Health care

Paul Krugman: Cruelty, Incompetence and Lies

Published by Anonymous (not verified) on Sat, 23/09/2017 - 3:03am in

"the evasions and lies we’re seeing on this bill have been standard G.O.P. operating procedure for years":

Cruelty, Incompetence and Lies, by Paul Krugman: Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing... Furthermore, their efforts to sell the bill involve obvious, blatant lies.

Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good. ...

Did Graham-Cassidy’s sponsors know what they were doing when putting this bill together? Almost surely not, or they wouldn’t have produced something that everyone, and I mean everyone, who knows anything about health care warns would cause chaos.

It’s not just progressives: The American Medical Association, the insurance industry and Blue Cross/Blue Shield have all warned that markets would be destabilized and millions would lose coverage. ...

Lindsey Graham, Bill Cassidy, and the bill’s other sponsors have responded to these critiques the old-fashioned way — with lies.

Both Cassidy and Graham insist that their bill would continue to protect Americans with pre-existing conditions — a claim that will come as news to the A.M.A., Blue Cross and everyone else who has read the bill...

Cassidy has also circulated a spreadsheet that purports to show most states actually getting increased funding under his bill. ... Independent analyses find that most states would, in fact, experience serious cuts... — and everyone would face huge cuts after 2027.

So we’re looking at an incompetently drafted bill that would hurt millions of people, whose sponsors are trying to sell it with transparently false claims. How is it that this bill might nonetheless pass the Senate?

One answer is that Republicans are desperate to destroy President Barack Obama’s legacy ... no matter how many American lives they ruin...

Another answer is that most Republican legislators neither know nor care about policy substance. ... Vox asked a number of G.O.P. senators to explain what Graham-Cassidy does; the answers ranged from incoherence to belligerence to belligerent incoherence.

I’d add that the evasions and lies we’re seeing on this bill have been standard G.O.P. operating procedure for years. ... Graham-Cassidy isn’t an aberration; it’s more like the distilled essence of everything wrong with modern Republicans.

Will this awful bill become law? I have no idea. But even if the handful of Republican senators who retain some conscience block it — we’re looking at you, John McCain — the underlying sickness of the G.O.P. will remain.

It’s sort of a pre-existing condition, and it’s poisoning America.

Last-Ditch Effort By Republicans to Replace ACA: What You Need to Know

Published by Anonymous (not verified) on Thu, 21/09/2017 - 5:51am in

This post originally appeared at Kaiser Health News.

Republican efforts in Congress to “repeal and replace” the federal Affordable Care Act are back from the dead. Again.

While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA), along with Sens. Dean Heller (R-NV) and Ron Johnson (R-WI)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.


RELATED: Democracy & Government


Mary Mayhew, commissioner of Maine's Dept. of Health & Human Services (left) and Gov. Paul LePage answer questions during a news conference to announce changes to the MaineCare system in Augusta, Maine, on Dec. 6, 2011. (Photo by Joe Phelan/Portland Press Herald via Getty Images)

The War on Medicaid Is Moving to the States

BY Greg Kaufmann | September 5, 2017

An earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-ME), Lisa Murkowski (R-AK) and John McCain (R-AZ) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.

After Sept. 30, the end of the current fiscal year, Republicans would need 60 votes ­— which means eight Democrats — to pass any such legislation because special budget rules allowing approval with a simple majority will expire.

Unlike previous GOP repeal-and-replace packages that passed the House and nearly passed the Senate, the Graham-Cassidy proposal would leave in place most of the ACA taxes that generated funding to expand coverage for millions of Americans. The plan would simply give those funds as lump sums to each state. States could do almost whatever they please with them. And the Congressional Budget Office has yet to weigh in on the potential impact of the bill, although earlier estimates of similar provisions suggest premiums would go up and coverage down.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed,” said Graham in unveiling the bill last week.

Here are five things to know about the latest GOP bill:

1. It would repeal most of the structure of the ACA.


RELATED: Health & Science


A July 2017 protest against the Republican health care bill in Milwaukee, Wisconsin. (Joe Brusky/Flickr cc 2.0)

Doctors Are Warming Up to Single-Payer Health Care

BY Rachel Bluth | August 22, 2017

The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices. 

2. It would eliminate many of the popular insurance protections, including those for people with pre-existing conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with pre-existing health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill. 

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-WI) and Doug Ducey (R-AZ), are being offset by opponents including Chris Sununu (R-NH), John Kasich (R-OH) and Bill Walker (I-AK).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letter to Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-KY) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-NY) on the Senate floor Tuesday.

 
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

The post Last-Ditch Effort By Republicans to Replace ACA: What You Need to Know appeared first on BillMoyers.com.

The Sickness of American Healthcare

Published by Anonymous (not verified) on Tue, 19/09/2017 - 11:55pm in

Some key facts that have been omitted from the debate over Obamacare and healthcare generally, apparently by design.

The Medicare for All Act of 2017: The Policies

Published by Anonymous (not verified) on Tue, 19/09/2017 - 2:55am in

BernieCare vs .ConyersCare in #MedicareForAll implementations, how to handle displaced worker, how to talk about taxes.

Paul Krugman: Complacency Could Kill Health Care

Published by Anonymous (not verified) on Mon, 18/09/2017 - 7:50pm in

"there is a real chance that Graham-Cassidy ... will ... become law, because not enough people are taking it seriously":

Complacency Could Kill Health Care, by Paul Krugman, NY Times: ...last year far too many people were complacent; they assumed that Trump couldn’t possibly become president, so they felt free to engage in trivial pursuits. Then they woke up to find that the inconceivable had happened.

Is something similar about to go down with health care?

Republican attempts to destroy Obamacare have repeatedly failed, and for very good reason. Their attacks on the Affordable Care Act were always based on lies, and they have never come up with a decent alternative. ...

The sponsors of the Graham-Cassidy bill now working its way toward a Senate vote claim to be offering a moderate approach that preserves the good things about Obamacare. In other words, they are maintaining the G.O.P. norm of lying both about the content of Obamacare and about what would replace it.

In reality, Graham-Cassidy is the opposite of moderate. It contains, in exaggerated and almost caricature form, all the elements that made previous Republican proposals so cruel and destructive. ... It would eliminate the individual mandate, undermine if not effectively eliminate protection for people with pre-existing conditions, and slash funding for subsidies and Medicaid. There are a few additional twists, but they’re all bad...

Yet there is a real chance that Graham-Cassidy ... will nonetheless become law, because not enough people are taking it seriously. ...

The main reason Republican leaders couldn’t do that on previous health bills was public outrage and activism. Letters and phone calls, demonstrators and crowds at town halls, made it clear that many Americans were aware of the stakes, and that politicians who voted to take health care away from millions would be held accountable.

Now, however, the news cycle has moved on, taking public attention with it. Many progressives have already begun taking Obamacare’s achievements for granted, and are moving on from protest against right-wing schemes to dreams of single-payer. Unfortunately, that’s exactly the kind of environment in which swing senators, no longer in the spotlight, might be bribed or bullied into voting for a truly terrible bill.

The good news is that for technical reasons of parliamentary procedure, Graham-Cassidy has to pass by the end of this month, or not at all. The bad news is that such passage is a real possibility.

So if you care about preserving the huge gains the A.C.A. has brought, make your voice heard. Otherwise we may wake up to another terrible morning after.

The Medicare for All Act of 2017: The Politics

Published by Anonymous (not verified) on Mon, 18/09/2017 - 4:00am in

The politics of BernieCare: The co-sponsors, the coverage, the funding mechanism.

Paul Krugman: Politicians, Promises, and Getting Real

Published by Anonymous (not verified) on Sat, 16/09/2017 - 3:35am in

Paul Krugman:

Politicians, Promises, and Getting Real, by Paul Krugman, NY Times: On Wednesday Donald Trump demanded that Congress move quickly to enact his tax reform plan. But so far he has not, in fact, offered any such plan...

Meanwhile, 17 Senate Democrats ... have signed on to Bernie Sanders’s call for expanding Medicare to cover the whole population. So far, however, Sanders hasn’t produced either an estimate of how much that would cost or a specific proposal about how to pay for it.

I don’t mean to suggest that these cases are comparable: The distinctive Trumpian mix of ignorance and fraudulence has no counterpart among Democrats. Still, both stories raise the question of how much ... policy clarity matters for politicians’ ability to win elections and ... govern.

About elections: The fact that Trump is in the White House suggests that politicians can get away with telling voters just about anything that sounds good. ...

On the other hand, the ignominious failure of Trumpcare shows that reality sometimes does matter. ... Once the public realized that tens of millions would lose coverage..., there was a huge backlash...

The story of tax reform ... is starting to look a bit similar. ...

In fact, Trump himself seems to be experiencing cognitive dissonance. “The rich will not be gaining at all with this plan,” he declared Wednesday. ... Is he oblivious, lying, or both? ...

The contrast between what he’s claiming and anything Republicans in Congress will be willing to support is so great as to practically invite ridicule and another popular backlash. ...

But is the push for single-payer health care taking Democrats down a similar path?

Unlike just about everything Trump and company are proposing, Medicare for all is a substantively good idea. Yet actually making it happen would probably mean ... a serious political backlash. For one..., it would require a substantial increase in taxes. For another, it would mean telling scores of millions of Americans who get health coverage though their employers, and are generally satisfied..., that they need to give it up and accept something different. ...

Democrats could eventually find themselves facing a Trumpcare-type debacle, unable either to implement their unrealistic vision or to let it go.

The point is that while unrealistic promises may not hurt you in elections, they can become a big problem when you try to govern. Having a vision for the future is good, but being real about the difficulties is also good. Democrats, take heed.

My Sister Served in the Army. The Biggest Threat to Her Survival is Congress.

Published by Anonymous (not verified) on Fri, 15/09/2017 - 4:00am in

This post originally appeared at Talk Poverty.


RELATED: Democracy & Government


Mary Mayhew, commissioner of Maine's Dept. of Health & Human Services (left) and Gov. Paul LePage answer questions during a news conference to announce changes to the MaineCare system in Augusta, Maine, on Dec. 6, 2011. (Photo by Joe Phelan/Portland Press Herald via Getty Images)

The War on Medicaid Is Moving to the States

BY Greg Kaufmann | September 5, 2017

My older sister, Lynn, was always getting into trouble when we were kids. I was the goody two-shoes in the family, but if I did ever get myself in trouble, she’d get in even more trouble to help me out. She was a good sister in that way — always looking out for me. When I was little, I didn’t like to sleep by myself during thunderstorms, and she’d let me crawl into bed with her because she knew I was afraid.

Now, in some ways, I’m her big sister. I do my best to take care of her.

Lynn — a 62-year-old army veteran — cannot walk. Her dementia makes it impossible for her to remember to take her medicine. Her forgetfulness has life-or-death implications, since she has diabetes, high blood pressure and high cholesterol. As a result, Lynn has been in a nursing home for the past four years. Medicaid pays the bills for that — just like it does for most people who need nursing home care — and I’m terrified of what would happen without it.

She’s not trying to take more than her fair share of the pie.

Lynn joined the army right out of high school. When she was in boot camp, she had a traumatic head injury during basic training. The military doctors held her for observation, diagnosed her with a concussion and then released her. She served her time as a private, then was honorably discharged and got married.

A few years later, she was struck by a car. She was at a crosswalk, and the car in front of her stopped to let her cross. But the car behind it was impatient, so it swerved around the first car, plowing into the crosswalk and hitting my sister. That left her with her another traumatic head injury, as well as the beginning of hip problems that will plague her for the rest of her life.


RELATED: For the Record


An elderly woman shows her gratitude to President Lyndon B. Johnson for his signing of the Medicare health care bill in July 1965. (Photo by © CORBIS/Corbis via Getty Images)

LBJ Launches Medicare: ‘You Can’t Treat Grandma This Way’

BY Bill Moyers | July 30, 2017

Over time the hip problems worsened, until she finally had a hip replacement in her mid-50s. She was able to walk without pain for a while, but she then contracted a MRSA infection in her new hip joint. That can happen with artificial joints — it’s rare, but once you have the infection it’s hard to remove. Lynn’s infection spread quickly, and it almost killed her. Doctors tried to treat her with some very powerful drugs at first, which made her thoughts so fuzzy that she said her brain was buzzing.

Eventually, doctors had to remove her hip bone to control the MRSA. Medicaid paid for this surgery, too — otherwise, we wouldn’t have been able to afford it.

Just four years ago, Lynn was working multiple jobs to put her daughter through college: in the cafeteria at her daughter’s school, at Walmart and at a deli. Now Lynn can no longer walk, or work. The doctors say the drugs impaired her brain and made her dementia onset much more quickly.

But this isn’t a sob story. I don’t want you to feel bad for her, or take pity on her. Lynn is still the same person I’ve always known, full of life and warmth. She can break the tension in a moment better than anyone I know. I still remember a moment a few years ago, when she was recovering from her first hip surgery. She flew into Washington, DC, to visit us, and we were trying to get her out of baggage claim and into the elevator in her wheelchair. The doors started to close, and nobody wanted to hold them — she was far away, and she was moving so slowly. But she shouted, “I’m coming as fast as I can!” across the airport. They actually held the door for her. In the elevator, she chatted with them amicably, asking how their Christmas was going. Strangers were smiling and talking to her — that’s a rare sight in DC.

Lynn would be lost without Medicaid. She served her country and worked hard to provide for her family. She’s not trying to take more than her fair share of the pie. She’s just somebody who needs care — and she didn’t expect to need the care that she needs as young as she is.

When our elected representatives decide to cut Medicaid — whether through repeated attempts to repeal the Affordable Care Act or a budget that cuts $3.6 trillion from services such as Medicare and Medicaid — they should think about what this means to people like me and my family. They should think about Lynn, and the millions of other veterans who have turned to Medicaid.

The post My Sister Served in the Army. The Biggest Threat to Her Survival is Congress. appeared first on BillMoyers.com.

Trump’s Inability to Turn Promise Into Policy

Published by Anonymous (not verified) on Fri, 08/09/2017 - 4:57am in

We created our “While He Was Tweeting” series to help readers keep up with the rolled-back regulations and budget and staff cuts under the Trump administration that may be getting lost amid coverage of the American president’s twitter account. We’re also keeping an eye on new legislation under the 45th president, but seven months in, Trump has achieved little on his “big ticket” items.

Here’s the status on some of Trump’s signature initiatives.


RELATED: Democracy & Government


Trump’s Voter Suppression Team Is Playing the Long Game

BY John Light | July 12, 2017

 
Commission on “Electoral Integrity”

Donald Trump’s Presidential Advisory Commission on Election Integrity has been controversial since it was set up in May. While the commission bills itself as being “bipartisan” its two leaders, Vice President Pence and Kansas Secretary of State Kris Kobach, are both Republicans.

After the commission’s first meeting, Dartunorro Clark of NBC News reported that it was clear that members “don’t see eye to eye” on the key question facing the panel.

Is there widespread fraud at the ballot box? Some of President Donald Trump’s appointees say yes, including its vice chairman, Kansas Secretary of State Kris Kobach; others on the commission argue certainly not and want to focus on issues like upgrading aging voting systems and encouraging registration.

It’s first action, requesting that all 50 states send in their voter registration records, has already led to a number of lawsuits. As of early July, 44 states said they either would not or could not, for legal reasons, hand over voter data to the commission.

Some voting rights experts, like Ari Berman, have called the commission a “sham” and called for its dismantling. He writes, “The commission was set up for one purpose — to spread false information about voter fraud, like Trump’s gigantic lie that millions of people voted illegally, in order to build support for policies that make it more difficult to vote.”

 
The Iran Deal

President Trump has repeatedly denounced the agreement that Barack Obama brokered with Iran on nuclear compliance. In an interview with the Wall Street Journal in July, Trump said he would have declared Iran as being noncompliant with the Obama-era nuclear deal “180 days ago.” The trouble is, as The WSJ reporter pointed out, Iran had been inspected twice before and was certified to be in compliance with the agreement.

The Trump administration has unsuccessfully tried to carve out plans to pull out of the deal. Earlier this summer, Steve Bannon asked former US ambassador to the United Nations John Bolton to come up with a strategy to that end. Then, Bannon was fired from the White House in early August, leaving Bolton’s plan in limbo.

Even if Bolton’s plan had somehow made it to the president’s desk, it was unlikely to pass any type of legislative review process. As Gardiner Harris from The New York Times reports, there’s bipartisan animosity to move forward with any type of changes to the current deal if Iran is found to be in compliance with the agreement, as it previously has:

Senate Republicans have signaled unease with the president’s vow to undo the deal and his own security advisers recommend preserving it. Calls placed to more than 20 Senate offices of opponents of the deal found few willing to discuss their positions publicly. Mirroring Republican unease, some of the groups that once fiercely opposed the deal are similarly silent.

 
Border Wall

Since day one of his campaign, the promise to build a wall along the US-Mexico border to prevent unauthorized immigration to US territory has been a key driver of the president’s popularity.

However, as shown during the Obamacare repeal “negotiations,” a promise does not always translate into policy. Many legislators are unwilling to fund Trump’s border fantasy. On one hand, most, if not all, Senate Democrats refuse to provide funding for the project. It is also unlikely that Republican leaders will support funds for the wall, especially given the fraught relationship between GOP leaders and the president after Congress failed to secure an Obamacare repeal earlier this summer.

Not surprisingly, knowing he’s unlikely to get congressional approval, Trump is again claiming that Mexico will pay for the border wall. On August 27th, he tweeted:

Later that day, Mexico responded:

As the Mexican government has always stated, our country will not pay, under any circumstances, for a wall or physical barrier built on US territory along the Mexican border. This statement is not part of a Mexican negotiating strategy, but rather a principle of national sovereignty and dignity.

 
School Lunches

One of the most controversial moments in the young Trump presidency was a move that seemed like a direct slap in the face to former first lady Michelle Obama. The administration announced early on that it was scrapping her healthy eating school lunch initiative.

Secretary of Agriculture Sonny Pudue made the annoucement in the annual conference of the School Nutrition Association. The New York Times reports:

After reminiscing about the cinnamon rolls baked by the lunchroom ladies of his youth, he delivered a rousing defense of school food-service workers who were unhappy with some of the sweeping changes made by the Obama administration. The amounts of fat, sugar and salt were drastically reduced. Portion sizes shrank. Lunch trays had to hold more fruits and vegetables. Snacks and food sold for fundraising had to be healthier.

“Your dedication and creativity was being stifled,” Mr. Perdue said. “You were forced to focus your attention on strict, inflexible rules handed down from Washington. Even worse, you experienced firsthand that the rules were failing.”

The former first lady memorably replied: “You have to stop and think, why don’t you want our kids to have good food at school? What is wrong with you? And why is that a partisan issue? Why would that be political? What is going on?”


RELATED: while he was tweeting


Some of the 7,000 members of the School Nutrition Association walked out on Purdue. But it turns out that it’s not all that easy to roll back the progress made in the last few years. Backboned by the Healthy, Hunger-Free Kids Act, which took effect in 2010, most of the moves toward healthier options are here to stay. As with civil forfeiture, which we reported on recently, much of the policy is made on the local level and school boards and nutrition groups are not willing to take a step backward.

Plus, there’s lots of grass-roots resistance. As The New York Times reports:

[The] Chef Ann Foundation, which provides grants to help schools create healthier food, will start the School Food Institute, which uses video courses to help school food-service operators and parents navigate the daunting bureaucracy of local and federal aid, with the aim of bringing from-scratch cooking back to all schools.

So what has the Trump administration accomplished with its very public move? Well, some areas of the country will see extensions on rules determining how much whole grain is required. Second, flavored milk can go back to having 1 percent fat (non-flavored milk is already fat-free). And most importantly, the limits on sodium will not rise as quickly as under the previous administration.

 
Read more installments in our series “While He was Tweeting” — keeping an eye on Trump’s wrecking ball.

The post Trump’s Inability to Turn Promise Into Policy appeared first on BillMoyers.com.

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