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Faux Accompli

by Cat Thu Sep 14th, 2017 at 10:00:12 PM EST

Now, I will relate how I came upon the Democratic Party's faux accompli. US press rarely or never cites the bill number of legislation which they are paid to promote. If it did, people might read the actual text.

Enemy of the People has been atwitter since Wednesday about Mr Sander's bold action, popularity, and political acumen despite partisan rivalry in repealing or reforming the PPACA. He promised in a NYT OpEd to introduce Wednesday, 13 September 2017.

On Wednesday I will introduce the Medicare for All Act in the Senate with 15 co-sponsors and support from dozens of grass-roots organizations. Under this legislation, every family in America would receive comprehensive coverage, and middle-class families would save thousands of dollars a year by eliminating their private insurance costs as we move to a publicly funded program.

So. I went looking for the text of Mr Sander's "Medicare-for-All" bill.

I was not disappointed. This is not, as the children say, my first clown rodeo.

S.1804 - A bill to establish a Medicare-for-all health insurance program appeared this afternoon: It has arrived with sixteen co-sponsors, all Democratic Party members, no text, and no related bill in the US House. Hold on to that thought. Why? Three reasons.

First, Sander's state of mind, mens rea. A four-year-stale draft of a "public option" S.1782 - American Health Security Act of 2013 is available for your review. It establishes

the State-Based American Health Security Program to provide every U.S. resident with health care services. Requires each participating state to establish a state health security program.

CMS is the division of DHHS that administer all Medicare benefit provider pricing and billing, Part A and Part B collections, and claims disputes --regulation. S.1782 abrogates federal administration ("single payer") to the states, each transforming Medicaid "infrastucture" into a Medicare-like health insurance market which "prohibit[s] the sale of health insurance in that state that duplicates benefits provided under the program." In other words, when I read the full text I should expect (i) a limited benefit schedule not unlike the PPACA Basic Coverage (with sprinkles) and (ii) a reserve for commercial marketing of "federally qualified" "advantage," or "supplementary," benefit schedules (Medicare Part C, Medicare Part D)(not covered by sprinkles).

What's not in S.1804? Seers say, it will

Cover all sorts of things. Sanders proposes generous coverage that goes well beyond what Medicare currently covers, and even well beyond what many people's private insurance plans cover. His plan would cover dental and vision care, for example, which are, for the most part, not covered by Medicare.

Benefits which are covered by Medicaid insurance providers in some states. I'm thinking of enrolling in Kaiser Permanente's plan for Maryland. Unlike PPACA "qualified plans" it provides me, an adult, dental and vision gratis, and a 25% discount on acupucture, chiropractic care, and massage therapy!

Medicaid and Medicaid Expansion adoption has a bit of a track record. In six years since the PPACA was enacted and the four years since Sander's introduced S. 1782, "participating" states have changed status and types of plan "waivers" conforming with the PPACA. I couldn't say to what extent constituencies approve or disapprove of those changes. I would dare say, 100% of new beneficiaries are pleased that they have any health care coverage. State Medicaid Expansion a/o 15 Sep 2017

MedicaidX: WA, OR, CA, NV, AZ, NM, ND, MN, OH, KY, WV, MD, NY, NJ, DE, CT, MA, RI, NH, HI, D.C., IN, PA, MO, IA, VT, IL, MI, AK
No MedicaidX: MT, ID, WY, SD, NB, KS, OK, TX, LA, WI, TN, AL, MS, GA, FL, VA, NC, SC, ME, UT
undecided: AR, NC

S.1782 was referred to the Finance Committee when it was introduced. It attracted no co-sponsors in the US Senate and no related bill in the US House. Perhaps members had time enough to calculate states' funding and liabilities "matched" by federal "health security" taxes under the act. Is there any reason to expect that the text forthcoming will not resemble it? I think not, because it need not. Bipartisan agreement in the boiler room has already sandbagged S.1804 "financing options" for good measure.

Second, as "we" should have learned from the 2009 PPACA escapade, Democractic Party senators do not recognize any compunction provided by customs of US Congress or balance of powers authorized by the US Constitution. Mr Reid read to Mr Baucus' Finance Committee amendments to a highway appropriations bill passed by the US House. These were not provisions of the House bill for "Medicare for All Act", cultivated by Mr Dingell over two prior sessions. That was abandoned. Mr Obama promptly signed the highway appropriations bill, and congress spent the following year or so reconciling PPACA provisions. Were the US Senate for some inexplicable reason to take up Mr Sander's Health Security Act v.2 ("a Medicare-for-all health insurance program") it would be amended to, oh, I don't know, a FUSION appropriation bill, emended into something unrecognizable, signed by the president, and enacted. The foil for the next iteration is same as the last iteration.
H.R.676 - Expanded & Improved Medicare For All Act, introduced 24 January 2017 with one hundred eighteen (118) co-sponsors, all Democratic Party members, would be abandoned. Conyers introduced it in 2013, too, and presided of the basement hearings in Dirkman. It's been languishing at the PHP website like a stoned oracle in a cave, occasionally fed dates  by the faithful.

What's fresh in H.R. 676? The "regional"  budget allocation (Swedish model) by the odious congress.   What's not new in H.R. 676? Conspicuously, Title I, Sec. 103, the massive leveraged buy-out, or "CONVERSION OF INVESTOR-OWNED PROVIDERS" that's necessary to assure single-payer market power.

(2) CONVERSION OF INVESTOR-OWNED PROVIDERS.--For-profit providers of care opting to participate shall be required to convert to not-for-profit status.
(4) COMPENSATION FOR CONVERSION.--The owners of such for-profit providers shall be compensated for reasonable financial losses incurred as a result of the conversion from for-profit to non-profit status.

(5) FUNDING.--There are authorized to be appropriated from the Treasury such sums as are necessary to compensate investor-owned providers as provided for under paragraph (3).

(6) REQUIREMENTS.--The payments to owners of converting for-profit providers shall occur during a 15-year period, through the sale of U.S. Treasury Bonds. Payment for conversions under paragraph (3) shall not be made for loss of business profits.

Third, I for one cannot think of any senator who would not object to Sec. 103. And I've had some difficulty, with reason, imagining there is a majority of the public who would not object to Sec. 103 even if Dwight D. Eisenhower fell from heaven with a Medicare card for every man, woman, and the truth burning on his lips. "Taxes shall set your health care free!"

They'd rather government not crowd out free enterprise. And they may well claim any appeal to eminent domain by the US itself, no matter the cause, is unconstitutional.

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Diversity is the key to economic and political evolution.
by Cat on Fri Sep 15th, 2017 at 03:57:08 PM EST
Early on I equipped myself with this reference European Observatory on Health Systems and Policies, because calculatedrisk gossip. I've read through once each of the usual suspects believed to exemplify "free", "socialist", or "nationalized" health care in contrast to USA "system".

Sweden HiT (2012) (pdf)

The Observatory lib is not updated frequently. Anecdotal and empirical annotation to the official story are invited.

Diversity is the key to economic and political evolution.

by Cat on Fri Sep 15th, 2017 at 10:51:26 PM EST
Having read the summary, it looks accurate.

Since then, we have got the patient law. Iirc, it mostly collected laws. One noticeable change was making self referrals over county lines easier.

There are a lot of complaints about health care in Sweden, and a lot of those are not wrong. But according to a recent Lancet study on Health Access and Quality, Sweden ranked fourth world wide.

So the way I see it, is that we have higher expectations of the health care than what can be delivered right now. And that is probably a good thing.

by fjallstrom on Tue Sep 19th, 2017 at 11:23:06 AM EST
[ Parent ]
Thanks for your review. I value your opinion highly.

Diversity is the key to economic and political evolution.
by Cat on Wed Sep 20th, 2017 at 03:41:26 PM EST
[ Parent ]
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Diversity is the key to economic and political evolution.
by Cat on Sat Sep 16th, 2017 at 07:55:36 PM EST
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Diversity is the key to economic and political evolution.
by Cat on Tue Sep 19th, 2017 at 12:54:05 PM EST
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US press and Democratic Party senators have spent the past seven calendar days though inventing amendments to it and provisions in it that they either approve or disapprove of.

Diversity is the key to economic and political evolution.
by Cat on Wed Sep 20th, 2017 at 03:38:54 PM EST
nine days late

S.1804 - Medicare for All Act of 2017

with no related House bill.

Diversity is the key to economic and political evolution.

by Cat on Fri Sep 22nd, 2017 at 12:31:19 AM EST
of Almost Medicare for All.

Beside institution of Medicaid Transition Plan (premium paid, capitation-subsidized PPACA "silver plan" insurance for everyone 20-34 years old! Millenials!!),

a few kind of critical components are missing.

  1. specification of "participating" medical provider seems to be turfed to secretary to write regulations;

  2. specification of supplementary ("advantage", "gap", drug "doghnut", sprinkles) insurance providers alludes to existing law;

  3. Income tax withholding tables for 35+ year-old "Medicare" enrolled by Y4 , all other tax contributions to the Trust Funds and state withdrawals from the Trust Fund. No wonder Sander's floated a draft.

Sanders does grant CMS power to negotiate universal (sort of) drug prices and service fees. So there's that.

Diversity is the key to economic and political evolution.
by Cat on Fri Sep 22nd, 2017 at 01:49:44 AM EST
[ Parent ]
Medicaid Transition Plan s/b Medicare Transition Plan.

That was a freudian, I won't lie.

Diversity is the key to economic and political evolution.

by Cat on Fri Sep 22nd, 2017 at 01:51:02 AM EST
[ Parent ]
having difficulty seeing improvement on PPACA through the cost-shifting scheme. ugh.

Diversity is the key to economic and political evolution.
by Cat on Fri Sep 22nd, 2017 at 01:54:00 AM EST
[ Parent ]
More bad news for "Medicare for All" proponents: Republicans Graham Cracker and Cassidy in the senate deconstruct the PPACA fences around Sander's Almost Medicare for All.

S.191 - Patient Freedom Act of 2017, introduced 23 Jan 2017 by Crazy Cassidy ... not 20 Sep 2017 as one might believe to judge by opposition press and partisans this week. It's had several months to fester and attract three other senate sponsors.

A lot of familiar 2016 crazy "replace" talk from House republicans incorporated in the text.

And it's a hot mess, true, purporting to restore patients' "choices" by, paradoxically, stipulating exactly what "free market" will prevail ... without statutory PPACA premium subsidies. These amounts appropriated by the congress will be deposited by each state in patients' HSA accounts. < wipes tears > Talk about priming investors' pumps!

alrighty then. WASS. anyhow.

I am feeling a little smug though to see MedicaidEx divide revived for the occassion.
Medicaid Expansion States Stand To Lose The Most Federal Funding Under Graham-Cassidy
That north-south divide never gets old.

Diversity is the key to economic and political evolution.

by Cat on Fri Sep 22nd, 2017 at 09:06:14 PM EST
<blockquote"Four states get 40 percent of the money under Obamacare: New York, California, Massachusetts and Maryland," Sen. Lindsey Graham, R-S.C., said on the Senate floor on Sept. 14. "Our goal is by 2026 to make sure every patient in every state gets the same contribution, roughly, from the federal government."</blockquote<p> Impeccable logic: that's what they call bible belt opt-out of MedcaidEx.

Diversity is the key to economic and political evolution.
by Cat on Fri Sep 22nd, 2017 at 09:13:53 PM EST
[ Parent ]
Protesters Arrested at Raucous Senate Hearing on Health Care
"We're all here for one common cause and that's to kill this Graham-Cassidy bill that was put on the table to take away Medicaid," [Disabled in Action delegate Brandon] Ezekiel said during an interview before the hearing. "Don't take it away - expand it. Make it universal for everyone."

Don't Mess with Medicaid. Save Our Liberty.

Diversity is the key to economic and political evolution.

by Cat on Tue Sep 26th, 2017 at 05:55:13 PM EST
[ Parent ]
A Few Things About Nonviolence: A Response to Yoav Litvin
Well, considering it was to make Sen. Whitehouse put a parallel to HR 676, the single payer healthcare bill, onto the floor of the Senate, I would say so. After being asked multiple times if I knew what was going on, they finally arrested me, cuffed me, processed me, and put me in a cell overnight in Providence.

Diversity is the key to economic and political evolution.
by Cat on Fri Sep 22nd, 2017 at 10:59:32 PM EST
Unions and Medicare for All: An Idea Whose Time Has Come 13 Sep 2017
Bernie's 2014 bill was focused on state-administered health plans. But he found out during his presidential campaign what a powerful response Medicare for All got, and he refocused his bill to make it much more similar to John Conyers' bill in the House, HR 676.

Calumny is what you get, when one accepts a politician's announcement at face value.And you don't read the bills entered into the record.

Links as above
S.1804: Titles (2), Related Bills (0), Text (1), Cosponsors (16), a Medicare Transition Plan
H.R. 676: Titles(2), Related Bills (0), Text (1), Cosponsors (119), a nationalized health service

Diversity is the key to economic and political evolution.

by Cat on Sun Sep 24th, 2017 at 04:27:06 PM EST
Labor's Stake in the Fight for Veterans' Health Care

Diversity is the key to economic and political evolution.
by Cat on Sun Oct 22nd, 2017 at 03:36:47 PM EST
[ Parent ]
Corrected AK status to MedicaidX column.

Other states coded purple or dark grey by Kaiser will remain in NoMedicaidX to emphasize, the states' commitment to MedicaidX or alternative plan coverage remains tenuous.

Over all, graphic representation of states' commitments and lack thereof to public comprehensive medical insurance indicates the unlikely consensus needed enact such federal mandate, regardless of public opinion polling.

The US does not permit public referenda.

Diversity is the key to economic and political evolution.

by Cat on Sun Sep 24th, 2017 at 05:41:32 PM EST
42 U.S. Code Part C - Medicare Choice Program
Chapter 42 is the collection of public laws (the "entitlement") specifying "single-payer" Medicare (Parts A, B) administration by and regulatory authority in the US Department of Health and Human Services (DHHS) since 1968. Part C is the subsection of 42 USC that activated Medicare-Part B (and Medicaid) benefit schedule marketing by commercial insurance carriers(1980), two payers. Over the years since (espec. 1988, 1997) amendments to this "title" by Republican Party majorities continued to shift DHHS duties from principal to payer of last resort, or "secondary payer". Here is a concise introduction to the evolution of MSP "private Medicare plans". The escalating costs of medical care claims is generally understood.

The so-called Graham-Cassidy bill relies on the inverse relationship of "single-payer" to market growths. So does Sander's bill.

Diversity is the key to economic and political evolution.

by Cat on Tue Sep 26th, 2017 at 02:30:22 PM EST
Newsletter: Is Health Care A Commodity Or Right? is a long-winded article attempting to exculpate the incongruity of S.1804 and HR 676, both purporting to effect "Medicare for All" insurance benefits.

First, the authors christen HR 676 "National Improved Medicare for All". That is a misnomer that should alert the reader, the information which came before and what follows is not entirely constructive description.

Indeed the authors link to "a chart comparing HR 676 and S 1804 and a chart outlining the transition for S 1804." In my review of the bills' text this morning, I did detect some conforming alterations to S.1804 since my first read. I'll not comment on those now.

Except to say, Flowers-Zeese opt-in/opt-out "universal medicare" coverage comparisons is misleading. Like the article's title.

What concerns me is what has not changed in S.1804. That remains unnecessary accommodation for election of and enrollment "mechanisms" for commercial insurance coverage paid by DHHS. What concerns me is the "alphabet soup" of annotated health plans exposed by "outlining the transition." Time has proved "market-based" choice do not control variable costs. Sanders' cannot serve two masters beating the same dead donkey.

"Do you get what I'm trying to say?  It is not a great setup for the people."

Diversity is the key to economic and political evolution.

by Cat on Tue Sep 26th, 2017 at 03:16:02 PM EST
Current Event of Unusual Size

The Japan News/AP | Obamacare survives as GOP concedes on repeal attempt

Standing alongside Cassidy, Majority Leader Mitch McConnell said: "We haven't given up on changing the American health care system. We are not going to be able to do that this week, but it still lies ahead of us."

Diversity is the key to economic and political evolution.
by Cat on Wed Sep 27th, 2017 at 01:28:41 PM EST
Here is a fine example of topical reporting. Freelancer jumps on Bernie Sanders' "Medicare for All". Has not read text of bill. Evidently is not intimate with anyone enrolled in Medicare Parts A, B, (C,) or D: Each part of coverage stipulates different capitation rates, patient co-pays and premium payments. Relies on 5 of 10,000 new Medicare enrollees to inform readers of Medicare benefits, fails.

Single Payer Opponents Say The Transition Process Would Be Too Difficult. But 10,000 People Do It Every Day.

She now pays around $350 a month for supplemental plans* that include dental insurance.

As it happens, this morning a took a call from a physician's office. The biller was seeking payment from my mother (age 78, Part A, B, no D), i.e. 20% co-pay for emergency surgery performed while hospitalized (for unrelated condition) in 2015. Part B pays 80% of physician services. Part A pays 100% of "major medical" care in hospital and, iirc, 120 days prescribed rehabilitation facility. My brother pays most of our mom's Rx costs, those exceeding Part D " doughnut hole" schedule in value.

My mother has no assets to garnish except her pension. Premium for "basic" Part B is automatically deducted from her SS check; that premium is scaled to income. The bill collecter would not tell me the balance due, vaguely claiming HIPAA privacy restraint. She did reveal my brother, the atty, has ignored her calls. So. What did I say to the bill collector?

"Thank you for this information. I will convey it to my mother."

(*) see comment above

Diversity is the key to economic and political evolution.

by Cat on Mon Oct 9th, 2017 at 09:18:19 PM EST
oFFS. One might imagine US residents would be by now experts on health plan benefits, they'd have no need for the gibberish published by the press, but you'd be wrong (Laidlaw v. Organ).
Trump's health insurance order pushes association plans to drive down costs -- for some
But after thanking the assembled supporters in the Roosevelt Room, Trump turned to leave without signing the order.
"Mr. President, you need to sign it," Vice President Pence said.
"Oh," Trump said. "I'm only signing it because it costs nothing."

That's correct.

Plans in the Health Insurance Marketplace are presented in 4 "metal" categories: Bronze, Silver, Gold, and Platinum. ("Catastrophic" plans are also available to some people.)

Being self-employed before the turn of this century, I purchased health insurance for my family from an insurance broker who sold plans offered to individuals by multiple carriers, seeking a community-rated "pool". This type of marketing (as in all commodity markets) without advertising the brand-name of the producer is called "white labeling." My insurance broker was GHI. I paid $810/mo. for comprehensive benefits ("major medical") to the broker's corp which distributed the tosh.

2017 Executive Orders Disposition Tables Donald J. Trump - 2017
Look it up.

Insurance carriers did not stop marketing catastrophic and "association" (community-rated) plans, before or after Congress passed the PPACA. "Federal-qualified" plan marketing on "exchanges" did not criminalize health insurance carriers that did not participate in the "exchange" market. NOR does the PPACA prohibit plans that do not conform with "federal-qualified" description; it does disqualify those plans from distribution by "exchanges" AND premium subsidy for rate-payers. So-called ACA plans offered by commercial health insurance carriers compete with all other carriers and even in the lines of business in their own portfolios. Those are the facts the press never recognize, when constructing the myths of cheap millennials' claims supporting expensive seniors' claims markets or cheap premium subsidies or cheap Medicare-for-All "supplementary"  and "transition" coverage. All rivers flow into the same carriers' pockets.

Of course, most ppl don't want to pay for  health insurance. And they despise Trump.
That's why they get punked over and over again.

True, after PPACA enactment some carriers did elect to withdraw this product line from the individual market (ie. NOT employer-sponsored group market), because the very few PPACA reforms of insurers' rating methods and minimum benefit schedules were sufficient to eliminate profitability of those "catastrophic" and "association" products --like term life insurance-- designed to maximize spread per claim. Later, more conspicuously, some of the same carriers withdrew ACA "metal" plans from the exchanges for the same reason. And, yanno wut, if they needed the money AND further taxable income allowances, they'd still be in it.

Trump is playing the hand he was dealt by US Congress. Rather than promote insurers' ACA plans, you will hear EO-authorized PR praising competition among carriers AND create NEW! carriers WHO WILL DRIVE COSTS DOWN (again).

What's the alternative?

H.R. 676, ppl. A national health service providing comprehensive medical benefits funded by your taxed premium collected by the DEPT of US TREASURY, not another insurance carrier.

Diversity is the key to economic and political evolution.

by Cat on Thu Oct 12th, 2017 at 08:08:34 PM EST

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