US health spending per capita is twice that of virtually every other developed nation. Health costs are a function of price multiplied by use (utilization). Our use of health care services is on the low side as compared to most other nations, while our prices are on the very high side. To top it off, we don't get very good (in fact comparatively poor) outcomes on a range of health indicators from life expectancy to infant mortality.
Employment-based health insurance covers about half of all working age Californians. It has been steadily declining in relative importance for the past 40 years. During that time, many more Californians became uninsured, and the Medi-Cal program enrollment grew. Recently under the ACA, mid sized and large employers were required to offer coverage of the ten essential health benefits to their full time employees. Low, moderate and middle income uninsured employees were offered coverage through Medicaid (MediCal) and the Exchanges (Covered California) respectively depending on their income. Uninsurance rates were cut in half in California.
Douglass was born a slave on the Eastern Shore of Maryland; he was often badly beaten and semi-starved by cruel slave owners, their overseers and slave breakers. In an extraordinary odyssey, he became the pre-eminent African American speaker and leader, writer, editor and newspaper publisher in the twenty years of lead up to the Civil War and during its turbulent aftermath. During his long life of activism he faced every issue from racism and political corruption to misogyny and nativism to a retrograde Supreme Court, which we all must now confront and combat yet again in the administration of President Trump.
“Stochastic terrorism is the use of mass communications to incite random actors to carry out violent or terrorist acts that are statistically predictable but individually unpredictable. In short, remote-control murder by lone wolf(ves).”
The Trump re-election campaign is underway, and he wants to ensure that his loyalists are in charge of the nation’s intelligence agencies. Witness the rapid rise and fall of Representative Ratcliffe from Texas to replace Director of National Intelligence Dan Coats who has minced no words in describing Russian efforts to interfere in US elections.
Today, President Trump tweeted a 10% tariff on an additional $300 billion of Chinese goods. So that likely increases the prices you will pay for most I-phones, clothes, shoes and kids toys by 10%.
In the heat of the Presidential candidates’ debate, crucial misinformation is inadvertently conveyed; some because the candidates don’t fully understand their own plans or those of their rivals, and some because they seek to elevate their own plans and dismiss their rivals.
Senator Bernie Sanders epitomizes the “Medicare for All” proposal. Vice President Joe Biden is the chief proponent of building on the Affordable Care Act. These are two very different ways to get to universal coverage with very important policy differences that merit serious thought and rational debate.
Senator Kamala Harris has outlined her own health plan for all Americans. Like Senator Bernie Sanders, she covers everyone. Like Senator Sanders she offers comprehensive benefits. Like Senator Sanders, she eliminates copays and deductibles, and premiums. She departs from Senator Sanders on three issues: the role of private insurance, the financing and the length of transition.
The debate between Senator Harris and Vice President Biden on school busing evokes memories from my past.
Here we are celebrating the extraordinary American moon landing achievement of 1969. It was also the time of great advances in civil rights, in health coverage for seniors, the disabled and the poor, and of a nation divided by the Vietnam War and the end of legal segregation – the American version of apartheid.
If it walks like a duck, quacks like a duck and hangs out with other ducks, good chance it’s a duck.
Financing Medicare for All is far better done at the federal than at the state level. Senator Sanders and others seek to do so in both the Senate and the House and it's a key issue in the Presidential campaign.
The Biden plan would offer more affordable coverage to all American citizens and legal residents. It does not help cover the undocumented.
For the next decade, we will be running annual budget deficits equal to about 4.5% of GDP as compared to the last 50 years where it was 2.9% of GDP. The levels of budget deficits will require an increasing share of the federal budget to be spent on interest payments to those who hold Treasury notes and other federal securities. Federal taxes are bringing in revenues of roughly 16% of GDP while federal spending is running at about 20.5% of GDP. The Presidential election in 2020 is crucial to the nation’s financial future.
The Medicare for America Plan, HR 2452 (DeLauro and Schakowsky), gives all Americans a choice of Medicare or private insurance. Individuals can choose public coverage through Medicare or private coverage through their employer or private coverage through a Medicare Advantage plan.
There are four Public Option bills – S 3 (Cardin), S 1261 and HR 2462 (Merkeley and Richmond), S 981 and HR 2000 (Bennett, Kaine and Delgado), and HR 2085 and S 1003 (Schakowsky and Whitehouse) . They give participants in the Exchanges (like Covered California) the option to choose a plan offering Medicare coverage. Some increase premium assistance and cost sharing reductions; others do not. All leave existing coverage through Medicare, Medicaid, CHIP, and employer plans unchanged.
There are two different Medicare for All Plans in Congress: Senator Sanders S 1129 and Representative Jayapal’s HR 1384. They are comparable, but with a few salient differences. Both cover all Americans for a comprehensive set of benefits with no cost sharing or premiums, using a Medicare-like payment program. Both eliminate all employer and individual private insurance and the existing Medicare program and most of the Medicaid program as well (Senator Sanders retains it for institutional long term care – i.e. nursing homes. Neither eliminates the VA programs for veterans or the HIS program for Native Americans.
Covered California released its initial report on premiums, premium assistance and plan participation for the coming year (2020). Premiums are down; plan participation is up; coverage is more affordable, and subscriber participation is expected to increase.