Donald Trump and maga Republicans have completely failed to provide America's working class with health coverage

Echo letter to the editor of The New York Times:

Medicare for All is very popular. Even people who distrust government are in favor of it. It is a crime and a disgrace that our rich country does not provide Medicare for all of us. Every other wealthy country has figured out how to do this.

Unfortunately in the US the influence and political power of the for-profit corporate health insurance companies cancel out the movement for Medicare for All. (Maine Writer: All working Americans already pay in into Medicare. Makes perfect sense for all who pay for the benefit to receive access to the coverage.) 

Therefore many go without health insurance because they cannot afford it. They are one illness or injury away from bankruptcy due to medical debt.

When will we join every other wealthy country and provide health care for all? I fear that I, at 82 years old, will not live to see it.

From Elizabeth R. Rosenthal in Larchmont, N.Y.
The writer is a retired dermatologist.

Insulin should be free!

History of Insulin

"In January 1922, Leonard Thompson, a 14-year-old boy dying from diabetes in a Toronto hospital, became the first person to receive an injection of insulin. Within 24 hours, Leonard’s dangerously high blood glucose levels dropped to near-normal levels."

#GOP Senator Susan Collins and Senator Joe Manchin alert!

Politics of insulin reveals the sickness of the United States health system. An echo essay published in the New Statesman, the United Kingdom edition (UK).

Build Back Better, Joe

"Joe Biden’s Build Back Better Act is the latest attempt to bring drug prices under control. It would cap prices for insulin and give the government more powers to negotiate with pharma companies."

Diabetics need insulin to stay alive but drug makers and Republican politicians ensure the price remains high.

By Charlotte Kilpatrick- A Franco-American journalist living in London. She writes about health and politics.

Until January 1922 diabetes was a death sentence. A hundred years ago, on 11 January 1922, a 14-year-old Canadian boy became the first diabetic to escape that fate by receiving an injection of insulin. Before that, those with Type 1 diabetes usually lived no more than two years after diagnosis. In 1923 the team of researchers who discovered insulin sold the patent to the University of Toronto for $1 because they wanted to keep the medicine affordable for everyone.

Flash forward 100 years and the price of insulin is anything but. Prices have soared: some formulations cost 1,000% more than they did at the turn of the 21st century. The price of one vial of Humalog insulin stood at $21 in 1999; it cost $332 in 2019, and many diabetics require more than one vial a month.

The reasons for the price rises are complex but can be whittled down to a simple fact: without insulin, diabetics die. Pharmaceutical companies that manufacture insulin have enormous leverage to charge whatever they want. In most developed countries diabetics don’t pay hundreds and sometimes thousands of dollars a month for insulin because governments regulate the price. The US, of course, is the exception. But with 10.5% of the US population diagnosed with diabetes — a percentage which is sure to grow — the rising cost of insulin has become a political punching bag.

It seems strange that a medicine invented 100 years ago has ballooned in price to the point that one in four diabetics reports rationing insulin because of cost. Yet despite its age, insulin remains relatively difficult to make. Unlike drugs such as paracetamol that are chemically derived, insulin is a biologic drug extracted from living organisms. Only three pharmaceutical companies — Eli Lilly, Sanofi and Novo Nordisk — produce insulin and control 90 per cent of the market.

This control makes it difficult for a generic drug maker to come up with its own version. By the time it could bring a generic to market, the big three insulin makers would have developed a newer version incrementally better than the older one. Because doctors naturally want to prescribe the best medicine for their patients, a company making a generic equivalent would find itself squeezed out of the market.

“Honestly, we sometimes call the big three insulin makers a cartel,” says Elizabeth Pfiester, founder and executive director of diabetes advocacy group T1 International. “They have demonstrated behaviour where they raise insulin prices in lockstep, and they have a near-complete dominance in the market. They also put large amounts of money into sponsorships and patient advocacy groups, so their influence is huge.”

Faced with growing pressure to lower prices, the pharmaceutical companies have started releasing cheaper formulations. Eli Lilly announced that it will make a so-called generic version of its Humalog insulin and sell it for 70% less, at $82.42 for an individual vial. Meanwhile, it charges Germans an even lower price of $55 for the exact same insulin.

Melinda St Louis, director of the Medicare for All campaign at Public Citizen in Washington, DC, says that giving the drug companies the power to decide insulin prices leaves diabetics at their mercy. “The reality is that a lot of people fall through the cracks. What we need to do to make insulin accessible for everyone is lower prices across the board,” she says.

Systemic illness
According to a 2021 report by the RAND Corporation, a think tank, sick Americans pay on average 256% more for medicine than people in 32 other countries. The price discrepancy is in part the result of the piecemeal nature of the US health insurance system, which favors large employers. Companies are only required to offer insurance to full-time employees: a waitress working 29 hours a week on her feet is not entitled to coverage.

Things could always be worse. A smoking diabetic who earns just enough in Dallas, Texas, to be above the poverty line to qualify for Medicaid (the government plan for the extremely poor) would be priced out of any of the plans offered under the Affordable Care Act, known as Obamacare.

Recognizing that some people could fall through the cracks, Obamacare provided states with free money to expand their Medicaid programs. Unfortunately for the hypothetical smoking diabetic, Texas is one of many Republican-controlled states that refused to accept the money on ideological grounds. 

Diabetics in other red states share the same grim luck. Six out of ten of the US states with the highest rates of diabetes have refused the Medicaid expansion to provide health insurance for poor people.

Build Back Better, Joe
Joe Biden’s Build Back Better Act is the latest attempt to bring drug prices under control. It would cap prices for insulin and give the government more powers to negotiate with pharma companies.

The sailing has been anything but smooth for Build Back Better. It barely passed the House of Representatives and is being held hostage in the Senate, where it needs every Democratic vote to pass. One Democratic senator who has voiced concerns is Kyrsten Sinema from Arizona, who says that negotiating drug prices with pharma companies would mean less money for research and development, and therefore fewer innovative drugs.

However, a 2017 study revealed that the premium Americans paid for the 20 best-selling drugs was $40 billion higher than the amount the drug companies spent on R&D. A Congressional Budget Office paper released in August reported that allowing negotiations could save the government 15-25% on drug costs.

In many cases Americans end up paying for the same medical research twice. The biggest public funder of drug research is the US taxpayer, through the National Institutes of Health, which contributes almost $52 billion to research. The results are then sold to pharma companies, which sell the drugs to Americans at jacked-up prices.

According to St Louis a cap on insulin prices is a step in the right direction, but it’s not enough. “The hold-out that we are seeing from some Democratic senators is an example of the outside influence of the pharma industry on our democratic process,” she says. “Sinema has received enormous amounts of campaign contributions from the drug companies that have all opposed [Build Back Better].”

Sinema, who raked in $1.1 million in campaign donations from pharmaceutical companies in three months, is far from the only recipient of Big Pharma money. The industry is the biggest spending lobbying group in the US, dishing out $352.8 million last year. That’s not the only way Big Pharma buys influence. It spent $6.65 billion in 2020 on advertising to convince patients to buy their medicines. That’s enough to bring five new drugs to market in a year.

For the moment negotiations on Build Back Better continue. Joe Manchin, Democratic senator for West Virginia, a state where 16% of the population has diabetes, is holding out on the legislation because he claims it will add to the deficit, and that poor families will spend the extra money from tax credits on illegal drugs.

Perhaps it hasn’t occurred to him and the 50 Republican senators who oppose the bill that poor families can’t afford to wait for lower prescription drug prices.

Wealthiest nation must prioritize health care for all

Although Donald Trump summoned a cult of made for television faces to applaud while he gave an uninspired stump speech in West Virginia, the fact of the matter is this - many Mountain State people oppose his Trumponian policies, particularly about health care.

Here is another "echo" re-posted letter to the editor, printed in the August 5, 2017, Charleston West Virginia Gazette Mail (a Pulitzer winning newspaper), published by the editor.

A CPA wrote to the editor about how one company where she worked put the money saved by implementing a new employee benefits plan into a CEO fund- "golden parachutes", money from the employees who contributed and never got their investments back.

Congress must repair and keep the ACA

I am a CPA with 30-plus years of experience, including benefits administration. I understand the nuances of the health care debate and the reasons why medical benefits have been systematically eliminated by employers over the past 20 years. I am appalled that our elected leaders refuse to address health insurance inequality.

I became passionate about this subject in the 1990s. I worked at a Michigan utility company when health insurance premiums began rising dramatically. 

My company chose to revamp the employee benefits package, resulting in cuts to our pension and medical benefits. 

Retiree medical benefits were eliminated. Six months after the new benefit package was rolled out to more than 3,000 employees, the $3 million annual cost savings was used to implement a Supplemental Executive Retirement Plan for the 10 top executives. Sound familiar? This trend has been going on for years. It did NOT begin with the passage of the Affordable Care Act.

Prior to the passage of the ACA, our eldest and unmarried daughter was denied coverage due to a suspicious pap smear. She could become eligible for Medicaid if she got pregnant. Really? We all know someone who has been denied coverage.

Why is our country the only developed nation that doesn’t acknowledge health care to be a basic human right? How can we live in the richest country in the world and not care about everyone’s health? Why do we allow legislators to concoct draconian health care bills behind closed doors? Why aren’t the legislators subject to the same reduction in benefits as the people they “represent”?

Congress must include diverse opinions and hold public hearings before they implement significant legislation. They must hold town hall meetings and listen to their constituents who reject both the House and Senate health care bills. Please, Sen. Shelley Moore Capito, now!

Susan Shirkey, Bradenton, Fla.

In fact, MedicareForAll would allow for the current law governing this benefit to expand coverage for everyone who qualifies, becasue working people who receive salaries and their employers contribute to this dedicated fund. It's time for all who contribute to have access to the coverage.

Saving coverage for pre-existing conditions & the Affordable Care Act

Dear US Congress- saving the coverage for pre-existing conditions is easy.  Just do it!  Expand Medicare4All!

Click here for organizational materials- from the website "Indivisible"

HOW TO SAVE THE AFFORDABLE CARE ACT (AGAIN)

Saving the Affordable Care Act (ACA) comes down to Congressional constituent power.  In fact, the ACA is a law, but supporting it as a means for affordable health care coverage for millions of Americans needs our relentless education, mobilized at the grass roots levels. We must prevent Republicans from repealing the ACA coverage from beneficiaries who pay premiums for the insurance!  

Of course, the easier way to improve the ACA and include coverage for pre-existing conditions is to expand the Medicare law to include everyone who qualifies regardless of their age (as of now, Medicare covers all qualified beneficiaries who are 65 years old and older).  

Republican Members of Congress (MoCs) are trying to repeal the Affordable Care Act (ACA)—again. They want to move forward even though their bill strips coverage from 24 million Americans, even though, in March, they had to embarrassingly pull their bill from the House floor before a vote, even though a recent Kaiser Health poll shows that 74% of respondents said Republicans should do what they can to make the Affordable Care Act work.

http://www.medicareforall.org/pages/Home

Call Congress to demand action in support of the ACA and Medicare4All!  Americans deserve health care coverage.  

Quality care is compensated care.  

Republican reality check: job losses & uncompensated care is immoral in ACA repeal

Republicans are well aware of the right and ethical replacement for the Affordable Care Act (ACA), also known as "Obamacare". It's an excellent program already working and ready to go called "Medicare for All". This program simply calls for expansion of those eligible for the Medicare benefit to those who are under 65 years old.

Nevertheless, the Republicans are "hell bent" (as Senator Angus King-I-Me, rightly says) to repeal Obamacare without any consideration about the consequences. Thirty million people will be forced, against their will and through no fault of their own, to be without health insurance coverage.

Senator Angus King speaks with staff at Bridgton Maine hospital 

Moreover, Obamacare repeal means health care providers will be forced to deny access to people who cannot pay because, frankly, hospitals and other professionals cannot absorb revenue losses by providing uncompensated care. 

Senator Angus King was interviewed while visiting the Bridgton Hospital in rural Western Maine. Consequences about Obamacare repeal will harm small hospitals because patients will loose access to care and cause reduction in labor force, due to loss of revenues.

BRIDGTON, Maine (NEWS CENTER-6) — The U.S. House followed the Senate's lead Friday afternoon and voted along party lines to begin dismantling the Affordable Care Act.

Sen. Angus King met with doctors, nurses and administrators Friday morning at Bridgton Hospital to hear from those on the front lines of health care — how repealing the ACA would impact rural hospitals in Maine.

Bridgton Hospital President David Frum told Sen. King that 8 percent of the hospital's patients have insurance through the ACA, and that if those people lose their insurance, it will mean a major loss of revenue and force the hospital to make cuts in services and likely jobs.

"You would likely be looking at a workforce reduction," Frum said, "and we are the largest employer in Bridgton."

Frum said rural Maine hospitals are looking at a "double-whammy" with the possible repeal of the ACA and proposed cuts outlined in Gov. LePage's budget. If both come to pass, he predicts some rural Maine hospitals could be forced to close.

Doctors told King that repealing the law without a replacement could mean fewer people getting preventative care — like vaccinations or cancer screenings.

King says he will take the information he heard Friday back to Washington as the political process to dismantle the ACA moves through Congress.

"Why don't we hold off on repeal until we do the replacement?" King said. "To me, it's so logical. I don't know how you argue against it?" (Especially when a replacement plan named "Medicare for All" is ready to go today, if Congress would permit beneficiaries who qualify to access their Medicare coverage before reaching age 65.) In fact, private insurance isn't really needed because, truth be told, Americans can greatly benefit from implementing Medicare for All. So, "the rest of the story" is this: the reason Medicare for All isn't viable has nothing to do with health care policy but everything to do with the powerful insurance lobby.

Speaker Paul Ryan alert!

Health care- quality care is compensated care

Senator Angus King- Independent of Maine, issued the following statement about the terrible Senate vote: 

Support the Affordable Care Act aka "Obamacare" unless a viable and suitable replacement is immediately enacted

"The Senate has made a serious mistake tonight. The repeal of the Affordable Care Act, without a credible replacement, will have disastrous consequences for tens of thousands of people in Maine and millions more across the country. Not only will it strip more than 75,000 Mainers of their health insurance — some of whom were never able to afford it before or who were denied it because of a pre-existing condition — but it will also substantially harm rural hospitals across the state, making health care that much harder to get. It doesn't make any sense, and I'm deeply concerned that it will jeopardize people's lives. I will continue to look for every opportunity to fight this bad bill, and I also continue to hope that my colleagues will abandon this misguided push and, instead, put politics aside and work together to fix the law."

Maine Writer says:

House Speaker Paul Ryan is leading an immoral process to repeal the Affordable Care Act (ACA) aka "Obamacare" unless there is a replacement plan already in place. In fact, such a plan exists, called "Medicare4All".  So, Republicans can just remove the 65 year age requirement for Medicare entitlement, and expand the entire population for coverage to those who make contributions to the program during their working lives.  Easy.

Quality health care is "compensated care'.  Providers deserve to by paid to provide care. Save the "Affordable Care Act" or replace it with Medicare for All!

In other words Dr. Rand Paul understands uncompensated care is no care

Repeal of the Affordable Care Act or ACA, aka "Obamacare" will leave providers uncompensated and 30 million people without insurance coverage. Dr. Rand Paul has a better idea. He wants to repeal Obamacare, but replace it immediately, with an alternate plan. Good idea, except no Republican plan is ready to replace Obamacare. HELLO?

Repeal of the Affordable Care act will increase uncompensated health care - a very bad public policy.

Although Dr. Rand Paul, a US Senator from Kentucky, wants to see the Affordable Care Act aka "Obamacare" repealed, he has no plan in mind to replace it. Although his opinion is wrong mided, he's pragmatic enough to know how repeal will harm the health care industry. In other words, 30 million people without health coverage is unacceptable, especially when these beneficiaries are paying for their coverage and providers deserve the compensation.

Kellyanne Conway the #Trump_microphone for #fakenews, said to Matt Lauer on the Today Show (and she has no understanding about how insurance works) that people are complaining about the quality of health care provided under Obamacare. That's a lie. People choose their own health care providers so the quality is consistent with patient provider choice. 

Moreover, the worst quality health care is uncompensated care. Hopefully, Conway must know enough about insurance to realize how people who don't have insurance are at risk for deteriorating health because they aren't covered.

(CNN) reports:As Republicans are taking control of Congress, Sen. Rand Paul is warning fellow lawmakers of the possible dire consequences of killing Obamacare piecemeal. Paul, in an op-ed published Monday, called for the total repeal and immediate replacement of the Affordable Care Act. The Kentucky senator argues that keeping popular provisions of President Barack Obama's signature health care law, while eliminating less popular, structural pieces, would "only accentuate the bankrupting of the insurance industry." Writing for the website Rare, Paul explained that Republicans needed to vote for a complete repeal of Obamacare, while simultaneously voting on an adequate replacement. 

"As we repeal Obamacare,we would be wise to vote on its replacement at the same time," Paul wrote. (This Dr. Paul double speak means "save the providers reimbursement" - a good idea.)

He added: "If Congress fails to vote on a replacement at the same time as repeal, the repealers risk assuming the blame for the continued unraveling of Obamacare."

The popular parts of the law -- such as one that allows individuals with pre-existing conditions to buy insurance after their diagnosis -- only work when the other parts like the individual mandate are maintained, Paul argued.

"If you repeal this mandate, but leave in place dictates as to whom may purchase insurance, you create a business model doomed to fail," he wrote.

Still, Paul avoided providing much in the way of specifics about a potential replacement system.

Instead, he suggested that "perhaps we should try freedom," (OMG- this is another double speak concept- freedom of choice already exists!) and sketched out four principles that should guide the formation of a potential replacement -- maintaining freedom of choice, offering health savings accounts  (these accounts only work for people who really use the benefit and hardly cover anything except for some copays, over the counter drugs and eyeglasses), removing state-by-state barriers, and providing "the freedom for all individuals to join together in voluntary associations to gain the leverage of being part of a large insurance pool."  (Dear Dr. Paul, you obviously have no understanding at all about how insurance works- ie, "part of a large insurance pool" is exactly how insurance already works...)

I have the best plan- the "Medicare for All" plan. Think about it. Medicare works, beneficiaries pay for the benefit and it's already in place.  Moreover, Medicare for All provides quality and compensated care, a win-win for patients and providers.

Cigna plus Aetna equals profits

Although Americans spend uncounted millions, probably billions, for health care coverage, we as a nation know very little about what we're paying for;  and it may get worse.  

In other words, we're paying for insurance to help us stay well while the companies who take our premiums want to be gatekeepers for the coverage we need when we're sick.

Health insurance profits are targeted towards to keeping people well, while collecting their (our) premiums. Contracts are signed with physicians and managed care groups who are given incentives for keeping "well" people among their beneficiaries. When people get sick, on the other hand, the plans kick in to case manage the care provided. As a result, many people who pay for wellness care find they're at a disadvantage when sickness care is needed and they're prevented from having access to high cost curative therapies. Did you ever see a health insurance advertisement featuring sick people speaking about how much they love their plans? Of course not.

On the other hand, Medicare, Medicaid, and Obamacare subsidies will pay for people who are sick and enter the plans without regard for pre-existing conditions, like diabetes.  

Now, we see where Cigna and Aetna, two big for profit health insurers, want to merge to create even more profit from providing wellness care. In other words, the plans collect your premiums for keeping you well and parcel out the coverage when you get sick.

Here's my crystal ball prediction. People who have complained about Obamacare, because they wrongly see it as government run healthcare, haven't experienced the consequences of profit driven "Aetna plus Cigna equals profits" coverage.

When health insurance companies like Aetna and Cigna are controlling the market place of coverage provided, they will destroy their competition including those plans subsidized by the Obamacare plans.  Health insurance rates will increasingly be driven by profits, rather than by patient care needs, even more so than now.

What America needs is Medicare for All. At least, in Medicare plans, the beneficiaries are given access to government websites that given them a quality analysis of their medical providers. Medicare also has public data to show the trends in health care utilization. 

In other words, a Medicare beneficiary can find out what their premiums are paying for and about the comparative quality of their providers. On the other hand, Aetna and Cigna will report some data in retrospective time of their choosing and only using their sanitized data.

Americans have little knowledge about what their health insurance premiums are providing for their benefits.  Although it's nearly impossible to educate everybody about the fine print in our health insurance laws and the coverage provided, we can at least demand that mega mergers, like what's proposed by Aetna and Cigna, be stopped. What we want are the assurances of knowing there will be competition in the health insurance industry. Most important, we need to know that those who pay the providers for the coverage we receive are looking out for out best interests rather than profits.

Medicare for All - we pay for it, we deserve it.  Stop mega mergers by "Aetna plus Cigna equals profits".

Republicans with a Health Reform Plan: Please Stand Up!

Republicans are joyfully creating fear about the initial ineptness of the Affordable Care Act's Insurance Exchange roll out, but their war dance hasn't produced a viable idea about how to create a system to provide access and affordability to health insurance provided for in the law.

It makes no sense for Republicans to oppose the Affordable Care Act, especially the Insurance Exchanges, when the law requires people to buy health insurance. This is the same as requiring people to buy automobile or home owners insurance.  Insurance Exchanges are a Republican idea created by the conservative Heritage Foundation. What was determined to have been a Republican idea is now somehow unworthy of their support - ...why????

Republican criticize the health care law, but it includes ideas that originated with conservatives. During an interview on NBC's Today show on March 30, 2010, President Barack Obama offered a specific example.

Obama told host Matt Lauer that "when you actually look at the bill itself, it incorporates all sorts of Republican ideas. I mean a lot of commentators have said this is sort of similar to the bill that Mitt Romney, created and passed in Massachusetts. A lot of the ideas in terms of the exchange, just being able to pool and improve the purchasing power of individuals in the insurance market, that originated from the Heritage Foundation. ..."

Robert Moffit, "The Rationale for a Statewide Health Insurance Exchange" (Heritage Foundation paper), Oct. 5, 2006,

Therefore, in the absence of any other new ideas from the Heritage Foundation, one would think this non-profit organization would applaud having one of its conservative ideas adopted into law. Instead, they've joined with those who oppose the law, just because they can.

So, let me get this again. Republicans came up with a plan whereby people would be required to buy affordable health insurance and now they're against it. Is that like the conundrum Vice-President Al Gore ran into when he came up with the convoluted "I was for it before I was against it..." line he created during a Presidential candidate debate with George Bush? Seems like what goes around comes around. Now it's the Republicans who were all for Insurance Exchanges, before they reneged.

Nevertheless, the news media must begin to ask the salient question. If not Obamacare's free market based Insurance Exchanges, then what? Would a Republican with a good idea please stand up and tell Americans what they have in mind to help people pay for health care?

A better idea is Medicare for all, of course. Too bad the Heritage Foundation has tried to discredit this popular insurance coverage for qualified beneficiaries who are mostly senior citizens.  

So here are the choices:

1.  Universal Health Care provided to all Americans regardless of income similar to plans already working in Canada and England?

2.  Medicare for all provided by beneficiaries who pay into the trust fund and receive benefits after contributing 40 quarters to the plan,

3.  Health insurance exchanges where people can sign up for health coverage they can afford to pay for.

Any other ideas?  I'm looking for Republicans who can add a number "4" to the above list.  Still waiting....

.....waiting.....

Nitty Gritty of the Affordable Care Act - There Is a Way: Medicare for All

There's clearly a way out, a light to focus on, for the policy leaders and consumer advocates who are understandably anxious about enrolling the uninsured into health insurance exchanges on October 1, 2013, when the Affordable Care Act begins.  It's called Medicare for All. It's a damn shame we don't have this desirable option to offer everyone come October 1, 2013, when people need it.  

Shame on short sighted Republicans, who are too greedy on behalf of their rich insurance executive supporters, to expand what already works, so everybody who needs the security of a health insurance safety net, can receive coverage.  

A forum on the Affordable Care Act (ACA), providing information from an expert panel, about how health insurance exchange enrollments will be rolled out in Maine, was presented in all its "nitty-gritty" detail this afternoon at the University of Southern Maine's symposium, presented by the Muskie Center. 

The health insurance exchanges are online marketplaces for individuals who aren’t otherwise covered by employer-sponsored insurance plans, Medicare or Medicaid. Some small businesses also will buy exchange plans to cover their employees. According to the Congressional Budget Office, about 85 percent of those expected to sign up for insurance through the exchanges this year will qualify for federal subsidies to help them afford their monthly premiums.
In the USM audience of about 130 people were many professionals who monitored the complex information for various provider and consumer groups.  It took a professional actuary to figure out what the experts on the panel explained.  In short, this ACA enrollment, beginning on October 1, 2013 and extending thru March 1, 2014, will have "bumps along the way", as stated by Trish Riley, the panel moderator from the Muskie Center.  In my opinion, these bumps would be more like curves in the road if Medicare for All were the outcome of the ACA enrollment.

Instead, the audience was shown a detailed Excel spreadsheet matrix with 60 cells filled with tiny print.  Already, at the outset, we can't read the fine print and we've hardly started.  

But, (!) were told, we'd be given a website address for the tiny print matrix,  so we could go to the page to read the words. Meanwhile, almost every audience member had either an iPad or a computer laptop so, given the website address, many could have accessed the detailed chart for the purpose of figuring out what it said. Nevertheless, the website address would be given later, we were told.  Consequently we had to listen to an expert or two on the panel to explain what we could not read because the fine print was entirely too small.  

What it boils down to is "nitty gritty"  "bumps in the road", all of it avoidable, if all Americans could  be given access to Medicare. (This is my value added opinion, not that of the symposium.)

There's absolutely no reason whatsoever why all Americans who pay Social Security and Medicare taxes shouldn't have access to the same health insurance benefits as those who qualify, at age 65 and over.  Medicare is not free.  It's paid for throughout our working lives and while we're on the benefit. Beneficiaries pay, even after enrollment at 65 years of age, for those who qualify by having paid the 40 quarters into the Social Security benefit, through FICA tax.  

Most important, Medicare for All doesn't require beneficiaries to read the fine print to figure out if they qualify for the precious metal levels of care including "bronze" or "silver" etc., or the "catastrophic coverage" plans.   Each of the insurance exchange choices has a group of fine print Excel blocks dedicated to the coverage, to explain the shared risk and/or pre-tax or post tax credit options.  

"A tax credit can be received up front, and it can go directly to an insurance company to immediately discount your monthly payment," Riley says, "so your out-of-pocket expenses for monthly payments are significantly reduced."

Unfortunately, on January 1, 2014, Maine's 70,000 people who won't qualify for Medicaid will be required to participate in one of the two insurance exchanges offered in the state through either one (a) Maine Community Health Options or (b) Anthem provider programs, unless their employer participates in the ACA, on their behalf, or they have another health insurance carrier.

Riley says the people who need to sit up and pay the most attention to the health insurance exchanges right now are those who will use the online insurance marketplace - in other words, those who don't have health insurance right now, or whose coverage is too expensive. That's estimated to be nearly 170,000 people in Maine, and Riley says the law uses a carrot-and-stick approach to encourage them to sign up.  

"Importantly, the Affordable Care Act not only creates discounts to premiums, but limits how much out-of-pocket exposure people have when they use health care," Riley says.

"Navigators" have been trained to help people make the choices most beneficial to them, and these people will be located at Community Health Centers and other central sites throughout Maine.

But one bump in the implementation of the Affordable Care Act in Maine is already emerging: Those whose incomes are at, or less than, the poverty level are actually not eligible for tax credits.

"So the poorest of the poor will get nothing, and will remain uninsured," Riley says. "That's because the Afforable Care Act originally assumed Medicaid - here in Maine, the MaineCare program - would cover all poor people. The Supreme Court said, 'No,' that was up to states."  And Maine's Governor vetoed the bi-partisan bill passed to provide this coverage.  

For the brave hearts who would like to figures out the health insurance exchange options for themselves or someone who needs the coverage, the website to begin the process is:

HealthCare.gov/subscribe.  

This site provides access to e-mail and text updates about the Health Insurance Marketplace.  It'll help consumers to find health coverage that fits their budget and meet their needs.  Whether a person is uninsured or just wants to explore their choices, the marketplace can help find a plan that's right.  It's important to begin this process by October 1, 2013.  

Also, call this 1-800-318-2596 or TTY 1-855-889-4315 for more information.

And, given the opportunity to enter any questions, please - paaaleeeze- find a way to ask why we can't all participate in Medicare for All!

Medicare for All - A National Insurance Plan

http://www.pressherald.com/opinion/everyone-deserves-access-to-healthcare_2012-08-05.html

Suppose Americans could buy health insurance with the following benefits?

1.  Coverage without regard for pre-existing conditions.
2.  No caps on coverage.
3.  Unlimited access to emergency and outpatient services.
4.  Price for services is correlated with cost of care.
5.  Provider administrative cost regulated.
6.  Affordable premiums published in national literature so everyone knows what the plan costs.
7.  Major benefits offered by the plan are evaluated and outcomes are publicly disclosed in quality reports.
8.  Ability to choose preferred providers.
9.  Publicly disclosed consumer satisfaction surveys
10. Reasonable co-pays for services- all co-pays disclosed prior to receiving services.
11. Wellness and preventive care paid for in procedures like mamograms and colonoscopies, without needing a diagnostic purpose for provider reimbursement.

It's surprising how many Americans don't know that Medicare provides all of the above. To be eligible for Medicare today, a beneficiary must be a person who is, either, 65 years or older, who contributed at least 40 quarters to Social Security during their working career, or disabled and receiving Supplemental Security Income (SSI) provided by Social Security.

But, Medicare doesn't need to be restrictive about who receives the benefit, if the US Congress would pass a law to open the plan to anyone who wants to pay the premiums.  

In the above letter to the editor to the Maine Sunday Telegram, it seems like the message about access to health care through "Medicare for all" might finally be getting out. 

"Medicare for all" should be a national bumper sticker.  Perhaps it would be, if people only understood how the benefit works!

Contributor Julie Keller Pease writes, "We need a health care system that provides access to every one of us, no matter how sick, poor, old or unemployed we may be. We need reduced costs. We need improved health outcomes."

The letter writer criticizes President Obama's Health Care Reform Affordable Care Act (ACA) for not providing enough access to health care.  Therefore, Medicare for all, as an alternative to the ACA, would have avoided the brouhaha created by the Hillarycare, Romneycare or Obamacare reforms.  

Clusters of first person letters to the editor would move "Medicare for all" forward because more people would pay attention to facts about the coverage, rather than to rhetorical political posturing and labeling.

 "Medicare for all" is a simplistic solution to providing insurance coverage for everyone who wants to pay the reasonable premiums.  

Medicare is already in place! With the national debate about health care reform still on the front burner, even after decades of attempts and failures to bring about reforms to help cover the uninsured, Medicare is the solution, it's efficient and it works. 

More letters to the editor, please!  I'll be glad to help anyone who would like to write a personal story.