Friday, March 10, 2017

Looks Like Federal Government Control of Healthcare Is Here to Stay

I'm glad people who understand legalese have figured out what the new Republican healthcare bill says.

The federal government still mandates what your policy will include.
While some of the regulations are tweaked with more flexibility, the 800-pound gorilla in the room — guaranteed issue mixed with community rating* (which is responsible for almost all of the premium hikes) — is left in place. Nor does this bill repeal the mandated essential benefits, which require insurers to cover a specific number of people and sex change operations, maternity care for men, etc.
And even the repeal of actuarial value “metal” requirements (platinum, gold, silver, bronze) — the most positive of the outlined changes — would not take place until the 2020 plans. 
Instead of penalty money going to the government, your healthcare insurer will be required to charge you 30% more for your coverage (Sec. 2711).  This will undoubtedly be just as effective as the Democratic penalties were in forcing young, healthy people to pay sky high prices for medical coverage.
By maintaining guaranteed issue, healthy individuals will just go without insurance, and then if they get sick, anyone can still demand a policy. It’s worth taking the risk of paying an extra 30 percent when you really need it in exchange for avoiding paying the equivalent of another monthly mortgage for nothing when healthy.
Moreover, the new premium penalty for those gaming the system won’t begin until 2019, but the individual and employer mandates will be repealed immediately. This will further hurt the solvency because, again, the bill would maintain the exchanges and the regulations. Therefore, higher prices mixed with fewer people paying into the system will result in a nightmare scenario.
I'm not sure that mandate will meet Justice Roberts requirement that it's only constitutional if it's a tax. Not too many taxes go directly to private businesses. Wouldn't it be ironic if Obamacare was constitutional but Trumpcare is not?

Lots of money will be lobbed at the states for Medicaid expansion.
As for Medicaid, the draft plan grandfathers in the entirety of the Obamacare expansion. Worse, it doesn’t freeze future enrollment for another two years, which will incentivize states to massively expand Medicaid before 2020. It also throws another $10 billion to states that never expanded Medicaid.
Federal taxpayer subsidies to health insurance buyers will continue in a fire hose manner.
. . . this House bill replaces the income-based subsidies with age-based subsidies – ranging from $2,000 for younger people to $4,000 a year for older enrollees, and as much as $14,000 for a family. It is a massive new entitlement for middle-income and lower-income Americans. It would apply in full for families earning up to $150,000, and then phased out $100 per thousand dollars earned over that threshold. Thus, a family could theoretically get some sort of subsidy well into the $200,000-plus income level. [emphasis added]
Does anyone think this will bring down healthcare costs? Or that limited healthcare insurance options will increase? Or that people angry about Obamacare will be happy about Trumpcare?

The key takeaway is that there is to be no repeal of the essential idea of Obamacare that the federal government should regulate how healthcare functions in the United States. Both parties and their leaders now agree with this. If the Democrats are smart, they will vote for this and then tweak it back to Obamacare when they get in power.

The only hope, and it is mighty slim, is voter anger. Rising healthcare insurance costs and dwindling choice of healthcare providers may keep that anger strong. But where is an angry voter to go?
*Community Rating: "A rule that prevents health insurers from varying premiums within a geographic area based on age, gender, health status or other factors."

Thursday, March 02, 2017

Cruz and Pelosi Agree U.S. Debt Problem Not Too Much Spending But Too Little Revenue

Heh. You can't make these things up.

Here's Ted Cruz right after President Trump's speech on Tuesday:

Here's Nancy Pelosi four years ago:

Wednesday, March 01, 2017

Sorry, I Am Still Against Big Government and for the Tenth Amendment

Though there are a number of things I like about the Trump agenda, I am alarmed by his policies expanding federal power and increasing the national debt. And dismayed by the cheering for this coming from Republicans and those who formerly were conservative.

From President Trump's speech last night:
To launch our national rebuilding, I will be asking Congress to approve legislation that produces a $1 trillion dollar investment in the infrastructure of the United States - financed through both public and private capital - creating millions of new jobs.
I am still against federal trillion dollar spending projects other than on national defense or truly federal constitutional duties. (Shoot, I would grumble but could only complain moderately were the trillion to go for post offices and postal roads since that's an enumerated constitutional duty. Article I, section 8, clause 7.

FDR's attempts at creating millions of new jobs didn't create anything long term. All such government attempts have been a disaster because the government, unlike an actual owner, doesn't have its well being tied to whether the venture continues on. What we need is not six month or year jobs, but ongoing jobs funded not by taxpayers but by people who voluntarily buy goods and services provided by businesses. The government isn't smart enough or flexible enough to do that.
Crumbling infrastructure will be replaced with new roads, bridges, tunnels, airports and railways gleaming across our beautiful land.
. . .
Another Republican President, Dwight D. Eisenhower, initiated the last truly great national infrastructure program - the building of the interstate highway system.
I also don't believe the federal government has any business being involved with local and state infrastructure projects. Interstate? Okay. That's what Eisenhower did. On federal property? Okay. But, not hospitals, schools, or state and local bridges, tunnels, airports or other projects. Federal money corrupts those processes and leads to huge boondoggles if not downright foolishness. As for railways, private investment created the great railways. Public investment has created money losers like Amtrak or Portland's own Max light rail which requires payroll taxes and federal, state and local grants to fund the vast majority (69% in 2015) of its budget needs.

We shouldn't be spending money on new federal projects when we are trillions in debt. I say that to the younger ones in the family too. You don't spend what you don't have. Running up the national debt is stealing from our children, grandchildren, great grandchildren and who knows how many generations after that. We're already nearly $20 trillion in debt. So, let's add another trillion? How about if we can come up with a trillion let's pay off a trillion of the debt instead. (Here's where I grind my teeth at people like Sarah Palin and the Tea Party who were so opposed to the rising national debt under Obama but are fine with it under Trump. They are either hypocrites or unable to think through the implications of their principles.)
The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going to do.
. . .
Fourth, we should implement legal reforms that protect patients and doctors from unnecessary costs that drive up the price of insurance -- and work to bring down the artificially high price of drugs, and bring them down immediately. 
It's not the federal government's business to raise or lower the cost of anything (unless there is a monopoly involved, and then the job is to break up the monopoly). If they can do it with health insurance, they can do it with everything else in our life. It's called wage and price controls. Never works. Just makes a big mess and creates shortages of goods and services.
My administration wants to work with members in both parties to make childcare accessible and affordable, to help ensure new parents have Paid Family Leave, to invest in women's health, and to promote clean air and clear water, and to rebuild our military and our infrastructure.
How about mandating paid family leave? Portland and then Oregon have mandated paid sick leave. Now Republicans want to add a national mandate for family leave. Please remind me of why Republicans were so against taxpayers funding birth control materials to such as Ms. Fluke? (Besides those who oppose birth control for religious reasons.) And like all such mandates on business this is going to result in businesses closing down because they can't afford that perk.
Education is the civil rights issue of our time.
 I am calling upon members of both parties to pass an education bill that funds school choice for disadvantaged youth, including millions of African-American and Latino children.
I also reject the notion that education is the new "civil rights" issue. Education is a family or local government responsibility not a federal government responsibility. I don't even think it's well done as a state responsibility except as a local community is devastated through natural disaster and needs temporary help. Where the federal government or state sets standards usually the graduation rate plummets and children come out knowing only what's politically correct rather than anything useful. Education becomes a political act tied to federal funds rather than an educational act purely for the benefit of the child.
I have ordered the Department of Homeland Security to create an office to serve American victims.
The office is called VOICE - Victims Of Immigration Crime Engagement.
We are providing a voice to those who have been ignored by our media, and silenced by special interests.
Why should victims of immigrants (no mention whether legal or illegal) get special treatment over victims of any other kind of violence or economic damage? And how would setting up an office to "serve" them help? This is just adding another layer to government which will be used politically by whatever administration is in power. How about setting up a system for any American to sue federal, state and local governments for damages caused by malfeasance in carrying out their duties?
But to accomplish our goals at home and abroad, we must restart the engine of the American Economy - making it easier for companies to do business in the United States, and much harder for companies to leave.
Except in time of war for the defense of the nation, I don't believe federal or state government has any right to tell businesses how to run their business and where to locate. Or to stop individuals or businesses from leaving the country. An economic Berlin wall is not quite as despicable as the "we'll shoot you down" Berlin wall, but despicable none the less. Threatening to punish someone economically if they leave your country is only a hop and skip away from threatening to make leaving a crime.

This is big government on steroids again. Just has an R after the President's name. Phooey!