GOP Healthcare Plan

It appears that the long awaited repeal and replace Obamacare health care bill that was promised will not come to fruition in the near future. It is truly a sad indicator of how partisan the politics of America has become that we find ourselves in the unenviable position of having a flawed national healthcare program in place as acknowledged by both parties, most Americans, and the majority of health care providers and insurance companies, but do not have the stomach, guts, leadership or whatever other word you might want to use, to fix it.

As far back as I can remember, our collective approach to the problem of providing a reasonable cost for the majority of Americans to pay for their moderate health care costs, while addressing the needs of the minority of Americans who cannot afford to pay for their above average health care costs, has ranged from assuming the heath insurance industry would humanely balance their profit with the well being of their customers, to creating arbitrary affinity groups (through employment, union or other trade or age related membership) to increase the pool thereby spreading out the costs, to the truly horrific idea that sick people deserve to be sick due to their poor lifestyle choices or equally poor luck from the birth lottery.

Mixed in with these inadequate approaches, the specter of America's love affair with individualism and capitalism pretends that health care is a commodity just like a car or a house, so that those with the most money will naturally be able to purchase the best health care, and those with the least will have to make do with the economy version.

And, we eschew the national health care model of most of the rest of the "civilized" world which creates a national pool of customers to lessen the costs of individual sickness or group trends of disease, by asking everyone to pay a little more in taxes.  The fact that this bigger pool is really just an extension of the affinity groups we are using today, is lost in the angst created by those who use the S word (socialism) to belittle the universal health care model that addresses the real issue behind our debate: costs.

The good news is that we should recognize that in their lack of unity, the GOP has done a valuable service to America in their inability to create a better plan.  It is imperative that the liberal media and pundits try to avoid gloating over the fact that they had 8 years to come up with a new plan and failed miserably, and focus on the fact that for whatever reason, concerns over the reduction of insured Americans, concerns over the sky rocketing costs which would have been passed along to the states, or even concerns that the GOP repeal bill did not go far enough to remove government from the heath care morass, whatever the reason, we must praise our GOP controlled legislature for not following through on their repeal and replace mantra by voting for just any new piece of legislation.  I applaud them for finally realizing that it is easy to criticize, but much harder to govern.

Will they merely repeal?  I would like to think that the answer is no, even if only because they are afraid of losing their jobs when they next run for office.

And who knows, perhaps the loss of the last 8 years, which might have afforded the chance to amend the ACA so that the needs of the truly sick, and those with limited access to health care insurance could have been addressed while balancing the costs to the aforementioned chronically ill along with the majority of Americans who face average and less than average health care needs, will spur us to find common ground across the water cooler, and common ground across the political aisle.

 

      

The Supreme Court and Hobby Lobby

First, a shameless plug.  There has been a burst of activity on my blog this past week.  It started on July 2, which was the day a letter of mine was published in the Philadelphia Inquirer.  This could be a coincidence, but I suspect not.  For all those new readers of my blog, thanks for your interest.  Also, if you would like to assist me in my goal of using writing as a second income so I can leave my late-night part time job, feel free to purchase my compilation e-book on amazon.

http://www.amazon.com/Short-Stories-wurdsfromtheburbs-Joe-Pugnetti-ebook/dp/B00F58LX8A

If you cut and paste the above link, you should be able to purchase it.  Thanks in advance.

So, another Supreme Court Ruling related to the Affordable Care Act and its implementation.  As is usual, there are many responses one can have depending on whose interpretation of the decision one listens to or is influenced by.  My suggestion is that if you are truly interested in an unbiased opinion of this decision, do not rely on those from the far right or left.  

In the few minutes that I spent reading about the decision, it is clear that the Supreme Court did not uphold the plaintiff's freedom of religion in regards to the free exercise clause of the first amendment nor did it make all contraception inaccessible for the women who work at Hobby Lobby.  

It was a very specific ruling concerning closely held corporations (as opposed to publicly traded corporations), in regards to how the Affordable Care Act is implemented with respect to the Religious Freedom Restoration Act (RFRA) of 1993.  Without getting into too many mind numbing details, the RFRA was a Congressional reaction to the previous Supreme Court ruling in Employment Division v. Smith (1990) which said that a person may not defy neutral laws of general applicability^[a] even as an expression of religious belief. "To permit this," wrote Justice Scalia, "would make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself." He wrote that generally applicable laws do not have to meet the standard of strict scrutiny, because such a requirement would create "a private right to ignore generally applicable laws".

Yes, Supreme Court fans, the same Justice Scalia who was part of the majority opinion in the Hobby Lobby case. 

In a nutshell, what happened was that the Supreme Court created a barrier in the work force that would prevent employers from dictating their religious beliefs to their employees, the Congress weakened that barrier through the RFRA, and the Supreme Court upheld the constitutionality of the RFRA as applied to federal statutes in Gonzales v. O Centro Espirita in 2006.   And, in allowing other groups, not for profit companies, businesses under 50 employees, and religious affiliated companies, among others to be able to opt out of the requirement, in effect by watering down the Affordable Care Act so that it was not the "law of the land", the Court had an easy justification in saying that other methods had been devised for women to gain access to those other contraceptive vehicles.  Sort of like saying, there are already exceptions, a few more won't hurt.

As for the women who work at Hobby Lobby, they will still have access to birth control methods which do not "abort' a newly fertilized egg, as certain IUD's and emergency contraceptive pills (commonly called after morning pills) do.  Other forms of birth control which prevent fertilization are OK with the religious beliefs of those who control Hobby Lobby.

So, while this is not the end of the world, nor is it the beginning of a legal restoration of America as a Christian nation, it is still disturbing to me on a number of fronts.

First, I am disappointed that the Supreme Court would backpedal on its initial ruling of 1990 which created such a rigid barrier between religious beliefs and work force rules.  Religion is a wonderful thing in its place, but allowing employers to hire, fire and conduct relationships with its employees with respect to their religious beliefs seems absurd.  

In addition to asking about benefits, compensation and job duties are we now supposed to ask for the religious affiliation of the employer?
For those who offhandedly reply that those Hobby Lobby workers who don't agree with the tenets of their owners' religion can find another job, I wonder if they know the religion of their employers?  Would they quit if the answer was Muslim?  Atheist?  Would they be outraged if their employer thought that a certain benefit, say the day off for Christmas, was not in agreement with their beliefs and so did not offer that as a benefit?

Second, I would find it amusing if it were not so sad that the gender of all those justices for the majority opinion is male, while three of the four with the minority opinion were women.  Only Justice Breyer, a man, crossed the gender line.  Really?  If the next justice is a women and replaces one of the five males of the majority opinion, does the court rule differently?  Also, and I have mentioned this before, the affiliated religion of all 5 justices in the majority is Roman Catholic.  Is it a coincidence that the Catholic religion still holds that birth control other than the rhythm method is a sin?  Of the 4 dissenting justices, 3 are Jewish where no such religious tenet exists.  Only Justice Sotomayor, a Catholic, crossed the religion line in this decision. 

Third, we are talking about birth control here.  Why, in the year 2014, is the method of planning one's family, to have or not to have children, the business of one's employer?  If the government came out and said, like China did a generation ago, that one child families are the law, most Americans would scream bloody murder at the intrusion of the government in our personal lives.  Yet we are OK with our employer doing the same?  The sad part is that most people, regardless of religious affiliation, use birth control in some form before they are ready to start a family.  Even most Catholics.  For those who still believe that each act of sex should result in the birth of a new baby, OK, your belief.  But keep it to yourself, don't hold it as a weapon over the heads of people who are looking for work or need a job to support their family.

Lastly, and most disturbing, is the recent court decisions that treat corporations as individuals. I googled corporation to review the definition.  But before I clicked on one, I saw a number of websites offering help in incorporating a business.  One such ad posted the cost at $49.   I wish it was that inexpensive to raise a child!!  

One of the best definitions I found was this

"A legal entity that is separate and distinct from its owners. Corporations enjoy most of the rights and responsibilities that an individual possesses; that is, a corporation has the right to enter into contracts, loan and borrow money, sue and be sued, hire employees, own assets and pay taxes.

The most important aspect of a corporation is limited liability. That is, shareholders have the right to participate in the profits, through dividends and/or the appreciation of stock, but are not held personally liable for the company's debts".

The reason I like this one is that it so clearly describes the state of capitalism in America.  All the positive  aspects of a business remain when one incorporates, especially the profit part.  But when things go wrong, the shareholders are not held for the company's debts. Instead, the taxpayer gets to eat the debt, either because the debtor can write off the debt owed by the failed company in their taxes, or the taxpayer must assist those left without work via unemployment, food stamps, health subsidies, etc.  Capitalism, in its present form, engorges those on their way to the top with all kinds of assistance, then protects those on the way down with all kinds of excuses to avoid responsibility. 

In essence, a corporation is a legal creation which allows the owners/shareholders to be removed from the debt which may result from poor management, changes in the economy, acts of god, defective products, superior competition, etc.  Personhood, without responsibility when things go bad. 

The right to donate unlimited money to buy candidates of their choosing, the right to feel religious infringement; what will be next for the corporation.  The right to marry, then sue for divorce?  The right to vote?  I often try to play devil's advocate with those who see doom and gloom with every topic they discuss, but I just can't understand why the Supreme Court justices of the United States of America, those nine individuals who are supposed to represent the best legal minds of our time, feel compelled to give carte blanche rights to a legal entity that can be created by filling out a form and paying $49.

Let's just hope that Hobby Lobby continues to stay in business.  It would be bad enough to realize that, should the business fail, the owners will have the years of accumulated profits tucked safely inside trusts and personal accounts untouched by the debt of the corporation that was so violated in its religious beliefs.  But it adds insult to injury in knowing that they can start a new "closely held" corporation in some other state and ram their religious beliefs about abortion down some future employees throats whose only goal is to find good employment in America. 

I wonder what Sharia law says about contraception?

Congressman Paul Ryan as VP pick

When I heard of Mitt Romney's choice of Wisconsin Congressman Paul Ryan as his VP running mate, I was a bit surprised.  My understanding of this very close presidential race is that the winner will be the team that is able to convince the middle ground voter to swing to their particular vision while energizing the base to actually go to the polls and vote.

From that basis of understanding, the choice of Paul Ryan seems to satisfy only the latter requirement, and, in fact, may provide as much motivation for the Democratic base as the Republican if the Obama campaign can successfully portray Ryan as a threat to Social Security, Medicare, Medicaid, and other assistance programs such as food stamps, student loans, and tax breaks for the middle class.  As for swaying those 10-20% of the voters still on the fence, it appears to be a wash, at best.  I would imagine that as many people who agree that we need to strive towards a more balanced budget and reduced deficit, will disagree with a plan that fundamentally shifts the burden of costs from the wealthy to the middle class; from the government to individual households.

As important as perception, perhaps the bigger issue is whether the American electorate will actually investigate the Ryan budget plan rather than listening to an opinion that reflects an agenda.  Towards that goal, I googled the Ryan budget plan and read both pro and con opinions, as well as portions of the plan.  Here are my impressions, and a few questions I would ask Rep Ryan if given the opportunity.

First and foremost, the Ryan plan would reduce the long term deficit and create a balanced budget.  Estimates vary, and factors that effect the economy of the United States that are out of our control, such as a continued European economic slowdown, potential military actions, natural disasters, etc, cannot be quantified, but most  non-partisan analyses of Ryan's budget show that his plan would provide slightly lower yearly deficits at first, with bigger federal savings achieved in the 2020 decade, and the potential for a balanced budget in the 2030 decade. 

This is true despite lowering the tax rates for the wealthy, and for corporations. 

Of course, similar results can be attained through the adoption of the Bowles-Simpson plan, but that plan has, so far, been rejected by both Democrats and Republicans as it requires some tax hikes, and no one calls for tax hikes in an election year, especially a presidential election year.

So the question is, how brilliant must this tax plan be, if it can reduce deficits, eventually create a balanced budget, and reduce taxes. 

A big part of the answer is contained in the health care proposal portion of the plan.  In it, the federal government slowly removes itself from the burden of rising health care costs. 

The problem is, if the federal government can no longer foot the bill for our aging population, then to whom will the burden shift?   It is clear that in our rush to believe that as Americans we need to be independent to the end, we may be missing the point that it will be up to each individual and their family to shoulder the difference between what the government will provide in a voucher and what it will actually cost for health care insurance and out of pocket health care costs. 

Here is the first big question though.  If Americans, especially older Americans, will now have to buy health care insurance, who will be selling it?  Currently, the health care insurance industry has a free pass on insuring the elderly and chronically sick.  Will they now be forced to cover any and all Americans who apply?  The fact is, our health care insurance providers can make the huge profits they earn, because they are not saddled with paying the health care costs for those currently on Medicare and Medicaid. 

And, if they are forced to sell insurance to all that apply, how will they price it?  In a way that the voucher accounts for at least 75-80% of the cost so Americans are only absorbing 20-25% more costs?  Or, at a cost they need to maintain profit, a cost which might make the voucher amount irrelevant?

Secondly, at what reimbursement rate will the health care industry pay for all those health care providers who are treating the elderly and sick?  My understanding of the current rates are that they do not always provide enough money for doctors, hospitals, etc. to cover their costs.  Will this still be the case?  Somehow, I would think it would be even worse if the health insurance industry plans to continue their enormous profits.

Third, what mechanism will exist which will provide an increase in the voucher over time.  Remember, people who retire at age 68 and live to 80, will be responsible for 12 years of health care costs.  Will the insurance industry maintain rates, which means less profit or will the voucher and allowance for higher out of pocket costs increase over time.  I couldn't find details on this in the plan.

I have two children, one about to begin his 3rd year of college, and one who will be a senior in high school this year.  I recently read that it costs the average family $275,000 to raise a child today.  That seems high to me, so lets say I have spent $300,000 on my kids so far.  While I don't have huge debts, I still have some, and I would guess that I would have less if my wife and I hadn't chosen to start a family.  But I accept these debts as a consequence of my decision to have children.  It seems that Rep Ryan's plan is geared to ignoring the problems of an aging population and ignoring the investments necessary for a strong country.  It seems to ask less from those with the most, while pretending that we, the people, in the form of the United States government, have no obligation in providing a secure time of life once we reach an age when our ability to pay for ourselves is reduced. 

While I may be choosing to evaluate Rep Ryan's cuts differently than those who advocate for him, the cuts are real.  Less federal money for food stamps and student loans.  Sort of like abandoning your kids.  And less money for the elderly as Medicare and Medicaid are phased out.  Sort of like abandoning your parents.

If that is the only way to prosperity, the only way for the greatest country on earth to deal with its budget problems, then we have much bigger problems than we think.


 
 
 

       

    

The Stimulus Package

Copy of my letter published in the News Herald

To the editor:

This past week marked the one year anniversary of the Economic Recovery Act, better known as the stimulus package. Much debate has taken place with the usual perspectives in full force; Republicans/conservatives claiming it has done nothing and calling it a huge government waste, Democrats/liberals touting that it staved off financial collapse and has saved and/or created a few million jobs. Everyone seems in agreement that we are far from clear of the recession but consensus on how to proceed continues to polarize the country.

For me, I have no doubt that the stimulus package did some good as it has helped me and my family directly. Let me explain. Unfortunately, I lost my job on January 4 of this year. I was in sales in the transportation industry. My job consisted primarily of maintaining my account base while bringing on new business. I periodically visited about 200 local businesses in a typical 2 month period. 

As I only started this job in May 2007, I was witness to the reduction in business both for my company and my customers beginning in late 2008. On a weekly basis, especially at the end of 2008 and the first half of 2009, I experienced the loss of customers due to bankruptcy and the loss of contacts due to layoffs and job eliminations. In some cases, my customers dropped employees that may have not been pulling their weight, in other cases, mid-level managers and supervisors, some with 12, 15 even 20 years experience, were let go to save money. There just wasn't enough orders. No orders meant less employees, and less shipping business for me. And, while some businesses began shipping again as 2009 drew to a close, hiring did not follow as companies focused on improving their bottom line. The recession was all too real to me then and it was clear that businesses by themselves were not in a position to move us out of its grip.

Which brings us back to the stimulus program. Many people are unaware of this but it included a subsidy to help defray the cost of COBRA for anyone who lost their job from Dec 2008 through Feb 2010. In my case, a COBRA payment that would have been an unreachable $1500 a month for the exact same coverage I had for myself and family while employed. The subsidy dropped the cost to just over $500 a month. 

While still quite a sum of money for someone unemployed, it gave me at least the opportunity to pay for a few months coverage while searching for something new. Without it, my family would have joined the ranks of the uninsured. And, to be honest, even with this subsidy, I may be faced with a decision to drop coverage if I can't secure a new full time position in the next few months. For those of you who believe that our health care system does not need reform, check with your employer to see what your COBRA cost would be should you lose your job. And for those who think that no one has benefited from the stimulus package, I would imagine that since unemployment is close to 10%, you probably know a number of people who have benefited in a similar way as myself and family. If not personally, then certainly you are encountering them in your neighborhood. They are in line at the grocery store with you. Or in the stands at your son's basketball game. They are ex-coworkers, your friends' cousins, the clerks at your local pharmacy or department store.

Was the stimulus program perfect? Of course not; it contained the usual pork and big money for large political contributors and special interest groups. But it is providing some money for the millions of unemployed people and their families so they can continue to eat and pay their mortgage. And it is helping untold American families (like mine) to at least have a shot at affordable healthcare coverage at a time when they can least afford to lose that coverage.