Some thoughts I have on Trumpcare

I don’t quite think I have to reintroduce myself to all of you, but it truly has been a long time since I sat down and wrote a piece for the consumption of my readers. (Editing Cathy’s last piece and writing two articles for the Patriot Post doesn’t really count for that purpose, nor does updating my Shorebird of the Week Hall of Fame page to add a couple player moves.) Unfortunately, things won’t improve on that front for some time, but the opportunity which presented itself to take my writing time was one I could not pass up.

But in this interregnum, we were given the bill to “repeal and replace” Obamacare, and since we are told President Trump has threatened to find primary opponents for any Republican who opposes it, I think I’m safe in calling this package Trumpcare. It’s still a government entitlement because there was a replace added with the repeal, and that already put a strike against it in my book.

The document I am going to base my initial impressions on will be the “talking point” document put out by the House GOP. To be honest, I really don’t have time at this point to read the original 123-page bill in depth, although I downloaded it for future reference and glanced through it to help with this piece. I look at this website as what the House Republicans are using as their chief selling points to the bill, so presumably this is their vision for federally-sponsored health care going forward. We have lived under Obamacare for about three years (as I recall, the major provisions did not all take effect before 2014, although some were in place shortly after the bill passed in 2010) so we know its effects: sizable increases in insurance premiums, a massive expansion of Medicaid (paid for in large part by Uncle Sam) to ratchet up the number of people with health insurance, subsidies for those who have less than a certain income yet are forced onto or choose to partake in the individual insurance market, the reduction in the number of competing insurance companies in many areas of the nation (some have just one insurer available to them), and the virtual elimination of catastrophic health insurance plans as insufficient for the needs of those insured. There were also a number of regulations and restrictions on insurers put in place, key among them the requirement of children being covered under a parent’s policy through the age of 26 and the elimination of discrimination based on pre-existing conditions.

With this massive incursion into private industry, for the first time the federal government required purchase of a product under penalty of law – those who chose not to buy health insurance were subject to a “shared responsibility payment” collected by the Internal Revenue Service. Imagine if you had to buy a car every four years whether you were happy with the one you had or not, and you may have the idea of how people felt about this. Obviously the economics of it were to make everyone pay a little something, but that’s not the way a free country is supposed to work for something that’s not essential to core functions of government.

Here are some of the provisions within the American Health Care Act (AHCA):

  • It “dismantles” the Obamacare taxes on prescription drugs, over-the-counter medications, health insurance premiums, and medical devices.

Okay, so far so good, although I suppose the definition of “dismantle” is in the eye of the beholder. I glanced through that section of the bill and it looks like this would not take effect immediately but at the end of this year. As a whole, individuals may see a little bit of savings but it won’t be something they will notice.

  • It eliminates the individual and employer mandate penalties.

This is perhaps the best news of all, but there is one huge catch to this: instead of paying this as a tax provision, you would have to pay a penalty to the insurance company in the form of a surcharge on premiums if you start up insurance again after not having it for a period of time. And that catch basically negates the whole benefit of removing the IRS from the equation, although I suppose an insurer could use the waiver of this surcharge as an incentive to bring people in.

  • It maintains the prohibition on charging more or denying insurance based on pre-existing conditions.

I have a big problem with this – not that it wouldn’t necessarily benefit me because I have asthma but because the idea for an insurance company is to make a profit by balancing the risks shared by the vast pool of policyholders with the expenses incurred by reimbursing those insured for loss. If someone is very likely to be a net loss to the insurer because they have a pre-existing condition, it should be the right of the insurer to refuse service. After all, banks don’t lend money at the prime interest rate to people who have poor credit records or no verifiable means of income because that would put their capital at too much risk for the return, so they either refuse the customer outright or charge an interest rate commensurate with the risk. That should be the right of a private insurer, too.

I was reading on social media that Maryland once had a high-risk pool for such patients, which was bankrolled by the state. While it’s not the use of taxpayer money that would be my most favorite, it is a state’s right to do so if they chose and there was nothing wrong with that system because it wasn’t directly competing with the private sector.

  • It keeps the provision of dependents being on their parents’ plan until they are 26.

This is another bad feature of Obamacare that should be buried with the rest of it. If you are 26 you should be able to stand on your own two feet and either be working for someone who offers insurance or be able to afford a plan on your own. (Or choose not to have insurance, which would be your right - although not necessarily recommended.)

  • AHCA also establishes what it calls a Patient and State Stability Fund.

Over the next nine years, the federal government will give out $100 billion to the states to assist them with their goals of insuring every citizen. I read quickly through this section and there are some provisions that give me heartburn: there are strings attached to the expenditure of the money and the states are required to come up with a larger and larger portion of matching funds for whatever they use the money for, up to 50 percent by the end of the program in 2026 – assuming, of course, this doesn’t become a more perpetual giveaway (which I’m convinced it will.) There is $15 billion allocated to this over the next two years and $10 billion per year after that, and I’m sure states will say this isn’t enough because they like that financial crack of Uncle Sugar’s money.

  • Modernize and strengthen Medicare by transitioning to a “per-capita allotment.”

The legalese on this one is beyond my scope of comprehension, but to me the idea of modernizing Medicare would be that of sunsetting it, not strengthening it.

  • Enhance and expand Health Savings Accounts.

One of the better features, although it would be even better with the free transfer of money between HSAs and other entities such as an IRA or 401 (k). If you needed more money in a particular year you should be able to move it without penalty.

  • A monthly tax credit for those who can’t afford insurance, up to $14,000 per year.

A subsidy under a different name. Basically they are replacing one tax scheme with another, still targeted to particular people.

All in all, I think the repeal should take place without the replace. It seems to me that we had a whole political movement and a bumper crop of angst spring up over the last eight years because people did not want any part of the government interference in their health care that Obamacare brought to us. Over that time, we lived with the disappointment of Republican excuses: “we’re only one half of one third of government,” “we have the House and Senate but the President won’t sign this,” “we can’t defund because there would be a government shutdown,” and so forth. After 2016, there was a Congress and President who campaigned on repeal, and yet you give us this?!?

A better alternative may be the plan presented by Senator Rand Paul, although it’s not perfect either. But it’s better than the GOP alternative, which is a great letdown for those of us who waited for the moment to eliminate the (not so) Affordable Care Act.

‘Death with Dignity’: compassion or dispatch?

March 11, 2015 · Posted in Cathy Keim, Delmarva items, Maryland Politics, Politics · 3 Comments 

By Cathy Keim

“Deserves it! I daresay he does. Many that live deserve death. And some that die deserve life. Can you give it to them? Then do not be too eager to deal out death in judgement. For even the very wise cannot see all ends.” ― J.R.R. Tolkien, The Fellowship of the Ring

The House Judiciary and Health and Government Operations committees held a joint hearing last Friday on HB1021, the Richard E. Israel and Roger “Pip” Moyer Death with Dignity Act. Yesterday the Senate Judicial Proceedings committee held a hearing on the cross-filed SB676.

The arguments that were offered at the House committee hearing on March 6, 2015, were exactly what were expected. The two sides are clearly divided here. The culture of death has no room for the culture of life. The desire to rule one’s own fate does not leave room for compassion or suffering, which are both elements of the human condition.

The siren call of death takes the guise of “fairness.” It is only “fair” that a person that is terminally ill should be able to end his suffering. Without a doubt, we all tremble at the thought of pain, dependency, loss of mental capacity and/or bodily functions. We all desire to be healthy and happy, but to equate the loss of our health with the right to die is a dire step.

Let’s run through some of the arguments that opponents of the bill put forth.

Maryland has outlawed the death penalty for anyone, no matter his or her crime. However, the same drugs that Maryland will not allow to be used to execute murderers are the drugs that will be prescribed for a person to die with dignity.

Physicians are not trained to kill their patients. It will inevitably change the doctor/patient relationship if the doctor is expected to offer death as an option.

People that are given a diagnosis of a terminal illness with six months to live will most likely respond by being depressed. They could kill themselves in a state of depression because there is no provision for a mental health professional to evaluate them in the current bill.

Physicians cannot tell with accuracy who has six months to live. Plenty of people live for years after they are told they have six months to live, but we will never know if they kill themselves out of despair. Amazingly, about 20% of the people that receive hospice care actually leave the hospice instead of dying.

Palliative care is available for patients in pain. We are not condemning our loved ones to endless, unrelenting pain.

Many of the most poignant cases that are presented as deserving a death with dignity are those afflicted with Alzheimer’s, ALS, or Parkinson’s. However, by the time they would want to die, they would not be able to self administer the drugs, so this bill would not “help” them anyway.

Handicapped people already feel pressured because they are using medical resources at a steeper rate than healthy people. This bill would increase the pressure on the handicapped to not use more than their fair share of medical care.

Do you see how the subtle pressure works? Especially once the government is in control of health care, there will be the pressure to manage care from an organizational, cost-effective perspective, not a personal case-by-case perspective.

An effective way to save on costs is to encourage the elderly, the handicapped, and the sickest patients to stop their suffering (and ours) by removing themselves. It does not even have to be said aloud, but the pressure will build on our weakest, most vulnerable citizens.

It is time now to stop and count the cost of this type of public policy. Our country was established with a Judeo-Christian foundation of which the keystone is that each individual is created in the image of God. This is the concept that gave birth to Western Civilization, which resulted in our Declaration of Independence proclaiming, “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Already we are seeing breaches in the wall protecting our weaker brothers. Abortion claims the lives of many babies because they are deemed defective (the vast majority of Downs Syndrome babies are aborted). Sex-selection abortions claim many female babies even here in the United States. Abortions are performed for trivial problems that could be surgically corrected like a cleft palate or even more troubling for the convenience of the mother. The absolutely logical next step after abortion on demand is the removal of the handicapped and elderly.

We are seeing the complete inversion of our thinking. Compassion used to mean caring for those that needed help. Now compassion is making sure that you can have a lethal dose of drugs to end your life. We have moved from compassion to dispatch, but in an Orwellian turn of the phrase, we still call it compassion. Then to keep up the farce, this bill would require the doctor to lie on the death certificate and list as the cause of death whatever terminal illness the patient had rather than suicide by overdose.

This Death with Dignity bill is a lie from start to finish. The true dignity would come from all of us rejecting this manipulation of our emotions and comforting our family and friends when they need comfort, not helping to finish them off.

Once again, I am aware of the pain, emotional and physical, that is present as we watch a loved one or ourselves move towards death, but this is part of the human condition. We do not make ourselves more human by rushing life out the door. We cannot create life, so let us not be over eager to take it away.

Fostering dependence

July 4, 2013 · Posted in Business and industry, Campaign 2014, Politics · Comments Off 

While many are attending a barbecue with family and friends or watching a fireworks show, there are big goings-on afoot in the world. I could have wrote on the demise of the Obama-backed Morsi government in Egypt, but that nation’s unrest isn’t a large threat to our livelihood just yet.

Instead, the news item I found interesting was the decision by Barack Obama to push the much-ballyhooed employer mandate back 12 months, from the beginning of 2014 to January, 2015. There’s all sorts of spin on this from the mainstream media (like the Washington Post, for example) but the timing of this is suspicious at best, as it occurs just six months before the original deadline. It’s intriguing how we now talk about the slowing down the rush, such as these two paragraphs from the Post piece by Dan Balz:

“This gives businesses some breathing room to figure it all out and not have to be rushed,” Democratic pollster John Anzalone said in an e-mail. He said he did not see it as a political decision, but added, “To be quite honest, whether it was implemented in 2014 or not, the Republicans are going to use the same rhetoric on Obamacare to attack Dems in congressional races [next year].”

And also…

Another administration official, who spoke on the condition of anonymity to talk candidly, said the action was not a reflection of the administration’s inability to implement the law, but rather its concern about getting this right rather than getting it done quickly.

So let me see if I have this straight. In 2010, we had to rush and pass the Senate version of the bill to see what was in it in the first place, all because the fragile coalition of Democrats was broken when Scott Brown was elected. Now there’s absolutely no hurry to put this employer mandate into place, even though American companies have wasted the last three-plus years dealing with strategies on how to cope with it. I really don’t see them running out and hiring millions of people based on a one-year reprieve from the proverbial firing squad of an employer mandate.

I know the real reason it was punted, though, and it’s called the 2014 elections. Forget taking over the House – surely Democrats are more worried about losing the Senate majority because they have a lot more seats to defend than the GOP does.

If the employer mandate was set in stone, chances are unemployment would reverse course and ratchet skyward, despite the administration’s best efforts at keeping the number low by tossing out long-term unemployed. If unemployment is 10 percent in an off-year election, you wouldn’t have enough Democrats remaining in Congress to occupy a phone booth, let alone run the Senate. (I say this with a caveat, though: there’s a reason Republicans are sometimes known as the stupid party – they have time and again snatched defeat from the jaws of victory.)

But if the impact is pushed beyond 2014 and Democrats manage to take back the House to go with the Senate, Republicans may be doomed to go the way of the Whigs. You’ll see expanded amnesty, more needless climate change regulation, the undermining of the Second Amendment – oh, and a faster push toward a single-payer health care system. This scenario is far more likely with a 2015 employer mandate.

If all this happens, we may just as well all be handed “dependence” cards, since surely the government will have one with our names on it. We’ll need that in order to be “put on the list,” waiting for months to secure our “free” health care. And if someone dies while waiting, well, chances are they were a conservative old fogey anyway. But if you’re a woman who wants her abortion six months into pregnancy, there will be no line for you. Step right up and have your fetus butchered while you wait.

Unfortunately, we already have too much government control of our affairs. After all, look at all employers have invested to prepare based on a government decision at the expense of actual tasks which can build market share or improve a product or process. That’s the sort of red tape which needs to be eliminated – stat!

WCRC meeting – June 2013

We hadn’t met in two months, but probably received enough information to make up for the difference in Monday night’s meeting.

After the usual preliminaries, we stopped for a special presentation. Two deserving students outshined a solid pool of applicants and were honored with the Wicomico County Republican Club scholarship. Both Joseph Pitsenbarger and Emma Miller hail from Parkside High School.

Once we presented the scholarships, the meeting was opened up to featured speaker Dr. Mark Edney. The local urologist and member of the American Urological Association’s Health Policy Council and Legislative Affairs Committee knows his stuff about Obamacare, and his nearly hour-long presentation was jammed full of facts to back up his thought that “Obamacare is a liberal-made disaster.”

His activism on the subject started with an op-ed on the Ryan/Romney plan prior to the 2012 election. But as more people questioned that plan with the talking points of Obamacare, Edney looked a little deeper to find, as one example, that half of all health care dollars are spent by the federal government, and spending on health care comprises 24 percent of the federal budget as well as 25 percent of Maryland’s state budget.

But that’s not really why we have the most expensive health care in the world, Edney continued. Much of that expense comes because we have the most technologically advanced system. Still, about 85 percent of Americans are covered under the existing system and the Democrats “have upset the apple cart” for them, said Mark.

Yet what Obamacare tries to do is make sure that all Americans have health insurance; meanwhile, it also creates a subsidy that affects even those in the middle class, up to 4 times the federal poverty level. Unfortunately, the CBO figures that Obamacare will only address about half – 25 million – of the 49 million uninsured in the country, down from 33 million estimated just two years ago. And the real challenge, said Edney, will be getting 2.7 million 18-to-35 year olds, predominantly male, to willingly pay a lot more for insurance to subsidize the aging population which uses most of the services rather than pay a tax penalty which is a fraction of the cost. The Affordable Care Act, Edney predicted, will be “the slow death of private insurance as we know it.”

Another problem on the horizon, added Mark, will be a shortage of suppliers. While the state is trying to expand the role of nurse practitioners, physician’s assistants, and pharmacists into those roles normally reserved for doctors, they’re not a substitute.

Instead of Obamacare, which diagnoses the problem correctly but fails to cure it, the better solution lies in free market reforms to the system, in particular introducing the aspect of competition. Edney pointed to the Medicare Advantage and Medicare Part D prescription drug programs as “excellent examples of competition.” He also suggested raising the Medicare age to 67, noting that most of those who would fall into that 65-67 age bracket continue to work anyway or would be eligible for Medicaid based on income.

Edney also discussed how this could affect us on a local level. While consolidation of providers has occurred up the Eastern Shore with the merger of Chester River Health and Shore Health, at this time our area still has cutthroat competition between several players: the Peninsula Regional Medical Center in Salisbury, Atlantic General in Berlin, McCready Memorial Hospital in Crisfield, and perhaps even Nanticoke Health Services in Sussex County, Delaware may need to combine their efforts or be swallowed up by even larger entities. He predicted some movement on this front within five to seven years.

After that extremely informative presentation, of which I barely scratched the surface, we still had to go through our business.

In her President’s Report, Jackie Wellfonder mentioned a number of upcoming events, noting the 2014 primary was exactly one year away. But on a closer timeframe, the Tawes Crab and Clam Bake will be July 17, the Pathfinders event in Worcester County will be July 20, and the rescheduled Agenda 21 meeting with the Republican Women of Wicomico will now be August 1.

She stole the thunder from Dave Parker’s Central Committee report, as he mentioned many of the same events in passing – adding that we will have our usual joint Tawes presence with Worcester and Somerset counties – but Parker came up with the quote of the night regarding this administration: “Everything Obama touches turns to mush…if it ain’t broke, don’t Barack it,”

Joe Ollinger has steadily been working on the upcoming WCRC Crab Feast September 7, assembling a small roster of volunteers and getting the tickets printed and available. They will be $1 more than last year, but $26 for all-you-care-to-eat crabs is still a good deal.

That seemed to be the extent of what people wanted to discuss insofar as business was concerned. But July’s meeting may be more productive in that regard. Meanwhile, it appears that our August meeting may feature another candidate for governor as Charles Lollar is penciled in as our speaker that night, so July may be a sweet spot for finalizing some loose ends before we start going wall-to-wall with campaigning candidates.

O’Malley keeps shooting his foot

Since the beginning of July, Governor Martin O’Malley has made nationwide news in a number of ways, but not necessarily with the headlines he may have preferred.

First we had the Change Maryland tax exodus report that I’ve talked about at some length – and so have a number of others. (Yes, there are eight different links in that sentence.) That begat other statements like this one from GOP U.S. Senate candidate Dan Bongino, who also made a swipe at opponent Ben Cardin – who is not my friend, by the way:

Sensing the futility of having to defend our worsening national and local economy, Senator Cardin, absent a few well-scripted photo ops, has been missing in action as a public face for the current administration. Happily filling in is our Governor, who prefers television appearances to actual governing. Never more than a breath away from a mimed sound bite, fed to him by the current administration, he continues to intentionally mislead the American people and Marylanders regarding the perilous state of the U.S. and Maryland economies, perpetually stating that both are “moving forward”.

Governor O’Malley, take off your blinders and put aside your Presidential aspirations. The U.S. economy is in the midst of the worst recovery in modern times and our great state has become an economic joke. We currently rank 42nd out of 50 in a recent report on state’s business environments, followed by another report showing a mass exodus of successful Marylanders avoiding our punishing tax load. (Emphasis in original.)

Even better was this from radio talker Mark Levin, who’s not known for mincing words (h/t to Jackie Wellfonder):

And the guy who started this whole news cycle, Change Maryland head Larry Hogan, himself on Wednesday dismissed O’Malley’s response as “a childish lashing out” on WBAL radio.

So what did O’Malley do yesterday? Double down on stupid. (Again, thanks to Jackie for this one.) This is from his Facebook page:

A new report conducted by the Hilltop Institute at the University of Maryland, finds that implementation of the Affordable Care Act will benefit the state’s budget by more than $600 million through 2020, generate more than $3 billion in annual economic activity, and create more than 26,000 jobs. This is more great news for Maryland’s families.

Naturally I had to respond:

If the group being cited has as part of its stated mission “Developing, implementing, and evaluating new delivery and financing models for publicly funded health care systems, including preventive health, behavioral health, oral health, and long-term services and supports” do you honestly think they would have some other conclusion?

The Left loves to jump on research when its funded by a particular industry and seems to conform with their word view, so how is this different?

But the most humorous thing I find about the study is that they project there will STILL be uninsured Marylanders. I thought the idea was to insure everyone? (Never mind the rose-colored glasses on economic impact, unemployment, etc. the report assumes, nor should we mention the $300 million a year state employers will have to pony up.)

(snip)

And why should O’Malley care? The impact will mainly fall on his successor; meanwhile he’ll be warming a U.S. Senate seat in preparation for his sure to be ill-fated Presidential run.

By the way, a summary of the report projections can be found at the Hilltop Institute site. I sort of suspect they know which side of the slice their bread is buttered on.

And here’s the rub: Does the governor honestly think that taking all these millions out of the private sector and redistributing it to the mobs who will be expecting their “free health care” for every sniffle, toothache, or paper cut will make money for the state? It didn’t work in Tennessee or Hawaii, and the jury is still out on Massachusetts.

Out here in the real world, we know the score. And while Martin O’Malley is trying his best to become a leading contender for the 2016 Democratic nomination by pandering to the causes liberals hold dearest, such as green energy and gay marriage, he’s forgetting that he’s also building a record of budget-busting failure to be used against him by the GOP. Quite honestly, stupid statements and “childish lashing out” are unbecoming of any governor, let alone who who fancies himself a prime-time candidate for the Oval Office.

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