The Battle for Healthcare in the US

Yves here. Note that the Obamacare replacement horse-trading is very much underway and that’s before you get to the fact that the Republican senators have much more diverse constituencies than the Freedom Caucus ideologues that are trying to drive the bus in the House.

By run75441. Originally published at Angry Bear

n 2026, an estimated 52 million would be uninsured in the US, a dramatic reversal from the 2016 uninsured count of 28/29 million. Pretty much, the Republicans will put healthcare back to the way it was pre-2014 if Paul Ryan’s bill is passed by Congress and Donald signs the bill in its present form.

– By 2018, 14 million could be uninsured with many of the uninsured practicing the tyranny of a minority, as John S. Mill might call it, upon the rest of the insured population as they drop out. Others will simply lose healthcare insurance as states withdraw from the Medicaid expansion and employers drop the coverage they were required to carry as they had 50 or more employees. Many of today’s insured will be unable to afford the increased premiums due to smaller subsidies. The elderly will be faced with smaller subsidies and a higher 5:1 ratio premium, which is up from the present 3:1 under the ACA program.

– Doctors, clinics, and hospitals have seen increased numbers of patients coming through the front door rather than the rear door due to the expansion of Medicaid to 138% FPL and subsidies for healthcare insurance to those under 400% FPL. My own PCP has seen many new patients who have never been to a doctor before except at the ER. With the proposed reversal of the mandate to have healthcare insurance and the dropping of Medicaid, it will fall upon hospitals and doctors to still provide stabilizing care as defined by law to all who arrive at their door. Except this time, the subsidizing payments for care for the uninsured to hospitals and clinics will not be available as it was reduced with the advent of the PPACA. It appears the AHA is not too pleased with Paul Ryan’s AHCA bill either.

– Our new Health and Human Services Secretary Tom Price had this to say; “You’re falling into the same old trap of individuals who are measuring the success of Medicaid by how much money we put into it. We ought not be measuring programs by how much money we put into it, we ought to be measuring them by whether or not they work.” Or take one aspirin and you will be alright in the morning. Interestingly, Republicans are happy with constituents paying a surcharge/mandate for not having healthcare insurance or healthcare. And if they suddenly have to have healthcare insurance, they pay the penalty to private companies rather than use it to fund subsidies. Who would have thought?

– Medicaid currently is not working according to Tom Price and as many as one in three doctors are not accepting Medicaid patients. That part is partially true. In a survey of its membership, the American Academy of Family Physicians discovered 68% of its members accepting new Medicaid patients in 2016. This is the highest level of Medicaid acceptance since 2004. The same argument was made for Medicare in the past. As Health Beat’s Maggie Mahar has said, “if Medicare is the largest business in town, are you going to ignore it or work within its confines?”

– Mr. Price argues on behalf of states claiming the granting of greater flexibility would result in better results and quality. My own observations with Michigan Medicaid when there was no Federal Government expansion disagrees with Tom Price’s claims. Michigan State Senator Joseph Hune said it all in one sentence when he stated; “I am ‘sick to his stomach with the expansion of Medicaid in Michigan.” Even with the expansion, the state legislature delayed the implementation of it to the following year so they could go on Christmas vacation and lost $thousands in Federal aid. This occurred in a state which can not fix its roads and bridges, argues about replacing Flint lead pipes, and wastes money going to 6th District COA and SCOTUS because it does not like rulings conflicting with its absurd beliefs. After all, Hune and his associates have their healthcare for life having been in the legislature for short periods of time; why should 600,000 Michigan residents matter to Hune and his associates.

Pre-Michigan expansion in order for adults to be insured and they had to be working. If they were working they had to be making just so much in order to be eligible. If they were not working, they were ineligible. Michigan and State Senator Joe Hune did their damnest to block people from access to healthcare. If this is Tom Price’s better results and quality, it did not work then and will only make it worse now.

Joan Aker at Georgetown University Healthcare Policy Institute puts greater state flexibility into perspective:

“So in practical terms what does that mean? States could get new flexibility to limit enrollment. They could gain the ability to limit enrollment directly by imposing enrollment caps or rolling back eligibility; or indirectly by putting up barriers such as imposing work requirements or lockout periods, which reduce enrollment. States could also gain more flexibility in determining what benefits people receive (in the case of children this might mean limits on the child-centered EPSDT benefit) or on how much families have to pay for those services (including premiums, cost-sharing or spend down rules before seniors qualify for long term services and supports). In fact, one piece of this so-called “flexibility” that is included in the repeal bill would allow states to require seniors to spend down even more of their assets before qualifying for long-term care services and supports by placing restrictions on how much equity seniors can have in their homes.” We did this in Michigan already and pre-PPACA.

– The AHCA penalizes the poor and elderly more severely than the ACA did. The ACA has a penalty for not getting healthcare insurance, which is based on the income of the uninsured and is paid yearly at tax time. The AHCA also has a penalty for not getting healthcare insurance. It is based upon the premium you would pay, not income, and each person pays the same penalty regardless on income; however if you are older, the 5:1 ratio will apply to your penalty. As I showed using a Avalere* chart, a 27 year old person making $11,880 annually would be paying $695 at tax time under the ACA and under the AHCA plan $1,006 for a bronze plan.

If the insured was 50 years old and made $11,880 annually, the penalty under the ACA is determined by income and remains the same; however under the AHCA, the penalty under a Bronze plan format jumps to $1,713. This is an ~ $700 difference between a 27 year old and a 50 year old. If it is a Silver plan add ~100 dollars for a 27 year old and ~ $250 for a 50 year old. Whether 27 or 50 and making $11,880 annually; the payment is harsh and is harder to pay the larger it gets.

As I get more information I will pass it on. There is much going on at a rapid pace and it takes a bit to gather it up.

*After leaving the White House Office of Management and Budget in 2000, Dan Mendelson founded what is today Avalere firm and initially named it The Health Strategies Consultancy LLC.

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  1. cripes

    Basically, the House crazies led by Ryan–and those on his right flank–are trying to impose confederate state type insurance schemes federally. One can’t really call this a health bill at all.

    The real question is whether they will manage to pass this monstrosity in some similar form or will it go down in flames? Hard to say. I think the ideologues are flexible on details–they really just want to say they did it and repealed ACA.

    But the alt-right may refuse to negotiate with the senate or the vestiges of the old republican moderates. But the strong arm of pharma, hospital and insurance lobbies may exert more pressure for a working model that works, mainly, to keep the moolah flowing into their unregulated, cost un-contained coffins, er coffers.

    It’s so deranged, I’m surprised the Canadians aren’t building the wall.

    1. craazyboy

      “I’m surprised the Canadians aren’t building the wall.”

      First, they will try and get Trump to pay for it.

      I keep thinking the wingnuts would be still basking in their election good fortune – really no result of anything they did for their base – and wisely vote NOT to screw the daylights out of their base along with the probable “others” that they regularly dream of screwing even more in their wildest, orgasmic dreams.

      But thinking is bad for you and can be yuugly bad for your finances and health, too, it seems.

      As a result of this deep thawt, I can’t even confidently predict how the vote would go even a few days out from now.

      1. Steve

        I’m surprised the rest of the planet hasn’t offered to surround the US with both land and floating blockades for free.

        1. craazyboy

          They know that would be an act of War, the US spends half the World’s defense budget, and we would be forced to increase defense spending and most likely mount an air invasion invading Kiev and then be strategically positioned to execute the dreaded Pincer Maneuver on Greater Europe and Asia simultaneously. The World would be forced to surrender, on bad terms. Central and S. America would surrender preemptively, of course, because of the frightening show of force.

      2. wilroncanada

        Trump is going to build a wall, as I wrote before–to keep his exceptional country-folk in.

      3. DH

        Trump will build the wall along the Canadian border when Canada starts sending the illegal immigrants back that are crossing the border as refugees.

  2. djrichard

    Remember when we had the housing crash and the call-to-alarm was over the … federal deficit?

    Same logic applies here. Trump won, so that means it’s not situation normal. “Change is required. What change? I’ll be damned if I know, but hey, let me try to get my pet agenda through and let’s see what happens.” Will Trump use the bully pulpit to beat those sons-of-bitches into submission? Or will he abdicate?

      1. djrichard

        Well as of today it appears that Trump is using his bully pulpit to beat congressman into submission, except instead of beating on the sons-of-bitches who proposed the health legislation under consideration, he’s beating on those that aren’t on board. So he’s owning it now.

        It also means he’s officially selling out his constituency now (dependent on whether you think his constituency that voted for him was poor or not). But assuming he is, then for somebody who supposedly knows what it means to make a good deal, you have to wonder who he thinks his stakeholders are now.

  3. jefemt

    Permissible non-participation under the ACA- without penalty- was if lowest-cost Bronze plan premiums exceed 8% of gross income. I’d argue that for most Americans, that 8%-of-gross opt out threshold was available in year one, certainly by the escalation in premiums by year two.
    Removing the insurance industry — not one iota of care- would immediately see a savings of at least 30%– some claim 40%.
    Paradoxically, we appear to be seeing a coalescence and consolidation of insurors, we will end up being delightfully exceptional, again— effectively being single-payor, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry whose executives and employees do not contribute to the CARE equation.
    Is the notion of insuring the health of a mortal critter a valid concept? Can we finally admit, as Bernie Sanders stated, that we are NOT a compassionate nation, and that the concept of health CARE as a fundamental utility function to all citizens is an honorable right?
    We sure seem to be delighted to add another $54 billion to the gas on the fire M I C.

    1. craazyboy

      Time for some early morning math. 5/3 = 1.66. Waddadachances the industry decides the insurance price is right for young people and the new 5-1 spread on rates manifests as an immediate 66% increase on rates for the 50 and over crowd? There are 80 million boomers in the 50 years to 70 years bracket now. Waddadachances of forced early retirements on a massive scale, as private insurance costs to corps seek the same “market driven” price level?

      1. luckyone

        That has already happened. I lost my job more than a decade ago, when my benign, auto immune disease triggered an increase in the cost of my health insurance.

        A friend recently lost her job for the same reason.

        1. Jen

          Been happening for a long time. In 1991, my mom was let go from her job with (irony alert) an insurance agency after she was diagnosed with metastatic breast cancer. Her boss told her they needed to cut staff and she was “the logical one to go.” She sued. They settled out of court. My mom had passed away by then but if it made those f***ers think twice before firing someone for having a terminal illness, it was worth it.

          Worse still – she was covered by my father’s insurance.

      2. jrs

        Noone who is 50 or so is a boomer, that’s actually Gen X (some Gen X are younger of course).

    2. marym

      effectively being single-payor, private sector, paying a monopoly an add-on cost of 35-40% to a parasitic industry

      I agree that this is currently a plausible outcome, including the co-opting of the “single payer” label. We should be using terminology like “publicly funded, not-for-profit, similar to Medicare.”

    3. djrichard

      We inflict free war on foreign nations. Think of all the money our Fed Gov sends to the MIC. Yet do those countries pay us back? Why no, it’s all free for them. Except Cambodia apparently.

      Same thing: we inflict free war on drugs on our selves. Think of all the money our Fed Gov sends to the prisons and police. Again, do drug users swept up in that even pay us back? Ingrates!

      So maybe we should think about healthcare the same way. Something to inflict upon ourselves. Take that you weak and infirm! Think of all the money that our Fed Gov could send directly to the doctors and hospitals in inflicting this on us. If they’d want to view those of us being inflicted with this as ingrates, I’d be copacetic with that.

  4. WhiteyLockmandoubled

    All true and more.

    For the 177 million folks of all races who get their insurance at work, the bill will accelerate the escalating crisis of underinsurance.

    The bill eliminates all ACA taxes except the 40% excise tax on health benefits, deceptively marketed as the Cadillac Tax (everyone, including Jonathan Gruber, now admits that most employers’ plans will be affected by the tax’s thresholds). The threat of the tax and the ACA’s failure to impose any cost controls on the insurance, pharmaceutical and hospital monopolies that dominate the system are driving out of pocket costs through the roof. Deductibles are up 89% since the ACA passed, private sector premiums have grown at 300+% of general inflation (Democratic protestations to the contrary notwithstanding).

    This is what the Democrats and the elite media keep missing — they go interview white Trump voters who actually got Obamacare or Medicaid, then snigger at them for not understanding their own interests. But they ignore the majority of the non-Medicare eligible population who are pissed because President Obama told them they could keep their plans and doctors, and their coverage is eroding rapidly.

    Sure, some of them hate Obamacare because it was the Sleeper Agent Black Fake President’s law. But most hate it because they are supposedly insured and can’t afford to go to the doctor.

    So now Trumpcare and the vicious monsters in the GOP will turn their insurance into even crappier high-deductible Health Savings Account plans, increasing the pressure on their families’ budgets, transferring even more of their money into the pockets of the insurance companies and giving the banks their own cut of fees on the accounts because how can you spend public money and not give them a a slice, and, of course, further degrade the public’s faith in the government’s ability to do anything but screw them over.

    And the corporate Dems? Save Obamacare! No self-reflection. No sense that the ACA, while lifesaving for millions of people, is also a deeply flawed intermediate step that has left the consolidated rent-seeking structure of the industry in place to extract wealth from our suffering, and is causing nearly as much insecurity among those who are nominally insured as it has brought security to those who were not insured in 2010.

    We have a two-front war on our hands….

    1. run75441

      No one said healthcare insurance is easy and the plan printed on two sheets of paper. Neither is true. A good example is going to an in network hospital because of chest pain and being x-rayed by an-of- network technician. You are either stuck with it or your insurance company negotiates with the tech on your behalf. Great midsized hospital MedCental.

      The MLR controls the amount of administrative cost as a ratio of total cost which is billed to you. 20% for individuals and 15% for group. Yea I know it is a lot. Then too, Commercial Insurance does more fraud work than Medicare and that adds up also.

      There is something called the Risk Corridor program also which was successfully torpedoed by Jeffrey Beauregard Sessions, Fed Upton, and Jack Kingston. This also exists and is a wild success for Part D except this one was installed by Repubs. What it did was take a portion of profits >3% and spread to Healthcare Insurance companies (including Co-ops) with losses > 3%. It only did a ratio of profits and losses exceeding 3%. This was meant to occur for 3 years to cover the pre-existing conditions and major illnesses new signups would have which no longer could be denied. The Part D one is successful and generates revenue. CBO said the ACA would be also successful and would generate $12 billion of which a part would go back to cover ACA costs. Congressman Kingston was successful in inserting Section 227 in the 2015 Appropriations Bill signed December 14, 2014. This little action put the final nail into the coffin for the Risk Corridor program. You can read here if you want the detail.

      The net effect? Insurance companies leaving the exchanges, Co-ops going bankrupt, insurance companies losing money, and higher premiums.

      Insurance companies are not the cost drivers and they are a reflection of what the healthcare industry has been doing. You are partially right; but, you missed the big cost factor.

  5. Jeremy Grimm

    This battle over health insurance reminds me of the Walrus and the Carpenter. The Republicans are the Carpenter — the Democrats are the Walrus — and we are the oysters. I doubt our health care or welfare receive much of their consideration.

  6. Eureka Springs

    Lordy, the complexity says so much.

    Rube Ponzi Goldberg and the Yakusa. RPGY would be a much more appropriate name for our insurance scams.. O, not care or this one. Until we find decency (H.R. 676 or a tri-care equivalent) I hope they do keep shoveling people all the oxy it takes to die.

    I have friend, 71 yrs old who has lymph something or another cancer and a couple missing discs in his spine. Can’t get medi anything because of an eight thousand dollar life insurance policy he had no idea was coming his way. They didn’t even say just give us the entire 8k and we’ll medi cover ya. So he sits in decay and agony, pumped full of oxy and morphine (which are outrageously expensive scrips) with no real treatment. An impossible condition in which shopping or negotiation, navigation can occur. Can barely move, or breathe when he tries to move. He’s managed to see a few doctors over the years, including several specialists, still doesn’t know his complete diagnosis, and mentioned the other day after all these years with back problems no health care professional examiner has ever touched him, his back.

    I have another friend, in her late 50’s now, poor, uninsured, had thyroid surgery just before Obaney, not care, took hold. Initial bill was 70k, she negotiated it down to 2k. Talk about price discovery.

    These horror stories are unlimited when one brings up the topic. And posts like today’s. I’ll never participate, even if I could afford to do so. Can you imagine being in the 0 to 40k bracket and ever breaking free unless you suddenly had a many tens of thousands of dollars increase in income? All of which will go straight to RGPY?

    1. JEHR

      The CBC did some interviews of various people on ACA and asked them about the new healthcare plan. (See Full episode of The Current for March 21, 2017 starts at the 46:15 minute mark.)

    2. Vatch

      Since you mention HR 676, the Expanded & Improved Medicare For All Act, I’ll take a few moments to encourage people to contact their Representatives and ask them to co-sponsor it. Here’s the current list of co-sponsors:

      Here’s contact information for Representatives:

      A couple of weeks ago I asked my Representative to co-sponsor HR676, and a few days ago I got a boilerplate reply about Medicare in general. This type of thing often happens when I make a specific request to a politician, so I called his office, and politely explained to the person on the phone that I want the Representative to co-sponsor HR 676. If something similar happens to others, I recommend that you call and clarify your position. It doesn’t take much time.

    3. run75441


      What does your Long Term Care insurance look like? Oh, don’t have that coverage? You do not go on Medi, you go on Medicaid and you sign away all of your assets (or exhaust them) worth some money except for a few before you get Medicaid. Your friend could sign over his insurance.

      “No one knows exactly how long you might need long-term care, realize that the average stay in a nursing home is 2.6 years for women and 2.3 years for men.”

      Long Term Care was a part of the ACA until some Senators killed the idea of having it. ~8 million people have it including my wife and I for 4 years. Since I am ornery, I will probably live longer and I will be passed off as soylent green.

      I really do not care if you have healthcare insurance coverage when it is available today. I just do not want to pay for you because you wish to practice your freedom not to be covered.

    4. River

      I still can not comprehend the American system. I had my thyroid removed, my cost was how ever much the t.v cost was in the hospital for two days.

      And going from 70K to 2K, price discovery indeed! That’s monstrous.

      1. run75441


        You are fighting with an unregulated healthcare industry (not including insurance).

  7. doug

    Don’t expect much from the house folks that voted to repeal ‘o not care’ nn times. They be paid buffoons…

  8. cojo

    Leave it to the republicans to do what they do best. Get elected saying government doesn’t work, then completely screwing things up with they hackneyed policy solutions and saying, “see, I told you so!”. The one saving grace, is should this new bill pass, it will accelerate the dissolution of the so called healthcare industry to the point where there is no other option but the only sane option, single payer, universal health care. However, the only way this will come to fruition is if the voters finally realize this is the only way to run a healthcare system and actually speak up loudly, “we’re mad as hell, and we’re not going to take this anymore!”

  9. RDE

    Message from the real world.
    Two weeks ago my dentist referred me to a root canal specialist for a necessary operation. I asked what the cost would be, and unlike most such requests regarding medical costs, received an answer: $1380.00. The closest airport is in Jackson WY, a very expensive travel market. The next day I was on a flight to Puerto Vallarta, Mexico. My cost for a root canal operation at a clinic equipped and staffed at least as well as the one in the States was $225.00. The total cost for airfare, a nice hotel, and a week’s beach time plus the dental work still left money in my pocket compared to having it done in the States.

    There is more to the story: About half of the Mexican dental clinic’s customers are Canadian. While everyone in Canada has free national health care services as a right, and thus isn’t forced to choose between health care and bankruptcy as in the US, dental care is privatized and therefore as expensive as in the US. Perfect example of how the “free market” prices its services in comparison to a regulated single payer national health care system.

    1. JEHR

      I can vouch for the expense of dental care in Canada: it seems as though my dentist is hell-bent on becoming one of those millionaires we read about: I paid $7,000 for one tooth implant which is ridiculous and I will not get another one; I will be content with holes between my teeth should I have to have any more pulled.

      1. Dead Dog

        Yes, every Australian dentist I have met appears to desire the 500k to 1m + salary and can get it if they have their own business.

        I went to Philippines in 2012. Twelve porcelain crowns, one dental implant – $2500. All done in 3 days. They are still in mouth and every Australian dentist since has said they are excellent. And, I had a great holiday too.

        Cost here in Oz – probably over $50k

        Quality teeth has always been a marker of the rich…

      2. RDE

        Dr. Fernando Penalva
        Plaza Marina, Puerto Vallarta, Mexio
        (2 miles from the international airport)

        Your savings on one $7000 tooth would pay for an entire winter in PV!

    2. Arizona Slim

      Here in Tucson, “going to the dentist” may well mean a day trip to Mexico. And some of those dentists are pretty good. I can name names if anyone’s interested.

      1. craazyboy

        They’re good and plentiful. Good selection just walking across the border. $4 parking on US side and no cab ride or venturing into unsafe areas.

        I have noticed prices on the basics are good. Like $35 for a cleaning/checkup. My place even throws in free X-rays once a year. You do have to watch out for the more esoteric things like dental implants. I was in the lobby waiting one day and a guy from Scottsdale showed up looking for a price quote on implants. After some lengthy theatrics and presentation on the part of the dentist lady(or could have been the biz person) he got a price of $4,000. He said that’s what he was quoted by his Scottsdale dentist and thanked her very much and walked out.

        So, beware you are still not safe from profiteering. Same goes for all the pharma shops they have down there. But they drop their shorts in an eye blink – so you just have to pretend you’re shopping in Mexico.

        1. Irrational

          Perhaps that is what the wall is for – keep Americans seeking cheaper health care in?!?

    3. run75441

      I heard Mexico is an option also. My son-in-law’s parents go there for dental work also.

  10. susan the other

    We could use a concept like ‘positive health care’ wherein we first get good health care and then we pay for it. There could be any number of entitlements which do the paying at that point without any insurance rigamarole at all. Health insurance is like negative health care. And cutting benefits before any service is given is insane, as usual. If this whole song and dance that cute little Paul Ryan is doing is simply to free up money to give the rich their tax cuts, he should at least have the humility to wait until medical services are given. The whole idea of health insurance is such a racket. Just think, what if everything were run on the insurance model. Pay a huge premium first, then maybe we’ll pay your bill later, if you can decipher your bill and afford to hire an attorney. Ha ha.

    1. JEHR

      I agree. Something else that single-payer seems to encourage is preventative health care. The family doctor does regular examinations and can give the patient information to prevent disease or to avoid other health issues. In other words, patients do not have to wait until they are extremely sick before seeking care; for example, diabetes can be headed off with proper diet and/or medication that will also prevent exacerbation of other illnesses.

      1. run75441


        Tell me what you think single-payer is that you embrace it so firmly. I need to understand what you believe it to be.

  11. J7915

    Never asked question. How much would it cost a 45 year old to buy into medicare? How about a 23 year old?
    As to the young, indestructible, they should be able to sign up with back fee penalty and a 3 to 6 waiting period during which all cost are still self paid.

      1. craazyboy

        “Just Because”. It’s the answer that works so far.

        Actually, I think the OCare, now defunct, “public option”, was essentially that. But right away I heard some talking head say that the “cost” would be based on the Medicare pool. Here is where they say 30% of ‘Merica’s health care dollars are spent on “end of life” care. I was thinking at the time that would be a sure conversation killer, and any discussion of how it should work predictably went “crickets”.

        Personally, I’ve never made an medical insurance claim and don’t understand why they want to drive me into bankruptcy at age 60. In my mind, I should be an American Hero and even be awarded a bottle of free aspirin, maybe.

    1. run75441

      About $280/month for Medicare A&B, Supplemental, and Part D. Add another $150 /month for vision and dental. I am assuming Tier 1 drugs at $30/month premium and no deductible or copay. Supplemental at ~$115/month. Hubby and Wife for $560/month.

  12. Carey

    I think the system is working precisely as designed: killing off the Many, slowly, so that
    maximum rent-extraction from them can occur. The ‘providers’ get paid because
    ‘insurance’, as the patients slowly die. What’s not to like? /s

    1. cojo

      The problem with your summary is that some of the other rent extractors want theirs too, plus it takes skill to extract the most possible from an unfortunate debt slave before killing them off. This parasitic behavior is well known in biology. In some cases the parasites can coexist with their hosts for many years without offing them. These tend to lead to chronic diseases like H. pylori stomach infections, malaria, HIV or Lyme disease. In other cases, the parasites are more aggressive and kill their hosts much quicker, such as Ebola, plague, or some of the hemorrhagic fevers.

      There are rare cases where the parasites live in harmony with the host and essentially will also contribute to the hosts health to keep them alive longer. This is known as symbiosis. In the political economic sphere, the United States was in such a symbiotic relationship during the post war years from 1945 until the 1970’s, before neoliberalism decided symbiosis was detrimental to ones freedom to exploit.

      1. JTMcPhee

        Beg to differ. At no time was the thing we call “the United States” in any kind of biological-parallel symbiosis with the rest of the world. At best one might say there is some parallel with the relationship between ants and aphids — the real relationship, not the one so gallantly described in so many texts that look hopefully at it as a kind of “farming.” Here’s a recent study that shows the interactions in more detail: Ask pigs and lambs and cattle how “farming” works out for them…

        It appears the ants studied use chemical controls, to keep the aphids dumb and docile, and hence available for “milking” said aphids(who in turn get their living by sucking the precious bodily fluids out of the plants in your garden that they infest) the same way the dominant economic powers of our own political ecology do. And the use of chemical restraints keeps aphids easily available, for an ant with a taste for protein to supplement the sugary “nectar,” to grab the nearest aphid and eat it.

        Seems to me any notion that ants “protect” the aphids is just a bland Pollyannthropomorphization, that exists, if at all, only in the sense that the ants protect their food source from other like-scale competing predators. The can’t do much to protect the aphids on my rose bushes from diatomaceous earth dusting, or spraying with soapy water…

        H. pylori is an interesting case — I recall an article noting that people with H. pylori, which is a pretty normal presence in normal gut flora and fauna, get some protection from esophageal cancer, which goes away when they are “treated” with the usual slug of heavy-duty antibiotics. So much common knowledge, and occasional illuminating research:

        The aggressive “capitalist” ants that make up the US empire have been exploiting, and milking, and eating, the aphids of the world since colonial days (see global trade, slavery, dead Indians, slash-and-burn agriculture, army-ant-like “progress” across an undefended continent.)

        If one looks close, often it is the case that nothing is what it seems…

        1. Cojo

          Less esophageal cancer, increase in gastric cancer and ulcers, overall, I’d say it’s a net negative to human health. I do like your ant-aphid analogy but I would say this was more apt in feudal times and perhaps today. I truly believe that after WWII, the American and European working class had about as symbiotic a relationship as anytime in human history. I think it had to do with capitulation due to the more severe threat of communism as well as some sense of national unity due to the war experience.

  13. rc

    The ACA was a massive tax and cost increase for the middle and upper classes that eliminated access to care for more people than it added. The US should have universal care for less than 10% of GDP. An 8% of GDP savings could fund tuition free college for all students, massive infrastructure expenditures and increase social security benefits or add a universal basic income.

  14. B1whois

    Yves and Lambert – With all due respect, I hope you take this as constructive criticism: I had a great deal of difficulty following this article. I have read it twice, the second time out loud and still it seems rather poorly constructed. A major problem is that even within the bullet points sentences don’t seem to flow logically from one to the next. They feel disjointed, more like they’ve been thrown at the page. I feel like an outsider reading something that was written for Insiders, and This is before I get to acronyms which are never defined.
    NC is so valuable, and I often feel I am doing a public service by sharing things from here to my Facebook page. But I don’t want to share things that are so difficult to follow that people may become discouraged about educating themselves. I am also worried that people will not advocate for themselves if they’re embarrassed about not understanding the underlying subject matter.
    I’m so sorry to be complaining, but you cover such important issues and they need to be understood. Thank you a thousand times for your work! (I am a monthly giver) Namaste

    1. run75441


      It is disjointed and a collection of various points, I have pulled together from various resources which I read on a continuous basis. It is not meant to flow from one point to another. I would have to write a couple of pages more to get it to do what you would like it to and quite frankly the average reader’s attention span is not that long. The acronyms I use are pretty common to me and also people like Maggie Mahar and others as well. Most can be found by Googling them..

      So few of you understood the PPACA which took months to pass and required some rather broad reading of legislative text. Quite frankly, I am discouraged so few people understood the PPACA other than to say we need single payer or universal healthcare. Yet so few of you knew what single payer was, what it should do, or even what it consists of in content. It was little more than a favorite word to be bandied about without any discussion of what it would do. If we relabeled the PPACA as single payer I would suspect many might except it as such.

      The AHCA is coming on strong, and much faster than the PPACA ever did and it is not open to critique the same as the PPACA by Democrats, Blue Dogs, and Joe Libermann. I hear a lot about Republican opposition which I strongly doubt will surface in the vote. This Thursday there is to be a vote on it in the House and if it passes, Obama’s “you can keep your insurance” cherry-picked from a paragraph referring to ESI could pass into history as one of the greatest lies by a political ideology intent on blocking whatever one man was attempting to do and reversing what he did.

      Thank you for your comments.

      1. marym

        Having followed the healthcare discussion since 2009, I would say that many participants in this discussion consider single payer to be HR 676 Expanded and Improved Medicare for All. This includes long-time advocacy groups Healthcare-NOW and Physicians for a National Health Plan. ,

        Link to a brief PNHP summary of the bill including a link to the full bill which is only 30 clearly written pages.

        It seems doubtful that labeling the ACA as single payer would fool anyone as it fails to meet the requirement of an actual single payer.

        1. run75441


          Right now Medicare costs ~$280/person/month dependent upon your income. It is means tested. This includes Part A and B, Supplemental, and Part D for Drugs ( I only included costs for Tier 1 drugs). Family of two pays $560/month. Do the math and whether you pay it or the gov pays it, this rolls out to be some rather “Yuge” numbers. Sure you might be paying less; but, how much less? CBO has not touched this yet and I would wait for them.

          Hmmm, what are we going through right now with the PPACA? Do you believe single payer would be immune to the Paul Ryans, McTurtles, and Dtrumps of the US going forward. The electorate chose the wrong president and many of you sat there and found much to criticize in HRC and Barack. We got the runt of the litter in 2016 and now we stand to uninsure 24 million and put us right back where we were pre-2010 with healthcare

          Did you read the Manager’s Amendment for the PPACA like Maggie Mahar and myself did to fully understand the PPACA. It was really long and was far longer than the 120 pages the Repubs put out. Most healthcare plans are tedious.

          In 2009 when you said you started to get interested in healthcare, Forbes rated healthcare insurance companies as the 35th most profitable industry. ” Pharmaceutical industry was in third place, with a 19.9 percent return, and the medical products and equipment industry was right behind it, with a 16.3 percent return. Meanwhile, doctors are more likely than members of any other profession to have incomes in the top 1 percent.”

          We have a service for fees environment where healthcare sells as many services as can be sold with little concern for the benefit achieved. So is it the healthcare insurance companies who are at issue when they do more fraud detection than Medicare or is it the healthcare industry?

          “There are few truly single-payer systems in the developed world. Canada has one, as does Taiwan. Most countries rely on many, many insurers. Germany, for instance, has more than 150 “sickness funds.” The Swiss and Dutch health systems look a lot like Obamacare’s health-insurance exchanges. In France, about 90 percent of citizens have supplementary health insurance. Sweden has moved from a single-payer system to one with private insurers. Yet all these countries pay vastly less for drugs, surgeries or doctor visits than Americans do.”

          Ezra Klein wrote “What liberals get wrong about single payer” . My friend Maggie Mahar of Health Beat Blog knew and she was writing on the issue since the early 2000s Take a moment and read this. If you think healthcare is going to be cheap, it will not be and you will pay something. Medicare in its present form is cheap.

          Thank you for your comments.

          1. marym

            Countries providing comprehensive universal healthcare have done so by eliminating for-profit health insurance and implementing instead a national health service; public, not-for-profit insurance; or highly regulated, private, not-for profit insurance. They, and HR 676, address Ezra’s provider pricing issue by government negotiation of prices.

            These countries provide universal healthcare for less cost and better outcomes than the US.

            Single payer has been scored by the CBO in the 1990’s, but the Dems in 2009 in addition to having single payer advocates arrested also refused to have HR 676 scored, because they’re neoliberal corporatists. Gerald Freidman also did a study in 2013.

            The ACA neither intended nor accomplished comprehensive, affordable, universal healthcare. Congrats on reading the 2K pages it took to avoid that, but I’m not impressed by neoliberal looting at the expense of the commons, or attempts to defend it.

            I do believe a system providing universal benefits would be far less vulnerable than ACA to attacks from the right, as we saw when Obama attempted his Grand Bargain. I do not believe Trump is president because some of us didn’t clap loudly enough for the terrible alternative.

      2. B1whois

        I think I was being kinda cranky actually. Since it takes a lot of time and energy to write well, this could mean that things don’t get covered at all because they don’t meet a quality criteria. That we be a loss. I reconsidered my comments after posting, but it was too late to delete them. I am glad I got this opportunity to pull the complaint back in recognition of the trade offs between quality and not getting the info at all. Thank you for your effort and expertise.

        1. anonylisa

          Agree with your first comment. Disjointed and full of typos. Also this author doesn’t seem to realize that NC readers are not “average” readers. We also know exactly what single payer is, and the ACA is not even close.

          1. run75441


            Full of typos? Let me know where so I can point them out to my editor.

            I do not believe you or many people on this blog know what single payer is as you throw it around casually as if were common place.

            If you know what it is, explain it rather than jabber about what you think it “might” be.

        2. run75441


          It is hard at times not to go ballistic. I would edit Maggie Mahar’s words on Angry Bear and there were times we would disagree. I hurt her feelings one time and she called me on it. She was right and I was belligerent as Yves might tell you also. I write at Angry Bear Blog and many of my posts have ben picked up and a few I was even paid for once in a GREAT while. Kind of fun.

          If you click on the links, they lead to other articles which I pulled much of these comments from for this post and which also gives it that scatter- brained approach. I think you will enjoy the columns. I am in Chicago this Friday to visit with Yves and looking forward to it. Thank you for your comments.

  15. mrtmbrnmn

    This entire obscene bu$ine$$ is about nothing but wealth care for the facking insurance companies. With all our grote$que and corrupt politican$ running around rattling their begging bowl$ yelping “Where’s mine??!!” Doesn’t it just make ya sick!!!

  16. Oregoncharles

    ” “if Medicare is the largest business in town, are you going to ignore it or work within its confines?””

    As of now, in a very thoroughly doctored town, being on Medicare makes it considerably harder to find a doctor. One clinic wanted me to fill out an application – which I did, then asked for it back and told them I thought it was inappropriate. The clerk seemed to agree.

    I assume it’s even more difficult if you’re on Medicaid, since you aren’t going to be filling in any gaps, are you?

    1. run75441


      No it is not that difficult and doctors do except Medicare as well as Medicaid. Medicare is the largest game in town and if they wish to stay in business, they will accept it eventually. Sorry to hear of your dilemma.

      “Oregon doctors accepted Medicare at the lowest rate of any state in the Kaiser survey: 79 percent.” If you are in Oregon, this could be why.

      I am on Medicare also and use the VA for some of my treatment as a veteran.

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