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.

Kentucky echo - letter supports single payer health care

"Clearly, a single-payer system, or some variant thereof, that enables free market principles and employs strategies which encourage better consumerism..." (try Medicare4All?) 

Americans already know somebody who is covered by Medicare. All the Congress needs to do is expand eligibility requirements.
Another echo, a blog posted from a "letter to the editor", published in the Kentucky Glascow Daily Times, supporting a single payer healthcare system. This letter was written by a Senator Mitch McConnell and Senator Rand Paul constituents: Dr. Phillip Bale and Dr. William Travis:

Dear Editor,

(In my opinion, Medicare4All proposals in Congress would meet the criteria described in this letter from Kentucky.)

Finding solutions to America's health care mess will require an informed and enlightened public who then demands sweeping change. Elizabeth Rosenthal, M.D., in her recently published book “An American Sickness,” accurately portrays an overpriced, underperforming system which too often does not prioritize patient interests and needs. She also offers multiple, practical solutions toward improvement which primarily call for much more transparency of cost while exposing ubiquitous examples of avarice and greed throughout the system.

Clearly, a single-payer system, or some variant thereof, that enables free market principles and employs strategies which encourage better consumerism could restore some rationality to a system run amok. However, entrenched interests and lobbyists within the medical-industrial complex will make certain that substantive change occurs only from the ground up. Legions of American citizens, armed with facts and a proper sense of outrage, must, and eventually will, be the voice and vehicle for this necessary change. The sooner, the better.

What's wrong with Health Savings Accounts and the Amoral GOP replace plan

Here's how it works, in lay language- it's not a good deal for middle class (and certainly not for those with pre-existing conditions!):

A health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. (But if the money isn't used, the employer keeps the balance.) Republicans want to expand this plan as part of their "Amoral care" replacement to the Affordable Care Act. 

Not a good idea, for lots of reasons.

HSA's or Health Savings Accounts are special tax exempt funds set up by an employER on behalf of the employee, who makes predetermined designated contributions to the account. It all sounds too good, because you provide the money and then can request the employer to pays the bills, submitted by you, for allowable purchases like reading glasses or over the counter medications.  

On the other hand, if the employee doesn't spend all the money allowed in a defined year of contributions, the employer keeps the cash difference. Therefore, the employER takes very little risk. 

For statistical purposes, if 10 employees contribute, then, statistically, on a bell curve, there will be at least 1 person who does not spend down their fund and the employer makes money.  

There's very little risk to the employER, because, if an employee over extends their contribution, the account dries up and the costs are shifted back to the employee, regardless of the reason for the spend down.

So, that's why it's fair to say HSAs are not a good alternative to the Affordable Care Act, because (a) a person must be employed to have a tax exempt plan (b) the employER must have the regulatory oversight to establish a tax exempt fund for this purpose, and (c) the fund forces the contributor to spend down the HSA contributions, regardless of whether or not costs are necessary; otherwise, the employER keeps the year end difference. Although the year end balance on most HSAs are small, in the aggregate, they are substantial, especially benefiting large employers.

Another problem with HSAs, of course, is that they force the contributor to spend more out of pocket money on health care than they need to, because only certain costs are allowable. For example, most prescription drugs are not allowable. Therefore, while a risk adjusted health plan might pick up some prescription costs, the HSA will not. Obviously, this is one HSA regulation that could easily be changed; but doing so would require an approved drug formulary for every employer. This conceptual reform would cause enormous challenges for the pharmaceutical industry, because each one would competitively be in a position of having to lobby for every employER's HSA plan. As it is now, the pharmaceutical companies bid competitively with insurance companies NOT with every employer that supports an HSA.

It's difficult to see where HSA competition for drug costs, if such a plan were hypothetically considered, could save anybody money, because the implementation would involve a lot of oversight and competitive investments.

In other words, HSA's work for the rich, who benefit from the tax exemption allowed; and the employERs, that keeps unused funds. On the flip side, HSAs don't help anyone who simply can't afford to make the contributions or who quickly spend down their accounts and can't afford the out of pocket expenses. HSAs in no way "replace" the safety of "risk adjusted" insurance premiums, paid by beneficiaries. In fact, insurance companies have the ability to assess, with actuarial analysis, the health care consumption of a large population of people and calculate the expenses of the accumulated funds in accordance with a contract, shared with the beneficiaries. 

In the Affordable Care Act, the mandate for all qualified Americans to have a health plan, or to otherwise pay a penalty, allowed for the insurance exchanges to recruit a large pool of beneficiaries that shared in the actuarial analysis. In other words, remove the mandate for coverage, thereby reducing the pool of people who pay premiums, and the population quickly melts down to a few who are too sick and, most assuredly, will eventually be unable to pay for the insurance.  

Therefore, the mandates are necessary to recruit a large risk pool.

Moreover, there's no way for the Republican "Amoral-care" plan to allow for more competitive "cross state" insurance companies to compete for coverage and then, somehow, lower premium costs. This "fantasy" is frankly impossible becasue the Republican plan puts the regulatory oversight of their "Replace" plan back into the hands of the states, but then supports interstate insurance plans. This is an oxymoron if I ever heard one. Health coverage cannot be given and then taken away.

States cannot control the GOP "Repeal" aka "Amoral plan", while, at the same time, giving licenses to interstate insurance companies, to authorize payments to providers. It's an impossibility. What it means is, every state must agree to license the same insurers and, worse, the reimbursement would be based on the lowest provider costs, which vary substantially from county to county (and even more so, from state to state)!  Most important, people with pre-existing conditions will find their coverage evaporate, because even if they happen to have insurance, their access to care will be dependent on where they happen to live and the services available.

None of this makes any practical sense.  

Yet, there's hope! Republicans could open their minds to accept the premise that Medicare works wonderfully, as does Medicaid in states that comply with the laws. 

Therefore, roll these benefits into a Medicare4All plan, with a safety net for the indigent, and expand the coverage to all qualified Americans.  Simple!  Maybe, too simple for Republican minds that, in my opinion, are basing their "Repeal" plan on what's in the best interest of the rich, who can afford to pay for health care, regardless of the expenses in the allowed choices, including, of course, the choice to "private pay." 

In my opinion, save the ACA until Medicare4All is a reality.