Saturday, March 11, 2017

Health care

[Update 4/13: Rep. Palmer is holding a town hall on Tuesday, April 18th. President Trump now appears to be reactivating on health care reform, and, to force Congressional action, he is threatening to cut off Obamacare subsidy payments that are used to pay health insurance premiums for lower income persons. This blog entry, and also Alabama expertise re health careStatements re health care and Does politics make us idiots, will be added to before Tuesday in order to contribute to calling out Rep. Palmer on health care.] [See Health care IIMaine, Can Rep. Palmer defend himself, Tom Price,  Shelby County GOP, and Calhoun County which have been added. (NB:Alabama expertise re health careStatements re health care contains the most extensive statement of my own views.)]

[Update 5/27: The special election to fill Jeff Sessions' seat in the U.S. Senate is underway, and health care should be a central issue in the election. I am picking up on this, starting with Health care III.]

To Rep. Gary Palmer, AL 6th Congressional district
The country is once again confronting overhauling its health care system.

Health, and how health care is obtained, are of huge concern to just about everyone.

The implementation of Obamacare during the past seven years has been wrenching and expensive for patients, providers and insurance companies. There have been defects and failures in the country's health care system for 25 years. One can well be dubious of Congress acting again on this subject, and whether our country's tortured experience in health care will continue for many more years to come regardless of what Congress does.

Under the circumstances, I think you owe it to your 6th district constituents to make a comprehensive exposition of your views about the following:

1. What do you think would be the best thing for Congress to do from the point of view of Alabamians (which hopefully would be applicable for all Americans)?

2. Assuming it is not realistic that Congress will do what you think best, and Congress is considering various things, what are the particular aspects, in order of their priority in your mind for Alabamians, that you will advocate for as the legislative process proceeds? (Possibly, you consider yourself as having little or no influence regarding the legislation, in which case just respond to the question by informing Alabamians of what you think Alabamians should consider important in the legislation and what Alabamians should try to find ways to push for in the legislation.)

Update 3/12
On this morning's Sunday talk shows, Trump spokespersons on behalf of the Medicaid spending cutbacks in the health care bill made the contention that allowing States more control over how Medicaid funds are spent would result in more and better health care being provided with fewer funds. It is requested of Rep. Palmer whether he believes Alabama would be able to provide more and better health care to those being served by Medicaid with fewer funds, provided the state had more control over the funds. If Rep. Palmer's answer is yes, particular information is requested about particular expenditures that are currently being wasted or spent inefficiently in the Medicaid program, which information would show how Alabama would do better with lesser funds if the state has control of the funds. Also, it would be appreciated if Rep. Palmer could give names of Alabama personnel in the Alabama Medicaid program who could vouch for what Rep. Palmer says.

A chimera of expanded plan choice reducing premiums and deductibles
The Trump team is touting that their plan will make health care more affordable by reducing premiums and decreasing deductibles, which will come about by increasing plan choice and increasing competition among plans, including across state lines.
In insurance, all premiums and deductibles go to pay for health care services, drugs and medical equipment plus insurance company overhead and profit.
Ultimately premiums and deductibles can be reduced only if prices for the health care services, drugs and medical equipment are reduced and/or less health care services, drugs and medical equipment are obtained.

1. Reductions not due to increased plan choice
a. If prices are controlled by the government, the government can reduce prices by fiat. The controlling of prices will result in less services, drugs or equipment being provided. The reduction of prices cannot be considered a result of competition.
b. If there is medical malpractice reform, and premiums for medical malpractice and amount of "defensive medicine" are reduced, that should result in reduced premiums and deductibles. This reduction is not a result, however, of more plan choice and more competition in plans.
c. If there is a reduction in demand, prices will fall and premiums and deductibles should fall. The health bill will result in a large reduction in demand by reason of Medicaid cutbacks and people dropping insurance because higher subsidies are replaced with lower tax credits.  Under principles of supply and demand, the reduced demand should result a reduction of prices but the amount of such reduction is highly unquantifiable and may be negligible. It is probably the wildest of imagining by the Trump team that this reduction by cutting back Medicaid and people dropping coverage will result in more than a small fraction of what is in their minds for reduced premiums and deductibles. Further the reduction in prices, premiums and deductible is not due to increased plan choice, but due reduced spending and reduced health services, drugs and medical equipment being obtained.

2. Reductions due to increased plan choice are highly dubious
If there is more choice in insurance plans, people may plan they don't want certain services, drugs and equipment to be covered under their plan. and that can allow the insurance company to charge them less in premiums and deductibles.
That creates a problem, however, that, if those people are allowed to do that, the people who need the services, drugs and equipment that the first set of people forego will have to pay higher premiums and deductibles to have the services, drugs and equipment covered by their plan. In other words, plan choice can reduce premiums and deductibles for some people but increase them for other people.
The same applies as regards the Obamacare mandate and what happens if it is eliminated.The elimination of the mandate will reduce premiums for those who choose not to have insurance coverage. As is well known, under Obamacare, the mandate results in healthier people having to buy insurance and pay premiums. If healthier people do not buy insurance, that will result in higher premiums and deductibles for the unhealthier people who buy insurance.
It should also be pointed out that consumers are unaware of the substance of their plan choice and and ostensible competition in premiums and deductibles. Under Obamacare, where there are standard benefits, insurance companies have competed on premiums and deductibles by reducing their "networks." Consumers cannot make a meaningful comparison of slightly higher or lower premiums compared to the "value" of a larger or smaller network. If there is more plan choice, comparison of premiums and deductibles will prevent genuine competition from happening.
Alabamians at mercy of chimeras on high
Rep. Palmer is asked above to speak about health care to his constituents. The extent to which he will oblige remains to be seen.
The extent to which Senators Shelby and Strange and Representatives Byrne, Roby, Rogers, Aderholt, Brooks, and Sewell will or can articulate for the benefit of Alabamians what has been asked of Rep. Palmer is dubious. It is also dubious the extent to which any of them will have meaningful input in the shaping of whatever legislation results.
Alabamians can watch daily the forces clashing high above. Not only can Alabamians do little to affect the out come high, they are being served up chimearas.
The Trump team is ready to reject whatever the Congressional Budget Office projects about reduced coverage, increased or decreased premiums and deductibles, particularly for those less able to afford greater financial burden or having greater needs.In rejecting CBO scoring, the Trump team does not appear of have substitute projections for Alabamians to have a sense of what is going to happen to their health care. The Trump team is making chimerical assertions about large reductions in premiums and deductibles that is going to save the country from the Obamacare "disaster."

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