Anthem abdicates health mission and social responsibility

It's irresponsibly for Anthem to sign a letter in opposition to the Graham-Cassidy legislation, while, in the same news cycle announcing the company's decision to withdraw from the insurance exchanges, supported by the Affordable Care Act.  In this wrong minded decision, Anthem is abdicating its mission and ignoring the social responsibility that comes with their healthy financial situation.  A bad decision to abandon the Affordable Care Act's health insurance exchanges is leaving tens of thousands without coverage.

Moreover, consider this article from Forbes- September 27, 2017: 

Want To Engage Millennials? Try Corporate Social Responsibility- by Marissa Peretz

Millennials are becoming even more engaged in philanthropic causes in 2017 than they were in late 2016, according to Phase 1 of the Millennial Impact Report. At the same time, employers continue to search for ways to engage millennials to successfully attract, hire and retain them. As millennials become an increasingly large percentage of the workforce, companies may take the opportunity to support their local community. Colleagues working together to accomplish a shared goal can have a positive effect on company culture. Embracing corporate social responsibility can benefit the bottom line as well. In a recent Cone Communications survey, 87% of Americans will purchase a product because a company advocated for an issue they cared about, and millennials are more likely than other generations to research the issues a company supports and the extent to which the company contributes.

Leading by example

Integrity- vision-positive attitude-inspiring

What does corporate social responsibility look like? 

There is a wide range of options. Some opportunities involve multiple companies devoted to community service. One such event is organized by nonprofit Technology Underwriting Greater Good (TUGG), which was founded by 3 venture capitalists from Accomplice and General Catalyst. “Our Annual Tech Gives Back day of service is the largest day of service in the tech industry globally,” said Elizabeth Dobrska, Executive Director of TUGG. “This is our 7th year, and we will have 1500 volunteers and 90+ companies at 50+ volunteer sites.” Participating companies include Wayfair and WeWork.

The opportunities are as diverse as the employees who volunteer for them. “We accumulated 1,570 volunteer hours on company time in 2016,” said Amy Hattan, Vice President of Corporate Sustainability at engineering firm Thornton Tomasetti. “One group used their time to volunteer at GrowNYC’s Teaching Garden, an urban farm featuring vegetable beds made from recycled plastic lumber, a small-scale farm, fruit trees, a high-tunnel greenhouse and rainwater harvesting systems.”

While some companies have formal programs, others let employees follow their individual passion for volunteering. “Our leadership team doesn’t dictate where people volunteer because we want our team members – those who live and work in the communities we serve – to decide where their time will have an impact,” said Chris Martin, President and CEO, Provident Bank. 

“Whether that’s picking up a hammer and helping Habitat for Humanity or spending the day throwing strikes during the Big Brothers Big Sisters Bowling Tournament, we encourage all team members to take time to give back. That is why we give every employee 2 paid days per year to volunteer.”

Corporate social responsibility may even dovetail with the company’s main business. “United By Blue, a sustainable outdoor apparel company with a strong focus on waterway conservation, allows its employees to take time off to volunteer at our company-hosted cleanups,” said United By Blue PR Associate Ethan Peck. “These take part on/near bodies of water (rivers, lakes, ponds, oceans, etc.) and are part of our mission to remove a pound of trash for every product sold - something we've stringently followed. We've picked up over a million pounds of trash thus far!”

Some companies approach projects with a longer time frame. “There is a nice trend in Fortune 500 companies such as Johnson & Johnson and Cigna that offer global pro bono advisor or volunteer programs to their employees," said Paula Caligiuri, PhD, D'Amore-McKim School of Business Distinguished Professor at Northeastern University. “In these programs, employees are on loan, whether for a few weeks or several months, to volunteer their professional skills in in developing countries. Companies can achieve their CSR goals while dramatically increasing employee engagement through volunteerism.”

Marissa Peretz is Founder of Silicon Beach Talent, a boutique recruiting and consulting firm in Los Angeles. SBT recruits designers, engineers, and leadership for emerging tech companies.

(I'm certain there're many people at Anthem who read Forbes. Maybe, they will even read and consider the message in this blog.)

Senator Susan Collins-Thank you from 300 advocates

More Than 300 Advocacy Groups Oppose Graham-Cassidy

September 28, 2017

Physicians, Patient Advocates, Insurers, and Hospitals Agree: 

Graham-Cassidy Would Have Devastating Implications for Millions of Americans in Maine and Across our Country

Washington, D.C. - More than 300 health care advocacy groups, including several representing Mainers, oppose the Graham-Cassidy health care proposal. This astonishing number of advocacy groups representing physicians, patients, insurance providers, and hospitals highlighted a wide range of reasons for their opposition to the proposal, including:

The American Medical Association wrote that the Graham-Cassidy proposal “would result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care.”

The Blue Cross Blue Shield Association opposed the Graham-Cassidy proposal because it “contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions.”

The Alzheimer’s Association wrote that “The proposed changes to Medicaid outlined in the Graham-Cassidy Amendment could have a drastic impact on [the more than 5 million Americans currently living with Alzheimer’s] given that more than 1 in 4 seniors with Alzheimer's and other dementias are currently on Medicaid.”
The American Cancer Society urged Senators to vote “no” on the Graham-Cassidy proposal, citing that the bill could cause insurers to: “Charge cancer patients and survivors far higher rates to make coverage unaffordable; eliminate coverage for cancer care in their health plans; and re-institute arbitrary caps on annual and lifetime coverage.”

According to Avalere, a respected firm that specializes in health care policy, Maine would ultimately lose $1 billion between 2020 and 2026, $2 billion by 2027, and $17 billion by 2037. Huge Medicaid cuts down the road more than offset any short-term influx of money under this “give with one hand, take with the other” approach.

The Maine Hospital Association has also cited analysis that shows Maine could lose up to $1 billion over the next decade. This would be a serious loss to Maine where the hospitals, with the exception of the largest hospital in Portland, lost $50 million dollars in the aggregate last year. Some of our hospitals could not survive cuts of this magnitude, thus depriving local residents of easily accessible health care.

Groups in opposition to Graham-Cassidy include:

Asthma and Allergy Foundation of America
AARP
Adult Congenital Heart Association
Alpha-1 Foundation
ALS Association
Alzheimer's Association
Alzheimer's Impact Movement
Academy of Nutrition and Dietetics
America's Essential Hospitals
America’s Health Insurance Plans
American Academy of Actuaries
American Academy of Family Physicians
American Academy of Pediatrics
American Cancer Society Cancer Action Network
American College of Cardiology
American College of Emergency Physicians
American College of Physicians
American College of Preventive Medicine
American College of Rheumatology
American Congress of Obstetricians and Gynecologists
American College of Surgeons
American Diabetes Association
American Foundation for the Blind
American Health Care Association
American Heart Association
American Hospital Association
American Liver Foundation
American Lung Association
American Medical Association
American Nurses Association
American Occupational Therapy Association
Academy on Violence and Abuse
American Osteopathic Association
American Psychiatric Association
American Psychological Association
American Public Health Association
American Society for Addiction Medicine
American Society for Radiation Oncology
American Society of Clinical Oncology
American Speech-Language-Hearing Association
Amputee Coalition

ANA-Maine and the American Nurses Association
Arthritis Foundation
Association for Community Affiliated Plans
Association of American Medical Colleges
Association of Oncology Social Work
Association of Public Health Associations
Association of University Centers on Disabilities
Autism Society
Autism Speaks
Autistic Self Advocacy Network
Big Cities Health Coalition
Blue Cross Blue Shield Association
Cancer Support Community
CancerCare
Catholic Health Association
Center for Medicare Advocacy
Children’s Hospital Association
Coalition to Stop Opioid Overdose
Consortium for Citizens with Disabilities
COPD Foundation
Crohn’s & Colitis Foundation
Cystic Fibrosis Foundation
Deadliest Cancers Coalition
Disability Rights Legal Center
Emergency Department Practice Management Association
Envision Healthcare
Epilepsy Foundation
Families USA
Family Voices
Federation of American Hospitals
Fight Colorectal Cancer
Genesis Healthcare***
HIV Medicine Association
Hypertrophic Cardiomyopathy Association
Infectious Diseases Society of America
International Myeloma Foundation
JDRF
Kaiser Permanente
LeadingAge
Living Beyond Breast Cancer
Lung Cancer Alliance
Lutheran Services in America
Lymphoma Research Foundation
March of Dimes
Medicare Rights Center
Michael J. Fox Foundation
National Association of County and City Health Officials
National Association of Medicaid Directors
National Association of Pediatric Nurse Practitioners
National Association of School Nurses
National Association of Social Workers
National Association of State Directors of Special Education
National Brain Tumor Society
National Center for Assisted Living
National Coalition for Cancer Survivorship
National Comprehensive Cancer Network
National Council for Behavioral Health
National Council of Urban Indian Health
National Foundation for Transplants
National Down Syndrome Congress
National Health Council
National Institute for Reproductive Health
National Kidney Foundation
National Network to End Domestic Violence
National Multiple Sclerosis Society
National Organization for Rare Diseases
National Patient Advocate Foundation
Ovarian Cancer National Alliance
Pediatric Infectious Diseases Society
Planned Parenthood
Prevent Cancer Foundation
Prevention Institute
Public Health Institute
Pulmonary Hypertension Association
Robert Wood Johnson Foundation
Sara Collins, The Commonwealth Fund
Sarcoma Foundation of America
Susan G. Komen
The Arc
The Children's Cause for Cancer Advocacy
The Leukemia & Lymphoma Society
Trust for America's Health
United Steelworkers
Volunteers of America
VoteVets
WomenHeart

America’s Health Insurance Plans (AHIP) – whose members include:

Affinity Health Plan
Aflac
AgeWell New York
Alignment Healthcare
AllCare
Allstate Insurance
AlohaCare
AMA Insurance Agency, Inc.
American Fidelity Assurance Company
American Republic Insurance Company
American Specialty Health Incorporated
Amerigroup Corporation
AmeriHealth
AmeriHealth Administrators
AmeriHealth Caritas Family of Companies
Anthem, Inc.
Arkansas BlueCross Blue Shield
Aspire Health Plan
AultCare Corporation
Avera Health Plans
AvMed Health Plan
Axis Global Accident & Health
Bankers Life and Casualty Company
Baptist Health Plan
Blue Cross and Blue Shield of Georgia
Blue Cross and Blue Shield of Illinois
Blue Cross & Blue Shield of Louisiana
Blue Cross Blue Shield Blue Care Network of Michigan
Blue Cross and Blue Shield of Minnesota
Blue Cross and Blue Shield of Montana
Blue Cross and Blue Shield of New Mexico
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of North Carolina
BlueCross BlueShield of Oklahoma
BlueCross BlueShield of Tennessee
BlueCross BlueShield of Texas
BlueShield of Northeastern New York
Blue Cross of Idaho
Blue Shield of California
Cambia Health Solutions
Capital Blue Cross
Capital District Physicians´ Health Plan
Care 1st Health Plan
Care N’ Care Insurance Company, Inc.
CareConnect
CareFirst BlueCross BlueShield
CareMore Health Plan
CareSource
Celtic Insurance Company
CENTENE Corp.
Chinese Community Health Plan
CHRISTUS
Cigna Corporation
Clover Health
CNO Financial Group
Colorado Choice Health Plans/San Luis Valley HMO
Commonwealth Care Alliance
Community Health Network of Connecticut
ConnectiCare, Inc.
CoreSource
DAKOTACARE
Dean Health Plan, Inc.
Delta Dental Plans Association
DentaQuest Group, Inc.
Denver Health Medical Plan
EmblemHealth
Empire Blue Cross and Blue Shield
Express Scripts Medicare
Eyemed Vision Care HMO of Texas
Fallon Health
Family Care, Inc.
Federated Insurance Companies
FirstCare Health Plans
First Choice Health
Florida Blue
Fresenius Health Plans
Gateway Health
Geisinger Health Plans
Gen Re LifeHealth
Group Health Cooperative
Group Health Cooperative of Eau Claire
Guarantee Trust Life Insurance Company
Gundersen Health Plan, Inc.
Harvard Pilgrim Health Care
Health Alliance Medical Plan
Health Alliance Plan
Health Care Service Corporation
Health Tradition Health Plan
HealthEquity
Healthfirst, Inc.
HealthMarkets
HealthPartners
HealthPlan Services
Highmark Health
Hometown Health Plan
Horizon BC/BS of New Jersey
HSABank
Humana, Inc.
Independence Blue Cross, Philadelphia, PA
Independent Health
Indiana University Health Plans
InnovaCare Health Solutions
InnovAge Care Management
Insurance Administrative Solutions, L.L.C.
Inter Valley Health Plan
John Hancock Financial Services
Kaiser Permanente
L.A. Care
LifePlans, Inc.
LifeSecure Insurance Company
Lighthouse Guild/GuildNet
Long Term Care Partners, LLC
Magellan Health
MagnaCare
Martin’s Point Health Care
Medica Health Plan
Medical Card System (MCS)
Medical Mutual of Ohio
Memorial Hermann Health Insurance Company
Meridian Health Plan
Moda Health
Molina Healthcare
Munich Re America HealthCare
Mutual of Omaha Insurance Company
MVP Health Care
Neighborhood Health Plan
Neighborhood Health Plan of Rhode Island
New York Life Insurance Company
Oscar Insurance Corporation
PacificSource Health Plans
Passport Health Plan
Peoples Health
Physicians Health Plan of Northern Indiana
Physicians Mutual Insurance Company
Piedmont Community Health Plan, Inc.
PreferredOne
Prominence Health Plan
Providence Health Plans
QualCare, Inc.
QualChoice of Arkansas
Regence BC/BS of Oregon
Regence BlueCross BlueShield of Utah
Regence Blue Shield
Regence BlueShield of Idaho
Resolution Health
Sanford Health Plans
San Francisco Health Plan
SCAN Health Plan
Security Health Plan of Wisconsin
Senior Health Insurance Company of Pennsylvania
Senior Whole Health, LLC
Sentara Healthcare
Sharp Health Plan
SilverScript Insurance Company
SummaCare
Sutter Health Plan
Starmark
State Farm Insurance Companies
Swiss Re America
TakeCare Insurance Co.
Thrivent Financial for Lutherans
Trillium Community Health Plan
TriPlus
Trusted Health Plan
Trustmark Insurance Company
Tufts Health Plan
UCare
UMB Bank Healthcare Services
UNICARE Life & Health Insurance Company
Unity Health Insurance of Wisconsin
Universal American Corp
University Health Alliance
UPMC Health Insurance Plans
USAA
VillageCareMAX
Virginia Premier
VIVA Health, Inc.
WEA Trust
Western Health Advantage
WPS Health Insurance
Zurich North America

***Genesis Healthcare has 1000+ employees in Maine.

###

Anthem decision - where is social responsibility?

It's impossible for me to believe that the Anthem health insurance company is too hard up for cash to continue providing coverage to beneficiaries, who are enrolled in the Affordable Care Act exchanges.
www.healthcarefinancenews.com/.../anthem-fourth-quarter-profits-jump-nearly-190-mil...

Anthem 4th quarter profits jump nearly $190 million over 2015

Medical enrollment increased by about 1.3 million members in 2016, or 3.4 percent, totaling about 39.9 million members.

Anthem mission statement: "dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our communities."

It's a cruel statement about Anthem's social responsibility to pull out of the Affordable Care Act's insurance exchanges. 

Frankly, it's not coincidental to recognize where the Anthem headquarter office is located, in Indianapolis, Indiana. It's the home state of Mike Pence, who was the state's previous governor and now the Vice President, serving under Donald Trump.  

Anthem's unethical decision to leave thousands of people uninsured without a viable reason for doing so, is likely rooted in political cronyism.  Mike Pence and his Koch Brothers libertarian colleagues likely had influence on this selfish Anthem decision.

Clearly, the Anthem decision isn't about money or bottom line financials. Although the Anthem "pull out" excuse is the anticipation of an unstable health insurance market, the unethical decision is not justified given the company's lucrative fiscal positioning. It is estimated that 26,000 Maine beneficiaries will lose coverage because of Anthem's selfish decision.

There must be a way for Congress to prevent Anthem's wrong minded decision.  Obviously, the Koch Brothers have the Republicans under their "oligarchy" thumbs. Their intention is to completely dismantle all social safety net programs, like health insurance subsidies and other humanitarian policies.

In other words, people who need health insurance just don't matter anymore. Even Anthem's lucrative financials and increasing enrollments have no impact on the company's social responsibility.

Shame on Anthem!

I'm calling on public policy experts and insurance regulators to stop Anthem's cruel and unnecessary decision. It's the company's social responsibility to support participation in the Affordable Care Act's health coverage. 

Rotarian point of view - speaking by writers

Speaking at a Rotary club is the most fun a writer can have

Rotary writer posting for another- from Maine Writer

"A nice note or comment from a reader is worth a hundred sales to people I don’t know and never hear from." ~ Jim Kaplan in the September 2017 "Rotarian" magazine. 

I got more than I bargained for last fall when I addressed the Rotary Club of Springfield, Massachusetts, USA, about my latest book, "Clearing the Bases: A Veteran Sportswriter on the National Pastime." 

Members gave me a standing ovation when I approached the podium and another when I finished my talk, asked good questions, and bought some books. But the real highlight came later, when I was approached by then-club President Laurie A. Rosner, a business professor and department chair at Bay Path University.

“I so enjoyed listening to all of your baseball stories,” she said. “It felt like I was right there. You are a great storyteller!”

That Rotary moment left me as happy as anything I’ve experienced in promoting 20 books over three decades. This may seem strange, since in past years I’ve done interviews on radio and television, and my books have been reviewed and discussed in newspapers, magazines, online, and in alumni publications. To explain Rotary’s appeal over these worthy outlets, let me lay out some modern realities about book publication.

Standard U.S. publishers turn out around 800 books per day: Already, you have 799 competitors. And that’s just for openers. Bowker, the U.S. agency that issues International Standard Book Numbers (ISBNs), figures more than twice as many books appear through alternate publishing venues such as e-books, publishing on demand, work-for-hire contracts, self-publishing, co-publishing, and hybrid publishing. All of which adds up to more than 1 million new titles a year.

Even if you scour book-review sections, attend author events, and catch writers online or on the radio or TV, you might be familiar with, at most, several hundred of these new titles. Any way you look at it, most authors struggle to get exposure, much less praise, much less impressive sales for their books. Working below the radar, these writers beat on, boats against the current, to borrow from the famous last line from "The Great Gatsby."

There’s more grim news. Lacking a substantial advance and a publisher’s plan to foot the bill for promoting your book – a declining, almost extinct culture – an author’s work is rarely cost-effective. I have a friend who published a great novel, spent $20,000 to promote it, and sold 550 copies in a year. Though we hear about blockbusters, most books average fewer than 250 sales in their first year of publication; authors who slug it out for five years may peak at a couple thousand. That’s barely enough to cover your expenses, much less turn a profit. As Lincoln Michel writes on the "Electric Literature" blog: “Writers should absolutely write with an eye toward art, not markets.”

So let’s table fame and filthy lucre. Writers still write. First-time authors thrill to seeing their names in print for doing something they find worthwhile. I write because I enjoy the process, have something to say, and hope my ineffable wisdom connects with readers. “I keep writing because I like to think I’m still getting better, and my mind needs to be occupied by something besides Washington politics,” says Michael French, author of more than 20 books, including the 2016 novel "Once Upon a Lie."

To be sure, talking at a Rotary club isn’t the only way to promote books. I created a flyer with an order form that I sent to some 30 acquaintances; posted excerpts from my book on seamheads.com, a terrific baseball site; and sent free copies to some of the most active members of the Baseball Book Club, a subset of goodreads.com. Two of them mentioned the book favorably, one giving it a five-star review on Amazon. But where was the ka-ching!? Where was the mass readership? Where was there any sense that any of the 500-odd other Baseball Book Club members were buying the book, much less reading it? I was lost in cyberspace.



You start to see why the human interaction of personal appearances is the most fun part of book promotion. A nice note or comment from a reader is worth a hundred sales to people I don’t know and never hear from. That’s why I schedule as many appearances as I can, especially at Rotary clubs, where members are so kind and receptive.

I give talks to other organizations, too, but they’re rarely as much fun. For one thing, there’s no guarantee of a good turnout. I told the director of a duplicate bridge club to remind members that I would be talking about my book at the end of play. A few people said, “This looks like a good book” – and they left the building! And a publicized library talk drew only the librarian and a member of her board. By contrast, at any given club meeting, I know I’ll get at least 15 enthusiastic Rotarians.

Any first-time speaker preparing to address a Rotary club would do well to be informed what the club stands for. In his satirical novel Babbitt, Sinclair Lewis painted Rotarians as materialistic, small-time, small-town hypocrites, boosters, and conformists, an impression that persisted even though Lewis later met Rotarians, studied this magazine, and concluded, “You have made me approve of Rotary.”

In addition to the business leaders, insurers, financial analysts, bankers, and others you might expect, my club in Northampton, Mass., boasts the city’s social services CEO, a chiropractor and strength coach, a foreign-language school head, even two ink-stained wretches of the Fourth Estate. This group will be receptive to virtually any speech subject.

What kind of speakers and other presenters are clubs looking for? The standard 15- to 20-minute talks, with time for questions afterward, typically address informational, educational, or public-awareness issues. Rotary casts the net wide enough to include local business, charitable, and elected notables, as well as authors and entertainers.

As a journalist, I’ve found these talks to be a godsend. After hearing a man speak about his book on the late Silvio Conte, Massachusetts congressman par excellence, I wrote a newspaper column about it. And often Rotary talks are pure fun. Hilary Price, who writes the newspaper comic strip Rhymes with Orange, gave a humorous address at our club and asked if we had ideas for her. Another member and I gave her some that she used.

What makes for a good Rotary talk? 

This isn’t rocket science, so start with something light. 

For instance: “As Yogi Berra might have said, thanks for making this talk necessary.”

Your audience is as interested in you as it is in your subject, so don’t be afraid to make it personal. In a March appearance at the Rotary Club of Santa Fe, N.M., I spoke to about 85 members and guests. I told the crowd that everyone who writes about baseball rather than playing it owes an explanation, at least to himself. In my case, it was simple. In the 10th grade, I was a substitute on the ninth-grade team. Not only that, I was so slow my teammates called me Snowshoes.

Tell your listeners where the talk is headed before they get bored or confused, and use anecdotes and examples to illustrate general points. Third baseman and manager Buddy Bell once told me, “The best thing about baseball is, you never have to grow up.” This was the perfect lead-in for my story about the time I entered the Red Sox clubhouse during a rain delay and found the players enjoying a golf game they had invented using bats, balls, cups, and towels. They were in seventh heaven: little boys creating a new game.

To paraphrase playwright Lillian Hellman, don’t tailor your views to fit the fashions of your audience. Rotarians are open-minded people who will respect your frankness even when they disagree.

Finally, leave your listeners with a happy thought to take home: I tell Rotarians that like many failed hardball players, I segued into softball. Early one evening I was standing in center field counting the daisies when a long fly ball headed in my direction. For once, old Snowshoes was off at the crack of the bat. I ran the ball down and made a spectacular one-handed catch. It was the last out of the evening, and as I jogged back to the infield, players on both teams were on their feet cheering me. It was unreal, it was otherworldly, it was magical. It was the kind of thing you’ll experience if you give baseball a chance.

Kind of like speaking at a Rotary club.

• Jim Kaplan is a member of the Rotary Club of Northampton, Massachusetts, USA, and a former Sports Illustrated baseball writer. His book "Clearing the Bases" came out last year.

• MaineWriter is a Rotarian member of the Rotary Club of Portland Maine

Maine Medicaid expansion- statement from Maine Council of Churches

A growing list of advocates support the "Yes" on Maine Medicaid Expansion citizens initiatives "Question 2".

Maine Council of Churches supports the expansion of Medicaid coverage

From the Executive Director

The Maine Council of Churches would like to add its voice to those of the Maine Hospital Association, the Maine Sheriffs Association, the Maine Chiefs of Police Association, and nearly 60 percent of recently polled Mainers in support of Senator Tom Saviello’s proposal to expand Medicaid coverage to more of Maine’s vulnerable and low-income citizens. The Council, rooted in Hebrew and Christian scripture, takes the biblical mandate seriously to love our neighbors and care for those in need. We believe it is our collective responsibility to share the means to health through access to health coverage, helping to ensure that all people can live healthy, whole, safe lives, free from the fear that their next illness will mean not only personal tragedy but also bankruptcy, homelessness, or even death. Thirty-two states have already elected to expand Medicaid coverage. We hope and pray that Maine will become the next to do so.

Unethical for Dr. Bill Cassidy to defend slash and burn of Medicaid

William Morgan Cassidy (born September 28, 1957) is an American physician and politician currently serving as the senior United States Senator from the state of Louisiana.

Physicians all over the world hear their patients cry for lack of ability to pay for curative treatments. 

Dr. Bill Cassidy, the physician turned politician and Louisiana Senator, knows what his patients have endured or given up in their struggles to afford health care.  Consequently, he should be defending Medicaid and the expansion of this benefit to more poor people, rather than forcing un-vetted legislation with Senator Lindsey Graham, for the purpose of capping the reimbursement in a "slash and burn" bill, to erode this important benefit.

Hippocratic Oath- "do no harm"

In my opinion, it's unethical for Dr. (Senator) Cassidy to support the Graham-Cassidy bill to repeal Obamacare, aka the Affordable Care Act.  In his profession of being a physician, he should seriously remember the Hippocratic Oath and protect his patients from avoidable harm.  

Instead, Dr. Cassidy is supporting the repeal of public policy, the ACA, that has helped to provide uninsured people with health coverage for the purpose of gutting Medicaid. I can't help but believe there are #KochBrothers incentives behind this unethical behavior. In other words, some back door deals. Maybe this unethical connection can't be proven, but Dr. Cassidy's behavior mystifies me because he is not exercising good or ethical judgement.

Nevertheless:

Cassidy defends his repeal bill as provider and insurer groups heighten criticisms~ by Virgil Dickson

One of the Republican co-authors of the new Senate bill to repeal and replace the Affordable Care Act said at a hearing Monday that the biggest beneficiaries of his bill are the states that chose not to expand Medicaid.

"I think if you're in a state that did not expand Medicaid, you are pleased about this bill," Sen. Bill Cassidy of Louisiana said at the Senate Finance Committee hearing to consider the Graham-Cassidy bill.

The bill would convert the ACA's funding for premium and cost-sharing subsidies and Medicaid expansion into $1.2 trillion in state block grants through 2026 and let states design their own systems, with few limitations on how they could use the money.* There is no provision for funding the block grants after 2026.

States that expanded Medicaid and enrolled lots of people in ACA marketplace plans would suffer the biggest financial losses. Many of those states, such as Ohio and West Virginia, are represented by GOP senators whose votes are needed to pass the bill.

Over the weekend, Republicans added $14.5 billion to the measure including extra funds for states of wavering GOP senators. But hospital leaders in those states remained fearful that the bill would lead to a loss of coverage in their states and a rise in uncompensated-care costs.

A chart that Senate Republicans circulated said the bill's revised version, released Monday morning, would provide 14% more federal funding for Arizona than under current law, Kentucky would get a 4% increase, Texas 49%, Alaska 3% and Maine 43%.

Alaska and Maine are represented by Sens. Lisa Murkowski and Susan Collins, respectively, two Republicans who helped kill the previous Senate repeal bill and whose votes are pivotal to passing this one.

The amended bill adds hundreds of millions of dollars in funding for sparsely populated states such as Alaska.

"It is highly unlikely that they could make enough funding or policy changes to end our concern," said Shayna Diamond, a spokeswoman for the Arizona Hospital and Healthcare Association.

Hospitals in Alaska also remained unmoved by the eleventh-hour changes to bill. Even with the additional money, on a net basis the state still would be a loser, said Becky Hultberg, CEO of the Alaska State Hospital and Nursing Home Association.

"It would still result in an increase in the uninsured population, and the bill's block grants would be technically challenging to implement," she said. "Both of those remain major concerns for the association."

Hospitals in Maine were concerned that there were still too few details about the bill to determine the impact, said Becky Schnur, a spokeswoman for the Maine Hospital Association.

Physicians, hospitals, insurers and patient groups also continued to slam the bill Monday.

The American Academy of Family Physicians said the revised version of the bill released over the weekend fails to ensure coverage for essential benefits. It issued a joint statement with America's Health Insurance Plans, the Blue Cross and Blue Shield Association, the American Hospital Association and the American Medical Association opposing the bill.

The AAFP said the Graham-Cassidy bill allows insurers to charge older Americans premiums that are five times greater than those for younger people. The bill would destabilize the individual insurance market and end the Medicaid expansion for low-income adults, the AAFP said.

"The result will be millions of Americans who have no access to needed medical care because they cannot afford or are denied health insurance," AAFP President Dr. Michael Munger said in a written statement.

*"few limitations on how to use the money?"- Including skillful u$e to creatively balance state budgets!

Medicaid caps- Revised Graham-Cassidy GOP repeal

There's plenty wrong with putting caps on Medicaid.

1.  If there are caps put on Medicaid based on a state's population, that means people who need care will be put on waiting lists.

2.  Neonatals and newborns will have to wait for somebody to die to receive Medicaid eligibility.

3.  When a state loses population (and several are already in a zero growth trend), then the Medicaid money will be reduced, even if the needs in the state are great- like Native Americans or a large number of discharged military who are in transition to civilian life and not yet employed.

4.  Putting state caps on Medicaid will force ethical dilemmas for health providers who will be giving care based on eligibility rather than on medical necessity.

5.  Medicaid caps prevent state's from addressing unforeseen population needs.  Pandemics will put populations at risk of choosing who gets life saving technologies.

6.  Poor people will be subject to even more health care rationing.

7.   It's wrong to shift health money. Graham-Cassidy pays for flimsy pre-existing conditions coverage by imposing caps on needy populations, like newborns, frail elderly, neurologically impaired, mentally ill, disabled and the chronically ill. Medical ethics will be upended, providers will be forced into examining "death panels" to determine eligibility based on population numbers, rather than on need.

Senator Susan Collins a pivotal voice and powerful health care vote

MAINE VOICES
Sen. Susan Collins is again poised to be a crucial vote on health care: Rejecting the latest Senate bill would protect our health and our communities- Dr. Sam Zager opinion represents Maine health care providers and Maine Providers Standing Up for Health Care.

MaineWriter preface:

Senator Susan Collins is a strong advocate for the most poor and frail in our nation and in Maine. Her family has experienced the impact of having loved ones who care for their relatives when they need expert long term care. Now, with her knowledge about how insurance coverage is managed, coupled with an in depth understanding of Medicaid and Medicare regulatory oversight, she has the capacity to apply her experience to protect those who cannot speak for themselves. Please opposed the Graham-Cassidy bill, it's a bad idea (as reported in the September 20, Washington Post).

In fact, all 50 state Medicaid directors have opposed the Graham-Cassidy Republican repeal bill to destroy the Affordable Care Act, a cruel piece of legislation now being considered by the Republicans. It's a very, very sad time in America, when politics has completely taken over the risk management of our national health care policies. In the Republican's resurrected attempt to repeal the Affordable Care Act (ACA), the cruel GOP bill will cut Medicaid by imposing a per-enrollee caps on services. 

This is health care rationing.  Moreover, somebody will have to decide when to cut care for very ill people, if this terrible bill passes. Pro-life advocates are hiding in the rafters, but they should be shaking the Congress to protect Medicaid.

It's outrageous to cap Medicaid beneficiaries' health care costs, because, for those who need the coverage, the medical caps will cause them mortal harm. We're talking about neo-natal premature babies, children born with heart anomalies, disabled people, patients with neurological diseases, the mentally ill and frail elderly. You might as well cut the oxygen to the people with chronic and acute care needs, as to put a cap on their medical care costs, by capping Medicaid. 

Obviously, the purpose of these disastrous cuts are so that states will have some change left on the table after they receive their Medicaid money for them to use for subsidies to put towards those who will need premium subsidies to cover pre-existing conditions.

Here is an opinon "echo" from Dr. Sam Zager, who represents Maine Providers Standing Up for Health Care, published in "Maine Voices":

PORTLAND, Me- The U.S. Senate is planning to vote next week on the health bill sponsored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La. Many observers consider it the Republicans’ last chance to repeal the Affordable Care Act before a Sept. 30 deadline. Although Sen. Susan Collins has yet to take a firm public stand, she is again poised to be a crucial opposing vote. Rejecting this bill would protect our health, our communities and the normal order of the Senate.

One similarity between Graham-Cassidy and its predecessors is the shoddy legislative process. Without any hearings or opportunities for public comment, Majority Leader Mitch McConnell, R-Ky., is bringing a hastily concocted bill to an unfortunate partisan vote.

“Bipartisan support – that’s what we really need when we’re tackling an issue as difficult as health care,” Sen. Collins told MSNBC’s Chuck Todd on June 22. The Congressional Budget Office (CBO) said this week that it would need several weeks to fully “score” the bill. This rushed vote, therefore, means that senators will likely not know how many of their constituents might lose their health insurance as a result of Graham-Cassidy.

In addition to process problems, Graham-Cassidy has grave flaws in substance. A core feature of the bill is a reduction in federal funds allocated to health care, especially for low-income Americans and other vulnerable groups.

The Robert Wood Johnson Foundation and Kaiser Family Foundation each independently estimate about 6 to 8 percent less federal spending for health coverage nationally in the first seven years under Graham-Cassidy (2020-2026). When combined with the proposed Medicaid caps per enrollee, $160 billion less would flow from Congress to the states.

Even with the bill’s block grant, Maine would lose $54 million under Graham-Cassidy. After 2026, Graham-Cassidy’s block funding would plummet to zero, so our state would lose $745 million annually starting in 2027.

What do these numbers mean in real terms, for real Mainers? 

The Graham-Cassidy cuts would ripple through our health infrastructure and cascade through our communities.

More hospitals and federally qualified health clinics would cut back staffing and services, or close completely. Fewer employers or workers would be inclined to relocate to Maine or stay here. Workforce sizes would then diminish, and the tax base would suffer. Education investment would decrease, with a subsequent decrease in workforce readiness.

The overall perception that Maine communities are declining would further deter investment in our state, and the cycle would repeat.

This health bill would, ironically, be terrible for health. It would significantly weaken the ACA’s guarantees regarding pre-existing conditions. It would cut treatment for opioid and other substance dependence. It would defund Planned Parenthood, thereby restricting access to contraception and cancer screening (federal law already prohibits Medicaid from funding abortions). It would eliminate the employer and individual mandate, further destabilizing insurance marketplaces in Maine and other states.

In addition to these rule changes, cuts to Medicaid would greatly harm the 34 million children, 27 million low-income non-senior adults, 10 million disabled Americans, 6 million seniors, 2 million expectant mothers and 1.75 million veterans who depend on it for health insurance.

Health insurance matters, and lack of it confers significant health risks. Last month, the New England Journal of Medicine published a review of many high-quality studies from the previous decade. 

Having insurance enhances financial security and reduces bankruptcies; improves access to primary care; improves medication adherence for chronic conditions; improves self-reported health, a validated measure of the risk of death, and improves mental health outcomes, such as depression.

Moreover, several studies over the past 25 years show lower death rates among people with insurance. One study found that states that expanded Medicaid had 6 percent lower mortality rates over five years, compared to neighboring non-expansion states. Two other studiesconcluded that providing health insurance to 1 million people would save around 2,000 American lives annually. This is consistent with international data, which show that countries with universal health coverage tend to far outperform the United States in health outcomes, at a fraction of the cost per person.

Susan Collins demonstrated incredible leadership this summer during the prior attempts to repeal the ACA. 

In June’s MSNBC interview, she said, “I cannot support a bill that is going to result in tens of millions of people losing their health insurance.” She withstood withering criticism from the president and others in her party, but held her ground. For the sake of our communities, our health and our lives, we hope Sen. Collins will do the same next week.

Sam Zager, M.D., of Portland is a family physician and a member of Maine Providers Standing Up for Healthcare.

Donald Trump - speeches are regressive exercises

"...first (Trump) address to the United Nations General Assembly...called both 'terrifying' and 'delusional' by experts."

Obviously, Donald Trump speaks in abrupt 140 character Tweets. Regardless of how much he's advised against his use of Twitter, Donald Trump continues to provoke the media and to malign people with whom he disagrees, via "Tweets".  

For whatever period of time his misuse of power is allowed to continue, the legacy he leaves will forever be tainted by immaturely constructed Tweets.

Donald Trump's  incendiary speeches are failures

Yet, Trump's ineffective attempts to give statesman quality speeches are even more regressive than his tirades of juvenile Tweets.  Although Trump's campaign rallies ramble to his right wing extremist base, by using repetitive headline grabbing slogans, he is unable to rise to the challenge of giving a major leadership address. Indeed, Donald Trump's failed leadership is painfully evident when he vainly tries to communicate lofty concepts or to summon visionary ideals. 

Rather than advance his leadership goals, Donald Trump's speeches are regressive statements, whereby he painfully reveals how unprepared he is to unify allies or to inspire the human condition.

For example, following his speech to the United Nations, the headline "take-away" was this: "Trump says many portions of the world are going to hell".  This stupid statement is a waste of human energy.  It's something like a drunkard would say at 1 AM, while holding on to the closing bar.

Donald Trump gave his first address to the United Nations General Assembly, pushing for “sovereignty” in what has been called both “terrifying” and “delusional” by experts.

The President, sticking to prepared remarks as he spoke in front of the signature green marble of the UN Headquarters in New York, spoke primarily on his “America First” doctrine, North Korea, and Iran.

He said this emphasis of “sovereignty” was the basis for the international cooperation upon which the UN was founded and what made former President Woodrow Wilson and Truman's Marshall Plan - that aided reconstruction of Western Europe in the wake of World War II - a success.

Although all the experts The Independent spoke with agreed that it was a consistently Trump-esque speech - “it was more rhetorically repetitious than intellectually coherent” according to UN expert at the European Council of Foreign Relations Richard Gowan.

The words “sovereign” or “sovereignty” were mentioned at least 18 times in the nearly 40 minute speech as delivered.

His main message to member countries gathered also addressed his core base: “I will always put America first, just like you as the leaders of your countries will always - and should always - put your countries first.”

Mr Gowan said the speech was more catered toward appeasing the President’s base of supporters who have stuck to Mr Trump’s repeated campaign and early term remarks that the UN is full of elitists and “just a good time “just a club for people to get together, talk and have a good time”.

TJ Pempel, a political science professor at the University of California-Berkeley, echoed that statement, adding that the speech was “good for headlines” but not much else in terms of reducing global threats.

Anjali Dayal, an international security professor at Fordham University, said the speech was "terrifying" since it was such a drastic break from past US presidents, despite the fact that sovereignty is still a “cornerstone” of the UN.

She said the main difference is interpreting what respecting that sovereignty means.

“I don't think it was a standard hawkish Republican foreign policy speech, even though much of what Trump said called back to the John Bolton era at the UN,” referring to the controversial US representative under George W. Bush’s administration.
Mr Trump spoke extensively on two particular countries: North Korea and Iran, calling them a “depraved regime” and a “murderous regime,” respectively.

Ms Dayal said: “it's hard to square the idea of sovereignty as non-interference with his language on North Korea, Iran, and Venezuela.”

After North Korea conducted its sixth nuclear weapons test recently, developed a hydrogen bomb, and fired test missiles over Hokkaido, Japan - the Security Council unanimously voted to place the strictest-ever sanctions on the hermit kingdom.

Today Mr Trump said that should Pyongyang not cease with developing its nuclear arsenal or attacks a US territory or ally the US would have “no choice but to destroy North Korea”.

He said, referring to the mercurial Kim Jong-un, that “Rocket Man is on a suicide mission”.

This is not much of a change in policy as Dr Stephen Saideman, an expert at Canada’s Carleton University, pointed out.

However, what worried Human Rights Watch’s UN Deputy Director Akshaya Kumar was that he said it at the UN.

War with North Korea would be an “incredibly disproportionate response to punish innocent civilians for the [North Korean regime’s] actions,” Ms Kumar told The Independent.

Neil Bhatiya, a researcher at the Center for a New American Security, told The Independent that Mr Trump’s rhetoric today ignored the “necessity of cooperating with Beijing on sanctions against Pyongyang”.

Mr Trump’s comments do not appear to take into the account the ripple effect of his apparently fatalistic view towards military action, according to Mr Pempel.

“The new sanctions authorities granted to the President have to potential to incur significant financial costs for China-based firms, which could have wider effects for the global economy if, for example, U.S. sanctions target certain large Chinese banks,” noted Mr Bhatiya.

Any implementation will have to be done in coordination with major players like China.

At the same time, Mr Pempel said this speech was “good for headlines” but not really serving the grander purpose of actually reducing a North Korea threat.

He argued that Mr Trump’s language does not do anything to help encourage more cooperation from Russia and China - who joined the world to vote in the Security Council for the strictest-ever sanctions on Pyongyang.

“This is the time for…encouraging China...and sending quiet messages to North Korea about a willingness to talk.”

Instead, Mr Pempel said the speech helped Japan, who worries that the US will abandon them and get “too close” to China, but also puts ally South Korea in a “tough” position of wanting more dialogue along the lines of President Moon Jae-in’s “sunshine policy” and realizing the real need for a militarized Seoul.

Despite what seems like a fatalistic attitude towards using military action to quell the threat of the isolated and mercurial North Korean leadership, Mr Pempel thinks Defence Secretary James Mattis had very little to do with the speech.

“He is usually reluctant to start with, and stay with, comments about military action. He keeps it quietly in the background but emphasizes diplomacy,” Mr Pempel said of the President’s trusted military adviser.

Trump says the US will "totally destroy" North Korea, if necessary, in UN speech

Mr Gowan argued that despite the threat of using American military might against Pyongyang, he appeared to still want to talk it through with China and Russia, as evidenced by US Ambassador to the UN Nikki Haley’s continued work.

The most “disturbing” part of Mr Trump’s speech for Mr Gowan was about Iran.

Mr Trump said that the Iran nuclear deal, signed in 2015 to redesign and reduce the country’s nuclear framework, was an “embarrassment” for the US.

Elizabeth Rosenberg, a Senior Fellow at the Center for New American Security, said that, at the very least, Trump’s words on Iran were “consistent” because it “reinforced the impression that he plans to take action to undermine the deal.” (MaineWriter: Another regressive statement, because Donald Trump has yet to deliver on his bellicose threats. Even his wasted bombing of the Syrian air field, to retaliate against Assad's assault on his own people, was merely a waste of time. Rather, it was a discharge of expensive old Tomahawk missiles.)

Ahead of the speech, a senior White House official said the goal was to separate the suffering of the Iranian people from the regime of Iran.

Mr Gowan said that “the idea that the Iranian people are going to rise up against their government because Trump gave a hectoring speech at the UN is delusional.”

Mr Trump “mixing the accusations towards the "murderous regime", its behaviour in the region, with what should be deemed a technical agreement the international community negotiated over more than 12 years” shows that this administration does not really separate the two, Dr Aniseh Bassiri Tabrizi, a Research Fellow at the Royal United Services Institute for Defence and Security Studies, told The Independent.Trump's America First doctrine will destroy the United Nations
North Korea diplomacy ‘exhausted’, says top US official

In Mr Trump also calling it "one of the worst" international pacts ever made, Ms Tabrizi said the administration undermines all the partners who worked on the deal during both the Bush and Obama administrations as well as “ignor[ing] the wishes of the Iranian people, who elected the current president twice because they believed a nuclear deal...was the best way to improve their living standards” since it lifted sanctions.

His rhetoric about the “rogue state” that has a “false guise of democracy” may be welcomed by his base, but ultimately does not aid in getting a better deal according to Ms Rosenberg.

It is “tremendously unhelpful with expanding arms controls of Iran” since there is less ally consensus on Iran’s non-nuclear activities.

Overall, several world leaders (except for Israeli Prime Minister Benyamin Netanyahu who was full of praise), agreed with Swedish Foreign Minister Margot Wallstrom who said to the BBC: 

"It was the wrong speech, at the wrong time, to the wrong audience.”

(MaineWriter- Donald Trump's "failed leadership" is painfully exposed in his failed speeches.)

Super antibiotic breakthrough promising for HIV

Interesting news report posted on BBC- Health (British Broadcasting) about a significant breakthrough in Human Immunodeficiency Virus - HIV- treatment.  

Scientists have engineered an antibody that attacks 99% of HIV strains and can prevent infection in primates.

It is built to attack three critical parts of the virus - making it harder for HIV to resist its effects.

The work is a collaboration between the US National Institutes of Health and the pharmaceutical company Sanofi.

The International Aids Society said it was an "exciting breakthrough". Human trials will start in 2018 to see if it can prevent or treat infection.

Our bodies struggle to fight HIV because of the virus' incredible ability to mutate and change its appearance.

These varieties of HIV - or strains - in a single patient are comparable to those of influenza during a worldwide flu season.

So the immune system finds itself in a fight against an insurmountable number of strains of HIV.

Super-antibodies

But, after years of infection, a small number of patients develop powerful weapons called "broadly neutralising antibodies" that attack something fundamental to HIV and can kill large swathes of HIV strains.

Researchers have been trying to use broadly neutralising antibodies as a way to treat HIV, or prevent infection in the first place.

The study, published in the journal Science, combines three such antibodies into an even more powerful "tri-specific antibody".

Dr Gary Nabel, the chief scientific officer at Sanofi and one of the report authors, told the BBC News website: "They are more potent and have greater breadth than any single naturally occurring antibody that's been discovered."

(Dr. Gary Nabel was with NIH before taking a position with "big pharma"- but apparently, his scientific background is paying off with the private sector.)

The best naturally occurring antibodies will target 90% of HIV strains.

"We're getting 99% coverage, and getting coverage at very low concentrations of the antibody," said Dr Nabel.

Experiments on 24 monkeys showed none of those given the tri-specific antibody developed an infection when they were later injected with the virus.

Dr Nabel said: "It was quite an impressive degree of protection."

The work included scientists at Harvard Medical School, The Scripps Research Institute, and the Massachusetts Institute of Technology.
'Exciting'

Clinical trials, to test the antibody in people, will start next year.

Prof Linda-Gail Bekker, the president of the International Aids Society, told the BBC: "This paper reports an exciting breakthrough.

"These super-engineered antibodies seem to go beyond the natural and could have more applications than we have imagined to date.

"It's early days yet, and as a scientist I look forward to seeing the first trials get off the ground in 2018.

"As a doctor in Africa, I feel the urgency to confirm these findings in humans as soon as possible."

Dr Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases, said it was an intriguing approach.

He added: "Combinations of antibodies that each bind to a distinct site on HIV may best overcome the defenses of the virus in the effort to achieve effective antibody-based treatment and prevention."

Washington Post Echo- GOP health care repeal is a bad idea

Another GOP health-care bill proves - "bad ideas never die"- Washington Post opinion: blog "echo"

GOP health insurance "repeal bill" is a bad idea

Republican senators (will sadly) try one last time to repeal and replace Obamacare. (Obamacare was built on the actuarial analysis that spreads the cost of the risk of coverage throughout the population covered. Republicans want to slash and burn the benefits that helps the most needy who need coverage for pre-existing conditions.)

Opinion in the Washington Post

In fact, the latest bill, from Sens. Bill Cassidy (La.), Lindsey O. Graham (S.C.), Dean Heller (Nev.) and Ron Johnson (Wis.), is about as execrable (ie "awful") as the others that GOP lawmakers previously failed to approve. The process by which Republicans would pass it would be as sloppy and partisan as the one to which senators such as John McCain (R-Ariz.) objected earlier in the summer. The outcome would be no less destructive.

The big difference now is the clock; the procedural window for passing a health-care bill along straight party lines will disappear at the end of the month, spurring Republicans to try one last time. 

That is a sad excuse to rush through — without even an attempt at bipartisanship and without a complete Congressional Budget Office assessment — a half-baked bill that would harm millions. Senators who objected to repeal-and-replace efforts before have no principled reason to change their votes.

The Graham-Cassidy proposal would cancel Obamacare’s major programs in 2020 and offer the states block grants instead. This plan at least does not include a massive upper-income tax cut, as previous GOP bills did, and it would seem to allow blue states to create and maintain universal or near-universal health coverage systems within their borders, even as red states went in a more conservative direction.

But the bill suffers from fatal flaws, even setting aside how red-state residents would suffer under the parsimonious health policies their governments would adopt. 

First, analysts project that it would scale back the money states would get over time, relative to what would have flowed their way under Obamacare. The Center on Budget and Policy Priorities, a center-left think tank, estimatesthe shortfall would total $41 billion by 2026. The bill’s funding formula would, in general, shift money from blue states to red states. These factors would make it difficult for states that like their Obamacare to keep their Obamacare.

Second, the bill would seriously cut Medicaid, which covers the poor and near-poor, putting yet more burden on states to cover needy people — if states even try.

Third, the state block grants that would underpin the Graham-Cassidy system would end in 2027; that would breed uncertainty in the market, fear among patients and rancor on Capitol Hill.

Moreover, the bill would make it easier for states to erode important safeguards guaranteeing that sick people can obtain the care they need.
And that is the rosy scenario. There is a good chance that many states would fail to create brand-new health-care systems by 2020, in time to stave off the chaos that would occur after Obamacare’s carefully regulated and subsidized health-care markets disappeared. Establishing such a system is hard under any circumstances. Doing so under a tight deadline, without the administrative, technical and other help that federal officials currently provide, would be very hard, the Urban Institute’s Linda Blumberg pointed out.

Some Republicans want to pass this policy disaster before the end of the month, in less than two weeks. A last-minute committee hearing would be nothing more than a fig leaf disguising a reprehensibly partisan process in service of an unworthy bill.

The New Yorker: Evan Osnos: Letter from Pyongyang "On The Brink"

The New Yorker September 18, 2017

Could Kim Jong Un and Donald Trump goad each other into nuclear war?

An interesting and well written first person tour into North Korea by Evan Osnos. 

Intersting article by Evan Osnos in The New Yorker- but he did not get to ask Kim Jong Un how he felt about "Nuh Jukgo, na jukja!"

Description of (~sort of~) the ordinary life of an American visitor in North Korea., 

Evan Osnos spoke candidly with his personal North Korean guide and chaperon. He stayed in Pyongyang and visited the Demilitarized Zone- on the North Korean side of the 38th Parallel

Take away from the feature story was this: North Koreans are prepared to die in a nuclear war rather than surrender to Donald Trump. "Nuh jukgo, na juka!" (You die, I die!) is the national mantra.

Nevertheless, my own observation, after reading the article, was this:

Obviously the North Koreans are willing to die because they consider it their zealous  duty to do so, if necessary. Nevertheless, it begs the question:  Is Kim Jong Un ready to die with them?

That's where the fulcrum between Donald Trump and Kim Jong Un is positioned.  (In my opinion.)  Frankly, Kim Jong Un seems to enjoy firing off nuclear threats, but I seriously doubt that he is ready for a "star wars" style weapon to find him, wherever he hides.

Kim Jong Un should stop his nuclear horror and focus, instead, on keeping his people healthy and economically secure.