Friday, June 30, 2017
Revised Estimate Shows Senate Bill Worse Than Thought
The Congressional Budget Office (CBO) predicted that the Senate bill (BCRA) would cost about 22 million Americans their health insurance. Some would come from individuals no longer buying plans (many because they could no longer afford them), and some would come from employers no longer providing insurance for employees -- but most would come from the 26% in cuts to Medicaid in the 10 year projection.
Well, it turns out the Senate bill is even worse than the CBO first projected. That's because the cuts to Medicaid don't stop at 2026. They grow even larger in later years -- growing to 35% by 2036. Those cuts past 2026, combined with the expected growth in medical care costs, would mean that millions more people would be dumped from Medicaid roles -- raising the number of people losing health coverage far beyond the 22 million projected.
The BCRA (i.e., Trumpcare) is a very mean-spirited bill. It would deny health coverage to a huge hunk of the American population. The Republicans have once again shown they simply don't care for their fellow Americans -- unless they are rich.
Obamacare & Single-Payer More Popular Than Trumpcare
These charts were all made from information in a new Economist / YouGov Poll -- done between June 25th and 27th of a random national sample of 1,500 adults (including 1,295 registered voters), with a margin of error of 3.1 points.
This poll asked what respondents thought of three different health care plans -- Obamacare, Trumpcare, and a Single-Payer system.
Obamacare was most popular with the public (48%), while Trumpcare was the least popular (28%). But the surprise for me was that the Single-Payer system was also much more popular than Trumpcare -- with 44% saying they would approve of it.
Single-Payer still doesn't have the support of a majority of Americans, and I doubt it will even be seriously considered until it has the approval of a substantial majority. But 44% is a pretty good starting place. That's much higher than it would have scored just a few years ago. If the Republicans continue trying to destroy Obamacare instead of fixing it (and are able to actually do that), we may see support for Single-Payer climb much higher.
That's because most Americans do see healthcare as a right -- and not a product to be sold to only those who can afford it (as the Republican officials continue to believe). They are not going to stand for the GOP to take us back to a system even worse than Obamacare.
The charts below are a demographic breakdown of public opinion on all three plans.
40% Of Dems Think Sanders Will be The 2020 Nominee
This chart was made from information in a new Rasmussen Poll -- done on June 26th and 27th of a random national sample of 1,000 likely voters, with a 3 point margin of error. Only Democrats were asked this question.
Personally, I find this poll rather frightening. About 40% of Democrats questioned said they thought Bernie Sanders (who is ashamed to call himself a Democrat or join the party) would be the Democratic nominee for president in 2020. About 47% said he wouldn't, and another 13% were not sure.
I know Sanders has a die-hard (and rather rabid) following among a minority of Democrats, but I had no idea this many Democrats actually thought he could be the party's presidential nominee. Personally, I think the Democrats have an excellent chance of unseating Trump in 2020 -- unless the party veers too far out of the mainstream and nominates an extremist like Sanders. I think nominating Sanders would insure a Democratic defeat in 2020.
There are a couple of saving graces about the poll. First, 47% did not think he would be the nominee. Second, the poll didn't ask that 40% if they wanted him to be the nominee, but only if they thought he would be the nominee.
Frankly, I can't see Democrats nominating someone who still refuses to join the party (and has refused to join for many decades). I also don't see Democrats voting for Sanders after the way he demonized Hillary Clinton in 2016 with unwarranted and untrue accusations. He's a big reason why we have Trump living in the White House.
The Democrats don't need to go outside the party to nominate someone who obviously doesn't respect the party and it's elected officials. There are plenty of good Democrats worthy of the nomination. We need to stop this Bernie nonsense and get serious about nominating a real Democrat who can unseat Trump.
Donald Trump Is Diagnosed As A "Malignant Narcissist"
This troubling (and scary) article was written by Olive Murphy at the Bipartisan Report:
If there’s one thing we can say about Donald Trump, it’s that he’s unlike any other world leader we’ve seen to date. The problem, however, is that his differences fail to set him apart in a positive manner.
Almost daily, Trump tweets about the “biased media,” “fake news,” or a world leader who has suddenly done something so terrible that he must take to Twitter to publicly berate them. Notice, however, that it’s always someone else with the problem. It’s never him.
However, John D. Gartner, a registered psychotherapist from the renowned Johns Hopkins University Medical School seems to think Trump may, in fact, be the one with the problem. Gartner, who teaches psychiatric residents at Hopkins, decided to break the ethical code known as the “Goldwater Rule” in order to warn the American public about the dangerousness of our new commander-in-chief’s mental state.
The “Goldwater Rule” is defined as “the informal term for part of the ethics code of the American Psychiatric Association saying it is wrong to provide a professional opinion of a public figure without examining that person and gaining consent to discuss the evaluation.”
Trump’s Democratic challenger, Hillary Clinton called it first. She said Trump is “temperamentally unfit” to serve as president, following his numerous sexist remarks about women, mocking of a disabled reporter, and blatantly racist statements about basically every single human being who isn’t white.
Gartner, who is also the author of In Search of Bill Clinton: A Psychological Biography, says “Donald Trump is dangerously mentally ill and temperamentally incapable of being president.”
According to USNews, Gartner unofficially diagnosed Trump with “malignant narcissism.” Although he himself has not personally examined Trump, Gartner claims it’s obvious from watching even a little of his behavior that he meets the diagnostic criteria for the disorder. Some of the characteristics include:
- Anti-social behavior
- Sadism
- Aggressiveness
- Paranoia
- Grandiosity
- Entitled
- Regressed
- Manipulative
- Destructive
- Egocentric
- Use of projection
- Lack of conscience
- Narcissistic
Gartner says that individuals with malignant narcissism often lack impulse control and empathy. He also says many who suffer from this disorder believe that others around them don’t recognize their greatness.
‘We’ve seen enough public behavior by Donald Trump now that we can make this diagnosis indisputably,’ Gartner claims.
As Psychology Today notes, “Malignant Narcissists will go to great lengths to achieve their aim. They can be intelligent, high functioning (hold an important job for example) soft-spoken, charming, tearful/seemingly emotional, gracious, well-mannered, kind and have the ability to form relationships. They may lie, falsely accuse, dramatize, smear, cheat, steal, manipulate, accuse, blame or twist to get what they want and feel justified in doing so. Because they are entitled, egocentric and desperate, they do not experience it as wrong.”
Malignant narcissists are:
‘Determined to gratify their wishes and furious if thwarted. Their desire can be so consuming that there is little comprehension of, respect for or ability to empathize with the other. They lack guilt or remorse and tend to feel or pronounce that it is they who have been mistreated. They can be of any gender, race or social class.’
As if that weren’t enough, malignant narcissism is incurable.
So there you have it. The leader of the United States of America is more than likely a malignant narcissist who has the fate of the free world in his two tiny hands. Not to mention, he now has access to the United States government’s nuclear codes. If that’s not terrifying, we don’t know what is.
Thursday, June 29, 2017
Trump Is Steadily Losing The Support Of Independents
The charts reflect the results from the new NPR / PBS NewsHour / Marist Poll -- done between June 21st and 25th of a random national sample of 1,205 adults (including 995 registered voters), with a margin of error of 2.8 points.
It shows that only 37% of the public approves of the job Donald Trump is doing, while 51% disapproves -- a negative gap of 14 points.
Democrats didn't like Trump back in February and still don't, while Republican support was strong in February and still is. It is among the Independents that Trump is steadily losing support. His net approval among Independents was about -11 back in February, while it currently rests at -28 -- a drop in support of about 17 points in the last four months.
Only 12%-17% Of Public Approves Senate "Health" Plan
The Senate Republicans crafted a health plan (actually more of a tax cuts for the rich plan) behind closed doors. But once their "secret" plan was revealed (and appraised by the CBO), it turned out that the plan couldn't even get enough GOP votes to pass. The Republicans have now gone back behind closed doors to tweak their plan, in hopes of getting enough of their party to agree to pass it.
They would be better off if they just tossed their plan out the window. It is extremely unpopular with the general public. Three new polls have been released on the plan, and it turns out that only a tiny percentage of the public approves of the GOP's plan. The three plans have approval at 12%, 16%, and 17% -- with disapproval at 45%, 58%, and 55%.
The Quinnipiac University Poll was done between June 22nd and 27th of a random national sample of 1,212 voters, with a 3.4 point margin of error.
The NPR / PBS NewsHour / Marist Poll was done between June 21st and 25th of a random national sample of 1,205 adults, with a 2.8 point margin of error.
The USA Today / Suffolk University Poll was done between June 24th and 27th of a random national sample of 1,000 registered voters, with a 3 point margin of error.
All three polls showed a majority of Americans don't want Obamacare repealed. They want it fixed. If the GOP continues to ignore the feelings of the public, they will be spanked at the polls in 2018.
Obamacare Is Responsible For Cutting Bankruptcies In Half
Back in 2010, before Obamacare was passed and went into effect, the number of personal bankruptcy filings was 1,536,799 (and was rising each year). The current yearly rate of personal bankruptcy filings is 770,846 (and the trend is downward). The bankruptcies have been cut in half since Obamacare went into effect.
Some of that is due to a better economy (although many Americans are still struggling in our tepid economy), but most financial experts agree that Obamacare was one of the prime factors in the drastic cutting of bankruptcy filings. Thanks to Obamacare, far fewer families are facing crushing medical debt that forces them into bankruptcy.
We could do even better by fixing Obamacare's problems (by covering more Americans and controlling medical and insurance costs), but the Republican plans (both in House and Senate) won't do that. Instead, they throw 22-23 million people off the insurance rolls while doing nothing to control costs, and they would again let insurance companies sell policies with inadequate coverage. If either of those plans are passed (and signed into law), we could expect to see personal bankruptcy filings rise sharply.
The chart above is from Consumer Reports.
New England Journal Of Medicine Opposes The Senate Bill
The widely respected New England Journal of Medicine has joined the AMA, AARP, and many other organizations in opposing the Republican's "health" bill. NEJM writes:
The Better Care Reconciliation Act (BCRA), as the U.S. Senate calls the health care bill released by a small working group of Republican senators last week, is not designed to lead to better care for Americans. Like the House bill that was passed in early May, the American Health Care Act (AHCA), it would actually do the opposite: reduce the number of people with health insurance by about 22 million, raise insurance costs for millions more, and give states the option to allow insurers to omit coverage for many critical health care services so that patients with costly illnesses, preexisting or otherwise, would be substantially underinsured and saddled with choking out-of-pocket payments — all with predictably devastating effects on the health and lives of Americans. What would get “better” under the BCRA is the tax bill faced by wealthy individuals, which would be reduced by hundreds of billions of dollars over the next decade — about $5,000 per year for families making over $200,000 per year and $50,000 or more for those making over $1 million, according to analysis of the AHCA, which included a similar set of tax provisions.1 We believe that that trade-off is not one to which we — physicians, patients, or American society — should be reconciled.
Under the BCRA, states could easily receive waivers to drop many of the insurance regulations created by the Affordable Care Act (ACA). Although the ACA requirement that insurers take all comers would nominally remain intact, states could reject the ACA’s mandated essential benefits, allowing insurers to refuse to cover such critical services as emergency care, mental health care, maternity care, chemotherapy, and prescription drugs, among others. In some states, health plans could become largely worthless, particularly for patients with preexisting conditions (a group that includes 23 to 51 percent of nonelderly Americans, depending on the criteria used2). By redefining essential health benefits, states would also restore insurers’ ability to place annual and lifetime limits on enrollees’ coverage, since the ACA protections against such limits apply only to benefits designated as essential.3 Older Americans all over the country could be charged five times as much as younger ones for coverage, whereas the ACA limited age-based variation to a 3:1 ratio. And the BCRA would repeal cost-sharing reductions for low-income persons as of the end of 2019, leaving them with unaffordable deductibles and coinsurance after that. As Americans know all too well from the pre-ACA era, many underinsured and uninsured people would risk being bankrupted by health care costs3 — or would die for lack of access to needed care.
Perhaps in a nod to pleas for a reform less “mean” than the AHCA, the Senate bill would phase down federal funding for the ACA’s Medicaid expansion more slowly than House Republicans proposed to do — but it would impose the same cuts in the long run, and it would implement an even more draconian version of the House’s proposal to cap federal Medicaid funding per enrollee or turn the program into block grants. All told, the bill would cut more than $700 billion from the program over the next decade. The poorest Americans, those requiring nursing home care, and those with disabilities or mental illness would suffer. These attacks on Medicaid would undercut health care for the 74 million Americans who rely on it.
Women’s health care would also suffer major blows under the BCRA. In states that chose to stop mandating coverage of maternity care, women of child-bearing age could be forced to pay unaffordably high rates for basic pregnancy coverage. Planned Parenthood would be defunded for a year, severely restricting access not just to family planning services but to an array of important preventive care services, including cancer screenings, for millions of low-income women. Another provision would prohibit the use of tax credits for any individual insurance plan that covered abortion services (with exceptions for rape, incest, and risk to the woman’s life).
And at a time when about 60,000 Americans are dying each year from opioid overdoses, the Senate bill would drastically reduce the funds available for confronting this massive crisis and providing affected people the help they need to become functioning, contributing members of society. In addition to removing many people with opioid use disorder from the Medicaid or individual-insurance rolls, the BCRA would provide a mere $2 billion over 10 years for efforts that experts estimate would cost $183 billion.4
The public response to the very similar House bill indicates that the GOP’s approach to health care reform is deeply unpopular throughout the country, with an approval rating below 20%5 — and for good reason. Like many U.S. physician and hospital organizations that are speaking out against the BCRA, we whole-heartedly oppose sacrificing Americans’ health care and health to further enrichment of the wealthy. The future of our health care system and the lives of our patients are at stake.
Wednesday, June 28, 2017
Trump Has Damaged World's View Of U.S. & Presidency
Donald Trump has poor approval ratings in the United States (hovering around 40% or less). But that poor rating looks good when compared to his approval outside the United States.
These charts reflect the finding of a new global survey by the Pew Research Center. That survey shows that Donald Trump has serious damaged the reputation of the United States and its presidency.
Toward the end of the Obama administration, there was 64% of people outside the U.S. who had confidence in the president. Under Donald Trump, that has fallen to only 23%. And the view of the world regarding the United States has suffered as well -- dropping from 64% under Obama to 49% under Trump.
Note that only one country has a significantly better view of Trump over Obama -- Russia, who viewed Trump positively by 53% (and Obama only viewed positively by 11%). Russians obviously think they will benefit from Trump being president. Israel also has a slightly better view of Trump (by about 7 points).
All other nations viewed Obama more positively than Donald Trump -- ranging from 5 points to 83 points. The world in general has substantially less faith in Trump than it had in Obama. In fact, Trump's figures are as bad as those of George W. Bush at the end of his term.
The charts below show the opinion specifically of Donald Trump. It certainly doesn't speak well of him that the world has a higher opinion of both the Chinese and Russian leaders than of Trump. People don't like Trump's policies or his characteristics.
Defeating GOP "Health" Bill Is Not Enough - More Is Needed
The Republicans in the Senate have put off voting on their health care reform bill (tax cut bill?) because the CBO estimate showed it to be a very bad bill. It would cost at least 22 million Americans their health insurance by 2026 (and even more in years after 2026). And it's only premium cost saving measure was to allow insurance companies to sell policies that covered far less and had much higher deductibles.
It was not reform, because reform should help more Americans to afford health care -- not less. The Republican bill needs to be defeated. But even if it is defeated, it should not be a reason to celebrate. That's because Obamacare (the Affordable Care Act) does need some reforms.
Don't get me wrong. Obamacare was a big improvement over the terrible health care situation that existed before it was passed. It did a lot of good -- covering about 20 million more with health insurance, stopping insurance companies from denying insurance (or charging prohibitive prices) for pre-existing conditions, covering contraceptives, stopping insurance companies from charging women more than men, eliminating the caps on how much an insurance company would pay for medical care, and allowing children to stay on their parents insurance until age 26.
But while Obamacare improved health care in this country, it did NOT fix all the problems of our health care system. There are some counties and states where health insurance is not offered (or is too expensive). Much of this has been caused by the uncertainty of the system due to Republican efforts to damage Obamacare -- but not all of it.
The fact is that Obamacare had some deficiencies when it was passed. First, it did not cover all Americans. If nothing is done, at least 28 million people will still be without health insurance by 2026. That's inexcusable. Other developed countries cover all of their citizens with health care or health insurance, and they do it at a much lower per capita cost.
Second, Obamacare did virtually nothing to control the rapidly rising cost of medical care in this country. Measures must be put in place to control those costs. At the very least, the government should be able to negotiate prices with doctors, hospitals, and drug companies.
Third, Obamacare did not mandate that insurance companies participate in all states and counties. This has resulted in many insurance companies cherry-picking the places they will sell insurance (picking only those places where they can make the biggest profit). If we are going to stick with a private insurance system, then any company wanting to sell health insurance in this country should be required to sell in every state and county -- and should be required to participate in the Obama subsidy program.
Obamacare is not the best of all solutions for health care in this country -- a single-payer system would, in my opinion, be better. But our politicians are not ready to do that, and the public is probably not ready to accept a change that radical (at least, not yet). But Obamacare could be fixed to work much better than it currently does -- and that should be done as quickly as possible.
The AMA Strongly Opposes Senate GOP "Health Care" Bill
It looks now like the Senate Republicans will not be able to vote on their "health care" bill (actually a tax cut for the rich bill) this week. Too many GOP senators have said they cannot support the bill. That does not necessarily mean the odious bill is dead -- only delayed while GOP leadership searches for the votes they need to pass it.
The American Medical Association (AMA) -- the largest association representing doctors in the United States -- thinks the GOP bill is bad, and they strongly oppose it. Here is what the president of the AMA (David O. Barbe) had to say:
A lot of big numbers have been tossed around in the days since Senate leaders unveiled a “discussion draft” of legislation—dubbed the Better Care Reconciliation Act of 2017 (BCRA)—that would dramatically reshape how our country’s health system is financed.
23 million is one of those figures. That is how many more people the Congressional Budget Office (CBO) estimated would be uninsured by 2026 if the American Health Care Act were enacted, relative to current law. And today, the CBO weighed in with its projection that 22 million more people would be uninsured by 2026 under the BCRA, again relative to the law as it stands. When such a figure is in the tens of millions, it is a number too high for America’s physicians and their patients to bear.
37 million is another number that comes to mind. That is how many children are covered by Medicaid, according to the Georgetown University Center for Children and Families. Nearly half of children in small towns or rural areas are covered by Medicaid, notes a recent report from the Georgetown center. I practice in one of these areas—Mountain Grove, Missouri, a town of 5000 with a median household income half the national average.
Those are the big numbers. But my mind keeps wandering back to a smaller figure: Two. Recently, I met two healthy, beautiful babies—twins who were born after just 27 weeks’ gestation, weighing less than 2 pounds. They spent their first three months of life in a Cleveland NICU.
"If I didn't have Medicaid, they wouldn't be there,” the twins’ mother, Lajuan Black, told me and the crowd assembled for a Cleveland press event the AMA held with seven other organizations that advocate for hospitals, seniors, babies, and patients with cancer, diabetes or cardiovascular disease.
Access to care for some of the most vulnerable members of our society—including those who require treatment for opioid-use disorder—would be threatened by the Senate proposal’s arbitrary, unsustainable, and shortsighted formula for funding Medicaid. At the 2017 AMA Annual Meeting, the AMA House of Delegates sent a loud, unequivocal message opposing the kind of per-capita caps found in the BCRA.
That is just one of the reasons why the AMA opposes this Senate proposal. Ideas such as extending cost-sharing reduction payments to stabilize the individual insurance market should be the start of serious discussions on how to improve the current law so we can ensure that high-quality, affordable health insurance is within every American’s grasp.
Warren Says GOP Bill Would Bankrupt Many - Kill Others
Before I ran for the Senate, I was a bankruptcy law professor. I spent decades studying why working families were going broke.
Back when I got started, most experts believed that people went broke because of wasteful spending – running up credit card bills at the mall. But for most people, that wasn’t the case at all.
At the time, nearly nine out of every ten families listed just three reasons for their bankruptcies: job loss, family breakup (death or divorce), and medical problems. Half reported two of those problems. One in 13 was hit by all three.
Nobody was talking about medical bankruptcy, but my coauthors and I showed what was right in front of our faces: At the time, medical problems were pushing about 750,000 solid, middle-class families into bankruptcy each year.
No, the Affordable Care Act didn’t end medical bankruptcies or instantly solve America’s health care crisis. But it did end the annual and lifetime caps on many people’s insurance plans. It allowed people with pre-existing conditions to get insurance. And it gave states the resources to expand Medicaid – so seniors who needed nursing homes and babies born early could get the care they needed.
The so-called “health care plan” that Senate Republicans want to jam in the next few days before they skip town for the 4th of July ends that progress.
It lets insurance companies sell skimpier plans for higher out-of-pocket costs. It lets private insurance plans reinstate annual and lifetime caps on benefits for people who get really sick. And it guts Medicaid for the sick, for the elderly, for people with disabilities – for people who have nowhere else to turn.
If the Republicans rip health care away from 22 million Americans this week in order to give billionaires a tax break, people are still going to get diagnosed with cancer. Seniors are still going to have strokes and heart attacks. People are still going to get hit by drunk drivers. Babies are still going to be born with lungs and hearts that don’t work.
I’ve studied this heartbreaking problem for decades. I know that if the Republicans pass this bill, more people – even the most hard-working, responsible people – will go bankrupt. Some will die.
Please: Now is the time to make calls. Now is the time to call your friends and family with Republican senators and tell them what’s on the line – even your FOX News-loving uncle. Now is the time to share your story, share your photo, share your video on Facebook, Twitter, Instagram, or Snapchat. Now is the time to share your friends’ stories. Now is the time to join a group and get connected – because two voices are more than twice as powerful as one.
This fight is personal for me. When I was 12, my daddy had a heart attack. He was out of work for a long time, and the medical bills piled up. We lost our family station wagon, and we were about an inch away from losing our home.
Today, our family probably wouldn’t have made it.
We all know someone – a cancer survivor, a mom who went into early labor, or a parent or grandparent who got Alzheimer’s or Parkinson’s and needed help. Any of us could get bad news from a doctor that our insurance plans wouldn’t cover.
I’m in this fight all the way – I’ll give it everything I’ve got. But if we’re going to win, we need every single one of us in this fight. We need to fight like people’s lives depend on it – because people’s lives will depend on what happens next.
Thanks for being a part of this,
Elizabeth
Tuesday, June 27, 2017
CBO Says Senate Bill Will Take Insurance From 22 Million
The Congressional Budget Office (CBO) has released its analysis of the Better Care Reconciliation Act of 2017 (BCRA) -- the Senate Republican bill to cut taxes for the rich disguised as a health care bill. And it's just as bad as we expected.
The bill would cause about 22 million people to lose their health insurance by 2026 -- raising the number of uninsured to 48 million Americans by that year. While that's a million fewer than the House bill (AHCA), the Senate cuts to Medicaid would continue after 2026 -- and that means the number of uninsured Americans would continue to rise after 2026.
While some of the rise in the uninsured would come from those currently purchasing their own policies or from employers no longer being required to purchase insurance for employees, most of those losing insurance would be people currently getting insurance help through Medicaid. The Medicaid program would be devastated.
The CBO also projected that insurance premiums would rise by 20% in 2018 and another 10% in 2019. After that, the average premium cost would go down. But that is not a cause for celebration. Current policies (under Obamacare) are required to pay about 70% of medical costs. But in 2020, they expect policies to cover only about 58% of costs -- meaning those policies will have fewer benefits and higher deductibles.
This means those buying individual plans might pay less for premiums, but if they get sick, they'll pay a lot more out of their own pockets for medical care. And it probably won't just be those who buy individual policies. We can expect a lot of employers to start buying plans for their employees that have fewer benefits and much higher deductibles.
The BCRA will do what it was intended to do -- give the richest Americans a huge tax cut. But to do that, the Senate Republicans will throw the poor, the working class, and even many in the middle class under the bus. It's a truly bad plan, and we can only hope it's defeated.
Approval Of Same-Sex Marriage Continues To Grow
I just thought you might be interested in these charts by the Pew Research Center on approval of same-sex marriages in the United States. They come from a survey done between June 8th and 18th of a random national sample of 2,504 adults, with a 2.3 point margin of error.
It shows that approval is not just growing among the public at large, but is also growing among all groups in this country (even groups that still disapprove).
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