Available Care Act – Beyond “Coverage”

Much talk about insuring people for healthcare needs.  The giant bedpan in the room is availability.  What good is having Medicare, Medicaid, exchange plans, if you cannot find a doctor for hundreds of miles who will accept your provider’s coverage?  Just look.

The pundits talk about providing millions of people “access” to healthcare; however, they cannot explain why many of the “covered” still do what they did when they had no insurance, go the emergency room of the public hospital known to be the one that cannot turn them down.

Health insurers specify what they will cover and what the insured must pay, in terms of dollars and percentages.  What they do not spell out, is the amounts they are willing to pay the doctors and hospitals for various treatments.  The doctors and hospitals that are willing to accept the insurer’s terms are added to a “network.”  If the insured uses these doctors and hospitals, “in network,” the patient pays less; “out-of-network” providers, the insured pays much more.

Medicare, and the related private insurance plans are shunned by many healthcare providers because of the intense complexity of coding rules, poorer reimbursement rates, and 6-month slow-pay of claims.  I cannot blame them for wanting the easiest, most profitable patients, but look at what that does to retirees:  it shoves them into the offices of the newest, least experienced doctors, who do not have privileges at the best hospitals.

Another specious barrier doctors erect is “not accepting new patients.”  If that is true, why do they prominently promote their doctors, facilities, and services?  Why do they list the insurance plans they accept, on fancy websites?  What do they do when patients get well, move, change, outgrow their need, or die?  Who takes their places?  Are there waiting lists?  This policy seems wildly inconsistent, and dubious to me.

Today’s labyrinth of laws, maze of insurance coverages, intricacies of medical practice, incorporation of hospitals, vast array of medical devices, tests, and procedures, and incomprehensible myriads of drugs and medicines, are the starting point of future choices.  The concept of choosing your doctors, clinics, and hospitals still appeals to me.  If all health insurance policies must meet some minimum standards of coverage, why should health providers exclude any of them?

We have a historic opportunity to put features into the fabric of healthcare; the federal government has more incentives and flexibility to “get it right” as they formulate new laws.  Why not pass a new law called “The Available Care Act?”  If you accept anything except cash for medical services or goods, you accept the coverage of any patient who walks in your door.

 

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Populists Remodel Both Parties, Instead of Constructing New Ones

“Americans are not only strongly dissatisfied with the state of the economy and the direction in which the country is headed, but with government efforts to improve them. As the Pew Research Center’s analysis of exit poll data (2010) concluded, “the outcome of this year’s election represented a repudiation of the political status quo…. Fully 74% said they were either angry or dissatisfied with the federal government, and 73% disapproved of the job Congress is doing.”

http://www.pewresearch.org/2010/12/14/how-a-different-america-responded-to-the-great-depression/

Like the two poles of a magnet, anger and dissatisfaction manifested in favor of a clearly popular Bernie Sanders movement on the left, and more clearly in the ascendancy of Donald Trump on the right.

The Democrats

Bernie Sanders attracted a large plurality of younger citizens to socialist ideas for solving perceived failures of government.  The Obama administration did nothing to ameliorate the impact of staggering loan burdens on college students; the Affordable Care Act not only failed to manage healthcare needs, it aggravated the problems of access and affordability.

Super delegates, and the strident support of the DNC establishment saved Hillary Clinton’s primary candidacy from an embarrassing drubbing by the populists.  Nonetheless, the Democrats had to shift their platform to the left to avoid losing the new voters Bernie Sanders attracted.  The party apparatchiks felt their grip on power slipping, and quickly adjusted to retain control.  Witness the remodeled Democratic Party

The Republicans

The Republican powers-that-be were not so lucky; by denying, resisting and eschewing, they lost control of the party to a populist candidate beyond their influence.  Donald Trump, by design or blind luck, tapped into the anger and frustration of a tsunami of new and dormant voters on the right. Instead of building a new third party, ala Ross Perot, Trump remodeled the Republican Party.  This massive wave of constituents was so strong that sixteen traditional candidates succumbed to mild taunting and criticism in televised debates, and strong turnouts in the primaries.

The barrage of criticism from both parties, the withdrawal of political support by RNC powerhouses, and the withholding of financial support by big-time contributors could not stop a political neophyte from becoming the Republican candidate on a tiny fraction of the money spent against him.  The Republican Party has been transformed into a conservative, populist majority; sour grapes, snubs, and disownment remain ineffective on the new dynamics of the party.

“I’m mad as hell, and I’m not going to take it anymore,” is our new national creed.

Obamacare – Expensive Eternity on Hold

Wouldn’t it be great to have unlimited hours and days to manage your family’s medical insurance?  Apparently, that is what is required under the new medical insurance regime.

Straight story:  My wife is a home health care nurse.  Her employer is a giant in the home health care business.  In addition to her paycheck, she had good health care insurance paid mostly by the company.

With the advent of the A.C.A aka Obamacare, employers were let off the hook for 2014 regarding penalties for not providing medical insurance.  At the same time, individuals were required to have it.  The home health giant dropped health insurance benefits, not for office staff or management, but ONLY for the nurses who delivered the care.

That led to the pursuit of an individual policy for my wife paid with after-tax dollars of $605 per month.  To the uninformed, this means having to earn $800 per month, paying $195 dollars in Social Security, Medicare, and income taxes, to net $605 to pay the premiums. (Question:  who got the $195 that she did not have to pay beforehand?)

Then we discover that her doctors are not included on the “in network” list or are not accepting her new coverage.  Several times we drove to the offices of doctors who were listed as providers on the company’s website, and discovered that they either dropped out of the “network,” or closed their doors.

In December she got notice that her premiums were increasing to $710 for 2016 for the math challenged, this is a 17.4% increase.)  Another $140 per month of earnings less $35 in taxes.  So we were facing paying $940 of her pre-tax earnings each month ($11,280 per year) for insurance with $2,000 deductible and $7,000 annual out of pocket.

Fortunately, her new employer offered her better health insurance benefits as of 01/01/2016 at $360 per month for her share.  She now only has to earn 470 dollars per month, and pay $110 in taxes to cover this benefit.

But wait, there is more.  We both tried for nearly two weeks to cancel the old policy.  Nowhere on the health insurer’s website are information or links to cancel a policy.  We called the 800 number for customer service numerous times, only to be subjected to hour plus waits ending in mysterious hang ups.  When I finally reached the customer service number after 1 hour and 40 minutes of waiting, I was informed that I had to call the Marketplace to cancel the policy.

After another wait, I was told I had to give them 14 day’s advance notice to stop the January premium payment.  This would have meant $710 paid for January for double coverage.  When I asked who I could talk to, I was given an 800 number that was answered by the health insurance company.

This is not apocrypha; this is first-hand experience.  Replicate this experience millions of times and you have the cost we are paying for the changes caused by Obamacare, not counting the coming tax filings by employers and employees, the IRS processing and enforcement.

 

Truth Is, Neither Political Party Has Real Solutions – Unsolved Problems Equal Unrivaled Political Power

Have you noticed how much time and blather are lavished on inventing and enlarging problems, blaming, and shaming the “other” for causing, maintaining, expanding and taking advantage of problems?  Have you paid attention to how little or no time is invested in compassionate, cooperative, thoughtful, creative ideas?  Have you noticed how little time is spent pursuing sometimes simple obvious solutions, and strategies to reduce divisiveness, or resolve negative issues?

That is because “Problems = Power” in politics – especially perpetual & perpetuated problems.

What is a problem?  Think about it – a problem is a perception, a belief, a concept, an idea, a puzzle, a construct that proposes that an obstacle, a burden, a threat, or a harmful condition exists for a person or group of people.

The word “problem” also implies that a “solution” or “answer” or “proof” is available.

If you want political power:

  • Define a “problem” and declare a solution is available.
  • Proclaim yourself the champion of a particular social, financial, cultural pain for which you have the answer.
  • Stand up as the leader who will right a present, past, or future wrong.
  • Convince others that you are a spearhead who will break the hold of nefarious conspiracies on the throats of the weak, disadvantaged, and marginalized.

The basic strategy appears to be:

  • Maintain and emphasize the “problem” to your intended constituency.
  • Complain publicly, and produce anecdotal, sometimes rare examples of the “problem,” victims, or damage.
  • Blame someone else for creating, expanding; and perpetuating the “problem.”
  • Berate anyone who could or could have, should or should have solved the “problem.”
  • Propose a law so someone else has to stop it, fix it, or pay for it.
  • Promise that, if elected, you will fight it, expose it, or make it “fair.”
  • Make emotional accusations that others intentionally cause the “problem” for their benefit.
  • Stir up anger and hatred for groups, classes, or nations accused of causing, imposing, or withholding solutions for the “problem.”

But do not, under any circumstances, actually do anything to solve the problem systemically because, when you solve the problem, you lose the power created by the problem.  (that is, if there really is/was /were a problem.)

Some statements sound like problems, but they are really just statements.  For example, I remember hearing:

  • “The poor will always be with us.”
  • “How much better is it to acquire wisdom than gold! and to acquire understanding is worthmore than silver!”
  • “Thethings you own end up owning you.”

Other “problems” are invented and protected, such as the “problem” of requiring a photo ID.

First, has anyone, besides me, ever been in another country?  Everyone, citizens, residents, & visitors must have “papers” such as passports, or else you go to jail or get deported, period.  Often, proof of birth is not on record, but the governments know this and have methods of dealing with it.  Guess what? – people get and keep IDs.

Second, we live in a culture of ubiquitous identity verification requirements.  How does anyone live in the USA without government issued ID?  We need ID’s to receive, record, do, buy, or operate anything worth receiving, recording, doing, buying, or operating.  Here are some examples:

  • Paychecks (job application & check cashing)
  • Social security checks (benefit application & check cashing)
  • Credit purchases
  • Food Stamps (benefit application & purchasing)
  • Unemployment (benefit application & check cashing)
  • Welfare (benefit application & check cashing)
  • Home & auto titles
  • Insurance
  • Marriage
  • Birth
  • Divorce
  • Buying alcohol
  • Driving
  • Attending school
  • Getting medical care
  • Internet purchases
  • Electricity
  • Sports events
  • Buying stupid stuff advertised on TV for $19.95, (but wait – order now &..)
  • And much, much more

Oh, I forgot, with everyone taking “selfies” these days, that means they have a smartphone, and the related bills.  They are also creating photo IDs on the internet.  So who is left?  The Disabled, the Aged, the Homeless, the Poor?

Why haven’t their family, or friends, or social workers, or political party members taken them to the Department of Motor Vehicles, or the Post Office, or wherever they need to go to get an ID?  The fact that the photo will be atrocious should not daunt you.  The ultimate ID is a US passport, good anywhere in the world.  Next is a driver’s license or a non-driver’s ID from the state.

Obviously, the first step is a census, a list of people who do not have an ID.  The opponents of having an ID seem to know who they are; so prove it; produce the list.  Then solve the problem instead of complaining.

Third, where photos are required, couldn’t we just have cameras, or smartphones to take pictures of people who have none (duh)?  For example, have digital cameras to take photos of any who wants to vote, but has no ID.  Email the picture, name, address, and phone number to a secure central server.  If there ever is a problem or doubt, you have the data to answer any questions. I’ll bet the pictures would come out better than the Department of Public Safety, or Department of Motor Vehicles, or, heaven forbid, Department of Corrections.  This data could also be used to create a photo ID, once verified.

Fourth, isn’t getting a photo ID something that lasts once you get one, or only requires renewal every few years?  If you average out the yearly cost of having a photo ID, it should be affordable (maybe $5-10 per year, at most).

I mean, if you knew Aunt Betty did not have a photo ID, couldn’t you help her get one as a 50th birthday present?  Also, if a political party wanted supporters to vote, couldn’t they spend some small fraction of the millions of dollars they raise to get them ID’s?  Naahh!  Just let the problem ride, and keep the power so you can accuse, complain, and litigate again next year.  Oh, and take the “problem” to the Supreme Court to make it permanent.

But, this is just one example.  Let’s think about how politicians develop strategies around problems.  What is missing, or mislaid?

  1. Avoid Problem Analysis – Strategy: generalize, exaggerate, fabricate, and avoid any details and real research.

Ask yourself, would the protestations of ANY of the current candidates for President solve ANY of the serious pains Americans are suffering?  All I have heard are mission statements, results promises, and slogans.  Oh, I forgot, blame, & snide ad hominem bombs hurled like fireworks into the air, never to land; entertaining, reinforcing, & useless.

  1. Avoid Solution Analysis – Strategy: poor math, blur the subject, blame obstacles, avoid saying who would really pay.

Has anyone heard of a workable tax/spend plan that would actually produce the stated result, in practice?  It must be out of fashion to think things through; for example, “Tax the Rich” probably won’t work, when we wiggle the definition of “rich,” and forget that people do not stand still for painful government actions.  They either stop the taxable behavior, or substitute non-taxable behavior, or cheat.  “Do Not Tax the Poor” is a problem when the definition of “poor” is feeble, and government spending exceeds the resources of everyone.

  1. Avoid Distinctions – Strategy: collapse specific meanings into general terms, confuse demographic groups by using the same words to describe different groups.

The most prominent example of this is the intentional, improper use of the word “immigrant.”  “Immigrant” means a person who is a citizen of another country living in the USA legally by registration (aka – Green Card), or through naturalization to become a citizen of the USA.

That is all.   The term is specific and narrow in its legal definition; it absolutely excludes “unregistered aliens,” “foreign nationals,” “migrants” and so called, “illegal immigrants,” and “undocumented workers.”  All of those terms refer to unregistered non-citizens living here in violation or our immigration laws.  But, clever politicians, journalists, and advocates substitute the word “immigrant” for people who are not citizens.

The effect of this is to rile up immigrants, who are Americans, and make it sound like Americans hate immigrants.  Use the right words and it is clear that Americans love immigrants; we ARE immigrants, or descendants of immigrants.  We oppose people violating our immigration laws.

It is deceitful, and “newspeak” to use euphemisms or the word “immigrant” with obfuscating adjectives to imply that illegal aliens are really just citizens who kind of sort of haven’t taken care of a few annoying, paperwork details, so it is okay for them to come here and stay as long as they want because they really are Americans; aren’t they?

All in all, we can be tricked into supporting causes and politicians by perceiving “problems” as reality.  Sure, there are real problems, like homelessness, nuclear threats, infrastructure neglect, terrorism, inadequate public education, business and government corruption, to name a few.

But “inequality,” and “poverty” will always exist because people are different and “unequal” in many ways.

Should we regard exceptional students, athletes, scientists, artists, inventors, leaders, entrepreneurs, other geniuses as affronts to those who are not exceptional?  Should we slow down the hard workers and ambitious business owners to make things more “equal?”

Should we fault those who adapt to the world the way it is, instead of insisting that the past return for those who are stuck there?  Should we respond to the politicians who accuse government for making terrible agreements with other countries, or for not meeting all of our personal needs?  Is there something not great about America the way it is?

Make no mistake, America is the best place in the world for people who treasure liberty, personal freedom to live and work wherever we want, love who we want, go where we want, strive for our dreams, and as citizens vote how we want.

Go the Middle East, or Asia, or Africa, or Central America to see how the “other half” lives, and you will kiss the ground when you get back home to the United States of America.

 

 

What None of the Presidential Candidates Want to Address – Parity for Mental Health Care

Sure, Obamacare was supposed to raise the level of care for mental health to the level of physical health.  Sure, President Obama declared a $500 million increase in federal spending for mental health issues.  And……..?   That equals $1.56 per capita.  The states are decreasing their spending on mental health faster than that every year.

Those who venerate Ronald Reagan’s presidency may not have noticed that, once he converted federal health care into block grants to the states, the spending and resources for mental health collapsed to a feeble level.  As the mental health facilities closed, the new prisons opened, and the homeless population mushroomed.  Some experts estimate that 29% of the homeless have severe mental illness.  Department of Justice studies show that 45-65% of local, state, and federal prisoners have severe mental illness; about 1/3 receive treatment.  In other words, the justice system is in charge of mental health care in America.  A police officer is the most likely person to interact with the seriously disturbed citizen on our streets.  Then the most likely outcome would be to be incarcerated in a de facto asylum, or relegated to the streets.

I do not have the answers, but denial will not make things better.  Maybe it would better to convert our prisons into hospitals, and our prison guards into psychiatric nurses.  The last figure I heard was about $39,000 per inmate per year (about $107/day) for incarceration.  Then most of those released have not been treated for mental illnesses.  What do you think the chances are that they will have other episodes that might put them back in prison?

No one can guarantee that treatment would reduce recidivism; no statistics exist to test that theory.  All I know is that people I know do very well, when they take their meds.

So, here is the question every candidate for federal office: “It seems that all the candidates agree that mental illness has played a prominent role in the mass shootings around the US.  How well do you think the federal and state governments are managing mental healthcare in prisons, among the homeless, and the public?  What do you think they should do to really meet the needs?”

 

President Obama OK’s Health Insurance Discrimination

Did your company drop your health insurance?  Wait until you find out the rest of the story.

Investigators in the Department of Labor were shocked to find that President Obama gave employers a year to pick and choose who gets health insurance.

That’s right; the seemingly innocuous exemption of employers from the Affordable Care Act has given businesses with thousands of employees “Carte Blanc” to ignore decades of legislative efforts to protect employees from benefit discrimination.

For the year 2014 employers may provide health insurance to top management and deny health insurance to the rank and file.

Yes, last week officials at the Department of Labor confirmed that President Obama gave the green light to big businesses; they can drop health insurance for any employees they choose not to cover.

The Department of Labor reported that a business, employing thousands of workers, is within the law to keep health insurance benefits for management and cancel coverage for the rest of the employees.

The one-year exemption from the “Affordable Care Act” lets businesses cut anyone they want from their group health insurance benefits.

Department of Labor enforcement agents were embarrassed to admit that they were powerless to stop businesses, with thousands of employees, from dropping health insurance for most of their employees while keeping coverage for selected management and administrative staff.

After pursuing several complaints, a DOL investigator declared, “The whole department was shocked and dismayed to find that this exemption allows employers to undo decades of anti-discrimination efforts.”

If you are one of the myriad employees who are left with no health insurance, look again at the government and laws you counted on to protect your rights.  Nothing you were promised is true.

A Business Owner’s Response To Obamacare

What a great time to load more burdens on business.  Just as the US economy has leveled off from its scary decline, the federal government has chosen to add regulations and taxes relating to health care insurance to the choice of whether to hire or keep an employee.

I suggest that now is the perfect time to deal with this extra cost head-on with a new concept of employment compensation:  Total Compensation Agreements.  That’s right, fire all your employees and rehire them under TCA’s.  A Total Compensation Agreement would put a number on the total amount the employer will pay for the services of an employee.  If the number is $75,000, then that amount would be allocated among the employer’s costs related to the employee; what was left would be their paycheck.

We are fortunate to live in the age of computers that can calculate how this would work out.  For example, if the employee’s health insurance is $25,000 for a family of 4, the program would subtract that amount from the $75,000 leaving $50,000; if the employer’s cost of  FICA, unemployment insurance, worker’s compensation, etc., was $5,000, that would be subtracted from the $50,000 leaving $45,000; if the employee’s withholding and FICA was $7,500, that would leave take home pay of $37,500.  That is it.

If the business cannot afford to pay more than $75,000 for this employee’s services, or the employee cannot afford to live on $37,500, then no job.

The TCA structure would eliminate all minimum wage employees, and almost all less skilled workers from consideration.  Only those people whose productivity and lifestyle matched the profile would be employed.  Already, many business have found that redesigning their business model to use technology and fewer people makes sense.

What else can a business owner do?  It is either this approach or failure as a business.  Do the numbers.

So far, the only thing a business owner does not have to do is stay in business.