April 20, 2017--Tax Scam

I'm dense so it's taken me awhile to figure out why the Republicans so passionately want to
"repeal and replace" Obamacare. Actually, some of the most conservatives want only to do the repealing.

I got swept into believing some of the rhetoric. Obamacare is deeply flawed. True. It does not allow most people to keep their doctors, true; and it is not containing the rise in the cost of either medical care itself or healthcare insurance. Also true.

But, after a little time passed and the Republican talking points were countered, it became clear that the Paul Ryan American Health Care Act is not about healthcare but about taxes--a critical step toward his plan to cut and reform corporate and income taxes.

Here's the math--

In a March 22nd Forbes Magazine posting (not a socialist publication) it was reported that contained in the final version of the proposed bill, after all the deal making with the House of Representatives Freedom Caucus and White House, the nonpartisan Congressional Budget Office concluded that the plan would result in an $600 billion tax cut over the next decade, with at least $274 billion of the cuts going directly to the richest 2%.

Further, Medicaid would be cut, again over the decade, by $880 billion, making it more difficult for low-income taxpayers to secure insurance.

Though from a healthcare perspective it would be a crisis for low- and middle-income people--the CBO also estimated that these cuts would mean that 24 million would lose their current coverage--from a tax-cut perspective it would be a bounty. Again, with the top 5% benefiting the most from the GOP version of tax reform.

Obamacare does include two tax surcharges for high earners--

For couples filing jointly, if their adjusted gross income is $250,000 or higher there is a 0.9% Medicare surcharge and a 3.8% surcharge on net investment income, with the latter being income from certain types of dividends and capital gains.

The Ryan plan calls for the elimination of these two taxes for very high earners.

If this bill were to pass (and although it was set aside last month it is still a glimmer in Paul Ryan's eye and seems to have the support of the president, who feels the need to get at least something, anything done--even something this harsh and regressive) then Congress and the president could move on to what really interests them--massive tax cuts for the wealthy. Paid for largely, and here's the perversely brilliant part, by repealing the two Obamacare tax surcharges. Doing this would yield $1.48 trillion, which would "pay for" most of the additional tax cuts in a manner so as to make then seem "revenue neutral."

Again, this healthcare shell game is not about healthcare but tax cuts.

The claim, of course, is that cutting taxes for the wealthy is really about helping the middle class, because if you cut "job creators'" taxes they will invest in businesses that generate high-wage jobs.

The only problem with this claim is that it's untrue--the massive Reagan tax cuts and the even larger Bush tax cuts did not boost the economy or create jobs.  What was created were massive increases in the national debt--nearly tripling during Reagan's time and doubling under George W. Bush.

In contrast, the debt after Clinton's eight years increased by just 32% and during Obama's two terms, after inheriting a collapsed economy, it went up by 68%.

I am embarrassed to admit that it has taken me this long to finally figure out what is going on and what all the congressional healthcare machinations are about--tax cuts.

March 9, 2017--Health Care Lottery

In an attempt to be responsible, I tried to read through the 123-page American Health Care Act, Trump- or Ryan-Care, promulgated by the Republican House leadership on Tuesday. I needed to do so, I thought, to enter the debate credibly with facts at hand.

I failed at that but did stumble on something morbidly fascinating and all too revealing--after ten pages of gobbledegook (see below) there were six pages of reasonably readable text about what to do with people covered by Medicaid who win state lotteries.

When I mentioned this to Rona, she said my new meds were making me hallucinatory. So I showed her the text and now she believes me, but has been walking around the apartment mumbling to herself.

First, a taste of the gobbledegook, taking it from the top of the text--

TITLE I—ENERGY AND COMMERCE Subtitle A—Patient Access to Public Health Programs
SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND.
(a) IN GENERAL.—Subsection (b) of section 4002 of the Patient Protection and Affordable Care Act (42 U.S.C. 300u–11), as amended by section 5009 of the 21st Century Cures Act, is amended—
(1) in paragraph (2), by adding ‘‘and’’ at the end;
(2) in paragraph (3)— (A) by striking ‘‘each of fiscal years 2018
and 2019’’ and inserting ‘‘fiscal year 2018’’; and
(B) by striking the semicolon at the end and inserting a period; and (3) by striking paragraphs (4) through (8).

Pop quiz to follow. 

Then, after ten pages of this, clearly by placement to highlight its importance, for a full six pages they turn to what to do about state lottery winners who are currently covered by Medicaid.

Here is a bit of the text--

SEC. 114. REDUCING STATE MEDICAID COSTS.
(a) LETTING STATES DISENROLL HIGH DOLLAR LOTTERY WINNERS.—IN GENERAL.—In the case of an individual who is the recipient of qualified lottery winnings (pursuant to lotteries occurring on or after January 1, 2020) or qualified lump sum income (received on or after such date) and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph (A), a State shall, in determining such eligibility, in- clude such winnings or income (as applicable) as income received—
‘‘(I) in the month in which such winnings or income (as applicable) is received if the amount of such winnings or income is less than $80,000;
‘‘(II) over a period of 2 months if the amount of such winnings or in- come (as applicable) is greater than or equal to $80,000 but less than $90,000;
‘‘(III) over a period of 3 months if the amount of such winnings or in- come (as applicable) is greater than or equal to $90,000 but less than $100,000; and‘‘(IV) over a period of 3 months plus1additional month for each increment of $10,000 of such winnings or income (as applicable) received, not to exceed a period of 120 months (for winnings or income of $1,260,000 or more), if the amount of such winnings or income is greater than or equal to $100,000. 

Of course if someone wins more than $80,000 that should be taken into consideration when determining Medicaid eligibility; but to give it this prominence, to devote so much textual energy to this literally one-in-a-million reality is to reveal the mean-spirited nature of conservatives when it comes to compassion for those who struggle. They reveal here how much they resent any poor person allegedly "getting away with" anything these politicians, themselves imbibing at the public trough, feel they do not deserve.

Take congressman Jason Chaffetz (R-UT) as another example when he spoke about health care for those with little or low incomes. There is an easy way to pay for heath care, he said--the poor should give up their smart phones and by doing so would have enough money to pay for health insurance.

To quote his version of the Golden Rule:

Americans have choices, and they've gotta (sic) make a choice. So maybe rather than getting that new iPhone that they just love and they wanna (sic) go spend hundreds of dollars on that, maybe they should invest in their own health care. They gotta (sic) make those decisions themselves.

Maybe if he knew how much he paid for his health insurance (nothing as a senator) or his smartphone (again, nothing as a $174,000-a year member of Congress) he would realize that if they gave up their beloved iPhones they still gotta get a lot more money from other sources to pay for it. 

Maybe they could give up eating. From the looks of Chaffetz his doing so wouldn't be a bad idea. But as everyone can see he doesn't wanna do that.

Senator Jason Chaffetz

June 26, 2015--Obamacare!

With the Supreme Court decision announced yesterday that the Affordable Care Act (ACA) is constitutional, in addition to all the lives that will be bettered and saved as a result, there is one jolly political irony for those of us who consider it a pretty good piece of social legislation and feel that Barack Obama deserves to leave office in two-and-a-half years with his reputation, all right--his legacy, enhanced.

Here's the irony--

From literally the day Obama was elected in November 2008, many activist Republicans saw his election somehow to be illegitimate and have done everything they can to bring him down and delegitimatize him and his accomplishments--again, his legacy.

This is not to say that he has been a "great" or even a "near-great" president (if he secures a sound deal with Iran regarding their nuclear weapons program his stature will rise further) or that he deserved the Nobel Peace Prize in 2009, but all things considered--the economy, the roiled world with its out-of-control nationalisms and terrorism--he has done a rather good job. The economy is decidedly better than the one he inherited and he did end in an admittedly bumpy way the two wars that George W. Bush started and led into chaos.

But still GOP leaders and most of their followers wake up every day thinking about what they can do to undo everything Obama had a hand in accomplishing. Nothing more fervently than the ACA which the House of Representatives under John Boehner's fractured leadership voted to repeal literally dozens of times. There was a time during 2010 after the GOP seized control of the House that they did so every week for months.

Even Jeb Bush yesterday, with all the courage of a marshmallow, vowed to repeal it the day he is sworn into office in January 2017

As a sneering epithet to stigmatize the ACA, Republicans labeled it Obamacare. They couldn't say it enough. It was supposed to remind Americans that this abominable piece of legislation was the result of "his" efforts, the best evidence that he was a European-style socialist.

The name stuck. And isn't it amusing that this healthcare law, which is already providing life-saving coverage for up to 17 million previously uninsured Americans, many of them poor, and now twice has been upheld by a radically divided Supreme Court, will likely remain a permanent part of our social safety net alongside Social Security and more appropriately Medicare and Medicaid?

No other law that I can think of is named for a president. Social Security isn't called Roosevelt-Security, Medicare is not referred to as Johnsoncare, nor is the Voting Right Act named for LBJ. Welfare reform is not Clintonfare. Yes, we have the Monroe and Truman Doctrines but they were promulgated by an executive order, not something hatched with their leadership and then considered and passed by Congress.

Obamacare will be the way the Affordable Care Act will forever be known. So three-cheers for it and Obama.

As Joe Biden was heard to say on an open mike back in Match 2010 when it was passed, "This is a big f---ing deal."

January 29, 2014--Uncle Eli's Tongue Factory

While the Obama administration is thinking about publishing a list of individual doctors who are off the charts in the amount they bill Medicare as a way of exposing them to public scrutiny and potential prosecution if there is evidence of over-billing, Health Management Associates in Naples, Florida is already publishing data of its own about doctors affiliated with its South Florida chain of hospitals.

In Naples, according to a report in the New York Times, scorecards are posted for all attending physician to keep track of how many over 65-year-old patients they admit to the hospital each day.

Doctors hitting the target to admit at least half of the Medicare and Medicaid patients who entered via the emergency room are color-coded green; the doctors who were close to that 50 percent target are coded yellow; and those not admitting enough to the hospital are red-lighted.

Since the HMA hospitals, reflecting national changes in the way medicine is practiced, employ more and more doctors rather than just granting them attending status, pressure on these salaried doctors to increase income (and their own bonuses) by admitting more patients who have good insurance is increasing. So much so that at a HMA Naples hospital a Medicaid-elegible child was admitted with a diagnosis of having "fever" when her actual temperature was normal, 98.7; and an 18-year-old with a minor knee laceration was admitted though the wound could easily have been treated in the ER and the patient sent right home.

These are not isolated cases but rather examples of routine business.

These hospitals, like most in the nation, are technically "not-for-profit," but beyond that IRS designation, they are very much in the business of making as much money as possible so as to be able to pay doctors top dollars and hospital administrators seven-figure salaries.

It is thus no wonder that the money-driven healthcare system in the U.S. is by far the most costly in the world and for "average" people far from the best.

With thousands of lobbyists keeping the pressure on politicians not to change anything, very little does change. Big Pharma, the AMA, health care unions, medical equipment companies, hospital associations all join hands in assuring that their bottom lines, not patient care and cost-containment, are paramount. And thus far they have pretty much had their way.

Occasional exposés and law suits as the one being launched against Health Management Associates are rare and only chip away at the problem.

But there is a simple way to keep an eye on quality of service and billing practices.

Years ago, an uncle of mine owned a meat processing plant in the South Bronx. While trying to "find" myself I went to work for him and spent long days unloading truckloads of hams, pork butts, and beef tongues.

The Department of Agriculture required that the meat be inspected and, if it passed, labelled as such--USDA Inspected.

So in Uncle Eli's plant, on site, there were two full-time federal inspectors. They wandered around at will in their long white coats, randomly selecting a rack of curing tongues for careful analysis. They were incorruptible, permitted to work at any single establishment for only a month or two so as to inure them from being approached for bribes. And, in order to contain costs to the government, Uncle Eli was required to reimburse the Department of Agriculture for their salaries and benefits.

It worked rather well and this approach to safety and quality control could easily be extrapolated to all hospitals that are allowed to bill Medicare and Medicaid.

These hospitals, like Paramount Meats, should be required to have a team of on-site inspectors who they would pay for and who would keep an independent eye on services and billings. If, for example, they discovered a red light-green light system designed to defraud taxpayers (which that in fact does), they would have the power to intervene and, if necessary, report abuses to the Medicare-Medicaid Administration which in turn could refer cases to the Department of Justice.

This would lead to a significant decline in medical scams and reduce costs to those of us--really all of us--who through our taxes are paying the cost of abuse and fraud.

Doctors, then, could again be held to the Hippocratic injunction to "do no harm."