Fixing The Affordable Care Act

Now that we are about to have a new President and administration, changes in the Affordable care Act (ACA) are inevitable, but what should they be? What are the problems that beg solution?

Private insurers who are covering about ten million Americans under the ACA are losing money even though all people without health coverage through their employer, on their own or through the federal government are required to sign up for coverage. The idea was that there would be enough healthy applicants to offset the cost of covering people with serious medical preconditions like heart disease and cancer. But there aren’t and there probably never could be enough. If one unhealthy patient needs life saving treatment like a heart transplant or extensive cancer treatment, it could cost millions of dollars. One healthy patient might pay $2,000 a year. It would take 500 healthy patients to pay for each unhealthy one like this.

But the ACA wanted to end the use of preconditions in evaluating coverage and so they thought that making everyone get it would offset their cost. In order to enforce  signups, those who did not sign up were to be charged penalties. They are now up to 2% of annual income.

Now that private insurers are withdrawing from the markets, one in five applicants will have only one private insurer to choose from, which is no choice at all. And the plans include high deductibles making it unlikely that the insured will ever get any benefit unless there is a catastrophic injury or illness. 

The majority of Americans do not like the ACA and want the new President to fix it. I have a suggestion for a way to make coverage voluntary, less expensive, and without deductibles.

First let all private insurers reject any applicant for medical reasons. Those rejected would immediately be eligible to the “public option” which will be a government-run program similar to Medicare and Medicaid. There will be a share of cost and there will be no deductibles. Those with low incomes who would be eligible to Medicaid, had their states expended the coverage under the ACA, would also receive the public option but with no share of cost.

Private insurers would lose some customers because they would not have to sign up. But the low income people who are not now able to get Medicaid in their state would make up for the lost enrollment by getting the public option.

Private insurers would have to compete for the healthy applicants who are no longer a captive audience. Insurers would have to offer competitive rates mindful that they could not use deductibles to avoid the first $5,000 of medical costs, more than most healthy members use.

Since getting coverage would no longer be mandatory, there would be no fines for non compliance as there are now.

And, yes, the taxpayer would have to pay the cost of these high risk patients, but we do anyway. The government has been reimbursing/ subsidizing both the rate payers and the insurers. Currently 5% of the population uses 50% of our healthcare dollars. The government needs to find ways to reduce these costs with changes in diets, exercise regimes, early interventions, drug and surgical treatments and in end -of-life decisions. In a sense, these high cost individuals are society’s responsibility since most have suffered poverty and its associated problems.

The result should make everyone happy. People with preconditions will always have coverage. People who cannot afford coverage and live in states that did not expand Medicaid, will have coverage. Those who do not want coverage do not have to get any. There will be no penalties for non-compliance.

Private insurers would provide more coverage for less and still make a profit.

The progressives will be happy to see a public option that could grow over time, not to compete with private companies but to complement them.

Conservatives will be happy because coverage will not be mandatory and the private option will be maintained, will not be threatened by single payer universal coverage, also known as socialized medicine.

Problem solved!

No Truth in Labeling

One of the most interesting and disturbing aspects of this year’s coverage of the campaign for President was the way the media and people quoted in it found it easy to label people based on remarks or actions. Labeling allows us to quickly react emotionally without having to think much about it. Labeling also allows us to discredit everything the discredited says or does to dramatically limit free speech with which we disagree.

The two greatest Russian metaphysicians, George Gurdjieff and P.D. Ouspensky, theorized that emotions are much faster than thoughts and that many of us have been conditioned to react emotionally to certain images formed by labels making most of us more like machines whose reactions are pre-programmed.

During this election cycle we have heard many people label others based on something that person had allegedly said or done. And worse yet, we saw people labeled by extending their past actions to extremes. The examples abound.

The main, but not only, focus was Donald Trump. He said that he wanted to build a wall on our southern border to stop illegal immigration from that direction. He said some illegals were bringing drugs, crime and even rape. This was translated as him saying that all Latinos are drug dealers and criminals. It was morphed into him being against all immigrants and that he was afraid of other cultures. He was labeled anti-immigrant, xenophobic and racist. When actually he was against illegal immigration. He married two immigrants, hired thousands and started businesses in countries all over the world. How is that being anti immigrant, racist or xenophobic?

He insulted several people. We don’t like people doing that and for good reason. He insulted a famous personality known for not mincing words. She insulted him and he insulted her. For insulting a woman he was labeled a sexist and possible misogynist. When we heard a tape of him talking like a teenager to a entertainment T.V. host with the mic still on, we were convinced. It was vulgar and immature. But it confirmed our label that he was a misogynist especially after a few women came out claiming to have experienced unwanted advances, which were then labeled sexual assaults. Misogynists hate women. That is exactly what the name means. How does what he said or did equal hatred of women? It shows the opposite - an immature attraction to women. People who hate women are very dangerous. They could kill them, hurt them, or just make their lives miserable. They do not have long loving relationships with wives and daughters.

Trump called for a delay in accepting Muslims from dangerous countries until we can be sure that they will not be a threat to Americans. He was labeled as hating all 1.3 billion Muslims. This concern about radicalized migrants also was seen as proof that he was xenophobic and racist.

He said he was against intervening in conflicts that do not have anything to do with us. Examples are Vietnam, Cambodia, Laos, Iraq, Afghanistan, Libya, Syria, Egypt, and Yemen. He said that the U.S. is paying too much while other NATO countries are paying too little for their defense. He was labeled a treaty breaker and unwilling to aid other countries. He was labeled isolationist.

He reprinted a poster showing that his opponent was in with Wall Street. The poster had a star with some writing on it. The star was six pointed, the same as a Jewish star and the star worn by many law enforcement officers. But the star associated with money labeled him an anti-Semite. He has a daughter and two sons who are married to Jews. His eleven grandchildren are Jewish. His daughter became Jewish. The Prime Minister of Israel supported him. And Trump is anti-Semitic?

The people hear these labels and respond with anger and fear. They take their frustrations to the streets feeling justified to respond violently to someone labeled sexist, racist, xenophobic, misogynistic and isolationist. The crowds become angry mobs spewing anger, hatred, vulgarity, and destruction while feeling self righteous and licensed to any level of abuse.

The lack of truth in labeling has brought out the worst in some of our people. It gave greater strength to the belief that the mainstream media is terribly biased. 

Political leaders and journalists have to be aware that they reach a wide audience and that the words they write or speak affect different parts of the population differently. Some take in the reports and balance them with other sources of information. But others with serious issues to deal with take this misinformation and overreact to it.

Now we hear that immigrants are worried and live in fear of immediate deportation from the Promised Land. Even though he said he would close the border and end illegal immigration, it does not mean that he will immediately deport 11 million people. He has said that he wants those who are involved in criminal activity to be identified and sent packing first. Then those who have arrived recently could be repatriated. But those who have been here and established roots will probably be safe. Still, we hear that even those not subject to removal are living in fear.

We hear reports that women are rushing to get birth control before Trump ends the Affordable Care Act as though that would happen immediately. If they would think rather than feel, they would realize that it would take at least a year or two to make any real changes to the ACA and even with them, they will still be able to get birth control. They are frightened without reason and it is not helpful.

Muslims living in this country are saying that they don’t feel safe now. This concern even though the issue has been accepting future refugees from countries having radical activity until they are fully vetted. It is not against all Muslims or all immigrants.   
We are seeing that there is a great cost to sensational, superficial and subjective reporting. This latest wave of examples is the most exaggerated form of it.

If we are at the beginning of a revolution against the status quo, let this status be no longer quo. Let us begin to insist on fair, honest, in depth reporting free of political bias, editorializing, and sensationalizing. Enough is enough! 

Whom Do You Trust?

When I was going to school on the west side of Manhattan in the mid 1950s, I used to get free tickets to see a new quiz show broadcast just down the block. The name of the show was “Who Do You Trust?” and was hosted by a young man from the Midwest named Johnny Carson.  He later replaced a future Westchester village neighbor of mine named Jack Paar on another show called “ The Tonight Show.”

I don’t remember what the quiz show was like anymore but do remember the incorrect grammar of it, “Who” instead of “Whom.”

But now the question arises in my mind on a more frequent basis.  Whom or who do I trust?  Whom should I trust?

We always trusted our priests. Now we know that there have been many abuses of young parishioners by Catholic priests and realize that though the mass media has never mentioned this, this practice has probably been going on for centuries.  And what made matters worse was that those on top of the church hierarchy covered up the crimes making more people subject to abuse.  Our evangelical leaders faired no better, not able to resist the sexual relations they preached against. And let us not forget the mullahs who preach hatred and violence to foster their campaign of the subjugation of women, their apparent raison d’etre and remain silent while their dictators slaughter their own people and their extremists torture innocents. Should or can we trust our religious leaders?

What about our bankers and financiers?  Can we trust them?  If you had money in Lehman Brothers, Merrill Lynch, Goldman Sachs, Chase, Bank of America, Wells Fargo or Barclay’s, you have probably realized that you cannot trust them to put your welfare above or on a par with their own interests.  They actually admitted it to a congressional committee trying to find out what caused the financial crash of ’08. Companies like Goldman Sachs knowingly bundled bad loans and sold them to their own clients while actually betting against them at the same time. Why would anyone continue to do business with such companies, companies they can no longer trust?

But surely we can trust our doctors. Now we learn that there are at least 100,000 deaths a year due to hospital error. Every night on the national news we learn that the doctors were wrong about something else and that we should stop doing what they told us to do.  The drugs they offered women to prevent problems with their bones, only work for five years after which they actually cause bones to break.  Aspirin was recommended for everyone to avoid stroke, heart attacks and even cancer, now has been found to present too many other health risks and should be used only by people with known heart problems. Then there are mammograms, MRIs, x-rays all thought mainly beneficial now found to cause to potentially life threatening problems if overdone. We spend more on medicine than any other developed country and yet have some of the worst results.  Can we trust our physicians?

But what about our free press, blessed by our very first amendment to the Constitution, surely we can trust the media to give the information we need, or can we? Not only has our mass media been characterized as sensationalist and shallow or just inaccurate, it can also be biased.  We have seen them show their bias in cases involving racial violence, seeming to want to fan the flames of violence and destruction in their superficial and sensational reporting. There was the alleged “stand your ground” murder of an unarmed high school football player that turned out to be a clear case of self defense. There was the case of the unarmed former high school football player who allegedly was shot in the back while having his hands up. A grand jury and then the U.S. Justice Department found that he was attacking a police officer and his hands were not up. There was the case of the young drug dealer reacting to his 20th arrest of the year by thrashing around in a police van. He accidentally hit his head and died a few days later. The media blamed the six officers. The result of these misperceptions caused by biased, superficial and sensationalist reporting lead to riots which destroyed property and threatened lives.The riots in Baltimore based on misinformation resulted in 56 homicides in six weeks - a record even for Baltimore, once the murder capital of America. What the media did not report was that 55 of the victims were black as were their assailants.

But the media has outdone itself during this election cycle. The mainstream media has not tried to conceal its choice for our next president and has done whatever it could to make their hope a reality. If it weren’t so serious, it would be funny.  We talk about the billionaires stealing this election, when it is the media which has left its fingerprints all over the crime scene. Talk about being superficial, sensational and subjective. It should be their slogan. The Times should change theirs to be “All the news that we see fit to print.” The result of this terrible reporting is mobs expressing fear and hatred while protesting against them. Tolerant people feeling they have license to be intolerant of those labeled intolerant and to hate those labeled as bigoted. They don’t see the irony in and hypocrisy of their misguided position.  

But at least we have our elected officials. At the core of our great nation’s democracy is representative government through free and open elections. American citizens can vote for and elect the person whom they feel best represents their interests. We have 535 people in Congress representing our best interests. Or are they?  Currently only nine percent of our people trust the Congress. You can only wonder who these nine percent are. 

It has also come to light that many of these legislators were also on the take. Some bought or sold stocks based on inside legislative information. Others accepted favors from corporations like free golf trips to Scotland on private corporate jets in exchange for favorable legislation. Still others allowed lobbyists to actually write legislation favorable to their efforts. The only word that comes to mind to describe such people is a five letter unmentionable name which begins with the letter “W” and is usually attributed to pliers of the second oldest profession. Using this term for legislators is an insult to their namesakes. Not even congress people trust congress people and they should know.

So who or whom does that leave? We can hopefully trust our family and friends, much of the time except when too much money is at stake. We can trust our instincts if they are conjoined with clear thinking and honest observation.

We can trust the exceptions to all these groups. There are some wonderful religious leaders in every religion with great faith and wisdom. There are even some honest bankers and financiers who put their clients first, give generously to charity and want to make this a better country. Banks are at the heart of our economy enabling families to borrow and save money to buy homes and pay for college tuition and helping businesses to develop and grow.

Our doctors have saved countless lives with skilled and innovative surgery and/or the prescription of appropriate medication. They are on the front lines fighting cancer, heart disease and the other medical causes of our suffering.  This very column would not exist if not for excellent surgeons who have performed numerous life-saving operations on behalf of its author.

There have also been courageous reporters like Morrow and Wallace but also Russert, Chronkite, Brinkley, Lehr, McNeil, and even Anderson Cooper on a good day. There were the great humorous news sources like Jon Stewart of the Daily Show, Stephen Colbert and we still have Bill Maher of Real Time.  I find that PBS can usually be relied upon for accurate and in depth reporting.

When it comes to our Congress, it seems hard to trust those on the right who are clearly in the wrong on some social and fiscal issues and those on the left who are moving us too far off center creating a culture of ubiquitous victimhood to expand their underdog base. Surely, there are congress people who truly love their country and try to work cooperatively to improve the lives of our people. However, no name comes to mind.

And when all else fails, you can trust this column to bring you ideas whose author truly believes will be of benefit to the you.  Trust me that I am someone whom you can trust.