Nel's New Day

November 15, 2014

Health Care on the Chopping Block?

Just a couple of days after Sen. Mitch McConnell (R-KY) and Rep. John Boehner (R-OH) became leaders of the 114th Congress, they declared open season on health care for the poor and middle class. Their starting salvo was announced in a Wall Street Journal op-ed in which they began with eliminating benefits for workers employed fewer than 40 hours a week. In typical GOP-speak, they said that this change would provide employees with “more hours and better pay.” In 2013, 43.8 percent of all workers, 60.9 million people, were employed at 40 hours or more. The question is whether members of Congress would lose their insurance if health care guidelines change. The people wanting the increase in hours worked to get health care, congressional legislators, work about two days each week. They seem to be saying that they would work harder if they didn’t get health care unless they worked five days a week.

Conservatives have been jumping with joy ever since Jonathan Gruber, self-proclaimed architect of the Affordable Care Act, proclaimed that it was the “stupidity of the American voter” that allowed the bill to become a law. Far from being an “architect,” Gruber served as a consultant to produce cost estimates of provisions and giving technical advice based on his overseeing similar reforms in Massachusetts. According to Gruber, Democrats kept the Congressional Budget Office from scoring the mandate as a tax and hide the provision that young and healthy beneficiaries would subsidize premiums for the sick.

Scoring the mandate as a “tax” would not have changed the estimate of increasing revenue by $4 billion in 2016 and approximately $5 billion per year for the next eight years. There was also no lack of transparency about everyone, healthy or sick, paying into the insurance, and the media incessantly covered this fact. AP reporter Erica Werner clearly explained that premiums varied only on age, geographic area, and tobacco use. The president told AARP in 2009 before the law was passed:

“[Y]ou get the healthy and the young people alongside the not-so-healthy and the older people. But we’re all kind of spreading our risk, because each of us don’t know at any given time what might happen.”

Gruber also complained that the law does little or nothing to control health care costs. Yet four years after the act passed, projections for health care in 2019 is $500 billion less than projected at the time that it passed. As costs increase in many other areas, a study of 48 urban areas shows an average 0.2 decrease in the “silver” plans. Costs seem to be all over the place from an increase of 28 percent in Anchorage (AK) to a reduction of 24 percent in Jackson (MS). At the same time, the government paid $104 billion less in 2014 subsidies than originally predicted. The country has seven million more people than insured before ACA, the government pays less than predicted, and the rise in healthcare costs has dramatically slowed.

Gruber has apologized for his statements, saying that they were just “off the cuff” at academic conferences. It may not be enough to save the millions of dollars that he was scheduled to make. Eight states hired Gruber to help design their health exchanges after he banked nearly $400,000 in 2009 through contracts with the Department of Health and Human Services. He and a few colleagues had state contracts for $1.6 million over seven years from Michigan ($481,000), Minnesota ($329,000), Vermont ($400,000) and Wisconsin ($400,000). He also advised Colorado, Connecticut, Maine and West Virginia.

Because of ACA’s requirement that insurers must spend at least 80 percent of premium costs on medical care, 6.8 million families are getting average rebates of $80 totaling almost $2 billion. That’s one reason premiums are being lowered. Subsidies are the other reason. If the Supreme Court denies these subsidies in states without state exchanges, people can see their insurance premiums increase by about 75 percent.

As people line up to register for health care this week, the U.S. Supreme Court may join the conservatives in Congress to kill off the law—and many people at the same time. Paul Krugman called the lawsuit to be argued this year as death by typo. The Supreme Court is set to determine if the word “state” in one sentence of the 2200-page law means that poor people won’t receive subsidies in the states that don’t have their own government-run marketplace. Krugman wrote:

“Judges who support this cruel absurdity aren’t stupid; they know what they’re doing.  What they are, instead, is corrupt, willing to pervert the law to serve political masters.”

Over two decades ago, the conservatives supported single-payer health insurance, but that was before the Democrats accepted the idea. When Congress started working on the plan in the president’s early years, the Democrats attempted to mollify the GOP by incorporating their ideas into the law. After the GOP pushed the Democratic legislators in a corner, the law received only one GOP vote, a representative. Current problems show that single-payer health care would be the best for almost all the people in the United States.

Megan Rothbauer’s $50,000 bill is one example of why the U.S. needs a single-payer plan. Up-to-date on her insurance payments, the Wisconsin woman went into cardiac arrest and was unconscious when she was rushed to a hospital. The place where the ambulance took Rothbauer, 30, didn’t take her insurance although one three blocks away did. Unfortunately, she wasn’t able to tell them where they should take her. Without the Affordable Care Act, she would have owed another $100,000. A single-payer plan would have kept her from the possibly of becoming destitute, but Rothbauer is now facing bankruptcy. Blue Cross Blue Shield stated that the fault is with the hospital. The hospital stated that they could have charged her more but didn’t. Medical experts indicate that this is a common situation.

Even knowing what hospital is in a network doesn’t always help. When probate attorney Jeffrey Craig Hopper was smashed in the face with a baseball while coaching Little League in Austin (TX), his wife made sure she took Hopper to a hospital that is part of their insurance network. The ER doctor sent the couple a bill for more than $700; he could do this because he was outside the approved network of physicians. Again, this is fairly common: in more than half of Humana’s Texas hospitals, none of the ER doctors is within Humana’s network.  The same situation goes for almost half the Texas hospitals with United Healthcare insurance and about a fifth of Blue Cross-accepting hospitals. Preparing for the next emergency, Jennifer Hopper couldn’t find even five doctors who would take their insurance at hospitals her plan uses in Austin.

For the fifth consecutive year, the United States, the richest nation in the world, ranked last in industrialized nation’s health care systems. The only industrialized nation without universal health care, the U.S. has the highest percentage of U.S. residents not seeking necessary medical care because they can’t afford it. Thirty-seven percent of Americans said they didn’t fill a prescription, visit a doctor, or get recommended medical care because they worried about the cost compared to only four percent of people in the United Kingdom.

The United States has the highest infant mortality and deaths possibly preventable with access to effective health care. It’s also at the bottom of “efficiency” because of the time and money spent dealing with insurance administration, lack of communication among health care providers, and duplicative medical testing. In “equity,” the 39 percent of adults with below-average incomes in the U.S. who could not visit doctors because of costs puts the U.S. also at the bottom, compared with the less than one in ten who have the problem in the UK, Sweden, Canada, and Norway. People in the U.S spent $8,508 per person on healthcare in 2011 compared to $3,406 per person in the UK, but the higher cost of health care in the U.S. doesn’t equate to better care.

The data that put the United States last was collected before ACA went into effect. Even if the Supreme Court destroys “Obamacare,” the nation many have a brief shining time of health care for residents in Democratically-controlled states. Even so, six million of the poorest residents lack health care if GOP states refuse to expand Medicaid. A negative Supreme Court decision could triple or quadruple that number.

In Oregon, Monica Wehby, the GOP candidate who just lost to Sen. Jeff Merkley, wants to be boss of the Oregon Health Authority. The day after the election, she called newly re-elected Democratic Gov. John Kitzhaber to ask for the job. The agency runs the state’s Medicaid program for 300,000 low-income Oregonians and may also administer Cover Oregon, the health insurance exchange, which Wehby wants to destroy. Her campaign slogan was “Keep Your Doctor. Change Your Senator.” Before she ran for the senate, she starred in a 2009 nationwide commercial warning about the plan’s dangers. The job would also give her a serious hit in salary: in 2013, she made $861,479 as a pediatric neurosurgeon for Legacy Health Systems, and the previous OHA director made $173,000. She says that she just wants to “stay involved.”

One question in the Supreme Court argument about ACA is whether the business-friendly justices will go against the money-makers in the insurance and health industries. They’re making more money, and they like it.

As in the past couple of years, the Supreme Court is addressing voting rights, health care, and possibly marriage equality. Millions of people will be waiting until their pronouncements next June.

 

October 12, 2013

Day Twelve of the GOP Government Shutdown: Other News Out There

Am I the only person irate that Congressional GOP members are willing to dismantle the United States of America in order to keep giant companies from paying 2.3 percent on medical devices? Even Sen. Susan Collins (R-ME), perhaps the most reasonable senator, is including this proviso in her proposal for passing a Continuing Resolution, the same CR that House Speaker John Boehner (R-OH) promised last July would have no attachments.

That 2.3 percent tax would be on the $13,000 charge that companies make for a device that costs $350 to produce. Michael Shopenn found out about this cost when he needed a hip replacement. To have this procedure in the United States, he would have to pay an additional $65,000 for the procedure—not including the surgeon’s fee—over the $13,000 artificial hip cost. Other patients are charged two to three times that amount for the artificial hip.

His cost for having a hip replacement was $13,660 in a hospital outside Brussels, Belgium. The charge covered not only the hip joint, made by Warsaw (IN)-based Zimmer Holdings, but also all doctors’ fees, operating-room charges, crutches, medicine, a hospital room for five days, a week in rehab, and a round-trip ticket from the United States. The GOP is willing to destroy the U.S. for a 2.3 percent charge on outrageously marked-up medical devices. Belgium also has the lowest surgical infection rates in the world and is known for its excellent doctors.

The medical-device industry spent nearly $30 million last year on lobbying.

While government shutdown talks stall, time has stopped on Capitol Hill. The people hired to wind the clocks have been furloughed. The almost 200-year-old Ohio Clock, famous for a place where senators hide whiskey, stopped at 12:14 last Wednesday. The stoppage is symbolic of the stoppagefor millions of people in the nation who are furloughed, sickened, injured, hungry, and growing poorer each day.

During the shutdown, the media has suspended reporting much of the news around the country. Here are a few events:

Two days before the shutdown on October 1, over 20,600 barrels of oil, 865,200 gallons, fracked from the Bakken Shale, spilled onto a wheat field from a Tesoro Logistics pipeline in Tioga (ND) in one of the biggest onshore oil spills in recent U.S. history. The U.S. National Response Center, responsible for responding to chemical and oil spills, didn’t make the report available for ten days because of the government shutdown. These reports are usually posted within 24 hours. The spill is far larger than the 5,000-7,000 barrels of tar sands spilled into a residential neighborhood last April in Mayflower (AR) from a faulty ExxonMobil pipeline.

With only 1,285 barrels cleaned, the oil spread out over 7.3 acres. The oil, spilled through a hole in the side of the pipe and ruining the fields for planting, was destined for an Albany (NY) holding facility along the Hudson River.

Food-borne pathogens are sickening and killing Americans in more than 18 states as employees for the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) are being recalled as “essential” employees. The dual outbreaks of a salmonella outbreak and a hepatitis outbreak in Hawaii are linked to contaminated Foster Farms chicken products and the Dallas-based USPLabs LLC dietary supplement, OxyElite Pro. As of yesterday, more than 300 people have gotten sick, including 87 hospitalized, and one is dead with reports of antibiotic resistance for the precipitating strain of salmonella Heidelberg.

With more than 45 percent of all FDA employees furloughed, daily operations such as crucial inspections of food imports are on hiatus until the government reopens. The skeleton crew of ten in the CDC has been trying to maintain updates for tracking food-borne pathogens and outbreaks.

Even without the government shutdown, the FDA, USDA, and CDC—responsible for keeping food safe through inspection and prevention programs—are so seriously understaffed that people in the U.S. annually report 3,000 deaths, 128,000 hospitalizations, and over 48 million annual instances of food-borne illness. Only 6 percent of domestic food producers and 0.4 percent of food importers were inspected in 2011 after George W. Bush gutted the FDA budget.

Foster Farms has done no recall. A law passed in 2011 will give the FDA authority to legally mandate a recall of contaminated food, but it has not been completely enacted yet. Although the law should take effect by mid-2015, amendments from the GOP in Congress may weaken the act. Currently, the government also permits a privatized inspection scheme in which meat producers self-inspect.

If you avoid food-borne illness, you might want to watch out for nuclear disasters. The Nuclear Regulatory Commission had to furlough approximately 90 percent of its workforce. Supposedly, the agency will continue to respond to emergency safety and security matters, and onsite inspectors will stay on duty. Although the media has reported extensively on the Japanese problems with nuclear explosions, it has largely ignored the problems at nuclear sites in the U.S., such as the Hanford Nuclear Reservation, located in southeastern Washington along the Columbia River. Last spring, a nuclear safety board reported that the underground tanks holding toxic, radioactive waste could explode at any minute, due to a dangerous buildup of hydrogen gas.

Six months earlier, the Defense Nuclear Facilities Safety Board (DFNSB) told the Department of Energy about their concerns of no adequate safeguards to protect against the buildup of flammable gasses inside Hanford’s waste storage tanks. An explosion would “have considerable radiological consequences,” they wrote. Six of Hanford’s 177 tanks, holding 56,000 gallons of radioactive water, leak about 1,000 gallons of nuclear waste each year. Construction of a waste-treatment plant would make the toxic chemicals safe for long-term disposal and keep the radioactive waste from leaking into the ground, but Bechtel, responsible for building the plant, has been purchasing parts with no quality guarantee.

Other nuclear sites needing to be cleaned are in California, Colorado,Tennessee, South Carolina, Idaho, and Texas. Thirty-four nuclear reactors—one-third of those in the U.S.—face flooding hazards. This week, a former chair of the US Nuclear Regulatory Commission called for shutting down the Indian Point nuclear power plant near New York City and the Pilgrim nuclear power plant in Plymouth (MA) citing safety concerns. Vermont Yankee Nuclear Power Station in Vernon (VT) and Kewaunee Power Station near Green Bay (WI) have already closed. Mechanical failures and safety concerns have hurried the demise of San Onofre Nuclear Generating Station on the California coast and Crystal River Nuclear Plant in Citrus County (FL). Sequester cuts have already reduced the cleanups at these nuclear facilities.

Although the potential default could be catastrophic with spiking borrowing costs and interest rates accompanied by plummeting stocks, some people can benefit.

  • Short sellers: Betting that the value of a stock or bond will drop instead of going up is an investment strategy employed by financial firms and the wealthy. A stock market crash will short almost every U.S. stock.
  • Investors in gold and silver: Gold and silver typically rise in value when the stock market is volatile, because they hold their value better than paper money or other assets. The price of both metals rose this week as default fears heightened.
  • Bitcoin investors (maybe): The value of this untraceable virtual currency has tracked closely with gold over the past year.
  • Currency traders: Traders who bet that the US dollar will decrease in value relative to foreign currencies stand to profit off of a US government default.
  • Pawn shops: If credit markets freeze, as they did during the 2008 meltdown, pawn shops will do well as they did after the last crisis.
  • Bankruptcy lawyers: Loss of jobs and other income bring people to the edge.
  • Mortgage servicers: Spiking interest rates can cause somehomeowners to default on loans and end up in foreclosure. Investors take the losses while servicers make back the money they are owed in a foreclosure sale as well as getting the fees that borrowers pay on delinquent loans.
  • The canned and freeze-dried food industries: Doomsday preppers are readying for the collapse of civilization by stocking up on these foods.

Thus people betting against the United States will make money, and  members of Congress keep getting paid and going to their gym.

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