare. Will Congress agree? Stay tuned.

That’s my story, and I’m stickin’ to it….

Here’s some video of the morning’s events:

Disruptive Women Panel #1 – November 3, 2010 from Amplify Public Affairs on Vimeo.

Filed Under: Business, Healthcare Tagged With: casey quinlan, disruptive women in health care, health insurance, Healthcare, healthcare reform

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