Saturday, September 24, 2016

Why Would Anyone Possibly Assume Trump Isn't A Health Care Expert?


I don't know what it's like in your state. I know a lot of nurses in Florida come from Haiti. When my friend Stephen's mom died after a long, protracted illness, he gave her primary nurse several hundred thousand dollars from his mom's estate. His mom wanted him to and Stephen described the nurse to me as an angel who made his mother's last years not just bearable, but worthwhile for her. Here in California, many nurses are also immigrants, but not from Haiti. Many come from the Philippines; many come from Mexico.

I just spent a couple of years battling a rare form of cancer and City of Hope was a second home for me. I picked City of Hope because a doctor there-- also an immigrant-- is one of the world's foremost specialists in this particular type of cancer. She has been successful in her efforts and she'll always be part of my life and in my prayers.That said, the people who I was with every day and sometimes 24 hours a day were the nurses, many of them from the Philippines. One, Cindy, makes my heart soar whenever I think of having to go to the hospital for blood tests, even now. When I heard Trump ranting ignorantly about Filipino immigrants in August, I nearly lost it. Does he have any idea about what these nurses bring to the table-- any idea how much more they contribute to society that he or his monstrous offspring do? Of course not.

I can't imagine how I could have survived without the skill and love from the medical professionals like nurse Cindy-- one of several dozen nurses who cared for me in the hospital and when I was recovering at home. I was reminded of the fragility we face as we get older and as we become susceptible to opportunistic diseases yesterday when I read about a Rand study contrasting Trump's and Clinton's health care approaches. Clinton's is far from perfect, but it's moving the country in the right direction. Trump's will help hasten the deaths of as many as twenty million Americans. Republicans like his plan because it saves the wealthy money and could allow lower tax rates for them.

William Hoagland, once a Cigna lobbyists and GOP Senate staffer and now a top executive the Bipartisan Policy Center, warns that Trump's jumbled hodge-podge of a plan only proves one thing, that, in his words, "Trump does not understand health care." He doesn't?

The premise of Clinton's plan is to make sure several million more people-- probably 9.6 million more-- would be able to afford health care premiums through ObamaCare. Trump's plan would deprive as many as 20 million people of health insurance, a death sentence for many.

Clinton wants to add the public option to Obamacare while giving individuals whose out-of-pocket medical spending exceeds 5% of their income a tax credit of up to $2,500 and lowering the maximum amount that people would have to pay toward Obamacare insurance plans from 9.7% of income to 8.5% of income (for people who earn less than $47,000 a year). Her plan moves the country in the direction of universal coverage, too tepidly for progressives but beyond what Obama achieved and nothing at all like what Trump is trying to "achieve" by going backwards. Sahil Kapur, reporting for Bloomberg, summed up the Rand findings with a key figure: "19.7 million lose coverage if Trump repeals Obamacare." His plan would also increase the federal deficit by $33.1 billion in 2018. He proposes tax credits that are meant to benefit rich people, like virtually all of his proposals.

To evaluate Trump’s plans, Rand modeled the effects of repealing Obamacare and replacing it with his proposals. The Affordable Care Act, or ACA, gave states funds to expand the government-run Medicaid program for the poor, and created markets where individuals could buy health plans, often with federal subsidies. It also lets children stay on their parents’ health plans to age 26, requires the purchase of health insurance, and bars insurers from excluding people who are sick, with so-called pre-existing conditions, from buying plans. Clinton’s plans were evaluated as extensions of the current law.

The researchers said they asked both campaigns to help with the modeling. Clinton’s campaign provided answers, while Trump’s campaign referred the researchers to its website, they said. Both campaigns were given copies of the analysis before it was published.

In his proposals, Trump would replace the ACA with a tax deduction letting people with health plans fully deduct their insurance premiums from their taxes. He would move to a system of Medicaid block grants, which would cut costs because the federal government would provide states with a limited, fixed amount of money. And he wants to allow insurance to be sold across state lines.

The deduction for insurance premiums would add about $8 billion in costs to the ACA repeal, increasing the federal deficit by an estimated $41 billion, while reducing the number of individuals losing coverage to 15.6 million, the Rand study found. The deduction would lead to lower health costs for higher-income people, who benefit more from reduced taxes, the researchers said.

“Distributionally, it benefits higher income people more than lower income people," Collins said.

From Clinton’s side, the researchers looked at four proposals, all of which would increase coverage and lower costs for individuals. Three of the proposals would add to the deficit, and one would cut it modestly.

The biggest proposal, according to the study, is a refundable tax credit of as much as $2,500 for individuals and $5,000 for families whose health-care costs exceed 5 percent of income. She also wants to fix what’s called the family coverage glitch, which prevents some low-income families from getting financial assistance.

But the proposal that’s attracted the most attention recently-- a government-run public option health plan to compete with private carriers on the ACA’s exchanges-- has some of the smallest effects. It would provide insurance to 400,000 additional people, while cutting the deficit by $700 million. The Rand analysis assumes the plan would pay providers Medicare rates, which are typically lower than those paid by commercial insurers, helping account for its lower cost.
In her analysis for The Atlantic yesterday, Olga Khazan pointed out that "Trump’s plans would lead to even greater numbers of poor people left uninsured... All of his proposals would also make health care more expensive for people buying insurance on the individual market, with the exception of high-income people, who would benefit from Trump’s proposed tax deductions. "Without subsidies, middle income and lower income folks can’t afford to buy coverage,” [Harvard Professor of Public Health John] McDonough said. “It’s only going to benefit higher-income people who are already buying coverage. [Trump’s plan] won’t expand coverage at all, and it will hurt the federal debt.”
Trump’s Medicaid block-grant idea has been put forward by other Republican policymakers, including the House Speaker Paul Ryan. Medicaid block grants won’t necessarily boot people from Medicaid rolls-- the federal government could, after all, make the grants very generous-- but past block-grant proposals have been stingier than the existing Medicaid system.

Selling insurance across state lines has been proposed by every Republican presidential nominee since 2005, as the New York Times’ Margot Sanger-Katz reported. The idea, built on the promise of competition in the free market, seems appropriate for a businessman like Trump. But it’s already been tried in some states, and it failed to catch on with insurers, who struggled to build up networks of doctors in other states.

Sara R. Collins, vice president of health-care coverage at the Commonwealth Fund, pointed out that if interstate insurance sales did pick up, insurers might flock to states with the weakest consumer protections.
It would be a race to the bottom, with insurance companies selling cheap plans that don't cover much and leave consumers up shit's creek without a paddle when they are most desperate for help. That pretty much defines Ryan's #BetterWay across all categories-- something Trump seems happy enough to go along with as long as he can put his logo on the White House.

A #BetterWay?

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At 9:32 AM, Anonymous Anonymous said...

So HRC's "public option" will provide coverage for, maybe, 200,000?

Now there's some major league incrementalism!

John Puma


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