Relevant and even prescient commentary on news, politics and the economy.

Michigan

EMichael:

The Repubs have a difficult time blocking national and state wide elections for Pres and Senators in Michigan. It is only when they pack a district or parcel a majority into several districts are they able to achieve a win in places where a fair election will contest who does win. In any case, the 11,000 difference between Trump and Clinton was due to record turnout in voting for “others” in 2016 as compared to 2012. I would attribute this to lies about Clinton on things disproven (Benghazi, security breaches, etc.) multiple times, “what-was-I-thinking” Comey’s two announcements so near to election day, and a failure of the Democratic National Committee to pay attention to Michigan. This last go around (2018), we were able to pick up congressional reps. Biden for sure cost us another. If people turn out and vote for other than Libertarians or Communists, we will win in spite of Repubs.

With regard to the civilians redistricting, it will be a battle to get a fair and impartial one. You can rest assured, I will not be on it for reasons such as pointing out the flaws in our state government which has been controlled since 1992 (Ballotpedia) (and before according to others) by Republicans using districting as a means of achieving their win.

Michigan is not a red state and will return to its former self unless Democrats get stupid or are fooled again by lies.

Click on the image for a larger version.

Past the leap, how Republicans destroyed Michigan.

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Former Senator Harry Reid on President Trump

David Axelrod interviewing former Senator Harry Reid on the Axe Files

There is too much going on with Trump and I believe he is purposely doing much of this as a distraction and also to antagonize Democrats. Abandoning the Kurds certainly draws a response from Democrats and most of the Republicans remain silent on things they know to be wrong. For some reason I believe he is setting the stage for something else to occur. If we as Democrats are wrong, all of our actions will reflect poorly on us and for sure he will make fun of our failures.

Reid — a savvy political operator whose moves reshaped Senate procedures such as the elimination of filibusters for most nominations by president, were criticized by Republicans during his time in Congress. Reid in the Axelrod interview acknowledged, Trump’s strategy in discrediting Democrats leading the impeachment inquiry into his actions with Ukraine.

Reid: I don’t think he is an intellectual powerhouse; but, he is basically a very, very smart man. Any argument he involves himself in and no matter what the subject, it is on his terms. You’re always arguing against him. He never, never, is willing to debate an issue on terms that aren’t his.

When asked how he would advise a candidate running against Trump, Reid warned,

Reid: Anyone that thinks Trump’s going to be beaten easily will have another thing coming.

The “evidence is very clear” that Trump was withholding foreign aid as leverage to pressure Ukraine, on a July phone call, to investigate former Vice President Joe Biden. Trump has denied any wrongdoing and has claimed the foreign aid was withheld so European allies could contribute their fair share. Democrats have accused Trump of a quid pro quo and abusing his power of office.

Reid: All you have to do is have a basic understanding of what the law in America: You can not do what he did and go unpunished.

Trump’s modus operandi has been to deflect on the accusations and make light of them publicly to his followers uses he stumbles into the truth in his words. There is no heart in the Republican party to denounce his transgressions even though they know he is wrong.

I see this in Michigan with the blaming of Democrats for issues with the state roads, schools, Detroit, etc. Except, an exception Michigan Republicans do not acknowledge, they the Republicans have had control of the state Senate since 1992, the state House 2/3rds of the time since 1992, the Governorship 2 of 3 times up till now, and a trifecta twice during the time period 1992 – 2018. Republicans control the legislature now. Typical argument:

“common sense doesn’t need to be documented. It’s very easy to blame everything on Democrats. Mainly because they’re guilty.”

“Sorry, your version of common sense can not alter the reality of what took place.”

It is a distortion of the facts on a national stage which has tickled down to the states and blathered on social media by Republican trolls.

And the politicians in Congress? The politicians are too interested in keeping their jobs as senators and congressional representatives to acknowledge the facts or tell the truth. And Democrats are too quick to jump on Trump’s transgressions and provide entertainment for Trump. He is playing the Democrats and laughing as he has the backing of his followers at the state level similar to the mini-conversation I had who denies reality, and those supporters in the Senate. He knows Democrats are toothless.

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Unsubstantiated Drug Price Increases

The ICER (Institute for Clinical and Economic Review)

Is an independent and non-partisan research organization. Its purpose is to evaluate the clinical and economic value of prescription drugs, medical tests, and health care and health care delivery innovations. ICER conducts rigorous analyses of all clinical data with key stakeholders to include patients, doctors, life science companies, private insurers, and the government and translate the evidence into policy decisions that lead to a more effective, efficient, and just health care system.

As explained by their site information, ICER is known as the nation’s independent watchdog on drug pricing. It’s drug assessment reports include a full analysis of how well each new drug works and the resulting “clinical value, quality of life, benefit to the health-care system and society” used to establish a price. Using the drug assessment report, a “value-based price benchmark” is established  reflecting how each drug should be priced addressing all four factors. Reports also evaluate the potential short-term budget impact of new drugs to alert policymakers to situations when short-term costs may strain health system budgets and lead to restrictions on patient access. Ensuring objectivity in its work, all ICER reports are produced with funding from non-profit foundations and other sources that are free of conflicts of interest from the life science industry or insurers.

What I have seen in the past is the ICER establishing pricing for new drugs taking into consideration these factors; “the patient’s quality of life, and the resulting benefits to the health-care system, and society.” This is the first time I am seeing the ICER looking at price increases and determining whether the value delivered substantiates a price increase. By the numbers: Here are the drugs (and manufacturers) highlighted in a recent ICER’s report, with the increase in net spending attributable to each drug’s price increase, and citing the increases could not be justified by the value delivered.

The figures reflect the dollars Americans spent on drug copays and other out-of-pocket costs in addition to the higher amounts people paid through health insurance premiums and taxes.

Past the leap is an explanation on how the ICER reached its conclusions for the nine drugs and the limitations to this findings.

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Resurrected Protester

This is news: Jane Fonda Arrested While Protesting in D.C.

Not particularly a news outlet (Hollywood Reporter – Ryan Parker reporting) I would read but, they have it out front and center in reporting on Ms. Fonda protesting about “the industries that are destroying our planet for profit.”

“I will be on the Capitol every Friday, rain or shine, inspired and emboldened by the incredible movement our youth have created. I can no longer stand by and let our elected officials ignore – and even worse – empower – the industries that are destroying our planet for profit. We can not continue to stand for this,”

It is not the first time Ms. Fonda has been taken into custody. She did protest the Vietnam war and taken into custody. Today Ms. Fonda was arrested with 15 other people for protesting in front of The White House. The protest focused on the lack of action by this administration, big business, and the overall nation on the overall inaction to climate change. Claiming to be “emboldened by the incredible movement our youth have created,” She has moved to Washington to be near the epicenter of the fight for climate change.

Maybe others will follow . . .

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Trump’s Attack on Seniors and Medicare

It is a given, Trump’s new executive order  is calling for “market-based” pricing or whatever the market will bear pricing to replace Medicare set pricing. Trump sees a conflict between Medicare and the market. Well he is right; but, his solution ll only aggravate the problem of costs.  It will drive up costs for everyone in Medicare, destroy traditional Medicare as healthcare for the elderly, steer more people into costly commercial healthcare, reduce Medicare funds at a faster pace, and allow the already profitable healthcare industry to increase profits well beyond what it is today.

But, but are Medicare Advantage Plans ripping people and Medicare off? “Yes they are” a for-profit industry is profiteering by taking advantage of a system of healthcare for which they wanted to be a part. As Trump signed the EO, it is stunning to watch a bunch of seniors up on the stage clapping as el jefe was showing off his executive order allowing commercial healthcare to further pickpocket them, exploit healthcare, and destroy Medicare. All smiles there . . .

Medicare Advantage programs are managed differently than Fee for Service traditional Medicare. Besides providing a series of services not found in regular Medicare, the MA plans instituted a different form of physician/hospital payment called Capitation. Capitation Payments are theoretically used by managed care organizations to control health care costs. The VA is a good example of this type of managing costs. A capitation payment model  controls the use of health care resources by putting the physician at a financial risk if too many services are provided to patients or if quality decreases as witnessed by return patients for the same disorder or illness. To ensure patients do not receive suboptimal care through under-utilization of health care services, MAOs measure the rates of resource utilization in physician practices. These utilization reports are then made available to CMS to measure health care quality, utilization, costs, etc.. They are also linked to financial rewards such as withheld fees and bonuses.

Past the leap, I explain how the capitation model can be gamed by Advantage plans.

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Second Whistle Blower Emerges

2nd whistleblower comes forward after speaking with IG: Attorney

The appearance of a second whistleblower will muddy the waters for Herr Trump claiming the first whistleblower got his conversation all wrong.

The existence of a second whistleblower — particularly one who can speak directly about events involving the president related to conversations involving Ukraine — could undercut Trump’s repeated insistence that the original complaint, released on Sept. 26, was “totally inaccurate.”

Attorney Mark Zaid is also representing the 2nd whistleblower. It is said this whistleblower has first hand knowledge of some of the allegations made by the first whistle blower. The 2nd whistleblower has made what is called a “protected disclosure” and can not be retaliated against as the person is now protected by law.

Attorney Zaid tells ABC News’ Chief Anchor George Stephanopoulos the second person — also described as an intelligence official — has first-hand knowledge of some of the allegations outlined in the original complaint and has been interviewed by the head of the intelligence community’s internal watchdog office, Michael Atkinson.

The House and IG investigation is moving forward with what the Trump administration has criticized as 2nd-hand information by the first whistleblower and also the recently disclosed first-hand knowledge of what was said during the phone call by a 2nd whistleblower. The corners are being rounded on Herr Trump with little chance of escape from the accusations. It will be interesting to see how McConnell and Republicans handle the total package of disclosures by whistleblowers. Will they provide cover for a malfeasant president? McConnell already said he would block the impeachment once it gets to the Senate.

And Trump tweets “Keep them Coming.”

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Trump’s Executive Order, Backdoor Privatization of Medicare – Updated

Trump’s Executive Order is Backdoor Privatization of Medicare,” Social Security Works, Nancy Altman, October 3, 2019

Thursday and I had to search around for someone who is an expert on Medicare Advantage Plans and Original Medicare. Nancy is one of those experts. Friday and Andrew Sprung has his commentary Trump’s Bid To Destroy Medicare up on xpostfactoid blog.

Commercial Healthcare Insurance has been become more and more expensive over the years with copays increasing, deductibles increasing, and premiums going up. Todays commercial healthcare insurance costs a single person ~$7200 and a family ~$20,000 with the single person paying 18% of the premium and a family paying 31% of the premium. Approximately 36 million people make less than $25,000 annually (retail workers, personal care attendants, warehouse workers and others as well). In a crude calculation, xpostfactoid: “The past ten years of healthcare cost increase relative to wage increase might cost a full-time average wage earner with family coverage $3,000-$4,000 this year in added costs and decreased wages, or, say, 6-8% of income.”

Today’s Employer sponsored Healthcare Insurance is unsustainable. The same holds true for Medicare Advantage plans due to the Commercial healthcare Insurance offering it as well. There are few controls which can be applied on the commercial side of the healthcare industry which is why there is a big push for true single payer healthcare of which Medicare and Medicaid are. If you wish more detail on how commercial healthcare insurance has exploded in cost, my earlier post Health Benefits for 2019: Premiums Inch Higher, Employers Respond To Federal Policy offers more detail pictorially and in verbiage.

As I have written other times, Medicare and Medicaid have been instrumental in reducing excessive U.S. healthcare costs. Medicare and Medicaid set the prices paid to providers with provider input and commercial healthcare insurance uses those prices to set their payouts. Medicare hospital rates are an approximate half of those paid on average by commercial healthcare insurance. Rates paid to physicians average about 78% of commercial insurance rates. In high-demand specialties and in regions with fewer providers; commercial healthcare insurers often pay four, five and six times Medicare rates. If you remember from Kocher and Berwick’s article, they proposed setting commercial Healthcare (while it still exited in the interim) payouts at 120% of Medicare rates.

This action by Trump and Republicans is a huge giveaway to the commercial healthcare insurance sector and the healthcare industry. Right now Medicare Advantage uses Medicare rates. If they can beat Medicare Rates, they keep the difference. If they can not meet the rates, the consumer pays the difference. What Trump has done is reverse the format. Medicare Advantage Negotiated Rates will be used to set Medicare Fee For Service rates to providers.

Past the leap is the President of Social “Security Works” Nancy Altman’s statement on Trump’s Executive Order talking about Trump’s lies.

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Health Benefits for 2019: Premiums Inch Higher, Employers Respond To Federal Policy

The argument has been, if people like their private and company sponsored insurance plans they can keep them; but can they afford to do so?

In a recent LA Times and KFF survey, 40 percent of respondents said they had difficulty affording health insurance or health care or had problems paying medical bills. An approximate one-half of respondents said they or a family member skipped or postponed getting health care or prescriptions in the past twelve months due to cost concerns. Those with higher deductibles were more likely to report problems with affordability and were likely to say their insurance worsened over the past five years as compared to people with lower deductibles. Over the last decade, deductibles have increased 162% (see chart below).

The annual Kaiser Family Foundation Employer Health Benefits Survey: In 2019 the average annual premium for single coverage rose 4 percent to $7,188, and the average annual premium for family coverage rose 5 percent to $20,576. On average, covered employees contributed 18 percent of the cost for single coverage and 30 percent of the cost for family coverage with variation across firms. Of the 9,000 firms the survey was sent to, 4,395 firms answered this question of whether they offer healthcare insurance for a response rate of 58 percent.

Fifty-seven percent of firms offered health benefits to at least some of their workers. Smaller firm employees faced a higher risk of affordability especially during recessions. Fifteen percent of all covered workers including the 35 percent of covered workers in small firms are in plans with a worker contribution of more than half of the premium for family coverage (2019). In firms with a high percentage of low-wage workers, the average worker’s share for family coverage was 41%. This is many ways to say the same thing, the cost of healthcare is increasing and private company plans may no longer have a lessening capability to pay for healthcare.

Employer-sponsored health insurance is the largest source of coverage in the United States, covering about 153 million nonelderly people. I am sure many people would like to keep the private healthcare insurance and pay less for premiums than what they are.

Premium and Deductible Increase Charts and key thoughts after the leap

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“House Democrats’ Drug Price Strategy versus a Cost Strategy”

The House Democrats just released their drug pricing plan (summary) on the 19th. I read through it rather quickly and I found it to be interesting and having targets which could work. Rather than jump right into this, let’s talk about purchasing a bit and then what I believe would be better.

In a purchasing negotiation there are two typical ways used to negotiate a price to your company. The first strategy is to tell a supplier you have done a market study, another supplier can offer a better price, and  all things are equal between him and the other supplier. The supplier has a choice of beating the new price or offering something else of value to the customer which will negate the difference and can not be acquired from the other supplier (whip-sawing a supplier is unethical and many do it).

The second strategy requires more work and requires you to understand the cost of materials, the process and its cost, and the overhead involved. It does establish a base in which a buyer can use to negotiate with “all” suppliers. With the former strategy, you are guessing whether you have a good price because you do not know the cost of manufacture. Purchasing has to be a bit more than just a clerk.

The House plan intends to negotiate on pricing using other countries (Australia, Canada, France, Germany, Japan, and the United Kingdom) pricing to measure against for the same drug. The legislation establishes an upper limit for the price as no more than 1.2 times of the volume-weighted average of the price of the six countries reached in their negotiation. Australia, Japan, and United Kingdom use a cost-based method of pricing a drug.

Here is a brief explanation of the House plan:

Year 1 and each successive year, the Health and Human Services (HHS) secretary would identify up to 250 brand name drugs appearing to lack pricing competition and having the greatest cost to Medicare and the US healthcare system. The data would be collected from Medicare, Medicaid, and healthcare insurance to determine aggregate cost based upon price and volume of sales.

The total of 250 items picked with:

  • the top 125 drugs in Medicare Part B responsible for a full 96% of Part B spending,
  • and 125 drugs responsible for 45 percent of the spending in Part D.

As show in the chart. “More” to be read after the leap.

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“Trump’s Call With the Ukrainian President”

The White House released this document on Wednesday, September 25, 2019. It details a July call between President Trump and President Zelensky of the Ukraine. About midway through it, there is a warning of the contents not being a “verbatim transcript.” I have taken some time to include the notes (red) which are found at the end of the post and have notated the particular passages to which the notes are detailing. If you need direction other than the notation at the end of the sentences, I can do so. I did not want to alter this more than what I did in adding the word “note.”

It is a surprising transcript showing Trump’s boldness.

The President: Congratulations on a great victory. We all watched from the United States and you did a terrific job. The way you came from behind, somebody who wasn’t given much of a chance, and you ended up winning easily. It’s a fantastic achievement. Congratulations.

President Zelenskyy: You are absolutely right Mr. President. We did win big and we worked hard for this. We worked a lot but I would like to confess to you that I had an opportunity to learn from you. We used quite a few of your skills and knowledge and were able to use it as an example for our elections and yes it is true that these were unique elections. We were in a unique situation that we were able to achieve a unique success. I’m able to tell you the following; the first time, you called me to congratulate me when I won my presidential election, and the second time you are now calling me when my party won the parliamentary election. I think I should run more often so you can call me more often and we can talk over the phone more often.

The President: [laughter] That’s a very good idea. I think your country is very happy about that.

President Zelenskyy: Well yes, to tell you the truth, we are trying to work hard because we wanted to drain the swamp here in our country. We brought in many many new people. Not the old politicians, not the typical politicians, because we want to have a new format and a new type of government. You are a great teacher for us and in that.

More of the transcript after the leap plus the notes concerning intent and meaning.

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