Tag Archives: Obamacare

RyanCare, ObamaCare, Red Ink and Ethical Dilemmas — Where have all of the adults gone?

Paul Ryan (R-WI) finds himself at the center of a firestorm.

RyanCare, or the Ryan Plan, represents a very significant society changing plan that is part of the Republicans’ partial repeal and replacement of ObamaCare.

In large part RyanCare focuses on reforming Medicare, although major and very significant changes have already been made to bolster Medicare’s future. The only way that RyanCare can be successful would be the repeal and replacement of major portions of ObamaCare, aka the Affordable Care Act (ACA).

I support the core ideas behind RyanCare — our nation faces major debt; Medicare is not only deeply in debt and unsustainable but to keep it functioning to serve those coming under its coverage over the next decade or two will require trillions of dollars —  but it will have to make its way on its own merits.

Selling Ryan Care will be tough. The mathematical problem aside, the larger question is whether RyanCare is ethical?

Is it ethical to create a system which effectively ends Medicare? Medicare came about because the good old days were not good for the aged and infirm. The good old days were actually very miserable.

>> I purposely do not say that RyanCare kills Medicare, although any number of both his supporters and detractors believe exactly that. You have to worry when supporters of a plan make repeated statements that reinforce your worst fears.

>> RyanCare and the basics of its coverage are not so different than ObamaCare per a comparison provided by the New England Journal of Medicine. The greatest difference is that short of catastrophic illness the RyanCare plans pushes unaffordable medical costs on the average (median and lower income) individual American. This leads to very credible charges that RyanCare effectively ends Medicare for those that need it the most and that probably could not get health coverage, or get affordable health coverage. The Congressional Budget Office (CBO) estimates that RyanCare will double out-of-pocket expenses, roughly equal to somewhere near $8,000-9,450 per year. RyanCare in 2022 would provide a premium subsidy/voucher for approximately $8,000 but this is to cover the government’s share of Medicare, not out-of-pocket expense — so please don’t confuse the two.

On the question of ethics, any attack or scaremongering against RyanCare also faces an ethical dilemma:  How can you support an approach to healthcare where the system will collapse soon enough due to its own overwhelming failure to be either properly funded or administered in such a way that Medicare is means tested and those that can pay greater costs actually do?

>> From the 2011 Medicare Trust Fund’s Board of Trustees report: “…the HI (hospital insurance) trust fund is now estimated to be exhausted in 2024, 5 years earlier than shown in last year’s report (2010), and the fund is not adequately financed over the next 10 years.”

>> The Medicare Trustees in their 2011 report also outlined Medicare’s future as dependence upon the Affordable Care Act (Obamacare) being successful: “The Affordable Care Act introduced important changes to the Medicare program that are designed to reduce costs, increase revenues, expand the scope of benefits, and encourage the development of new systems of health care delivery that will improve health outcomes and cost efficiency. The financial projections in this report indicate a need for additional steps to address Medicare’s remaining financial challenges. Consideration of further reforms should occur in the near future.”

Medicare 2011 Board of Trustees Report

Medicare 2011 Board of Trustees Report; red highlighting of items by Bill4DogCatcher.com

What I would like to see:

>> I would like to see some mature adult conversation. “The enemy isn’t conservatism. The enemy isn’t liberalism. The enemy is bullshit.” —Lars-Erik Nelson. Politifact notes that most partisan critics of the opposing view are often not only wrong, but they strongly mistate the other side’s actual position, or even their own position — this includes President Obama himself. Too many folks that should know better are just big fat flaming liars in this debate.

>> Universal availability of coverage. No preexisting condition discrimination. This doesn’t mean unlimited health care until the last breath. Rationing has always existed, whether by panel, policy or by income. Let’s not pretend otherwise. Conservative criticism of ObamaCare’s ‘death panels’ is probably much more exaggerated than the impact of RyanCare’s individual responsibility to fund more of your own care — with RyanCare’s level of personal responsibility being an approximate doubling of out-of-pocket expenses that come close to 35-40 percent of individual income for those at or below median income. Rationing of health care has and will always exist. Let’s acknowledge that rationing exists and decide upon what kind and how much of health care we will fund as a society.

>> We cannot fund everything, yet neither does our system encourage self-responsibility. Talk of self-responsibility is very irresponsible when it come to the aged and infirm that would live without the possibility of independent affordable coverage. The average net worth of Americans ages 44 and under is not even enough to pay for a heart attack + surgery + care. Older Americans have an average net worth of $181-232,000 but for most this includes the equity in their home. ‘Personal responsibility’ is a great campaign phrase but let’s not pretend that it is anything more … or not too much more than another way of saying ‘your problems are your problems, not mine’.

>> Let’s not talk about free markets but responsible markets. There hasn’t been a free market in health care since HMOs were first founded in the 1920s and Blue Cross Blue Shield expanded on that in the early 1930s. A responsible market would segment tests and procedures to reduce costs. For example, an annual physical consists usually of a battery of very standardized tests. Is there any reason that you couldn’t go to a pharmacy and get those same tests done? Doctors and hospitals need to stop hiding costs by providing itemized bills that represent actual charges — not charges plus subsidized costs averaged across items and procedures. A tooth brush or an aspirin should not cost $70-80 in a hospital stay, or you get charged for things that were never used. Let’s acknowledge the money game by insisting on responsible accounting that reveals the shell game that is going on.

About Paul Ryan and that firestorm — Republicans publicly trashed Obamacare in 2010 and turned the Medicare argument into Mediscare. Much of their criticism was with merit but the way they went about it was over the top, beyond misleading and played on emotion: we were supposedly on the verge of death panels and rationed care.

In 2012 the Republicans are offering death panels by income affordability and rationed care because few may be able to afford RyanCare. That will be the campaign theme of the Democrats — and much of their criticism will be with much merit. Yet they will predictably go over the top, be beyond misleading and play on emotion.

We know who decides most elections: those over the ages of 45. Mediscare worked in 2010 and it will work in 2012, just for the other party.

Seniors may well vote against the GOP. While the GOP works hard to assure them that they will be unaffected by RyanCare, American seniors are old enough to remember the good ol’days and that they weren’t.

I have concerns. I want change. I want responsible change. I want balanced budgets and I want to see a sense of ethics that balances individuals with the reality of the greater society that we live in. You affect my healthcare choices. I affect yours. So can we work this out?

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Health Care in 2011 – Regulate it as a Utility

Health care should be regulated as if it were a public utility.

For some I know that this will be a stretch, but health care access is a public need.

No, the Emergency Room (ER) does not represent acceptable health care access — and using the ER degrades the quality of care that folks receive and only treats the symptoms of those that cannot afford a regular doctor.

Life isn’t fair. Until it becomes so then our society, or any civilized society with any compassion for the less well off or aged without resources, will eventually demand better care and some uniformity in the delivery and cost of medical services.

I have health coverage, very good health coverage. I also know those that do not. They are not lazy, unproductive citizens — none are looking to get by on the public dime. of course, neither do they have many dimes, or dollars.

I am not advocating for free or socialized medicine and medical care. I am saying that no American citizen should ever have to worry about trading off healthcare for food, to pay their electric bill or to give up their home. Means testing is fine with me. Means-tested copays are too.

Whether it is ObamaCare or RyanCare — please look all Americans in the eye and tell us that if we need medical care that it will be available if we cannot afford or some insurer refuses to provide coverage or both.

Taking care of our fellow Americans when in need is neither left nor right, liberal nor conservative. It is just the American thing to do.


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Health Care Reform Act Headed for the Supreme Court due to Partial Victory by Virginia Constitutional Challenge? Yes.

by Bill Golden
Bill4DogCatcher.com and JeffersonConservative.com

The Health Care Reform Act, AKA ObamaCare as it is called by both supporters and detractors, has stumbled badly in its attempt to fend off a constitutional challenge posed by Virginia.

On Monday, August 2nd, 2010, U.S. District Judge Henry Hudson denied Health and Human Services Secretary Kathleen Sebelius’s motion to dismiss a lawsuit brought by the state of Virginia challenging the new health care insurance law. His ruling stated that it is far from certain Congress has the authority to compel Americans to buy insurance and penalize those who don’t.

The stumble comes from the entire Health Care Reform Act (HCRA) depending upon the individual mandate for the HCRA to have meaning. Please remember that Virginia chose carefully as to how it challenged the HCRA’s constitutionality: it did not challenge the power of the Congress to pass such a bill; Virginia challenged the constitutionality of requiring individuals to have health insurance.

Failing to overcome Virginia’s challenge, the fate of the HCRA now goes to a court trial to begin October 18th, 2010. Win or lose, both parties will undoubtedly appeal to the U.S. Supreme Court.

The effective outcome is that many states will delay beginning to implement the HCRA until its constitutionality is determined. Just as Arizona is stymied in its ability to implement portions of SB1070 so is it the same for the HCRA whose first requirements and benefits went into effect as of July 2010.

My view is that Arizona will ultimately prevail at the Supreme Court level and Virginia may well also prevail.

Back on March 21st 2010, just hours before the vote was taken in the House on the Senate version of the HCRA, I gave my opinion and an overview of the constitutional issues facing the HCRA.

My opinion then and now:  “As much as I believe health care reform is needed, and needed now, the senate version of health care reform is both unconstitutional and overreaching. If the senate bill should be passed by the House then it will be more of chimeral victory that will be defeated in the SCOTUS due to its many flawed provisions, rather than the total sum value of its intent.”

For more info: What the press is saying about this development.

Bill Golden is an independent observer of American politics, trends and economics. Bill’s political views meet at the crossroads of conservatism, libertarianism and being a practical centrist. No longer a member of any political party, Bill would undoubtedly be declared a DINO if he were a Democrat and a RINO if he were Republican.

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$$ Follow the money – Who voted Yes or No on the Health Care Reform Act

Do $$ influence votes? Maybe. Maybe not.

View all political contributions at http://maplight.org/us-congress/bill/111-hr-3590/423082/contributions-by-vote

Senators voting ‘No’ on the Health Care Reform bill, just voted upon by the House, received an average of $595,820 in political contributions from anti-Obamacare Groups. Senators voting ‘Yes’ received an average of just $156,323 from pro support groups.

Republicans may have lost the health care reform bill vote but Republican senators raked in the cash over Democrats $3:1.

Some key senators voting ‘No’ got an incredible amount of money from groups against Obamacare:  Saxby Chambliss (R-GA) $1,543,267;  Bob Corker (R-TN) $1,358,939;  John Cornyn (R-TX) $1,315,356;  Jim DeMint (R-SC) $1,277,935.

The highest contribution received by any health care reform supporter was $632,550 by  Arlen Spector (D-PA); and next was Max Baucus (D-MT) with $444,539, but average ‘Yes’ vote only got $156,323.

For something to be so publicly unpopular as the health care reform bill , it is very counterintuitive that it was much cheaper $$ to get a ‘Yes’ vote than a ‘No’ $$$$$$ vote.

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A Republican Waterloo – Losing The Health Care Reform Vote May Hurt Republicans More Than Democrats

by Dennis Sanders, RepublicansUnited.us
Commentary by Bill Golden, Bill4DogCatcher.com

David J. Frum is a Canadian American conservative journalist active in both USA and Canadian politics, a former economics speechwriter for President George W. Bush, and founder of FrumForum.com (formerly NewMajority.com), a political group blog.

David Frum lets conservatives and Republicans have it for their intransigence during the health care debate:

At the beginning of this process we made a strategic decision: unlike, say, Democrats in 2001 when President Bush proposed his first tax cut, we would make no deal with the administration. No negotiations, no compromise, nothing. We were going for all the marbles. This would be Obama’s Waterloo – just as healthcare was Clinton’s in 1994.

Only, the hardliners overlooked a few key facts: Obama was elected with 53% of the vote, not Clinton’s 42%. The liberal block within the Democratic congressional caucus is bigger and stronger than it was in 1993-94. And of course the Democrats also remember their history, and also remember the consequences of their 1994 failure.

This time, when we went for all the marbles, we ended with none.

Could a deal have been reached? Who knows? But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994.

Barack Obama badly wanted Republican votes for his plan. Could we have leveraged his desire to align the plan more closely with conservative views? To finance it without redistributive taxes on productive enterprise – without weighing so heavily on small business – without expanding Medicaid? Too late now. They are all the law.

No illusions please: This bill will not be repealed. Even if Republicans scored a 1994 style landslide in November, how many votes could we muster to re-open the “doughnut hole” and charge seniors more for prescription drugs? How many votes to re-allow insurers to rescind policies when they discover a pre-existing condition? How many votes to banish 25 year olds from their parents’ insurance coverage? And even if the votes were there – would President Obama sign such a repeal?

by Dennis Sanders, RepublicansUnited.us

I totally agree. GOP leadership can huff and puff all they like, but they aren’t going muster any votes to take away something that has been given to them. It’s a nice issue to stir up the passions of the base for the next few years, but let’s face it: this legislation is here to stay.

Sure, conservatives and Republicans might have their revenge in November and pick up a few seats-something that will make the hardliners feel good- but in the end, this is victory for the Democrats. We will end up with a bill that will be in effect long after the leading GOP leaders have left Washington.

Ross Douthat has made fun of moderate Republicans in the past for basically becoming the accountants of the welfare state- allowing Democrats to have their big government programs, but making sure these plans were fiscally sound. What would have happened had the party allowed Olympia Snowe to help work out a deal that would have made health care reform more fiscally sustainable? What if an Orrin Hatch (who is not a moderate) or Bob Bennett had been able to force a tax on so-called “Cadillac Plans” that would help fund the deal and also lead to some meaningful reform on costs?

We will never know because the leadership made damn sure no Republican cooperated. I think in the long run, this will be the GOP’s Waterloo, a big spectacular loss. We can’t see it now, but give it five or ten years.

We lost this one, big time.

Bill4DogCatcher.com sez: Tactics may win battles but poor strategy loses or wins wars. The Republican strategy had no tactics except delay and obstruction, and their strategy was to hope that the TEA Party rallied enough support to scare the bejesus out of lawmakers. A war lost due to squandered opportunities to capture the conversation and to work for the American people.

Here is the Election 2010 scenario as I see it: there will be a constitutional challenge to the passage of the Health Care Reform. However, there is a degree to which that really doesn’t matter. Timing will reward the Democrats.

The Supreme Court will not hurriedly accept appeals to overturn the new Health Care Reform Act. Sometime in 2011 may be the earliest that they accept a challenge, late 2010 at the earliest. This is bad news for Republicans.

Between now and late spring 2010 there are no major political issues for Republicans to champion. They have put all of their hopes into a single issue and failed miserably. Their closest allies, the TEA Party in particular, already consider the GOP largely impotent and this just proves it. Republicans can expect to face challenges across the nation in their primaries and in the general election from third party and independent conservatives.

Between now and late summer 2010 the economy will make improvements. These improvements will be sufficient enough to make President Obama and the Democrats look like they are doing good things — although I do predict an economic downturn in late 2010: see 2010 Dog Catcher Predictions – Economics, from January 3, 2010.

The Democrats, despite their historic ability to grab defeat from the jaws of victory, will do well enough in November 2010 to maintain control of one or both houses of Congress. The Republicans — between now and November 2010 — will descend into self-pity, playing pin the tail on the donkey, anger and will remain without a strategy.

There are issues that Republicans can win on in November but they will need to listen to cooler heads — and I think that there are some smart folks in the TEA party that actually have the basis for a winning plan, although TEA must work to overcome their negative imagery: one part deserved and one part the natural way politics works when there is strong disagreement and your opponent wants to paint you as being on the edge … about to fall off.

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Schoolhouse Rock- How a Bill Becomes a Law

Back in the day (1970s) when we were trying to reestablish faith and trust in how the U.S. government ran and worked, a series of public service commercials would run during Saturday morning cartoons. It could never happen now because whoever did it would be accused of political indoctrination. Conversations are so hard to come by these days.

Other topics were covered, too. Things like grammar. Ok, so that last sentence would not parse correctly – apologies to my 8th grade English teacher who made us diagram every sentence. (Hell on earth, but thanks Mr. Moss, Southside Junior High, JAX Florida for trying).

Anyway, I strongly recommend this Schoolhouse Rock lesson on how a bill constitutionally becomes a law. Enough of taking shortcuts — both parties seem focused on sliding into homeplate rather than just hitting the ball out of the park. So I recommend this to all.

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Health Care – When The Fight Resumes, Fall 2009 … Do Conservatives Have An Argument?

Now that Congress postponed in late July putting forth a national health care plan, we have more time to think through this.

Below is how I see the national health care option argument as it exists today.


A majority of Americans, however slight the majority, would like to see the U.S. have some form of national health care plan option. Increased unemployment in Fall 2009 could boost those support numbers, as long as President Obama and Congress are seen as making a good faith attempt at economic stabilization.


With a Democratic president and a strong majority in both the Senate and the House of Representatives, the Democrats could pass a national health plan without any Republican votes. This assumes Democrats can reach agreement. The pressure will be on in late 2009 to either pass or to suspend the campaign for a national health care plan. The Republicans have been totally ineffective so far in making a case against Obamacare. Republican natural allies, the Democratic Blue Dogs, have found themselves doing all of the heavy lifting as Republicans have spurned almost all attempts at bipartisanship or even working closely with the Blue Dogs.


The predominate counterargument is conservative. The conservative argument is that government should not do for people what people should do for themselves. The argument is also made that there are publicly available options to provide a safety net to the uninsured and to those unable to afford medical care;  business and the free market is more efficient at providing better and less expensive services than the government.

PREDICTION: The Democrats will come to some agreement prior to early 2010. While this will be too late for the 2010 Federal Budget Year, it will be a decision that conservatives and Republicans will be unable to roll back even should they do well in 2010 mid-term elections.

MY POSITION: I oppose a national plan. However, I believe that major reforms of the health care industry are not possible. The health care insurers like things the way they are (438% increase in profits since 2000), and they have invested heavily in funding non-reform with more than $440,000,000 given to Republicans since 2000 in campaign contributions.


Democratic Blue Dogs: Generally agree that national health care reform is needed but are very sensitive to anything which increases the national debt, and which does not seem like actual reform. Blue Dogs have the greatest chance to shape the winning argument.

Republicans: Chaos reigns within the party and they have no plan at all. Period.

Conservatives: The traditional conservative argument does not hold up under close inspection: publicly available resources are largely non-existent. They have no credible argument — see example of Virginia below.

Independents: Independents tend to take the Blue Dog position.


Virginia has much to be happy about. It has largely escaped the worst of the 2007-2009 Recession. It was, and remains, among the Top 3 most economically blessed states in the Union. And Virginia seems poised to grow in both wealth, affluence and influence. Virginia was just named the “Top State for Business” for the second time in three years.

Yet, Virginia has a health care issue. Many Virginians do not see the problem as pronounced as some other areas since 1 in 8 Virginians receive medical care through affiliation with current or past military service. Approximately 1 in 7 Virginians are not covered by health insurance of any kind.

The conservative arguments holds that where there is demand there will be a supply of service to meet that demand. It is also argued that private groups are already providing many of these services; a public health insurance plan would just hurt the efforts of these groups.

So how well does the conservative argument hold up? The common availability of public resources by private groups is largely myth.

Below is an example of the Free Clinic network in Virginia. A Free Clinic is a private, nonprofit, community-based or faith-based organization that provides compassionate, quality health care at little or no charge to low-income, uninsured people through heavy use of volunteer health professionals and partnerships with other health-related organizations.

After reviewing Virginia’s “safety net” health care network below, the nation’s second largest such network, you tell me how strong is the conservative argument of supply-and-demand, private providers work best.

Virginia – Population 7,700,000

— 1,061,000 uninsured Virginians.

— Total clinics statewide: 55.

— Virginia has the 2nd largest network of free health clinics in the USA.

— Virginia counties with no free health clinic at all: 30+

— Ratio of uninsured Virginians PER clinic: 20,000:1

— Efficiency: $5.40 of services provided for every $1 received; 75% private sector funding, many services are contributed.

— Eligibility for use: A family of 4 may earn no more than $25-31,000 (150-200% below the poverty level).

— Virginians can find a master list of free health care clinics online at http://www.vafreeclinics.org


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