Trump’s Broken Promise, Cavalier Giveaway of Basic Healthcare to the Rightwing

New Orleans   Incredibly after all of the promises of a better healthcare program, all the President wants now is a sale, no matter how shoddy the merchandise. This is the short con. Meeting with the so-called Freedom Caucus, he agreed to get rid of the Affordable Care Act’s “essential health benefits” guaranteed to everyone as part of the basic health plan regardless of cost. This doesn’t include the caps on senior pay, the ability to cover children under parents policies until 26, or the waivers for pre-existing benefits all of which this bill is also giving away or the fact that his concession bargaining has now lowered the supposed savings by more than half.

Regardless, let’s just review the ten essential benefits that all Americans stand to lose as a reminder of why this entire package should be dead-on-arrival to the Senate, if it ever makes it there.

The Affordable Care Act’s Ten Essential health benefits include:

  • Ambulatory patient services (Outpatient care). Care you receive without being admitted to a hospital, such as at a doctor’s office, clinic or same-day (“outpatient”) surgery center. Also included in this category are home health services and hospice care.
  • Emergency Services (Trips to the emergency room). Care you receive for conditions that could lead to serious disability or death if not immediately treated, such as accidents or sudden illness. Typically, this is a trip to the emergency room and includes transport by ambulance. You cannot be penalized for going out-of-network or for not having prior authorization.
  • Hospitalization (Treatment in the hospital for inpatient care). Care you receive as a hospital patient, including care from doctors, nurses and other hospital staff, laboratory and other tests, medications you receive during your hospital stay, and room and board. Hospitalization coverage also includes surgeries, transplants and care received in a skilled nursing facility, such as a nursing home that specializes in the care of the elderly.
  • Maternity and newborn care. Care that women receive during pregnancy (prenatal care), throughout labor, delivery, and post-delivery, and care for newborn babies.
    Mental health services and addiction treatment. Inpatient and outpatient care provided to evaluate, diagnose and treat a mental health condition or substance abuse disorder. This includes behavioral health treatment, counseling, and psychotherapy.
  • Prescription drugs. Medications that are prescribed by a doctor to treat an illness or condition. At least one prescription drug must be covered for each category and classification of federally approved drugs.
  • Rehabilitative services and devices – Rehabilitative services (help recovering skills, like speech therapy after a stroke) and habilitative services (help developing skills, like speech therapy for children) and devices to help you gain or recover mental and physical skills lost to injury, disability or a chronic condition (this also includes devices needed for “habilitative reasons”). Plans have to provide 30 visits each year for either physical or occupational therapy, or visits to the chiropractor. Plans must also cover 30 visits for speech therapy as well as 30 visits for cardiac or pulmonary rehab.
    Laboratory services. Testing provided to help a doctor diagnose an injury, illness or condition, or to monitor the effectiveness of a particular treatment. Some preventive screenings, such as breast cancer screenings and prostrate exams, are provided free of charge.
  • Preventive services, wellness services, and chronic disease treatment. This includes counseling, preventive care, such as physicals, immunizations, and screenings, like cancer screenings, designed to prevent or detect certain medical conditions. Also, care for chronic conditions, such as asthma and diabetes.
  • Pediatric services. Care provided to infants and children, including well-child visits and recommended vaccines and immunizations. Dental and vision care must be offered to children younger than 19. This includes two routine dental exams, an eye exam and corrective lenses each year.

Read and weep. Listen and pick up the phone and call Washington. Now!

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Please enjoy Blondie’s Long Time.

Thanks to KABF.

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Pork Barreling and Horse Trading with Ryan’s Healthcare Disaster

New Orleans  They might have the votes, and they might not have the votes to get this mess of a healthcare abomination out of hardcore ideologue and Speaker Paul Ryan’s House, but all signs point to a squeaker that will smell like it crawled out of a dumpster by the time it gets to the Senate.

We already know that the President and his people will say virtually anything without regard to fact or fantasy, and they seem to be using that proclivity in hyper-fashion with recalcitrant House of Representative moderates, saying that the Senate will fix and modify the mess. Most folks on the used car lot that Congress has become would walk away from that lemon.

For the suicidal, largely anonymous so-called Freedom Caucus, they have bent over backwards to take something terrible and make it even more horrid. They want work mandates for Medicaid despite all evidence that establishes that not only are these ineffective, punitive, and needless, but that people need healthcare to get well, so that they can work. Ok, here you go! Some of them want funding of some programs to stop immediately rather than in 2018, so, hey, let’s accelerate the death spiral for another vote or two. Anything goes these days.

And, talk about pork barreling and horse trading for votes in this district or that, and any principles go out the window. Congressman from upstate New York want to push the share of the Medicaid bill from the county coffers to the state for a billion or more, no problem, if these couple of Congressman are Republican and the Governor of New York is a Democrat. Heck, make him pay up. Some coal miners with black lung realizing that they could be hammered by cutbacks in Medicaid that are keeping them alive, no problem, write in an exception for coal miners with black lung.

Are you seeing a pattern here? Even if something emerges, it is going to be jerry-rigged like a Rube Goldberg contraption. They are already asking the American people to pretend this will be some kind of viable health plan, and now they are going to ask us to pretend it will actually work.

No one likes this thing. Republican and Democratic governors are aghast. Doctors, hospitals and the elderly associations are up in arms.

This is clearly no longer an exercise in healthcare policy. This is all about big league politics now. They need to prove on the first bill coming out of the Trump barn that they can win. No matter what or how bad the smell.

Whatever happens in this first vote, no one can believe anymore that this is going to end well.

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Please enjoy Big Boys  from the late great Chuck Berry.

Preservation Hall Jazz Band Santiago.

Thanks to KABF.

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Where are the Citizen and Patient Protests to Protect Affordable Care?

New Orleans   In the activist moment with cries for resistance, I wonder why the healthcare issue is being left behind by many, as well as the current Obamacare beneficiaries, and why we are not all massing in protest at the threats and head fake proposals to replace care?

Don’t misunderstand me, I’m aware of the moving stories at some of the Congressional town hall meetings where some of the sick and infirm along with others have asked their electeds the hard, life-or-death questions, involved in eliminating healthcare insurance. I know the risks to the Affordable Care Act and the fear it has stirred has increased support for the Act past 50% in the polls. I know the Koch Brothers are trying to rekindle their grasstips base to demand repeal or else. I know the Freedom Caucus, concerned Republicans, and others are pointing out the costs and naked emperor-has-no-clothes aspects of Speaker Paul Ryan’s so-called secret plan demonstrating their divisions. I know the President has discovered that health care is complex. I know various sides, pro and con, are on the airwaves with video and sound bites.

What I don’t know is why we aren’t seeing people in motion in serious numbers?

With more than 20 million people on Obamacare and many of them on the highly threatened expanded Medicaid coverage the ACA triggered, that would seem a big and bad base ready for action. If our neighbors and friends in this group are just scared and confused, how about the many millions in schoolhouse door states that stubbornly refused to expand care, take Texas for example? Or, Florida, Georgia, North Carolina, and Wisconsin? Don’t tell me there aren’t millions in that number caught in the gap between low income qualification and not enough income to afford insurance. And, how about all of the service workers in nursing homes, home care, food service and elsewhere with company provided play pretend policies with $5000 and more deductibles who want reform so that they can finally have coverage?

Don’t tell me there are not millions mad and desperate for care?

Where is the campaign that moves people state to state in this fight, like the effort that helped win the fight in the first place? Where are the community organizations that are listening to their members and making this the issue they are moving on right now?

Is the issue too complex as Trump claims? The tactics are numerous, so are the targets the problem? Sure the distance is huge between us and DC, both physically and philosophically, but how about state legislators and governors, those are closer, and every report seems to say, governors are on their knees begging the White House not to cut and run on Obamacare, dumping the problem to them without enough money to fix it. How about hospitals? If we start hitting them hard on charity care that they are supposed to be providing, but aren’t and their tax exemptions, maybe they would get in gear. A couple of thousands of them according to IRS reports are making more than a million a year, so they might move to the feet and voices of patients’ protests and demands?

The problem with resistance is that it’s reactive. We need offense, not just defense. We need it now before our weaknesses devour our strengths.

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Is There a Resistance Movement or Resistance Moment?

Bristol   I definitely don’t want to be standing at the station when the whistle blows that the train is moving out. I have to admit that I have my ears perked up at every sound to try to hear whether it’s the thundering feet of a movement or just the sharp cry of a moment.

I’m too jaded in this work to see Congressional town halls as the birthplace of the next revolution, but I don’t want to be blind to history either, and a snippet of the news like the one that follows makes me sit up straight and stand at total attention:

In fact, some of the most formidable and well-established organizing groups on the left have found themselves scrambling to track all of the local groups sprouting up through social media channels like Facebook and Slack, or in local “huddles” that grew out of the women’s marches across the country the day after the inauguration.

When the people are moving and established organizations and institutions are having to work overtime to catch up with them, that’s a very, very interesting sign. In a time of movement, it may be difficult for this kind of activity and anger to be channeled in the way that these same organizations and institutions are hoping to move the stream. It’s good news though for the 30 million lower income families taking advantage of the Affordable Care Act that there are many of the flags being waved as elected representatives slink home from the Congressional chaos are focusing on saving health care.

There are other signs too. When seasoned organizers report that they expected 200 at a meeting, and 1000 showed up, as my generation said, “you don’t need a weatherman to see which way the wind is blowing.” The Times also reported on other barometers that people were in motion:

Anti-abortion demonstrations in some cities this month were met with much larger crowds of abortion rights supporters. At a widely viewed town-hall-style meeting held by Representative Gus Bilirakis in Florida, a local Republican Party chairman who declared that the health care act set up “death panels” was shouted down by supporters of the law.

And, perhaps more interestingly, an organizer for Planned Parenthood posed the question plainly as she tries to ride this wave of momentum:

“It doesn’t work for organizations to bigfoot strategy; it’s not the way organizing happens now,” said Kelley Robinson, the deputy national organizing director for Planned Parenthood, which is fighting the defunding of its health clinics. “There are bigger ideas coming out of the grass roots than the traditional organizations.”

If she’s right, that’s a call to arms for all of us to get ready to move, because grassroots activity needs formation, planning, resources, and direction in order to win. That’s not bigfoot, that’s soft touch, listening, and work on the ground that takes a moment and helps make a movement and births new organizations and great social change.

When that whistle blows, we have to all be on the train.

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A Good Checklist for Grading an Obamacare Replacement

Greenville   In the chaotic back and forth over what may be about to happen to the Affordable Care Act, it is becoming almost impossible to follow the real issues as the bull passes our knees and rises towards our chin on all sides of the debate. We know something bad is about to happen, but we need a good checklist to measure the extent of the disaster even as we know the pain is likely to be terrible.

Harold Pollack from the University of Chicago and Timothy Jost from Washington and Lee University School of Law did all of us a favor in an op-ed in the Times by listing what they called “seven important questions that Congress must answer before repealing the Affordable Care Act.” Many of their questions are also clearly benchmarks for measuring the minimum standards for equity and justice that should be demanded by all Americans for any so-called replacement coming from Congress.

Here’s their list in brief:

1. How many millions of Americans will lose coverage? They also make the point often lost in the debate that tax credits and deductions are “nearly worthless” to lower income filers who would likely be priced out without direct subsidies.
2. Will people over 55 pay higher health premiums for the same coverage? This is a critical equity and cost issue for senior citizens with fixed incomes. The current Act limits the premium for older Americans to no more than three times that for younger citizens. Speaker Ryan has proposed going five times, which would be a budget buster for seniors.
3. Will the new plan let insurers charge women higher premiums than men while offering them less coverage? Obamacare in a critical reform banned this practice? Will the Republicans attack and penalize women for being women?
4. What other services are likely to be cut? Before Obamacare a third of the market policies did not cover addiction treatment and “nearly 20 percent lacked mental health coverage.” Will Republicans embrace the tragedy and roll this back along with other benefits?
5. Will the new plan let insurers reinstate annual or lifetime limits on coverage? Will Republicans allow a life-threatening illness to bankrupt victims and families while giving insurers a free-ride? We have to ask what insurance is for if there’s no coverage?
6. What will happen to the more than 130 million Americans with pre-existing conditions? This is huge and Congress needs to have the right answer because this was a critical reform of Obamacare and one that was popular enough that Trump even echoed its promise during the campaign.
7. How much more will those with costly illnesses or injuries have to pay in out-of-pocket costs? Costs are now capped at $7150 for individuals and $14,300 for families, and that’s way too much. Current Republican proposals thus far offer no cap to either deductibles, which are already leaving lower income workers outside of coverage in healthcare and service jobs, or cost sharing. You could drive a truck over people unless this loophole is closed.

This list of questions is really only the starting point, but any replacement at the least needs to answer these questions correctly to even pretend to be called a national healthcare protection plan. Keep them handy to grade the outcome in the common debate.

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Doctors Can’t Be Trusted About Healthcare

Cancun   Of all of the bad nominations coming our way, the notion of Georgia Congressman Tom Price running the Health and Human Services has the most impact on millions of people because of the impact of his virulent opposition to the Affordable Care Act and the jeopardy it places not only on 30 million beneficiaries there, but also on millions more because of additional threats to Medicare for the elderly and cutbacks in Medicaid for the poor generally. Some hold out a sliver of hope because Price keeps saying that he’s a doctor, and he wants that to mean something along the lines that he cares about peoples’ health. He’s taken the Hippocratic Oath, so he’ll “do no harm.”

James Surowiecki points out in the current New Yorker, that in fact the record of doctors and the American Medical Association has been to oppose virtually every governmental medical program providing health security for Americans for a century now. Doctors organized to oppose universal health care when it came to the ballot in California in 1917 during the First World War, claiming it was a “dangerous device imported from Germany.” The AMA in the 30’s opposed pre-paid medical groups where customers paid a flat fee in exchange for care and was fined for anti-trust violations. The AMA campaigned against the creation of Medicare, and hired Ronald Reagan to go on the air and warn us about so-called “socialized medicine.” The AMA was in the thick of the fight to oppose the Clinton health plan during his first term and only supported Obamacare after the so-called “public option” was off the table.

Ten thousand doctors have already organized in opposition to Price and his plan to scuttle the Affordable Care Act, and though the AMA has endorsed his nomination as a former member of their delegate board and a long-time friend in Congress, there is a schism mounting within the AMA over its stand as harmful to patients. Most hospital associations have been silent over Price’s nomination, but have come out strongly in opposition to the plans to end Obamacare as catastrophic in terms of patient care, hospital closings, job loss, and economic ruin within the healthcare industry. Nurses’ unions have been pretty unanimous in opposing the end of Obamacare.

Price is likely to hide behind the public’s assumption that as a doctor he’s an expert on healthcare. Reading Michael Lewis’ new book, The Undoing Project: A Friendship That Changed Our Minds, might take away any notion that doctors should be seen as our modern day priests. Experiments conducted under the influence of work by Daniel Kahneman and Amos Tversky found that fairly simply algorithms outperformed doctors in making diagnoses of many medical conditions, largely because of the unchecked biases of doctors for the way they are used to seeing and working. That’s scary, but true.

And, as Surowiecki points out repeatedly, the AMA is little more than a very effective special interest group, a closed shop union for doctors, if you will, and their own reports indicate repeatedly that their primary purpose is protecting the income security of doctors. Putting money in doctors’ pockets should never be confused with providing basic healthcare for Americans. We don’t need an algorithm to know the facts about that.

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