The Healthcare Fixes Unfixed, Divide and Conquer on Display

Sofia    There’s no national healthcare in Bulgaria from what I learned in recent discussions, so this is a country where Americans can come to die and feel at home.  Think about that for a minute.  Living costs are relatively low.  Healthcare costs are relatively high.  Is this the world we want?  Perhaps so, because we seem headed for that situation, like it or not, ready or not.

Reading the morning papers on-line and getting past the Trump twitter tirades, the endless Russian hacking stories, and the usual grist for the mill, it was hard to miss a story in the Times that reminded us that no matter what small joy we may have harbored at the failure of the Republican Congress, the Trump project of starving the Affordable Care Act to death is making good solid progress around the land.  Worse for America, but probably great news in the West Wing of the White House is that it is yielding an even more politically beneficial result for the Trumpsters and the right wingnuts:  it’s dividing America even more.

I’ve ranted about the problems of lower waged workers suffering from the Obamacare loopholes and compromises that called them “covered” by the minimum standards of a healthcare plan if they were working for 50+ employee companies when their employers were allowed to say they were offering qualified plans with such absurd $4000 to $6000 deductibles and 9% of monthly income payments that literally NO ONE in many lower waged companies with hundreds of workers were electing coverage since it would suck up a huge portion of their checks when they were making $10 to $15 per hour.  More cynically, they were also barred because they were ostensibly covered by their employers from receiving any of the subsidies or shared cost assistance from the Obamacare marketplaces, so unless their states had expanded Medicaid, they were caught in the gap.   Nothing was sorted out in these years perhaps due to gridlock in Congress and perhaps because who really cares about low wage workers anyway?

Now in the Trump attack on the lower middle class, his starving of Affordable Care is leading, as predicted to soaring price and deductible increases on sketchy plans, almost identical to those faced by lower waged workers.  Families are seeing 50% or more increases in some states, and deductibles running up to $6000 before they are able to get benefits.  Now middle-income families are in the same boat as lower waged service workers where the cost of having insurance is creating a huge, sucking hole in their paychecks.

The shameful difference is that too many, if the Times’ report is to be believed, are not blaming Trump, the Republican Congress, gridlock, or anyone else.  They are blaming lower income families and – painful irony alert – lower waged workers.  Despite the fact that many families in both of these population segments are working their asses off at any and all jobs they can muster, this is now fueling support for even more draconian work requirements for the poor and lower income families access food stamps or even Medicaid benefits.

If that isn’t a master Machiavellian stroke approaching pure evil, what is?  Pretending Trump and his people are corrupt clowns may be satisfying to some, but as the Affordable Care fight shows, we’re in a death match now, and, friends, don’t fool yourself that we’re winning.

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Veterans Might be Caught in the Slipstream of Trump Turmoil

Little Rock   The latest news flash is that current Secretary of the Department of Homeland Security and former four-star Marine general, John Kelly, has been named the chief of staff at the White House, busting out another 6-month wonder. The hope is that he will bring discipline, order, and stability to the White House, but it’s a long stretch to believe that. Just imagine Ivanka, Jared, the boys, and President Trump as Marines for even a moment, and you know it’s just a picture that doesn’t fit. Trump is calling in Kelly to be recess monitor for a wild bunch running and yelling constantly. I just don’t see this working out well, but we’ll hope for the best.

Speaking of turmoil and the Trump’s generals, I would also argue that the state and protection of the health and welfare of our veterans is worth a bunch of worry as well. In almost a footnote, Congress recently was unable to pass the “popular” Choice bill for veterans health care. Seems that rather than increase the appropriation as needed, they simply tried to reappropriate money within the Veterans Administration budget and move it around to fund Choice while cutting back elsewhere. This is a department where most observers already felt it was unfunded in looking after 22 million veterans in the United States now, 9 million of whom use the VA for their primary and ongoing healthcare. If veterans healthcare isn’t protected, you know the rest of us are in deep, deep trouble.

Not that the Choice bill is anything to necessarily celebrate. Recently we spoke at some length with Suzanne Gordon, an expert in this area, who wrote a recent book about the strengths and weaknesses of the VA healthcare system, with her recommendations excerpted in the current issue of Social Policy. Choice is basically a system that allows a qualified veteran to chose a private doctor outside of the VA system and have it reimbursed by the federal government. There are certainly situations in which this is necessary. Obviously, there can’t be a VA hospital or clinic everywhere, especially given the ratio of military veterans to rural parts of America, but the real deal, according to Gordon and most anyone who has looked at the matter, is that this is a huge stalking horse for privatization of the system. That’s a problem!

Gordon was effusive on the many strengths of the VA system, especially in the areas of mental health and response to the drug crisis sweeping large parts of the country. All VA personnel are trained on mental health cues and signs of depression and suicide prevention, though ironically one of the programs threatened by the funding situation is in fact the suicide crisis line. No private facility can beat that record. So, yes, she acknowledges, there have been issues around waiting lines and other matters, but that still does not argue that the VA system currently continues to be best-in-class.

So, why the privatization push by some representatives? The VA is a public institution, and private hospitals, clinics and doctors are just that, private. They can make contributions to political campaigns. I rest my case. This is not about care, but campaigns.

General Kelly is no liberal. His performance at Homeland Security has been frightening. We can’t expect miracles, but at least a general might make sure his former soldiers are taken care of better.

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